Transgender London

Ontario Ministry of Health Consultations With the Trans Community

The Ontario Ministry of Health has recently entered into consultations with the Transgender Community and its Health Care Advocates. This is a move that is welcomed from the rooftops by the Trans Community. Figuratively, (if not literally) the lack of action by the Ontario (or any government for that matter) is killing the transgender community.

The trans community is largely unprotected when it comes to human rights. This is a repetitive theme through this site as is the lack of responsive health care; both physical and mental. The fact is that the M.O.H. have recognized the desperation of the community and is preparing to act on that. Of course this does nothing for legal problems we encounter but healthcare is a start. Their first meeting took place in July 2009 and the results of that meeting can be viewed here.

While this meeting didn't tell us anything we didn't already know, it is a start toward some meaningful dialogue about our needs. While it is unreasonable to expect that the MOH should fund complete transition, certainly some basic aspects could and should be covered.

In this writer's opinion, they must remove CAMH (Clarke Institute) as the sole gatekeeper for SRS surgery in Ontario. Despite the claims of CAMH as having the most experienced team in North America it can also be argued they have the most notorious; if not nefarious one. Too many "rejects" from their gender program have had to acquire their SRS through other means. These "rejects" are living happy and successful lives in their correct gender role. The rejection rate at CAMH should be examined carefully. It is not congruent with the statistics of the mental health community at large. Additionally, this writer has heard stories (both first hand and second hand) of their "program" that can be considered abusive toward their clients.

It is unreasonable to expect that a single gatekeeper anywhere in the province should control access to government funded SRS. It can place an undue hardship on the transperson to travel to and from this clinic. Additionally, the shear number of cases could overwhelm any gender clinic. Finally, by following the protocols of WPATH, mistakes in the approval process are minimized. Therefore, an experienced therapist can equally determine the suitability of a patient for SRS. If they cant, they should not be in the business; plain and simple. There are very many qualified therapists in this province who are both willing and capable of making these kinds of recommendations.

The approval process itself has checks and balances at every step. Every physician and therapist along the way has to be satisfied that s/he is doing the right thing by approving transitional care whether it is the initial referral to a therapist or subsequently to an endocrinologist, a second opinion for mental health then finally the SRS surgeon. No doctor will go forward until they are fully satisfied they are doing the right thing for their client. The fact is that every step is safeguarded. By removing CAMH from the equation the "single source shopping" is eliminated not the approval process with its protections.

Next, access to hormones should be taken into account. A user need-based system dependent upon the patient's ways and means could allow for funding to subsidize this. It is often done already through other government social programs. However, this doesn't help the "working poor". The incidence of poverty within the trans community is overwhelming as a statistic therefore some subsidy should be provided.

In so far as surgical procedures are concerned, I believe that the choice of surgeon should be up to the individual. The fact that SRS can be acquired offshore for significantly less cost than the Montreal clinic should weigh in on this decision. Additionally, the best and leading edge SRS surgeons are in Thailand. It is a waste of taxpayer dollars to insist that GRS Montreal be paid almost exclusively when this surgery can be acquired for less cost elsewhere. Of course, any problems down the road could reflect back on our healthcare system, however the incidence of this is extremely low and as such is nearly a moot point. Besides, the offshore surgeons stand behind their work and will perform any revisions at no cost. (Getting there is of course the real expense in such a case.) Some of these surgeons demand that their patients remain for 3 weeks to a month post op so they can be assured there are no complications. This kind of care far exceeds anything provided elsewhere in the world.

Cosmetic enhancements such as breast augmentation should not be covered in my opinion however I do believe that electrolysis should be covered. Again there are many very experienced and qualified electrologists both within and outside of the medical establishment. This painful process can be very costly and done incorrectly can leave permanent scars. A proper dermatology clinic would eliminate any health risks that occur when the patient goes outside the health system.

The current system allows for mastectomy and hysterectomy for the transman and there is some support for penile reconstruction. Still, this isn't enough in most cases and like the transwoman he too must rely on his own abilities to acquire medical intervention.

None of this is cheap but neither is it exorbitantly expensive. When held up against the cost of social support for a transperson, the cost of SRS is about the same as one year of support; support that is forcing poverty in its own right. These costs can include subsidized legal, healthcare, housing support plus unemployment claims that lead to welfare costs. So, is SRS cheaper than a continued support of the transgender person? It isn't rocket science and no calculator is needed to do the math.

Following the above simple recommendations could save the government many many tens or hundreds of thousands of dollars annually. This is money spent in social support because the trans community at large cannot afford transition that will allow them to live stealth in their true gender. By eliminating these roadblocks, many trans persons will be able to find and keep meaningful jobs.

This is a real step in the right direction. The alternative is to continue killing us very slowly at the taxpayers expense.

Kimberley.

This site was last updated 08/11/10