Trans* healthcare in Canada is difficult to navigate. Despite having a universal healthcare system, the types of medical treatments available to transgender people across the country are far from universal.
In British Columbia (my province of residence), the differences between what types of gender confirmation surgeries—legally called sex reassignment surgery—accessible to trans women and trans men is downright discriminatory.
If I wanted to have bottom surgery, I would have to win—what I consider to be—some magical lottery. However, the same barriers do not exist if I were a trans women.
Trans men in British Columbia have had a long fight in order to gain the rights to access medically necessary surgeries.
It wasn’t until 2010, that MSP agreed to pay for chest contouring surgeries for trans men. Prior to 2010, trans men would either have to live with shapeless and nipple-less chests, or they would have to pay a minimum of $2000 in a private clinic. The thinking was, having a proper male-looking chest was cosmetic.
When MSP decided they would pay for this procedure, they eliminated the ability to receive treatment through a private clinic. But to make this even more complicated, prior to 2010, MSP would pay for the mastectomy—minus chest contouring—only if done in a public hospital. The problem: Only private clinics in B.C. performed this surgery as a gender confirmation procedure.
Have breast cancer? Yes, we can treat that in a hospital! Are you a trans man who needs top surgery? Sorry, we won’t do that in a hospital, even though the procedure is the same. This also changed in 2010, when Vancouver Public Health was directed to make operating rooms in the Lower Mainland available for this procedure. However, need top surgery because you’re transgender? You must go through a horrible approval process! Need breast reduction to treat gynecomastia? No problem! Are you trans man, don’t want to go through the approval process, deciding to go the private clinic route once available to you? Sorry, the province will no longer allow that ever since they decided to pay for the procedure. It’s downright discriminatory.
Trans women never had any such restrictions when going for top surgery.
In 2010, trans men could now get mastectomy and contouring, hysterectomy, oophorectomy, and vaginectomy, but still no phalloplasty. Since B.C. re-instated coverage in 1993, trans women have had access to breast implants if no growth occurred after two years of hormones, penectomy, orchiectomy, and vaginoplasty.
Last year, B.C. decided to open the door a little bit more for trans men. And, I really do mean little. People around the country applauded when it was announced that BC MSP would now pay for trans men to have phalloplasty, if they are capable of paying the travel to and from Montreal, accommodations, and all other necessary expenses, minus the cost of surgery.
The rub: MSP will only pay for 25 surgeries over five years, equaling five surgeries per year. After 2018, the program may end upon review. Currently, there are over 50 trans men waiting for this surgery. Those men are at the mercy of a review panel who will decide who is more deserving of this treatment.
As I said before: It’s pretty much a lottery. We have no insight into what criteria is being weighed in order to decide who needs it the most.
Trans women have no such barriers.
There are barriers in B.C. that both sides share:
If you want top surgery:
If you want bottom surgery:
The assessment process is rather intrusive, despite the new standard of care,with a medical review board gaining access to personal healthcare records. This, in and of itself, is also a barrier for both trans men and trans women, as they don’t want their personal lives opened up for review. Also, part of the assessment process requires that you see a designated assessor:
Out of all the provinces that pay for gender confirmation surgeries, British Columbia is the only province that places limits on trans men for phalloplasties. In their great cis wisdom, policy makers have decided it is too risky—the first excuse was too experimental—to cover it across the board.
With no guarantee that this treatment will be available beyond 2018, many trans men in British Columbia will either be forced to move out of province for treatment, are be forced to pay tens of thousands of dollars out of pocket.
On top of all of this, there are no guarantees that this mighty review panel will approve any surgeries, regardless of your gender identity and expression. So, you may spend years going to the necessary doctors and psychiatrists, only to receive a “no.”
This has got to change.