Trans DIY

On the verge of turning 40, I’m in my doctor’s office after weeks of gentle urging from my girlfriend.

I assume she just doesn’t understand my issues about doctors. Since the time I hit puberty in the 1970s, I’ve sat in many a doctors’ waiting room, never my favourite setting.

Doctor number four told me that because of my high testosterone level I could become a lesbian, since lesbianism was caused by hormonal imbalances like mine.

Doctor number seven told my parents that I should be put on feminizing hormones before my facial hair got too established. I sat across from him in a quiet rage.

Since then, the powers that be have determined I am “intersexed” – having characteristics of both sexes. But I have resisted official diagnoses.

Increasingly, other transsexual, transgender and intersexed people are resisting the official diagnoses, resisting the rules and procedures set out by medical establishment on how they should be treated. More and more people are taking their gender reorientation or sex reassignment into their own hands.

After all, there’s little incentive to go through the clinical system anymore.

From 1970 to 1998, the Ontario Health Insurance Plan covered the cost of sex reassignment surgery for individuals approved by the Clarke Institute Of Psychiatry in Toronto. (Now called The Gender Identity Clinic at the Centre For Mental Health And Addiction, it’s still commonly referred to as the Clarke.)

Jumping through the Clarke’s hoops meant the cost of your transition was covered. But in October 1998, Mike Harris’s Tory government removed sex reassignment surgery from the list of services covered by OHIP.

This was very bad news for transsexuals. But it removed a big obstacle to transitioning on your own. Why not? A good doctor. Hormones. Peer support. Counselling. Referrals to a good sex reassignment surgeon. Though there are risks, there is much less hassle.

I remember my two-spirited Cree friend, Billy, telling me that two-spirited people like us were special because we were gatekeepers between the worlds, between life and death, birth and rebirth. But it’s been all ass backwards, with doctors as gatekeepers and trans folk following along. More people are agreeing we have to reclaim the gatekeeper tradition and become our own gatekeepers to our bodies and our identities.

Christina Strang, the coordinator of the Meal Trans program and the Trans Youth Drop-in at the 519 Church Street Community Centre, started transitioning in her late teens. She tried living as a gay boy but that didn’t work out.

Christina lived as a woman – her name, her dress and her identity – in another city for almost a year, not knowing anything about hormones.

Male-to-female (MTF) transsexuals usually take estrogen (the female hormone) combined with a suppressor of testosterone (the male sex hormone) in order to grow their breasts, decrease beard growth and soften skin.

As soon as Strang moved to Toronto to go to school and heard there were resources to help her transition – including hormones – she got an appointment at the Clarke. She described the experience as “demoralizing.”

The doctors she talked to were critical of her Queen St W look. She says they were vague about what treatment they had to offer. She kept going, but also met trans women who were transitioning on their own. By word of mouth, she found a doctor who would prescribe her hormones.

What makes the Clarke so demoralizing? Attitude aside, it’s mostly because it strictly follows the Standards Of Care For Gender Identity Disorders, the main international manual for doctors who are serving transsexual people. Taking it too literally leads to one-size-fits-all solutions.

The Clarke expects a full year of crossdressing while working at a full-time job and passing – all without the help of hormones. Most find it to be a harrowing year. And an unnecessary one.

According to a discussion paper on gender identity, issued by the Ontario Human Rights Commission in 1999, many clients criticized the Clarke “for their stringent standards, for the timing of and access to hormone therapy and for eligibility requirements. Consultees felt that the requirements do not reflect the real life needs of most transsexuals and therefore are accessible to only a few.

“Before hormone therapy has begun, and without a lengthy period of electrolysis, the likelihood that a person will ‘pass’ as a woman is low,” the report continues. “The result is that living as one’s gender can be highly stressful and may open the door to discriminatory treatment.”

After more than two years of appointments, the Clarke has yet to agree to write letters Strang needs to be eligible for sex-reassignment surgery. Depending on the nature of the surgery, most surgeons accept one letter from a psychiatrist. Others follow the Standards Of Care to the letter and demand two letters.

Many of the rules don’t make sense to Strang.

“They are very good at putting you down if you hang around with other transsexuals. They really discourage that. It’s been shown in our community that self-esteem is a motivating factor and they aren’t concerned about our self-esteem at all.”

Young people have other obstacles. Until this January, the Standards Of Care recommended against any hormone therapy for anyone under 16 (now it’s permitted for those with parental consent). But trans youth advocates say early use of hormones can suppress unwanted secondary sex characteristics, like facial hair, avoiding many hours of electrolysis at a later date.

“I consider transitioning for transsexuals a matter of life and death. You wouldn’t with hold insulin from a diabetic. It’s the same thing here,” Strang says.

Ezri Kaysen is a transsexual woman who started considering transitioning last September at the age of 21. She found a general practitioner through Strang. Supportive doctors in Toronto are known by name within the trans community. A good doctor is familiar with the Standards Of Care, even if they don’t follow it to the letter.

Kaysen wanted to avoid crossdressing for a year without hormones and to transition at her own pace. She says having a good therapist is key.

“Going through the Clarke doesn’t have any bearing on whether you get the surgery or not. This way you can transition at your own pace instead of going to a doctor who is basically the gatekeeper, who tells you what to do,” says Kaysen.

Marcus (not his real name) is an 18-year-old female-to-male (FTM) transsexual. He went to a doctor he heard about at a peer support group at The 519. His main goal was to get a prescription for testosterone.

FTMs who take testosterone can expect their period to stop within a few months, their voice to deepen and their clit to grow larger and more sensitive. It’s available in pill, patch or injectable form and starts at about $40 for a six week supply. (Most drug insurance plans will cover hormones if the doctor avoids the word “transsexual.”)

Marcus rates his experience with his doctor as “pretty cool,” though the testosterone was not forthcoming. The doctor told Marcus he would have to wait until he was in his 20s and Marcus has had a change of heart anyway.

“Transitioning is not just about the technical stuff, it’s also about learning to accept who you are and to like yourself. Having people around you who love you. It’s a process that goes on your whole life,” Marcus says.

Marcus at first didn’t think much about long-term health risks – hormone therapy can increase the chance of heart disease and liver problems, for example. But after seeing the film Southern Comfort – about a transsexual man who can’t find a doctor to treat his ovarian cancer – Marcus did start to worry a bit.

According to the Ontario Human Rights Commission paper, “general practitioners often do not have the resources or expertise needed to provide appropriate services to transgender patients. As a result, there are many transgendered individuals who self-medicate and self-treat with hormone therapy, which subsequently puts their health at risk. Many individuals in this situation reported that they felt they have no other options.”

The biggest risk of self medication is that the person is often cut off from essential emotional, medical and community support.

Isaac (not his real name) is in his early 30s and started transitioning six months ago. He injects himself with hormones, which he got through his doctor, every two weeks.

“The reason I don’t go to the Clarke is because I don’t support institutions, and being that I’m mixed blood I feel that those types of institutions are not made up of my people, for my people,” Isaac says. “I don’t feel that my needs as a mixed-blood person would be dealt with. I feel that the decisions I make about my body are my decisions to make and I don’t feel that I have to jump through hoops for other people who don’t know anything about me, who haven’t lived my experience at all.”

Isaac is critical of the Standards Of Care because it doesn’t take into account how diverse people are. Since he started transitioning, he’s been proud of his health and appearance.

“I found a nutritionist, I found a physical fitness trainer, I found out about T [testosterone] and how it affects my body. I ask my doctor questions about what I need to be watching out for. Every day I feel more and more me. I am more than capable of making decisions about my health and my life. I can do my own research and make the decisions that are good for me,” says Isaac.

Gender identity clinics can be a good thing for some people, as long as they treat trans people with respect.

At the World AIDS Conference in South Africa this spring, Strang met a doctor who was with a clinic that hired people from the trans community to do outreach. There is also clinic in the US run by a transsexual doctor.

Both of these doctors are on the committee that puts out The Standards Of Care. In their hands, future editions might better reflect the trans community’s concerns and needs.