Desire for and Successful Access to Feminizing and Masculinizing Gender-Affirming Surgeries: A Cross-Sectional Canada Wide Survey

Background: An increasing number of transgender and non-binary (TNB) individuals are presenting for gender-affirming surgery (GAS) in Canada. The purpose of this study is to understand demand and completion rates of GAS among transgender and non-binary (TNB) individuals. Methods: The Trans PULSE Canada cross-sectional survey recruited TNB individuals aged 14+ living in Canada in 2019. Using Trans PULSE Canada data, we analyzed desired and completed procedures according to surgery type and gender identity. Results: Among 2118 respondents who answered surgery questions, vaginoplasty (84% of trans women and 32% of non-binary people who were assigned male at birth) and mastectomy (98% of trans men and 63% of non-binary people who were assigned female at birth) were among the most desired procedures. There were low levels of completion across all types of surgery. The highest level of completion was 48% for mastectomy in trans men. Surgeries not consistently covered by provincial health insurance had completion levels between 0% and 5%. Those with non-binary identities had lower completion percentages across all surgery types. Conclusion: This study highlights significant demand for GAS among TNB individuals in Canada, with completion percentages varying based on gender identity and surgery type. The low completion percentages speak to persistent challenges despite provincial health insurance coverage for some surgeries. This emphasizes the need to address barriers to ensure equitable access to gender-affirming care. Further research is needed to understand how to mitigate these barriers effectively.