One of the significant differences between the transsexual experience and that of people in the gay community is that there is a definite medical process involved. And as in many areas, this medical process is in crisis. In Alberta, for 2008, the trans community will be putting a call out for awareness and improvement in access to care.
Needs exist in a number of areas, right down to the most basic. Finding a family physician who is taking on new patients is challenging for anyone in the current Alberta population explosion, but the number of those willing to see and treat transgender patients is miniscule. It is so much so, that most existing treatment is currently being done by a handful of General Practitioners who are over their patient load, but still making exceptions for transfolk - specifically because they know that we have nowhere else to go. Some of the reasons given for not seeing trans patients include the fact that there is not a lot of education given on how to treat, while others cautiously cite “moral” grounds. And while the latter might be legally actionable, would a patient really want a doctor who is resistant and holds the patient in contempt to oversee their health, hormones and medical processes?
Finding psychiatrists to treat transfolk is also quite difficult. There are some psychologists, but psychiatry is an integral part of the gender transition process - or that is to say, finding psychiatrists who are willing to treat trans persons in the manner outlined in the Diagnostic and Statistical Manual edition IV, rather than by discredited “ex-gay” procedures or under alternate diagnoses such as Dissociative Identity Disorder (DID, once referred to as “multiple personality disorder”) or Bipolar Disorder. And of these, only three doctors in the Province are GID-certified and can recommend patients for hormones and surgery – but one of these only treats children, while another is winding down his practice toward full retirement.
Alberta, Canada has had a reputation in the trans community for being one of the luckier areas in which to undergo gender transition. Although most Canadian provinces fund GRS (gender reassignment surgery) in full or in part for MTF transwomen and hysterectomy and chest surgery for transmen, Alberta has had the most transparent process and a top-notch GID-certified therapist, although he has sometimes had a waiting list of up to 2 years.
This therapist is Dr. Lorne Warneke, who runs the gender clinic in Edmonton, and who tirelessly compiles the data and statistics needed to continually justify the operation of the clinic. But, as with many centres, he faces funding limitations for both purposes. In 2007, for example the number of potential approvals for surgery exceeded Alberta’s maximum annual quota of sixteen.
Dr. Warneke has not been alone in treating the transgender community. In fact, Dr. J.H. Brooks has also worked with transsexual patients since the 1970s, also in Edmonton, but at a separate clinic. Both doctors have opened their hearts to their trans patients and shown incredible devotion, as typified by the fact that Dr. Brooks – past retirement age and sidelined twice with health complaints – still soldiers on to treat patients one afternoon per week. I think that sometimes, once GID therapists have worked with transfolk for awhile, there must be a bond that develops. Most other “mental illnesses” require continual monitoring, ongoing medication, the conditions may or may not go into remission, etc. But unlike those cases, Gender Dysphoric patients can go through an entire process within a few years, at the end of which they are often (but not always) “cured” – or at least well on their way to leading happier, more fulfilled lives. To be fair, transsexuals acquire a number of other issues related to coping pre-transition, so it is never that easy.
But for doctors whose case loads include some heavy and troubling people (Dr. Warneke is also renowned for his work with ADHD and troubled children; Dr. Brooks also sees a number of court-ordered and institutional patients), trans patients must sometimes be a breath of fresh air, those rare success stories that they can look back at and feel a sense of accomplishment.
Dr. Warneke, 65, has also been active in the community when few others could be found doing so, with public speaking, lobbying schools and employers, and advocating in judicial matters. But he cannot carry the torch forever. He is looking for another therapist to step into the role and perhaps eventually oversee the clinic. He says to The Edmonton Sun: “I’m good for another few years… But at some point, I’m going to have to start slowing down.”
Other Barriers To Care
There have been additional areas where finding medical care has been challenging. Most Alberta cosmetic surgeons refuse to perform breast augmentation (a non-funded procedure) for transwoman. And while some will perform mastectomies for transmen, they now charge significantly far more than for other patients, putting Alberta Health in the position of having to determine whether it is more cost-efficient to pay the difference or send patients out-of-province. Similarly, many endocrinologists will not take referrals of transsexual patients unless gated through Dr. Warneke (despite the latter’s long waiting list), while others will not take referrals of trans patients at all.
Clinical staff also, at times, pose a difficulty in the process by willfully using a person’s old name and pronouns to humiliate them in the waiting room; neglecting to do things such as including them in the day’s waiting list; or failing to forward test results to the appropriate parties. Mistakes do happen, but when they habitually come from the same people and drip with intent, then there is a clear problem in professionalism that certainly wouldn’t exist were it someone’s race or disability that they took issue with.
This is not a condemnation of the existing health system – much of this exists because there has been very little previous dialogue between the medical and transsexual communities.
Some of this does take place on the grassroots level, between trans patients and the doctors who choose to treat them, and has been ongoing. There is still a necessary process of advocating for ourselves and each other, by reaching out to receptive physicians (and nursing and med students) and educating them about our needs.
Part of it also requires dialogue on a larger scale, though, and the transgender community is looking to initiate that. First on the plan is a letter campaign to Alberta Health, in hopes of addressing some of these issues. Later, in November, there will be some participation in a diversity conference for the medical community. Interested people from all sides – medical professionals, transfolk and supporters – are all welcome to visit www.albertatrans.org/opendialogue.shtml for more information.
And along the way, we continue to do what we can in terms of building those rapports.
Meanwhile, from Alberta’s perspective, a psychiatrist with the dedication of Dr. Warneke is still irreplaceable, in many ways. Should he retire, we would definitely be sorry to see him go, and I can’t speak for his plans afterward. But hopefully, someone might rise to the challenge of overseeing the clinic here in enough time that he might have the energy and interest in working with therapists to help them streamline the medical processes in the larger picture here, and elsewhere as well.
One can hope, and put out the call.
”Mercedes Allen is a writer who blogs at http://dentedbluemercedes.wordpress.com/, has been featured on bilerico.com, PageOneQ and others, and has also developed the website at AlbertaTrans.org as a resource for transgender information and support.”