April 4, 2024

Non-binary Canadian demands that the government cover his extreme genital surgery

An Ontario man is suing the provincial government’s health insurance plan to cover niche gender-affirming surgery in the United States which will give him both a vagina and a penis. 

The case concerns K.S., a 33-year-old who was born as a male, but now identifies as a “feminine dominant” non-binary. He uses a female name. The most appropriate surgery for his gender identity, he feels, is a “penile-preserving vaginoplasty”, a procedure which is offered at the Crane Center for Transgender Surgery in Austin, Texas. It is not available in Canada. 

According to legal documents, K.S. says that “to ignore ‘the other third’ of her and how she presents would be invalidating; she is ‘both,’ not exclusively one or the other but literally a mix.”

The insurer countered that a vaginoplasty without removing the penis (penectomy) is considered an experimental procedure and is not an insured service. However, the Ontario’s Health Services Appeal and Review Board overturned the insurer’ decision. It said that a vaginoplasty is listed for public coverage and that there is no reason why it should not include a penectomy.

The case is currently being considered by Ontario’s Superior Court of Justice. 

According to the National Post:

K.S. argued that forcing a non-binary person to undergo binary surgery — male to female, or female to male — would only exacerbate her gender dysphoria and would be akin to an act of conversion therapy, which has been banned in Canada since 2022 … 

In its decision, the health services appeal tribunal referenced standards of care as set out by the influential World Professional Association for Transgender Health, or WPATH, which considers a penile sparing vaginoplasty a valid treatment option for non-binary people. The board said it adopted the trans care group’s logic that “gender diverse presentations may lead to individually customized surgical requests some may consider ‘non-standard.’”

This case obviously raises weighty questions about the ethics of experimental surgery. But the head of the Crane Center, Curtis Crane, has solved them to his satisfaction. Crane is a member of WPATH, the World Professional Association for Transgender Health. He says in a promotional video on his website, that “I can’t think of a time that a patient has come up with a surgical request that I haven’t been able to fulfill”. For instance, “I had a trans man come to me and he wanted a phalloplasty but he wanted to keep his vagina and I said, well you know no problem. I’ve never been asked to do this and I’ve never there’s certainly not anything published on it and I’ve never seen it but I’m happy to think about this.”

He did some soul-searching and discovered that it was ethical. This was his reasoning: “being a trans man or trans woman or non-binary has nothing to do with your anatomy, has nothing to do with what’s between your legs.” Furthermore, he reasoned, “if gender exists on a continuum why then would my surgical treatments be binary? It doesn’t make any sense to recognize that gender exists on a continuum but I’m only going to offer all male options or all female options.”