politics Why Making Transgender Reassignment Surgeries More Accessible Matters

Proposed trans healthcare legislation provides a welcome change.

In 2010, at the age of 22, Marcel (whose name has been changed to protect his identity) came out as transgender. First, while still a student, he started hormone replacement therapy. The testosterone would help him build muscle, grow more body hair and lower the pitch of his voice. By 2012, he took a 9-to-5 job to supplement the cost of a bilateral mastectomy—a surgery that, when performed at a private clinic, can cost upwards of $6,000. His friends donated about a third of the money he needed for the procedure, and his sister helped out, too; the rest came out of his pocket.

The cost of a more intensive procedure, phalloplasty (better known as “bottom surgery”), was out of reach, fundraising friends or otherwise. That would have to be funded by the government.

Those in Ontario who seek to physically transition, like Marcel, are met with a figurative brick wall. As it stands, the Centre for Addiction and Mental Health in Toronto is the only institution in the province where transfolk can be assessed and recommended for surgery that is covered by government health insurance. With almost 1,200 on the waiting list for a referral, many wait on standby. Marcel was told he would have to wait at least two years to see a professional at CAMH.

The Ontario government is trying to change that. On November 6, health minister Eric Hoskins announced a proposal that would open up the assessment and referral process to 600 other qualified institutions. The proposal comes months after the province vowed to expand services beyond CAMH in order to shorten a wait list that has been growing at a rate of 100 names per month. Though it could be months before the proposal becomes legislation, it is a step forward in trans healthcare that has been a long time coming—one that is, for many, a matter of life and death.

Marcel knows this all too well. Years after his top surgery, he began to experience dysphoria, a phenomenon in which those who are transgender become emotionally, physically and mentally dissatisfied with their bodies, and can experience anxiety, depression, dissociation and other roadblocks. Stuck on the CAMH waiting list and unable to afford the surgery without insurance—which can cost up to $150,000—he fell into a depression. “I felt like I had no solution for my dysphoria, like I had no options,” he says. “I was exhausted.” Making matters worse were the murmurs in backchannel Yahoo forums that suggested his two-year wait at CAMH would realistically end up taking four to six years. In 2014, he attempted suicide.

Marcel was able to bounce back, surviving his attempt and seeking professional help to cope with his dysphoria. Many other transfolk will not. In one Ontario-based survey, the Canadian Mental Health Association notes, 77 per cent of trans respondents said they had seriously considered suicide; 45 per cent had attempted.

For its efforts to help those transitioning—among the most vulnerable—the government should be applauded.

But there is still a long way to go. For one, while OHIP covers mastectomies, it does not fund breast augmentation, facial feminization surgery or tracheal shaving for those who transition from male to female; they are considered “elective” procedures. “These are not necessarily ‘elective’ for many women,” Maya Cole, a Toronto transwoman, tells Torontoist. “I consider [those features] a part of my past, and it’s something that’s necessary for me.”

Surprisingly, there is also only one surgeon in the entire country qualified to perform bottom surgery, located in Montreal. As a result, many trans Canadians opt to travel out-of-country for the procedure; through this route, transfolk must pay their own room and board, travel and food. “We need to look at the provision of the surgical services and we’re looking at that,” Hoskins said at the November 6 press conference.

For now, those like Marcel and Cole are forced to take their transition one painstakingly slow step at a time. But it’s not all doom and gloom, despite how far the government still has to go for trans rights. Had such a proposal been around during Marcel’s darkest days, he says things may have turned out differently. “It would have made a massive difference to my mental health, just knowing the wait list situation would be eliminated,” he says.

Both he and Cole seem hopeful—and they’re right to feel that way.