Michelle Anderson, an attractive 42-year-old with long brown hair and a slim build, is a former Victoria resident who now lives on the Sunshine Coast. She spends most of her time tucked away at her waterfront cabin, working on her garden and playing with with her two dogs, Buster and Cali. Today, the barely noticeable five o’clock shadow growing below her chin has her feeling insecure. It’s there because she was in the middle of her electrolysis program, part of the process of transitioning from male to female, when the British Columbia Liberals cut funding to the Vancouver clinic that was assisting with her transition. Anderson had moved from Victoria in the late 1990s to attend the Gender Dysphoria Program at Vancouver Hospital (also known as the “Gender Clinic”). She was undergoing hormonal treatments and preparing for gender reassignment surgery, but was left in the cold after the budget cutbacks halted her treatment. She soon went to the Sunshine Coast in search of a peaceful environment, feeling disillusioned with a trans health system that was failing her. “I don’t flaunt being transsexual, but I’m proud of who I am,” she says. “The response I usually get is that I’m very non-threatening.” “I don’t want to be on display, but I’m definitely open to people’s fascination with transsexuality,” she adds, joking that when she throws around words like “tranny” in her neighbourhood, she usually finds herself in a discussion about car motors. For many people, both transgendered and not, the question of what words to use when talking to or about transgendered people is a thorny one. The choice of what pronoun to use becomes extremely important, even politically charged, when gender is being discussed at this level. Do you say he? She? Or something else? And, above all, what does transgender mean? That’s a question that comes up often, and the answer is, in many ways, still being defined. Talking about transgender, or trans, issues can be touchy, whether you’re transgender yourself, you know someone who is transgender, or you’re just curious about how to approach it. On one side, there are fears of rejection or ridicule. On the other, there are fears of offending someone or sounding like an ignoramus. These fears prevent both trans and non-trans people from conversing about gender differences. And yet, transgender advocates are adamant the more we understand about gender diversity, the more the rules about gender will lighten up, and the freer everyone will be to talk about it.
Talking transitions And yet, transgender issues often get scant and simplified coverage in most media outlets. They tend to focus on legal battles, hate crimes against trans people, and changes to “pro” or “anti” transgender policies. What gets left out is the necessary context for understanding transgender persons—who are as diverse as any group on the margins of what society defines as “normal.” “There’s no stereotypical transgender person. Any stereotype falls apart when we start looking at the differences among people,” says Aaron Devor, a sociology professor at the University of Victoria. Devor points out that transgender people exist in every culture, social class and age group—and many are so well-transitioned into one gender, it’s not noticeable they were ever another. For 20 years, Devor has taught and studied gender and transgenderism. Last year, Devor became public as a transsexual—officially changing his identity from Holly to Aaron. He is not keen to talk about his personal gender reassignment from a woman to a man, citing what he describes as the media’s fixation with people’s private parts. “The public is interested in everybody who is ‘different.’ There’s not a lot of room for privacy,” says Devor. His concern about how the transgender community is represented is echoed by the people spoken to for this article, by those who did and did not agree to speak on the record. One woman responded to my query for an interview by e-mail, writing, “I’m not sure I’d like to see yet another voyeuristic peek into private trans lives.” While most agree there are many individuals and organizations which support transgender people, they feel society in general is still not tolerant of gender diversity. “When you don’t fit in to society’s expectations, then you become vulnerable to all sorts of discrimination.” Devor has found, over the course of his research, that trans people find “it’s hard to get a job and get services from the government, people will stare at you on the street, it’s hard to find a public place to go to the bathroom, young men may harass and harm you.” And yet, he adds, “A transgender person wants to be treated with respect like any other person: it is a right as a citizen.” Nick Matte, a UVic graduate student and trans activist in Victoria, says mistreatment of transgender people often stems from people not knowing what to say, what language to use. “Many trans people worry about having to deal with people who don’t respect their gender identity. Because trans people are often represented in the media as freaks, it’s easy for people to get away with disrespecting trans people by using the wrong pronoun, or degrading trans people for being transgender. That’s a major daily concern for a lot of people,” he explains. Matte points out that the term “transgender” incorporates many gender identities. In my chats with trans folks, the following gender definitions arose: transsexual (living as a gender different than the one assigned at birth), cross-dresser (wearing clothing considered appropriate for the “opposite” gender), intersex (having a physical body outside the “normal” realm of male or female due to biological or incidental reasons) and androgynous (not identifying as clearly one gender or the other—sometimes called pan or bi-gendered). Matte gives educational talks on transgender and workshops to university, college and high school classes, as well as community groups and social service providers, about ways to work with trans talk and people. Devor agrees with Matte that ignorance is part of the problem in raising awareness about transgender issues, and he puts the onus on mainstream society to start doing their homework before approaching the trans community. “If you’re an everyday person and you want to open up to someone, a tactful way to do it is to get your hands on something to read about transgender. Don’t focus on the trans person you are talking to, focus on the topic—it shows you are aware and open. If they choose to join you in the conversation, they will.” For her part, Anderson isn’t offended by people who are curious about her transexuality. Rather, she jokes about friends and family who think being a transsexual “is so cool,” and muses that people’s ignorance about transsexuals usually stems from “watching too much Oprah or Jerry Springer.”
Care and lack of it Social tolerance is often the least of a transgender person’s worries when it comes to being treated equitably and respectfully. Devor and Matte say some of the greatest fears for trans people stem from a negative history, and current lack, of social support systems. “Many trans people fear being fired or discriminated against in their workplaces and those who stand out as visibly trans have difficulty getting hired despite qualifications,” says Matte. “Hate crime and discrimination legislation don’t specifically cover gender identity or gender expression. So, as trans people, we can fairly legally be fired, harassed, or denied the rights of non-trans people.” Health care is also a major concern. The importance of finding health care practitioners who are respectful and knowledgeable of transgender is illustrated by the story of Tyra Hunter, a trans woman from the Washington, DC, area. In 1995, Hunter was in a fatal car accident. Reports, which later led to a wrongful death suit, revealed that emergency attendants stopped treating Hunter when they discovered her male genitals. Her death outraged the trans community and implanted a general fear among many. “Every trans person knows this story,” says Devor. As Anderson experienced first hand, health care for transgender people in B.C. took a major leap backwards in 2002, when the Vancouver Gender Clinic closed. It offered hormone replacement referrals, urological/gynecological treatment, psychiatric, psychological and social services, and was the only place in the province where people could be referred for public health coverage for transition-related surgeries. The clinic’s closure left people unsure where to get care, and unable to apply for public health funding for sex reassignment surgery. “There was a huge emotional impact of the clinic closing for many people because, at the time, no alternative services were available,” says Joshua Goldberg. He’s co-ordinator of the Transgender Health Program in Vancouver, a program that was established in 2003 to help restore some of the services once provided by the Gender Clinic. It currently provides peer counseling, referrals, advocacy and outreach for transgender people, their loved ones and organizations. One of its biggest projects includes a referral service to trans-friendly health and social services in B.C., based on a 2002 survey of trans people and doctors compiled by several advocacy organizations. Goldberg says much of the program’s work is helping doctors who ask how to deal with trans patients. However, the big gap in services comes with a lack of references for gender reassignment surgery. Goldberg says his program is negotiating with the Medical Services Plan to determine which doctors in B.C. will have the authority to grant referrals for surgery, but at this point, very few have the authority to do so. Previously, psychiatrists at the Gender Clinic referred patients for surgery if they met the criteria of having Gender Identity Disorder (basically, the desire to be the opposite gender, coupled with an ongoing feeling of discomfort with one’s original gender). Patients transitioning from one gender to the other were required to live as their desired gender for a minimum of two years before surgery could happen, and had to begin preparation for surgery through counselling and sometimes hormone replacement therapy. Gender reassignment surgery is done at only one clinic in Canada, the privately owned Clinique de Chirugie Esthetique St. Joseph in Montreal. It can cost anywhere from $15,000 to $100,000, depending on what is being done. For men transitioning to women, surgery can include breast augmentation with saline implants, surgical shaving of the Adam’s apple, and vaginoplasty—where the penis and testicles are amputated and a vaginal cavity and clitoris are formed with detached skin and a sensitive gland from the penis. For women transitioning to men, a penis is created with skin from the forearm and attached around a catheter in a surgery called phalloplasty. Other surgeries used in the process of becoming male can include hysterectomy and testicular implants. For both sexes, the surgically created genitalia will never look or feel totally natural. However, many transsexuals view surgery as the ultimate release towards being able to live as their true gender. The entire transition process can take a number of years, and Anderson wasn’t finished by the time the budget cuts hit. “It’s devastating to be cut off when you’re halfway there,” says Anderson. “It’s been difficult to find support on many levels. I just haven’t been able to feel comfortable anywhere since the clinic has closed.” Anderson says she doesn’t want to get her hopes up for surgery again. She has the added complication of being HIV positive, and the only clinic willing to treat her, in Oregon, is no longer taking patients. “It would be wonderful if I could get the surgery, but it’s not the end of the world if I don’t,” she says with a shrug. “When you have HIV and you know your life may be shorter because of it, you get used to just enjoying the happiness you have in your life and not getting depressed about what may not happen.” However, not getting the surgery means, for Anderson, sacrificing hopes for intimacy she can feel good about. Her last relationship, with a heterosexual man, lasted four years, but she never felt comfortable with sex, which always reminded her of her maleness. “Being intimate was difficult for both of us. He became comfortable after talking to other heterosexual people in relationships with transsexuals, but for me it was always a bitter reminder of the part of me that’s still a man,” says Anderson. “It’s very lonely, but unless I get surgery there’s always going to be that confusion and discomfort when intimacy happens.” Anderson says living as a transsexual without sex reassignment surgery is made tolerable by a society that increasingly accepts people with gender differences. “I’m surprised about the acceptance I’ve experienced, especially in a small community. I went through the era of non-acceptance of gender differences in the ’60s and ’70s, so I’m still on guard of people’s reactions to me,” she says. “If I can help a person understand by just being myself, then that’s worth it. Look at the gay community; it has come leaps and bounds in the past 25 years. It gives me hope that one day parents will give birth to children and say ‘the world holds a lot for you, whether you are gay, straight, transgender or whatever’.”