Are the medical needs of transgender and non-binary people being met?

In 5 seconds A study finds barriers to gender-affirming care for transgender and non-binary people in Quebec.
Hormone therapy is one of the most important medical needs during transition, for transgender and non-binary individuals.

When asked about their most important medical needs during transition, transgender and non-binary people regularly mention hormone therapy, a survey by researchers at Université de Montréal has found.

Of the more than 220 people polled online in the spring of 2023 – ranging from 26 to 40 years old and identifying as either transmasculine, transfeminine or non-binary – hormone therapy was cited as the top need across all age groups and gender identities.

Overall, more than 95 per cent of respondents cited hormone therapy as their first priority, ahead of facial, upper body, lower body and genital procedures. For those other procedures, needs varied greatly according to gender, personal history and social perception.

Published last month, the study was conducted by Geneviève Fortin, a PhD candidate in public health, with Claude Amiot, a "citizen researcher," and Annie Pullen Sansfaçon, a professor in the School of Social Work.

“This consensus is not so surprising,” said Pullen Sansfaçon, who holds the Canada Research Chair in Partnership Research and Empowerment of Vulnerable Youth.

“Hormone therapy is generally considered less invasive than surgery, more gradual and partially reversible. It is often seen as an important first step in medical transition.”

Not fully accessible

The findings about the priorities of trans and non-binary people raise a key question: are their needs being met?

According to the research team, hormone therapy in Quebec is not fully accessible. While the cost is covered by the RAMQ, Quebec’s public health insurance plan, which theoretically makes it more affordable than some surgical procedures, access is far from equitable in practice.

Geographic barriers can be a major problem. 

“Outside the major urban centres, starting hormone therapy can be complex,” said Amiot, a woman who completed her transition in Saguenay–Lac-Saint-Jean. “There is a lack of specialists, so we are sent to the city, which involves costly and time-consuming travel.”

Fortin added that there are also less visible barriers, such as stigma, fear of being poorly received and mistrust of a healthcare system that has not always been safe for transgender people.

As for surgery, it requires an extended period of time off work, travel and post-operative care. A significant proportion of trans people in Quebec have modest incomes, Pullen Sansfaçon pointed out.

“For isolated individuals, particularly older trans people, these barriers can be insurmountable,” said Amiot. “Lack of a support network combined with financial insecurity can transform a theoretical right into a practical obstacle course.”

Facial hair an issue

Another example cited in the study is laser facial-hair removal for trans women. It is officially classified as a cosmetic procedure and therefore not covered by the RAMQ. However, for many trans women, it is not a matter of comfort or vanity.

“Facial hair can expose people to transphobia, harassment and even violence,” said Pullen Sansfaçon. “It affects identity, safety and mental health.” Being recognizable as a trans person in public spaces is not a neutral experience, Amiot added. It can be a daily risk.

The research team concluded that classifying this treatment as cosmetic ignores its essential role in reducing dysphoria and ensuring personal safety.

Share

Media requests

Université de Montréal
Phone: 514-343-6111, ext. 75930