Island of the dolls.
(First published July 24, 2026 on CBRC.net)
OK, I’m not sure “Island of the dolls” will be the next PEI tourism or recruitment campaign — but it could be! That’s all I am saying.
As a clock-y, rural, transsexual millennial, I have to say, I did not choose to work in trans health. It was just something I had to navigate. It’s hard for trans folks to not become experts in this process. Coupled with my DIY punk rock ethos and my “can’t leave well enough alone” attitude, implicating myself into health policy was simply a natural progression.
First, we need to paint a picture.
From 2018 to 2023, PEI had a Gender Confirming Surgery policy. It was a bad policy, but a policy nonetheless — something many provinces still do not have in 2026. Gender-affirming care was accessible through primary care if you had a decent provider, and since 2021, through a Health PEI clinic for folks who didn’t. Werk.
All in all, in 2021, access to medically necessary gender-affirming care on Prince Edward Island was reasonable… That is, unless you were a trans woman.
The World Professional Association for Transgender Health's Standards of Care (SOC 8) is the largest body of internationally peer-reviewed evidence on transgender health. Within it are general assessment criteria to meet recommended treatment guidelines, as well as the professionally recommended treatment options themselves, proven to improve outcomes for trans people. Unsurprisingly, public health policies frequently reference these standards because of its comprehensive evidence-based approach.
Despite WPATH's official position on medical necessity (2016), in 2021, PEI continued to recategorize most women's gender-affirming interventions as vanity procedures. Today, this is still true for most provinces, regardless of whether they claim to use SOC version 7 (2012), or version 8 (2022). So, while provinces strictly follow WPATH’s guidance for assessments, the recommended treatments to address the very issues identified in those assessments are actually denied if you are a woman.
The health authority was selectively deciding which clinical recommendations to accept, and which to dismiss. This decision process was not founded on clinical evidence — it actually contradicted it.
The choice to explicitly exclude feminizing procedures from the province’s care policy was shaped by biases that devalued femininity and feminine traits while upholding traditional masculine ones. This is a fight being fought across Canada, and not unique to PEI. This is also where Gender Affirming Care PEI (GACPEI) steps onto the scene. Our big move: I faxed the above sentiment to Health PEI’s leadership. Yes — faxed. Agencies hate a paper trail, and I love a good fax because of that.
To their credit, Health PEI quickly responded and soon committed to a third-party review to look into my claims. Within 4–6 weeks, they came to terms with the facts as we had laid them out. Health PEI’s executive leadership graciously included a seat at the boardroom table for us to consult on updating the care policy with trans women in mind.
When the province’s new Gender Affirming Procedures Coverage policy was launched in July 2023, PEI instantly became a trans health leader in Canada, and Gender Affirming Care PEI was awarded a PEI Human Rights Day Award later that year for this work.
“I am so grateful for a resource like GACPEI — people who will put time and energy into supporting, caring, and advocating for people in our community — who are committed to helping those in need to navigate the health care system.” — community member
Today, PEI's policy is still the best in Canada, and except for the Yukon, all other provinces and territories continue to deny care to women based on the sexist notion that femininity is inherently superficial, along with the oppressive fact that deep-rooted systemic misogyny can still overshadow medical evidence in healthcare simply because “that’s the way it is.” While many jurisdictions are updating parts of their policies to align with SOC 8 assessments, the misogyny around feminizing treatments continues to be grandfathered in without challenge (BC, NB, NS… I’m looking at you).
After the success of our policy change, GACPEI was in a unique position. We built such a strong, somewhat unprecedented, relationship with Health PEI during this work, that we inadvertently became even more knowledgeable about healthcare processes and systems change. On one hand, we had accomplished what we set out to do; the other hand left us wondering, “What else can we do?”
Unsure, we reached out to the local community to ask for some priorities. They wanted a health navigator. OK. We got to work and by April 2024, we were hiring the province's first Trans Health System Navigator; an employee of the community (GACPEI) working alongside the health authority (Health PEI), paid for by the Department of Health and Wellness (PEI Government).
Then we started hearing from providers. They wanted education — actually, not just Trans 101, they wanted certification. In November 2025, we brought our CME Mainpro+ certified gender-affirming primary care workshop to about twenty providers in Charlottetown.
“The approach taken by Gender Affirming Care PEI, which emphasizes community engagement, policy participation, and authentic peer support, is paving the way for a more inclusive and accessible healthcare system.” — community member
By most accounts, the Gender Affirming Care PEI story has been a pretty good one, and we’ve been a shining example of what collaboration between health authorities and community can look like.
But, nothing is without its hiccups.
Partway through 2025, despite fantastic feedback and favourable third-party evaluations, Gender Affirming Care PEI was defunded by the government of Prince Edward Island (not Health PEI) by about two thirds. They did not provide warning or rationale. Today, we're still in talks with the Department of Health and Wellness, but as of this publication (April 2026), no budget for 2026-2027 has been confirmed to us by the Government of Prince Edward Island.
Working in the health policy world has inadvertently shaped GACPEI into a formidable health leader. This has led to so many incredible collaborations with various organizations, including PEERS Alliance, Canadian Medical Association, Healthcare Excellence Canada, Women’s Legal Education Action Fund, Community-Based Research Centre, and so many grassroots groups from coast-to-coast-to-coast.
We want all trans people to live long, happy, healthy lives, regardless of where they live in Canada, but until the rest of Canada catches up with medical evidence… dolls, we’d love to have you come live on Prince Edward Island.
If you would like to donate to support our work, invite us to speak, or hire us for policy or advocacy consultation, find us at www.gacpei.ca.
