James Gardner is a much happier man after undergoing the first of three gender-affirmation surgeries paid for by the province.
His procedure was one of an estimated 20 phalloplasty surgeries funded through the sa国际传媒 Medical Services Plan since 2015. The complex surgery, which creates a functioning penis out of tissue from other parts of the body for people transitioning from female to male, was deemed 鈥渆xperimental鈥� by the ministry between 2003 and 2012.
鈥淢ost of us didn鈥檛 think we鈥檇 ever get it or have to wait up to 10 years,鈥� said Gardner, a 58-year-old Victoria broadcaster. He underwent a radial forearm phalloplasty that involved extensive grafting of skin, arteries and nerves from his left forearm and expects to undergo the second part of the three-phase process this spring.
Gardner has yet to regain feeling in his arm, but said it has been worth it because he feels so much lighter, so much better.
鈥淣ot all trans men want these surgeries for various reasons and don鈥檛 feel they need them to be a man,鈥� he said. 鈥淥thers like me require these surgeries to feel 鈥榤ore congruent with our bodies.鈥欌��
He got MSP approval for the phalloplasty in early 2015, and that May travelled to the Montreal clinic where most surgery for sa国际传媒 residents is performed. On Sept. 26, 2016, he underwent six hours of surgery.
鈥淚t is very invasive,鈥� he acknowledged, adding he needed three months off work to recuperate. 鈥淵ou have to have a lot of courage going into it, because it鈥檚 not a lot of fun.鈥�
Not every transgender person 鈥� whose biological sex does not match their gender identity 鈥� chooses to have surgery. sa国际传媒 covers gender reassignment surgeries for those who want to alter their anatomy to match their gender identity.
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The province reversed its ban on funding phalloplasty in 2012, but it was four years before anyone received the surgery. In 2014, health officials maintained that no one had come forward 鈥� a view at odds with a waiting list estimated at 100 people desperate for the life-changing surgery.
At the time, funded female-to-male surgeries were limited to five a year, even though male-to-female gender surgery has long been funded by MSP in substantial numbers.
The most recent figures show there were 115 lower-body surgeries for all transgender patients in 2015-16: 105 to create female genitalia and 10 to create male genitalia. From April 1 to Sept. 30, 2016, the most recent period for which figures are available, there were 30 lower surgeries, 22 for female genitalia, eight to create male genitalia.
It is not possible to confirm how many three-phase phalloplasties have taken place since MSP coverage was reinstated, but fewer than five people have had more than one procedure, said Brett Mineer of the Provincial Health Services Authority. The authority co-ordinates services for transgender people, working with the Ministry of Health, regional health authorities and trans representatives on a provincial model of care.
On top of gender surgery, the province pays for thousands of dollars worth of post-operative care in Montreal, which patients formerly had to fund on their own. Gardner鈥檚 first go-round required 12 days of recovery time in Montreal; he estimated the province paid about $5,000 for that.
Patient feedback made it clear that having to come up with such sums was 鈥渁 barrier to care,鈥� said Lorraine Grieves of Trans Care sa国际传媒, which works to improve co-ordination of transgender health services.
Since December 2014, sa国际传媒 residents no longer need to apply for MSP coverage for gender surgery but have been automatically covered if it was recommended by a qualified assessor. Candidates still must complete one or two surgical-readiness assessments to ensure they are prepared and have the best possible result, but a psychiatrist no longer has to sign off on gender-affirming surgery. 鈥淚t鈥檚 more of a straightforward surgical referral,鈥� Grieves said.
As well, more sa国际传媒 doctors and nurses are being trained in follow-up care for transgender patients in case of complications that can occur once patients have returned from Montreal, she said.
Gardner said complications can include anything from urological issues to graft sites on forearms, deep wounds that take months to heal.
He expects to go back to Montreal by May for construction of a urethra to allow urination while standing up. Stage three will be the insertion of testicle implants and a penile implant, an inflatable erection device, he explained. 鈥淭hat鈥檚 it.鈥�
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Almost all gender-affirming genital surgeries for sa国际传媒 residents are performed by three Montreal specialty surgeons in a private clinic, although Trans Care sa国际传媒 and MSP are working to provide services at several American centres.
鈥淚n the meantime, we need more access to surgeons in the U.S.,鈥� Gardner said, noting, 鈥淪ome sa国际传媒 trans men are being given this option on a case-by-case basis.鈥� Different surgeons have different techniques, including using the thigh or abdomen as the donor site for phalloplasty.
Grieves said transgender people need health-care options closer to home.
鈥淲e would love to see this care happen in sa国际传媒,鈥� something she said would be 鈥渜uite do-able in five years鈥� time鈥� with the right resources, planning and surgical recruitment.
Gardner is happy that gender surgery now comes under the auspices of Trans Care sa国际传媒
鈥淪ince they鈥檝e taken over this specialized program from MSP, they have been a lot more respectful and inclusive in their consultations with the transgender community,鈥� he said. 鈥淲e are getting there.鈥�
He felt he was 鈥渢reated like a child鈥� when contacting MSP; now he can call up Grieves when he needs to talk about something. 鈥淪he keeps us in the loop.鈥�
Transgender patients are still responsible for their own travel expenses for surgery.
鈥淭hose who have financial difficulty can get their airfares covered through Hope Air,鈥� said聽Gardner, adding for him it鈥檚 tax-deductible as a medical expense. (Hope Air arranges free flights for financially disadvantaged people who need health care.)
鈥淲e are the first to go for these surgeries, and they don鈥檛 yet know what we need,鈥� he said in an email to the sa国际传媒. 鈥淭hey are starting to get a better idea. There is no blueprint for this; we are all pioneers.鈥�
