Friday, June 24, 2011

June 24, 2011 - Off the Shelf: the long-lost Trans Health Article!

Transsexual Health Care in Newfoundland: Negotiating Red Tape and Old Stereotypes

In June 2007, Jefferson McCreath, a male who knew she was actually a woman born transsexual, moved to Newfoundland to take a job with the provincial government. Shortly after establishing herself into her new house, new job and new town, she took immediate steps to start her transition.

Although transsexualism was traditionally considered a mental illness the global medical community has almost unanimously recognized it as a physiological condition that can only be rectified through physical intervention: hormone replacement therapy (HRT) and sex reassignment surgery (SRS).

The Harry Benjamin Standards of Care, 6th Edition, (SOC) are globally recognized as the best-practice for transsexual health care. McCreath was saddened to learn that this protocol was not recognized in Newfoundland. Even worse, she found an old out-of-date government policy that required patients to travel to Toronto to complete a program at the infamous Gender Identity Clinic at the Centre for Addictions and Mental Health (CAMH), before the province would fund SRS. She also found that most other procedures were not covered, no matter what.

McCreath had already become familiar with the many horror stories that had been told by CAMH patients about the negative treatment and strange research experiments they were apparently forced to undergo before being considered for funding; and how a reported 90% of patients were rejected. The SOC make it clear that any team of doctors can oversee the application of the protocol. The idea that a special mental illness gender clinic would be required seemed absurd, so she decided not to attend there.

Even through private care, McCreath knew that she would not be able to get HRT or SRS unless she was able to procure the services of doctors who would act as gatekeepers to allow access to the product. So the search was on.

Meanwhile, McCreath couldn’t wait to get her transition under way. So she took the primitive step of “going full time” before ever taking a hormone pill. Finally, in early 2008, Jennifer had put together a suitable medical team that would provide hormones, and eventually, a recommendation for surgery.

Before starting HRT, Jennifer knew that she would have to store sperm if she had ever hoped to become a biological parent. While the Newfoundland Health care system often provides this service to testicular cancer patients, she was advised that this would not likely be covered for her. So Jennifer opened the wallet and traveled to a private clinic to have sperm stored.

The HRT first started with estrogen and a testosterone blocker. Quickly, it became evident that the blocker had adverse side effects. So rather than wait for her to complete her one year Real Life Experience test (RLE) to prove her readiness for SRS, her doctors supported the idea that she should immediately seek to have her testes removed. Well, once again, Jennifer dug deep into the wallet and found herself traveling to a private clinic, in the USA.

2009 started with shock and disappointment. After initially feeling accepted at work, she noticed job duties being taken away and given to other new people in the organization. Then shortly thereafter, what was supposedly a safe and secure job became a layoff. While she had speculations that her transition may have been a factor, she did not have the resources or the energy to fight it. So Jennifer set out to do the impossible, find another job.

By this time, Jennifer had filed a Human Rights Complaint with the Human Rights Commission of Newfoundland and Labrador (HRC). The complaint was against the Newfoundland Medical Care Plan (MCP) for what she stated was discriminatory treatment, as she was denied care, and funding for care, as a transsexual, that would ordinarily be provided to others. She also complained that it was discriminatory for her to require a recommendation from CAMH, for procedures otherwise obtainable and fundable upon the recommendation of a Newfoundland doctor for others. Furthermore, she complained that MCP’s policy to refuse to fund SRS at private clinics in Canada was inappropriate given the lack of such a service being available in Canada by any public institution.

Unfortunately, Gender Identity and Gender Expression are not included explicitly in the Human Rights Code of Newfoundland. So Jennifer’s complaint was based on “sex.” Two years later there has been no decision rendered by the HRC.

Jennifer specifically wanted to have her SRS performed by Dr. Pierre Brassard in Montreal, given that he was the only SRS surgeon in Canada, and given that he is considered one of the best in the world. A year later, and 40 job interviews later, Jennifer finally landed work (as a file clerk, of all things). While this job would only pay half of what she was previously earning, this would at least allow Jennifer to have a financial foundation and allow her to further build upon her credit rating. On January 24/11, Jennifer had SRS with Dr. Brassard.

One other issue that remained were that with almost three years of estrogen, Jennifer was not seeing mature breast development. After conducting extensive research, it became evident that adding the natural female hormone, progesterone, would be the only way for this to happen. Unfortunately for Jennifer, her doctor was reluctant to provide this hormone as the Canadian trans health network did not recommend it. Determined, Jennifer made yet another trip to the USA to a private medical clinic, where she was able to secure progesterone.

It may seem that Jennifer’s transition is over, but that is far from reality. Although she has had nine laser sessions on her face, there is still an extensive amount of facial hair that will need to be eliminated through electrolysis. Additionally, Jennifer has been combating male pattern baldness, which is irreversible, by wearing wigs. This is far from an ideal solution; however, hair transplants are also expensive. Jennifer also needs to work on finding her female voice. Meanwhile, Jennifer continues to battle underemployment, and more recently, depression.

So, what’s up next for Jennifer? She’ll keep fighting for her rights and others, through educational and advocacy work. Jennifer’s vision is for transsexuals, and any other non-cisgender-conforming individual, to have timely and funded care, upon recommendations from their local doctors.

Jennifer recently joined Canadian Professional Association of Transgender Health (CPATH) as a non-voting member, to become part of a policy development committee, where she took a leadership role in penning a membership expansion policy that would allow CPATH to grow. Jennifer hopes CPATH will become an internationally-recognized body of knowledge for trans health, so that they can combat the old myths of the American Psychiatric Association’s DSM-V Gender Identity Committee, that transsexualism is a mental illness under the classification of “paraphilic fetish” (a label deemed suitable for sexual predators).

In addition to trans health policy work, Jennifer has also been recuited by PFLAG Canada to create and deliver a series of trans educational lectures, which will help Chapter leaders from across the country, better learn how to offer peer support to individuals who attend peer support meetings. There will also be an information package preparted and distributed.

Furthermore, Jennifer has also entered preliminary discussions with transwomen from across Eastern Canada to form the first officially-registered non-profit organization who will have an exclusive mandate of undertaking societal education, peer support, and advocacy & government lobbying, with regards to trans issues.

Jennifer also continues to play a key role in community peer support and education locally, and nationally. She frequently speaks publicly about trans issues, provides informal trans consulting advice on her blog, YouTube, and in person. Ultimately, Jennifer is concerned that she has essentially taken on the role of “unofficial spokesperson” for trans issues in Newfoundland, and even more concerned that it is she, not the Department of Health, who many people are turning to on a regular basis for help and advice.

Finally, Jennifer has taken a leadership role in managing the planning and delivery of a project team that will plan and deliver an awesome series of events for Pride Week 2011 in the City of St. John's, as part of one of the non-profit companies that she co-runs, St. John's Pride Inc. (for more info, see )

Meanwhile, she's always willing and able to make time to talk to anyone about trans issues. contact her at .

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