Johnstone: Time to act on gender-affirming health care in Ontario

Health care for trans people has improved in the past two decades but progress has stagnated even as demand has risen.

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In March 2022, Centretown Community Health Centre closed the waitlist for its Transgender Health Program, which provides gender-affirming health care to trans and gender-diverse people across Eastern Ontario. Why? Because the waitlist is more than two years long and there simply isn’t capacity to serve the sheer number of patients walking through the doors.

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The capacity problems at Centretown are indicative of a provincial crisis: transgender people — especially youth —need access to evidence-based and medically necessary gender-affirming health care but meet only barrier after barrier.

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A new private member’s bill, the “Gender Affirming Health Care Advisory Committee Act” introduced on Nov. 16, has the potential to begin addressing the many problems in gender-affirming health care — but it needs Premier Doug Ford’s support to make it through Queen’s Park.

Gender-affirming health care is broadly defined as health and social services to support a transgender person’s transition — including hormone replacement therapy, surgical interventions such as breast removal or genital reconfiguration, and mental-health support. The problems in gender-affirming care in Ontario are undoubtedly complex, ranging from medically necessary services still left out of OHIP coverage (such as chest masculinization post-breast removal, facial feminization surgery and surgeries to shave down someone’s Adam’s apple); to chronically underfunded gender-affirming care clinics; to family doctors hesitant to provide services to trans people due to stigma and ignorance.

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These issues aren’t all on the current provincial government but are longstanding issues in our health-care system going back decades. Health care for trans people has undoubtedly improved over the past two decades but progress has stagnated even as demand has risen over the past 10 years due to increasing social acceptance of trans people.

I can’t help but reflect that if any other type of health care — cancer treatment, mental-health interventions, diabetes care — were in the same state as trans health-care is now, with horrendous wait lists, barriers to care and lack of access in rural communities, it would be widely recognized as a source of provincial shame and identified as the crisis that it is. Gender-affirming health care has been in that state of crisis since the day it came into existence: desperately trying to keep afloat an underfunded system that quite literally saves lives.

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Part of the problem facing gender-affirming care is the stigma and misinformation surrounding health care for transgender people. In the United States and United Kingdom, and here in Canada too, there are efforts fuelled by anti-trans groups to restrict access to gender-affirming health care, and the topic itself can be contentious for thoe political parties with strong support in social conservative spaces.

But health care shouldn’t be politicized; it should be based on medical evidence. What does the evidence tell us on gender-affirming health care? It proves that this care improves mental health and increases overall wellbeing. In fact, transition-related surgeries have a lower “regret rate” than almost every other major surgical intervention. The results of a 50-year survey published in 2010 of 767 transgender people in Sweden found that only about two per cent of expressed regret after gender-affirming surgery. Compared to a 20 per cent regret rate for prostate surgery or a 13 per cent regret rate for cancer treatments, regret rates for gender-affirming surgeries are extremely low.

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Additionally, major medical associations across the U.S. support the provision of gender-affirming health care. The right thing to do in order to ensure that everyone has access to the health services they need is to improve coverage for and access to gender-affirming health care in our province.

Earlier this month, we marked Transgender Awareness Week — an opportune time for all of us, but especially for elected officials — to reflect on how they can support trans people, advance inclusion and address health inequities impacting this vulnerable community. NDP MPP Kristyn Wong-Tam introduced the Gender Affirming Health Care Advisory Committee Act, which would trigger a review and report on improving gender-affirming health care in our province.

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There is no better moment for Ford to support improving access to gender-affirming health care for transgender Ontarians. My hope and invitation to the premier and the Ontario government is for them to support this bill. Trans people live in every part of Ontario. We are part of every demographic group and every community. Our health care shouldn’t be controversial, but the status quo is unsustainable. This government has an incredible opportunity to improve transgender people’s health and wellbeing. I can only hope it will put politics aside and stand on the right side of history.

Fae Johnstone, MSW, is the Executive Director of Wisdom2Action and a trans and LGBTQ2+ educator and activist in Ottawa.

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