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Canada’s SRS mishmash

Until sex reassignment surgery (SRS) is rolled out in Ontario, the province will remain the biggest jurisdiction in Canada that doesn’t cover it as part of its provincial healthcare.

For trans women surgery is covered in British Columbia, Alberta, Saskatchewan, Manitoba, Quebec and Newfoundland. However in two of those provinces there are stinging caveats.

In Manitoba only 60 percent of SRS expenses are covered and trans people have to front the costs themselves and get a partial refund. That tally can run more than $20,000. Quebec covers the surgery only if it is performed at a public hospital, effectively shutting Quebeckers out of one of the continent’s best clinics, located in Montreal.

For trans men only Alberta has comprehensive coverage. That’s because BC, Saskatchewan and Quebec only provide surgeries that are not trans-exclusive. So removing the breasts and uterus (mastectomy and hysterectomy) are covered, but phalloplasty — deemed experimental — isn’t covered except in Alberta.

British Columbia may have the cruelest asterisk on its promise of SRS. There, space in operating rooms has reached a crisis point. Despite training a Vancouver doctor, Cameron Bowman, the province won’t allocate time in the operating room for SRS surgery. After finishing his training in 2006 he has yet to be allowed to perform SRS in Vancouver. He now has 150 referrals but no way to operate on them.

“This surgery is requested more here than anywhere else” in Canada, says Bowman. He says that it’s obvious from the length of his waiting list that the demand for SRS overwhelms its availability.

Applying for SRS in all provinces is complicated. The process requires getting referrals from gender identity disorder-certified doctors. In all provinces that have a consistent policy, trans people seeking surgery must also pass the so-called “real life test,” which involves living full-time as the gender patients are transitioning to.

Mercedes Allen has written extensively on the differing provincial health models. She says that Alberta tops the list when it comes to coverage. The province has one of the most comprehensive plans for trans women — including voice therapy — and it’s one of the only provinces to cover trans men’s surgery (mastectomy, hysterectomy and phalloplasty or metoidioplasty).

There’s still more that can and should be covered in Alberta, says Allen, including offering trans women breast augmentation, face feminization and facial hair removal. Still, the Alberta system could be used as a model for Ontario.

“In terms of access I think Alberta does considerably better” than most, says Allen. “We have a gender clinic located in Edmonton and we have certified doctors who work outside of that clinic. That part works. It’s not so much gatekeepered. It’s not brokered by one entity.”

But with waiting lists clocking in at 12 months for a first assessment, getting access to the trans surgery in Alberta is still a lot of work, she says.

With movement in Ontario, activists in provinces where the surgery is not covered (Nova Scotia, New Brunswick, PEI and for the time being Ontario) are demanding that their provinces step up to the plate.

Kevin Kindred is the head of the Nova Scotia Rainbow Action Project (NSRAP).

“NSRAP has always been of the view that funding of SRS is both responsible healthcare policy and an important part of full equality for transgendered Nova Scotians,” he says. “We continue to work with the province’s medical community to address this issue, and are encouraged to see these developments in Ontario.”

Trans activists, including Allen, say the territories “tend to be completely unaware of trans issues.”