Transgender Health Care Access

Despite being one of the most progressive countries in the world on gay and transgender rights, the hurdles of transgender healthcare access in Canada remain a leading cause of activism for its community members. 

According to a 2020 report by Trans PULSE, more than 80% of trans and non-binary respondents said they have a primary care provider, however, 45% of them revealed that they'd experienced having one or more unmet health care needs within the past year. It's a stark contrast to only 4% of the general population reported having unmet medical needs in 2015 to 2016.

What Kind of Specialized Health Care is Needed?

Trans people require access to specialized healthcare services to address their unique and more pressing concerns, such as:

• Hormone replacement therapy 
• Gender-confirming surgeries or any medical procedure designed to align their physical characteristics to their gender identity
• Trans-specific gynecologic, urologic, and reproductive care
• Mental health treatment: CMHA data suggests LGBTQ+ individuals have higher rates of depression, anxiety, obsessive-compulsive and phobic disorders, suicidality, self-harm, and substance use and are at twice the risk for post-traumatic stress disorder (PTSD) than heterosexual people.

Publicly Funded Gender-Affirming Medical Care in Canada

Access to transgender health care in Canada differs from province to province. However, there are still evident barriers at the national level that can have a huge impact if the relevant people were to take the necessary action. Presently, Canadian provinces and territories provide public funding for medically essential gender-confirming procedures for transgender people.

The 2018 national scan by UFCW Canada, the country's private-sector union, and the Canadian Professional Association for Transgender Health (CPATH) compiled a list of the transition-related procedures offered in each province and territory.

Here's what we found:

• Manitoba - The Manitoba government provides state funding for gender transition surgeries, including orchiectomies (removal of testicles), penectomies (removal of the penis), vaginoplasties (reconstruction of the vagina), mastectomies (removal of breast tissue), hysterectomies (removal of the uterus), and oophorectomies (removal of the ovaries).

• British Columbia - Trans Care BC covers both feminizing (orchiectomy, vaginoplasty, valvuloplasty, and breast reconstruction) and masculinizing gender-confirmation surgeries (clitoral release, hysterectomy, bilateral salpingo-oophorectomy, metoidioplasty, and phalloplasty).

• Saskatchewan - The most common gender-affirming surgeries like hysterectomy and mastectomy are covered and provided in Saskatchewan. More complicated transition-related surgeries may be sought after outside the province and can be 100% covered by the Ministry of Health if approval is given beforehand.

• Alberta - Alberta's Gender Surgery Program covers phalloplasty, metoidioplasty, or vaginoplasty. However, procedures that are cosmetic in nature, including chest contouring, breast augmentation for those with breast growth, facial feminization, tracheal shave, and voice pitch surgery are classified as uninsured services.

• Ontario - OHIP covers most types of sex reassignment surgeries, such as chest and genital procedures, including private clinic stays outside of Canada. 

• Quebec - Members of the LGBT community can have gender-reassignment surgeries (mastectomy, penectomy, vaginectomy, hysterectomy, scrotoplasty, metoidioplasty, phalloplasty, and erectile and testicular implant) and treatment for free through Quebec's public health care insurance plan. However, surgeries deemed to be purely aesthetic in nature, such as breast implants or plastic surgery to achieve a more feminine look, are not included in their insured services.

• Nova Scotia - Gender-affirming surgeries are also an insured benefit in Nova Scotia. Hysterectomy, oophorectomy, orchiectomy, penectomy, breast augmentation, breast reduction, mastectomy or chest masculinization surgeries are available in the province. Surgical expertise for phalloplasty, metoidioplasty or vaginoplasty is provided at the Centre Métropolitain de Chirurgie in Montreal.

• Newfoundland and Labrador - Under the Medical Care Plan (MCP), transition-related surgeries are covered in Newfoundland and Labrador. These include breast augmentation, mastectomy with chest masculinization, hysterectomy, orchiectomy, salpingo-oophorectomy, and genital reconstructive procedures like vaginoplasty, metoidioplasty, and phalloplasty. 

In 2019, transgender surgery assessments were made available in the province. Meaning, the province no longer requires trans and non-binary individuals to be evaluated by the Centre for Addiction and Mental Health in Toronto, Ontario, to determine whether they would be approved to undergo gender reassignment surgery.

• Prince Edward Island - All gender-confirming surgeries are covered by PEI Medicare but are referred out-of-province to the Centre Métropolitain de Chirurgie (CRC), also known as GRS Montreal. They also have drug assistance programs for those who need access to hormone replacements.

• Yukon -Trans individuals living in the Yukon Territory get coverage for gender-affirming surgeries to treat gender dysphoria, which includes chest and genital surgeries and genital reconstructive surgeries. Yukon is the only territory in Canada that provides this coverage on their health insurance plan.
  
  In 2017, the Yukon Legislative Assembly passed amendments to the Vital Statistics Act, providing the LGBTQ+ community legal protection against discrimination and allowing them to change their gender markers on their birth registrations without undergoing transition-related operations. 

• New Brunswick - In 2015, non-binary and trans activist, AJ Ripley, was featured in the VICE documentary "On Hold: Canadian Transgender Health Access." They talked about the lack of state-funded treatment services for the trans community, especially in New Brunswick, where they live and where LGBT rights were not in the province's human rights code. Ripley also started an online crowdfunding campaign called "Take My Breasts Away," seeking financial aid for their FTM top surgery. They also had an in-person consultation with our very own Dr. Hugh McLean about their FTM top surgery.
  
  Fast forward to 2020, New Brunswick Medicare now covers medically necessary gender-confirming surgeries for transgender persons living in the province. These include female-to-male transition surgeries (vaginectomy, hysterectomy, salpingo-oophorectomy, mastectomy with chest masculinization, metoidioplasty, phalloplasty, erectile and testicular implants) and male-to-female procedures (vaginoplasty, penectomy, orchidectomy, construction of a vaginal cavity and the vulva).  

Nevertheless, pectoral implants, breast augmentation, facial feminization, tracheal shaving, hair removal, travel, accommodation or medications prescribed outside of a hospital, voice and communication training are excluded from the province's list of insured benefits.

https://www.youtube.com/embed/rUMYIykH_U8

On the other hand, sources show that although appointments to see primary-care providers are covered in the Northwest Territories and Nunavut, the assessment for hormone replacement therapy and other transition-related surgeries and treatments are not covered.

What Are the Potential Barriers?

Unfortunately, despite strides in the right direction, there are still solid barriers to getting full access to transgender health care in Canada.

Sources suggest that transgender individuals under-utilize or intentionally avoid healthcare services altogether. The Trans PULSE survey revealed that at least 12% of trans and non-binary respondents said they avoided going to the emergency room in the past year when they needed care, simply because they were trans. 

Harassment

There are several contributing factors to what truly prevents them from getting the treatment they need. Based on a 2013 study, trans people in Canada and the United States report high levels of violence, harassment, and discrimination when seeking stable housing, employment, health or social services.

In the last five years, the Trans PULSE report also shows that respondents experienced abuse and harassment related to their gender identity in the forms of:

• 68% verbal harassment
• 16% physical assault
• 26% experienced sexual assault

Beyond the lack of transgender-specific health care policies in some provinces in Canada, we can say the fear of being harassed, discriminated against, or outed in a public setting played a pivotal role in why the LGBTQ+ population is hesitant to go to state-funded clinics or hospitals. 

Low Income

Access to state-funded transgender healthcare in Canada becomes much more critical in light of the fact that bisexual and trans people are over-represented among low-income Canadian households. It means they do not have the financial resources to pay for private clinics, which offer a more comprehensive range of LGBTQ-specific treatment services.

An Ontario-based study found that half of trans individuals live on less than $15,000 a year in 2010. A decade after, the 2020 Trans PULSE survey still paints the same picture for the LGBTQ+ community. Most of the respondents were highly educated, with 50% saying they had a college or university degree and 19% having a graduate or professional degree. At least 43% reported having full-time employment. Still, more than half of the respondents aged 25 and up stated they had a personal annual income of less than $30,000. 

The Price of Waiting

Based on the VICE documentary, 30% of the annual suicide attempt rate among trans people were those who seriously considered suicide if they were made to wait for gender-affirming surgery. The risk drops to 11% if they are given access to a full medical transition.

These figures powerfully illustrate that although a lot of progress has been made to improve transgender health care in Canada, more work needs to be done to give each and every person in the LGBTQ+ community complete access to timely treatment services.

For more information on FTM/N top surgery and other gender-affirming surgeries, don't hesitate to reach out to us. A friendly member of our team will be more than happy to answer your questions.

Contact McLean Clinic today!