Changes to gender-affirming surgery requirements in Alberta raise concerns

Transgender advocates are raising the alarm after changes to requirements for gender-affirming procedures in Alberta.

A new form from Alberta Health for gender-affirming procedures requires a referral by a psychiatrist. Prior to this, a general practitioner or other mental health provider’s authorization would suffice.

Esme Nethercott, 20, says they have been waiting for top surgery for nearly three years. They have discovered the newly implemented expectation could put them at the bottom of the list.


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“It just keeps getting vaguely pushed back. Every time I talk to the secretary there is no concrete answer and the word ‘ballpark’ is always used, she tells me surgery will be during this span of months, but the months never come,” Nethercott said.

“I don’t know what I’m supposed to do, who I am supposed to get it from, and I don’t know what I’m supposed to prove,” Nethercott said.

“Trans people just need more certainty about what is going on.”

Advocates worry the additional requirement will further bottleneck an already strained system.

Lindsay Peace is co-founder of Skipping Stone, a non-profit working to fill the gaps in care for the transgender community.

“I feel like it’s the next thing to denying people access,” Peace said.

There are so few psychiatrists who provide transgender care, getting that signature is already a long process.

“The state of trans health care is already a crisis. The people making these decisions are doing so with seemingly no knowledge or understanding what the impact is,” Peace said.

“I want the system to own up to the fact that they are not doing their job.”

It’s not clear whether the patient’s spot on the waiting list will be held while they secure that additional signature, or exactly where they will end up in the queue for surgery.

Psychologist Ashleigh Yule says she fears for her clients.

“When they are on a wait list without a date and without contact with clinics, without knowing where they are on the wait list, that is really risky and a lot of these people are just trying to stay alive,” Yule said.

Skipping Stone is now calling for action and has initiated a letter-writing campaign to compel the Ministry of Health to amend this decision.

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