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Closing the Circle: BC and Ontario Gender Surgery Clinics

Updated: Nov 18

By felicia rembrandt and Robin Singer



Ontario


In June 2019, Janet Macbeth, a forty-year-old man described as a “mother” of two from Wallaceburg Ontario, was one of the first persons to receive a vaginoplasty at a Canadian public hospital.


The surgery was performed in the recently created Transition-Related Surgery Program (TRS) at Women’s College Hospital (WCH) in Toronto. None of the mainstream media that covered this ground-breaking event noted the tragic irony of a historic institution, created in 1883 as a medical college for women, recognized as a Centre of Excellence in Women’s Health in 2005, now appropriated to create pseudo-women with faux vaginas.


That June, world-renowned American activist-surgeon and “transwoman”, Dr. Marci Bowers assisted Dr. Yonah Krakowsky, the program’s medical lead, urologist, and passionate trans care advocate in performing the first vaginoplasty. This was an operation, as The Globe and Mail put it, “that gave her [Macbeth] the female genitalia she had always desired.”


Dr. Bowers, currently president of WPATH, had performed over 2000 gender surgeries and helped train the team at the WCH. Dr. Bowers is famously known for working on the many procedures performed on one-time child media-star Jazz Jennings.


Dr. Bowers said of the surgery, “This effort speaks to the specialized knowledge required to perform vaginoplasty, which is considered ‘the jewel’ of gender-affirming surgeries. It’s a surgery that I’ve often said takes as much art as it does science.” The surgeries at WCH will use a modified penile inversion, in which the surgeon creates a vaginal cavity between the rectum and urethra, which is then lined with skin from the shaft of the penis or scrotum. The procedure involves elements of urology, gynecology, general surgery and plastic surgery, said Dr. Bowers, as well as a dash of “artistry” to construct the clitoris, labia and pubic mound from existing tissues.


Dr. Krakowsky, who has been an advisory board member for Acerus Pharmaceuticals and Paladin Labs, a Montreal pharmaceutical company, and is also on the Pfizer speaker’s bureau, hopes the teaching hospital’s multidisciplinary model is transferable across Canada. He said, “I think the long-term goal is for this to be available in every province.


The TRS program was the culmination of the Ontario government’s decision to fund chest and genital gender surgery as of March 2016.


Surgical procedures require two assessment letters but they can be provided by the 1050 readily available health care providers listed throughout the province with Rainbow Health Ontario (RHO), a program funded primarily by Ontario Health. A diagnosis of persistent gender dysphoria is required for those wanting to access genital surgery.

RHO forms the foundation of the information network necessary to create the greatest possible number of consumers for synthetic sex “care.” On its website, RHO states “Ontario Health funds RHO to act as a catalyst in improving services [for 2SLGBTQ+ people], increasing knowledge, showcasing innovative practice and encouraging networking and collaboration.”


In addition to listing doctors willing to provide referrals, it also provides training for professionals in assessment readiness for treatment and delivery of some aspects of medical care, such as puberty blocker injections. The three or four-hour courses are open for a nominal fee to physicians, nurse practitioners, registered nurses, registered social workers and registered psychologists.

There is an ideology lurking behind these innovations. It may be glimpsed in WCH executive and trans-identified female, Jack (Cheryl) Woodman’s criticisms of such government safeguards as assessment letters. She says, Then you have to go through additional governmental approval processes, and this doesn’t exist in any other healthcare realm, so to some degree it puts trans people in a position to almost have to prove their gender . . .We need to shift the needle on this.”


“Shifting the needle” means for Ontario to be more like Yukon which is considered to be the “gold standard” for gender care. A global news story explained, The territory reduces the number of specialists required to sign off on procedures, removes the pathologizing term and requirement of a “gender dysphoria diagnosis,” and offers public health coverage for residents requiring rarely covered gender-affirming procedures like facial feminization, laser hair removal or tracheal shaves.”


The ideology, then, is the belief that “transgenderism” is not a medical condition.


In 2017, WCH partnered with RHO, the Centre for Addiction and Mental Health and individuals from the community to form the Trans Health Expansion Partnership (THEx). THEx supports the expansion of health services for trans individuals in communities across the province, which includes the development of the Transition-Related Surgery (TRS) Program at WCH. Thus the surgical clinic is embedded within the information and marketing network provided by RHO. It is simply the end stage of a process anyone can enter through the RHO portal, which seamlessly guides people, large and small, into either the children’s gender clinics or the TRS program at the WCH.


By October, CTV news advised that procedures at the TRS Program included “mastectomy, chest contouring, breast augmentation, oophorectomy (removal of ovaries), orchiectomy (removal of testicles), scrotoplasty, penile implant post phalloplasty, testicular implant, select surgical revisions and hysterectomy. In addition to the surgeries themselves, the program will offer a streamlined system for surgical referrals and will be rooted in a ‘client-engaged model of care,’ where patients are active partners in their healthcare journey.

When Woodman, then President of WPATH, joined WCH as Vice-President, Strategy, Quality, Risk and Chief Privacy Officer in 2018, she was determined to improve the existing program to make WCH a hub of trans care in Ontario saying, “This is a passion project for me.” “There is a need for culturally competent care” — services that promote and are rooted in respect, equity, safety and trust. Woodman was referring to wait times, coverage of associated costs and geographic access.


Screenshot from ctvnews.ca video https://toronto.ctvnews.ca/video?clipId=2470019&jwsource=cl

Woodman set out to remedy the lack of trans-related academic programs by setting up integrated sex, gender and reproductive health services for women, trans, gender diverse or intersex individuals across their lifespan in Canada. The national Sex, Gender and Reproductive Health Centre (SGRH) formed at WCH. Woodman explained in a WCH annual report that:


WCH plans to build on its existing range SGRH services, as well as its strength in research, education, community partnerships and advocacy to address gaps in care, enhance integration of services and increase access, particularly for marginalized communities. As a result, the new centre will include new or enhanced care services in areas like sexual function, menopause care, trans care, early pregnancy loss, abortion and others. Ultimately, our goal is to create a national centre of excellence where patients across the gender spectrum can receive SGRH services in a safe, integrated and inclusive manner throughout their lives.


She offered no explanation for why women and “gender diverse” people should be lumped in together, or why abortion and menopause care should be provided in a setting where men are operated on to look more like women.

Woodman stresses that demand for “gender-affirming” surgeries has been increasing “exponentially” while complaining that system capacity and resources have not kept up.

According to a report on the clinic’s opening,


After the Liberals expanded approval-granting powers to health-care providers across the province, the number of gender-reassignment surgeries that OHIP covered in Montreal and outside of Canada jumped from 158 in 2015-16 to 414 in 2018-19, according to the Ministry of Health and Long-Term Care.


At the same time, the province began tracking the number of transition-related surgeries that were already being offered inside Ontario, including chest surgeries and the removal of the uterus or testicles.


Such surgeries nearly tripled from 204 in 2016-17 to 548 in 2018-19, the ministry said.

Government officials guard gender-related healthcare numbers carefully even though they are readily available at CIHI to carefully documented individuals. But highly paid trans-influencers such as Woodman are quick to quote select numbers to keep government gender-related funding growing exponentially.



In the years since the clinic opened, no numbers have been released on the various types of “lower” surgeries performed. But eDialogue, the online publication of the College of Physicians and Surgeons of Ontario (CPSO) has also stepped up to promote gender medicine to its physicians. A grab bag of health care professionals was featured in the June issue, touting the rewards of adding “trans care” to family practices.


This past summer, the federal government showed its support for closing the gap between consumers and providers of the hormones, hormone suppressants (puberty blockers) and surgeries required to create synthetic sex bodies, choosing Sherbourne Health (the host site of RHO) as the location for a funding announcement:


Today, on behalf of the Honourable Jean-Yves Duclos, Minister of Health, the Honourable Marci Ien, Minister for Women and Gender Equality and Youth, announced more than $5.1 million in funding from the Sexual and Reproductive Health Fund for projects by the Community-Based Research Centre (CBRC), the Canadian Centre for Gender and Sexual Diversity (CCGSD), Egale Canada and Sherbourne Health. These nation-wide projects will help improve sexual and reproductive health services, as well as develop resources and tools to support LGBTQ2 communities in getting the care and supports they need.


It should be noted that both CTV and Global ran uncritical stories about the need for more “gender-affirming care” in Canada. While Global TV is family-owned and operated, CTV is owned by Bell Media, a subsidiary of BCE, whose chairman of the board is Gordon M. Nixon. Nixon sits on the board of directors of Blackrock, the mammoth investment firm owned by Larry Fink, which requires all companies it invests in to give priority to ESG (environmental, social, governance) initiatives. Fink is also co-chair of a company that runs a transgender youth health care program.


British Columbia


The second publicly funded gender surgery clinic opened in Vancouver in 2019, the same year that Toronto’s WCH clinic started performing surgeries. It was the culmination of a project that began with the opening of the BC Children’s Hospital Gender Clinic (BCCGHC) in 1998.


Advertised as a “clinic without walls,” the BCCHGC provides hormone suppressants (puberty blockers), and cross-sex hormones to children up to age 16. It operates in partnership with Trans Care BC, established in 2014, and in accordance with the World Professional Association of Transgender Health (WPATH) Standards of Care (SOC). Though version 8 of the SOC was only published this fall, the Trans Care website already advertises it as the version it follows.


Trans Care BC is, according to the website, “a BC-wide information service and resource hub. We work to make sure people have the information they need to access gender-affirming health care and supports.” It is “committed to increasing access to gender-affirming care across B.C. by raising care provider knowledge, competency and cultural safety.”


To people who don’t believe in gendered souls, or that males can occupy female bodies (and vice versa), Trans Care BC seems like a major advertising and promotional site whose purpose is to entice troubled people into changing their sex.


As a resource hub, it offers “gender-affirming” courses, and toolkits and even CME-accredited online training for physicians interested in referring patients for wrong-sex hormones and surgeries to create bodies that look similar to the bodies of the opposite sex. It offers a weekly clinical mentorship call and quarterly clinical speaker series.


Trans Care BC was born under the liberal government of Christy Clark, when Terry Lake, the Minister of Health, began holding steering committee meetings with the ministry, the Provincial Health Services Authority (PHSA) and Vancouver Coastal Health (one of the six health regions within the province) to “offer expanded and sustainable health services to support transgender communities across the province.”


Interestingly, in it’s 2014-2017 Service Plan, created in response to the government’s 2013 Mandate Letter, the Ministry of Health made no mention of expanding gender treatment, instead focussing on the issues it identified as pressing: elder care for a growing population of seniors, chronic disease, mental health and substance abuse and people with significant disabilities.


Why was there no mention of “transgenderism” and its need for lifelong medication and multiple, expensive surgeries?


In 2020-21, the year of COVID, Trans Care BC proudly reported that 641 double mastectomies had been performed on gender-distressed people.


In its 2021-22 report, Trans Care BC announced several “improvements”, additions and new initiatives, including changing its language to be more inclusive of “trans Indigenous and Two-Spirit, non-binary, gender fluid and agender people.” It developed a Hormone Injection Supplies Toolkit, and a Supporting Gender Creative Children and their Families online module designed for people who work with children and their families in various capacities. This includes, but is not limited to, day care, school, community centres, social work, health care, and mental health care.” It performed another 647 double mastectomies.


But its greatest cause for celebration was the Gender Surgery Program B.C. “scaled up to offer the full spectrum of genital reconstruction surgeries including vaginoplasty, vulvoplasty, phalloplasty, and metoidioplasty procedures.”


The Gender Surgery Clinic within the Vancouver General Hospital is the only clinic in western Canada to offer “lower” surgeries. As with Trans Care BC in 2014, the 2018-2021 Service Plan also makes no mention of the Gender Surgery Clinic.


There is a five person team at the Surgery Clinic, headed by Krista Genoway, plastic surgeon, and Alex Kavanaugh, reconstructive urologist. Dr. Kavanaugh’s medical degree is from the University of Calgary.

A primary care physician can provide a referral for lower surgeries and one or two surgical assessments are required. Here is what the Trans Care BC surgical care website says about such assessments:

  • An assessment appointment typically lasts between one and two hours. You may need to return for a second visit if you don't have a plan in place to be cared for after your surgery or for other reasons such as complexities in your current health or social situation.

During the assessment, you will be asked about:

  • Your gender identity and feelings about your body.

  • Your expectations of the surgery and how it will impact you socially, emotionally and financially.

  • Your health history (current and past medical and mental health conditions, surgical history, medications, allergies, smoking status, exercise, nutrition, family history, etc.)

  • Your understanding of the surgical procedure, risks and post-operative healing process.

  • Your support network and strategies for thriving in your changing gender expression with family and friends, at work and at school.

  • Your surgical aftercare plan.

Such assessments are under attack in BC as well. A recently published paper produced partly by Trans Care BC researchers surveyed 35 people who had been through the assessment process, or were about to, to find out their responses to it. The authors lay out the criticism of surgical assessment, which they argue “have worked as a form of medical gatekeeping, forcing patients to ‘prove’ their trans identities to their assessors in order to

access medically-necessary care (Collazo, Austin & Craig, 2013, p. 234). This approach can cause patients to view assessments as an adversarial, bureaucratic, delegitimizing, and disempowering process (Bockting et al., 2006; Collazo et al., 2013, p. 234), undermining the open and trusting therapeutic relationship required for effective care (Barker & Wylie, 2008, p. 123).”


They note that an alternative approach, an “informed consent model” takes a “client-centered approach that balances individual needs within a harm reduction philosophy" (Cavanaugh

et al., 2015, p. 4). It is promoted by some trans healthcare facilities in the United States (e.g., Fenway Health, Callen-Lorde, Tom Waddell) as well as organizations in Canada (e.g., Rainbow Health Ontario, Trans Care BC) and beyond (e.g., Trànsit in Spain).”


It seems clear, given the easily accessible information portals which direct gender-distressed children first to clinics in children’s hospitals, and ultimately to the new adult gender surgery clinics, government increasingly does not consider transgenderism a health issue. If “transgenderism” is naturally occurring, as gays and lesbians successfully argued about

homosexuality, then the only reason the medical establishment might need to get involved is to change the body to match the internal sense of gender -- body modification, much like piercing and tattooing, paid for by the taxpayers of the province. Lip service is given to the requirement that potential consumers have “persistent gender dysphoria,” but with only token referrals and assessments needs, for the medical establishments in BC and Ontario, “transgenderism” is diagnosed by the individual consumer.


The BC Medical Journal, an organ of BC Doctors (formerly BC Medical Association) has contributed to the efforts to increase the numbers of synthetic sex surgery patients by publishing what is basically an infomercial written by the team at the Gender Surgery Clinic. Its February 2022 edition provides descriptions of the surgeries, reasons patients might want them, notes about its coverage under the provincial health care plan, and possible medical complications for each procedure.


The situation in both Ontario and BC reveal Health Ministries that have been captured by an ideology that denies the existence of a medical problem. The portals of RHO and Trans Care BC are in effect wide nets baited with freebies – hormones, hormone suppressants and surgeries – along with a promise not to pathologize, and covered in the rainbow glitter of “affirmative” language. Once in the net, children are funnelled to the children’s gender clinics, and later to the surgery clinics, which simply “close the circle.”


Yet not all is well. At least one of the doctors, Dr. Yonah Krakowsky of the WCH clinic, has concerns about tracking surgical outcomes.


He comments that “Importantly, these new Canadian GAS clinics have been launched in hospitals that prioritize patient-centered care and advancing research. But there are lessons to be gleaned from the current state of the literature.”


He outlines the problems:


Other areas of concern are that the defining principles of each surgical technique are not standardized, validated trans patient quality-of-life measures have yet to be developed, and the available data are divergent. Thus, reporting is unclear due to inconsistency with respect to surgical language and the absence of standardized validated GAS outcome tools. Ostensibly, patients and surgeons alike lack access to robust data reporting on the full spectrum of patient outcomes, including psychosocial and quality-of-life outcomes.


In other words, this is all experimental. The unanswered question -- who are the Master Experimenters and why have our health care professionals given them permission to use live human beings as their subjects?




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