Province wants more doctors to be able to refer patients for gender reassignment surgery

Reann Legge is counting down the days.

In January the Saskatchewan trans woman will travel to Montreal for gender reassignment surgery. 

"I was just in such a state of euphoria when I got that phone call," she said Tuesday. 

Legge said it took years to get the surgery booked and approved for funding. 

The Ministry of Health is now looking for physicians who are interested in becoming recognized as a provider of referrals for out-of-province gender reassignment surgery.

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The province covers the full cost of some procedures performed outside of Saskatchewan. Those wanting bottom surgery, for example, must travel to Montreal — the only place in Canada where the procedure is available. But in order to get that kind of out-of-province surgery, a recognized doctor has to provide a referral. 

There are currently six recognized doctors allowed to give Saskatchewan people referrals, but only one of them is actually in the province and she says her wait time is three years.

"I have patients who wake up in the morning and see their body and feel suicidal because this is the wrong body and they're so distressed, so dysphoric about having the wrong genitalia in place," said Dr. Sara Dungavell, a psychiatrist based out of Saskatoon.

"So waiting means that they're sitting in this space of despair." 

Dungavell says family physicians would be well suited to give the recognized referral since they usually have more experience with surgery than psychiatrists.

"I actually think that it makes a lot more practical sense to have a family doctor who talks regularly about any kind of surgery," she said.

Overall, she says she supports the government's call, hoping it will reduce the wait time for what can be a lengthy process.

Legge questions why it took so long for the province to build capacity. 

Step in the right direction

An advocate for trans health says having more doctors who can approve out-of-province surgery is a step in the right direction, but she says there are still too many hurdles to jump through.

Typically trans patients seeking gender reassignment surgery need to see at least two psychiatrists. 

"One of the big things that needs to change in addition to adding more approved authorities is really to just to get rid of that second step and allow doctors to make direct referrals to these authorities," said Cat Haines, co-chair of TransSask, adding the process itself is confusing. 

"I don't think there's a single other procedure in the province that requires you seek psychiatric care before being deemed ready to go through other care." 

Haines also said simplifying the process would be more humanizing because the current system "increases stigma toward trans people and promotes the idea that it's a mental illness."

"It's the transgender person's own knowledge of themselves that dictates when they're ready to talk about it and start going through the process of surgery," she said.   

It's unclear how many doctors will respond to the province's request, but advocates say there are not enough physicians to treat trans patients in general—not just when it comes to their transition. 

Nevertheless, the provincial government says having more recognized doctors will provide additional resources for those wanting the surgery.

"Increasing the number of Recognized Authorities will increase access to services for Saskatchewan residents," the Minister of Health said in an email.

Doctors who are interested in providing referrals for out-of-province gender reassignment surgery are asked to get in touch with the Ministry of Health.