Times Colonist article about phalloplasty funding in B.C. misses the mark

The following article written by the Victoria Times Colonist’s Katherine Dedyna was forwarded to me via a mailing list this morning:

Not all transsexuals are created equal in the eyes of the B.C. Ministry of Health: MSP covers genital surgery to transform males to females, but not females to males

While I’m pleased to see some discussion of the issue happening, my overall feeling is that this article is poorly timed and misguided.

I do agree that it is discriminatory for B.C.’s Medical Services Plan to fund MTF surgery but not FTM surgery, but I also think the issue is not so cut-and-dry, at least not in these economic times.

The roll of a government as I understand it, is to act on behalf of its constituents. Do people in B.C. want MSP to fund phalloplasty? I doubt it.

We have other battles to be won before we can even think of having phalloplasty funding in place.

I am a transman who is aiming for genital reconstructive surgery and it will probably be years before I can afford it. I’m also a self-employed tax payer who just shelled out almost $15K in income tax.

Personally, I would like to see some of my tax dollars flushed into the B.C. medical system to ensure that ALL citizens of this province have reasonable access to a family doctor. I know just how lucky I am to live in a community of 1200 that has three GPs. When I need to see the doctor, I can get an appointment within a few days. This is not the norm in B.C., and it needs to change. I’d also like to see procedures such as eye exams covered. Surely, eyesight contributes to quality of life for British Columbians, right?

In the area of trans health, I’d like the Ministry to ensure that pre-T guys get better access to a doctor who can refer them to an endocrinologist to start testosterone therapy. And, how many guys are there in B.C. who would experience a radical improvement in their quality of life if MSP would cover—fully and completely—top surgery performed by the skilled and talented Dr. Bowman, right here in our province?

Victoria psychiatrist Dr. Gail Knudson says there are hundreds of people waiting for transgender surgery in B.C.

How many of these people are transmen waiting for top surgery? Now, how many are waiting for phalloplasty?

Again, I do think the current coverage situation is discriminatory, but I’m a very fiscally driven person myself and I can see that unfortunately, money plays a huge role in this imbalance.

As far as I know, MTF genital confirmation surgery is far less expensive than phalloplasty. Please correct me if I’m wrong, but aren’t we talking about something like $15,000 compared to $40,000 (minimum)?

Nowadays, a phalloplasty is performed in “a single operative setting,” Bowman says. The addition of an erectile prosthesis is delayed for a year until sensation “grows” into the neo-phallus. Testicular implants can then be placed at the same time.

While phalloplasty theoretically can be a single operative event, it very often is not. Plenty of trans men opt-out of the erectile prosthesis due to short and long term complications, but judging from my communications and observations most do want scrotoplasty and/or glansplasty.  So, while we can say that the specific creation of a phallus with urethral extension can be performed in a single operation, many trans men who go this route wind up having a minimum of two surgeries to complete their genitalia (and this is aside from potential complications that require further surgical intervention.)

Victoria transsexual Sean Brown is puzzled by the discrepancy for coverage for genital surgery depending on gender.

“I just think they should be covered equally. What actually irks me is that penis reconstruction is not covered, but removing ovaries and a hysterectomy are.”

I think this is a shortsighted comparison, both medically and financially. While the jury is still out about the effects of testosterone relating to cancer, many endocrinologists recommend complete hysterectomy to prevent cancer, particularly if there is any family history. I don’t deny that phalloplasty can improve the quality of life of a trans man, and therefore improve his health, but I also don’t think the medical necessity between these two procedures can be compared apples to apples. (Which is not to say that I think one procedure is more medically necessary than the other. The comparison is not so black and white.)

Furthermore, the fee that a surgeon is paid for a complete hysterectomy in B.C. is in the area of $500. (Hospital stay is taken from a global hospital fund.) I don’t know how much a surgeon is paid for phalloplasty, but I have to assume we’re talking about a difference in the area $15,000 or more.

What I also find troubling is that there is no mention of metoidioplasty at all in this article, a procedure with costs that  are comparable to MTF genital surgery. I presume this is because Dr. Bowman is trained in phalloplasty and not metoidioplasty. However, I’m fairly certain that metoidioplasty is a procedure that is more in demand by trans men—and not just for financial reasons. Personally, in my perfect world I would have the genitalia that matches my gender, and if phalloplasty was a completely funded procedure I would have a harder time choosing between it and metoidioplasty, but cost is not the only factor in my decision making.

This swerves off-topic from my main points, but I couldn’t resist:

Nor is Abbott aware that anyone has made a request for the province to reconsider MSP coverage for phalloplasty. “Were someone to tender such a request, like all other proposals, we would look at it. … And we would attempt, as we have to this point, to engage the best medical expertise possible.”

No one has made a formal request for the reinstatement of phalloplasty coverage, really? Well then, perhaps I should get out a pen and start writing an application for metoidioplasty funding. Apparently, there’s a chance that MSP would “engage the best medical expertise” to evaluate my request! Consider it done.

In the end, I definitely agree that the current state of FTM surgery funding in B.C. is unacceptable and discriminatory. Steps need to be taken to remedy the situation to improve the quality of life for British Columbia’s trans men. Under the current economic situation however, I think this article focused too much on a procedure that is wildly expensive and unlikely to be acceptable to the voting populace. A stronger case for addressing this discrimination could have been made had the article pressed for top surgery coverage, a procedure that I’m sure there is a much longer line-up for in this province. Additionally,  the article could have mentioned metoidioplasty as a less expensive FTM genital procedure that’s also worthy of provincial funding.

The people who want to see this situation changed need to think more like marketers: ethics aside, the issue of transgender surgery funding needs to be strategically sold in these times where basic medical needs for all British Columbians are not being adequately met.

One thing I’m grateful for is that comments on that article are closed. Otherwise, we would be forced to witness a long and steady stream of angry comments from tax payers who are tired of seeing their hard earned money get pissed away by both the provincial and federal governments. We need these people onside if there’s any chance of improving health care funding for trans men in British Columbia. Anything less, and the B.C. Ministry of Health will continue to fabricate false reasoning to continue this trend of exclusion and discrimination in an effort to protect the Liberals’ status as the governing party.

ps. Katherine Dedyna also authored a companion article to this one, entitled Growing up different: B.C. transgender patients line up for surgery but doctor who can do it is denied OR time. I very strongly agree with the points made in this piece.