Transgender Quebecers face surgery delays, patients from outside the province get faster care

Fraser Place says gender-affirming surgery will finally allow her to feel comfortable in her body. But the 26-year-old Montrealer says that sense of comfort feels very far away.

Recently, GRS Montreal, the only clinic offering fully subsidized gender-affirming surgery in Quebec, announced that changes in provincial funding would delay wait times – possibly by years.

This news leaves Place feeling as if its future is at stake.

“It’s quite upsetting,” he said in a recent interview, “knowing that this is probably going to extend into the rest of my 20s and maybe even my early 30s.”

However, what is more frustrating for Place and transgender advocates is that the delay is only affecting Quebecers. Wait times for out-of-province patients – about 65 per cent of private clinic clients – are staying largely the same and in some cases decreasing.

Jacob Franklin, co-administrator of the Trans Patient Union, an advocacy group for transgender and non-binary patients, said people should be outraged by the situation.

“A clinic in our own city, in our own province is able to serve non-Quebecers better because their funding system is adequate,” he said in a recent interview.

GRS Montreal provides a lifeline to transgender people in Quebec and the rest of Canada, particularly in the Atlantic region, where many clinics do not have the capacity to perform complex procedures. New Brunswick, for example, refers the majority of patients seeking bottom surgery to GRS.

Recently, the clinic announced that funding cuts from the Quebec health department will force it to perform fewer surgeries and delay wait times — but only for Quebec residents, a decision that leaves patients like Place no choice but to wait or pay out of pocket for procedures that can cost up to $100,000.

About 35 per cent of the clinic’s patients are Quebecers, about 40 per cent are Ontarians, 13 per cent are from the Maritimes, 11 per cent are from Western Canada, and about one per cent are from outside the country.

GRS owner and medical director Michel Gagner says GRS has the potential to “double or even triple” the number of surgeries performed per year for Quebecers, but the province has strict limits on its budget for the clinic. Each year, when Quebecers’ budgets are reached, the clinic continues to offer surgeries for people from elsewhere in Canada, who are funded by their provinces’ health care plans.

“This limitation, combined with high demand, contributes to long wait times (for Quebecers),” he said.

GRS Montreal’s website says it performs about 1,600 surgeries each year. Gagner did not want to give exact figures.

Clinic owner says Quebec’s budget needs to be doubled

In the 2024-25 fiscal year, the wait time for Quebec residents to have breast removal surgery, known as a mastectomy, was 18 months. It’s been at least two years now. The wait time for out-of-province patients was 13 months in 2024-25. It’s been six months now.

The delay through 2024-25 for the female genital reassignment procedure — known as vaginoplasty — was about 20 months for Quebecers, and is now 34 months. The wait time for that process was the same for out-of-province residents in 2024-25, but now it is 18 months — almost twice as short.

Updated projections for Quebecers indicate a three-year wait for surgery to remove the testicles, called orchiectomy, and a three-year wait for masculinization of the genitals using existing genital tissue, called metoidioplasty.

“These two, three-year waiting periods are really devastating for trans patients,” Franklin said. “We have people who have reached out to us with news in crisis.”

Gagner, for his part, said the clinic had received “numerous messages expressing concern, frustration and distress.”

When Place heard the news, she said, “I felt like my world was ending.”

Place, who is originally from Ottawa, is awaiting phalloplasty, a procedure the clinic says makes the genitalia “like biological male genitalia on both a functional and aesthetic level.” As for phalloplasty, the clinic said it could not provide a clear timeline, noting that the procedure depends on individual factors, including lasering out hair from the patient’s forearm for skin grafts.

Place submitted her paperwork for surgery more than a year ago and is scheduled to meet with a surgeon in April. And while he doesn’t have a date for the surgery yet, he knows it will take longer than he anticipated.

More than 1,200 Quebec patients were waiting for surgery at the clinic at the end of 2025, Gagner said, adding that the clinic has “seen a sharp increase in demand over the last few years.” If the province does not increase its funding for the clinic in the next fiscal year, the backlog will continue to grow, Gagner said. They warned that waiting times could reach four years for vaginoplasty and three years for mastectomy.

Quebec, meanwhile, says it has not made any cuts to the GRS budget. Health department spokeswoman Marie-Pierre Blier said in an email that funding for the 2024-25 fiscal year was “exceptionally high” at $9 million. That year’s budget was increased to “allow the planned surgical program to continue.”

But that envelope drops to $7.3 million for 2025-26, he confirmed. It was “always clear” that the increase in 2024-25 was a one-time measure, adding that provincial funding to the clinic has more than tripled since 2018-19. Financial resources are limited and difficult choices will have to be made, the spokesperson said. Funding in the 2023–24 budget was $8 million.

Gagner says provincial funding needs to be doubled to between $14 million and $15 million to realign wait times to meet demand and adequately meet the needs of the population.

Paying out of pocket can be prohibitive for many transgender patients in their 20s and 30s, Franklin said, adding that they have to put other major projects on hold to pay for health care.

“You’re drowning in debt, you’re not saving. You’re not saving for a house or a wedding. You’re not doing these important, expensive things.”

An agreement between the hospital center of the Université de Montréal, the Quebec Department of Health and GRS Montreal gives the private clinic exclusive responsibility for publicly funded gender-affirming surgeries in the province until 2028.