In the recent years, transgender health care in Canada has seen dramatic improvements. More provinces have expanded their public healthcare packages to accommodate gender-affirming surgeries, including FTM/N top surgery or genital reconstruction procedures, for gender dysphoria treatment. However, access and availability of transition-related treatments are still far from reach for most members of the LGBTQ+ community because of the long wait times.
What’s the average waiting time to get a gender-affirming surgery in Canada? The country’s first study on transgender patients’ experiences published in 2017 by researchers from the University of British Columbia revealed it’s anywhere from one month to nine years. The results of the study showed frustrating inconsistencies in trans patients’ experience across the country.
In this article, we break down the study’s key findings to pinpoint where the bottleneck is coming from and what’s causing the delay in delivering life-saving surgical procedures for the Canadian LGBTQ+ population.
The application process towards a gender-affirming surgery in Canada is divided into several steps. The first one is a surgery readiness assessment. Whether you are getting a transition-related operation done from a publicly funded or private clinic, a surgical readiness assessment is required by most surgeons to ensure that a potential patient is prepared and will get the best results post-surgery.
According to Trans Care BC, the primary criteria for most types of gender-affirming surgery in British Columbia are:
Before even receiving a readiness assessment, the individual needs to follow several processes to qualify for one. This can range from:
Getting referred to an assessor through your primary care provider:
Depending on the type of gender-reaffirming surgery, one or two assessments carried out by different assessors may be required. Surgical readiness assessments can be covered if they are qualified assessors working in the publicly-funded health care system. You can also have them conducted by qualified private assessors, such as psychologists or clinical counsellors.
Once you’ve been referred, you have to wait for a schedule for your surgical readiness assessment. The actual appointment lasts between one to two hours, where you’ll discuss your gender identity, medical history, and surgical aftercare plan. In some cases, you may be asked to come back to provide additional information.
Get a recommendation:
The qualified assessor may or may not recommend you for surgery or recommend you return for further assessment. They would send their recommendation directly to your primary care physician, who will send you a referral for surgery.
In British Columbia, most people (60%) easily or very easily got referred to an assessor, and half of these trans people (50%) did not have to spend any money on their assessment appointment(s).
Half (50%) of the respondents in BC waited 150 days or less between the referral and their most recent surgery readiness assessment appointment. This is in contrast to the average of 180 days other patients in the country reported. However, BC’s wait time also had unusual fluctuations, with some people waiting for a single day to as long as 1,825 days or more than five years.
On the other hand, the average wait time between referral and assessment in BC also differed according to the types of gender-affirming surgery planned.
Data suggests that for all types of gender-affirming surgery in Canada, 71% had their surgery paid for, at least partially, through a government health care plan. The vast majority (93%) only had one source of funding. Almost seven out of 10 Canadians had their transition-related surgery funded with a public health plan, and one in three people said they used their own money as their sole source for surgery funding.
Unfortunately, not everyone receives approval for the life-changing surgery they had in mind. Aside from having an existing medical condition that increases the risk of being on general anesthesia, many hopefuls are deemed ineligible due to two primary reasons:
After getting approved for funding, the vast majority of participants (84%) said they did not have any problem getting a referral to a surgeon for gender-affirming surgery. More than half (57%) also said they were able to choose the surgeon they wanted.
The average wait time between getting an approval and surgery date was less than 12 months or less for half of the surgeries in BC. In other parts of Canada, the wait time was eight months or less for half the surgeries.
The researchers said each patient’s experiences were so diverse, with waiting times ranging from a month up to 108 months or nine years. The longest wait times were reported in the following gender-reaffirming surgeries in Canada:
Interestingly, the researchers also noted that 50% of the people taking the survey were currently waiting for their surgery and/or had a scheduled surgery date, and had already been waiting for at least 17 months. Half of the people who were now waiting for surgery but did not have a scheduled surgery date had been waiting 11 months or more when they took the survey.
Elizabeth Saewyc, one of the lead authors on the study, gave VICE a few valid points regarding what her thoughts were on the potential causes of the long waiting process for accessing gender-affirming surgery in Canada.
The long wait times for gender-affirming surgery in Canada have been exacerbated exponentially by the unexpected arrival of the COVID-19 pandemic. Both public and private hospitals and clinics had to cancel scheduled surgeries and other transition-related procedures to adhere to stringent lockdown restrictions placed in different countries worldwide. Currently, we see many health care providers tackling their backlogs with surgeries booked up to 2022.
One of the biggest concerns caused by the long wait times in gender-affirming surgery in Canada would be its detrimental effects on the mental health of the LGBTQ+ population, who are already at an increased risk for:
This is cemented in a quote by N. Nicole Nussbaum, former president of Canadian Professional Association for Transgender Health and staff lawyer at Legal Aid Ontario, “Trans people are at the highest risk of suicide and self-harm between the period that they’ve mentally decided to transition and when they complete their medical transition.”
For inquiries about gender-affirming surgery in Canada or to learn more about what an FTM top surgery at McLean Clinic is like, don’t hesitate to reach out to us. A member of our team will be more than happy to answer your questions.