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The Pyrrhic Victory of OHIP-funded Sex Reassignment Surgery

An open letter to George Smitherman and David Caplan

by Nikki S., Transgender Columnist

  CAMH Gender Identity Clinic

CAMH Gender Identity Clinic.

Like many others in the trans community, I was pleased to hear that the Liberal government had taken the bold step of re-listing Sex Reassignment Surgery (also known as SRS, GRS, or simply, “the operation”) under the list of OHIP-provided services. When it was removed in 1998, it caused a great deal of hardship to many people.

There’s no question that, for some, SRS is a medical necessity. For those with severe gender dysphoria, SRS is the only cure. No amount of psychotherapy or hormone treatment will alleviate the pain of being disgusted with a major aspect of one’s own body. For those who suffer the most, surgery is the only option, and without access to quality services and medical care, some people choose to undergo this procedure however possible – often with devastating consequences and horrifying results.

It should also be noted that not every person identifying as “trans” desires, or intends to undergo, Sex Reassignment Surgery. It’s a personal decision that each person must make for themselves, and I also believe that a significant period of living in one’s identified gender, combined with hormone therapy, should be part of the education process for anyone who desires SRS. This process is necessary to determine one’s comfort with their new gender role, and to see how the body reacts to the physical and psychological changes brought about by cross-gender hormones. SRS, for male-to-female transsexuals, removes the main producers of testosterone, which leads to major changes in one’s physiology, emotional state, and perception of the world. It’s something that a potential SRS patient needs to be aware of, in order to make an informed decision.

However, after someone has chosen to live permanently in their identified gender, has undergone hormone therapy, and has been properly educated on the limitations and potential complications associated with SRS, the decision should ultimately by up to the individual. As long as they can demonstrate an understanding of what the procedure can and cannot do for them, they should have the opportunity to make this medical decision for themselves. The real tragedy behind re-listing SRS under OHIP is that decision is not in the hands of the individual – it has been placed back in the hands of the CAMH Gender Identity Clinic.

It is not my place to dig up old graves, and re-examine the horrors and despair that this branch of CAMH has wrought upon our community. The cases are well-documented, and are well known to those who have been subjected to their “reparative therapy” over the years. Of particular notoriety is the Child and Adolescent Gender Identity Clinic, which has brought untold pain to children and adolescents who exhibited behaviours not normally associated with their gender. This is not the place where we want decisions about our lives being made for us.

CAMH does not publish their requirements for an SRS recommendation letter, but during a 2006 Ontario Human Rights Commission case, Dr. Robert Dickey, current head of the CAMH Gender Identity Clinic, was asked to testify, and under oath, he outlined the process here: LINK

Articles 36-48 are the ones that deal with the process employed by CAMH.

Now, compare that to the normal standards of care employed elsewhere in the world. WPATH (The World Professional Association for Transgender Health, formerly known as the Harry Benjamin Association) is the worldwide leader in discourse, research, medical recommendations, and all things trans-related. Their Standards of Care are outlined herein: LINK

CAMH’s model differs WPATH’s in many significant areas, including:


- A rejection rate over 90%, and an intentional minimization of the number of people recommended for SRS;
- A minimum of two years of constant psychiatric assessment, possibly as many as six, before recommendation is given (compared to one year for WPATH);
- Provision of independent proof that you live in your identified gender on a full-time basis (which sometimes requires a person to “out” themselves if they’ve managed to live their lives without their birth gender being detected);
- Full-time employment, or full-time placement in school or volunteer position (which discriminates against those with disabilities which may preclude this, and often forces people to remain in unsafe or uncomfortable jobs, rather than risk unemployment while searching for a more tolerant employer);
- For the purpose of their assessment, any involvement in the sex trade does not count as employment (highly discriminatory, given the very high percentage of trans sex workers);
- No history of diagnosis for other psychological disorders (though certain diagnoses of depression, if related to gender dysphoria, are sometimes taken into account);
- A systemic discrimination against female-to-male trans people, for whom the SRS options were once judged as being “inadequate” or “experimental,” leading to a total refusal to write recommendation letters. Even now that phalloplasty and metoidoplasty are accepted procedures, CAMH still issues fewer than one female-to-male SRS recommendation per year, compared to the four-to-six SRS recommendations for male-to-female transsexuals.

Ultimately, SRS is just one of many procedures that a transsexual might require during transition. OHIP will not cover costs for electrolysis or laser hair removal, hormone therapy, breast augmentation, facial feminization surgery, or any travel costs associated with SRS. There are no surgeons in Ontario currently performing surgery, and the only option is a small clinic in Montreal. While the relisting of SRS is a positive development, it is clear that much more work needs to be done.

George Smitherman

George Smitherman.

Mr. Smitherman, you deserve a great deal of recognition and commendation for your decision to re-list SRS under OHIP, and restore the services that were removed in 1998. I personally wish to thank you for your bravery and support, and I thank you for taking this important step forward in advancing trans-focused health care services. We are among society’s most disenfranchised and disregarded groups, and this unpopular decision will bring hope to many people who never believed they could gain the piece of mind that SRS will bring. Mr. Smitherman, thank you very much.

Now, Mr. Caplan, I implore you to help us improve these services, and move towards a client-centred, culturally-sensitive model to meet the health needs of the trans community. It is education, and informed choice, that should determine one’s access to surgical procedures – not the rigid pathologization currently employed by CAMH, which casts off and discards so many desperate people that fall outside their unrealistic and outdated expectations.

  David Caplan

David Caplan.

Mr. Caplan, your predecessor has taken a bold step forward to improve our care. However, leaving OHIP-funded SRS decisions solely in the hands of CAMH would result in two regrettable steps backward. We have a chance to modernize and improve our care for so many Canadians – we cannot allow this opportunity to pass us by. The Sherbourne Health Centre, which currently serves the health care needs of hundreds of trans people, is perfectly poised to help you meet this challenge. The Trans Health Lobby Group, which has worked with Mr. Smitherman on many previous issues, is equipped to help spread awareness, and educate the public on the need for improved services. And, there are thousands of trans people with their own stories to tell, to remind us of the very real human toll that the CAMH model has wrought on our community. We hope you will let us help you with this new challenge, and give us the chance to say our piece. This decision affects us most of all, and we hope you will let our voices be heard.

  Datingbook: Canada's Online Dating Social Network

A Pyrrhic Victory is one that has devastating consequences for victors. The re-listing of SRS is, to be sure, a victory for the trans community, and should be celebrated as such. But OHIP-funded SRS, left solely under the iron fist of CAMH’s Gender Identity Clinic, would be a devastating setback for the trans health movement, one with consequences almost as dire as the original 1998 delisting of SRS. A client-centered, multiple-access model, similar to the WPATH and Sherbourne Health Centre standards of care, is what our community truly needs; this would be a true victory for trans people across the province, and a shining example of success for public health care.

Mr. Caplan, please let us help you meet this difficult challenge, so that we might together improve the lives of trans people across Ontario. Thank you for your time, and I welcome your response.

About the writer:

Nikki S. is a transsexual from Toronto, attending University of Toronto for Sexual Diversity Studies and working towards her Master's in Counselling Psychology. Her goal is to become a psychologist specializing in gender issues and helping others in the GLBT and Trans communities.

She appears regularly at Goodhandy's as one of the 'Diamond Girl' dancers, and is also involved with several community and political organizations working to improve the lives of transpeople everywhere. Her email is Check out Nikki's other articles: LINK

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