Outed by the Health-Care System

The Montreal Gazette, Canada
By Max Harrold, THE GAZETTE 12/13/2011

MONTREAL - For most sick people in a doctor’s waiting room, a walk-in clinic or the hospital emergency, the etiquette of the receptionist, nurse and doctor is not likely the top priority. Getting better is.

But for people in the years-long process of transitioning genders, the name called out and the pronouns used can be the difference between medical treatment and psychological torture.

Many Quebec health-care workers routinely out transsexuals by arguing in public about their name and sex as indicated on the medicare card, advocates for trans people say.

Transphobia – prejudice and hostility toward people who don’t fit standard gender images – is widespread, they add.

Gabrielle Bouchard, a coordinator at the 2110 Centre for Gender Advocacy in Montreal, said it’s exhausting to repeatedly argue about gender and one’s name regarding a mortgage or when applying for a job – but it can be especially hurtful while trying to obtain publicly funded medical services.

A trans person may not look much like the photo on their ID.

“I hear this story over and over – people saying, ‘I will die of pneumonia before being called Mr. once more in the emergency room’ or ‘I will not go to get this blood test because I’m not sure I will be treated respectfully’ or ‘I’m not going to get medication at the pharmacy because the pharmacist will say out loud: Well your name is Mr.; why are you coming to pick these pills up?’

“The danger that comes with that is trans people do get beaten up and they do get killed. That fear is real,” she said.

“People often say, ‘I cannot keep on living with the gender that was given me at birth. I have to move. Either I kill myself or I transition.’ ”

Françoise Susset, a psychologist who is one of just four professionals in Quebec who regularly diagnoses gender dysphoria – the profound discomfort with one’s genetic gender – noted that Quebec law does not allow a person to legally change gender until after surgery, the last part of a lengthy process.

The law should be changed, she said. “It’s anxiety-producing and it can mean the difference between someone being able to live privately or being stared at for the rest of their life.”

Trans people should be able to change their legal gender after a gender dysphoria diagnosis and after living in the chosen gender for a year, she suggested.

Nora Butler-Burke, an outreach worker at Action santé travesties et transsexuelles du Québec, said there’s a huge lack of information about trans health issues in health care, “particularly in French and in a Quebec-specific context.”

The group put out a 60-page bilingual guide on trans health three months ago and is about to publish another 1,000 copies because there is a lot of demand for it.

“Doctors, for example, do not receive proper training on the impacts of long-term hormone therapy or of taking hormones without medical supervision,” Butler-Burke said.

The group also conducts workshops for health-care workers.

“We tell them, hey, if a trans person comes in with a stomach ailment or a broken ankle there’s no need to go on a tangent about what different types of surgeries they may have had.”

Leslie Labranche, a spokesperson for the Quebec Order of Physicians, said there have been no official complaints against doctors for refusing to treat trans people or for treating them unethically.

“All doctors have a duty to give care,” she said.

Pierre-Paul Tellier, a family physician who is director of McGill University’s Student Health Services, and who volunteers with the community group Head & Hands, said some doctors don’t want to treat what they don’t know.

“They’ll say: First, this is a difficult patient; two, they have an issue that I’m not familiar with; and so, three, I’m not going to deal with them,” Tellier said.

He agreed many doctors could use a big dose of sensitivity.

Not all trans people can demand to be treated with respect, he added.

“They’re just starting their process. They’re anxious about who they are and how they’re going to be treated. When confronted sometimes they don’t have the energy.”

Paul Saba, a family physician who works in a clinic and out of Lachine hospital, said the key to dealing with unknown patients is communication and respect.

Similar to dealing with HIV issues a few decades ago, health-care workers need to be open-minded and to learn about trans issues, Saba said.

In the end it comes down to a fairly simple premise of medicine, he said.

“We have to be human to each other; we have to be kind to each other.”


“I was 18 and trying to find a psychologist (to get a required recommendation to start hormone therapy), so I ended up in Montreal with a job at McDonald’s. But I lost that job because of stress and anxiety related to not being able to transition. I still could not see a (psychologist).

I tried asking in CLSCs and hospitals: Who do I need to see to get a recommendation for hormones? Nobody could help me. So eventually I started taking hormones illegally from the black market. And I put one of those packets of pills in my pocket and went to every endocrinologist I could find, telling them ‘I already have these so will you help me take them properly or should I continue risking my health?’”

Sonya Fiset, 23 on hormone therapy for four years and waiting for more counselling and one day, surgery to complete her transition to becoming female

I went to a clinic for a lung X-ray. I didn’t have a lot of experience at that point and I didn’t think to tell them to remind the person who’s going to call my name to say Mister instead of Madame. The technician comes out and calls out ‘Madame Vallée’ but he didn’t say it very loud, so I asked him ‘Did you say Vallée?’ and he said ‘madame’ and then he just started shouting it, like ‘I’m looking for a madame.’ I signalled to him to calm down so I could talk to him and explain the situation and as I approached him he was still yelling at me.

I said, ‘Look, I’m transgendering. The paperwork doesn’t match my identity. Why do you have to shout? You’re in the medical profession. Can’t you have a little respect.’ He yells at me: ‘I have to make sure you’re not committing fraud and pretending to be somebody you’re not.’

Jacky Vallée, 38
transitioned from female to male three years ago



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[Photo: http://bit.ly/srxIXM Transgender woman Sonia Fiset displays
her original health card at the offices of the Centre for Gender
Advocacy. Fiset says she can’t afford the psychological evaluation
required to have an operation to change her sex.]