Toronto home to first public hospital in Canada that offers transition-related surgery

Kiera Howe is a patient advisor at Toronto‘s Women’s College Hospital (WCH), helping transgender patients through a journey she herself has undergone.

“I started my process four years ago with Women’s College because I’m a patient with the family health practice. I went in there and said I want to start hormones because I’m transgender,” she said.

Then in September 2018, she packed her bags and left the city for surgery.

“I had my surgery in September in Montreal and one of the reasons I had to go to Montreal was because there was no surgical program in Toronto,” she said.

“I thought it was inconvenient, it would have been much better to have the surgery in Toronto and be around my friends and family during recovery and for the eight days after the surgery,” said Howe, who has been able to have her follow-up appointments at WCH.

Last Monday marked the first time vaginoplasty, a surgery that constructs a vagina out of penile tissue for trans patients, had been performed in the province in more than two decades. It also made WCH the first public hospital in the country that offers this type of operation.

“The need for vaginoplasty in Ontario is great, in Toronto specifically great as well,” said Dr. Yonah Krakowsky, urologist and medical lead of the Transition-related Surgery Program at WCH. “We know there are hundreds of people waiting for this surgery.

“Vaginoplasty surgery, for the most part, over the past two decades, hasn’t been available in Ontario. Certainly not through a public academic program,” he added.

Krakowsky noted that Toronto is home to world-class institutions performing some of the most complicated surgeries in the world, but medically necessary vaginoplasty was not one of them.

“It really took an institution, Women’s College here, saying this is an important need in health care, there’s a large gap that needs to be bridged and we have the motivation to make the infrastructure possible,” said Krakowsky.

Transition-related surgery was excluded from Ontario Health Insurance Plan (OHIP) coverage in 1998 and it was not until 2008 that select procedures were made eligible under the plan.

Then, in March 2016, OHIP changed the funding criteria for transition-related surgery to align with internationally accepted standards of care for Gender Dysphoria. The change expanded the list of health-care providers who can provide surgical eligibility assessments.

Two years later, WCH established its Transition-Related Surgery (TRS) Program. And by June 2019, the WCH TRS Program began offering vaginoplasty.

Jack Woodman, Chief Strategy and Quality Officer at WCH, spearheaded the effort to have gender reassignment surgeries available at the hospital.

“I have been honestly beaming with pride that this happened at my organization,” said Woodman, who participated, along with the WCH team, in Toronto Pride’s Trans March.

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“This kind of surgery is really, medically necessary because it comes from a diagnosis of gender dysphoria,” explained Woodman. “Different individuals have different levels of gender dysphoria and, depending what it is, some folks may need surgery.. and some folks may not want surgery at all.”

Woodman said there are hundreds of trans patients who have received approvals for surgeries, but they were not able to have them in Ontario.

For Woodman, that “was a real gap in care.”

Howe has recovered physically from the surgery.

“This is huge. This is sort of really setting my body in the way I feel it should look and the way it should feel,” she said.

Howe now spends her time helping to advise and guide others through the process in a program that aims to become a model for other provinces in Canada.