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

Trans people have had better health care in the last two decades, but there has been little progress despite increased demand.

Publishing date:

Nov 28, 2022  •  13 hours ago  •  4 minute read

Following the Club Q shooting in Colorado Springs, many people attend a candlelight ceremony at the Human Rights Monument in Ottawa. Fae Johnstone (below), who advocates for the rights of transgender persons to receive health care, says that ‘Particularity of the problem…is the stigmatization and misinformation surrounding the care for transgender people. Photo by Julie Oliver/POSTMEDIA Centretown Community Health Centre ended the waitlist for its Transgender Health Program. It provides gender-affirming care to transgender and gender-diverse persons in 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.

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.

These issues aren’t all on the current provincial government but are longstanding issues in our health-care system going back decades. Trans people have had their health care improved in the last two decades, but the rate of progress has stagnated despite increased demand over the past ten years. This is due to greater social acceptance.

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 healthcare has been in this state of crisis since its inception. It is desperately trying to survive in an underfunded system that literally saves lives.

Gender-affirming healthcare is not without its problems. This is due to the misinformation and stigma surrounding transgender health care. Anti-trans groups are pushing for restrictions on access to gender affirming health care in the United States, United Kingdom, and Canada. It is also possible that the topic can become contentious for political parties supported in conservative social spaces.

But health care shouldn’t be politicized; it should be based on medical evidence. What evidence does this show us about gender-affirming healthcare? It shows that this care can improve mental health and overall well-being. In fact, transition-related surgeries have a lower “regret rate” than almost every other major surgical intervention. In a survey conducted over 50 years and involving 767 Swedish transgender people, only two percent expressed regret following gender-affirming surgeries. The regret rates for gender-affirming surgery are much lower than the 20 percent regret rate for prostate surgery and the 13 percent regret rate for cancer treatment.

Major medical associations in the U.S. also support gender-affirming healthcare. To ensure everyone has access the health services they require, it is important to increase coverage and access to gender-affirming healthcare 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. Kristyn Wong Tam, NDP MP, introduced the Gender Affirming Health Care Advisory Committee Act. This would set off a review and report to improve gender-affirming healthcare in our province.

Ford should support increasing access to health care that is gender-affirming for transgender Ontarians at the best possible time. I invite the premier of Ontario and the government of Ontario to support this bill. Trans people can live in any part of Ontario. Trans people are part of every population 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 only hope it will forget politics and be on the right side in history.

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

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