When I first arrived in Toronto from Colombia in the fall of 2021 to study journalism, I was still grappling with my identity. Growing up in a mostly Catholic society, I had often fantasized about getting away, and creating a new life from scratch. Back in Colombia, I still hadn't come out to my parents as trans. I was scared of what their reaction would be—so starting my medical transition at home hadn’t felt like a realistic option. That changed once I moved. Halfway through my first semester, I felt ready to pursue medical transition.
 

By early January the following year, I’d gotten my first HRT prescription, after three months of weekly sessions with a therapist and a primary care provider at my university. I didn’t initially realize how much easier my experience accessing care was than average: I was able to get my prescription relatively fast, and with few financial barriers. My university had matched me with a doctor and therapist who understood trans healthcare, and who made me feel safe discussing gender-affirming care. My therapy and doctor’s appointments were covered through the school’s insurance for international students, as were up to 80 percent of my prescribed medications.
 

I remember stepping outside into what would be my first winter storm in Toronto, and making my way to the pharmacy to fill my first prescriptions for estradiol and spironolactone. For once, I felt in control of how my body would change, and to my surprise I paid less than $10 out of pocket for a month and a half’s worth of meds, thanks to my insurance. 

 

I felt ecstatic to be in a country—and attending a school—with such a streamlined process for people to access HRT. For a long time I assumed my experience was close to universal in a city like Toronto. I didn’t know that many trans people in Canada struggle to find doctors who are willing to provide gender-affirming care, or that others spend years on wait-lists to receive their initial HRT prescriptions. 
 

I continued to be shielded from this reality for years, while my student insurance covered my healthcare costs. But in the winter of 2025, as my graduation date approached, I learned that accessing HRT—or any trans-affirming healthcare for that matter—would become much harder once I was no longer a student. 
 

Upon graduating, I learned, I’d face the barriers to healthcare access many immigrants contend with in Ontario. Even with a valid work permit, immigrants under the age of 25 who have not yet become permanent residents are unable to access OHIP unless they are working full-time in Ontario, for an Ontario employer, for at least six months. (Those over 25 can apply to the Trillium Drug Program, which helps cover drug costs for people that meet an income-based deductible.)

Without access to OHIP or any other form of medical insurance, I knew my healthcare costs would pile up. Uninsured immigrants accessing gender-affirming care in Ontario can expect to pay around $50 for routine blood work and about $200 for doctors’ visits. Monthly HRT costs for uninsured trans people can cost up to around $250 a month, depending on the form of medication taken.
 

Leaving school also meant leaving a family doctor I trusted to sensitively handle my gender-affirming care. Suddenly, I found myself joining a long list of trans Ontarians struggling to find a doctor willing to oversee their medical transitions.
 

When I graduated in June, I had two months’ worth of hormones left, and the countdown to figure out how to renew my prescriptions was on. Living in Toronto, I had access to more trans-friendly clinics than most—but even so, getting care was challenging. One LGBTQ2S+ health clinic I reached out to put me on a three- to six-month-long wait-list, and informed me their consultation fee for non-OHIP holders was $300 per appointment. Planned Parenthood offered a consultation for free, but told me their wait-list was long—up to four years for an initial appointment. 

I considered buying private insurance, but while companies such as Canada Life and Manulife have plans for temporary residents, none of them cover HRT. I eventually opted for a travel insurance plan that cost $150 monthly, which would cover my prescriptions as well as any emergency medical expenses I might have in the future. It notably wouldn’t cover consultation fees for routine doctors visits or blood work—meaning that my healthcare expenses would still be upward of $1,000 a year. While the costs were stressful, they weren’t insurmountable for me. For others, that may not be the case: research shows that one in five recent immigrants in Canada live below the poverty line.
 

Canada has a reputation as a safe haven for trans immigrants, and in some senses, this is true: moving here can allow us to flee persecution or discrimination in our countries of origin. But this reputation is waning as immigration laws tighten, and the country takes steps to reduce both its refugee and permanent resident targets. 
 

And, despite the popular conception that Canadian healthcare is universal, it isn’t—not for Canadian citizens who are trans and struggling to find a doctor, and certainly not for trans immigrants. The barriers to care we face put us at risk of having to delay, or pause, our transitions if we can’t afford care, or find a way to access it quickly enough. Our healthcare system shouldn’t be tiered. All provincial governments, including Ontario, should expand their healthcare coverage to all residents, regardless of their immigration status. 
 

Making HRT accessible for trans immigrants under provincial healthcare plans would drastically change the lives of low-income trans people—who should have as much of a right to access medical transition as anyone else. It would also provide a more streamlined, and safer, route to access HRT and ensure proper dosing, regular blood testing and safe administration. 

For my part, in September 2025, just as my prescriptions were about to run out, I got lucky again: I found a nearby walk-in clinic where a physician was willing to extend my prescription, something not all providers—and especially not all walk-in doctors—are willing to do. While I had to pay more than $100 for the appointment, I walked out with a one-year prescription in hand.
 

I don’t know what the future holds for me in regard to finding stable healthcare access, a full-time job that allows me to get OHIP or my PR. But I’m taking it day by day, hoping the haven I searched for five years ago when I first arrived in Toronto wasn’t fleeting after all.