Local access to healthcare for transgender patients lacking, one advocate says

A local transgender rights advocate says he is not surprised to hear results of a new study that says about half of transgender Ontarians do not feel comfortable discussing transgender-related health concerns with their family doctors.

Wesley Austin transitioned from a woman to a man seven years ago. He said at the time, he did get some resistance from his doctor.

"I've had a lot of challenges, fewer than most, though, I'd say I'm pretty lucky. Care in this region was really hard to come by when I was first transitioning. My family doctor at the time was not knowledgeable at all about transgender issues," he told The Morning Edition host Craig Norris Wednesday morning. "I think some of it was resistance and a lot of it was just lack of knowledge."

Austin said many doctors don't seem to realize they are capable and legally allowed to prescribe hormonal therapy for their transgender patients. Instead, a lot of doctors think they need to get letters from the gender identity clinic at the Centre of Addiction and Mental Health (CAMH) in Toronto.

"I've heard from a lot of folks in our trans community who don't have a family doctor and who are looking for one but want one, that if not familiar with trans issues, is at least open to learning about them and open to supporting them as they transition and that care is really hard to come by," Austin said.

"There are a couple of doctors in the area whose specialty is turning out to be trans medicine," he said. "On the whole, that is still the exception."

Difference in care

The study led by Greta Bauer, an associate professor at Western University's department of epidemiology and biostatistics in London, Ont., found 47.7 per cent of transmasculine and 54.5 per cent of transfeminine patients polled through the Trans PULSE research project said they were not comfortable discussing transgender issues with their family doctor.

More than a third of transmasculine and transfeminine respondents – 37.2 per cent and 38.1 per cent respectively – reported a transgender-specific negative experience with their family physician, the study found.

All patients need to feel comfortable with their doctor.- Greta Bauer, associate professor at Western University

The study surveyed 433 trans people over the age of 16 in Ontario, 356 of which had a family physician.

Among the negative experiences felt by patients were people who had been refused care by a physician, physcians using hurtful or insulting language, being told by a medical professional they were not transgender, being discouraged from exploring gender and having a doctor belittle or ridicule them.

Bauer said the study shows not everyone in the province has the same level of health care.

"All patients need to feel comfortable with their doctor, otherwise there are barriers to accessing care – whether it's for medical transition-related care or bronchitis," Bauer said in a release about the study, which was published last month in the scientific journal PLOS ONE.

Exposure to issue key

Austin has been invited to speak to students at the McMaster school of medicine in Kitchener about transitioning, and the needs of transgender patients. He said while students understood the biological aspect of transitioning from one gender to another, "they had no idea how to ask sensitive clinical issues like, does this person need a pap smear or a prostate exam."

But, he said, students seemed open to learning more and they are much more exposed to the concerns of trans patients than older doctors.

"I think it's an exposure thing. The generations of trans folks that came before me coined the term, they brought it to consciousness, they stopped hiding shadows and said we are entitled to this. My generation is now saying yes, not only are we entitled to this, but we're entitled to the same level of care and concern that every other Canadian is entitled to," he said.

"I'm hoping the generation behind me will start specializing, will start being able to take for granted … that of course they're entitled to that care, of course that information is available, why wouldn't it be?"

Local doctors

Transgender people looking for a doctor can visit the website for Rainbow Health Ontario, a province-wide program working to improve access to services and promote the health of lesbian, gay, bisexual, trans and queer (LGBTQ) communities. 

In Waterloo Region, OK2BME through KW Counselling Services offers a number of support services for the LGBTQ community.