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TG Healthcare in Ontario

The Ontario Healthcare system is a huge obstacle for transgendered people.  It is not TG friendly.  This is not to say that doctors aren't, only that the system (OHIP) is not.  Among the trans community most feel that it is even discriminatory.  There are good arguments for this position and until June of 2008 the Ontario Government has steadfastly refused to alter its position in regards to TG Healthcare.  First a bit of history.

Prior to the Conservative, Ontario Government of Mike Harris, transgender healthcare was sponsored by OHIP.  In 1998, the Harris government removed funding for TG Healthcare.  Even prior to that, anyone wanting to transition had to go through the Clark Institute in Toronto (now known as the Center for Addiction and Mental Health; CAMH) for evaluation and approval.  That institute is not particularly trans friendly, or at least certain doctors employed there.

This meant that a transgendered person living in a remote area would have to travel to Toronto for "approved" care.  No one else in the province was authorized to approve transition if it was to be publically funded.  The conservative government of Mike Harris  closed even that door in 1998 with the argument that funding for transitional surgery could be better used for cardiac care.  I doubt that the number of transitional surgeries performed in a month would come near the cost requirements of a single cardiac bypass patient. 

Even today, 10 years after this decision, one can acquire SRS for approximately US$18,500 (source: http://marcibowers.com/grs/surgery4.html) or if one wants to travel abroad to Asia for about 2/3 of that price.  That includes all hospital fees, surgeon fees, evaluation and medications.  Only the travel costs and a couple of tests are not included.  The cost for Cardiac By-pass Surgery in Ontario ranged from a low of Cdn$16000 (for a simple uncomplicated procedure on a "young person" to a high of Cdn$54000 in a complex procedure. (source: CMAJ • MAR. 23, 1999; 160 (6))  The government's argument does not stand up to scrutiny of logic or fact.  Further to that, SRS is best performed in either the US or Thailand where Ontario facilities would not be impacted; only the cost of the procedure.

OHIP coverage today allows for SRS in the case of accidental trauma or where intersex conditions are the case in point without much problem.  the provincial government has again reinstituted SRS for Gender Identity disorder but again under the same discriminatory conditions applied prior to 1998.  The following is from the OHIP website outlining SRS requirements since 8 June 2008.

First, one would have to ask who would perform such surgery in Ontario, and in the case of trauma, what would be the treatment protocol?  Would a truly qualified and experienced surgeon who is out of province or country have even greater difficulty due to previous "care" while the patient had to wait months or even years?  As stated, even in such cases, the regulations require the patient to go through the Gender Program of the Canadian Addiction and Mental Health Association.  In essence it is asking someone who is cisgendered to go through a program for transsexuals.  What isn't stated is that the province will only fund 20 SRS surgeries per year.  So, even with approval, one could wait for many years.

Again this is a slap in the face of the many, very qualified physicians and psychologists elsewhere in the province to deal with a gender case.  Does the Minister of Health actually believe that only care by the CAMH is qualified as expert?  Oddly enough the expertise of these other doctors is accepted worldwide; just not in Ontario.  It is noteworthy however, their expertise in treatment of other conditions is unquestioned.

And the last piece of hypocrisy?  The Federal Government recognizes GID as a legitimate disability for taxation purposes.

Okay so we have that bit out of the way.  Confused yet?

If transpeople's rights are protected under the The Ontario Human Rights Code and the Canadian Charter of Rights and Freedoms, why is it that we cannot acquire the necessary healthcare in the Province of Ontario for what is an accepted medical condition?  Oddly enough, the provinces of British Columbia, Alberta and Quebec among others do offer coverage in their provincial healthcare plans.

No one has yet been able to answer that question for me.

CAMH

Now to CAMH itself.  First of all it has a horrific history of what can only be considered as abuse of the transsexual community.  This approach stems directly from the beliefs of those who run the Gender Program at CAMH; Drs. Ray Blanchard and Ken Zucker among them.

At this point it is absolutely essential to state that CAMH is a world recognized research institute and has done some exceptional work over its history and there is no reason to believe that this will not continue.  The issue in question here is their Gender Program and nothing else.  By extension, the funding by the government has to be considered as approval for this abusive approach.

Now, to the not so illustrious history of Drs. Blanchard and Zucker.  Both men are PhD's in psychology, not MD's.  Both are professors at the University of Toronto (who are also intrinsically linked to CAMH).  So we have the U of T and the government both funding this program with Dr. Blanchard able to use it for his personal "research".  This writer will not call into question Dr. Blanchard's research but will repeat often stated public opinions by others who have.  These opinions are widely available on the internet.  There are other major players in this drama, most notably Dr. Michael Bailey of Northwestern University in Illinois, and Dr. Anne Lawrence M.D. who was/is an Anesthesiologist who has fully transitioned.  Dr. Lawrence has since turned her sights on transsexualism as an area of expertise.

Within the trans community, anyone who can avoid the CAMH does so like the plague.  This reinstatement of funding does nothing to assuage the fears of the trans community and the government has in fact done us a great disservice.

Dr. Ray Blanchard.

Without going into his personal history and qualifications (they are widely available on the internet) it is truly safe to say that much of Dr. Blanchard's research and publication has dealt with sex offenders as a particular area of expertise.  He is also one of the very few researchers who has looked at transsexualism.  He makes a very loud claim that he has helped many transsexuals go through transition and this is without dispute.  The dispute is that there are many, many more who he has failed to help for reasons that will be stated shortly.

Within the area of academia it is often considered essential for someone in Dr. Blanchard's position to regularly publish findings of his/her research.  (Publish or Perish).  These research papers are traditionally held up to scrutiny by a panel of peers who are at arm's length from the author so that an impartial review of not only the findings but the methodology used to acquire the data is based in accepted scientific method and principle.  This is where a great deal of the controversy surrounding Dr. Blanchard is rooted. 

Prior to 1989 Dr. Blanchard was a little known researcher, however his theories of Autogynephilia changed all that.  In fact it was another couple of years before this research was truly brought to the fore by Dr. Lawrence who recounted her own experience as proof of Dr. Blanchard's theories.  This particularly angered the transgender community because her claims gave credence as "proof" that his theory was sound.  The fact is that the transgender community at large reject his findings and Dr. Lawrence' cheerleading.

Autogynephilia and Androphilia

There are multiple problems with this theory that begin with the research itself.  It has been widely charged that Dr. Blanchard used a subject group that would fit his findings and no control group was established.  Also charged has been that the size of his research group was so small as to render the statistical variance to be so wide that the findings were questionable if not moot.

This is where Dr. Zucker enters the equation because as the primary Psychologist in the CAMH Gender Program, he was able to provide the subjects for Dr. Blanchard's study.  In this he has been considered complicit.

In short, Dr. Blanchard used subjects that would be suitable to his theories and thus reinforce his "findings", not the other way around.  It is in short; bad science if it can be considered science at all.

The theory of Autogynephilia is rooted in the concept that transsexualism is a pathology of homosexuality and falls into two distinct categories. First Blanchard sees Gender Identity Disorder as paraphilia (a defined sexual disorder) however Gender Identity Disorder is not listed as paraphilic in the DSM and neither is homosexuality.  Paraphilia is about sex; transsexualism is about gender identity.  To equate the two in any way is a distortion of fact.  Every transsexual will identify gender identity as not being congruent with their sex. 

Blanchard takes the opposite position with this theory of Autogynephilia which proposes that male transsexuals are aroused by seeing themselves with female bodies; or conversely, the desire of homosexual men to establish permanent relationships with male partners (Androphile).

As I stated, this approach places not only homosexuality but transsexualism as a pathology which is completely rejected by the APA and WPATH respectively.  And let's not forget the millions of transsexuals who in no way identify as homosexual.  According to Dr. Blanchard they are not transsexual.  It has been this approach that has done so much damage to so many who have sought treatment.  Statistically this approach has a reported error of in excess of 12% of misdiagnosis of those who were approved for SRS.

This writer totally rejects both of these theories by Dr. Blanchard as not meeting even the basest of personal needs or description based on my own feelings.  This is not to rule it out as applicable to some people, but not all, or for that matter even a significant number of transsexuals.

Lastly, this theory did not include Female to Male transsexuals nor did it address the "condition" or even theorize about it.

Dr. Ken Zucker

Dr. Ken Zucker is a firm proponent of Dr. Blanchard's theories and in fact applies them toward his own treatment protocols; particularly with children.  He rejects claims of Reparative Therapy calling it instead Conversion Therapy.  Crap by any name still stinks.  He is very quick to point out the volume of his published work and editorial duties.  This does not make him a scientist, let alone a good one but it might qualify him as a writer.

First it is important to realize that of all children who identify as primary transsexuals, only about 1/4 of them actually pass through puberty and adolescence with this diagnosis intact.  Most of these children begin to identify as homosexual once into their teens.  This poor statistic seems to be held up as proof of Dr. Blanchard's theories.  In the opinion of this writer, such a statistical variance (deviation) would automatically call any credibility of Autogynephilia into question.  Sadly this is not the case.  All research studies appear to have been performed around Autogynephilia ignoring any other factors such as childhood Gender Dysphoria while noting that sexual awareness doesn't usually occur until around the time of puberty

Due to his personal beliefs, Dr. Zucker has used and continues to use Reparative Therapy (Behaviour Modification) in his treatment of child transsexuals.  He believes that a strong role model will "cure" the child.  This approach has been rejected by every psychological organization in the world.  WPATH (World Professional Association for Transgender Health) expelled Dr. Zucker from its ranks for his steadfast refusal to cease and desist from using this proven to be harmful approach in treatment.  Again, he is reinforcing Blanchard's theory that transsexualism and homosexuality are pathologies.

He is claiming to stand on WPATH standards for treatment but the foregoing does not seem to support those claims.  Additionally this writer has been unable to confirm his credentials via web posted CV or his readmission into WPATH.

Dr. Michael Bailey

As was noted earlier, Dr. Bailey is a professor of psychology at Northwestern University.  He published a book titled "The Man Who would be Queen" that was promoted as a scientific study of Autogynephilia only it was written in an easy to read format for the individual.  No scientific data was accumulated or proven and when WPATH called into question this publication as a scientific treatise, Northwestern launched an internal investigation.  The results of that investigation were never made public.

As a result of this, Dr. Ray Blanchard resigned from WPATH citing their interference in scientific study which he claims is outside of their mandate.  His very public letter of resignation is available on the internet.

Dr. Anne Lawrence

Dr. Lawrence turned her focus toward transsexualism and in a very widely promoted essay affirmed her own feelings of Autogynephilia.  This essay created a very strong backlash from the transgendered community that still exists today.  She has conducted some excellent work in the field but still holds to her own writing on Autogynephilia.  This obviously calls her work into question for its impartiality and in particular her support for transsexualism as a pathology.

The stories of the people listed above are only a miniscule portion of their involvement in Transgender Health and study.  It is strongly suggested that anyone interested should read their works, critiques and history in order to determine for themselves the place these people hold.  Admittedly this author's bias is without shame.