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Surgery wait lists for gender-affirming care still too long: UBC study

Lower body surgery for trans people only available in Montreal and U.S.

The Trans Pride flag flies outside Vancouver City Hall .

Emily Jackson / Metro

The Trans Pride flag flies outside Vancouver City Hall .

Waking up in a body that doesn’t match your mind is a reality many transgender people across Canada face everyday and access to the surgery required to treat this condition can be expensive and complicated, according to a new UBC study.

The study is the first in Canada to look into transgender patients’ experiences when seeking gender-affirming care. Researchers surveyed 337 transgender Canadians and found 60 per cent of participants had to travel two or more hours for the surgery. Some travel to the United States for the surgery and others travel to Montreal, home to the only surgical centre in Canada that performs lower body surgeries like phalloplasty and vaginoplasty.

“These surgeries are medically necessary – they should be processes that are as readily available as hip replacement surgery or bypass surgery,” said Dr. Elizabeth Saewyc, principle investigator on the study and executive director of UBC’s Stigma and Resilience among Vulnerable Youth Centre.

Long wait times for medically necessary surgeries can cause acute distress for some people suffering from gender dysphoria, where people’s internal sense of gender does not align with their gender assigned at birth, said Saewyc.

“That kind of distress can create challenges for people including significant mental health challenges. We found that people who experience extreme gender dysphoria can become suicidal, especially if there are really long and difficult waits to get surgeries to change parts of their bodies to align with their gender.”

In addition, travel costs for the surgery are not covered by the province’s healthcare plan, said Saewyc.

Trans Care BC, a program that oversees gender-affirming healthcare in B.C., says it is working on creating a surgical centre for lower-body operations in the province.

“We know that there is a real want to have all [gender-affirming] surgeries happening in the province of B.C. but the solution to do that is complex and probably many years away still,” said program director Lorraine Grieves.

While there is no legislative reason why the centre cannot operate in B.C., it takes time to train enough surgeons to perform the complicated procedures, she said.

But even finding a healthcare professional trained to conduct a surgery assessment, a prerequisite to gender-affirming surgery, can be difficult, said Saewyc.

Researchers found that 40 per cent of participants in B.C. had trouble finding an assessor and wait times of five months to a year were common.

Trans Care BC has been training healthcare professionals across the province this year to increase the number of assessors in communities, said Grieves. In addition, the centre has set up a hotline for trans people, loved ones, or healthcare providers who are looking for guidance about gender-affirming care.

But despite these improvements, people seeking gender-affirming surgery still face challenges finding the care they need, said Saewyc.

“I think there is still along way to go,” she said.

“We need to do more to actually ensure people have reasonable access to care and that care is effective, gender affirming, that they have truly informed consent and they get the care in a timely manner.”

The UBC study was co-authored by Helene Frohard-Dourlent, a postdoctoral fellow at UBC and was funded by the Trans Care BC.

Trans Care BC


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