Changing face
The Ontario government’s health insurance plan (OHIP) began covering sex change surgery in 2008 for the first time in 10 years. But the funding comes with conditions. The stipulations, put forward by OHIP, have met mixed responses from the province’s trans communities because they reinforce the idea that transsexualism is a psychiatric disorder.
Irene Quarcoo│April 13, 2009
Brian Jones* did not need a doctor’s diagnosis to tell him what he already knew.
He was a woman.
Doctors diagnosed Brian, now Kate, with Gender Identity Disorder. This was the beginning of Kate’s transition from one sex to another. But it wasn’t all smooth sailing and Kate was in for a surprise. Her decision to become a woman left friends and family grief stricken.
The conflict between a person’s physical sex and their actual gender identity is considered, by many in the medical community, to be a psychiatric condition, called Gender Identity Disorder. People who experience this conflict are referred to by the medical community as transsexual. Categorizing transsexualism as a disorder allows access to healthcare and provincial government funding, but many in the trans community find this label problematic.
Kate’s story
As a man, Kate struggled for years with alcoholism, depression and terrible nightmares. She thought her desire to be a woman was a mental illness and wanted to get better.
Press play to hear Kate's story
Revelations
Until very recently, the Internet was one of the few places for trans women (a woman who was born male) and trans men (a man who was born female) to turn to for information and support. Online, Kate found a community of trans people, who shared experiences, tips and tricks. For the first time Kate saw that the life she wanted could be a reality. “I realized this was something within my reach; it didn’t cost millions of dollars,” says Kate. At the time, she began to seriously think about changing gender and later she decided that it was something she needed to do.
A dose of truth
Kate’s loved ones didn’t take the news well. “When I made the decision, I was so happy. I never thought people would be sad. I thought they would be happy for me. But to them it was like I was dead,” says Kate.
Kate’s decision to transition came as a surprise to her wife of 30 years. “She went into shock initially; she couldn’t believe it. After disbelief, came anger and rage. I was so upset to discover how badly she felt about it. She was so upset to discover [I wanted to transition],” says Kate. Her wife became abusive so Kate moved out for six months and the two sought marriage counselling. It worked. The two are back together but, even now, seven years later Kate’s wife has still not accepted the transition.
The patholigizing of transsexualism*
“Until I started looking into it, I didn’t know that [transsexualism] was considered a disorder,” says Kate.
The Diagnostic and Statistical Manual of Mental Disorders lists mental health disorders and is used as a guide medical professionals. Better known as the DSM-IV, the manual categorizes transsexualism as a psychological disorder called Gender Identity Disorder (GID) or gender dysmorphia. According to the American Medical Association GID “is a serious medical condition recognized as such in both the Diagnostic and Statistical Manual of Mental Disorders [DSM]” and by the World Health Organization.
“There’s a small group of people that like the clinical, patholigizing process of being evaluated by psychiatrists,” says Gapka. However, a vast majority of the trans population don’t like that transsexualism is considered a disorder.
This classification describes a situation where there’s a conflict between a persons gender and their physical sex. According to the DSM-IV the disorder causes psychological distress and sees people go to great lengths to make their sex match up with their gender.
Time for change…
“Surgery’s not for everyone” says Nik Redman, a DJ and community activist. “There’s different ways to transition.” Some people simply live as their true gender, change their name, their clothes. Others undergo hormone replacement therapy which puts male or female hormones into the body, causing the growth of breasts in trans women and the deepening of voices in trans men among a host of other changes.
Still, some trans people choose to have surgery. “It’s definitely not about cosmetics but about people living their lives the way they want to,” says Redman. But many cannot afford it. Surgery is not cheap. It can cost anywhere from $6,000 to $125,000.
In 1998, the Harris government stopped funding sexual reassignment surgery. When Kate began transitioning in 2001, her company health plan covered her hormones but she had to pay for her surgery out of her own pocket.
Kate had surgery but she had to pay for it herself because OHIP had stopped funding sexual reassignment surgery.
Changing times…
On June 3, 2008, the government of Ontario began funding sexual reassignment surgery for the first time in 10 years. Many in the trans community had been lobbying for this. The provincial government amended Regulation 552 of the Health Insurance Act. This means sexual reassignment surgery is now covered by OHIP.
“Reaction was mixed. In one way it was really significant because we’ve been trying to do this for eight years and we finally got it. On the other hand it was not the way we’d hoped,” says Susan Gapka, Chair of the Trans Health Lobby Group (the group advocated for the reslisting of Sexual Reassignment Surgery.) OHIP doesn’t cover all types of reassignment surgery. Breast reconstruction surgery is just one that’s not automatically covered by the provincial insurance plan.
“So far, I don’t know anybody who’s had surgery under [the new provisions]. People are stuck in these bodies they want to change,” says Redman.
According to a provincial government bulletin, surgery can only be insured if a patient has gone through a “Gender Identity Clinic program operated by the Centre for Addiction and Mental Health [CAMH].” To have surgery covered by OHIP a person must be diagnosed with GID, leaving many who identify as trans out in the cold. The government is using the same standards used under the Harris government before it removed sexual reassignment surgery from the list. Under these standards fewer than 15 people were approved for surgery every year.
What’s wrong with GID?
There are two major schools of thought when it comes to GID. On the one hand it’s seen as necessary because it provides healthcare and support for the trans population. On the other it serves to alienate trans people and feed into stigma which surrounds the trans community.
“Largely members of our community reported it as a very negative process which didn’t make them feel good about themselves. There was also a lot of misdiagnosis,” says Gapka
Many trans activists have and continue to rally against the patholigizing of transsexualism. “A lot of trans people don’t feel that being trans is a psychiatric disorder and they would rather not have it listed in the DSM as a psychiatric condition,” says Rupert Raj, a psychotherapist at Sherbourne Health Centre. “However, some people in Canada would rather have it stay in there because it means they would be covered for economic reasons but for ideological reasons they’d rather have it pulled,” says Raj.
“There’s a great thought that this is an old fashioned way of deciding who we are. And that clinical psychiatric evaluation doesn’t give people power,” says Gapka.
What now?
The Ministry of Health and Long-Term Care, Centre for Addiction and Mental Health, community groups and representatives from the trans community are talking about health service delivery for trans people.
“We want our healthcare delivered in community-based settings,” says Gapka. “If you’re fortunate enough to live in large urban centres like Toronto, there are quite a few clinical and community resources,” says Raj. But the story is different in Canada’s smaller cities and rural areas. “It’s pretty much a wasteland,” says Raj “so a lot of people have to come to the larger cities.” People, such as Gapka, want to see this change “We want it delivered in a number of sites around Ontario” she says.
With the issues some in the trans community have had with service delivery in the past many are waiting for the next chapter in trans history.
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Glossary of terms
Transgender: An umbrella term for people whose gender identity and/or gender expression differs from the sex their birth sex. This term applies both the those who have and those who have not changed their bodies through hormones or surgery
Transsexualism: Older term used mainly in medical circles. Many transgender people prefer the term "transgender" to "transsexual." This is when an individual identifies with a gender different from the sex they were born. Some transsexual
people still prefer to use the term to describe themselves. However,
unlike transgender, transsexual is not an umbrella term, and many
transgender people do not identify as transsexual. Definition courtesy of GLAAD
Transition: Altering one's biological or birth sex. This can be done in a variety of
ways including, but not limited to: changing ones name, having surgery
and taking hormones.
Sexual Reassignment Surgery: Surgically altering any part of ones body.
Gender Identity Disorder (GID): A controversial DSM-IV diagnostic classification for transgender people.
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