Transgender Policies and Guidelines that exist in Canadian provinces for Medically Necessary Hair Removal
During my research I came across a recent paper providing updated information for support or lack of for transgender surgery including financial support from provinces across Canada.
Why is this Issue Important?
Hair removal is a necessary pre-surgical procedure prior to performing gender-affirming surgeries such as vaginoplasty and phalloplasty.
A recent Canadian survey of 337 people who had undergone gender-affirming assessment and/or surgery found that 71% of people had their gender-affirming surgery at least partially publicly funded.
However, even when surgery is publicly funded, most patients face significant out-of-pocket costs for travel, care and supplies following surgery, and for hair removal prior to surgery.
Therefore, as provinces increasingly develop and implement programs for gender-affirming surgery, they are also seeking guidance on whether and how to regulate and financially support the range of services that people undergoing such surgeries require.
This rapid response was requested to specifically identify policies, financial support and professional regulations used across Canada for medically necessary hair removal for gender- affirming surgery.
What was found.
One non-systematic review focused on laser hair removal for genital gender-affirming surgery and a recent high-quality systematic review which evaluated non-invasive anesthetic methods for dermatological laser procedures.
The non-systematic review indicated that complications can arise from using hair-bearing skin in genital gender-affirming surgery, there is limited data regarding hair-removal practices in preparation for genital gender-affirming surgeries, and that hair removal techniques vary among dermatologists and other practitioners. For example, in male-to-female genital gender-affirming surgery, the hair removal required depends on the surgical procedure being used which can require some or all of scrotal hair to be removed. For female-to-male genital gender-affirming surgery, the reviews note that permanent hair removal is only required for phalloplasty with urethral lengthening (construction of a neourethra). Moreover, the review also indicates that skin for this procedure is often taken from forearm radial artery or the anterolateral thigh with hair removal being required for both, and there is often less certainty with the location of skin taken for the latter.
The systematic review identified variability in procedures for hair removal, including the types of and settings used for lasers, application time and pain outcomes.
The systematic review also noted that non-invasive aesthetic methods may be favourable compared to placebo or no anesthesia, and that better pain reduction was achieved through topical anesthetic drugs and pneumatic skin flattening as compared to skin cooling, but it also indicated that this evidence is insufficient to draw conclusions.
Eight out of 10 provinces were found to have provincial regulations for hair-removal equipment to help ensure workplace safety, and while Nova Scotia and Newfoundland and Labrador lack such provincial regulations, safety guidelines specified by Health Canada were still found to apply for use of Class 3b and 4 laser hair removal which still apply in the provinces without regulations of their own. Even in jurisdictions with provincial regulations, it is generally unclear whether legislation only applies to cosmetic hair removal or whether it extends to medically necessary hair removal as well.
Manitoba was found to be the only province which provides funding for hair removal as part of gender-affirming surgery, and other ‘medically necessary’ hair-removal services appear to largely be under the care of family physicians or dermatologists. Laser hair removal for feminization is covered under the Manitoba Health Services Insurance Plan if the referral is made by an approved provider on the Trans Health Klinic team. In addition, laser hair removal on the forearm for the purpose of phalloplasty surgery is covered if a psychological assessment (from an approved provider) has taken place which supports readiness for the surgery .
The professional regulations for hair removal that we identified were for electrologists and estheticians, neither of which were found to be regulated health professions in any province except for Manitoba, in which they are considered a regulated trade requiring mandatory certification.
*The information above was taken from a research company Rapid Synthesis conducted November 6, 2018. Citation, Panchal P, Hammill AC, Wilson MG. Rapid synthesis: identifying policies, financial support and professional regulations for medically necessary hair removal. Hamilton, Canada: McMaster Health Forum, 6 November 2018.
More support and awareness for the transgender community is vital and Canadian standards and support through each province must get with the times.
WPATH – The World Professional Association for Transgender Health
The World Professional Association for Transgender Health is an international multidisciplinary, professional association whose mission is to promote evidence-based care, education, research, advocacy, public policy, and respect for transgender health. The vision of WPATH is to bring together diverse professionals dedicated to developing best practices and supportive policies worldwide that promote health, research, education, respect, dignity, and equality for transsexual, transgender, and gender nonconforming people in all cultural settings.
Bruce Jenner – Before Caitlyn Jenner – After
One of the main functions of WPATH is to promote the highest standards of health care for individuals through the articulation of Standards of Care (SOC) for the Health of Transexual, Transgender, and Gender Nonconforming People. The SOC are based on the best available science and expert professional consensus. Most of the research and experience in this field comes from a North American and Western European perspective;thus, adaptations of the SOC to other parts of the world are necessary. The overall goal of the SOC is to provide guidance for health professionals to assist transsexual, transgender, and gender nonconforming people with safe and effective pathways to achieving lasting personal comfort with their gendered selves, in order to maximize their overall health, psychological well-being, and self-fulfillment. This assistance may include primary care, gynecologic and urologic care, reproductive options, voice and communication therapy, mental health services (e.g., assessment, counseling, psychotherapy), and hormonal and surgical treatments. While this is primarily a document for health professionals, the SOC may also be used by individuals, their families, and social institutions to understand how they can assist with promoting optimal health for members of this diverse population.
WPATH recognizes that health is dependent upon not only good clinical care but also social and political climates that provide and ensure social tolerance, equality, and the full rights of citizenship. Health is promoted through public policies and legal reforms that promote tolerance and equity for gender and sexual diversity and that eliminate prejudice, discrimination, and stigma. WPATH is committed to advocacy for these changes in public policies and legal reforms.
For more information go to www.wpath.org
7th Version of the SOC Sept. 2011 – Original SOC was published in 1979 and revisions were published in 1980,1981,1990,1998, and 2001
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