This text is part of the special Acfas Congress notebook
People who begin their gender transition and who take the medical and surgical route often encounter the discomfort and lack of training of health care workers… when they are able to access it. The conference Gender-affirming care for French-speaking transgender people in Canada focuses in particular on this issue.
A transgender woman enters her doctor’s office. She has just had a vaginoplasty and wants to see a gynecologist. The doctor is perplexed. Is a gynecologist able to examine a transgender person with a neovagina and prostate? “This example clearly represents the lack of tools available to health professionals,” explains Stéphane Bolduc, clinical researcher in regenerative medicine, full professor in the Department of Surgery of the Faculty of Medicine of Laval University and co-responsible for the conference at 91e Acfas congress.
Insecurity and distress
This lack of knowledge of the reality of transgender people means that “not only do they pass from one health professional to another like a hot potato, but they carry a great emotional burden,” says Sara Tremblay, health researcher. trans people and speaker at the conference. They often educate doctors or reassure them that they can treat them. They experience insecure medical situations, “such as this person who is told by a doctor that he does not know what to do with his case, but that he will try something. It has a good intention, but it’s clumsy! »
For young trans people seeking hormone therapy, access to care is sometimes complex. Because pediatricians do not feel equipped to support a gender transition, more than a year can pass before an adolescent between the ages of 14 and 18 has access to a gender affirmation clinic. “The young person can then wait 12 months more to get their first prescription,” underlines Annie Pullen Sansfaçon, full professor at the School of Social Work at the University of Montreal, holder of the Canada Research Chair in partnership research and empowerment vulnerable young people and speaker at the conference.
This wait, similar for adults who opt for surgical intervention, can be difficult to cope with in this pivotal period that is adolescence, but there is no point in rushing things. In general, the standards of care of the World Association of Professionals for Transgender Health (WPATH), which recommends, for example, a certain number of meetings with a professional at each stage of the transition, are respected by doctors. However, the distress of these young people is sometimes such that “some choose hormones bought online or on the street,” says the professor. We therefore need more professionals with the knowledge to support them and make them understand the options available to them.”
Prejudices and inequalities
Because social prejudices against transgender people are still present, they sometimes color the care they receive. In some cases, lack of education leads to repeated microaggressions. “Saying transgender to refer to a transgender person,” explains M.me Tremblay is placing emphasis on the genital system, when it is a question of identity. To be told by a doctor, in a casual tone, that he may be wrong in the terms he uses, is denigrating. »
If accessing gender reassignment surgery is a relief for a transgender woman who wishes it, it is not always the end of obstacles. “Coverage from the Régie de l’assurance santé du Québec is such that the surgical transition of a trans woman costs around $10,000. That of a trans man is… free! » says Mme Tremblay. Indeed, certain female hormones are not covered, just like breast augmentation, unlike mastectomy. “It’s a misogynistic system,” laments Mr. Bolduc, “in which exceptions are not part of the billing system. »
In addition to education on gender-affirming care in the health system, it is necessary to facilitate the path to take to begin a transition. “For transgender people who suffer from attention deficit disorder, for example, the paperwork to be completed and the follow-up with authorities is a labyrinth,” believes M.me Tremblay. In this sense, a care corridor for transgender people is emerging in Quebec and health professionals sensitive to the cause have built communities of practice. As Mr. Bolduc maintains, it is not a question of transforming the health system for transgender people, but “if the accessibility of the system improves for the general population, it will also improve for them”.
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