When Ethan Belcourt flew to Montreal to have gender-affirming surgery done, he felt alone.

The 49-year-old Winnipeg trans man didn't have friends or family to support him as he went for surgery in Montreal at a private clinic last November.

"It's hard because you're leaving your support system … and if you can't afford it you can't take anyone with you."

Belcourt is one of many patients who have been sent by Manitoba Health over the years to a clinic in Montreal to have bottom surgery done.

In the 2017-2018 fiscal year alone, a total of 88 Manitoba residents had transgender operations, including 14 patients who required out-of-province surgeries, a provincial spokesperson said.

The operation physically affirms one's gender and is often considered the most complicated surgery transgender people undergo. It's usually broken into multiple surgeries, meaning multiple trips to Montreal.

Ethan Belcourt flew to Montreal to have gender-affirming surgery done last year as part of his transitioning journey from female to male. (Lyzaville Sale/CBC)

That is something a new plastic surgery graduate from the University of Manitoba is hoping to change.

Dr. Blair Peters is packing his bags and in July will be in St. Louis, Mo., for training in peripheral nerve and microsurgery, which will give him the skill set needed to learn how to do bottom surgery.

Blair Peters has been awarded the $75,000 R. Samuel McLaughlin/ MMSF Research and Education Fellowship Award in Medicine. (Blair Peters/Submitted)

"I think it's going to be incredibly rewarding and I hope everyone realizes how important these procedures are to these individuals."

Peters, 30, has been awarded the $75,000 R. Samuel McLaughlin/ MMSF Research and Education Fellowship Award in Medicine.

Once he's finished in St. Louis, he'll head to Portland to continue his training at the Oregon Health and Sciences University — the leading centre for gender-affirming surgery in North America.

During his residency, he did about 100 above-the-waist surgeries on transitioning patients and noticed a massive need for a Manitoba doctor who can do bottom operations.

"You're getting surgery in one province and then you travel back home post-operatively and then it can be hard to access follow-up care and the care pathways that currently exist can be a little bit complicated and hard to navigate."

Belcourt, who still has two more lower surgeries to go, had complications after doctors did a skin graft from his arm for his first operation and remembers feeling frustrated trying to access care in Winnipeg.

"It was hard because you don't have your doctor here who knows the system of what you've went through and the full surgery."

Janet Macbeth is a patient in the Transition-Related Surgery Program at Women's College Hospital in Toronto, which in May said it performed the first vaginoplasty in more than two decades in Ontario. (Michael Wong/Canadian Press)

Peters said up until last week, patients across Canada have had to go to Montreal or leave the country for the procedure.

Last week, officials at the Women's College Hospital in Toronto said doctors there performed the first vaginoplasty in more than two decades in Ontario. The surgery constructs a vagina for trans patients.

The B.C. government has promised to make bottom surgery available for transgender people this year.

Peters, who was born and raised in Winnipeg, said his motivation to specialize in trans health is personal.

"Growing up as an LGBT person, I think we all know what it's like to feel like you don't really have a say in things and it's hard to get your own interest and rights heard."

"I've gotten to know a lot of the community members and what better way to have a career and make your living treating and serving your own community? I can't imagine anything more rewarding than that."