self-referred: a quebec trans health survival tool


(((ASTT(e)Q  (Action Santé Travesties et Transsexuelles du Québec) aims to promote the health and well-being of trans people through peer support and advocacy, education and outreach, and community empowerment and mobilization. For more information go to )))

This is excerpted from ASTT(e)Q’s guidebook, “Self-Referred: A Quebec Trans Health Survival Tool”. The full document will be available online soon at

A presentation on the content, creation and distribution of the guidebook was presented by Jackson Ezra, current resource
coordinator at ASTT(e)Q, at Study in Action 2012, Montreal

why we made this guide
Trans people often have a hard time navigating health and social services. Everybody deserves to be treated respectfully by their family doctor, nurses, and social workers, and members of trans communities are no different. Furthermore, trans people need jobs, stable housing, and support if and when their rights are disrespected. Trans people also need services that are specific to and respectful of their needs and experiences. Many of us find that community organizations and resources, as well as our friends and communities, can support and care for us in conjunction with more standard health and social services.

Regardless of the stage of transition you are at or plan on taking, finding health and social service professionals you trust and who treat you with dignity can be challenging. There are few resources that are specific to trans realities. Much of the wisdom and information within our communities is only shared informally between individuals.

what is included in this guide
Knowledge is power: the more information you have, the more you’ll be able to advocate for yourself, whether it be against a disrespectful doctor or social worker, uninformed staff at a shelter, discriminatory landlords or employers, or abusive cops. Having access to trans-specific resources and knowledge can even help if you are confronted by rejection from your family or community.

“Self-Referred” was conceived of by trans people from a variety of backgrounds and has information specific to the needs of trans people living in Québec. Because it was created in an urban context, by people living in Montréal, the scope is limited. Many of the resources listed are Montréal based, but resources relevant to rural communities and other cities in Québec have been integrated throughout. Topics include a look at daily struggles in the lives of trans people, hormone therapy, surgery, legal name and sex designation changes, HIV/AIDS, sex-segregated spaces, and legal rights and advocacy tools.

The term ‘trans’ is used throughout the guide. Trans is usually used as a short form for ‘transgender’ and/or ‘transsexual.’ It literally means “crossing to another side.” Someone who presents, lives, and/or identifies as a gender other than the one they were assigned at birth is trans. At the same time, we acknowledge that trans communities have diverse needs, priorities, identities, and ways of talking about themselves. Ultimately, we support the right for people to self-determine and self-identify using whatever words suit them best.

who we are
Self-Referred is an initiative of Action santé travesti(e)s et transsexuel(le)s du Québec (ASTT(e)Q). ASTT(e)Q is a project of CACTUS Montréal and was founded in 1998, largely in response to Montréal’s lack of health care and social services that were sensitive to trans people’s needs. The project grew out of a support group for trans women living with HIV and was informed by a trans community–led needs assessment that aided in determining the shape and direction of ASTT(e)Q. The organization is part of a long and rich history of activism, advocacy, and community organizing for improved access to health care and social services, housing, decent working conditions (particularly for sex workers), HIV prevention, and an overall greater quality of life for trans people in Quebec.

ASTT(e)Q aims to promote the health and well-being of trans people through peer support and advocacy, education and outreach, and community empowerment and mobilization. We understand the health of trans people and our communities to be related to economic and social inequalities that have resulted in trans people experiencing disproportionate rates of poverty, un(der)employment, precarious housing, criminalization, and violence. We believe in the right to self-determine gender identity and gender expression free from coercion, violence, and discrimination. We advocate for access to health care that will meet the many needs of our diverse communities, while working collectively to build supportive, healthy, and resilient communities.

Finally, we would like to acknowledge and honour the work and lives of those who have come before us: trans people who have struggled and fought for their right to live in peace and dignity, and to make decisions about their bodies on their own terms. This guide is dedicated to all of the trans elders whose work and persistence make it possible for resources like this one to be created, and to the resiliency and strength of trans youth who build and foster supportive community even in hard times.

Trans people have been pushing for greater access to health and social services throughout history. This activism continues today, and the state of access to services is constantly shifting.

an eye to the future
We wanted to end this guide with an eye to the future. “Self-Referred” is meant as a roadmap for trans people dealing with health and social services in Québec. Please share this guide and the knowledge that you have gained from it with others, because the more we equip our communities with knowledge and information, the stronger and more resilient we will become.

Finally, we also wanted to speak to the activism of day-to-day survival, in other words, how sharing our stories, standing up for each other, or simply making it though a really rough day are all ways in which we are struggling for broader social change in our communities. When we look out for each other, talk about our challenges, support a friend when they feel like their options have run dry, persuade a new GP to start prescribing hormones, and build families and tell our children our stories, we become stronger. When we support each other post surgery, write to our friends and loved ones in jail, warn each other about bad clients, create spaces for our youth to meet and socialize, we are activists and leaders in our communities. When we fight against police brutality and repression, demand our right to easier access to name and sex designation changes on our IDs, help create networks of doctors and providers who work with the undocumented migrants in our communities, we are telling the world that we live here, too!

It is in part because of this activism of day-to-day survival that social services for trans people exist today. This guide was initiated as a part of a project that was started by trans people fighting for trans support services in Québec . There will always be a lot of work to do to improve trans access to respectful and relevant health and social services, but changes will happen, as long as we are empowering ourselves with knowledge and information.