Canadian trans people still have limited access to health care: report

Transgender and non-binary people are still struggling to obtain appropriate medical care within the Canadian and Quebec health networks, a report says.

According to a 2020 pan-Canadian survey to determine the impact of COVID-19 on access to health care for transgender and non-binary people in Canada, more than one-third of respondents experienced an unmet need for general health care. By comparison, this proportion was 45 per cent of trans individuals before the pandemic, compared with four per cent of the general population.

This difference can be explained, among other things, by interruptions in medical services, particularly in hormone therapy treatments. Among the approximately 58 per cent of respondents who were taking hormone therapy — a medical treatment that allows transition to the desired gender — more than a quarter had to temporarily suspend this care during the pandemic.

“It’s harmful, waiting. Studies have shown that gender-affirming care has a direct impact on mental health and indicators such as suicide attempts. (…) If you don’t have access to these services, your psychological health can even worsen two to three times,” says Annie Pullen Sansfaçon, holder of the Canada Research Chair in Transgender Children and Their families.

Without these treatments, a person may be at higher risk of experiencing gender dysphoria, a medical term used to describe distress related to an incongruence between their sex assigned at birth and their gender identity. This psychological and emotional suffering can cause, among other things, anxiety, depressive episodes or suicidal thoughts.

“Gender-affirming care is vital care, and it is considered essential by the World Professional Association for the Health of Transgender People,” emphasizes the professor at the School of Social Work at the University of Montreal.

Although some trans people are successful in getting the gender-affirming care they need, their experiences within the health-care system can still be difficult.

“The College of Physicians and other orders could protect us, but in fact, complaints are frequently deemed inadmissible and transphobic gestures are considered non-reprehensible blunders,” says Mathé-Manuel Daigneault, a transmasculine person working as a co-ordinator of the research team on young trans people and their families.

Too often, trans or non-binary people who consult for any health problem have to face intrusive, even inappropriate questions related to their gender identity.

“Several people talk about having their pants pulled down when they consulted for shoulder pain. We have stories where the doctor does not even ask for consent, or he does not explain the medical reasoning behind the gesture. But because we are trans, it passes,” he laments.

For Pullen Sansfaçon, these situations generally stem from a lack of basic training for health professionals.

“That’s often the problem, the broken arm syndrome: you go to see your doctor for an arm and finally, you pick yourself up answering questions about your genitals,” she explains.

Other pitfalls can compromise the quality of services offered to trans people, including being misgendered, not going by their chosen name, or having to “educate” medical staff about transgender health.

In the eyes of the professor, the inclusive and welcoming treatment of the entire LGBTQ+ community within the health system is above all a question of social responsibility, as gender identity is protected by the Canadian Charter of Rights and Freedoms.

“It’s sometimes a problem of lack of tools, but I think everyone could at least get some basic training. (…) It allows the person who is at reception, the nurse who does the triage, in short, anyone who interacts with a trans person to make sure that they do not get misgendered or ask intrusive questions”, she says.

The Canada Research Chair on Transgender Children and Their Families also offers the module Trans Diversity 2: Health and Social Services. The free five-hour online training teaches the practices to adopt to better meet the needs of trans and non-binary people in the health sector.

This kind of mandatory training could improve the experience of all trans individuals in the health-care system, believes Daigneault, and not just those who have “completed” their transition.

“We often focus on people who are actively undergoing treatment and who are seeking care,” he says. “Unfortunately, just because you consider your transition complete doesn’t mean you can easily navigate the health-care system without experiencing transphobia.”

This article was produced with the financial support of the Meta Fellowships and The Canadian Press for News.

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