There's a cost associated with the change. Sometimes it's prohibitive for some who are, for example, on ODSP, the Ontario disability support program. At this time in Barrie, it's $1,200 a month. A one-bedroom apartment is $1,000 a month, so it's a question of where you want to put your money in terms of that.
Our agency does help with the change, but remembering that it's all part of the mental health process of someone. They just don't decide at age 30 or 50 that they're a trans man or trans woman. It has been a lifelong process.
Preferred name is not a nickname. Some practitioners still refer to it as a nickname. It's not a nickname, it's a preferred name.