When Janet Macbeth underwent surgery in Toronto on Monday, it was a milestone not just for her, but for Canada.
Ms. Macbeth, 40, was the first patient to receive a vaginoplasty – a four-hour operation that gave her the female genitalia she had always desired – at Toronto’s Women’s College Hospital (WCH), the only public hospital in the country to offer the complex surgery.
“This is such an amazing program and it has so much promise,” Ms. Macbeth said in an interview before her surgery. “It’s something I feel honoured to be a part of.”
As awareness and acceptance of transgender rights has grown, so, too, has the demand for gender-reassignment surgeries, also sometimes called gender-confirming surgeries.
But until now, transgender Canadians have had to travel to the United States or to a private clinic in Montreal to receive any kind of bottom surgery, as procedures replacing a penis with a vagina, or vice-versa, are known.
The formal launch of the vaginoplasty program at WCH should begin to alleviate the Montreal clinic’s waiting list, which has grown substantially since the Ontario government loosened its rules for approving public coverage of gender-reassignment procedures three years ago, according to one of the surgeons who operated on Ms. Macbeth on Monday.
“That was the impetus for this program,” said urologist Yonah Krakowsky, medical director of the new Transition-Related Surgery program at WCH. “How can you open up these assessments and have so many people now approved for surgery without providing any access to surgical care?”
Before Ontario’s former Liberal government made a regulatory change in 2016, the Ontario Health Insurance Plan (OHIP) paid only for gender-reassignment surgeries for patients who had first received approval from one overburdened clinic at the Centre for Addiction and Mental Health (CAMH) in Toronto.
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.
Other provinces have also seen an increase in demand for genital surgeries, including British Columbia, which is planning to offer bottom surgeries soon at Vancouver General Hospital.
Dr. Krakowsky and his surgical colleagues operated on Ms. Macbeth on Monday under the experienced eye of Marci Bowers, a world-renowned California surgeon who flew in to guide the Toronto team through its first three vaginoplasties at WCH this week.
Dr. Bowers has a transgender history of her own, having grown up as Mark before transitioning more than two decades ago. She has since performed transition-related surgeries on nearly 2,000 patients.
“Many of them consider this life-saving,” Dr. Bowers said. “They’ve battled this for most of their lives. The concept of gender identity is just now coming to light as being a core element of your soul, if you will.”
For Ms. Macbeth, the dawning realization that she was a girl trapped in the wrong body was one of her earliest memories.
Growing up in a conservative family in California and Georgia, she had little choice but to bury her frustrations about her gender identity. The Jerry Springer Show, where transgender people were treated like freaks, shaped her view of the future that awaited her if she came out.
“There were no role models,” Ms. Macbeth said. “There wasn’t anyone saying, ‘Hey, look! Here’s somebody that’s transgender and they have a career and they have a family and they’re living a great life.’ That’s not the representation that I would see.”
Nonetheless, Ms. Macbeth said she partly came out of the closet as a student at the University of California, Santa Cruz, declaring herself queer and trans to some close friends, including the Canadian woman she would go on to marry in 2005.
When the couple moved to Walpole Island First Nation, near Windsor, Ont., Ms. Macbeth, afraid of being shunned in her new country, returned to the closet. She lived as a man until just before their second child, a girl, was born in 2017. Her son is now 5 and her daughter is 2.
“I wanted to be able to show my children that you can be yourself. How can I model that type of behaviour if I can’t even do it myself?” Ms. Macbeth said.
Ms. Macbeth was approved to travel to Montreal for a vaginoplasty, but she chose to wait until the Toronto program – which was already providing other transition-related surgeries – was ready to add vaginoplasties to its repertoire.
Dr. Krakowsky is hopeful that Women’s College Hospital will eventually recruit a surgeon capable of performing phalloplasties, the even-more-difficult feat of constructing a penis.
“Going through surgery – whatever the surgery is – is disruptive and difficult enough as it is,” he said. “We know medical outcomes are better if you don’t travel for health care.”