Canada’s First Hospital-Based Transition-Related Surgery Program Launches at Women’s College Hospital
June 17, 2019, TORONTO, ON – Women’s College Hospital is proud to establish the first Transition-Related Surgery (TRS) Program at a publically funded hospital in Canada. Through the training and recruitment of clinical staff with specialized expertise and in partnership with community health centres, the hospital is building capacity across its new program and working to increase access to surgical care for trans and gender diverse individuals.
“At Women’s College Hospital, we have a bold strategic vision to create a healthier and more equitable world for everyone,” says Heather McPherson, President & CEO, Women’s College Hospital. “This means that we are working to improve access and remove existing barriers to healthcare services for under-represented groups. Trans and gender-diverse patients have faced many disadvantages in accessing care that meets their unique needs. So WCH is developing programs and services that close the health gaps this community experiences. Our Transition-Related Surgery program is a good first step and we also recognize that there is more work to be done to support this community.”
Initiated in 2018, the program includes specialists in plastic surgery, urology, gynecology and anesthesiology as well as a dedicated team that includes nurses, physical therapists and social workers. The hospital’s program currently offers mastectomy, chest contouring, breast augmentation, oophorectomy, orchiectomy, scrotoplasty, penile implant post phalloplasty and testicular implants. Women’s College Hospital is a teaching hospital and is fully affiliated with the University of Toronto, which means the TRS Program also includes academic health sciences research and medical education opportunities to train the healthcare providers of the future.
“Ontario has the largest trans population in Canada – yet, before our program started, people in Ontario had very limited options for their trans-related surgical care. They would either have to travel to a private clinic in Montreal or abroad. When they returned home, follow-up care was also hard to find,” says Dr. Yonah Krakowsky, Urologist and Medical Lead, Transition-Related Surgery Program, Women’s College Hospital. “Creating a program that is Ontario-based not only creates access to care locally, it also provides cost savings to the health system by eliminating the need for out of province coverage. There is an unequivocal need for the care we are providing.”
New in June 2019, the WCH TRS Program will be the first hospital-based program in Canada to offer vaginoplasty. In addition, there has been no access to privately funded vaginoplasty surgery in Ontario for more than two decades and until recently; LGBTQ+ healthcare was not specifically included in Canadian medical education. This week the hospital will welcome Dr. Marci Bowers, a world-renowned American surgeon who specializes in transition-related surgery to work alongside WCH surgeons as part of an advanced international training opportunity.
“Training surgeons around the world to perform surgeries like vaginoplasty is very meaningful to me,” says Dr. Marci Bowers. “As a woman with a transgender history, I feel personally connected and invested in this work. There are very few surgeons who have this expertise so it’s vitally important to increase our global capacity for trans healthcare through programs like the one at Women’s College Hospital.”
Transition-Related Surgery in Ontario
TRS was excluded from Ontario Health Insurance Plan (OHIP) coverage in 1998 and select procedures were only made eligible under the plan in 2008. The lack of publically funded procedures combined with restrictions on who could provide assessments led to long wait times. On March 1, 2016, OHIP changed the funding criteria for transition-related surgery to align with the World Professional Association for Transgender Health’s (WPATH) internationally-accepted standards of care for Gender Dysphoria. This change expanded the list of qualified healthcare providers who are able to provide surgical eligibility assessments to include nurse practioners, registered nurses, psychologists and registered social workers with a Masters Degree. In Ontario in 2018, there were more than 1,500 OHIP approved transition-related surgeries compared to under 200 in 2010. Patients must have OHIP approval prior to surgery in order for the procedure to be insured. Some surgical procedures are not completely covered under OHIP and for many individuals the out-of-pocket costs are prohibitive. The Women’s College Hospital Foundation (WCHF) has created a compassionate fund to assist patients to cover some of the out-of-pocket expenses.
“Trans healthcare can be difficult to access, especially when it comes to surgery, which makes Women’s College Hospital’s TRS Program so vital to improving trans health outcomes within Ontario,” says Janet Macbeth, a patient in the TRS Progam.“Over the past year, through my interactions with their amazing team, my certainty has grown that this is where I am most comfortable having such a personally important surgery. I am immensely grateful to be a part of this program.”
Women’s College Hospital
For more than 100 years Women’s College Hospital (WCH) has been developing revolutionary advances in healthcare. Today, WCH is a world leader in the health of women and Canada’s leading, academic ambulatory hospital. A champion of health equity, WCH advocates for the health of all women from diverse cultures and backgrounds and ensures their needs are reflected in the care they receive. It focuses on delivering innovative solutions that address Canada’s most pressing issues related to population health, patient experience and system costs. The WCH Institute for Health System Solutions and Virtual Care (WIHV) is developing new, scalable models of care that deliver improved outcomes for patients and sustainable solutions for the health system as a whole.
Women’s College Research Institute (WCRI) is tackling some of the greatest health challenges of our time. Its scientists are conducting global research that advances the health of women and improves healthcare options for all, and are then translating those discoveries to provide much-needed improvements in healthcare worldwide.