A man living in Ontario, Canada, who identifies as nonbinary, wants to have a vagina without losing his penis — and he believes the public health care system should fund the complicated procedure that will supposedly give him dual external genitalia.

The patient, identified only as K.S., is a 33-year-old man who has been described by his endocrinologist as "transfeminine," a term applied to males who identify more closely with the feminine end of the so-called gender spectrum but who do not want to lose their masculinity entirely. K.S. uses a woman's name and prefers female pronouns. In court documents, he seemingly estimates that he is about two-thirds feminine and one-third masculine.

In 2022, K.S. petitioned Ontario’s Health Insurance Plan to agree to fund surgery that would allow him to have a faux vagina constructed without using tissue from his penis. His endocrinologist endorsed this petition. For the sake of K.S.' "personal interpretation of ... gender expression," he should "have a vagina while maintaining a penis," the endocrinologist claimed.

The surgery is so complicated that no Canadian hospitals perform it. In order to have what the National Post calls a "penile-sparing vaginoplasty," K.S. would have to travel all the way to Austin, Texas, to visit Dr. Curtis Crane, who describes himself as "uniquely qualified to treat patients requiring major genitourinary reconstruction."

Crane has previously bragged that he can perform nearly any kind of gender-related surgery imaginable. "I can’t think of a time that a patient has come up with a surgical request that I haven’t been able to fulfill," he said on a Facebook live session three years ago. Crane also insisted that penile-sparing vaginoplasties are not necessarily "uncommon." "I probably do 10 or so a year," he said.

Despite Crane's confidence and self-reported experience, OHIP ruled that the special vaginoplasty is experimental and denied K.S.' request. K.S. then appealed that ruling with the Ontario’s Health Services Appeal and Review Board, which overturned the OHIP ruling and decided in K.S.' favor.

OHIP, in turn, appealed the review board's decision with Ontario’s Superior Court of Justice, which heard the case in February. A ruling from the high court is expected in the next few months.

K.S. and his attorneys have argued that denying him the chance at both genitalia would be "invalidating" since he considers himself "literally a mix" of both genders. They also say such a denial is a form of conversion therapy, which is banned in Canada.

Dr. Crane took the attorneys' arguments a step further, claiming that "it's kind of assault to make a patient remove an organ that they’re enjoying."

But Canadian Gender Report, a group concerned about the rise in gender-related medicalization of children, believes cases like K.S.' show just how far "off the rails" things have gone. "Our public health-care system is at the breaking point and really needs to focus on procedures that are medically necessary," said CGR founder Pamela Buffone.

"Is this type of surgery health care?" Buffone continued. "The patient will not be physically healthier because of the operation, which is likely to result in complications and the need for corrective surgeries and further demands on the health system."

Though the case may seem strange, it is not entirely unprecedented. Last year, OHIP authorized funding for Nathaniel Le May, a 41-year-old woman who identifies as a man, to undergo a procedure to create a phallus without compromising her vagina and uterus. She had argued that forcing her to destroy her biological reproductive organs in order to gain a synthetic one was akin to forced sterilization.

Le May hinted that OHIP had engaged in some kind of discrimination in denying K.S.' claim. "Why is it considered experimental in her case to have a vagina and a penis, but not in my case?" Le May said. "Why did OHIP concede that it is an insured service for me but continue to fight that hers is not? OHIP is being inconsistent."

"My outcome is the same as K.S. We will both have a penis and a vagina."

K.S. declined the National Post's request for comment.

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