The Chronicle Herald (Provincial)
Transgender woman denied surgery
‘I just want my breasts to fit my frame’
SYDNEY — Depression swept over Scarlett after she was denied provincial coverage for gender-affirming top surgery.
Like many transgender people, the 25-year-old suffers from gender dysphoria - which is when somone suffers poor mental illness, like anxiety, depression or suicidal ideation, because their gender assigned at birth isn't what they know it should be. It is curable with treatments like gender affirming surgeries.
Scarlett, whose identity is being hidden to protect her from harassment from transphobic people she knows, needs top or breast augmentation surgery as treatment for her gender dysphoria.
But she was denied her application for provincial coverage for the surgery in 2019 after an examination done through her clothes with a cis gender female doctor (someone who identifies as the gender assigned to them at birth), that was based on scales used for cis female bodies.
"I just want to feel in my own body. My chest right now, it's, my breasts don't fit my frame. I have a large rib cage so I look disproportionate. Especially if I have my top off and stuff, I look disproportionate and that causes me a lot of dysphoria because it doesn't look like it's supposed to look," said Scarlett.
"And it's not even about having big boobs or whatever. It's about, I just want my breasts to fit my frame and proportionate to my body."
NOT ALONE
Advocate Veronica Merryfield is helping Scarlett fight the province's decision; she doubts many trans women have been approved for Nova Scotia coverage for breast augmentation surgery since 2017 when it was added as an insured procedure.
"There are restrictive rules put in place to stop it (approval for the surgery) - they want 18 months on hormones instead of the internationally recognized 12 months, and they tend to say no if a certain amount of growth has been achieved which is typically small," said Merryfield, a woman who was born intersex and raised male.
"The person themselves should be the self-assessor under informed consent. They should be the ones to say (what size breast they should have) and not all these gatekeepers."
An interview request sent to the Nova Scotia Department of Health and Wellness was unable to be accommodated, however, some information was provided via email.
They confirmed 44 gender affirming surgeries, both top and bottom for trans women and trans men, were done in Montreal under provincial coverage in the 2020-2021 fiscal year.
The number of breast augmentation surgeries for trans women was not provided.
INSUFFICIENTLY EXAMINED
In order to be eligible for the procedure, a trans woman has to get two letters from WPATH (World Professional Association for Transgender Health) professionals, including a specialist letter from a doctor at the Halifax Sexual Health Centre.
The examining doctor follows guidelines from WPATH for standard of care and based on how much breast the woman already has, will determine eligibility.
Merryfield and Scarlett said eligible size is determined using the Tanner Scale, a system which uses five levels to describe different stages of body development in females and males, through puberty to maturity. The scale is made according to cis gender people, those who identify with the gender they were assigned at birth.
Both women believe this scale isn't accurate for trans women because they generally have larger shoulders, rib cages and overall body structures.
Scarlett said the cis female doctor who did her assessment for eligibility didn't ask her to remove any clothing, including her jacket. The doctor looked at Scarlett through the clothes and determined Scarlett's breasts were large enough to make her ineligible for provincial coverage.
"Based just on my weight, she never examined me, she basically just looked at me through my shirt and she was like, "I can already tell you don't qualify. You have enough breast growth already." She didn't base this decision on breast growth. She was basing this decision on fat," Scarlett said.
"It made me feel unlistened to, like, just kind of disregarded. Not taken seriously, not given a chance to explain my side ... to explain they don't look proportionate for my body and they are underdeveloped."
Merryfield believes the levels on the Tanner Scale used in Nova Scotia for assessing the surgery is level two or three. Two is the level where female breasts start developing. The last level, five, would be mature female breasts.
"Why does the medical system that is supposed to help make it so hard for women to get these surgeries they need?" Merryfield said.
The Cape Breton Post was unable to verify with the Department of Health and Wellness what level of the Tanner Scale used to determine eligibility for provincial coverage.
Through email they did confirm eligibility is determined "on an individual basis, based on the recommendation of the person's healthcare professional."
BODY FITTING CLOTHING
Although gender affirming surgeries became an insured service in Nova Scotia in 2014, breast augmentation for trans women wasn't a part of the list until 2017 after a human rights complaint was filed by the province.
Serina Slaunwhite filed the suit after being denied the surgery, which is gender affirming for trans women and not cosmetic.
For Scarlett, breast augmentation isn't something she can afford without the help of provincial coverage.
Although her bottom surgery was covered, it was still costly as transportation to Montreal where the surgery is performed and accomodations for the month long recovery after aren't.
When she is finally able to get the top surgery she needs, Scarlett said she knows it will give her the confidence she's longing for to dump the baggy clothing she's hiding under for some body fitting outfits and low-cut tops.
"I want to feel sexy for once," she said. "I feel it will be so validating."