When I began my journey of transition seven years ago I started by doing reading. What I found was a lot about the steps leading to going ‘full-time’, information about medical transition, information about the challenges. Some of it was helpful. Some of it was not helpful. At the time, there was still a lot of emphasis placed on going ‘stealth’ post-transition. What was lacking, and still is lacking, are resources and support for those who have ‘finished’ their social and/or medical transition.
By focusing on the journey of transition we have, it seems, lost sight of what people may need once they have ‘completed’ their transition. For those who have socially transitioned there are still challenges that are faced in life. For those who have medically transitioned there is often a lack of resources to help with issues that may arise. Often, people need resources and supports for both.
Social transition is, by its nature, more common than what is traditionally seen as a full medical transition. The reasons for this are many. The short answer is that not everyone needs medical transition and those who do need it often cannot afford it. Those working on improving trans health care (in this post I am referring to physical and mental health care) tend to focus on access to medical transition. The general consensus among those looking to improve health care for trans people is that one should not need to have a referral from a mental health provider for hormone therapy. There is less consensus with regard to what should be required for surgical referrals. (Referrals are a subject for a different post) What is often not talked about is what good mental health care for trans people would look like.
We, as a community, do not talk about what happens when one is seen as ‘done’ and requires more care. What happens when a person is struggling with their mental health? It does not matter what the reasons for the struggles are, they are often not well handled. If the struggles are directly related to problems arising from or concurrent with medical transition procedures the situation is worse. We do not like to hear it when people report problems with HRT or surgery. We do not adequately talk about what the challenges post-surgery are or can be. This is part of a larger problem with discussing surgery, I topic I discuss in “Shhhh, it’s a Secret! How we don’t talk about surgery.”
Seeking mental health support ranges from being difficult to downright impossible. While we are in transition providers often say they don’t work with transitioning people. If we’re ‘done’ it is still all too common for providers to not want to deal with trans people because of their gender issues. This happens even when that is not the problem the person is seeking help with. Being trans, even post-transition, is part of our history. Thus, it will likely come up in some way in any counselling or therapy, even if just in passing. Yet, when figuring out our gender identity questions isn’t the primary concern, we don’t have all that many needs other than someone who is a good counsellor or therapist.
On the physical health front dealing with medical providers is often difficult. Many, if not almost all, trans people have had experiences with health care providers that range from awkward at best, to causing significant harm at worse. Trans people are regularly asked about their surgical status when seeking help for common health problems such as ear infections. When the problems one is having are related to complications from gender confirming surgery the challenges increase. Most providers are not adequately educated on the topic. Intentions may be good, but knowledge and experience are often inadequate to meet the needs of the person. Seeking specialist help with problems is often not easier. Many, if not most, specialists do not have the required knowledge or experience. The result is that the person may be referred back to the surgeon.
Referring a person back to the surgeon, while the best option medically, may not be practical in real terms. In the North American context those who have genital surgeries must, in the vast majority of cases, travel significant distances for their surgery. This travel can be expensive and is usually at the person’s own expense. Having to travel for adequate follow-up for complications is problematic to almost impossible. While email is a possibility for some follow-up, photographs may be sent to seek consultation. They are a great tool, but often not adequate for good decision making.
Like many issues that are seen as “trans” issues there are overlaps with other issues. It is common to have to travel for medical care that is highly specialised. Often, as for trans related care, travel is at the person’s own expense. Overall, we can, and must do better for everyone who must travel for medical care.
For those who are trans the need for adequate care does not stop when transition is ‘finished’. It is ongoing. Some improvements have been made, but more can be done. More must be done to ensure that the health needs of trans people are met even when transition is ‘finished’. We must go beyond just focusing on accessing HRT and surgery and look at what happens afterwards.