There are only two surgeons in all of Canada that specialize in complicated sex reassignment surgery, according to experts. And they both work at the same clinic in Montreal.
Glowing news articles on celebrities such as Caitlyn Jenner in recent months are certainly inspiring, but the reality for Canadians who identify as transgender is not quite as heart-warming.
To be clear, not all people who identify as transgender want to undergo sex assignment surgery, but for those who do it’s a long, hard and often expensive process.
Waiting a ‘really long time’
“People have to wait a really long time,” said Jan Buterman, president of the Trans Equality Society of Alberta (TESA), in a phone interview with Yahoo Canada.
Indeed, because there are so few doctors and surgeons specializing in the field there are really long wait times in Alberta, as well as in the other provinces and territories.
Funding for the surgery was halted in Alberta in 2009, but reinstated in 2012 after a public outcry. These days there are currently only two doctors in Alberta, both located in Edmonton, who can do an evaluation and decide if someone is eligible for surgery, said Buterman. The wait list to see those doctors is about 18 months, said the TESA head. But there are many barriers to even getting to that point. To see a specialist a person must be referred to them by a family doctor first. Getting a family doctor with the current shortage can be a challenge, Buterman noted. Then there are the out-of-pocket costs of travel and taking time off work if a person is coming from outside the Edmonton area.
Once Albertans clear that first hurdle and get the OK for surgery there are many more hurdles to come. Surgeries are not done in the province, with people usually sent to the Centre Métropolitain de Chirurgie Plastique in Montreal. Both surgeons at the Quebec clinic are currently on vacation and unavailable for interviews. The wait list to get surgery at the private clinic, which attracts patients from around the globe, is about two years, said Buterman. Again, while the actual surgery is usually covered under most provincial health-care plans related costs, such as travelling are not generally covered.
“Other things are not covered,” said Buterman. “Things like taking care of facial hair, such as adding facial hair -- which can be a very expensive procedure.”
Some Canadians get so fed up with the long process that they opt to pay for everything themselves and get surgery overseas, in places like Thailand, noted Buterman. While the prices vary, a 2010 CNN report pegged costs at between $9,000 to $20,000 (USD) for male-to-female surgery and about $12,000 to $20,000 for female-to-male surgery.
For those opting to get surgery at home there are similar barriers and hoops people must jump through across Canada. In Ontario, for example, those seeking hormones and/or surgery must meet several criteria, including having received a diagnosis of Gender Dysphoria and being over the age of 18.
For kids and youth
The process for youth who identify as transgender is even more convoluted, and as with all health-care differs province-by-province.
In British Columbia, children and youth who are presenting with gender questioning usually travel to Vancouver for treatment after a referral from their family doctor, said Dr. Daniel Metzger in a phone interview.
Dr. Metzger, who is a BC Children's Hospital endocrinologist and is on the provincial Transgender/Trans* Health Steering Committee, says about 40-50 children and youth get treatment every year in the province, with kids as young as four and five seeking care. Again, for those coming outside of the Vancouver area there are out-of-pocket costs, such as having a parent take time off work to accompany their child. Dr. Metzger says there are several groups that will help families with those costs, if needed.
Every child will take their own path, but generally, a specialist will offer the option of taking hormone blockers to delay puberty in a bid to “give them some breathing room” to decide what they want to do later in life, explains the pediatric endocrinologist.
Generally, youth must wait until they are 18 to undergo sex reassignment surgery and then would go through the same process as other adults in Canada. Like Alberta, B.C. currently does not have any surgeons who do sex reassignment surgery. But, Dr. Metzger says the province is working on that and he is hopeful there will be one surgeon doing sex reassignment surgeries in B.C. within a few years.
While many people, under and over 18, who identify as transgender still face serious obstacles and discrimination there is hope among experts and advocates that access to health care and acceptance of the trans community will continue to flourish in Canada and elsewhere.