Are you a trans, non-binary or genderqueer person in Quebec wondering how to affirm your gender identity? Gender-affirming care could be the solution you’re looking for. This includes options like using gender-affirming gear, taking hormones or having surgery. The following article walks you through some options for transitioning and what’s covered by the public health insurance plan offered by the provincial government.
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Understanding and expressing your gender identity is a personal journey. There is no right or wrong way to go about it. It’s completely okay to take things at your own pace. If you do decide you want to express your gender differently, gender-affirming care could be the right option for you.
Gender-affirming care refers to changes that can help someone align their body with their gender identity. In other words, if you feel like your assigned sex doesn’t match your true self, there are ways for you to express and affirm your identity physically. This can include temporary measures, like wearing gender-affirming items to change your appearance, as well as more permanent measures like hormone therapy or surgery.
Gender-affirming gear
Gender-affirming gear includes wearable items that can help you feel more comfortable in your body. They can help you express your gender by changing your physical appearance.
A few examples of gender-affirming gear are binders, tape, breast forms and packers. It’s important to research the different effects of gender-affirming gear, so that you can choose what feels best for your body and use each item safely.
In Quebec, gender-affirming gear isn’t covered by the RAMQ. You can either pay for an item yourself or reach out to community organizations, that might provide them for a lesser fee or for free. Aide aux Trans du Québec can assist you in your quest for more information and direct you to the closest organization that can provide you with gender-affirming gear.
Hormone therapy
Hormone therapy is another type of gender-affirming care that can allow you to make changes to your body. Some effects can be temporary, while others can be permanent.
If you wish to express your gender by taking hormones to change your physical appearance, the RAMQ may be able to cover it. It covers over 8000 prescription drugs, including most medication used for gender-affirming care. Some of the most common examples are testosterone and estrogen.
Taking estrogen can make breasts grow, decrease body and facial hair, and decrease muscle mass. On the other hand, taking testosterone can increase your hair and muscle mass, and give you a deeper voice. But it’s important to remember, everyone’s experience is different.
To get hormones, you have to speak with a doctor or other health professional. They will determine which medication could work for you, prescribe it to you and explain what is covered under the RAMQ. Once you have a prescription, you can purchase the medication from a pharmacist in Quebec.
You can also use the RAMQ’s prescription drug search tool to verify which hormones are covered. If you have private health insurance, make sure to check directly with your insurance provider to understand your coverage.
Gender-affirming surgeries
Surgeries can allow you to change your body permanently. You may have heard the terms “top surgery” and “bottom surgery”.
In Quebec, some gender-affirming surgeries are covered by the provincial government if your situation meets certain requirements. Examples include breast tissue removal (mastectomy), genital feminization (vaginoplasty and orchiectomy) and genital masculinization (metoidioplasty and phalloplasty).
To proceed, you need to obtain a letter of recommendation from a qualified professional. The surgeries also need to be done by a provider approved by the provincial government to be covered. Currently, the provider that is responsible for these surgeries is GrS Montréal.
It’s important to note that you may need to meet certain requirements to be eligible for surgery. For example, medical professionals might ask you about your experience with gender dysphoria and other types of gender-affirming care when discussing whether surgery is right for you. A great majority of surgeries also require you to be at least 18 years old.
However, many surgeries are not covered. For example, facial feminization surgeries, voice surgery, Adam’s apple surgery and breast augmentations are not covered by the provincial government. But it’s important to note that some surgeries may be covered by your private insurance, so make sure to double-check with your provider.
In 2021, Quebec’s administrative tribunal allowed a rhinoplasty surgery to be covered by the RAMQ regime for several reasons. They considered the rhinoplasty to be medically required and not just purely esthetic. The patient’s rhinoplasty was connected to both their Graves’ disease and their gender identity.
They concluded that based on the facts, the surgery was justified by physical and psychological functional difficulties. They also found that the request process had been followed properly, since the patient’s surgeon had submitted an authorization request to the RAMQ before the surgery. It’s important to note that coverage requests are not often accepted for rhinoplasties.
Other questions you might be considering
Other measures can also help you affirm your gender. For example, you can make a request to change your gender marker and your first name on your official documents.
If you’re considering transitioning or seeking gender-affirming care, you may feel concerned about facing discrimination. However, it’s important to know that the law offers protections that can help you understand your rights and where to turn to for support. These protections include anti-discrimination laws, such as Quebec’s Charter of human rights and freedoms.
For additional guidance or support, you can contact Aide aux Trans through their free and confidential helpline and referral service available seven days a week, from 9 a.m. to 9 p.m. You can also reach out to Interligne via phone, text or chat for information, and access their legal clinic for legal support.