transgender

When people are generally required to check one of two boxes - male or female - those whose gender identity falls outside the boxes are rendered invisible. (Illustration: Elisha Lim)

By Mandy Van Deven
Briarpatch Magazine
January/February 2010

The first step toward addressing an issue is to make it visible. An alcoholic will fail to get sober until he or she admits to having a problem. Slapping around one’s wife was not a punishable offence until it became socially and legally recognized as domestic violence. Visibility is gained through definition, and with visibility comes the power to create social change.

Transgender and gender nonconforming people are just beginning to shed the cloak of invisibility that has shrouded their participation in social and political life. The success of productions featuring middle-class transgender people, like the film Transamerica and the television show The L Word, is opening the door to public conversations that had previously been relegated to academic departments of women’s and queer studies. These popular portrayals are not always politically correct, but they do help to foster the development of an active and visible transgender citizenry working for public recognition of equal rights. Unfortunately, however, transgender visibility seems to be stalled along class lines, a problematic development that advances the rights of a privileged few at the expense of community-oriented movement building.

Similar to queer activism, transgender rights organizing appears to be gaining ground in major metropolitan areas including Washington, D.C., and Toronto. Legal victories for public bathroom access in New York City and anti-discrimination laws in Maine, as well as the election of a transgender mayor in Silverton, Oregon, are certainly cause for celebration. However, the focus on battles that require class privilege means that other battles that would make a significant impact on the majority of poor transgender people have scarcely begun. Would-be transgender activists must often favour their own material conditions above collective advocacy in order to simply survive – a position working-class feminists and feminists of colour have been arguing for decades regarding their place in the movement for women’s liberation. Given this reality, organizing around transgender issues should be viewed through an economic lens in addition to one of gender.

Transgender and gender nonconforming people in the U.S. list their three most important and immediate needs as housing, employment and health care. This is no different from the main preoccupations of low-income people generally, which is not a coincidence as a great number of transgender people live in poverty. (In the United States, a transgender person is twice as likely to live below the poverty line.)

A disproportionate number of transgender people are relegated to low-paying jobs, denied work, or fired for reasons directly related to their gender identity. More than two-thirds report experiencing verbal and physical harassment on the job. Since there are few legal protections against such discrimination, transgender folks have little recourse to address mistreatment on the job, and employers consistently fail to protect transgender workers; in fact, many times they contribute to the abuse. All of these factors contribute to the disproportionate numbers of transgender people experiencing chronic unemployment.

Transgender people who apply for public assistance face difficulties in obtaining the benefits they both need and are entitled to, particularly when they lack access to appropriate identification documents. Those who do receive benefits may do so in a program that has a minimum work requirement in an environment that proves to be dangerous for transgender people, creating a difficult choice between losing benefits and maintaining one’s personal safety. Given their limited employment options, many transgender people become involved in the illegal activities of the street economy – sex work, theft, selling drugs – and so may wind up entangled in the legal system, thus further marginalizing them.

Access to affordable housing is also a problem. Housing refusal is common, leaving many people to live in homeless shelters or on the street. Shelters, which tend to be sex-segregated, bring another unique brand of difficulty, particularly when transgender individuals are not allowed to bunk with members of their self-identified sex or given access to shower and bathroom facilities that suit their needs. Shelters can be unsafe and harassment from other residents and staff is common. Transgender people are frequently turned away from shelters (some even have policies barring their entry) or are thrown out when the staff finds out they are transgender.

Although class and gender intersect deeply and complexly for transgender folks, very little research has been done into the discrimination they face. Figures that are typically calculated by means of the census, public assistance intake forms or social service agencies are lost because transgender identity is not tracked. When people are required to check one of two boxes – male or female – those whose gender identity falls outside the boxes are rendered invisible. The same is true for laws that do not specify protections if a person’s transgender status makes them a target for a crime, such as workplace discrimination or hate violence.

This lack of data contributes to further barriers, as non-profit organ­izations that have trans-specific initiatives face an enormous challenge in obtaining funding. “Getting government funders to understand the risk and vulnerability that transgender people are at to be homeless and getting grants that apply to this work is the biggest challenge we face,” says Yasmeen Persad, the transgender program coordinator at Supporting Our Youth (SOY) in Toronto. A lack of finances is not simply a reality for transgender and gender nonconforming individuals; it is also a reality for the organizations that assist those individuals.

No one decides to do social justice work because they think it will be easy, but some areas are more challenging than others. Low-income transgender people are highly vulnerable to social isolation, abuse and violence – factors that make becoming an advocate or activist extremely difficult. According to Lynn E. Walker, the program director of the Transgender Transitional Housing Program at Housing Works in New York City, “One of the greatest challenges for our clients derives from the reluctance of trans and gender nonconforming people to advocate for themselves. Many clients have experienced long years of disempowerment and homelessness, sometimes complicated by physical and mental illness, and unfortunate encounters with the criminal justice system. Consequently, they tend to prefer to avoid advocacy events where they may encounter institutional and governmental authority, which for them are symbols of ignorance and instruments of oppression.”

The topics that get the most attention from transgender advocates and activists, therefore, are often those of primary interest to middle- and upper-class transgender folks. This is particularly the case in the U.S., where health care disparities are so pronounced: advocating for insurance companies to cover sex reassignment surgery will no doubt benefit transgender people with enough class privilege to actually have health insurance, but what about the need for basic medical care that low-income transgender people are unable to afford?

Organizing to provide free, comprehensive health care services for transgender people would prove to be a much more inclusive and effective organizing strategy. These services could include the provision of basic medical care and medications, including hormones and antidepressants; psychi­atric and psychosocial services like individual and group counselling; and HIV prevention and treatment as well as substance abuse treatment facilities for the disproportionate number of transgender folks who are afflicted with these ailments. A breakthrough in health care provision would represent a momentous step forward for the rights and well-being of transgender people, and would foster the conditions for more activists to step forward.

The Transgender Transitional Housing Program at Housing Works in New York exemplifies the kind of work organizations could be doing to address low-income transgender people’s needs. Tackling all three of transgender people’s most pressing needs, Housing Works provides “one-bedroom furnished apartments for gender non-conforming people and people of trans experience living with HIV/AIDS for up to twenty-four months. Along with appropriate medical, dental, and mental health care, [they] assist them in finding affordable permanent housing, and for those who are interested, the agency provides legal and administrative support as well as vocational training to enable them to obtain satisfactory employment.” Housing Works takes a holistic approach and works for transgender rights where it can make the broadest impact.

Increasing the visibility of low-income transgender people is a step in the right direction but it is not enough to make a sustained impact on their most pressing needs. For that, activism is needed.

Creative solutions can be implemented to solve the problems that are inherent in the current systems that serve low-income people. Transgender-only housing units or floors in existing facilities can be established with private, lockable restroom facilities and staff who are trained in transgender sensitivity. Exclusions of transition-related and gender-specific health care can be removed from the policies of medical facilities and health insurance companies. Governments can invest in transgender-specific workforce development and public assistance programs. Laws and policies that prohibit employment discrimination and workplace harassment can be amended to include transgender and gender non-conforming people. Although transgender organizing is newly emerging, the movement need not make the same mistakes as its well-meaning predecessors by ignoring the class-based needs of the majority of its members.

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By Calvin Neufeld
Briarpatch Magazine
March/April 2009

One of the great myths of our culture is that at birth each infant can be identified as distinctly ‘male’ or ‘female’ (biological sex), will grow up to have correspondingly ‘masculine’ or ‘feminine’ behavior (public gender), live as a ‘man’ or a ‘woman’ (social gender role), and marry a woman or a man (heterosexual affective orientation). This is not so. . . . A significant number of people in fact do not fit this simple idea of biological gender destiny.
- Lisa Josephine Lees, Gender: Exploring Diversity and Acceptance

Yesterday I received a long-awaited item in the mail: an application package for admittance to the Gender Identity Clinic at the Centre for Addiction and Mental Health in Toronto. This is the golden ticket for Canadian transsexuals who are in need of medical care (including hormones, surgeries and counselling) and who can’t afford to pay for it themselves. Toronto’s Centre for Addiction and Mental Health, commonly referred to as CAMH, is the gateway to it all.

Many provinces, including British Columbia, Saskatchewan, Manitoba and Ontario, require that transsexuals seeking government-funded medical care be assessed at this Toronto clinic by a team of doctors who are considered to be experts in the field of gender identity. With their stamp of approval and recommendation for surgery (both are required and can take years to receive), most provinces will fund all or part of the cost of all or some of the procedures the patient needs. It’s an elite program from which 90 per cent of applicants were reportedly turned away between 1969 and 1984. Evidence suggests that they have made few changes to their methods or approach since then.

I’ve been wondering for months what I have to do to be one of the lucky few. I don’t know for certain; like everything else related to transsexuality, no one seems to know for certain - not my doctors, not other transsexuals and not my health minister.

Guided only by rumours and the accounts of transsexuals who have been through this process, I have had to machete my own way through the neglected undergrowth of transsexual health care in Canada.

Regarding Caitlin

The first thing I pull from the package from CAMH is a letter. The letter is addressed to me, Calvin. But in the subject line I see written in bold, RE: Caitlin. I assume that they got this name from my endocrinologist when he made the referral, and seeing it makes me uneasy. That name has no place there since it’s neither my legal name nor my chosen name. It’s a name I haven’t used in years.

I’m a guy now. I have a flat chest and a beard, and according to my birth certificate I was born Calvin Neufeld, a boy. I don’t even have female reproductive organs anymore; that was the price I had to pay for the birth certificate. More on that later.

There is only one thing left for me to do before my transition is complete: genital reconstruction. It’s a relatively straightforward procedure for male-to-female transsexuals (in effect, turning an outie into an innie) but a considerably more challenging undertaking for female-to-male transsexuals. Complete genital reconstruction is typically achieved through several surgeries over several years. The entire procedure is high-risk and costly, with generally unimpressive (and often impotent) results.

It sounds crude and insane, I know. But when you don’t know what it’s like to have sex with your wife, when you have to hide in the men’s change room for fear of becoming a victim of violence, when you’re terrified of being left to die by a shocked emergency crew, when half of your body still feels like someone else’s, even the poorest of options becomes palatable.

I want to feel as complete as I can, now that I know it’s possible. My face, my voice, my chest - even the gut that showed up at around the same time that my butt disappeared - they’re all mine. I finally know what it’s like to look at my body without surprise. What I had before always felt foreign.

Hormones get most of the credit for my transformation - small doses of a clear, thick, yellow fluid that requires a large needle, a steady hand, and a deep intramuscular injection every week for the rest of my life. Thankfully, my wife gets a kick out of giving shots.

But hormones only change secondary sexual characteristics. From the beginning I knew I wanted my transition to be complete, and to be completed quickly so that I could get on with my life with as little awkward androgyny as possible.

My surgical corrections began with a hysterectomy and bilateral salpingo-oophorectomy - meaning, in trans terms, that I had all my internal “girl bits” taken out. It wasn’t my first priority (that had always been chest reconstruction) but it was the only procedure I could access under provincial health care, and only through a loophole. It took some investigation to find a sympathetic gynecologist on the other side of the province who would overlook the fact that Ontario had not yet re-listed sexual reassignment surgeries. (It was announced in May 2008 that, after a 10-year hiatus, the procedures would again be considered medically necessary procedures under Ontario’s health care plan.)

“As long as your health card says you’re female,” said the gynecologist (my first and only), “it won’t be a problem.” She is a leading surgeon in her field and a Mother Teresa to trans men like me. Without the procedure, I would not have been allowed to change the sex designation on my birth certificate, leading to some awkward (if not dangerous) moments at hospitals or airports with my mismatched ID.

It was an experience I don’t regret - in fact, I am grateful for it. My uterus was an organ I had no desire to use and under the influence of high doses of testosterone over long periods of time it could have killed me. What I do regret is that I did it on someone else’s terms, to satisfy some random, meaningless criterion for legal sexual status.

Two months later, while still recovering from the hysterectomy, I managed to raise the $8,000 I needed to remove the breasts I had been painfully strapping down under my clothes, day after agonizing day. There were rumours that the provincial funding of sexual reassignment was forthcoming, but even once the funding was restored we were promised at least a two-year waiting list - and only if we happened to be approved by CAMH staff first. I knew I couldn’t endure several more years of the suffocating binding and back pain, and turning away from my wife when getting changed. It was more than a medical necessity for me; it was the most liberating experience of my life.

Today, with the help of the hormones, the hysto, and the “top surgery,” I move unquestioned and unobstructed as a male in the world. But I’m not yet complete. There is one last surgical process that I need to undergo, but for lack of the tens of thousands of dollars needed to pay for it myself, the only way I can get it is through the narrow gateway of the Centre for Addiction and Mental Health.

A year on testosterone

The conditions of application

The letter from the CAMH introduces an attached questionnaire and informs me that they are requesting “a written life story regarding your gender identity issues and two photographs (one crossdressed, if possible).” Should I be admitted to the program, they tell me that I can expect to undergo assessment on an out-patient basis at their clinic, where I will be interviewed by two psychiatrists, a psychologist and an endocrinologist, and will undergo “a complete physical examination, and possibly [be] asked to undergo psychological testing.” I’m picturing myself on a glass slide under a human-sized microscope, a medical oddity squirming under their clinical gaze.

The questionnaire they sent is all but impossible for me to fill out, both practically and ethically: half of the questions don’t apply to me, and half conflict with my sense of integrity.

Since they begin by asking only my Name on Birth Certificate, Sex as on Birth Certificate, and Name Used, they don’t seem to have later-stage transsexuals like me in mind, whose birth certificate reveals none of the information they want. Throughout the questionnaire, the language they use forces me to picture myself as a middle-aged lawyer trying on his wife’s panties on the weekend in order to come up with an answer that fits the question.

Some of the questions seem routine. Others make me wince. They want to know all the jobs I’ve ever had that lasted longer than a year. My income. A sexual history (Please give details). Do I have kids? Followed by, At what age did these desires begin?

How can I squeeze my story through these slots? How can I remember when “these desires” began when my childhood memories are of Calvin - from Watterson’s comic strip - not of Caitlin. Or perhaps some androgynous hybrid of the two. I don’t even have blond hair, but my memories are of Calvin, doing the things I did, saying the things I said, playing with the stuffed tiger I made myself and digging up dinosaur bones in the backyard. It’s not what others saw, but it’s what I saw, or what I wished to see. I don’t remember a girlhood. And I don’t remember when that began.

Next, the questionnaire asks me whether I have “dressed in clothes of the opposite sex (crossdressed).” And at what age did I do it first? Then, at what age did I begin crossdressing occasionally? Frequently? Continuous crossdressing at home? Continuous crossdressing outside home? Full-time cross-living? And date when full-time living and working in the opposite gender role began.

I can’t even halfway bend my mind through the loops of what counts as crossdressing for me, versus what counted before, if it counted, and how often I did it, when and where. Not to mention the curious misuse of the term “gender role” in this context, as though I’d gone from dishwashing to chainsawing.
The last part to this particular string of questioning asks me to list previous attempts to get medical care for this condition. I’m given two lines for my answer. I could fill two pages.

Still, they give me plenty of response space to list details of every suicide attempt. And confessions of self-mutilation. My psychiatric history. Have I used alcoholic beverages? Describe quantity and circumstances of intake. Oh, and describe the size, shape, and function of my sex organs. Now I need a drink.

Finally, they want to know the name, birthplace, age, address, and marital status of my mother, father, brothers and sisters (living and deceased) including step- and half-siblings.

I’ve never had to tell this much to anyone.

Meanwhile, south of the border

On June 17, 2008, the American Medical Association called for the removal of financial barriers to health care for transsexuals by passing Resolution 122. The resolution asserted the need for “public and private health insurance coverage for treatment of gender identity disorder as recommended by the patient’s physician.” The resolution affirms the effectiveness of medical treatment for transsexuals and emphasizes that Gender Identity Disorder is a serious medical condition which, if left untreated, “can result in clinically significant psychological distress, dysfunction, debilitating depression and, for some people without access to appropriate medical care and treatment, suicidality and death.”

The resolution also states that the American Medical Association, along with the World Professional Association for Transgender Health and other health experts in Gender Identity Disorder, “have rejected the myth that such treatments are ‘cosmetic’ or ‘experimental’ and have recognized that these treatments can provide safe and effective treatment for a serious health condition.”

It is hard for me not to compare this to my experience of Canadian transsexual health care - the blind investigation, the awkward questions to inexperienced health care providers (and their receptionists), the bureaucracy of the Office of the Registrar General, the white lies and rogue doctors and long-distance travel, and the endless efforts to explain myself to a head-turning or head-shaking public in the absence of reliable statistical or medical data. In the distraction of medical controversy, religious debate, media carnivals, prejudice and tradition, the immediate well-being of transsexuals is being neglected. While the world decides what to make of us and whether we are in our right minds or deluded, we remain socially ostracized and without the medical care that we consider appropriate to our needs.

But the fact remains that, according to Ontario’s Ministry of Health, I am legally entitled to government-funded medical care for treatment of gender identity disorder. What I don’t have is access to that treatment, and the barriers extend well beyond the financial. I’ve had to fight and cheat and lie my way to the care that I needed - even when I had to pay for it myself - and now I’m being asked to trade my secrets and my dignity to get the rest. If I’m lucky.

I know I’m going to do it though. I have no other choice.

Sidebar: Trans Facts

• Statistics indicate that the total number of people whose bodies differ from standard male or female at birth (i.e. intersex people) are 1 in 100 or greater. This can mean many things, including incongruity in genetic sex (XX/XY), being born with at least partial sex organs of both genders, or having ambiguous sex organs. Unfortunately, this natural differentiation poses enough of a threat to our binary model that as many as 1 in 500 infants endure surgeries to “normalize” genital appearance. Among many disturbing forms of common medical intervention, this can involve surgically shaving clitorises longer than 1 cm in length, and surgically assigning a female sex to males with a stretched penile length under 2.5 cm.
• Some clinical reports suggest that over 70 per cent of transsexuals have contemplated suicide at some point in their lives and between 17 per cent and 20 per cent have attempted suicide at least once. (Egale Canada)
• Suicide rates are significantly lower in treated transgender patients than in nontreated. Untreated transsexual patients have suicide rates as high as 20 per cent while treated transmen have suicide rates of less than 1 per cent. (Medical Therapy and Health Maintenance for Transgender Men: A Guide For Health Care Providers)
• For many transgender people, finding a safe place to use the bathroom is a daily struggle. Even in cities or towns that are generally considered good places to be transgender (like San Francisco or Los Angeles), many transgender people are harassed, beaten and questioned by authorities in both women’s and men’s rooms. In a 2002 survey conducted by the San Francisco Human Rights Commission, nearly 50 per cent of respondents reported having been harassed or assaulted in a public bathroom. (Peeing in Peace: A Resource Guide for Transgender Activists and Allies)
• In all cases of provinces offering coverage of genital reconstruction surgery, patients are forced to travel to a costly private clinic in Montreal, after which they are typically refunded only a portion of their medical expenses. Their travel and accommodation fees, which can amount to thousands of dollars, are not reimbursed. The Montreal clinic, which bills privately and refuses to accept Quebec health insurance, caters to the wealthy U.S. market which supplies 95 per cent of its patients. Canadians seeking sex reassignment surgery are put on a waiting list for a year or longer.

Across Canada, in order to obtain approval for SRS, patients have also been forced to travel to Toronto to undergo a lengthy and invasive assessment at the Centre for Addiction and Mental Health (CAMH), a psychiatric hospital focusing on forensic psychiatry, sex offenders, and major mental illness (schizophrenia, first break psychosis, mood disorders and anxiety disorders). Patients who have been through the CAMH program report it being a demoralizing experience. In order to access hormone therapy, the CAMH requires a full year living and “passing” as your felt gender while working at a full-time job - all without the help of hormones. After hormone therapy begins, patients are required to undergo another year of this so-called “real life test” before CAMH staff will consider approving a patient for surgery. In 1999, the Ontario Human Rights Commission issued a discussion paper criticizing the CAMH for their stringent standards, their policies regarding hormone therapy, and their eligibility requirements. Some patients have reported that doctors and specialists at the CAMH would refer to them by their birth-assigned sex rather than their felt gender.

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By Jesse Invik, Suzanne Mills and Tyler McCreary
Briarpatch Magazine
November 2005

What does it mean to be transgendered? If you are born in a body that fits your internal idea of who you are and what your gender is, you have probably never thought about it. But more people than you might imagine face this issue. Someone you know and care about may be struggling with it today. Alternating between the journalistic and the personal, drawing on the experiences of a female to male transgendered person, we hope this article will facilitate greater understanding of the struggles that transgendered people face.

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