K'JIPUKTUK, HALIFAX—The provincial government has released a list of gender confirming surgeries (also known as sex reassignment surgeries) which will now be paid for by MSI. Though this is a large step for Nova Scotia, many concerns still remain, says Kate Shewan, vice-chair of Nova Scotia’s Rainbow Action Project in a recent NSRAP press release.

Gilanders Ungar, a transgender man, says he was ecstatic when he first heard the announcement and called MSI right away. However, he learned very quickly that the chest masculinization procedure he was looking for would not be funded.

The province has said it will be funding standard mastectomies but not chest masculinization, a surgery designed to remove breast tissue and create a masculine looking chest. It’s also the procedure many female-to-male transgender individuals are seeking.

“Chest masculinization and chest contouring both involve nipple reconstruction as well as implants and other procedures, which aren’t part of standard mastectomies,” says Christine Gibbons, manager of policy and planning at Nova Scotia’s Department of Health.

Ungar says that top surgery (also known as chest surgery) seems to be the most sought after surgery for females transitioning to males. He says that bottom surgery can be complicated and risky, and as a result top surgery is more common.

Ungar says if the full top procedure that he is looking for is not being offered within Nova Scotia, he might choose to pursue it elsewhere. He says he might choose to save up money for the procedure to be done out of province, but he hoped instead to use these funds to further his education. “So this isn’t really helping me much,” he says.

Shewan says not every transgender individual is seeking surgery. Those that do vary in their needs and desires when it comes to surgery.

“[Doctors] need to understand the surgical outcomes that people are looking for,” says Shewan.

Though individuals of the transgender community in Nova Scotia now have more opportunity to seek out surgical options, other barriers and challenges still stand in their way. “When you’re looking at a gender transition from a medical perspective, it’s a long, complicated and multi-step process,” says Shewan.

Access to counsellors, hormone therapy, and wait times for not only surgeries, but also clinical eligibility, create a bottleneck in the system leaving patients without proper care.

The province estimates they will see potentially  four to eight  patients who want to undergo gender confirming surgery per year, says Gibbons. This number she says is based on the volume of patients in other jurisdictions in Canada.

However, any patient who wants to undergo surgery must first be assessed and deemed clinically eligible. Potential patients can be denied if they do not fit criteria stated within the World Wide Standard created by the World Professional Association for Transgender Health (WPATH), which is a globally recognized assessment tool, says Gibbons.

“We are committed to working with NSRAP as well as other members of the trans community and other advocacy groups [...] to identify where the barriers and challenges are and determine what we might be able to do to address them,” says Gibbons. “We realize that providing funding for sex reassignment surgery is a significant step, it is only one of the ways we’re addressing those barriers.”

MSI will be funding the following eight surgeries:

• Mastectomy: Surgical removal of the breast and breast tissue.  

• Oophorectomy: Surgical removal of one or both ovaries.

• Hysterectomy: Surgical removal of all or part of the uterus.

• Penectomy: Surgical removal of the penis.

• Orchiectomy: Surgical removal of one or both testicles.

• Phalloplasty: Surgery, which constructs, repairs or enlarges the penis.

• Metoidplasty: Testosterone treatment used to enlarge the clitoris, which is then followed by surgery to construct a penis.

• Vaginoplasty: Surgery, which creates or repairs the vagina.

See a timeline of transgender rights in Nova Scotia here: http://cdn.knightlab.com/libs/timeline/latest/embed/index.html?source=0A...