Doctors, advocates urge province to expand access to gender-affirming care

A 2015 study found that about 35 per cent of transgender Ontarians have seriously considered suicide over the previous year. Access to gender affirming care, which isn’t widely available in the province, can substantially reduce that risk.

Amelia Smith underwent a vaginoplasty in May of 2021 at the Women’s College Hospital in Toronto. It’s the first publicly funded transition-related surgery program in the country and is still the only one in Ontario.

“It’s incredibly important for people’s mental health to be able to get these surgeries, to be able to live in their bodies as they see fit, no matter what that may be,” explained Smith.

Women’s College Hospital surgeon Dr. Alexandra Millman said these surgeries are truly lifesaving for people.

“Gender dysphoria can cause a lot of internal distress and we know that people may even [die by] suicide if they don’t have access to the care they need.”

Before Women’s College Hospital launched their program in 2019, the only options for patients who had to get gender-affirming surgery was either to do it privately or out of the province.

“For a lot of patients, they’re not coming from very high socioeconomic backgrounds and it can be really hard for them to travel to take time off work and to pay privately for these surgeries,” said Dr. Millman.

Traveling after a major surgery is also difficult for the person undergoing the procedure.

“There’s a lot to keep track of and it can get very costly if you have to travel. Not to mention the discomfort that would come with traveling after surgery, because for myself, I had a catheter – just going around with the catheters not easy,” added Smith.

Bill aimed at expanding gender affirming care in Ontario denied

Both Dr. Millman and Smith say access to gender affirming surgeries needs to be expanded in the province.

Ahead of Trans Day of Remembrance on Nov. 20, Toronto MPP Kristyn Wong Tam introduced a private member’s bill called the Gender-Affirming Health Care Advisory Committee Act in hopes of doing just that.

The bill aimed to improve access to gender-affirming health care for trans, two-spirited, non-binary, gender diverse and intersex people in Ontario.

However, the motion by Wong-Tam to pass the bill by unanimous consent was denied on Thursday.

“We need to ensure that every member of the House truly supports that trans health care should not be up for debate, anything less would be transphobic. Delaying the passage of this bill will cost trans Ontarians their lives,” said Wong-Tam, prior to the denial.

“Healthcare is not always friendly, not always competent and not always affirming for trans people. Many are still fighting and waiting and still not getting the care they need, all of what I’ve just said is far too common.”

The bill would have required the government under the Minister of Health to establish a Gender-Affirming Health Care Advisory Committee within 60 days of the act coming into force.

The committee would then have to report back to the Minister of Health with recommendations on how to address “stigmas and discrimination, lengthy wait times, outright denial of care, exclusion of care and referral requirements that make it difficult for people to access the care they need,” said Wong-Tam.

“This happens all the time in the normal course of government business – what we’re asking for is not radical, nor is it unusual,” she added.

It’s not the first time this bill has been tabled and denied in the legislature. It was first brought forward in 2021, but was stalled and died when the legislation was dissolved prior to the 2021 election.

“If Doug Ford and the Minister of Health were serious about fixing the health care system for everyone, they would not have delayed this bill’s passage,” said Wong-Tam in a statement after the denial.

While it was denied unanimous consent, the legislation could still be called for a second reading.

Dr. Kate Greenaway, who runs the Connect Clinic – a virtual gender-affirming health care clinic – said she currently has a waitlist of over 2,000 people for her clinic alone and the wait times for gender-affirming surgeries can be up to three years for some.

“Patients wait to see a provider who can request the surgery. They then wait for the Ministry of Health to approve the surgery, which is anywhere from six to eight months and then they wait for a surgeon depending on the surgery requested,” Dr. Greenaway explained.

There currently is no accurate estimate of the number of people waiting for this care.

“The problem is there’s no centralization of services … There is no provincial mandate, with timelines for people to be seen. Not that it would really help us because we don’t have enough providers to meet that demand, or the infrastructure to do it,” said Dr. Greenaway.

“What we have is individual providers and clinics who are stepping up to help people in need. What we don’t have is lasting government or Ministry of Health support for what we do,” she added.

Wong-Tam said the province must establish these standards so Ontario residents can know what to expect when seeking this type of care.

When asked why gender-affirming care should be prioritized while the entire healthcare system in Ontario is going through a crisis, Wong-Tam said it is possible to have multiple priorities that converge together based on the foundational value that, “every Ontarian should have access to appropriate health care that is life-saving [and] life-affirming.”

“We recognize that even if the bill passes today, it’s not going to radically change anything. The waitlist will still be as long as it is,” said Wong-Tam, prior to the bill’s denial. “But it starts a conversation on what type of healthcare system that we want to have in Ontario, and who are we ultimately serving?”

Dr. Millman said they have expanded their services since the program first opened at Women’s College Hospital, including hiring a plastic surgeon and another urologist to expand the vaginoplasty program, but it still doesn’t cover everything that every person wants to get.

“Some of that is ministry level and some of it is our hospital level, but we’re really hoping to be advocates for our patients to get all the surgeries that they need … and not all of the surgeries are available or funded,” she explained.

Smith tells CityNews since her surgery, she has returned to Women’s College to talk to about her experiences with other trans people going through the program.

“These surgeries do have a marked change. They do have a significant effect on people’s lives. I know that my life has been changed significantly. I feel a whole lot more confident ever since my surgery and I think that it’s just so important that we remember that.”