WHEN CARE IS “SILLY” AND “DANGEROUS”: How Ontario’s Transgender Health Care Crisis Isn’t a Mystery—It’s Neglect

I’ve been a patient of my family doctor since I was twelve. Through adolescence, adulthood, and thirteen years abroad, I’ve trusted him with my health. Yet when I recently asked for estrogen—backed by decades of research and clear medical guidelines—he called it “dangerous.” My request for basic blood work? “Silly.” This wasn’t ignorance of the science. This was a refusal.

As a former legal practitioner, I know what it takes to get licensed in a highly regulated profession. I tend to defer to skilled, highly trained professionals—often even when it comes at the cost of my own health and well-being. That was the case this past week. Despite knowing the data and having done more research on the subject than my own doctor, I almost let him talk me out of getting the care I needed.

My doctor first suggested my request for medication was ‘unnecessary,’ and that any testing would be “silly” or “a waste,” since he “wouldn’t really know how to interpret it.” This is not the care I should expect from someone who acts as a gatekeeper to my own health. His honeyed British delivery filled the cramped exam room, yet it felt like it was coming from far away. The walls seemed to press in as I watched the scaffolding of trust I’d built over decades begin to splinter. The notes I’d prepared the night before sat useless in my mind, like a script for a play I no longer knew how to perform. My resolve seeped out into the sterile air, leaving me with only the bitter taste of silence. Anger burned in my chest, but beneath it was a quieter wound—a deep disappointment in myself for letting my own voice vanish when I needed it most. If not for a friend who came with me and acted as my advocate, I might have walked out of that office—again—without the care I know I need to be the best version of myself. After we left the doctor’s office, my dear friend, who has seen me confront others with absolute or perceived authority, experience, or training, described my deference to my own treatment as uncharacteristically “odd.”

What if a different trans person, in need of the same vital care, lacked the information and talking points saved on her phone or the support of a determined friend by her side? What does that mean for her potential and her access to essential, life-affirming, gender-affirming care?

And it’s not just me. Ontario’s own data proves this is systemic. A major study found 43.9% of trans Ontarians reported an unmet healthcare need in the past year—versus 10.7% for everyone else. Nationally, trans and non-binary Canadians report unmet healthcare needs at eight times the rate of the general population. That gap is not an accident.

The Numbers Behind the Neglect

The data confirms what many in my community already know: access to transgender health care in Ontario is profoundly unequal.

• A landmark Ontario study, the Trans PULSE Project, found 43.9% of trans people reported at least one unmet healthcare need in the past year—compared to just 10.7% in the general population. That’s a gap of over 33 percentage points.
• A 2019 national survey showed 44.4% of trans and non-binary Canadians had unmet healthcare needs, compared to 5.5% among all Canadians.
• Among those who have sought emergency care while presenting in a gender different from their assigned sex at birth, 52% reported negative or discriminatory experiences.

These aren’t small disparities. They are a public health crisis hiding in plain sight.

A System Designed to Stall

• Ontario’s relationship with gender-affirming care has been anything but stable. OHIP covered transition-related surgeries starting in 1970, then delisted them in 1998. Coverage was only reinstated in 2008, and until 2016, only CAMH could approve surgical referrals—a centralized bottleneck that created massive delays.

Family doctors could prescribe hormone replacement therapy tomorrow. They don’t. Many won’t even learn the protocols—public, proven, and safe. Instead, patients are told to wait months or years for overwhelmed gender clinics. Some wait over a year just for a surgical consult. The province knows this. It funds too few clinics, trains too few providers, and lets waitlists pile up like it’s still 1998, when gender-affirming surgeries were delisted from OHIP.

When I raised this with my MPP, I got polite words and zero follow-up. That’s the political playbook: wave a rainbow flag in June, ghost us in July.

This isn’t a question of resources. It will. The science is settled. The treatment is safe. The need is urgent. What’s missing is the courage to say that trans lives deserve the same timely, competent care as anyone else—and then to act like it. Because until Ontario stops treating evidence-based medicine as “dangerous” and “silly,” the statistics will keep writing the same story. And people like me will keep paying the price.

What Needs to Change

If Ontario is serious about equitable healthcare, here’s where it must start:

1. Mandatory training in gender-affirming care for family physicians and nurse practitioners.
2. Increased funding for gender clinics and surgical programs to reduce wait times.
3. Clear provincial targets for equitable access to care, enforced through accountability measures.
4. Routine integration of HRT and related care into primary care, so patients aren’t left hunting for specialized clinics.

To my trans sisters, brothers, and non-binary individuals seeking to be better informed and advocate for themselves, I recommend watching the video linked below. It contains valuable information that you can take to your doctor to help you advocate for your needs more effectively.

Here are some helpful links for trans and non-binary patients:

1. Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society* Clinical Practice Guideline
2. Standards of Care for the Health of Transgender and Gender Diverse People, Version 8
3. Assessment of Gender-Affirming Hormone Therapy Requirements
4. Achieving Physiologic 17-ẞ-Estradiol Levels in Transgender Females on Estradiol Transdermal Patches and Optimal Dosing

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