A Canadian court has ruled that taxpayers will fully fund the $70,000 cost of gender-affirming surgery for a non-binary individual who wishes to undergo a unique procedure that preserves both a penis and creates a neo-vagina.

The individual, referred to only by their initials, K.S., was assigned male at birth but uses female pronouns and does not identify strictly as male or female, according to court documents from the Ontario Superior Court of Justice.

K.S., 34, filed a lawsuit in 2022 against the Ontario Health Insurance Plan (OHIP) after it denied funding for a surgery to construct a neo-vagina at a clinic in Texas. The surgery would involve constructing a female sex organ between the scrotum and anus while retaining a fully functional male sex organ.

In a landmark ruling, the court determined that Canadian taxpayers would cover the cost of the procedure, including the $70,000 for the surgery and travel expenses to the U.S.

The request for funding was supported by Dr. Irena Druce, an endocrinologist at the Ottawa Hospital, who, along with mental health counselor Yael Sela, assessed K.S. and concluded that they have “persistent gender dysphoria.” They stated that K.S. qualified for the surgery after undergoing hormone therapy for a year and living for 12 continuous months in a gender role that aligned with their gender identity.

The procedure, known as penile-sparing vaginoplasty, is only offered in Texas and is not available in Canada. However, the ruling ensures that K.S. can travel to the U.S. for the procedure, which will leave the penis fully functional and create the neo-vagina.

OHIP initially rejected the request, arguing that the procedure is not covered because it does not involve a penectomy, as outlined in its schedule of benefits. The insurance company also argued that the surgery was considered experimental in Ontario. However, K.S. appealed the decision to the Health and Services Appeal and Review Board, which overturned OHIP’s denial, ruling that the surgery should be covered even without a penectomy.

When OHIP appealed the ruling, the panel once again sided with K.S., affirming that the vaginoplasty procedure, even without a penectomy, should be fully insured. In November 2024, three judges from Ontario’s Appeal Court upheld this decision, rejecting OHIP’s arguments and confirming that the vaginoplasty falls under the province’s insured services.

The court’s decision also noted that K.S. identifies as transfeminine but does not fully align with traditional concepts of femininity, making the preservation of their penis alongside the creation of a neo-vagina crucial. K.S. also hopes to contribute to clinical research in this area of gender-affirming surgeries in the future.

Along with the victory for the surgery, K.S. was awarded $23,250 in damages. Ontario now has until June 23 to appeal the ruling to the Supreme Court of Canada.

K.S.’s lawyer, John McIntyre, expressed satisfaction with the decision, noting that it was the third unanimous ruling confirming that the surgery is covered under Ontario’s Health Insurance Act and its regulations.