Less than two months after Bruce Jenner revealed to the world that "for all intents and purposes, I am a woman," during a prime-time TV interview, she donned a white bustier on the cover of Vanity Fair as Caitlyn Jenner.

Famed photographer Annie Leibovitz expertly captured Jenner's first public appearance as Caitlyn. Some people compared Jenner's beauty to that of Oscar-winning actress Jessica Lange.

But what's being presented as a seemingly fairytale story is not the reality for many transgender people who face long wait lists and costly procedures that public health services don't necessarily cover.

In addition, while there are increasingly more transgender people who are welcomed by their families and communities, some face systemic transphobia through the denial of health care, difficulty finding a place to live or workplace discrimination.

"These are all things that [Jenner] doesn't have to face on a day-to-day basis," says Jack Hixson-Vulpe, a 28-year-old education and training facilitator for The 519, a city of Toronto agency that helps support transgender people and other groups.

Lengthy wait times

Jenner's estimated $100 million US net worth means she wouldn't be subject to lengthy wait lists for publicly funded surgery, says Hixson-Vulpe, who has undergone his own transition.

Jack Hixson-Vulpe

Jack Hixson-Vulpe says transgender people have been discriminated against historically, but the transgender community is 'still here and we are still fighting.' (Steven J. Wilson)

In Ontario, only Toronto's Centre for Addiction and Mental Health can approve someone for gender-changing surgery and referred patients wait about a year for their first appointment, according to its website. It takes several months more to have surgery approved, and then applicants must wait for a surgery date.

People transitioning from male to female wait about six months for genital surgery, says Pierre Brassard, a Montreal plastic surgeon who performs gender reassignment surgeries. Those seeking a female to male transformation can wait up to a year and a half, depending on the required procedure.

Costly surgeries

Most Canadian territories and provinces fund some form of gender reassignment surgery, but there is generally other costly work involved that those transitioning may want.

"It's hugely expensive," says Trish McNorgan, a 65-year-old transgender woman living in Winnipeg. "I spent a small fortune on my transition."

"I spent a small fortune on my transition." - Trish McNorgan, a 65-year-old transgender woman

The military covered her gender reassignment surgery in 2009, while she was in the air force.

Still, McNorgan paid about $20,000 for facial feminization surgery, some $6,000 for hair implants, and another several thousand for breast implants, fat grafting and electrolysis to remove facial hair.

Some medical costs associated with transitioning, like hormone supplements, may continue for life, says Hixson-Vulpe.

There are also potential non-medical expenses, he says, like new clothes, makeup or voice lessons. Not everyone has the $30,000 to $50,000 to spend on all these procedures, he says.

Family strain

Another factor when transitioning is the "extreme amount of anxiety" that can arise when dealing with potentially unsupportive people, says McNorgan.

Her elderly mother refuses to speak to her now, and the change temporarily strained some other relationships in her life.

In 2011, a study by a U.S. group looking into transgender issues found that of its 6,450 respondents 55 per cent said their family relationships were weaker after coming out. Forty per cent reported at least one family member "chose not to speak or spend time" with them afterwards.

Caitlyn Jenner

Caitlyn Jenner was featured on the cover of Vanity Fair after revealing her plans for transition in a television interview with Diane Sawyer. (Vanity Fair)

Matched against this, however, is the emotional and mental wellbeing of those individuals struggling with gender identity.

Before her transition, McNorgan struggled with alcoholism and drug addiction, using substances as a coping mechanism.

She attempted suicide more than once. The last "pretty serious" attempt partly prompted her transition.

"I reached the point where, you know, I really couldn't go on with the way things were," she says.

The U.S. transgender survey found 41 per cent of respondents had attempted suicide. 

The 2015 Canadian Trans Youth Health Survey by the University of British Columbia surveyed more than 900 transgender youth and found that more than one third of 14 to 25 year olds had attempted to kill themselves at least once.

Employment, housing, health care

Another hidden cost of transitioning is the possible "domino effect" of discrimination, says Hixson-Vulpe.

Transgender people often face employment, housing and health-care discrimination, he says. Some even face violence. 

He hears stories of transgender people losing their jobs or not being hired because of their transition.

In the U.S. survey, respondents were nearly four times more likely than the general population to live in a household bringing in less than $10,000 US annually and were twice as likely to be unemployed.

Some landlords will reject transgender applicants and some doctors will refuse to treat transgender patients, Hixson-Vulpe says.

Jenner has 'a lot of guts'

Jenner's transition has obviously been different than the norm, but that is not to say it was easy, or without family disapproval or emotional strain, as the tabloids pointed out.

"There's no less a mental toll on [her] than there is on anybody that goes through this," says McNorgan. "It's the hardest thing that you ever do."

"It takes a lot of guts for somebody in a position like she's in to do this," she adds. Jenner's "life is right there for everyone to see."

But as Jenner and other celebrities publicly come out, it makes it "less difficult" for others, she says.

"I would have been tarred and feathered if I did this in the '50s," she says of her transition. "The only way that it's going to get better for trans people is for information to get out there and for people to tell their stories."


The National Gay and Lesbian Task Force and the National Centre for Transgender Equality survey was distributed in English and Spanish by more than 800 trans organizations, but was inaccessible to some ethnic minority groups due to language barriers.

The University of British Columbia survey questioned 923 young people between 14 and 25 years old across Canada, with the exception of the Yukon and Nunavut. The majority of respondents reported being white and more than three quarters spoke only English at home. The survey asked different questions of younger respondents (ages 14-18) and older respondents (19-25).