The province of B.C.'s Medical Services Plan (MSP) has opted to begin covering phalloplasty, or the surgical creation of a penis, for transgender men.
Dr. Gail Knudson, who is the chief assessor for gender-confirming surgery in the province, made the announcement at the Canadian Professional Association for Transgender Health (CPATH) conference in Winnipeg last week.
It will be covered for five people a year, said Ryan Jabs, communications officer at B.C.'s Ministry of Health.
It's something transgender people and CPATH have been working to have covered for some time.
Phalloplasty is a medically necessary surgery for some transgender men.
"It maximizes overall health, psychological well-being [and] self-fulfilment," said Jim Oulton, president of CPATH.
"It's about equity and health care for all. For those people that phalloplasty is an appropriate option, it needs to be in place. And so that's a real celebration here in B.C. that we're moving in that direction."
Oulton said there is a big disparity however in what is available in B.C. compared to the Maritime provinces where he worked previously.
Phalloplasty is currently covered in Alberta, Manitoba, Saskatchewan, Ontario and Québec, said François Grenier, executive assistant at CPATH.
"With British Columbia getting on board and valuing the medical necessity of phalloplasty, then that's going to influence other provinces too," said Oulton.
All Canadian phalloplasty patients must travel to Montréal for surgery, where it's performed at the Brassard plastic surgery clinic.
Dr. Cameron Bowman, a Vancouver plastic surgeon who performs other transgender surgeries, is trained in phalloplasty and able to perform it, but B.C. has not established a program to allow clinic time, operating room access and staff for phalloplasties. The province would also need a specifically trained urologist.
Grenier said MSP previously had misconceptions about phalloplasty, considering it not to be valid surgery because it was not far advanced enough to be worth funding.
"My opinion is that (phalloplasty) is pretty far ahead," Grenier said. "You have urethral lengthening, you have erogenous sensation, you have tactile sensation, you have hot/cold (and) pressure. The scrotoplasty is now (also) pretty good, depending on what techniques you're using."
The cost of a phalloplasty is between $40,000 to $45,000.
There are about 28 people who have been identified as being on a wait list for the surgery, said Noah Adams, a social worker and researcher who attended the CPATH conference and presented on phalloplasty. However the 28-person list is outdated and so the actual number is likely smaller. He said MSP will begin by contacting the 28 people to ask if they still want phalloplasty.
According to CBC, B.C.'s Health Ministry reviewed phalloplasty for coverage in 2006 and 2010, but decided not to fund it at those times.
The U.K. and Belgium both fully cover phalloplasty for transgender patients, said Grenier.
According to Trans Respect Versus Transphobia Worldwide, a European project that aims to map the legal and social situation of transgender people all over the world, 25 countries have funding for female-to-male gender reassignment surgeries. The information is however not specific to phalloplasty, and includes other surgeries such as breast removal, chest contouring and metoidioplasty.
Not all transgender people feel they need surgery. But many do, and for some of those individuals, phalloplasty may be the thing that makes them feel at home in their bodies for the first time in their lives.
Correction: A previous version of this article stated Dr. Bowman needed more practise before he could perform phalloplasty on his own. This is not in fact the case. Dr. Bowman is trained and able to perform the surgery, and is not doing so because of the reasons mentioned above. Apologies for any confusion.
Larkin Schmiedl is a contributing editor at rabble.ca, a staff reporter at the Kamloops Daily News and the host of Gaydio on CFBX 92.5 FM in Kamloops, B.C., which airs Tuesdays 9-10p.m.