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Five ways to improve Canadian trans healthcare

The Ontario government is making great strides, but can do more

The Ontario government announced increased access for trans people seeking certain types of gender reassignment surgeries on Friday, Nov 6, 2015.

While removing the bottleneck at the Centre for Addiction and Mental Health — currently the only place where Ontarians can receive an initial assessment when requesting  approval for publicly-funded surgery — will be a welcome change, it doesn’t solve all of the medical needs of trans people in Ontario.

To learn more about what the Ontario government could be doing to provide better healthcare for trans Ontarians, Daily Xtra spoke to Dr Greta Bauer, an associate professor in epidemiology and biostatistics at Western University and the former co-principal investigator for the Trans PULSE Project. Here are a handful of other issues that the Ontario government should tackle in order to make the health care system more trans-friendly.

Improving access to surgeries

While Friday’s announcement is likely to reduce wait-times for trans people, the fact remains that only one Montreal surgeon is able to perform a complete range of gender-confirming surgeries in all of Canada.

This forces many trans people to go abroad and pay out of their own pockets in order to avoid overly long wait times.

“It presents problems in aftercare because people return, they have surgical complications and they’re having them far away from their original surgeon,” Bauer says.

And while other, less complex surgeries are commonly performed in Ontario, there can occasionally be problems with the Ontario Health Insurance Plan that can limit access for some patients.

“There’s been a bit of a bottleneck with regard to OHIP payment for chest surgery,” she says. “The billing is put through for mastectomy, but the actual surgery that trans men need isn’t just mastectomy, it’s chest construction and contouring. So at the clinic in Montreal, they offer all of that under the billing of mastectomy, but not all doctors will do that. That’s a technical thing that could be worked out.”

Mental health for trans people

According to research done by the Trans PULSE Project, trans people are at extreme risk of suicide. The study found that in a one-year period, around 35 percent of trans Ontarians have seriously considered suicide, while 11 percent have attempted suicide.

“I don’t think the province is doing a great job with mental healthcare generally speaking,” Bauer says. “And then that becomes exasperated when you have a population that has some serious service needs and time-sensitive service needs.”

While access to medical transition can help reduce the prevalence of suicidal thoughts among trans people, better mental healthcare is sorely needed, especially for people who are waiting to start hormone therapies or get surgery.

Getting better statistics

Despite the shockingly high rates of suicidal thoughts and suicide attempts within Ontario’s trans community, there isn’t any real idea of how many trans people are taking their own lives, because trans people aren’t identified as trans in death certificates.

Bauer says that while there are some groups in the US and Canada pushing for better numbers, it’s unlikely we’ll ever have the whole picture.

“You’re not going to necessarily know for someone who chooses that route over transition, they may not have told anybody,” she says. “We’re never going to have perfect measures on completed suicides.”

Education for healthcare professionals

As part of Friday’s announcement, Minister of Health Eric Hoskins pledged additional funding to Rainbow Health Ontario, an initiative from Toronto’s Sherbourne Health Centre which helps train medical professionals in providing care to trans people. Over 600 people have been trained so far.

“That’s been great, and so far there’s been enough people who have been interested in this kind of work who feel that they could use more information, but ultimately of course this is something that should be included in curricula as part of core medical training,” Bauer says.

And if more general practitioners had the cultural competency to help treat trans individuals, that could also help reduce wait times for trans patients, since they wouldn’t have to rely on specialists such as endocrinologists.

Puberty suppression

Increasingly, trans children are coming out at younger ages, but the services to support them aren’t always adequate.

“For the kids who need it, we need to make sure that there’s access to puberty suppression and hormone treatment, because puberty can be a pretty traumatic time for some trans kids.

According to Bauer, there are three cities with major centres where trans children can go to receive puberty suppression: Toronto, Ottawa and St Catharines.

“But it’s something that all the paediatric endocrine clinics need to be able to do,” she says. 

(Editor’s note: An earlier version of this story misspelled St Catharines.)