Today on this Transgender Day Of Visibility, I am humbled to share one of the most important things I will ever publish on this blog.

As a medical student, I’ve been incredibly frustrated with some of the large gaps in my curriculum. One that I keep bumping into time and again is caring for trans* folks. Fortunately for me (and now for you, my readers), I have a dear friend who was willing to answer some questions about being a trans* man.

I met Charlie 6 years ago. Charlie has always had the biggest heart imaginable and will always be your biggest cheerleader. He will do anything to help others grow and learn. So I knew he was the perfect person to help me (and you!) become better future healthcare professionals. It’s unfortunate that the burden is always placed on folks with lived experience to educate us, but Charlie has been so gracious in doing just that and I am forever grateful.

I sent Charlie 6 questions that really only begin to scratch the surface of what it’s like to be a trans* man and interact with the healthcare system, and here are his answers!


Please note that Charlie is a trans*man living in Canada who recently underwent female to male (FTM) top surgery in Ontario. Navigation of the healthcare system will surely be just as frustrating in other provinces and countries, but the examples will be specific to Canadian healthcare.

1) Tell me about yourself! What’s your name? Where do you work? What are some of your favourite hobbies?

My name is Charlie Graham, I’m 24 years old and I’m a training store manager at Starbucks in the downtown core. I have two cats and a banana ball python, and I’m just a happy quiet transgender guy just puttering through life really. I have a partner named Emily, and I’m currently pursuing education in Floral Design. I’m very active in the trans* community, I do a lot of work in education and activism, I’m currently focusing my energy in trans* employment. Other than that, not up to too much!

2) The person you just told me about, how is that person different from the one I met 6 years ago?

The person you met 6 years ago is very physically, outwardly different. When I met Giuliana I was an extremely outgoing, fiery brunette girl, struggling to keep my voice down. I’m not by any means ashamed of who I was, I take great pride in the changes I’ve made in my life. When I met you 6 years ago , I was violently depressed and anxious with no sense of what was wrong. I was between medications, doctors, specialists, all of which couldn’t really pinpoint what going on. Having experienced a few very traumatic events, most medical solutions were based on grief counselling and behavioural therapies to combat post traumatic stress. It wasn’t until late in university that I really had exposure to the trans* happenings in the world and started experimenting with gender presentation. I made a great friend who was also a trans* male, and honestly through our companionship and education I learned so much about myself, and all the things I hadn’t considered. As soon as I started my transition, I was able to completely cut free of any and all anti-depressants because I genuinely had found the solution.

3) Tell me about your experience with healthcare during your transition. Was it good, bad, easy, hard to access, etc.  

Healthcare during transition was quite difficult, especially considering I had the upper hand in being able to assert myself in my own healthcare decisions. Healthcare with trans* needs is an expansive topic but I will unpack my discussion as politely and concisely as possible. At the end of the day, the thoughts I express are my own, and represent my own lived experience.

My unique healthcare experience could be mostly divided into family practice, endocrinology, operative services and OHIP. I knew once I solidified that I was going to medically transition, I would have to move to Toronto, as access to resources for all of those things would be easier.

Family Medicine

The fact of the matter is, it’s difficult to find a new family doctor for anyone. For trans* people, it’s not only about the doctor itself, it has a lot to do with social implications of entering a doctor’s office as well. My first family doctor who supported my transition, had administrative staff and nurses who refused to call me by my preferred name as it did not match my health card. So every time I went to the doctor, which at that point was once a week, I was exposing myself to an entire group of people in the waiting room, who had to watch a bearded man walk in after the nurse announced my particularly female birth name. Something they didn’t realize is that it was also a huge safety concern to expose me in that way.

Certain populations of Trans people have a 1 in 12 chance of being murdered, as a result of their gender expression. Regardless of if the statistics apply to your area, when you start socially transitioning, one of the first things that comes to your attention is that you run a huge risk to your life at the expense of other people.

Finding a family doctor who is accepting new patients, is understanding of the medical needs of trans* people, who has a complete team who is on board, is incredibly difficult without a waiting list of 8-12 months.

Endocrinology

With regards to HRT (Hormone Replacement Therapy) it is recommended to use an endocrinologist, and as a specialist, the service takes months to access. In my particular journey, I opted to not use an endocrinologist, which was my own conscious mistake, and my family doctor at the time prescribed my dose of inter-muscular Testosterone. In retrospect, I genuinely wish I had waited to see an endocrinologist. I had specified to my GP that I wanted to be placed on low-dose testosterone so that I could take things slower, I was placed on the highest possible dosage. I learned after that it was truly a miracle that I did not get incredibly sick. After my first round of blood work came back, my GP was unable to explain to me what my testosterone levels were, and what a healthy testosterone level in a transitioning male was.

The reality is that through social support, young patients learn how to ask for what they want, without truly understanding how hormone replacement therapy works.

Operative Services

5 weeks ago I had a double incision mastectomy, with contouring and nipple grafting, and I’m genuinely the most happy I’ve ever been in my entire life. The process to get there however, was the most tedious of them all. Currently in the GTA, there is only 1 clinic that performs FTM Top Surgery, the closest second place being in Montreal. The procedure is considered by most institutions as an “elective” surgery, however most recently OHIP has opted to cover majority of the costs associated with the procedure, which brought operative costs alone from $11,000 to $2,260 out of pocket. Remaining costs associated were primarily for the element of contouring which is a procedure that redistributes some of the fat tissue under arms and around shoulders and creates a more dynamic pectoral muscle so that the chest looks masculine. (If you would like to hear more about the procedure, send me an email I can go into full detail about it with you).

To get under the knife, you’re looking at (on average) a 2 year wait. Between OHIP approval for surgery, the initial consultation, and the actual procedure. Other procedures, including phalloplasty and vaginoplasty, wait times could be significantly more.

4) What do you think your biggest barrier was during your transition?

I think my biggest barrier through majority of my transition was that I honestly felt like I was alone. I had my wonderful girlfriend there beside me the entire time, and I had so much support from friends, but I just wished it could have been easy.

5) What do you think is the most important thing doctors and other healthcare professionals need to know about trans folks ?

I think the most important thing for doctors and other healthcare professionals to know is that every experience is unique, similar to every other patient you have in front of you. At the end of the day we just want to feel respected. Whether that means learning and using our pronouns or names (regardless of what our health card tells you), deviating from medical terminology, not fetishizing or obsessing over patients as being “fascinating”, or understanding patients from a place of what makes them comfortable, it’s about doing what you can to respect the person in front of you. Challenge yourself to be constantly learning and assessing your behaviour, and understand that these patients come to  you with their guard up always, and will be analyzing everything you do, merely just to protect themselves.

6) Are there are people, resources, communities, or organizations that have been particularly helpful to you during your transition that you think other folks should know about?

(I could go on about this forever.)

First I’d like to mention, that if you have any questions or want to have a conversation with someone about any of the information that you’ve just learned, my email is charliejamesgraham@gmail.com and I invite you to email me.

The Sherboune Health Centre has released a very important document for those involved in trans* health care, I highly recommend it:

http://sherbourne.on.ca/lgbt-health/guidelines-protocols-for-trans-care/

This is the link to apply for OHIP funding for gender reassignment surgeries : http://www.health.gov.on.ca/en/pro/programs/srs/ (click the prior approval form)

In terms of organizations that have been particularly useful to me:

Egale Youth Outreach and the 519 Community centre have been my go-to for anything and everything, as well as different mentors in the community.

Feature image via theflyingbats

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