This post was written for The Canadian Centre for Gender and Sexual Diversity and may be found here.
Amid all the negative news about LTBTQ* rights being limited and laws explicitly allowing discrimination being passed in various states in the United States of America we do have some good news to celebrate. At the beginning of March the Ontario government released updated regulations on how people can get funding approval for GCS (Gender Confirmation / Congruency Surgery). Prior to the change in regulation anyone requiring GCS who falls under the Ontario health care plan was required to go through the Adult Gender Identity Clinic at CAMH in Toronto. Under the new regulations qualified providers are allowed to submit the recommendation for surgery. These standards are based on the WPATH SOC 7 (World Professional Association for Transgender Health Standards of Care 7). With wait times at CAMH of more than two years access to surgery has been long and time consuming (see: Please Hold, Your Medical Transition is Important to Us) and quite frustrating to access. Further, anyone living outside of Toronto and not in Northern Ontario is required to pay their own travel and accommodations in Toronto or access, if available, through a video link. What do the new regulations mean for myself and others?
First, access to timely medical transition is important for all of us. Not having to wait two or more years for an initial assessment means that we do not have to be on edge for as long. It also means not worrying about how the process at CAMH works and what rules they impose on trans people in deciding whether or not someone deserves surgery. There are many factors that determine whether or not one needs surgery, wants surgery, and is ready for surgery. Each of these is distinct and unique for each person. I am thrilled that this should now be more accessible to people. That said, wait times for providers who are able and willing to work with those seeking medical transition are still not as common as we need them to be. There are not many of us who are trans and also providing services to trans people. I am one of the few who do.
Second, what is this going to do to wait times for surgeries? Currently there is only one clinic in Canada that offers a full range of GCS options, and it is in Montreal. If one needs to have surgery performed in a full hospital, that is not available in Canada. With an increase in the number of surgery approvals wait time for surgeries will now become an issue. While we celebrate this change, we need to have good quality surgery and after care provided in multiple locations around Ontario. Travel to have surgery is costly and takes us away from those who would otherwise be able to be supportive in our recoveries.
Third, while this is an excellent improvement for access to care many gender affirming procedures are not covered by the provincial health care plan. Breast augmentation, facial feminization surgery, permanent hair removal, voice surgery, and tracheal shave are all procedures trans women need and are required to pay for themselves. The cost of permanent hair removal is out of reach for many of us. Many of us, including myself, are living well below the poverty line and struggle to pay rent and to eat. These procedures that help us to affirm our identities are completely out of reach. For trans men hair replacement is not covered, chest contouring is not covered. In addition, we do not have any coverage for mental health care that is provided by most psychologists, psychotherapists, or social workers. While psychotherapy is not required for a medical transition it is something that many of us benefit from as we explore and grow in our journeys of transition.
Overall the changes to the approval process for surgery is long overdue and is to be cheered and celebrated. While we celebrate this change many of us still struggle with issues that have yet to be addressed when it comes to our medical transitions. We celebrate, and we continue our ongoing work to improve access to health care for ourselves and others.