A report by Alison Zamudio
Base image source: Catalyst Surgical
BC Ministry of Health confirms over 2800 girls and women have had their breasts removed since 2018
This report was first published on Alison's "Speak Free BC" Substack on January 16, 2025
I recently received a response to a freedom of information (FOI) request I submitted over half a year ago from the British Columbia Ministry of Health. While some of the contents had little to do with the request, the information it did contain was surprisingly helpful in understanding the current scale of gender treatment in BC. The principal document referenced below, from the FOI package, is "Hospital and Provincial Health Services Division - PHSA Supplemental Note - Trans Care BC “Gender Affirming Care: Overarching Care Landscape,” as well as "Legislate Session - Estimates Note: Trans Care BC and Gender Affirming Surgery Program."
What is gender treatment? A primer:
For those who are unsure what is meant by gender-affirming surgeries or why people would be getting them, it all relates to the incoherent idea that people feeling “gender dysphoric” (or that they should have the body of the opposite sex, or even a mix of the two) should, instead of receiving psychological therapy, try to alter their bodies to become more like the opposite sex.
Gender surgeries are part of the so-called “gender-affirmation care” process. Generally starting with wrong-sex hormones (testosterone if you’re female and estrogen if you’re a male), or puberty blockers (if you’re still young enough), it progresses to breast removal (top surgery) for women, followed by lower (genital) surgeries for both sexes.
Of course, none of this leads to becoming the opposite sex, and while the rate of detransition is not known (because there is no meaningful follow up) surveys suggest it is significant.
The number of gender surgeries in BC
So, what was in FOI release?
An internal BC Ministry of Health report included in the release shows how the number of gender surgeries—both Upper Gender Affirming Surgeries (UGAS−e.g. breast removal and breast construction), and Lower Gender Affirming Surgeries (LGAS–genital modification)—have progressively increased while the wait times have mostly decreased.
Trans Care BC, created in 2015, is the organization that oversees gender-related care in the province. It is itself the treatment pipeline, holding the centralized referral waitlist for surgeries.
According to the FOI release, since the creation of Trans Care BC, the number of UGAS has increased by 138% between 2018 and 2023, while wait times have decreased.
Lower gender-affirming surgeries have been available in BC since 2019. The number of LGAS increased by 122% from 2019 to 2023.
The types of surgeries included in UGAS are: “chest surgeries,” which are ironically the removal of breasts (lest the term “breast” heighten a patient’s dysphoria), and “breast surgeries,” which is the construction of breasts (implants) for men for whom estrogen has not resulted in desired breast growth.
Unfortunately, the number of surgeries is not broken down by age group.
The number of chest surgeries (mastectomies for females) in BC increased from 200 in 2018-2019 to 582 in 2022-2023. By the first ten months of the 2023-2024 fiscal year, 502 surgeries had been performed, putting the total on track to surpass the previous year's count by about 20 surgeries.
The FOI release indicated that a total of 2,848 "gender affirming" chest surgeries were performed in BC between 2018 and 2024 (not including those forecasted for 2023-2024).
The number of breast surgeries (breast implants for males) is much lower but also increased year over year from 22 surgeries in 2018-2019 to 78 in 2022-2023.
The number of surgeries up to the tenth month of the 2023-2024 fiscal year is only 33, so unless a very high number of surgeries was planned for the last two months of the year, the number of breast surgeries decreased last fiscal year.
The FOI release indicated that a total of 283 "gender affirming" breast surgeries were performed in BC between 2018 and 2024.
Based on the information in the FOI release, over 3,100 “upper gender-affirming surgeries” were performed in British Columbia between 2018 and 2024.
Disfigurement of healthy bodies
Of course, the most serious of these two surgeries is chest surgery (breast removal), as it is the removal of healthy tissue which, for younger women who have not yet had children, robs them of the ability to breast feed in the future, and robs their future children of superior breast milk and the mother-child bonding experience. For women who end up leaving their transgender identity behind, not having breasts may be an obstacle to finding a male partner.
Breast surgery is also serious, with risk of complications and difficult to reverse if the patient decides to detransition. Astoundingly, many men are duped into believing that they can somehow embody women simply by getting breast implants.
Both men and women undertaking these surgeries have done nothing more than disfigure their healthy bodies, for the sake of an incoherent ideology.
Now, turning to LGAS (or genital surgeries). This includes vaginoplasty for men and metoidioplasty and phalloplasty for women.
Trans Care BC describes these surgeries on its website:
Trans Care BC claims that vaginoplasty “allows you to pee sitting down and have receptive vaginal sex” but hedges its bets by adding in brackets that “(many people retain or develop the ability to orgasm).”
Trans Care BC advises that risks specific to “penis construction” include “dissatisfaction with appearance or function — The size or shape of your penis or scrotum may not align with your expectations. Your penis may not function in the ways that you had hoped.”
Although LGAS appears to only include the vaginoplasty, metoidioplasty and phalloplasty, women can also have their healthy uterus and ovaries removed via hysterectomy (removal of uterus) and oophorectomy (removal of ovaries).
According to the BC Ministry of Health FOI release, the number of LGAS increased from 54 in 2019-2020 to 120 in 2022-2023 (an increase of 122% in three years). In 2023-2024 the number of surgeries up to the tenth month of this fiscal year was 103, suggesting that the total could be around 124.
Based on the information in the FOI release, over 450 “lower gender affirming surgeries” were performed in British Columbia between 2019 and 2024.
In comparison to chest or breast surgeries, which are already serious interventions, it’s difficult to exaggerate the complexity of LGAS and the potential complications. There are frequent revision surgeries and a high possibility of serious infection. Even the Trans Care BC website lists an impressive number of potential complications. These are not surgeries which anyone can simply undo. And what is the result? Poor facsimiles of genital organs
that do not function as such and that are not aligned with a properly functioning reproductive system (e.g., the phalloplasty tube-shaft is not connected with functioning testes).
The growth of gender treatment in BC
One needs to remember that these totals only go back to 2018 for UGAS and 2019 for LGAS.
Before 2019, LGAS were carried out in Montreal. The actual total number of people in BC who have had gender surgery is much higher. Moreover, the gatekeeping for these surgeries has decreased over time while availability has increased.
As noted in the FOI release, since the World Professional Association for Transgender Health (WPATH) published its latest standards of care (Version 8) in 2022, the following changes were made with regard to gender treatment in BC, making access to these procedures easier and faster:
Only one surgical assessment, instead of two, is now advised for all gender-affirming genital surgeries.
A former ‘congruent living’ requirement (living in a way that aligns with one’s perceived gender identity) was removed.
The length of recommended hormone therapy prior to genital surgery for adults, if indicated, was reduced from one year to six months.
For persons just learning about this issue and wondering where it started and how it picked up momentum, ideas about transgenderism began to circulate widely and have an impact on the younger population in the early 2010s.
Following increased exposure to transgender concepts in the mid 2010s, there was a dramatic rise in the number of young people seeking gender-related treatment.
As Dr. Lisa Littman observed in 2018, the trend shifted notably in the US when the number of females presenting at gender clinics surpassed the number of males, inverting the previous trend. Littman also found that social contagion was a key cause of the increase in girls claiming to be “trans.”
What was almost assuredly propelling this contagion was wider media exposure to transgender ideas through network shows such as I Am Jazz, which premiered in 2015, and also through social media platforms such as TUMBLR and Instagram.
In BC, SOGI 123 lessons started to be rolled out in schools in 2016, with curriculum that undermines the objective reality of sex and promotes concepts of gender ideology. It’s not really surprising then, that by 2018, the number of referrals for gender surgeries in BC started to take off.
Also impacting the growing number of surgeries was that gender treatment in Canada became focused solely on medicalization.
For those experiencing gender confusion, Trans Care BC “Health Navigators” help prospective patients “access services and identify pathways to gender-affirming health care.” That is, to find treatment which emphsizes medicalization. While there may be access to counselling, it is, by law, purely “affirmative” in that it does not challenge patients’ ideas that they are either non-binary or trans.
This approach was codified with the passing of Bill C-4 by the Liberal government in 2022, which made attempting to change anyone’s gender identity illegal in Canada.
Henceforth, even if counsellors wanted to help patients find their way out of gender confusion, they would be charting dangerous waters by doing so. Without patients being able to seriously delve into their psychological issues or challenge their own beliefs, they are inevitably being put on track to be medicalized.
In 2022-2023 Trans Care BC Health Navigators handled 6,000 cases—up 18% from the previous year. This means that in the same year that 6,000 cases were handled, an equivalent of 13% (780) had surgery. This does not include the number of minors and adults put on hormones. As stated in the FOI:
“Transition-related medical interventions: Depending on the client’s needs and goals, the patient may begin with assessment for hormone therapy, and then may progress to surgery and post-operative care.”
There is no actual diagnosis in this process. None. The process, as indicated here and on the Trans Care BC website, is entirely in the hands of the patient, potentially with the exception of those presenting with extreme mental or physical health complications.
Trans Care BC’s 2019 “Strategic Placement” notes that gender-affirming care is “inclusive of non-binary identities” and that a client’s model of care is based on their “gender affirming goals.”
It is hardly surprising that when children, youth, and adults are bombarded with information supporting medicalized gender treatment through media, social media, and governmental medical institutions such as Trans Care BC, the number of patients seeking medical treatment increases. And when patients are also put in charge of diagnosing themselves and choosing their own treatment path, the trend toward medicalization is inevitably reinforced, as reflected in the statistics found in the FOI release.
We are now in a situation in BC where, since 2018, over 2,800 girls and women have had their healthy breasts amputated.
In BC, where the population of women between 15 and 49 is 1,113,785, this amounts to 2.5 women out of 1,000 in the age bracket most likely to undergo this surgery. Again, this analysis does not include medicalization through hormones—a typical first step in the medicalization pathway that can irrevocably alter one’s appearance, voice, and health and that often leads to irreversible gender surgeries.
Photo of Faith by Matthieu Zellweger. Alison, the author of this report, recently wrote about an interview with Faith, a detransitioner from Ontario, on Emily Duggan’s podcast, Moms Against the Norm.
Faith: “By 16 I was on puberty blockers, by 17 I was approved for top surgery. By 18 I had been given testosterone. Because of how bad my mental state was at this time I don’t even remember most of my appointments, which doesn’t bode well for informed consent. But that doesn’t seem to matter. The doctor who diagnosed me, as per her own admission, did not even know that I had other underlying mental health conditions.”
Impact on health resources
In addition to the obvious harm that these surgeries cause, the impacts to our healthcare system and the healthcare budget are not to be understated. One way that these surgeries impact the system is indicated through wait times.
The FOI clearly shows the Ministry’s drive to shorten wait times for gender surgeries. For LGAS, the Ministry acknowledges that the wait period is relatively long, and no target number of weeks was provided. For UGAS, the target number of weeks for completion of surgeries is 26 weeks, within which 93% of chest surgeries, and 85% of breast surgeries were completed. (It should be noted that according to BC Surgery Wait Times, mastectomies required for health reasons have a wait time of about six weeks.)
Trans Care BC took over the gender surgery waitlist in 2018 in an effort to streamline it.
The data contained in the FOI release confirms that now in BC, within just over six months of being referred, individuals can get breast or chest surgery. For comparison, according to the BC Surgery Wait Times, 90% of the following surgeries are completed within much longer timeframes, some over a year:
Hip replacements — 52 weeks
Knee replacements — 57.9 weeks
Foot/ankle surgeries — 56.4 weeks
Given that the surgeons performing breast and chest surgeries are not the same as those performing joint surgeries, the impact on the surgeries listed above would not be direct. However, health care budget is still being rerouted to gender surgeries, operating room time, nursing time, supplies and materials. It certainly appears that UGAS are a higher priority than replacing seniors’ hips and knees which could be causing those seniors real and considerable pain.
In terms of costs, the core funding allotted to Trans Care BC is a total of $6.4 million annually. Of that, $2.4 million goes to the Gender Surgery Program which includes $300,000 strictly for pre-LGAS hair removal. This does not appear to cover surgery costs, which are billed to the Medical Services Plan (MSP). Calculating the private-pay costs of UGAS cited on the Trans Care BC website of $10,000 per surgery in 2021-2022, the total would be $6.6 million. For LGAS, based on costs cited on the Healthline website, each surgery could cost about $50,000. The total for LGAS based on the number of surgeries in 2021-2022 would be another $6.6 million.
Even if the cost of these surgeries were half that amount, the total would be more than the annual budget for Trans Care BC.
Put all together, if the surgery costs are about correct, the total costs of Trans Care BC plus the actual surgeries could be $19.6 million.
Nearly $20 million annually, potentially, for surgeries that in no way have been proven to be necessary or that even have a corresponding diagnosis.
Nearly $20 million for surgeries for which individuals, even minors, can be referred, without having anything wrong with them besides their mental health.
Robyn Hodgson, registered nurse and manager of non-binary care, discusses gender affirming care on CTV’s “The Social” in June 2024. Hodgson rejects the argument that believing one has been born in the wrong body is a mental health issue. “…there's always a stigma around mental health … historically gender identity has sometimes been, have been thought to be a mental health issue, and it is not.”
Where do we go from here?
According to the FOI, the number of referrals for gender affirming surgery appears to be plateauing over the last two fiscal years. This presents some very limited hope that transgenderism is not as virulent a social contagion as it was just two years ago. There is no denying, however, that our health system in BC is still eager to race as many patients to their surgeries as possible by reducing wait times.
Egale, “Canada’s leading organization for 2SLGBTQI people and issues” argues that gender-affirming health care is a “basic human right.”
Minors and adults alike are still diagnosing themselves while BC’s Ministry of Health helps them harm their own healthy bodies by encouraging these surgeries. It goes without saying that the Ministry needs to examine the evidence reviews coming out of Europe and reconsider the provision and support for these treatments.
The Ministry also needs to look itself in the mirror and ask why this is the only treatment course which requires no diagnosis beyond the vague notion of “gender dysphoria,” even while this minimally cautious approach is declining in favour of viewing gender treatment as a form of self-actualization and an actual human right.
Medicine as an option, and not as a cure, must end in order to stop these so-called “treatments” from causing more harm.
Read more from Alison on the subject of gender on her Speak Free BC Substack:
Kommentarer