Trans Needs Assessment

(Update 2013: I wouldn’t even consider doing a post like this now.  But at the time this was written, it was in response to a query about trans issues in Alberta, while few trans Albertans wanted to respond to surveys or be politically engaged in any way.  Prior to 2009, in fact, many people were strongly opposed to suggestions of organizing, for fear of losing funding for reassignment surgery (which happened in 2009 and was restored in 2012).  In 2008, I tried to compile this to the best of my ability, voicing concerns that were raised in support groups and on message board — anything I was aware of at the time.  It’s inadequate, under-representative and is in dire need of updating with survey-based information.  I leave it in place because it does provide an introduction to some mostly transsexual-specific needs for people who are just starting to learn about trans issues)

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It is impossible to say how many people there are in the transgender community, as statistics in Alberta have not been gathered.  This is also complicated by the fact that a majority of transfolk prefer to live in “stealth,” hidden and unknown among the population.  It is also further complicated by the community’s diversity, creating a question of whether to attempt to count transsexuals, who have the most specific needs in the community or to also count a larger range of gender-variant persons.  Recent studies elsewhere approximate the transgender population as representing between 1:4000 and 1:2000 persons.

Transgender issues are often defined legally as ones of “gender identity” which encompasses the specific needs of transsexuals, and “gender expression,” which encompasses a wider array of gender variance that people choose in everyday life, even beyond the transgender community.  The firing of Stacey Fearnall (who is not transgender) by Nathaniels Restaurant in Owen Sound, Ontario because she’d shaved her head to raise money for breast cancer research, for example, becomes an issue of gender expression because it contravenes the typical expectation of feminine presentation – it’s doubtful that something similar would happen to someone male.

Although we are united in solidarity with the gay and lesbian community against heterosexism and discrimination, and although we share several similar needs (albeit compounded sometimes by our visibility), the transgender community does have some concerns that are unique to us.  Needs both specific and shared include:

  • Public Funding for Gender Reassignment Treatments needs to be maintained, including continued funding for Gender Reassignment Surgery (GRS).  This is considered a medically necessary procedure (see other handout: “Why ‘Sex Change’ Surgery is Medically Necessary,” or online at http://www.albertatrans.org/documents.shtml).
    One aspect of transition that is not currently covered and needs consideration is facial hair removal (electrolysis or laser) for male-to-female transsexuals, a process which makes an incredible difference in how a transsexual presents and integrates into society (it is covered in Ontario, for example).
  • Access to Therapy and Other Medical Treatment, Both Trans- and Non-Trans –Related.  Stories abound about transgender patients being refused referrals to GID-certified therapists or even for treatment of issues such as ear infections once it is determined that someone is transgender.  Greater awareness within the medical community about transgender persons and the established standards of care for them is needed.Of particular concern to the transgender community is that there are only two GID-certified psychiatrists in the Province, one of whom is winding down his practice as he retires and the other of whom has a waiting list upwards of 12 months just for an initial assessment (and who is also looking toward retirement in coming years).  Recruiting of psychiatrists to study and treat Gender Identity Disorder is vital, or alternately to open the field up to all psychiatrists, so it is not so “gatekeepered.”  Additional support for the Gender Identity Clinic at the Grey Nuns Hospital in Edmonton in order to relieve the existing backlog is also desperately needed.
  • The Cessation of the Stigmatization of Transgender Identities as Mental Health Issues.  Until a biological / medical determination is proven, the classification as a mental health issue remains, if only to acknowledge the distress that living as a closeted transgender person can cause, particularly the distress of transsexuals who, until transition, are forced to live a lie in order to make society happy.  Even so, it needs to be acknowledged that transgender identities are not merely “chosen,” that those identities are far more intrinsic to transfolk than a “sexual kick” (which is a common misconception) would be, and that repression of these identities results in cycles of shame, fear and self-loathing, and sometimes results in self-destructive behaviour or suicide.  It needs to be particularly recognized in the medical community that aversion or “reparative” therapies intent on forcing people to accept their biological sex are damaging and must be discontinued.
  • Anti-discrimination Legislation.  While protections are assumed to be “read in” by the courts and Human Rights tribunals based on previous verdicts, it is still subject to interpretation by judges, and protection is not always certain.  Specific Inclusion in Human Rights Act is needed, for both transgender people and other gay, lesbian and bisexual persons.
  • Legal Protection in Employment, Housing, Public Accommodation and Access to Credit.  One of the fastest-growing issues for transgender people has been the availability of affordable housing, an issue which affects many Albertans, but can be amplified by landlords’ resistance to having transgender tenants.  Being that there are few controls on the amount and application of rental increases, it is also easy for transgender people to be specifically “priced out” of their existing accommodations. Additionally, many shelters and social programs are gender-specific, and transgender people are sometimes dually excluded from those reserved for either gender.Transgender people are particularly vulnerable in regards to employment.  There is some recourse through the Human Rights tribunal because of a previous precedent, but there is no legislation to discourage firing for being trans in the first place, and because of the need to live in stealth, many transgender people are afraid to avail themselves of such means.
  • The Cessation of Gender Assignment at Birth to Intersex Infants.  It has been shown – sometimes quite tragically – that such assignments can create transgender-related conflicts and difficulties in intersex people, later in life, should they be arbitrarily assigned to a gender to which they don’t identify.
  • Inclusive Protection in Hate Crimes Laws.  Hate crimes against transgender people are sometimes (but not always) covered as “sexual orientation,” although this is a statistical inaccuracy.  Transgender is not an orientation.  It is about who we are, a separate aspect from who we love.  Transgender identities are also still sometimes used to “reasonably justify” actions against us (“panic strategies”).
  • Trans-Positive Education.  In discussions of equality and diversity, transgender people should be included.  Close monitoring of bullying in schools is also strongly advocated for the protection of those children whose gender expression is the subject of controversy.
  • Support and Education for Parents, Spouses, Children, Friends, Family, Co-Workers and other Allies.  While one organization is doing its best to meet this need (PFLAG) and has monthly meetings in Edmonton and Calgary, provision of support, information and outreach would be invaluable.
  • Gathering of Statistics Relating to the Transgender Community, Particularly With Regard to Suicide / Crime / Hate Crimes, Medical Issues and Treatment.  Without these statistics, it is incredibly difficult to understand the scope of the situations that transgender people face.
  • Safeguarding Against Maligning in Court Due to Transgender Identity.  The right is needed (and not currently present) to not have our transgender identities used against us in a court of law, such as to deny us child custody or access, or the use of the discovery of unexpected genitalia as a seemingly “reasonable” argument in order to lessen the punishment for violence (“panic strategies”).
  • The Availability of Public Documentation Changes.  This is currently available for documentation produced in-Province, upon the presentation of documentation that GRS surgery has been performed.  The rare transsexuals who forego surgery, however, have no legal recourse to do so, even if they have been living as the gender to which they identify for several years.  Allowing them documentation change (or alternately to omit the gender marker from their identification) is vital.  Transsexuals born in other parts of the world who might not be able to change their birth certificates could also benefit from some form of birth recognition document that would establish them as the gender to which they identify.
  • Clear Policies in Law Enforcement and Criminal Systems with Regards to Transgender Persons.  Law enforcement needs to have clear and thorough policies on the arrest, search and treatment of transgender detainees (Edmonton currently has such a policy, Calgary’s is uncertain, and Provincial RCMP and other legal bodies have no such policy).  This also includes options for accommodations in the prison system that don’t house according to birth sex — preferably also not resulting in the serving of entire sentences in solitary confinement.
  • Support for transgender support and advocacy programs.  While organizations such as the Pride Centre of Edmonton and Calgary Outlink support the transgender community as best they can and this is appreciated, the existence of different needs is sometimes beyond what they are familiar with and mandated to do.  Additionally, transgender people living in stealth are often afraid of association with GLBT entities.  Transgender-specific agencies are needed, preferably on a Provincial level (as needs between Edmonton, Calgary and rural centres are very similar, yet markedly different from those in the rest of Canada because of medical and legal variations).  AlbertaTrans.org attempts to fill this void in a budgetless capacity, but is not equipped to completely fill this need.  It should be stated that I am not pushing specifically for AlbertaTrans.org to be funded, but that SOME entity on a larger scale is needed.
  • Should a surge of transgender discussion occur in media within the Province, A Trans-Positive Awareness Campaign May Be Required.  As stated, most transgender people prefer “stealth,” and would rather not be discussed so openly — but in some jurisdictions where legislation or media events occur, awareness becomes vital to (for example) combat the creation of the transgender “boogeyman” portrayed as predators in womens’ washrooms, as witnessed recently in Montgomery County, Maryland and in the State of Colorado.

Because many in the transgender community become marginalized due to discrimination, shame / social stigma, economic disparity and the expenses associated with transition, support of outreach in the following areas also indirectly benefit many of the disenfranchised within the transgender community (provided we are given access to them):

  • HIV and other sexually-transmitted-disease prevention, detection and management.
  • Substance Abuse Programs.
  • Prostitution Outreach and Legal Protections for Sex Trade Workers.
  • Shelters, Recovery Programs and Halfway Houses.
  • Suicide Prevention Programs.
  • Support for Comprehensive Health Care for All Albertans.  Because we understand the need for Gender Reassignment Surgery (GRS), we also realize the need for other medical concerns that the health board scrutinizes and questions, such as diabetic treatments, vision and dental care, reasonably-demonstrated treatments which are still deemed “experimental” by the Province, and more.  Preventative medicine is also encouraged, and seen as the best way to save money in Health Care in the long term.

It is often said that the measure of a society is the way in which it treats its most disenfranchised.  Addressing transgender issues, many of which overlap with other marginalized communities, can go a long way to creating a better, stronger Alberta.

  1. Brava, and I *will* be stealing it for use locally.

    • Shari M.
    • July 30th, 2008

    These are all very important issues that you raise here. I shall suggest that we borrow freely from them in the next Transgender Town Hall meeting via conference call. You put a lot of work into this, Mercedes. Thank you!

  2. Hi again, Mercedes et al,
    I have a pressing question, and am wondering if anyone could help me. What is the age when one can undergo the SRS? Is there a distinction made between the hormone treatments or are they deemed to be part of the SRS? Are there any limitations with respect to age, or is it based on parental consent, if a child is under 16?

    I have been looking at Australian case law, and it appears the only case showing an instance of gender transition is that of Kevin v. Family Court of Australia, the case of a 13 yr. old transgendered boy.

    I apologize for the naive questions and hope you can help me. You may also write me at shqipster@gmail.com.

    Many thanks!
    Arber

    • Shari M.
    • August 16th, 2008

    Arber: I’m sorry I didn’t see this sooner, but I have a little information that may be useful. Dr. Norman Spack of Children’s hospital is working with pre-puberty gender variant children, and administering hormone blockers to them to delay the onset of puberty. I know there are people coming from the UK to see him.
    His information is as follows: Dr. Norman Spack, Endocrinology Department, Boston Children’s Hospital Boston
    300 Longwood Avenue, Boston, MA. Phone is 617-355-7476

    I would suggest doctors there in Austraila contact Dr. Spack. I am totally unfamiliar with Australian laws. I’ll also contact you via your e-mail address, which I just saw.

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