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Gender-Affirming Healthcare Must be Made Accessible

In March of this year, the Yukon government passed a gender-affirming healthcare policy considered the “gold standard” for healthcare legislation among trans advocates. The policy extends healthcare coverage to include hormone replacement therapy (HRT), facial feminization surgery (FFS), and voice training, among other gender-affirming procedures. This breadth of coverage is unprecedented in Canada, and although advocates have called for similar policies to be established nationwide, other provinces fall far behind. 

Despite transition-related healthcare – including feminization and masculinization surgeries – being deemed medically necessary under international guidelines, many provinces restrict healthcare coverage to only include bottom surgery and HRT. In Quebec, procedures such as FFS and breast augmentations are considered “esthetic care” and thus are not covered by the Régie de l’assurance maladie du Québec (RAMQ). Furthermore, the procedures that are covered are only available to Quebec residents: this excludes refugees, recent immigrants, and out-of-province residents from receiving necessary care.

Even Quebec residents have difficulty accessing the bare minimum of gender-affirming care: bureaucratic opacity and long wait lists often lead to trans people paying out-of-pocket to receive necessary care at private clinics. For one, the copious paperwork required for gender-affirming procedures is notoriously hard to navigate; healthcare providers themselves struggle with the paperwork so much that they are often unable to assist patients with referrals and completing the forms required to begin HRT. This means that  patients often rely on other trans people who have successfully completed the paperwork to walk them through the process, rather than being helped by healthcare officials. Applying for HRT also requires evaluation from a psychiatrist or clinical psychologist, but Quebec’s 20,000 person waitlist for mental health services poses a significant barrier to accomplishing this first step towards HRT approval. Additionally, there are significant financial hurdles to accessing mental health services: at the Human Sexuality Unit of Montreal General Hospital, therapy costs upwards of $200 a month, none of which is covered by RAMQ. Given these bureaucratic and financial factors, individuals seeking HRT often have to wait one to three years to be approved for treatment, according to Action santé travesti(e)s & transsexuel(le)s du Québec (ASTT(e)Q)

While McGill boasts of their LGBTQ-inclusive medical services, students also face barriers to getting care at the Wellness Hub. Counselling services at the Hub are known to have long wait lists, and this wait time is exacerbated by requesting an LGBTQ professional. Students have encountered problems with psychiatric care too: one student claimed that his psychiatrist at the Hub “gave him false information on where he could receive an HRT prescription and failed to complete a referral request.” Prolonging the wait for HRT and mental health services is dangerous for trans people: a study published in BMC Psychiatry found that barriers to gender-affirming care are associated with higher rates of suicide. As such, it is crucial for trans people to have easily-accessible gender-affirming services, both within and outside of the university.

Besides the wait times and financial burden associated with gender-affirming care, many trans and non-binary people have experienced discrimination and hostility under the care of mental health professionals. Quebec follows the transmedicalist model of gender-affirming care, requiring a diagnosis of gender dysphoria to undergo gender-affirming procedures. This is an outdated philosophy that subjects trans people to distressing psychological evaluations and excludes those who do not experience symptoms of gender dysphoria. At the Human Sexuality Unit, this means that trans people must “[answer] a host of personal questions […] in front of a panel of up to nine people affiliated with the clinic.” Rather than developing an informed consent model for gender-affirming care – under which doctors would educate patients about their desired procedures and give them bodily autonomy – the Quebec government is imposing a system where psychological distress secures necessary care for trans people. 

Gender-affirming care is critical to the wellbeing of trans people – healthcare coverage should reflect that. Quebec needs to adopt a model of care that promotes the wellbeing of trans people by providing them with easily-accessible mental health services and gender-affirming procedures. Healthcare professionals should receive training on trans-sensitive care and be aware of which gender-affirming procedures they are licensed to perform in order to reduce transphobia in medicine. McGill University needs to acknowledge and eliminate the barriers that students face while accessing healthcare.

To advocate for trans rights, support groups like ASTT(e)Q and Egale Canada by  donating or volunteering. Queer people can also volunteer for the Queer Autonomous Patients Front, which accompanies people to their healthcare appointments.

If you are seeking gender-affirming care, reach out to the Union for Gender Empowerment at McGill or the Centre for Gender Advocacy at Concordia – these organizations can direct you to the appropriate services. Additionally, the Centre for Gender Advocacy has crowdsourced a map that catalogues which Montreal clinics have a history of discriminating against trans people. You can also consult ASTT(e)Q’s Trans Health Survival Tool, which includes information on where to receive HRT, gender-affirming surgery, and how to legally change your name and sex designation.