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ST. JOHN'S, N.L. - All Blair Curtis wants is to live his life in the body he deserves.

Curtis, 18, of McIvers, is more than a year into his transition from female to male. He has been undergoing hormone therapy for more than a year as the first step of the gender-confirmation process.

The next step is a psychiatric evaluation at CAMH, a psychiatric clinic based in Ontario. Curtis is currently on a waitlist for an evaluation — a wait that could last as long as five years.

Until he is approved for a mastectomy, Curtis says, he has to wear a binder to help him present a more masculine appearance.

“A binder is a tight-fitting vest that squeezes my chest to make it appear flatter and more masculine. Something I am forced to wear in order to feel comfortable enough to walk outside of my own house,” Curtis wrote in a letter to the provincial government.

“Your body is supposed to feel like home, but mine feels more like a cage.”

Curtis says the procedure is a matter of life and death, in many cases.

Rates of depression and suicide among the transgender community far surpass the rest of society.

In 2017, a review of academic literature on mental health among the transgender community was conducted by researchers from McGill, Dalhousie and the University of Saskatchewan. The researchers found that 29 per cent of transgender individuals had attempted suicide in their lifetime, while 55 per cent had suicidal thoughts, compared with 0.5 per cent and 3.7 per cent among the general population, respectively. Those numbers were found to have dropped considerably once gender-confirmation surgery was completed.

Currently, Newfoundland and Labrador is the only province that requires the psychiatric evaluations to be performed by CAMH in order to pursue gender-confirmation surgery.

Curtis filed a human rights complaint against the Department of Health on Dec. 5. The complaint names Health Minister John Haggie in hopes of changing the policy, which forces people who wish to pursue the procedure — otherwise known as top surgery — to go out of the province.

“Your body is supposed to feel like home, but mine feels more like a cage.” - Blair Curtis

Curtis says the provincial Medical Care Plan (MCP) needs to change.

“I went to my doctor, who prescribed me testosterone. She told me that any time I go see her, she has to say that I have a sex disorder, because that’s what MCP classifies it as,” he said.

“Being trans isn’t a disorder. It makes me feel like they’re trying to claim that I have a mental illness because I identify a certain way. It makes me feel like I’m lesser than any cisgender person because they’re claiming I have a sex disorder, when in reality I just identify differently than cisgender people do.”

A cisgender person is anyone whose gender identity corresponds with their birth sex.

As well, while MCP does cover the cost of a mastectomy, it does not cover the cost of the reconstructive surgery needed after the surgery to allow for a masculine chest upon recovery.

“The surgery I require is the same as someone who had a mastectomy for breast cancer. If a woman had her breast(s) removed, when recovered, she has the option to receive reconstructive surgery which is cosmetic and covered by MCP,” Curtis wrote in the complaint.

“Reconstructive surgery is not a medical requirement, but a psychological one. My breasts have also had a psychological impact on me. How are my psychological needs less important than my cisgender counterparts’?”

The Department of Health missed a Dec. 20 deadline to respond to Curtis’s human rights complaint.

“We covered the mastectomy piece, but we didn’t cover the chest reconstruction piece."- Minister of Health John Haggie

While Haggie could not comment on why the deadline was missed, he says the government is working on changing the processes needed for gender-affirmation surgery and what MCP will cover.

“We want the same things. Our challenge is trying to get things right,” Haggie said.

“We do have a group of physicians in the province who have an interest in doing these kind of assessments for us. We require, from that point of view, some significant regulatory change. We’re working on that.”

Haggie says the Department of Health is looking at expanding MCP coverage to include more of what’s needed for gender-alignment surgery.

“We covered the mastectomy piece, but we didn’t cover the chest reconstruction piece. Our advice now is, for this group of individuals, it’s not a reasonable approach,” he said.

“We are now in the process of changing the policies to allow the masculinization procedure after the mastectomy as part of the suite of insured services.”

However, even with policy and legislative changes to allow more MCP coverage of gender-alignment surgery, most of the procedures will always have to take place outside of the province, according to Haggie.

“There’s never going to be the ability to do some of these kinds of surgeries anywhere but a national centre, simply because the numbers aren’t there for any one jurisdiction,” he said.

Haggie says it’s a complicated process to change the rules, but he’s hopeful some announcements will be made before the end of 2019.

Until the changes are made, Curtis remains in limbo, unsure of when he will be able to undergo the required surgery and how much he will have to pay out of pocket.

Curtis says at the moment, even with what’s covered under MCP, he expects to pay as much as $15,000 for surgeries at private clinics, along with some of his travel and accommodation costs.

But it’s not about the money for Curtis. He says he just wants to live his life like everybody else.

“I wear a binder that, every day, if I want to go outside I have to put it on. You’re not supposed to wear it for more than eight hours. It’s restricting my lungs,” he said.

“To be able to not have to wear it, so I can even go swimming, would be life-changing.”

Curtis has started a Go Fund Me campaign to help cover the costs associated with the surgery.

Twitter: DavidMaherNL