Factors & Services for transsexual / transgender Transition in Newfoundland

Introduction: I am often asked for a list of resources for transition and trans services in Newfoundland, so I decided it was time to sit down and type out a long blog. The following contains a list of facts, as well as personal opinions based on my transition experience in Newfoundland.  While I strive to keep the information as accurate and realistic as possible, please keep in mind that I am NOT a doctor or lawyer and NOTHING on this blog constitutes formal medical or legal advice. Also, keep in mind that this blog was written July 17, 2012, so the information may no-longer be up to date.

Project Manage your Life: While doctors can help you decide what is right for you, ultimately, you have to take responsibility for your own life. There is no magical blood test that can determine whether or not you are trans. This decision must come from you based on your own identity. Keep this in mind at all times as you negotiate your way through life. If you know what you need, don't be afraid to doctor shop until you find ones willing to work with you and meet your needs. if you don't know what you want, find doctors and other resources that can help you sort out what you want and need.

Coming Out: once you have come out to yourself as trans and have decided that transition is a must, you will need to carefully map out transition. This has physical, mental, social, financial, and societal implications. Every transition is unique and should be mapped out based on various life circumstances of the patient, their family, their friends, their employers, and others who may somehow impact or be impacted by the transition. An experienced therapist can help map out a transition plan. This includes deciding who you need to tell, in what order you will tell them, what you will tell them, and how you will tell them. TSroadmap.com is a site I highly recommend reviewing, as it will give you a list of every factor you will need to consider.

Provincial Health Standard: there is no formally-recognized trans program or trans protocol that has been endorsed or recognized by the Provincial Government. 

General Health Funding:  Newfoundland residents may apply for general provincial health care insurance, that is available to all residents. Medical Care Plan. MCP will allow you to visit family doctors, on the public purse.

What you need to know about CAMH:  Centre for Addictions and Mental Health is a health care organization in Toronto, Ontario.  As per current MCP Policy for the coverage of transsexual surgeries, which is outlined in great detail in a letter I received and posted on my blog, trans patients who feel they require bottom surgery, and wish to have the Provincial government pay for it, must attain a recommendation letter from CAMH.  In my opinion, this is the only thing that CAMH can offer, that doctors in Newfoundland can't. Take special note, MCP will not cover procedures if done at private clinics on Canadian soil.

Standard of Care:  World Professional Association for Transgender Health (WPATH.org) recently released their 7th edition Standards of Care. This is the most-recognized and most-utilized guideline for trans heath by trans health care providers.  Canadian Association for Transgender Health (CPATH.ca) endorses its use and has trained many doctors in Newfoundland to become familiar with the guideline.

Hormones: any doctor licensed to practice medicine in the province may write prescriptions for hormones and hormone blockers. An endocrinologist is a hormonal expert and is often sought to monitor the hormone levels of trans patients; however, an endo is not essential. A family doctor or psychiatrist may also write prescriptions.

Hormones are generally not prescribed without a formal diagnosis of Gender Identity Disorder (to be renamed Gender Dysphoria in 2013 by the American Psychiatric Association).  A psychiatrist or clinical psychologist may make this diagnosis - usually upon 3 months of psychiatric assessments and therapy sessions. Psychiatrist visits are covered by MCP, so long as a family doctor has made a referral. Clinical Psychologists are generally not covered by MCP. WPATH suggests that assessors have at least some experience with trans patients. To find a current list of ready & willing experienced doctors, I'd recommend contacting CPATH.

My general advice is to start with your family doctor. Talk to them about your hormone desires and find out if they would be willing to prescribe upon a recommendation from a mental health professional.

Financial Coverage for Surgeries: As stated in the MCP policy, bottom surgery may be covered if recommended by CAMH. Top surgeries, facial surgeries, hair removal, hair replacements, egg/sperm storage, voice surgeries, are not covered.

Access to Surgeries: Most surgeons will follow WPATH standards, and hence, will require two recommendation letters for bottom surgery, and one recommendation letter for top surgery. Bottom surgery will require one letter from a psychiatrist and one from a clinical psychologist.

WPATH does not necessarily require hormonal treatment as a prerequisite for surgery.

WPATH does recommend that the patient undergo a 12 month "real life test" where they prove they can function in society while living and presenting themselves full time in a new gender role that corresponds with their desired new sex.  Specific requirements as to what constitutes "full time" is up to the mental health professional.  If you have a mental health professional willing to help, but needs guidance, I would refer them first to CPATH, and then to WPATH.

ICATH.ORG Model:  An alternative to psychiatric diagnostic trans models, the "informed consent" model has recently conceptualized in clinics in Seattle Washington, and London Ontario. The theory behind this is that patients should have the right to make decisions about their bodies, and that so long as they are able to demonstrate that they understand the implication of taking hormones, doctors at these clinics will give them hormones, without the diagnostic process, so long as they consent and pass a physical. 

Medical Resources:  many trans people have found doctors here in Newfoundland to oversee their assessment, hormones, real life tests, and surgery recommendation letters.  Waiting lists may be an issues, so seeking out doctors on the mainland, may be another option.

Hormone Guidelines:  there are many guidelines in the world for transsexual/transgender hormone regimes.  Vancouver Coastal Health's model is probably the most-used one in Canada.  The Endocrine Society is another model often used.

Surgical Resources: it's best to do your homework. research all the surgical options and read up on all the surgeons.  Having gone through vagina/clitorus/labia plasty with Dr. Pierre Brassard, I am very pleased with the results. I have parts that look genuine, and I was female-orgasmic within a year post-op.

Egg/Sperm storage: hormone replacement will render a patient sterile very quickly. it is very important for patients to understand this implication.  Those who may wish to have biological children later in life must consider storing egg/sperm at a fertility clinic for future use. As of 2008, i was unaware of any private clinics in Newfoundland. I highly recommend Repromed in Toronto.

Facial Hair removal: laser is cheaper than electrolysis, but it is not always as efficient and effective. I did 10 sessions of laser on my face at Hillcrest Clinic on Thorburn Road in St. John's.

Hair replacement: hair transplant may be an option for those who have moderate male-pattern-baldness. A wig may be the only option for those with substantial male pattern baldness. 

Voice:  for F2Ms, testosterone will naturally deepen the voice, in most cases, within 3-6 months.  For M2Fs, voice retraining or risky vocal surgery are the only options. Deep Stealth productions offer free do-it-yourself voice retraining kits - which may or may not prove effective.  Vocal coaching is another option, although I have never sought out such a resource in Newfoundland.

Financial: Transition costs MONEY! As part of your transition plan, you will have to factor your financial situation into your expectations in terms of timetable and overall deliverables.  Most importantly, you need to function in society. Before you can even think about transition, you need to be sure that you can afford the basics in life: rent, food, electricity, phone, etc.

Employment:  coming out at work and negotiating a successful transition on the job requires a perfectly-executed plan; and even with perfection, you may still lose your job due to transphobic employers.  Do all you can to ensure you have a safe and secure job. Although I lost the job I had while in the early stages of transitioning, I have managed to retain employment at a new job, which I found less than a year later. TSroadmap.com highlights key considerations. I would also be happy to chat with anyone about my experiences in this matter.

Housing: not every landlord will be comfortable renting to a transsexual. This is discrimination, but it is a sad reality of life in Newfoundland. I've found that renting property managed by major property management corporations to prove more effective than renting from an average Joe. Be prepared that you could find yourself unable to renew a lease. 

Family:  Not only are you going through a drastic change, but your family and friends are going to be faced with your change too. You never really know how people will react. Be prepared to face losing even the closest of people in your life.  Spouse/partners, parents, children, best-friends, social clubs - all may elect to ostracize you. Be prepared.

Romance and Sex Life: hormones will change your body, your emotions, your sex drive, and perhaps the functionality of your sex organs. Hormones may even change your perception of attraction (meaning, you may come out of transition with a different sexual orientation). obviously, affects of these matters could add stress, anxiety, or depression to you and/or to your partners.

General Presentation:  I personally felt that I had to over-sell my feminine presentation, in order to satisfy my doctors that I was living a true real life test.  Going through a change of gender presentation mostly requires self-confidence and self-comfort.  Not all women are girly-girl feminine. In my case, I was initially very anxious to fem it up. I got right into the make up, the dresses and skirts, the pink, the shaved legs.  But after a while, I went back to my somewhat tomboyish ways.

Remember, transition and gender presentation is about you and about satisfying yourself to live the life that you feel you need to live.  Don't ever allow yourself to be pushed into anything you are not comfortable with.  If this means you have to doctor shop until you find ones you feel you can work with, then do it.

Privacy/Stealth: remember that you are a human being and you deserve your rights to privacy. Never feel obligated to disclose anything you don't feel another person needs to know, or something you don't feel comfortable disclosing. Not everyone necessarily needs to know that you are transitioning. Those who do know or need to know, may not necessarily need to know all the details.

Pronouns:  It is up to you to decide if and when you wish to ask others to refer to you using a new gender pronoun and/or to use gender neutral pronouns. While we all deserve the right to live in a gender gray area, keep in mind that the rest of the world thinks sex and gender are binary. your transition may be easier to sell if it is perceived to be a binary change, whether it really is or not. While the older standards of care treated trans matters as binary, the new version reflects that gender is a gray area.

Legal Name Change:  to change your name in Newfoundland, you generally need to be a resident in Newfoundland for at least 6 months. You may apply to have your name legally changed by contacting the office of Vital Statistics. Although the Provincial Government has a right to refuse name change requests, this is a rarity. Once your legal name change has been registered, you may take action to have all of your various ID documents changed - most likely starting with your birth certificate.

Legal Sex Change:  the policies and procedures for changing legal sex will depend on where you were born. You will need to consult the office of Vital Statistics of the Government province for which you were born.

Human Rights: transphobic discrimination is a sad reality in Newfoundland. There exists, a Human Rights Act of Canada and a Human Rights Act of Newfoundland and Labrador. Most matters of discrimination will fall under one of these two jurisdictions. While both Acts prohibit discrimination on the basis of Sex, it should be noted that while protection for matters relating to gender, gender identity and gender expression have been loosely implied, they are not explicitly stated at the Federal Level. Update: Gender Identity and Gender Expression were added to the provincial Act as of 2014.

While we all have every right to fight discrimination, we also have to keep in mind that we need to be careful about choosing our battles. It may be unfair, but one can easily be labelled as a complainer for complaining too often, even if it is justified. Furthermore, the burden of proof is generally upon the victim.

Depression:  transition takes its toll emotionally - usually because of external factors in the world who make life difficult for transitioning people.  Loss of employment, housing, family, friends, sex drive, sex functions, energy, muscle strength, metabolism, etc, can lead to stress, anxiety, and even depression. Don't be discouraged. This is fairly common.  If you think you are depressed, talk with your doctors and they can help you manage your depression as you negotiate transition.

M2F Side affects: replacing testosterone with estrogen may drastically reduce your strength, speed, endurance, muscle mass, metabolism, and ability to process oxygen. I went from being a near-elite-level male athlete, to an exhausted, overweight, weak female who needs more sleep. Be prepared for this, and when it happens, embrace it! your estrogen is working!  Just remember it will also bring the desired affects - feminization of body, and feminization of emotions.

Trans Peer Support: There is no substitute for mentors. Having other M2F friends who were deeper into the transition process than I, served to be extremely valuable. It is so important to have someone to ask questions and someone who can relate to what you are going through. Unfortunately, I am the only known out transwoman in Newfoundland that you can clearly find via google. There are others here who are not necessarily out. Likewise, the transman community is small too, and there are only a small handful of those who are out publicly.  I'd be happy to try to engage the few that I know into consulting with you, should you desire others to talk to. Meanwhile, I am quite happy to offer my peer support.

East Coast Trans Alliance: This is an informal network of trans-identified individuals from all four provinces in Eastern Canada. It was initially created with the intent to become a non-profit society; however, that never got off the ground, but the community still exists and functions through a facebook group. Learn more about them at www.eastcoasttransalliance.org

Newfoundland Patients Association for Transsexual Health: I am in the early stages of putting together a recruiting program to bring trans-identified patients of the Newfoundland health care system, to formulate and formalize a non-profit society for which we can use to educate and advocate for better health services, as well as to make new friends and contacts in and out of the trans and health care communities. To learn more about this concept, see www.npath.net

Jennifer McCreath Consulting: As I have already stated, i am not a doctor or a lawyer, but i am a person who has lived the transition experience in Newfoundland. I feel it is in my best interest to help other trans-identified people negotiate their lives. The more happy and successful trans-identified people we have here, the sooner transsexualism will be accepted by the masses. I am more than happy to do whatever i can to help others, and i will generally offer my time to individuals, for free, when my schedule allows. Consider it an offer of friendship!  To learn more, see www.jennifermccreath.com

Other Peer Support:  Some trans people find comfort in developing friendships and acquaintanceship with members of the gay/lesbian/bisexual community.  While I have had many challenges relating to and developing good rapport and friendships with various local gay/lesbian entities, and while I don't necessarily endorse or support all of these, I am quite happy to at least point out the ones that I am aware of:

EGALE Canada has conceptualized a concept known as the Gay/Straight Alliance. These are student-run, teacher sponsored, peer groups that now exist in many high schools and universities. Visit www.mygsa.ca to find out whether or not your school has one of these organizations.

LBGT-MUN - The Student union at Memorial University has an LGBT services program. Visit them at www.munsu.ca/lbgt

St. John's Pride Inc., is a registered non-profit society that oversees community events and support services for members of the LGBT community. Learn more about them at www.stjohnspride.ca

The NL Sexual Health Centre - AKA Planned Parenthood, has a LGBT youth program. learn more about them at www.nlsexualhealthcentre.org

PFLAG Canada (www.pflag.ca) has a St. John's Chapter. they offer general support for members of the LGBT community, and their families, friends, and allies.

International Frontrunners is an alliance of LGBT-friendly running/jogging/walking/social clubs. A chapter exists in Newfoundland that is based in St. John's. find them here www.frontrunners.org

Other Resources:

www.tsroadmap.com I can't emphasize enough how important this site was to me. It was created and is managed by Andrea James, a well-known transitioned post-op M2F who currently lives in California. She is an avid advocate and activist for the trans community.

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