Wait lists: Barriers to Trans Healthcare

Zack Marshall calls for comprehensive strategies to address long wait lists and other barriers to the provision and use of trans healthcare services.

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Over the past few years, trans people have become increasingly visible in mainstream media. Most recently, we have heard about the controversy surrounding trans people’s abilities to safely access public bathrooms. In film, we saw Eddie Redmayne nominated for an Oscar for his portrayal of Lili Elbe, a trans woman who received gender affirmation surgery in the 1930’s. We have Sophia in Orange Is the New Black and Nomi in Sense8, both of whom are trans women acting on television. Benjamin Melzer recently became the first trans cover model for Men’s Health. This increased visibility of trans people in mainstream culture likely coincides with increasing numbers of trans people attempting to access healthcare services.

The term trans or trans* is an umbrella term used to refer to people who do not identify with the gender they were labelled at birth. This umbrella term includes identities such as transgender, genderqueer, or gender non-binary, as well as terms that may be associated with more medicalized histories such as transsexual or people diagnosed with gender dysphoria.

Despite increased visibility in the media, trans people continue to face multiple barriers to accessing health services. There are many reasons trans people may need to interact with health care systems. Trans people, like any others, need to see physicians or specialists in relation to health promotion. Trans people may also need to access specific services related to gender affirmation such as hormone therapy or surgeries.

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For trans people seeking access to medical transition, current Standards of Care from the World Professional Association of Transgender Health require interactions with health and mental health professionals. Despite international standards, each province in Canada has its own requirements for trans people attempting to access medical transition. A 2015 study by The United Food and Commercial Workers Canada and the Canadian Professional Association for Transgender Health highlights the differences across provinces with some providing comprehensive coverage and others providing none at all.

In addition to differences in coverage, provinces and territories in Canada have divergent approaches to the ways that they organize health services for trans people. For example, adults in Nunavut, and North West Territories wishing to access medical transition are currently out of luck. Transition-related medical care costs are not covered in the territories. In June 2016, New Brunswick became the last province to commit to funding gender affirming procedures. Trans people from Newfoundland and Labrador must be assessed for surgeries at the Gender Identity Clinic at the Centre for Addiction and Mental Health in Toronto.

Each province typically has one or two clinics that provide assessment and approval services for trans people seeking medical transition. This has led to a severe bottleneck, one which providers are often afraid to discuss. For example, the current wait list for patients from Newfoundland and Labrador to be assessed at the Centre for Addiction and Mental Health in Toronto is two years. Long wait lists have prompted some patients to consider travelling abroad in order to access surgery. Providers are hesitant to discuss these wait lists, in part, because of the potential impact on patients’ mental health. Policy makers are also concerned that addressing backlogs in assessment clinics will shift wait lists from assessments to surgical teams.

If there are not enough surgeons trained to provide gender affirming surgeries, and/or those surgeons cannot obtain access to operating room time in local hospitals, then we are simply moving the problem from one administrative arena to another. We have seen attention to this issue recently in British Columbia, where an online petition highlights the situation facing hundreds of transgender people in British Columbia currently on wait lists for gender affirming health care.

The implications of these wait lists are that people take their healthcare into their own hands through private fundraising. Perhaps you have seen posts on Facebook or other social media asking you to help raise funds for trans-related surgeries?

How could we improve the current system? One option is to develop specialized trans-focused health care services in urban and rural centres in each province. These services would need to include multiple access points and must be organized to effectively manage and reduce wait lists. Recent announcements in British Columbia and Ontario, suggest positive steps in this direction.

We also need to provide appropriate training and mentorship to prepare trans-knowledgeable healthcare workers. More broadly, we need to collaborate with trans communities to develop local visions for trans healthcare that centre on the experiences of trans and gender non-binary people and their families.

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Zack Marshall is a PhD Candidate in the Division of Community Health & Humanities at Memorial University, and a Lecturer at Renison University College, affiliated with the University of Waterloo. @isthatethical