Canadian Court Orders Taxpayer Coverage for Non-Binary Individual’s $70,000 Gender-Affirming Surgery Including Neo-Vagina While Retaining Penis

K.S. (pictured), a 34-year-old Canadian who was born male at birth, sued the Ontario Health Insurance Plan (OHIP) in 2022 after the insurance company denied their request to pay for the cost of a surgery to construct a 'neo-vagina' at a clinic in Texas

A non-binary individual in Ontario has won a landmark legal case granting full public funding for a $70,000 gender-affirming surgery, which will involve the creation of a neo-vagina while retaining a fully functional penis. The Ontario Superior Court of Justice ruled that the Ontario Health Insurance Plan (OHIP) must cover the procedure, travel costs to the United States, and an additional $23,250 in legal compensation.

The individual, identified in court documents only by the initials K.S., is a 34-year-old Canadian born male who uses female pronouns but identifies as transfeminine and non-binary. K.S. filed a lawsuit against OHIP in 2022 after the agency denied coverage for a penile-sparing vaginoplasty procedure to be performed at a specialized clinic in Texas—the only facility offering the technique, which is not permitted in Canada.

The company, which is run by President and CEO Matthew Anderson (pictured), argued the surgery cannot be publicly funded because the vaginoplasty would not be accompanied by a penectomy and is not a procedure listed on its schedule of benefits

K.S. requested the construction of a neo-vagina in the perineal space between the scrotum and anus while preserving the penis, citing this as vital to her gender identity. The appeal noted that she had completed over a year of hormone therapy and lived continuously for 12 months in a gender-congruent role. These requirements were confirmed by Dr. Irena Druce, an endocrinologist at the Ottawa Hospital, and mental health counselor Yael Sela, both of whom diagnosed K.S. with persistent gender dysphoria and supported her candidacy for the surgery.

OHIP initially denied the request, arguing the procedure was experimental and excluded from its schedule of benefits because it did not include a penectomy. However, the Health and Services Appeal and Review Board overturned that decision, ruling that vaginoplasty—even without penectomy—is a covered service under provincial law. OHIP appealed again, but the Ontario Court of Appeal upheld the ruling.

Dr. Irena Druce (pictured), an endocrinologist at the Ottawa Hospital, submitted a 'Request for Prior Approval for Funding of Sex-Reassignment Surgery' for K.S. after completing multiple assessments

Justices Benjamin Zarnett, Steve Coroza, and Lise Favreau stated that vaginoplasty remains an insured service regardless of the surgical technique or whether the penis is removed. They emphasized that the term “vaginoplasty” in the Schedule of Benefits is broad enough to include various approaches, including penile-sparing methods.

In a physician’s letter, it was noted that K.S. “Identifies as transfeminine but not completely on the ‘feminine’ end of the spectrum,” and thus seeks to maintain both male and female sex organs as part of her gender identity. Dr. Druce, whose medical research includes transgender health, supported this individualized approach to care.

Judge Benjamin Zarnett (pictured) and two others denied the insurer's appeals, ultimately ruling that taxpayers have to fund K.S.' s surgery. They also awarded her $23,250

Beyond the courtroom, K.S. had previously shared personal details about her life on Reddit, including struggles with bipolar disorder, experiences with child abuse, and advocacy for disability rights. She also posted in online communities focused on adult baby diaper lover (ABDL) interests, describing herself as a “transgender baby” and expressing fetishes involving incontinence and childlike behavior. She stated that her bedroom was decorated to resemble that of an eight-year-old girl.

K.S.'s Reddit account has since been deleted. The Province of Ontario has until June 23 to appeal the ruling to the Supreme Court of Canada.