Toronto hospital to become second in Canada offering genital-reconstruction surgery

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A Toronto hospital is set to become just the second place in Canada to offer genital-reconstruction surgery, a move that comes amid growing demand from trans people across the country for sex-reassignment operations.

Ontario Health Minister Eric Hoskins announced Thursday that his government plans to expand access to so-called top surgeries such as mastectomies and breast augmentations and to start providing bottom surgeries through Women's College Hospital next year.

Offering genital reconstruction in Canada's largest city is expected to alleviate some of the backlog at the private Montreal clinic that is currently the only place in the country offering vaginoplasties and phalloplasties, complex procedures performed by relatively few surgeons around the world.

"There's been exponential growth in need for access to these services in the past several years," said Cheryl Woodman, the chief of strategy and quality at Women's College Hospital.

"The [demand] has just increased to the point where the two surgeons in Montreal are not able to see all of the patients that need to be seen."

In Ontario alone, the province's public health insurance plan covered 203 transition-related surgeries – also known as gender-confirming surgeries – in the 2016-17 fiscal year, up from 158 and 154 in the two previous years.

A constellation of social and practical changes is behind the soaring demand, Woodman said. People feel safer coming out as "non-binary, gender diverse or trans" now than in the past, she said.

"And social media has made communities all over the world really more accessible so there's opportunities to connect with peers and feel supported."

In Ontario, a recent regulatory change has also ushered more trans people into the pipeline for surgery.

The Ontario Health Insurance Plan used to cover sex-reassignment surgeries only for trans people who were first assessed at a single overburdened clinic at the Centre for Addiction and Mental Health (CAMH) in Toronto.

But last March, the provincial government altered the regulation so that qualified health-care workers anywhere in the province could do the assessment, which is based on criteria from the World Professional Association for Transgender Health (WPATH) – the same standards CAMH uses to determine if a trans patient qualifies for OHIP-funded surgery.

(The WPATH standards vary depending on the surgery, but they include a persistent, well-documented diagnosis of gender dysphoria, that the patient be in good mental and physical health and, in some cases, that he or she take hormones and live as their desired gender for a year.)

CAMH's waiting list has since been cut in half, from 1,516 before the regulatory change to 761 now, a CAMH spokesman said. The waiting time for an assessment has dropped to 20 months from 30.

Woodman said Toronto's trans health community, including leaders at CAMH and Rainbow Health Ontario, an LGBTQ program that trained nearly 300 health-care providers across the province to conduct the referrals, anticipated that as the bottleneck cleared at CAMH, it would move to the surgical procedures themselves.

That is why Women's College, which already performs some gender-confirming day surgeries such as mastectomies, hysterectomies and orchiectomies (removal of the testicles,) began scouring the globe for a specialist in bottom surgeries.

Woodman said the hospital is close to reaching an agreement with a surgeon who she hopes will begin performing the surgeries in Toronto next year for patients across the country.