Ryder Chidley always felt out of place within himself; within his skin.

He grew up as a she, but never really felt like one.

It was always a struggle to get Chidley to wear dresses on school photo days.

When the 25-year-old looks back, he remembers himself as a confused little girl who always felt like something was missing. A tomboy who preferred to hide his long brown hair in a hat, wear dirty sneakers and play rough outside.

As a teenager, something clicked: “I wanted to be a boy because I knew inside that’s who I truly was — who I truly am.”

What Chidley didn’t know was how hard it would be to access health services as a transsexual person in Ontario. How long it would take to get approved for sex reassignment surgery. And, how much was stacked against him.

Waiting lists for transgender health services in Ontario have never before been more unwieldy.

It can take up to a year to see a primary care doctor — and, as in Chidley’s case, three and a half years to make it to the operating table for sex reassignment surgery, a procedure he is still waiting on.

Health experts fear the lengthy delays to crucial health care are putting an already vulnerable community at risk. They are calling on the government for urgent help.

In the past few years an unprecedented surge in the number of people identifying with gender dysphoria has flooded the few health clinics in the province that cater to the trans community, pushing waiting times longer than ever before.

The adult gender identity clinic at Toronto’s Centre for Addiction and Mental Health (CAMH) — the sole gatekeeper that can approve trans people for sex reassignment surgery — has more than 700 patients on its waiting list.

“We are actually overwhelmed with the recent pace of referrals,” Dr. Chris McIntosh, head of the CAMH clinic, told the Star. “This is a severe problem. The waiting list is not a benign situation.”

Since sex reassignment surgery was re-listed as a government-funded procedure in 2008, the number of people undergoing the operation has soared from less than five in 2008 to 151 last year, costing the province almost $2.2 million.

The massive increase has outstripped resources at CAMH, which now has a waiting list of almost two years for a first appointment, McIntosh said.

It took about 18 months for CAMH to return Chidley’s call.

Once trans patients are given the green light for surgery by CAMH, they still have to wait at least another six months before reaching the operating table — which is in Montreal because no doctor in Ontario can perform sex reassignment surgery.

It took nine months for Chidley to secure a surgery date with the Montreal clinic and his sex reassignment is scheduled for October this year.

What most concerns health professionals about this bottleneck of unmet need is new research that shows trans people are at a heightened risk of mental health breakdowns, self harm and suicidal thoughts while they wait for clinical help.

“Sitting on a waiting list for that long causes mental health issues,” McIntosh said.

More than 75 per cent of people attempting gender transition consider taking their own lives and almost one in two attempt suicide, according to the 2010 Trans PULSE project, which surveyed 433 people from Ontario’s trans community.

CAMH has asked the government for help; requesting it expand the number of locations where trans people can seek approval for sex reassignment surgery to ease the overflowing demand.

Dr. Eric Hoskins, Minister of Health and Long Term Care, said in a written statement to the Star that he recognized there was more the government needs to do for the LGBTQ community.

The ministry is looking into options to reduce wait times for trans people, Hoskins said.

“It can be a trying time psychologically for individuals experiencing gender dysphoria and we owe it to them to ensure that they’re treated in a timely fashion,” he said.

For Chidley, the three-year wait for surgery has put his entire transition on hold.

Since he started taking testosterone in 2012, Chidley has worn a chest binder, or a “really tight corset”, everyday to flatten his breasts. The pain is “physically traumatizing” and the binder also restricts his breathing while climbing trees for his job with a tree care company in London, Ont.

“Waking up and having to put that on everyday and feeling like you’re not who you want to be — that’s basically what that waiting period does,” he said.

Two of his trans friends who went down the same path couldn’t handle feeling like they were in limbo and gave up on the waiting list, choosing to pay upwards of $20,000 out of their own pockets for the gender reassignment procedure in private clinics.

“Is it worth it, waiting this long so you can get the operation for free? Honestly, I don’t think so, but I don’t have that kind of money,” Chidley said.

Rachel Clark, an education facilitator at The 519 Church Street Community Centre, is on the same waiting list, but she is making the transition from male to female.

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Like Chidley, it took Clark three years to get approved for surgery by CAMH, a wait that she said put her entire life on hold.

“It doesn’t feel like you have control over your own health care. You just want to get through it and get over it so you can get your life back,” she said.

Although the waiting list is an “enormously huge issue” which is putting trans people in danger, Clark does not believe anyone is to blame for the current situation.

“The need just wasn’t there five to 10 years ago,” she said.

“Now that it’s becoming more acceptable and safe for trans people, a lot more people are coming out. The medical sector just hasn’t caught up with us yet.”

It is not just Ontario’s medical system that is struggling to handle an unprecedented rise in patients presenting with gender dysphoria (an unusual condition where anatomical sex doesn’t match a person’s gender identity) — doctors around the world are reporting a similar trend.

Transgender issues fell under an international spotlight last month, when former U.S. Olympian and reality TV star Bruce Jenner, from Keeping Up with the Kardashians, came out as a trans woman.

Media coverage such as the Jenner interview, advancements within the worldwide LGBT community and a general societal shift in awareness and understanding of trans issues was likely fuelling the increased demand for sex reassignment surgery, CAMH’s McIntosh said.

“What’s becoming obvious is that there are many more transgender people out there then we ever thought there were,” he said, adding, it’s more important now than ever before to break down barriers for trans people seeking health care.

In five months, Chidley will undergo his long-awaited sex reassignment surgery. His excitement is outweighing his nerves, he told the Star.

It’s the little pieces of life that he will gain that he’s looking forward to the most. Things other people wouldn’t even think about — feeling at home within his own skin, being able to take his shirt off on a hot day, swimming.

As for the chest binders, well, he plans to set them all on fire post-op.

“After surgery, I will feel the closest I’ve ever felt to being me, inside and out,” he said.

Procedures funded by OHIP

Sex reassignment surgery was removed as a funded procedure under the Ontario Health Insurance Plan (OHIP) in 1998.

It was re-listed in 2008 and covers both female-to-male and male-to-female surgeries.

Under OHIP patients can seek reproductive and genital surgery, including genital reconstruction, mastectomy and reduction mammoplasty.

Insured services for female-to-male include: Hysterectomy, bilateral salpingo-oophorectomy, vaginectomy, scrotoplasty, urethroplasty, phalloplasty, metoidioplasty, placement of testicular prostheses, penile implant and reduction mammoplasty/mastectomy.

Insured services for male-to-female include: Penectomy, orchiectomy, vaginoplasty, clitoroplasty and labiaplasty.

Patients seeking OHIP-funded sex reassignment surgery must be recommended for surgery by CAMH. Requirements include the patient living in their new gender role for at least a year before undergoing the operation.