In the 1960s, Mayhem law prevented doctors from operating on patients in a way that would harm their ability to serve in the military. This made transition related surgeries difficult to acquire. While shady doctors still performed them, they were often done in secret.
This would start to change in the 1970s. In 1976, the Provincial government of Ontario updated the Vital Statistics Act to include the ability to change one’s legal gender. Unfortunately, this still required a transgender person to get surgery first.