A new report provides a detailed look at the experience of Ontarians seeking gender-affirming surgery, painting a patchwork portrait of transgender patients paying up to $10,000 in extra expenses and spending anywhere between a few days to 10 years waiting for pre-surgical assessments.

The research draws from the results of a Canada-wide online survey conducted by University of British Columbia researchers between July 2016 and June 2017. Of the 751 respondents, 284 were from Ontario and reported major barriers to accessing gender-affirming surgery, defined as surgical procedures that change someone’s primary or secondary sex characteristics to match their gender identity.

Forty-five per cent said it was difficult to get necessary assessments and 57 per cent travelled more than two hours to go under the knife. On average, transgender Ontarians also waited more than six months longer for pre-surgical assessments than respondents from other provinces, the survey found.

But the study’s senior researcher Elizabeth Saewyc said these results should be considered a baseline portrait of the trans-health landscape in Ontario because the survey was conducted after the province passed landmark regulatory changes that cleared away barriers for transgender patients.

Since then, there have been hopeful signs of change, many of which are consistent with recommendations made in Saewyc’s report. At the Centre for Addiction and Mental Health — once the only place where transgender Ontarians could get pre-surgical assessments — a backlog of 1,600 people on the wait-list was cleared in August, with wait times now reduced by more than 50 per cent.

Across the province, more than 325 family doctors and health providers are now trained to provide pre-surgical assessments and competent health care for transgender patients. And at Women’s College Hospital, plans are underway to create a surgical program that provides all gender-affirming surgeries; currently, Ontarians who require lower surgeries like vaginoplasty or phalloplasty have to travel to a clinic in Montreal.

The data from this survey is vital and unprecedented in Ontario, according to Devon MacFarlane, director of Rainbow Health Ontario, which is part of the province’s Trans Health Expansion initiative.

“As we create change, we’ll be able to look back at the data from this survey and say, ‘OK, we can actually show that we made a difference here,’” MacFarlane said. “We have so little understanding of what’s going on around trans people’s health and well-being.”

Ontario’s transgender population is currently unknown but studies have estimated that as many as one in 200 adults identify as trans. While not everyone who identifies as transgender will seek surgery, gender-reassignment surgery is considered medically necessary for many transgender people; studies have shown that transitioning through hormones or surgical procedures can reduce the risk of depression or suicide, which tends to be disproportionately high for the transgender community.

The survey confirms what many already knew about the historical difficulty of accessing gender-affirming surgery in Ontario. The average wait time between getting a referral and getting assessed for surgery was nearly 14 months; waiting for the actual surgery took another seven months on average, with some people waiting as long as 15 months. (For comparison, the average wait time for patients who require knee replacement surgery in Ontario is roughly two to four months.)

Patients who travelled more than two hours to have surgery — which was more than half of the Ontario respondents — also had double the rate of self-reported complications, though the vast majority were considered minor.

For advocates like MacFarlane, the survey tells a mixed story. On the one hand, it reveals a patchwork system in Ontario full of barriers and inequities. But it also validates the work that has been triggered by Ontario’s 2016 regulatory shift, which finally opened the door to transformative change.

“Five years ago, some of these changes would have seemed like a dream,” said Dr. Amy Bourns, a family physician with Sherbourne Health Centre. “And yet, in our actual experience with patients, we see that there’s obviously still work to do.”