A transgender activist has filed a human rights complaint against the Nova Scotia Department of Health, saying it's unfair the province covers breast removal surgeries for transgender men, but not breast augmentations for transgender women.

Serina Slaunwhite has spent the last 18 months fighting the provincial medicare program after she was denied breast implants in April 2017, on the grounds the surgery is not considered to be medically necessary.

She filed the human rights complaint after she felt her concerns went unanswered.

"This should be included along with the rest of the surgeries that are publicly funded by the province for sex reassignment surgery .... It's gender discrimination," Slaunwhite said Thursday.

"Why is that not covered? If you're going to do masculinization surgeries and breast removal for trans men, then they should be able to do the opposite for trans women."

She said Nova Scotia's MSI program wouldn't give her a "clear cut answer."

In an email, Department of Health spokeswoman Tracy Barron said transgender women usually develop breasts through hormonal therapy, which is covered by provincial pharmacare programs, while the only way for transgender men to permanently masculinize their chest is through surgery.

'Preference' not covered, department says

"Implants are not covered for any individuals who would prefer larger breasts," she said.

"Breast implants are covered in Nova Scotia for severe congenital or developmental asymmetries and also in breast cancer reconstruction."

But Susanne Litke, a lawyer at Dalhousie Legal Aid Service who represents Slaunwhite, said in many cases breasts grown during hormone therapy aren't substantial enough for transgender women to feel at home in their bodies.

She said this kind of surgery can help transgender women "pass" — a term referring to their ability to be perceived as the gender they identify as — which can, in turn, mean being able to avoid hurtful comments and harassment from others.

"It doesn't always develop the size and volume of breast that they would be comfortable with in terms of the passing issue," said Litke about transgender women being able to grow breasts during hormone therapy.

Medical necessity, lawyer argues

"When that breast development isn't enough for the person to be comfortable in their body, then it's a medical necessity."

Litke said the province's sex reassignment policy is a "simple regulation" that could be easily changed by the government if they wanted to and that B.C. and Saskatchewan have already chosen to fund breast augmentation surgery for transgender women.

"Nova Scotia can take a lead here in Canada, we can be ahead of the rest of the provinces who don't have the surgeries added," she said.

Without coverage, breast augmentation can cost several thousand dollars.

Greater access to this service could also help transgender women avoid gender dysphoria, according to Kate Shewan, executive director of the Youth Project, an organization dedicated to supporting young people struggling with their sexual orientation or gender identity.

Gender dysphoria, recognized by the Canadian Psychological Association, is a condition where people feel a disconnect between how their body appears and how they identify.

Shewan said the condition can be mitigated through gender-affirming surgery.

"For some trans people, the chest or the breasts can be an area of significant distress or discomfort," she said, noting that failing to "pass" can result in harassment or violence toward a transgender person.

"When you're experiencing that level of discomfort for an extended period of time ... it can cause people to have difficulty interacting in society."

Mastectomy requests are simple

Michael Davies-Cole, a local transgender man and activist, said it would be relatively simple for him to walk into a doctor's office and get a referral to get a mastectomy or chest masculinization surgery, while transgender women aren't afforded the same right.

He said cisgender people — those who identify with the gender they were assigned at birth — don't realize the kinds of steps transgender people need to take in their everyday lives.

"We get up in the morning and we literally spend more time than you can imagine deciding what to wear so we can pass for that day," he said Thursday.

"And the irony is, we're asked to pass for something we already are."

Slaunwhite and Litke said they are waiting to hear back from the Nova Scotia Human Rights Commission.

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