First I need to fill out a huge document in which I state why I need this. Then I wait. The wait time right now is two years to see someone, likely three by the time I get there as it keeps getting longer. Then I have to travel for five hours to a specific facility - there's only one in Ontario - to prove to someone that I need this. Then they'll either have me come back (more wait) to prove again that I need this. Or they'll set-up the surgery - which would then be maybe 3-6 months away.

They're paying a private medical facility to perform the work; if I have the means I could just as well skip the three years and pay for it myself. Or spend a fraction of the cost and do it overseas.

Note that this isn't for all things in Ontario, but is true for gender affirmation surgeries.