Dr. Sarah Fraser finds her calling in gender affirming care

When Dr. Sarah Fraser graduated from medical school, she wasn’t planning to build a career in gender affirming care. Today, she calls it the most rewarding work she has ever done.

“I’ve never had so many people tell me that I saved their life,” Fraser said.

Growing up in Pictou County, Fraser originally pursued a career in environmental sciences before applying to medical school later in life. After residency, one of her roles was working at the Halifax Sexual Health Centre, where patients seeking gender affirming care started appearing in her schedule.

Fraser quickly realized something surprising: she didn’t know much about gender affirming care. In fact, she didn’t even know what she didn’t know.

“There aren’t many hours dedicated to queer healthcare in medical school,” she said. “In the U.S. and Canada, it’s about four hours total in a four-year medical school program, and that’s not specific to gender affirming care. That’s including all queer health topics.”

So, she started teaching herself. She completed courses, attended conferences, read academic journals and leaned heavily on colleagues already doing the work. Eventually, Fraser began bringing practitioners together through a monthly virtual discussion group where providers shared knowledge, asked questions and learned from one another – a group that still meets today.

The more she learned, the more she saw how significant the need was. In 2024, Fraser opened Coastal Gender Affirming Care, a clinic dedicated to providing gender affirming care for patients across Nova Scotia.

Today, the clinic has grown to four physicians, a licensed practical nurse, three administrative assistants and a director of people operations. The team supports roughly 1,300 patients both in-person and virtually, welcoming new patients every week.

While her work focuses on transgender and gender-diverse patients, gender affirming care is broader than many people realize. A cis woman experiencing unwanted facial hair because of a medical condition, for example, may seek treatment because it helps her feel more comfortable and confident. Voice training, laser hair removal, hormone therapy and surgery can all fall under the umbrella of gender affirming care, depending on a person’s needs.

“At its essence, we’re helping people feel more like themselves,” Fraser said. “That’s the most rewarding thing - witnessing the impact this can have on people’s lives.”

Before opening her clinic, she spent time working as a hospitalist, caring for patients facing serious illness and end-of-life situations. Yet it wasn’t until she began working in gender affirming care that she started regularly hearing patients tell her that she saved their life.

Those experiences reshaped how she thinks about medicine.

"In general, people come to medicine when they have an illness and they're suffering," Fraser said. "You try to treat them and make them feel better, to bring them back to how they felt previously. 

“Gender affirming care is different. You’re watching someone blossom into a fuller version of themselves. Mental health improves, social health improves, and their confidence grows. Being part of that journey and being able to witness it is just so special."

June is Pride month, a time when 2SLGBTQI+ people and their allies come together to highlight the resilience, celebrate the talent, and recognize their communities’ contributions.

"Why is it important to talk about gender affirming care during Pride season? Actually, I don't think it is," Fraser said.

Although the quote may sound surprising, Fraser isn't dismissing Pride season. Her point is that conversations about gender affirming care, healthcare access and support for transgender and gender-diverse people shouldn't be limited to a single month or season. 

“I see a lot of organizations step up during Pride month,” she said. “But this is something we need to be continuously advocating for.” 

At Coastal, supporting equitable access to healthcare isn’t a June issue, it’s everyday work.
For family members or friends supporting someone who is transgender or gender-diverse, her advice is simple: be open-minded.

“The difference it can make for people who are transgender and gender-diverse to have support from a family member or friend is so enormous,” she said. “If you can be open-minded and supportive, that goes such a long way.”

• Looking for gender affirming care? Individuals can self-refer to Coastal Gender Affirming Care by booking an appointment online at www.coastalgac.com. Referrals from physicians and nurse practitioners are also accepted. 

Photo of Dr. Sarah Fraser is a queer family physician who founded and serves as medical director of Coastal Gender Affirming Care. She is also an associate professor of family medicine at Dalhousie University, where she co-directs the Medical Humanities program.