Transsexual and Intersex Community to be denied HRT Coverage

The Drugs Program Branch at the Ministry of Health has recently announced that products currently covered under Hormone Replacement Therapy (HRT) will no longer be made widely available, in order to cut current costs. Intentional or not, the rules as rewritten exclude thousands of transsexual, transgendered and intersex people who rely on HRT to aid them during and after their transition. It is telling that throughout the text of the bulletin(s), no mention was made regarding HRT and the trans community, nor were there any trans-specific resources listed in the research texts cited.

The changes in coverage are to take effect starting March 01, 2006. Both Estrogen products (Premarin, Estrace, Estradiol, etc.) and Testosterone products (Cypionate, Enanthate, etc.) will no longer be covered for transsexual, transgendered and intersex men and women. Only biological men with a sufficiently low blood serum testosterone level and biological women suffering from menopausal symptoms (for short-term usage only) will continue to be covered.

In a community that is already widely discriminated against, this decision could have catastrophic ramifications. Transsexual, transgendered and intersex people already face ongoing discrimination in their daily lives. Many of the affected men and women have difficulty in finding safe and adequate employment, housing and/or access to quality healthcare. This can be considered nothing less than a tragedy for those who are already on a fixed income or who cannot afford the high cost of hormones.

HRT is a well established and highly effective treatment for transsexual, transgendered and intersex people. There is no medical basis for denying HRT coverage to the men and women within these communities.

This change in policy with respect to HRT products in the provincial drug formulary has overlooked the following points:

1. The crucial role that HRT plays in helping transsexual, transgendered and intersex people live healthy and functional lives, and thus will negatively impact on their health and well-being;

2. Does not accurately reflect the medical and psychiatric literature that supports the use of HRT as a highly effective and standard treatment for transsexual, transgendered and intersex people; and

3. These oversights represent a policy that discriminates on the basis of one's gender identity. Access to provincial coverage for HRT is limited to medical conditions intrinsic to one's physical sex at birth rather than on the basis of genuine medical need.

For these reasons, we call upon the Ministry of Health to immediately revisit this policy and reinstate coverage for transsexual, transgendered and intersex individuals who require HRT as part of their ongoing treatment.

The official health bulletins can be found at:
http://www.health.gov.on.ca/english/providers/program/drugs/bulletin/bul_fall05.pdf
http://www.health.gov.on.ca/english/providers/program/drugs/bulletin/bul_fall05_2.pdf