Transgender Quebecers face surgery delays, out-of-province patients get faster care

Fraser Place says gender-affirming surgery will finally allow him to feel comfortable in his own body. But the 26-year-old Montrealer says that sense of comfort feels excruciatingly far away.Recently, GrS Montreal, the sole clinic in Quebec offering fully subsidized gender-affirming surgeries, announced that a change in provincial funding will delay wait times—possibly by years. The news has left Place feeling like his future is on hold.“It’s quite jarring,” he said in a recent interview, “knowing that this is probably going to stretch out for the rest of my 20s and maybe even my early 30s.”What's more frustrating for Place and transgender advocates, however, is that the delays are only affecting Quebecers. Wait times for out-of-province patients—roughly 65% of the private clinic's clientele—are largely staying the same and in some cases getting shorter.People should be outraged by the situation, said Jacob Franklin, co-administrator of the Trans Patient Union, an advocacy collective for transgender and non-binary patients. “A clinic in our own city, in our own province, is able to better serve non-Quebecers because their funding systems are adequate,” he said in a recent interview.GrS Montreal offers a lifeline to transgender people in Quebec and the rest of Canada, particularly in the Atlantic region, where many clinics don't have capacity to perform complex procedures. New Brunswick, for example, directs most patients seeking bottom surgery to GrS.Recently, the clinic announced that a funding cut from the Quebec Health Department will force it to perform fewer surgeries and delay wait times—but only for Quebec residents, a decision that leaves patients like Place little choice but to wait or pay out of pocket for procedures that can cost up to $100,000.About 35% of the clinic's patients are Quebecers, roughly 40% Ontarians, 13% come from the Maritimes, 11% from Western Canada, and about one per cent from outside the country.GrS has the capacity to “double or even triple” the number of surgeries it performs per year for Quebecers, but the province has hard caps on its budget for the clinic, says Michel Gagner, GrS owner and medical director. Every year, when the budget for Quebecers is reached, the clinic continues to offer surgeries for people from elsewhere in Canada, who are funded by their provinces' healthcare plans.''This limitation, combined with a high demand, contributes to longer wait times (for Quebecers),'' he said. GrS Montreal's website says it performs nearly 1,600 surgeries every year. Gagner did not want to give precise figures.In the 2024-25 fiscal year, the wait time for breast-removal surgery, known as a mastectomy, was 18 months for Quebec residents. Now it's at least two years. For out-of-province patients the wait time in 2024-25 was 13 months. Now it's six months. The delay in 2024-25 for the procedure to create female genitalia—known as a vaginoplasty—was about 20 months for Quebecers, and now it's 34 months. The wait time for that procedure was the same in 2024-25 for out-of-province residents, but now it's 18 months—almost twice as short.Updated estimates for Quebecers indicate a wait of three years for surgery to remove testicles, called an orchiectomy, and three years for the masculinization of genitals using existing genital tissues, called a metoidioplasty.‘’These two, three years waiting times are really devastating for trans patients,’' Franklin said. ''We've had people who've reached out to us in crisis about the news.’’Gagner, for his part, said the clinic has received ''many messages expressing concern, frustration, and distress.”When Place heard the news, he said, “It felt like my world was ending.”Place, originally from Ottawa, is waiting for a phalloplasty, a procedure the clinic says creates genitals “like biological male genitalia on both a functional and esthetic level.” For phalloplasties, the clinic said it could not provide a clear timeline, noting that the process depends on individualized factors, including lasering hair off a patient's forearm for a skin graft.Place submitted his paperwork for surgery more than a year ago and is scheduled to meet a surgeon in April. And while he doesn't yet have a surgery date, he knows it will take much longer than he anticipated.More than 1,200 Quebec patients were awaiting surgery at the clinic at the end of 2025, said Gagner, adding that the clinic had observed a ''sharp increase in demand over the past few years.'' If the province doesn't increase its funding for the clinic in the next fiscal year, Gagner said, the backlog will continue to grow. Wait times could reach four years for a vaginoplasty and three years for a mastectomy, he warned.Quebec, meanwhile, insists it has not cut GrS's budget. Funding for the 2024-25 fiscal year was “exceptionally high” at $9 million, Marie-Pier Blier, a spokesperson for the Health Department, said in an email. That year's budget was raised to “allow the planned surgical schedule to continue.”But that envelope dropped to $7.3 million for 2025-26, she confirmed. It had “always been clear” that the increase in 2024-25 was a one-time measure, adding that provincial funding to the clinic has more than tripled since 2018—19. Financial resources are limited and difficult choices must be made, the spokesperson said. Funding in the 2023-24 budget was $8 million.Gagner says that to meet demand provincial funding should be doubled to between $14 million and $15 million to recalibrate the waiting times and adequately meet the needs of the population.For many transgender patients in their 20s and 30s, paying out of pocket can be prohibitive, Franklin said, adding that they would need to put other big projects on hold to pay for healthcare. “You're going into debt, you're not saving. You’re not saving up for a house or getting married. You're not doing these significant, expensive things.”An agreement between Université de Montréal's hospital centre, the Quebec Health Department, and GrS Montreal gives the private clinic exclusive responsibility for publicly funded gender-affirming surgeries in the province until 2028.

Transgender Quebecers face surgery delays, out-of-province patients get faster care

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