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Challenges To Receiving Gender-affirming Care In Canada

Wait times and opacity: Problems with Ontario’s current healthcare system in particular have exacerbated its shortcomings for the trans community…

By Warren Urquhart

Today, health care in Canada, especially Ontario, is not in good health. Our healthcare system, which promises (and often delivers) free point-of-service care, has long been a point of pride for Canadians. That pride is falling amid crises ravaging healthcare workers and patients from sea to shining sea. Emergency rooms and ICUs are being closed sporadically – and in the emergency rooms that remain open, patients are experiencing long wait times, and even longer wait times to get admitted to hospital (currently, an average of 20.1 hours).

There is no short-term resolution in sight for these healthcare quakes. And the crisis, like all those that affect the broader population, hits our most vulnerable populations hardest. Gender-affirming health care in Canada (and Ontario in particular) was never perfect – ask a trans person. Trans PULSE Canada, a national community-based survey on the health and well-being of trans and nonbinary people, found that while trans folk have primary healthcare providers at about the same rate as the general population, 45 per cent of trans and nonbinary people had an unmet healthcare need, which is about 41 per cent higher than in the general population.

Things needed to get better before COVID – and instead they got worse. Trans PULSE Canada’s subsequent research found that the pandemic aggravated barriers to healthcare access. The most significant concerns, the study found, appeared to be the rescheduling of surgeries, the unavailability of hormones, and the scarcity of specialist care sometimes required for the provision of gender-affirming services.

Erin Ziegler provides gender-affirming care and also advocates and researches in this area as an assistant professor at the Toronto Metropolitan University’s Daphne Cockwell School for Nursing, and a nurse practitioner at Queen Square Family Health Team. A nationally renowned trans healthcare practitioner and advocate, she knows the challenges facing trans and non-binary folk all too well: “Access to gender-affirming care is still a huge barrier.… [The pandemic] highlighted those existing barriers and existing challenges the trans population was already facing.”

Extended wait times are no strangers to transgender folk. In Ziegler’s practice, she has found that the period in which OHIP approves gender-affirming surgery has gone from six to eight weeks, to around seven to eight months. And Ziegler has to wait until that approval has been received before she can refer her patients to a surgeon, where they will be placed on yet another waitlist.

Ziegler, of course, is an expert on providing gender-affirming care, but the general lack of education in the medical community about transgender health care is another issue. In an interview last year, trans organizer Fae Johnston told CTV News that “most physicians don’t know that [they can prescribe hormones], and don’t feel like they have the knowledge and skills, necessarily, to provide care to trans folks.”

Ziegler echoes that concern: “There’s still not a lot of emphasis on trans health and trans health issues in health curriculum.… Healthcare providers don’t know a lot about it.”

And it certainly doesn’t help when Ontario closes the doors of healthcare providers known for quality gender-affirming care. Brampton-based Wise Elephant Family Health Team, known for its service to the trans and nonbinary community, was closed in 2021 because of a lack of funding from the Ontario government.

Even the journey to the doors (or Zoom waiting room) of a healthcare provider known for providing gender-affirming care can be bumpy. Kaito, 27 (they/them), is a Greater Toronto Area-based trans-masc social worker who has been transitioning for over a year. Kaito self-describes as someone who has been relatively privileged in their transition – but even that privilege couldn’t fill some of the glaring gaps in gender-affirming care. The first barrier Kaito noticed was information: the who, what, where and whens of transgender health care were hard to find for potential patients. Kaito either had trouble finding those resources, or when they did, found they were outdated.

Fortunately, Kaito eventually found great information about gender-affirming health care in Ontario through other trans and nonbinary people. The trans community on Reddit and similar forums pointed Kaito to South River Community Health Centre. Kaito’s experience there has been a positive one – but while the online trans and nonbinary folk provided a wealth of information, that’s no excuse for the lack of “official” sources on gender-affirming care.

That lack of information is a theme: a lack of curriculum for healthcare practitioners to learn about providing care to nonbinary and trans folk, and a lack of information for nonbinary and trans folk themselves to find healthcare practitioners.

We have seen some bright spots when it comes to information: in 2021, Canada became the first country to collect census data on transgender and nonbinary people. But even then, researchers like Ziegler are funding studies out of their own pocket because of the lack of resources available. The aforementioned Trans PULSE Canada provided great insights – but money is needed if we want to see further informative projects in the same vein, and break the opacity surrounding transgender Canadians.

It is important to fix the above problems for transgender and nonbinary Canadians, because they deserve health care just like everyone else. But aside from health care, funding is needed to disseminate information about that health care to those who provide it, research it and receive it. Those in power must act today, even though these problems should have been addressed far before yesterday.

WARREN URQUHART is a soon-to-be consumer protection lawyer finishing up the licensing process in Ontario (none of the opinions expressed represent the views of Warren’s employer). When he’s not writing or working, he’s drinking coffee or lifting weights (sometimes at the same time!).

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