A recent policy statement provided an excellent description of the barriers to medical transition faced by Two-Spirit, trans, non-binary and gender-diverse people (TTNB). Up-front costs, wait times and a lack of access to qualified doctors are just a few examples of these barriers to vitally important medical care for TTNB people.
As a transmasculine non-binary person, I have personally confronted several of these obstacles during my medical transition.
One such barrier was related to my prior approval request for a phalloplasty funded by the Ontario Health Insurance Plan (OHIP). This gender-affirming surgery is only funded by OHIP if prior approval has been granted.
My request was approved with the condition that the phalloplasty be accompanied by a vaginectomy. And before a vaginectomy can be performed, a hysterectomy is medically required.
I was shocked and enraged, because neither a hysterectomy nor a vaginectomy are medically necessary prerequisites for a phalloplasty, and—furthermore—I had no desire whatsoever to subject myself to these additional procedures.
This left me with the choice of either undergoing unwanted and medically unnecessary surgeries in order to receive funding for my phalloplasty, or continuing to live with gender dysphoria that could only be treated by a phalloplasty.
Over several months, I tried as hard as I could to explain to OHIP that this decision was discriminatory and in violation of my human rights, in addition to forcing infertility upon me. Unfortunately, I was unsuccessful. My appeals to reason weren't enough, and I realized that I was going to have to fight. I went to the Health Services Appeal and Review Board to have the decision appealed.
The appeals process was stressful and very emotionally taxing, but I took comfort in knowing that what I was going through would help others who didn't have the privilege of defending themselves. I did feel privileged, because a trans friend, Frank Nasca, was in their last year of law school and agreed to represent me pro bono.
I kept asking myself how many people before me had agreed to undesired and medically unnecessary surgeries because they didn't have the strength, the courage and the resources to appeal similar decisions. The idea that there were people who had probably undergone medical procedures that they did not want made me feel sick to my stomach, but it also gave me the strength to continue the appeals process and defend myself.
After about a year of this fight, just before my hearing at the review board, OHIP overturned its decision and granted me prior approval for a phalloplasty without an accompanying vaginectomy. This approval was communicated without apology nor explanation.
Worse yet, this decision reversal happened in June 2023 and still today, five months later, the prior approval form remains unchanged. The only surgery options available on the form require an accompanying vaginectomy. I have followed up several times with the OHIP Executive Director and even the Health Minister asking for the form to be changed, but they insist on perpetuating this systemic discrimination. My experience is just one story among many. Like many TTNB people, I am navigating a health care system that was not built to respond to our needs. Whether due to inadequate funding, interminable wait times or coercive and discriminatory policies, our communities do not receive the care they need.
What will happen to the next TTNB person who does not want an accompanying vaginectomy? Will their prior approval be denied? Will they have the energy and the privilege to appeal OHIP's decision? Will they undergo unwanted surgeries in order to receive approval and funding for the surgery they do want?
These questions are part of the many urgent reasons for action in various levels of government to ensure that TTNB people can have safe and easy transitions.
The recommendations in the policy statement are realistic, essential and exactly what TTNB people need for universal transition access. Transitions are not a collection of elective medical procedures—they are a medical necessity that saves lives.
I am calling on all levels of government involved to implement the recommendations presented in the statement as soon as possible.
By Nathaniel Le May