When Emma Ritchie first began her transition into a woman, she felt like she was fumbling in the dark, alone in a life or death situation.

That's because for years, Hamilton has been a veritable desert for transgender healthcare, leaving an extremely vulnerable population that is at high risk for suicide without the support it needs.

For many, even finding a doctor who is willing to prescribe hormones and start the transition process has been near impossible in the city — which in many fields is a healthcare destination in southern Ontario.

Instead, many of the city's trans people have been pushed to the margins, and forced to go to St. Catharines or Toronto for care.

"There's definitely a lack of available care," Ritchie told CBC News. "Honestly, I couldn't find any doctors in Hamilton that were willing to start it with me."

The demand is beyond anything I would have imagined. The majority of the clients I see in Niagara are from Hamilton. - Dr. Carys Massarella

Many within Hamilton's trans community echo those sentiments — but finally, a change is appearing on the horizon.

A new group of healthcare providers has formed the Hamilton Trans Health Coalition, with the aim of giving Hamilton's trans community the resources a city its size should have.

Dr. Carys Massarella is one of those doctors. A trans woman herself, Massarella has long been one of the community's most important voices. She works as an emergency physician at St. Joe's, but is also the lead physician at Quest Community Health Centre in St. Catharines, which specializes in transgender care.

To say she is swamped would be an understatement. Massarella only works at Quest one to two days a week, but the clinic has over 1,000 regular patients. Current wait times just to see a doctor there are between four to six months.

"The demand is beyond anything I would have imagined," Massarella told CBC News. "The majority of the clients I see in Niagara are from Hamilton."

A sky-high suicide rate

That wait list frustrates her — especially considering suicide statistics for trans people. According to the Canadian Mental Health Association, 77 per cent of trans respondents in an Ontario-based survey had seriously considered suicide and 45 per cent had attempted suicide.

"It's a huge conundrum for me, knowing that, and having the waiting list that I have," Massarella said.

"There is nowhere specifically for people seeking these services in Hamilton."

Dr. Carys Massarella is as an emergency physician at St. Joes, and also the lead physician at Quest Community Health Centre in St. Catharines. (St. Joseph's Healthcare Hamilton)

The Hamilton Trans Health Coalition is trying to bridge that gap, says Siobhan Callaghan, a family doctor and one of the founders of the coalition.

That won't be with a dedicated clinic, but with a coordinated effort to get doctors in the city to deliver care, and educate them on what exactly is needed to serve the trans population. Trans people who are looking for information, or to be lined up with a doctor, can contact the coalition for help.

"For a city the size of Hamilton with the population and the services we have … it's crazy that we're not servicing this population," she said. "We have realized what a huge need there was."

Cole Gately, a trans man who is a founding member of the coalition, says that things have been so dire for care in Hamilton that he had to educate his own doctor on how to help him.

"We have this amazing health system in Hamilton," he said. "The whole idea is to build the capacity of Hamilton to have quality trans healthcare."

'We saw a need, so we just went for it'

Ideally, Massarella says, Hamilton would have its own dedicated transgender health clinic, but there seems to a lack of will within senior levels of government for that.

"It's a LHIN-level discussion," she said. "They need to take the lead on this."

A spokesperson from the local LHIN (local health integration network) did not directly answer questions about what could be done to improve trans healthcare opportunities in the region. LHINs oversee the allocation and integration of health care in regions across the province.

Cole Gately is one of the founding members of the Hamilton Trans Health Coalition. (Cole Gately)

"We certainly understand that access to health care is an important issue for transgendered people in communities across our LHIN including Hamilton and we appreciate that there is always more that can and should be done," said Trish Nelson, director of communications, in a statement.

"As we develop the work plan and focus for the six sub-regions across our LHIN, including the Hamilton sub-region, the need for health equity is vital.

"We know we will need to work with our community health service providers and stakeholders to plan for and address those needs as they are brought forward to us."

Gately says that trans healthcare doesn't seem like a priority for the LHIN at the moment, so the coalition is taking things into its own hands.

"We saw a need, so we just went for it," he said. "This is the time we can just embrace this, and the LHIN will start noticing."

To find out more about Hamilton Trans Health Coalition, or for help to connect with a doctor, you can contact Gately at gately@sympatico.ca.

The coalition is also setting up a drop-in clinic twice a month, starting in April. Here are the details:

For those without current health care:

1 and 3rd Wednesday every month starting April 5th

9:30 a.m--12:30 pm.

Self-Referral, Drop-in or call to leave a confidential voice message 905-526-7137

adam.carter@cbc.ca