Ever wondered how long it takes to get gender-affirming surgery in Canada?
According to the country's first study of transgender patients' experiences, some Canadians waited only one month, while others waited nine years.
The new University of British Columbia study surveyed 337 trans patients in BC and across Canada on a wide range of procedures that address gender dysphoria. The results point to some mysterious and frustrating disparities between patients.
All of the respondents had either been assessed for surgery or went under the knife at least once within the last five years. In BC, the median wait time for a surgery assessment was 150 days, compared to 180 days in the rest of Canada. Some waited as little as one day for an assessment, while others in the same province waited five years.
Elizabeth Saewyc, one of the lead authors on the study, told VICE the time it takes to see a surgeon can vary based on a few factors. One barrier is a simple "capacity issue" that can only be solved with more surgeons and specialists in the field.
For "bottom" surgeries like vaginoplasty and phalloplasty, Canadians are pretty much limited to booking one Montreal clinic, says Saewyc. According to an announcement from Ontario's ministry of health this summer, the province will be opening a similar surgical ward in 2018.
The survey found most patients traveled more than two hours for surgery. Patients who traveled long distances self-reported more complications than those who accessed surgery at home.
But Saewyc said the wait time disparity before surgery approval isn't about travel or the number of surgeons.* It has to do with the different levels of training among family doctors and other frontline health staff.
Patients, particularly in rural areas according to Saewyc, may be accessing outdated information, and may have a GP who "has no clue where to start." This adds to a "lack of clarity in the pathway" that slows down trans patients seeking surgery.
To further explain the timing difference, Saewyc pointed to recent advances in the way patients are approved for gender-affirming therapies. Saewyc says experiences of arbitrary "gatekeeping" have been reduced as new policies around informed consent come into force. Those who had assessments and surgeries more recently probably had an easier time because five years actually make a huge difference.
"It's important to remember that Trans Care BC only got started as a provincial service at the end of 2015," she told VICE. Since then, the number of people trained to assess surgery eligibility in BC has grown from 14 to 26.
The findings paint a picture of a medical field undergoing some growing pains, and offers an interesting demographic snapshot that raises some concerning questions.
For one, the vast majority of participants (we're talking 80 percent here) were white. Ten percent identified as "multi-ethnic" and four percent as Aboriginal.
Saewyc told VICE it's hard to know exactly what variables led to that result. "Perhaps white trans people have better access, or don't encounter the same barriers, or it may just be a matter of who is willing to participate in the survey."
Two-thirds of the patients made less than $60,000 a year, and most relied on government health plans to pay for procedures. Ages ranged from 18 to 69, though the average patient was in their mid-30s.
Saewyc said it's significant that 12 percent of participants identified as non-binary. It's relatively new for clinicians to recognize a need for surgery in patients who are neither masculine or feminine identifying.
Finally, only nine percent of those surveyed lived in small towns, something Saewyc hopes is a focus of future study along with "ethno-cultural" barriers. "We need to focus on groups underrepresented in our research, and that would include transgender people in rural areas," she told VICE.
Though the UBC study is a first of its kind, and will likely be repeated in a few years, Saewyc says there will always be room to ask more questions.
"We need further research to understand the experiences of trans people of colour and Indigenous and two-spirit people seeking these surgeries, to understand what the barriers are."
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*Updated October 19, 12:45 PM.