TORONTO - Canada's health-care system may be built on the premise of equal access for all, but the transgender community says the provision of services for those who don't conform to traditional notions of male and female can be far from universal.
A common complaint is that many doctors and other medical practitioners lack an understanding of what it means to be transgender, and even seeking routine care can lead to invasive and irrelevant questions about sexual orientation and genitals.
And with some practitioners, the response to a transgender patient can be outright hostility.
"Health care is incredibly inaccessible for most trans people across the country," says Ryan Dyck of the LGBTQ advocacy organization Egale Canada. "Finding a health-care professional outside the MTV — Montreal, Toronto and Vancouver — is pretty difficult.
"And the reality is prejudice and discrimination against trans people in this country is extremely high, and so quite often trans people will encounter doctors who simply say 'I won't treat you because your trans.'"
Dr. Carys Massarella, lead physician at the transgender care clinic Quest Community Health Centre in St. Catharines, Ont., says many doctors feel uncomfortable dealing with transgender patients because they've had virtually no training in medical school or as interns and residents.
"Some of the clients I see in the clinic, there's no question that they're afraid to tell their doctor because they think the doctor will fire them if they identify as (transgender)," she says.
"Or if they do disclose to their doctor, their doctor has a very negative attitude towards it, like 'You can't be serious? Why would you do that? You'll ruin your life.'
"I remember I had one patient whose doctor told them they should pray."
A study she co-authored, published last year in the Annals of Emergency Medicine, found that 21 per cent of about 400 transgender Ontarians in the 2009-2010 Trans Pulse survey reported having avoided hospital emergency room visits over concerns about how they would be treated.
More than half of those who did seek care at an ER in their "felt" gender reported negative responses, such as hurtful or insulting language, being belittled for being trans, being told practitioners did not know enough to provide care, and in some cases, being refused care.
Still, attitudes in the medical community are slowly starting to change, says Massarella, herself a transgender woman.
"There are more doctors now who are willing to entertain the idea at least that you have persons who may have this transgender identity. They want to do the right thing, but often they don't know what to do."
Increasingly, medical schools are including LGBTQ issues in their curriculum, notes Massarella, who teaches one such course at McMaster University in Hamilton.
"The med students are demanding it, quite frankly," she says. "There's a huge need and desire for young doctors and medical students. They want to learn about this. They want to be able to treat their trans and queer-identified clients in a respectful way."
Massarella says the Quest clinic is one of a handful of centres across the country for transgender children and adults that offer a safe, supportive environment for patients as they navigate transition socially, medically and, if they so choose, surgically.
Patient care is based on the assumption that questioning gender is not a pathological illness, but simply a person recognizing their core identity.
"And that's the kind of health care they're looking for," she says. "They're not looking for people to fix them. They're looking for people to help them."
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