By Lauren McKeon
Most people feel awkward taking their clothes off in front of a doctor. But for transsexuals, a routine physical can lead to persecution. Worse, a recent report reveals that some can’t find care at all.
When Michelle B. booked an appointment with Toronto’s renowned plastic surgeon Dr. Robert Stubbs, she wasn’t expecting to be shown the door so quickly.
Boyce acknowledges that every time she enters a situation with a health care provider — be it a surgeon or a general practitioner — there’s a risk she’ll be treated differently. But reactions like Stubbs’, she says, are too blatant to be ignored.
It took Stubbs’ one question to determine he couldn’t treat Boyce: she was a transsexual. Stubbs is not trained to operate on transsexuals and does not accept them as patients. “In a private clinic, I have the right to choose who I can safely look after,” Stubbs said.
Boyce claims Stubbs slammed his book down and yelled, “I don’t do you people,” before tearing out of his office. She didn’t let him get away. She stopped him and yelled right back, “You can’t treat people like that.”
Boyce has since filed a complaint with the Ontario Human Rights Commission. Stubbs cannot comment on the incident or whether Boyce was ever a patient due to doctor-patient confidentiality laws. None of the allegations have been proven. Unfortunately, findings of the Ontario Public Health Association’s Trans Health Project show that a huge chunk of the health care system in Canada has adopted the attitude: it just doesn’t do transsexuals.
It points to huge gaps in trans specific health care that have resulted due to major cuts in funding since the 1990s. Marked among those are the removal of funding for electrolysis in 1992, the following removal of sexual reassignment surgery (SRS) in 1998, and most recently the conditioned funding for hormone therapy — all services trans people deem invaluable to live comfortably in their own bodies.
Susan Gapka, one of the principal investigators for the project, says trans people have been erased from the health care system. “There’s such an absence, a volume of misunderstanding … Our needs are not being attended to.”
Martine Stonehouse knows it too well. When SRS was de-listed, she was left halfway through her transition. She says there was no consultation with the trans community on behalf of the government around the issue. She, and the rest of the Ontario trans population, were shocked to read an article in the Toronto Sun on Oct. 4, 1998 saying that SRS was gone — they had been assured only months earlier by government health officials it would not be cut.
Stonehouse launched a case against the government the next year. In 2002, her case was linked to three more transsexuals who were left without the funds to transition once SRS was removed — operations can cost up to $50,000 each. It wasn’t until 2003 that they reached a basic agreement with the government. But, less than 24 hours later, she says, Dalton McGuinty stepped into power and crushed negotiations, sending the case back to tribunal hearings.
Finally, in late 2005, after seven and a half years, the government agreed to pay for her SRS. Only two more, out of the four who filed the case, were granted the same funding. The fourth was refused because, unlike the others, he wasn’t enrolled at the Gender Identity Disorder (GID) clinic at the Clarke Institute way back in 1998 — one of the major restrictions the government set for funding.
Not that many transsexuals would blame Andy McDonald for steering clear of it until 2001. Now held by the Centre for Addiction and Mental Health (CAMH), the clinic remains affectionately dubbed Jurassic Clarke by trans people. A large part of the community point to its mandatory Real-Life Tests as a prime example of medical circle’s lack of understanding.
The Real-Life Tests require clinic patients to live one to two years as their desired sex before being cleared for SRS. But, says Stonehouse, the time periods don’t allow for flexibility. Some trans people have been living as the opposite birth sex for years, she points out, and know they are ready.
Plus, adds Carmen Mattioli, the general administrator at the Vancouver Transgender Health Program, the tests can make life very uncomfortable. “You’re out there trying to be female,” Mattioli says, “but all your bodily functions remain male.”
And if a trans person has difficulty “passing” without surgery and hormones, they become vulnerable to ridicule and abuse from the public.
“It’s like living in limbo,” Stonehouse says of her extended Real-Life Test. Especially, she adds, because she won’t marry her fiancé, who she’s dated since 2003, until she’s completed her surgery. “Because,” she gestures to the body part she seems uncomfortable even naming, “well, just because.”
Despite being granted funding, she might not hear wedding bells any time soon. Part of the condition, she says, is that her surgery has to be done the way it was back in 1998. Since there are no publicly funded surgeons in Ontario who will do SRS, that means shipping her to England. Which might have been OK, she says, if the SRS surgeon there hadn’t retired, leaving no likely successors.
But not all discrimination in the health care system surrounds trans specific care, warns Boyce The other problems, she says, are with basic needs and treatment in the ER. Boyce remembers going to a Toronto with a nasty case of food poisoning. When she arrived staff were “scrambling to get IV bags” to hydrate her. As soon as her history became clear, though, she says, she was suddenly left alone. Boyce stayed there overnight, receiving the occasional glass of juice.
“And I never saw another doctor after that,” she says.
Gapka adds that many general practitioners will leap to the conclusion that any complaints are trans related. You can go in with a sore throat, she says, and the doctor will say, “‘Oh, it’s got to be your hormones.’”
And if you don’t hear something like that, Michelle B. adds, who also worked on the Trans Health Project with Gapka, you’ll get transferred from doctor to doctor like “a ping pong tranny.”
In her ideal world there would be a central repository of information on transsexuals and health care. This would not be a place to send trans patients, but a place where physicians could go to get the answers they needed. Especially those in rural regions — areas the project shows have higher instances of trans health ignorance.
“Suppose a general practitioner in Hicksville, Ont. freaks out. We can say, ‘no, it’s OK, here’s a number you can call, they’ll walk you through it.’”
These health care barriers become layered if you’re a trans person of colour, says Rupert Raj. Raj, who is of Polish and South Asian decent, has been a trans activist for over 30 years. Currently, he works at the Sherbourne Health Centre as a counselor for gay, lesbian, bisexual and transgender people (GLBT) — one of the only places in Ontario that actively provides trans positive health care.
Raj appeared in a movie called “Rewriting the Script: A Love Letter to Our Families,” which dealt with the experiences of GLBT South Asians and their families. He says people need to understand that trans people don’t live in a vacuum — they have family, friends, culture and religion just like anyone. And if you’re coming from a background where your family doesn’t understand, you could wind up leading a fragmented life, being a different person everywhere you go.
It’s harder to access health care when you feel ostracized like that, Mattioli says. Young trans people of colour, with no family or community support, especially have trouble accessing the system. Their parents generally don’t want to help them do something as deviant as changing genders.
And when parents do get involved with their child’s health care, it’s to “fix” them.
Mattioli recalls a group session he facilitated at the Vancouver Transgender Health Program between parents and children. There was a Chinese mother who was adamant that her daughter, who identified as male, was mixed up.
She didn’t want him to be a he, Mattioli says. She also didn’t want him to be in group therapy, he adds, she was convinced “we were going to brainwash him.”
Reece Lagartera, a trans man of Philippine decent, says his circumstances are different because he’s been in the public eye for years as a drag king. His parents want him to live the way he wants, but there’s still little things like using the correct pronouns. They brush stuff like that off as a North American thing, he says.
Although he adds not all trans people of colour are so fortunate. He knows landed immigrants who are trans that have difficulty accessing the health system. Not only are they likely to come to the country with no job and little money, he says, there’s also huge language barriers. In some languages, like his parent’s, the word transgender doesn’t even exist. So how would they even know where to begin?
That’s why, he explains, he hasn’t had the formal discussion with his father, “He wouldn’t even know what the word meant. How do you explain being a transsexual? There’s no concept.”