Credit: Brian Wong/Xtra
On Mar. 12, the Yukon government announced significant changes to their trans-related health-care policies. Starting in April, the territory will be expanding coverage to include a wide range of medically necessary procedures—such as facial feminization surgery (FFS) and voice training—and better align with international best practices and standards of care, as set out by the World Professional Association for Transgender Health (WPATH).
Transition-related health care is considered medically necessary by national and international guidelines, in large part due to the role such procedures play in reducing dysphoria and physical or mental distress. But in most provinces and territories, health coverage lags years behind best practices.
Prior to this expansion, the Yukon government only covered a limited set of procedures: Vaginoplasty, phalloplasty, mastectomy, hysterectomy and chest contouring—all of which are often colloquially referred to as either “top” or “bottom” surgeries by trans communities and health-care providers. While coverage of top and bottom surgeries is essential, the previous policy omitted many procedures considered medically necessary by WPATH.
Under the old plan, “unless you had advocates in your corner, it was hard to access trans health care,” says Andy Pelletier, a non-binary person and trans advocate living and working in Dawson City. “And many procedures had to be covered by trans people themselves, out of pocket.”
But the new policy—which was developed in consultation with local trans and gender diverse communities, WPATH and other leading experts in trans health care—now covers both surgical and non-surgical procedures, including voice and mannerism coaching, vocal surgeries, FFS, hair removal and body contouring procedures. The policy does have some limitations: it applies only to residents with a Yukon health card. To qualify, patients also need a referral from a qualified mental health provider, which can take some time to obtain.
While not all trans people want or need to access transition-related health care, the lack of coverage for medically necessary services means trans people often shoulder these staggering financial costs. FFS, for example, can cost between $30,000 and $50,000. Given that trans people in Canada are largely low-income (Trans Pulse Canada research indicates that 48 percent of trans people in Canada make under $30,000 a year), these costs present an often insurmountable barrier.
“The new coverage policy reduces really significant financial barriers,” says Pelletier. “Trans people have often had to pay out of pocket for medically necessary procedures and cover travel costs, given that most procedures can’t be performed locally.” At present, most transition-related medical procedures—with the exception of hysterectomies and salpingo-oophorectomies—aren’t available in the Yukon, so having both medical and travel costs covered is a game-changer for trans folks living in the territory.
“The lack of access to gender-affirming health services, including surgery, represented a significant unmet health care need within the transgender community, often preventing transgender individuals from leading happy and healthy lives in our territory,” says Pauline Frost, the Yukon’s minister of heatlh and social services. “We are pleased to provide public health care coverage of these important procedures, as part of our people-centred approach to wellness that helps Yukoners thrive.”
Trans health coverage in Canada varies significantly from one region to another, given that health care rests within provincial and territorial jurisdictions. This results in a smorgasbord of policies with little consistency and clarity across regions, further complicated by issues accessing health care. For example, while procedures like top surgery may be covered in some provinces, accessing them is complicated by geographic distance. (Trans folks often have to go out of province to access procedures that are not available in their home region.) Country-wide, wait times for trans surgeries regularly stretch to a year or more. Cost can also prove to be a barrier, as many procedures are not covered under provincial plans. Many provinces, for example, will cover top surgery but won’t cover FFS, or will cover double mastectomies (breast removal) but not chest masculinization procedures.
Niko Stratis, a Toronto-based writer (and regular Xtra contributor) lived in the Yukon for 30 years—she left in part due to safety concerns as a trans woman. “Trans women face a lot of violence in this world, and one of the reasons we access these surgeries is to make it safer to live in this world,” she says. “I don’t want to sit at a table at a coffee shop and worry about getting harassment in the bathroom. Surgeries can mitigate that. They might sound cosmetic on the outside, but they’re affording us safety and alleviating dysphoria.”
Through their new insurance policy, the Yukon government has surpassed every other province and territory in Canada and delivered the most comprehensive trans health insurance policy in Canadian history. Looking towards the future, Stratis says, “I hope other provinces and territories see the Yukon and realize they have a lot of catching up to do. Hopefully this sets a precedent—and creates a ripple effect of other provinces and territories aligning their trans health coverage with international best practices.”