Advancing gender-affirming surgery Medicare policies in Canada: A qualitative description study
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Published on: August 19, 2025
Dave Gwun1, Ivy Quan2, Emery Potter3
1Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.
Background:
Gender-affirming surgery (GAS) is a component of gender-affirming care. Access to GAS in Canada continues to be inconsistent owing to jurisdictional differences in GAS policies. Given the increasing politicization of transgender, non-binary, and gender-diverse (TGD) individuals and its impacts on policy, we aimed to explore the experiences of individuals involved in GAS policy development across Canada to identify facilitators and barriers to GAS policy advancement.
Methods:
We conducted a qualitative description study with phenomenological overtones. Between May and December 2024, we interviewed 27 individuals who engaged with, were informed, or counseled on GAS-related Medicare policies. Interviews were transcribed verbatim, coded by two independent coders, and developed into themes using NVivo (Version 14.0). Themes were mapped onto Kingdon's Multiple Streams Framework, encompassing the problem, policy, and political streams, and the policy window.
Findings:
We generated 11 themes from our analysis. Themes were categorized under the problem stream (awareness of or interest in TGD lives and concerns, raising awareness and capturing government attention, and strategies for defining "the problem"), policy stream (feasibility, consensus, and advocate-led policy development), political stream (political will; internal political champions; pressure from TGD activists, advocates, and allies; and transphobia), and policy window (luck, timing, and magic). Participants found that GAS policies were advanced when clearly defined problems, feasible policy solutions, and political converged.
Conclusion:
Advancing GAS Medicare policy requires clearly defined problems, feasible policy solutions, and political will. Successful policy changes hinge on skillful advocates who are prepared with actionable policy solutions that seize brief and unpredictable windows of opportunity when they arise.
