The pathways are really variable for people, so it's a really hard point to speak to.
I think, as you heard, the journey is very long for people. Often, someone might think for a long time about coming out and talking to a professional, and then the search to find that first professional can take a long time. Many people start with hormone therapy and then sometimes after a year, five years, 10 years—it totally depends on the individual—they might think about surgery. Some people will never access surgery. It really depends on where one is in any given province or anywhere in the country, because access is not even.
We found in B.C., as we've explored the client journey, that there are just many bottlenecks along the way and, in fact, big variation in clinical practice, in part depending on when people were trained. It's been really new work to start to bring together providers and people who access services to try to have more standard pathways and more clear standards of care.
For example, our B.C. patients are travelling to Montreal for the most complex surgeries, for genital reconstruction surgery, and then returning home. That wait can be—once the referral is in—anywhere from nine months to two years, for say, a vaginoplasty, which is one of those surgeries.