One of the more interesting things I found when I started my transition and investigating the various ways one can transition was the predominance of one way of looking at transition. The expectation of both the medical professionals and from a large percentage of the trans community is that it’s like following a roadmap. One just has to follow all the steps and one will have transitioned and be a whole person. For some, yes, their transition does follow a relatively straight path. The expectation from others in the trans community often follows this same pattern and many people say that one can set a hard and fast timeline. In reality transition is not so simple. As Kat “Kyosuke” Callahan stated in a recent post on Jezebel, “Transition doesn’t come with a fucking GPS.”1 Yet the pressure is that there is this GPS that one is supposed to follow or one is accused of “doing it wrong.” Critisism that one is doing it wrong comes from multiple sources, psychologists, medical doctors, psychiatrists, other trans people and cis people to name a few. All think that they know better than the individual trans person what the person’s transition or non-transition should look like.One group of trans people that gets a lot of pressure, criticism and downright hostility from both trans people and the medical ‘care givers’ are those for whom surgery is not right for them in their transition. For those transitioning from male to female this means that vaginoplasty is not right for them so they chose not to undergo the surgery. For those transitioning from female to male the various surgeries, mastectomy, hysterectomy, phalloplasty etc. may or may not have one or more of those procedures depending on their own journey and needs. This tends to shock people. I have been told in various places that “if a trans woman transitions but does not have surgery they aren’t really a woman.” There is a lot of judgement within trans communities around how one transitions, how one presents during and after transition. Often the criticisms can be contradictory. One person saying “you’re too femme, too much makeup, you’re over doing it.” While another says, “you’re not femme enough, your voice is too deep, you’re not wearing enough makeup.” I have heard people transitioning from female to male state that they have received similar comments, but from the opposite perspective. Either way the messages can be confusing and are judgmental. Often they cause a person transitioning to feel inadequate and not supported by what ought to be their own community.
Medical professionals who make these sorts of judgments can cause even more harm than the comments from those in trans communities. The medical professionals are the gatekeepers. They are the ones who have the ultimate say on whether or not a trans person can get the care they need. Some doctors won’t even treat a trans person. Other times the professional has their own idea of what a transition is and how it is done. My own experience with someone specializing in working with those transitioning was that they had a set of steps that one takes and if one doesn’t follow what they say the steps should be one isn’t doing it right and won’t get required referrals. To their credit they did not say that all trans people must have surgery(ies). There are many so-called professionals who will insist that a trans person undergo treatments and surgeries that are not appropriate to them in order to get required care. If someone goes to these types of practitioners and explicitly states that surgery is not right for them they are refused the medications required for proper hormone treatment. If one doesn’t appear to be appropriately masculine or feminine then they aren’t ‘doing it right’ and will be refused treatment. This leads to coercion and essentially people having surgeries not because it is something that they have discerned is right for them, but because it is the only way to get the aspects of treatment that they do need. This coercion results in much harm to people that will last a lifetime. Negative attitudes by medical professionals is also a reason why many do not seek care, especially after experiencing hostile responses from people who are supposed to be providing care.
What can be done?
First, we need to get rid of the whole ‘gatekeeper’ mentality that says that the medical professional is the one who knows best. Care involves a two-way dialogue with the person who is seeking to figure out what is best for them. It involves listening and asking the questions that will help the person in their journey. In order to achieve this people who are providing care must be given adequate training both in their professional schools and in ongoing professional development. When someone seeks medical help for most ailments it isn’t a question of whether it is ‘real’ or not. The issue is acknowledged and appropriate treatment is given. When trans people are not able to get adequate care the result is significant. A recent study showed that 60% of trans people refused medical care attempt suicide.
Second, everyone should keep in mind that no two transitions are exactly the same. We all have our own stories. While there are many similarities in trans narratives, there are also a lot of details that are specific to each individual. It is imperative not to judge the person, but to do what one can to help them in their journey. (see my previous post for some ways to do this) What is right for my transition is not necessarily what is right for someone else’s transition. I can share my own experiences and feelings, but they are my own, not someone else’s.
Third, lobby politicians to make sure that care is accessible. Here in Ontario this means removing the stranglehold CAMH (Centre for Addiction and Mental Health) has on recommendations that the Ministry of Health provide funding for needed surgeries. The current wait times are in excess of 18 months for an initial assessment. Additionally it is up to the individual to figure out how to pay for the travel to Toronto for care. The Ministry of Health does provide some travel assistance to those in Northern Ontario, but those not in the specified region are stuck footing the bill themselves. In response to an inquiry about having other locations available this was the response:
As far as a second clinic is considered, there are currently no immediate plans to open a second. This is based on the communication between CAMH and the ministry on their demand and ability to manage the wait times. Received on 2014-01-29.
In other parts of Canada ensuring adequate care would mean making sure that provincial health care systems will fund necessary surgeries. In the United States pressure must be put on employers and medical insurance providers to include trans health requirements in their policies. Some companies do provide this care, but it is not universal.
1: The post may be found at http://jezebel.com/bruce-jenner-transitioning-or-not-youre-reporting-it-1512265204 and addresses rumours being published in gossip media about someone and claiming they are transitioning. The post addresses serious issues in how media deals with one aspect of reporting on people who may or may not be trans.