Being Jackie

Transition Related Surgery program reaches milestone in patient care delivery

Jackie standing against wall smiling

Jackie, Transition Related Surgery program patient 

Being Jackie

Transition Related Surgery program reaches milestone in patient care delivery

Jackie standing against wall smiling

Jackie, Transition Related Surgery program patient 

“There wasn’t a moment. I think I knew it all the way back to my childhood, as long as I can remember.”  

Jackie’s transition journey began almost three years ago when she shared what she had always known with her close family and friends. “Before my transition, I was uncomfortable with something, but I didn’t know what that was until I figured out that I was trans,” says Jackie. “Before I was out, I was very quiet and kept everything to myself. I was mentally exhausted, and my dysphoria was just something that I couldn’t get out of my head.”

Jackie’s experience is all too familiar for many. With continued gaps in education and training in nursing or medical schools, it can be difficult to not only learn about the options available for trans and gender diverse (TGD) patients but also to receive quality care and consultation. While TGD identity doesn’t always hinge on transition-related surgery, Jackie’s dysphoria made it clear that vaginoplasty was the right decision for her.

Jackie’s loved ones embraced the news with unwavering support, allowing the now 22-year-old lifeguard and swimming instructor to embark on a path toward self-discovery and authenticity. “I felt so lucky,” she says. “To be supported by my family and friends from the very beginning of my journey – not everyone in our community gets that lucky.”

But this wouldn’t just be a milestone for Jackie – it would also be one for Women's College Hospital’s (WCH) Transition Related Surgery (TRS) program, which would welcome her as its 100th vaginoplasty patient. This achievement highlights the tenacity of the surgical program. It is a testament to all the TRS patients before Jackie, whose experiences shed light on the importance of support, research and determination in the pursuit of gender-affirming care.

Under the leadership of Dr. Yonah Krakowsky, medical director of TRS, and nurse practitioner Emery Potter, Women’s College Hospital’s transformative journey to enhance healthcare for TGD individuals began in 2017. This initiative would make WCH the exclusive provider of genital transition surgeries in Ontario and only the second such clinic in Canada at the time.

“I consider it a real privilege to be part of the TRS program and to contribute to its growth,” says Dr. Alexi Millman, a urologist at WCH. “Our capacity for vaginoplasty surgeries has more than tripled since the program's inception, and I see it continuing to expand. The program has meaningfully contributed to WCH’s trajectory of becoming a true centre for excellence with respect to sex and gender in health.”

Dr. Alexi Millman standing in OR smiling

Dr. Alexi Millman in the operating room 

To ensure precision and inclusivity at the onset, WCH initiated a comprehensive education campaign extending from pharmacists to environmental service workers to volunteers within the hospital, aimed at equipping them to support TGD patients. They also invited 20 TGD people to walk through the surgical journey, identifying potential areas of discomfort.

Changes were made. Washroom signs went from the traditional male-female binary to include gender-neutral messaging. The hospital tweaked its electronic health records system, prioritizing patients’ chosen names over legal names. Even more granular changes, like providing opaque bags for wigs in patient lockers, showed a nuanced understanding of the unique needs of TRS patients.

The TRS program expanded its capabilities by hiring a nurse practitioner. A pelvic physiotherapist also underwent specialized training, contributing to the formation of a robust multidisciplinary team capable of addressing the diverse needs of patients. Over time, the profile of the program rose, and so did the demand for this life-saving care.

“Advancements in research into TGD healthcare and commitments to staffing and expanding specialized services within the TRS program have played a pivotal role in meeting the rising demand,” says Olivia Drodge, a physiotherapist working in TRS. “As a pelvic physiotherapist, my role is crucial in optimizing patients’ physical health and well-being throughout their surgical journey. Collaboration between various specialties ensures that patients receive surgical expertise, mental health support, social support, rehabilitation and pain management.

Olivia Drodge working with patient doing exercise with medicine ball and dumbbells

Physiotherapist Olivia Drodge conducting pelvic floor exercises with a patient

With the help of this interdisciplinary team of clinicians, the program has made strides in ensuring comprehensive care for patients like Jackie, emphasizing a patient-centered approach and providing resources, guidance, and a supportive community throughout the process.

“My best friend and I were obsessed with doing the research ourselves. We thought we already knew everything we needed to,” says Jackie. “Still, the entire team was friendly and approachable. They made me feel so secure and spent time telling me all the things I might not find in a resource book, like hotel discounts and tips for post-surgical care.”

Jackie also emphasizes the importance of support during the first-year post-op, praising the TRS team's open communication and guidance. "I’ve recently had some post-op complications, and my relationship with the people in the TRS program has made it a lot easier to share my concerns and deal with these issues," she says, noting the hospital's commitment to follow-ups, both medical and emotional, showcasing a holistic approach to patient care.

Reflecting on her experience, Jackie acknowledges the significance of being the 100th recipient of vaginoplasty at WCH. Her hopes for the future extend beyond personal milestones. "I want the program to keep reaching people who need it. These surgeries are quite literally saving lives."

Trans-Link Canada Project Forges Ahead With

$2.5 Million Grant

Translink Canada Group Photo

Trans-LINK Canada Network members at network planning meeting at WCH

Transgender and gender diverse (TGD) individuals face high rates of sexual assault and intimate partner violence, yet access to safe, non-stigmatizing services for TGD individuals remains limited. The Trans-LINK Canada Network seeks to address this pressing issue with the help of a $2.5 million Partnership Grant from the Social Sciences and Humanities Research Council (SSHRC). The network is led by Women's College Hospital senior scientist Janice Du Mont in collaboration with a multidisciplinary team of experts.

Read This Story“TGD people are highly susceptible to experiences of violence,” says Hannah Kia, co-applicant and assistant professor at the University of British Columbia’s School of Social Work. "Anti-trans stigma and discrimination often underlie these experiences, with TGD individuals frequently encountering inequities when seeking safety and support post-violence.”

The initiative involves collaboration with 56 diverse partners, including community and healthcare organizations and peer leader advisors, to actively engage the perspectives of TGD individuals.

“We are initiating several key research studies that will enhance our understanding of the unique experiences and needs of TGD survivors,” says Du Mont. “Project activities will include co-designing training and guidelines, generating policy recommendations and disseminating information nationwide to bolster our collective response to this urgent issue.”

The SSHRC Partnership Grant has already facilitated crucial advancements for the Trans-LINK Canada Network Project. Leaders from the community and healthcare organizations are guiding regional project activities, and seven diverse trainees from various disciplines have been recruited. Trans-LINK Canada Network Planning Meetings were recently held nationwide to discuss barriers to care for TGD persons regionally and how to begin dismantling those barriers. Women's College Hospital played host to the first of these meetings in May 2024.

In a pioneering effort, the project is undertaking the first nationwide survey in Canada dedicated to specifically studying sexual assault and intimate partner violence against TGD persons. A geographic information systems (GIS) mapping component is also being used to map TGD-affirming community organizations and hospital-based violence treatment centres nationwide. Interviews with TGD persons are now on the horizon to evaluate the accessibility of services for TGD persons who have experienced sexual assault and intimate partner violence, with recruitment commencing in the summer of 2024. Subsequent focus groups will assess partnering organizations' potential for collaborative and comprehensive service delivery.

The project is also developing online learning modules to educate professionals across various sectors on effectively addressing the unique needs of TGD survivors of sexual assault and intimate partner violence. The evidence-informed curriculum for health and social service providers is undergoing an external stakeholder review.

At the core of these efforts is the establishment and evaluation of a National Knowledge Hub, serving as a central repository for research and knowledge sharing within the national network, aimed at improving support for TGD survivors of gender-based violence across Canada.

“Our new partnership will champion a cutting-edge, coordinated and evidence-based national network, ensuring health and community organizations can co-create and exchange knowledge,” says Du Mont. “This collective capacity is necessary to revolutionize and inform the coordination of supports for TGD survivors of sexual assault and intimate partner violence.”

“And in doing so, I believe the trans-LINK Canada Network will address serious gaps in research, policy and practice,” adds Kia.