Healthcare Delays During the Pandemic had Unique Impacts for Trans People, Engage Study Finds.

Since COVID-19, the importance of timely access to healthcare has been brought into stark relief. For many trans and gender-diverse people, disruptions to care have been particularly challenging. A recent mixed-methods study, conducted as part of Engage, explored access to gender-affirming care and other experiences of trans and gender-diverse people during COVID-19.[1]

Engage researchers conducted interviews with over a dozen trans, nonbinary, and gender nonconforming individuals between November 2020 to October 2021, capturing experiences at the height of COVID-19-related lockdown measures.  Participants—based in Montreal, Toronto, and Vancouver—described challenges that were unique for trans and gender-diverse people. 

For example, gender-affirming surgeries were deemed “non-essential” in various jurisdictions, prolonging wait times and existing backlogs. These delays were more than just inconveniences; they had profound impacts on participants’ mental health. Some described this as “frustrating” and a “double standard,” considering other types of care that were not delayed. 

Researchers also spoke to participants who faced challenges filling prescriptions for hormone replacement therapy, given supply chain shortages in North America for testosterone. 

Today, COVID-19 prevention measures are no longer impacting care in the same way, yet barriers to gender-affirming care continue. Provincial insurance schemes vary when it comes to coverage for gender-affirming procedures, and only 26% report having received all the gender-affirming care they need.[2] While supply chains have stabilized, testosterone can still be difficult to obtain as it is a controlled substance in Canada. Testosterone is regulated this way to reduce doping in sports, but there are growing calls to revise this regulation and increase access to the medication.[3]

The findings of this study underline the need to prioritize gender-affirming care in our healthcare system. As COVID-19 shook healthcare norms, it magnified existing disparities. The experiences shared by participants cast a spotlight on public policies that aren’t working for people who are made to be marginalized in our country, including barriers to gender-affirming care.

Yet amidst these challenges, participants in the study were resourceful and resilient. For example, while in-person connections were cut off, online knowledge-sharing took place to inform other community members about local availability of medications like testosterone, or strategies to extend use of the medication. Others described time at home as an opportunity to experiment with gender without fear of transphobia or gender policing.   

These findings from Engage serve as a poignant reminder that healthcare is not a one-size-fits-all solution. If we don’t purposefully work to reflect the needs and experiences of queer and trans people in healthcare and public health policies, our systems will fail queer and trans people. While gender-affirming care saves lives, people wait for years to receive the care they need, clinicians lack appropriate skills and training, and significant out-of-pocket costs remain. It is imperative that we listen to the stories shared in this study and work toward a future where healthcare is truly inclusive, responsive, and equitable for everyone.

The Engage COVID-19 study seeks to document COVID-19 infection, immunity and related determinants among gay and bisexual men (GBM), and to examine how this population perceives and is impacted by measures to curb the spread of the disease. Funding was provided by the Canadian Institutes for Health Research (CIHR) and the COVID-19 Immunity Task Force (CITF).

[1] Grey C, Sinno J, Zhang H, Daroya E, Skakoon-Sparling S, Klassen B, Lessard D, Hart TA, Cox J, Stewart M, Grace D. Queering public health: A critical examination of healthcare access and gender expression among trans, nonbinary, and other gender nonconforming people during COVID-19. Health & Social Care in the Community. 2023 Mar 4;2023.

[2] Trans Pulse Canada. Health and health care access for trans and non-binary people in Canada. [Internet]. 2020. Available at:

[3] Garrison R, Thompson D. White Paper on the Status of Trans and Gender Diverse People. June 2023. Available at:

January 11th, 2024