Trans health care in Canada: A provincial lottery

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If last month's attack on the Centre Métropolitain de Chirurgie in Montreal revealed anything, it's the dire lack of surgery resources for trans people in Canada.

Currently, most trans Canadians have to travel to the Centre Métropolitain de Chirurgie in Montreal for gender confirmation surgery covered by provincial health-care plans.

Following the attack, some trans activists professed concern about the vulnerability of trans Canadians' access to vital procedures when they are only provided through one clinic.

A provincial lottery

All Canadian provinces now fund some surgeries -- with New Brunswick being the last to announce coverage at the beginning of June. However, access to and coverage of the many different gender confirmation surgeries depends on where in Canada you live, creating a health-care lottery. Quebec covers the most gender confirmation procedures, which are all performed in-province.

The availability of procedures tends to favour the trans male population, with no province offering publicly funded breast reconstruction for trans women, while all provinces cover mastectomies for trans men.

Some of the more straightforward surgeries, such as mastectomies, hysterectomies and orchiectomies are performed in-province. However, all the provinces that do cover more advanced procedures, such as vaginoplasties and phalloplasties, funnel these patients to the Montreal clinic.

Prince Edward Island is the only province not to cover either of these surgeries, which are also colloquially known as "bottom surgery."

The Canadian territories are lagging behind the provinces, with only the Yukon providing some coverage for gender confirmation surgery. It remains to be seen whether the federal government will put pressure on the Northwest Territories and Nunavut to provide this vital resource.

Ontario has recently increased its health-care service points for its trans residents. Rainbow Health Ontario is accrediting more health-care practitioners to refer trans patients for surgery -- until last year, the Centre for Addiction and Mental Health (CAMH) in Toronto was the only referral agency.

Ontario has also added one more top surgery clinic to its coverage for trans men, meaning travel outside the province is no longer necessary for this procedure. However, the Montreal clinic still remains one of the primary surgery access points for Ontario residents, and for the rest of Canada.

Jordan Zaitzow is the Trans Health Connection Coordinator at Rainbow Health Ontario, an organization that has been training health-care providers to deliver trans inclusive and trans specific services. While Zaitzow is keen to celebrate the recent changes in access to both primary health care and surgery for trans people, he also notes the length of time it is taking for the system to catch up.

"We have a long waitlist of people who are desperate to move forward with surgery; they've already been waiting sometimes for years," Zaitzow told rabble. "Primary health care is in some cases reacting quite slowly. To hear this great news [of funding] and to not get care can be quite difficult for some people."

A bottleneck effect

The growing demand for surgeries is creating a bottleneck effect. Canadian trans rights advocate Sophia Banks argues that the increase in referrals won't reduce the waiting list, which already spans two to three years.

"We only have one surgeon in all of Canada. So if all of a sudden we have more people coming…is that really going to speed anything up when we're still only working with one doctor?" She concludes, "for trans health care to be adequate we need surgeons in all provinces."

Banks is also quick to note the disparity in the kinds of procedures that are covered for trans men and those covered for trans women. "The surgery that trans women are offered is only genital surgery, whereas for trans men they get offered both top surgery and bottom surgery, and a hysterectomy. Why are trans women not offered chest surgery but trans men are?"

Zaitzow agrees that more equitable surgery coverage needs to be provided for trans women.

According to Zaitzow, the criteria for coverage revolves around whether a surgery is considered medically necessary or not. "All the surgeries that trans women want are considered cosmetic because the system is so misogynist. If you don't want breasts, that's covered, but if you do want breasts, that's [considered] cosmetic," Zaitazow said.

Both Banks' and Zaitzows' comments raise the question of which kinds of surgeries are and aren't considered socially acceptable for trans people to have.

Following the arson attack on the Montreal clinic, Jayne Ellen Heideck, a trans woman from B.C., has been arrested and charged. Heideck was a former patient at the clinic.

Banks cites a general pressure on trans women to have vaginoplasties. "I know a lot of trans women who are unhappy with the surgery. I think it sucks that you don't have a choice of what doctor to go to. You have one doctor and that's it. And then I think there's a lot of pressure to force women into having [a] vaginoplasty when not every trans woman necessarily wants it."

This pressure could be the result of gender essentialism, that encourages trans men and trans women to have certain procedures in order to fit a normative standard of what a man or woman should look like.

While the health-care situation is fast improving for trans people in Canada, there are still changes that need to be made. Primary health-care services that are trans inclusive and trans specific are needed as well as increased access to gender confirmation surgeries.

We should celebrate the improvements, but we should also pressure provincial and federal authorities to provide these services across the country.

Stay tuned for part two: what trans rights advocates are celebrating and what they feel needs to change about trans health care in Canada.

Laura Brightwell likes to think of herself as a writer. She is currently a PhD candidate at York University and can be found online at and rabble and @mslauralipstick on Twitter

Photo: flickr/torbakhopper


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