Experts are calling for greater resources for health care for transgender people, no matter which party forms the government after the Oct. 21 election.
Access to certain types of health care, such as hormone treatments and surgeries, can be costly and inconsistent for many transgender people depending on where they live, and experts say the situation requires support at the federal level.
“There’s work to do in every jurisdiction to improve safety for trans people, on education, on gender diversity. An all-hands-on-deck approach is needed,” Lorraine Grieves, program director at TransCare BC, told Global News.
“Certainly any role the federal government could take up in terms of making improvements would be welcomed by all.”
WATCH (Sept. 16, 2019): Transgender care in Alberta at risk after lead of gender program resigns
Health experts define gender-affirming health care as an umbrella category that can include services such as counselling, hormone therapy and surgeries. Trans people may choose to access some or none of these services.
While health-care services are under provincial and territorial jurisdiction, federal parties are making specific promises related to improving health care for transgender and non-binary people.
Two of the main federal parties have included pledges on this in their electoral platforms.
The NDP’s platform, released earlier this year, includes a section entitled “Upholding LGBTQI2S+ rights,” in which the party states that it would work with provinces to ensure equal access to gender-confirming surgery across the country and that these “procedures and medications are covered by public health plans.”
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It also pledges to develop a national action plan to ban conversion therapy for minors in Canada and to work with provinces and territories to support “eliminating this practice in all parts of the country.”
An NDP spokesperson told Global News in an email that the party’s pharmacare plan would include coverage for hormone treatments and blockers, and that “expanded access to mental health care will benefit trans youth in particular, who often lack access to mental health care.”
READ MORE: How a proposed conversion therapy ban and LGBTQ2 issues are mobilizing Canada’s Christian right
The Green Party platform, released on Monday, mirrors the NDP commitments on supporting access to gender-affirming health care and banning conversion therapy. It says that the party would negotiate the Canada Health Accord to expand services including access to gender-affirming health services “such as hormones, blockers and surgery.”
A Green Party spokesperson said the party’s pharmacare plan would cover hormone prescriptions, but did not provide further details.
The Liberals have not yet released their 2019 platform. The government signalled earlier this year that it supports national pharmacare. A Liberal spokesperson did not say whether the party had electoral commitments specifically regarding gender-affirming health care and surgeries, but said via email: “The fight to end discrimination is not over and a lot of hard work still needs to be done — including in the realm of access to health care. Liberals believe Canada’s health care system needs to be sensitive to the needs of all patients.”
The Liberal government also said earlier this year that it wanted to explore criminalizing conversion therapy at the federal level.
A spokesperson for the Conservative Party did not respond to multiple emails from Global News seeking comment on its stance on gender-affirming health care. The party’s 2015 platform did not mention LGBTQ+ health care.
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Wait times
It depends on the location, but wait times for certain types of health care for trans people can vary. For surgery, it’s often the longest. And the state of limbo can be unbearable.
In Saskatchewan, for example, only six doctors are recognized by the province to refer patients for out-of-province gender-affirming surgeries — as of last year, the wait time for one of those physicians was years-long.
Until earlier this year, a private clinic in Montreal was the only place in Canada that offered gender-affirming lower surgery. And while many provinces cover patients travelling to another province for health services, patients are often left to fund their travel and accommodation costs.
In May, the transition-related surgery program opened at Women’s College Hospital in Toronto, the first public hospital in Canada to offer gender-affirming lower surgery. A similar program is expected to launch in Vancouver this fall, for people covered by B.C.’s provincial health plan.
Janet MacBeth, 40, says wait times for surgery and other specialized health care services can have detrimental mental health impacts.
MacBeth came out as transgender in 2017, after her wife became pregnant with their second child. She met with a health-care provider to start transitioning with hormones and was eventually referred to a health centre in Chatham, about two hours from her home.
“It’s still hard for individuals to actually get the initial basic hormones before any surgery,” MacBeth told Global News.
Her medical benefits plan through work covered the prescriptions, otherwise she would have had to pay out of pocket because they are not covered by the province.
READ MORE: Toronto home to first public hospital in Canada that offers transition-related surgery
MacBeth had planned to undergo vaginoplasty surgery at the Montreal clinic, which was still the only place to get it in Canada, but a spot opened up for the procedure at Toronto’s Women’s College Hospital. This would mean that she wouldn’t have to travel so far and would be closer to the facility for follow-up appointments.
A 2017 survey of 337 trans and non-binary people in British Columbia conducted by UBC who had undergone assessment or surgery in the last five years touched on the scope of this.
“Even when their surgery was covered, most people still had to cover a number of costs out of pocket, including travel costs, accommodation, aftercare facilities, and aftercare supplies,” the survey states.
Some people reported spending none of their own money while some people reported paying as much as $58,000.
The survey also found that some people in B.C. waited for as little as one day and as long as 1,825 days for an initial referral and assessment. Wait times for surgery ranged from one month to 108 months. More than 60 per cent of the respondents had to travel two hours or more for their surgery appointments.
In May, MacBeth became one of the first patients to undergo the surgery there. “I just feel so much better,” she said. “My life is better.”
The demand for the surgeries in Toronto alone is high. “We know there are hundreds of people waiting,” the program’s lead Dr. Yonah Krakowsky told Global News in June.
READ MORE: Head of program’s resignation raises questions about accessibility to transgender care in Alberta
Primary care
Hélène Frohard-Dourlent, a researcher in sexual orientation and gender identity at the University of British Colombia, said that the federal government could also encourage more consistency when it comes to primary care.
A 2019 study based on a survey of the experiences of trans people in primary care in the Canadian Family Physician journal found that participants reported that physician knowledge of trans identities and health care needs was lacking.
“Physicians had limited understanding of appropriate interactions with trans patients, including correct use of gender pronouns,” the authors wrote.
Frohard-Dourlent, who uses they/them pronouns, told Global News that it is important to discuss primary care for trans people in addition to things like hormone treatment and surgeries.
“Trans people are people who have specialized health care needs in some areas. But they also just need good access to good primary care just like any other Canadian,” Frohard-Dourlent said. “I would love to see a specific mandate rate for provincial health authorities to make sure that the people that they’re accrediting have some competence in this area.”
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