Transsexual/Intersex People Denied HRT Coverage

Recently, changes to Ontario's drug formulary for Ontario Drug Benefits (ODB) have been made. (see http://www.health.gov.on.ca/english/providers/program/drugs/bulletin/bul_fall05.pdf) Starting March 1 2006, coverage for hormone replacement therapy (HRT) products is to become very limited. Estrogen (Premarin, Estrace, Estradiol, etc.) will be a covered expense only for biological females experiencing menopausal symptoms. Similarly, testosterone (Cypionate, Enanthate) will only be available for biological males with a sufficiently low blood serum testosterone level. Although the motivations for this change were to stem abuse of the system by those whose use of these products may not be medically necessary alongside a response to the latest research on the long-term effects of HRT, access to these therapies for thousands of transsexual, intersex and transgendered men and women will be compromised in the process - hopefully an unintentional outcome. For the majority of ODB recipients who are on limited fixed incomes, the cost of hormone products is a significant expense that many would otherwise be unable to afford, coverage for these products, as currently slated, is withdrawn. HRT is a well established and highly effective treatment for trans and intersex people. As such, there is little medical basis for removing coverage of these products with respect to this particular population. Given that this change in policy with respect to HRT products in the provincial drug formulary: i) Has overlooked the crucial role that HRT plays in helping transsexual, intersex and transgendered people live healthy and functional lives, and thus will negatively impact on their health and well-being; ii) Does not accurately reflect the medical and psychiatric literature that supports the use of HRT as a highly effective and standard treatment for transsexual, intersex and transgendered people; and, as a result of these oversights iii) Represents 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 sex at birth rather than on the basis of genuine medical need. For these reasons, we the undersigned call upon the Ministry of Health to revisit this policy and reinstate coverage for transsexual, intersex and transgendered individuals who require HRT.