Gender-affirming care in Canada: How Health Spending Accounts improve access

For many trans, two-spirit, and non-binary Canadians, accessing gender-affirming care is not just a nice to have— it’s essential, it’s what makes living as your true self possible. 

Yet too often, public coverage related to gender-affirming care is patchy, private insurance can be restrictive, and out-of-pocket costs are overwhelming. This all being said, Health Spending Accounts (HSAs) offer a rare thing: control. 

Piggybacking off our last blog — “Wait, your HSA can do that?” — we wanted to dive deeper into an often overlooked category of eligible expenses: gender-affirming care. 

Unlike those rigid, dusty, old benefits plans that define what care “counts,” HSAs empower individuals to get reimbursed for eligible medical expenses that reflect their real healthcare needs. 

Hormone therapy (HRT) 

Some who are seeking gender-affirming care, include hormone therapy as a part of their journey. It can help someone on their journey to feeling truly themselves. Yet provincial drug programs may only cover these medications under specific conditions, and not all employer plans include them. 

But... wait! You guessed it. 

The trusty Health Spending Accounts can reimburse prescription costs for eligible hormone therapies when prescribed by a medical professional. This includes: 

• Estrogen and testosterone 
• Anti-androgens like spironolactone 
• Puberty blockers (for youth, when medically indicated) 

Under CRA rules, prescription drugs may be eligible if they are dispensed by a pharmacist and prescribed by a licensed medical practitioner. 

For employees navigating transition, the ability to get reimbursed for hormone therapy costs through their HSA provides both financial relief and a powerful message of respect, and we think that’s pretty rad. 

Mental health services 

Gender-affirming care isn't limited to physical procedures — it can begin with mental healthcare. Therapy can play a vital role in helping people navigate gender dysphoria, discrimination, social transition, and the emotional toll of systemic barriers. Unfortunately, access to mental health professionals is still expensive and coverage in the category, although improving, still has yet to get with the program. 

With an HSA, services like individual therapy, psychological assessments, and counselling provided by registered mental health professionals are eligible for reimbursement. This includes visits with: 

• Registered Psychologists 
• Psychotherapists 
• Clinical Social Workers 
• Registered Counsellors (where provincially recognized) 

By the way, we’re not just throwing things at the wall and seeing what sticks. The demand for this care is real: A 2021 study in the Canadian Medical Association Journal found that 46% of trans Ontarians reported unmet mental health needs, citing cost and discrimination as major obstacles (CMAJ, 2021). 

Being able to consistently see the therapist of your choice — without worrying about whether a benefits provider will cover the session, or who you’ll see instead when you reach the maximum for the service — can make a profound difference. HSAs give that freedom. 

Gender-affirming surgeries 

While some gender-affirming surgeries are publicly funded in Canada, access is far from equitable. Waitlists can be long, coverage differs by province, and private plans too often exclude surgical procedures deemed “cosmetic.”  

Honestly, what a headache.  

For those seeking surgery, this can mean years of delay or complete ineligibility. 

HSAs, on the other hand, allow for reimbursement of many surgical procedures as long as they meet CRA eligibility guidelines (sorry for sounding like a broken record with this one) — which often means being prescribed by a qualified medical practitioner. 

This opens the door for eligible expenses related to different types of gender-affirming surgeries. 

Voice therapy 

Voice plays a central role in how a person is perceived — and for many, finding a voice that aligns with their identity is truly empowering.  

Now, we hate sounding like we’re stuck on repeat here but... most traditional benefit plans exclude voice therapy or limit it with little regard for gender-affirming needs. 

Under the CRA’s guidelines, licensed speech language pathologists are eligible practitioners whose services may be reimbursable through an HSA.  

That means plan members may be able to use HSA funds to access gender-affirming voice training with qualified professionals — whether they’re learning to feminize, masculinize, or neutralize their speech. 

Electrolysis 

Hair removal is one of the most commonly accessed — and most commonly excluded — services when it comes to gender-affirming care. Yet, electrolysis can be essential for alleviating dysphoria and aligning with their gender identity, especially pre-surgery. 

According to CRA guidelines, these services are eligible when prescribed for medical reasons — which can include gender dysphoria, when backed by a practitioner’s recommendation. 

This makes HSAs one of the only consistent ways to receive financial reimbursement for gender-affirming hair removal in Canada. 

Something to note 

What’s reimbursable using an HSA is based on the CRA’s guidelines for eligible practitioners and eligible expenses. These lists are written in legalese so they aren’t always super clear and certainly don’t detail every possible scenario.

The best way to ensure an expense is eligible is to check in with our Claims Team for some expert guidance. 

Why HSAs matter in the bigger picture 

Let’s be clear: benefits alone can’t fix the systemic barriers that non binary, two-spirit, and trans people face. But they can make a tangible difference in a person’s ability to access timely, affirming care. 

Traditional group plans are often out of sync with lived experience. They rely on those outdated, cobweb developing, notions of what’s “medically necessary” — and they can come with exclusions that disproportionately impact trans and non-binary members. HSAs do the opposite. They’re: 

• Flexible 
• Self-directed 
• Tax-efficient 
• Inclusive by design — not exception 

When paired with good policy and inclusive workplaces, HSAs are a powerful tool for improving access to care. 

According to Egale Canada, nearly 70% of trans people experience discrimination in healthcare — and 41% have avoided care altogether out of fear and/or cost. Removing financial barriers through flexible reimbursement models  is a small but crucial step toward change. But hey, we know HSAs aren’t a magic bullet, and the impact they can make hinges in part on their level of funding – but they ensure equity, and we believe equity is what makes the difference. 

Final thoughts 

Offering an HSA isn’t just a smart benefits strategy — it’s a tangible way for employers to show they care about their team members, not just the majority. For trans, two-spirit, and non-binary Canadians, gender-affirming care isn’t elective. It’s essential. 

Got questions? We’d love to hear from you! Get in touch with our team today. Want more bite-sized Blendable content? Follow us on Instagram, LinkedIn, and Facebook!