But she said she just encountered obstacles.

“This is an impossible fight,” Bosco said. “It feels like all the old hatred is lingering in the system and everywhere. I don’t know what to do. I just want to live my life, but I’m struggling here.”

Earlier this month, Bosco and her social worker Margie Boese went to the Ontario Service Center in western Toronto with LOFT Community Services so that Bosco could apply for the card. She currently has only one health card, which means she cannot pay taxes or apply for assistance programs, such as the Canadian emergency response benefits last year to help people affected by COVID-19.

Bosco said that the staff at the Ontario Service Center asked her if she had had “bottom surgery” and told her that she needed to provide the surgeon’s instructions and contact information.

“This is ridiculous to me,” Bosco said. “My medical information is only between me and my doctor. Having to protect myself for some random person, my gender, it’s really shameful.”

In addition, she said that whether she had genital reconstruction or breast surgery has nothing to do with her female identity.

“I know who I am. I don’t need to prove to you,” she said.

Provincial requirements are huge obstacles

Bosco later learned that the Ontario Service Center staff’s requirements for the photo card were not entirely correct. According to the Department of Transportation, she can actually provide a letter from any doctor licensed in Ontario or a psychologist who has examined or treated her, and can say that changing her gender name is “appropriate.”

But Bosco said that this requirement is a huge obstacle for transgender people facing systemic discrimination in the healthcare system because they may not have a doctor they trust to provide letters.

If a person changes their birth certificate to reflect their gender, or wants to change their name to “X” and keep the gender specified at birth in the record, a doctor’s certificate is not required.

Bosco said that neither of these is her choice. Her birth certificate comes from another country that does not allow her to change her gender, and she is not identified as “X”, nor is she a male.

“The point is to have an ID to identify myself. This is not my way of identification. These marks are not mine,” she said.

Need to educate employees, the social worker said

The process for transgender people in Ontario to change and update their identities using name and gender markings is very complicated and time-consuming. The LGBTQ service provider 519 in Toronto has a clinic to help them understand the system.

The agency’s judicial assistance coordinator, Al McDonough, said that the clinic is in high demand, providing waiting services for 50 people at a time. They say it takes months to integrate applications, and more time to get approval or rejection—a major problem when people need identification to apply for school, work, or housing.

Although everyone may have different opinions on the doctor’s letter requirements for photo cards, McDonough said that in general, this is problematic.

“This is a way of medicalizing and pathological transgender people and saying that we cannot verify our gender and our own experience,” they said.

McDonough said the request also created obstacles.

“In order to get affirmative care, they need to align their ID with their gender – and in order to get their ID to align with their gender, they need to get affirmative care,” McDonough said. “If they can’t get to the end of that cycle, it will have a big impact.”

At the same time, Bosco’s social worker Boese witnessed these incidents in Service Ontario and said that there is a clear need to educate employees and hire transgender people to help steer the province towards a more inclusive system.

Watch | The medical director of the Manitoba Vaccine Task Force apologizes to transgender people:

Dr. Joss Reimer apologizes for the “wrong, inappropriate and disrespectful” wording related to gender issues in the COVID-19 vaccine consent form. 0:22