News & Views

(This is part of a series of posts in answer to questions asked by people at West Hill when I spoke on Feb 22nd.)

Can you offer any advice on how we can show our acceptance in our behavior – as well as how we can learn more & share more?

In my experience, the most effective way that people can show acceptance of transsexuals is to be respectful of their self-declared gender identity. Think about how you would behave toward a trans woman who looks like a football player but feels like Audrey Hepburn inside. Treating people according to who they are inside is a lesson we are taught from a very young age (“don’t judge a book by its cover”), and that rule applies here too. If you’re not sure what behavior is appropriate, my recommendation would be to simply act naturally. Nothing makes a person more uncomfortable than to sense that they make others so. If you really think of transsexuality as no big whup, chances are that’s the message your behavior will communicate. We all make mistakes, we all slip on pronouns, we all find ourselves surprised from time to time. Having a genuine desire to be affirming and respectful is more important than getting your behaviors just right.

If you want to learn more about sexual and gender diversity, I would recommend the book Omnigender by Virginia Ramey Mollenkott.

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What specifically were you referring to when you mentioned the CAMH fears – and how might we help make the assessment a more safe, respectful experience?

The except below is from a blog entry I wrote last year called “CAMH or Jurassic Clarke?”:

In his May 15, 2008 announcement of plans to restore provincial funding for sexual reassignment surgery, Ontario Minister of Health George Smitherman has indicated that transsexuals will once again to be forced to undergo a lengthy and strenuous approval process at the Centre for Addiction and Mental Health (CAMH) in Toronto in order to access health care under the Ontario Health Insurance Plan. While the transsexual community is delighted that coverage will be restored for a few people each year, it is a bittersweet victory for those who are familiar with the tainted reputation of CAMH.

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What organization other than CAMH would be more acceptable and appropriate? Medical alone (Toronto General Hospital, for instance) is not enough; who can do the mental?

At the time of reinstating provincial coverage for sexual reassignment surgery (SRS), the directive from the Minister of Health was that CAMH and Sherbourne Health Centre in Toronto were to work together to create an effective model to implement how trans candidates in Ontario were to be assessed for Gender Identity Disorder and recommended for SRS. This means that CAMH can no longer be the sole gatekeeper for all trans Ontarians. However, it remains unclear exactly how this multiple assessor model will play out. We also have the Trans Health Lobby Group, The Rainbow Health Network, and Rainbow Health Ontario closely monitoring the progress and seeking to ensure that the voices of trans people are heard as a new model for care is developed.

Sherbourne Health Centre provides innovative primary health care, counseling, support, outreach, health promotion, and education programs in Toronto, with particular focus on the LGBT community. It is trusted and respected by the LGBT community, but their services are limited to a specific geographic region of Toronto and therefore remain inaccessible to trans people in the rest of Ontario and Canada.

Rainbow Health Ontario (RHO) is a province-wide program that works to improve the health and well-being of lesbian, gay, bisexual and trans people in Ontario through education, research, outreach and public policy. Their mission is to improve access to services and to promote the health of Ontario’s lesbian, gay, bisexual and trans communities. They have launched an LGBT Provider Directory featuring free listings of programs and services as well as individual service providers that have expressed a commitment to providing competent and welcoming care to LGBT people in Ontario. It is designed to facilitate and improve access to LGBT health and social services in Ontario by providing a central source of information. This is a good way to improve access to knowledgeable and competent mental and medical care for transsexuals across the province.

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I know a female (50+ years old) who has never been happy as a woman. How can I talk about this with her? Any resources?

The most important way to talk about transsexuality with a transsexual person is respectfully and attentively. Every transsexual experience is unique, every gender identity is unique, so it’s important not to make assumptions or to impose definitions, pronouns, etc. based on your experiences with other transsexual people. Being willing to listen, learn, affirm and respond respectfully to this person’s unique experience is a great place to start.

A good Google search will bring up plenty of resources. Below are a few helpful ones:

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Intersexuality is only biological diversity – what about psychological diversity?

The transgender umbrella is a helpful indicator of the kind of gender-related psychological diversity that exists in the world. In the same way that sexual orientation spans a spectrum from exclusively homosexual to bisexual/asexual to exclusively heterosexual, and in the same way that our bodies can develop physically as exclusively masculine, exclusively feminine, or just about anywhere in between, gender identities range from exclusively male to exclusively female and anything in between. Many people (genderqueers, androgynes, two-spirited people, etc.) feel that they are neither male nor female or both male and female. Some people can be very specific about feeling a 60/40 split, for instance, while others experience their gender as somewhat more fluid or less defined.

 

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(This is one of the questions people asked me when I spoke at West Hill on Feb. 22nd.)

Is your life expectancy the same?

To my knowledge there is no agreed-upon life expectancy for transsexuals.  It is a condition that is still in the early stages of being studied and understood.  If I were to make assumptions based on what I know, I would say that the life expectancy of transsexuals overall is lower than that of the general population. The life expectancy of treated transsexuals (those with access to appropriate medical treatment and care) is probably significantly improved, but is still likely to be lower than that of the general population.  We do know that there are comorbid factors that reduce the life expectancy of transsexuals, such as elevated levels of depression, suicide, drug abuse, loneliness, etc.  These comorbid factors have been shown to be alleviated or eliminated with appropriate medical treatment and care.

Long-term effects of hormone therapy on transsexuals have not been adequately studied.  There is debate, however, over its long-term health effects.  For example, a transsexual man who takes testosterone will be at higher risk for certain illnesses, such as heart disease (the risk becomes elevated to the level of a biological male) and ovarian cancer (since trans men stop menstruating under the influence of testosterone, the unused reproductive organs can atrophy, which is why it is recommended by some experts that trans men undergo a hysterectomy rather than risk cancer.)  The use of estrogens in the case of trans women can increase the risk of breast cancer, but again it is thought that the risk is elevated only to the level of biological women.

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