Resources for Medical Professionals

Thank you to Mercedes Allen from AlbertaTrans.org for allowing us to adapt this from her original document

 

 

   Transgender health is governed by the World Professional Association for Transgender Health (WPATH, formerly Harry Benjamin International Gender Dysphoria Association), which oversees the recommended Standards of Care for trans* people (with the exception of therapists, most doctors will encounter specifically transsexuals, in cases where trans-related health concerns must be addressed). The WPATH Standards of Care are recognized practice by the American Medical Association, the American Psychiatric Association (which currently governs the diagnosis), the American Psychological Association, and the Canadian counterparts of all three. The Standards of Care are a guideline, so there is some flexibility in treatment based on an individual's needs.

   Transsexuality is defined as "Gender Dysphoria" in the DSM-V, classification 302.6 or 302.85 (depending on if it is diagnosed in childhood or adulthood). This means that it is currently listed as a mental health issue, but ongoing studies in genetics, brain composition and effects of Endocrine Disrupting Chemicals on the foetus indicate that there may be at least a biological component (if not a biological origin) as well (Zoe Brain tabulates some of the studies, for those who are curious).

   In Saskatchewan, there are two psychiatrists that have experience treating trans* folk, Dr Donna Hendrickson in Saskatoon (306-668-0505, 505 4th Ave N) and Dr. Anne Bellows in Regina (306-766-7800, 2110 Hamilton Street). If a patient is indicating they desire Gender Reassignment Surgery (GRS, also know colloqually as "bottom surgery"), Sask Ministry of Health requires individuals to be assessed by the Gender Clinic at CAMH in Toronto or Dr. Warneke at Grey Nun's Hospital in Edmonton.

   The transition process for trans* people in Saskatchewan is extrermely long. For this reason, and the anguish caused by Gender Dysphoria that can often lead to anti-social behaviour, self-destruction and/or suicide, it does sometimes fall to other medical professionals to help ease the situation. This often means having a referral to one of the above gender therapists put in as soon as possible, and finding for them an additional support system, either through a trans-friendly psychologist/psychiatrist/counsellor ("trans-friendly" is important, as not all therapists treat according to the WPATH SoC, and some therapies, such as aversion therapy, can be extremely harmful -- which is exactly why the WPATH SoC is the medically-accepted standard) or through local support groups. For male-to-female patients, it is also a good idea to stress the importance of commencing facial hair removal as early as possible, as it will usually make an enormous improvement on their gender presentation (most laser hair removal clinics and electrologists will have prior experience with transgender people). Facial hair removal does not require a referral, and is not currently covered by Sask Health, but a percentage can be deducted for health maintenance at tax time.

   Assisting trans* patients may also include things such as writing a "carry letter" (to assert that the patient has Gender Dysphoria, is living as their identified gender, and that it is appropriate for them to dress as, be addressed as, and travel in spaces for their identified gender), or supplying hormones/monitoring endocrine levels once you are certain of their sincerity/determination. In these latter cases, we do recognize that these steps may be frightening steps for a General Practitioner to take and that the WPATH SoC does not require them of you -- but because of the waiting periods in Saskatchewan, in cases of extreme distress and desperation, these steps can go a long way to assist someone with Gender Dysphoria. The Transhealth program sponsored by Vancouver Coastal Health has resources documenting transgender hormone regimens for those who are willing to prescribe within trusted guidelines. It is important to monitor endocrine levels regularly -- every three months is recommended, at least in the first couple years of transition or following changes to type or dosage. If the patient is over 50 or has other current medical concerns, it is sometimes preferable to have their health monitored by an Endocrinologist -- most Endocrinologists in Saskatchewan prefer to have a letter from one of the above gender therapists, so you may need to speak with them before sending the referral about why a particular case is urgent.

   The initial phase of gender transition can be very scary for a patient, which is why support networks mentioned above are crucial. However, once a patient with Gender Dysphoria has settled into living in their identified gender role and is on hormones, much of the original distress is alleviated. A need for surgery may still be urgent to the patient, but he or she has been provided hope, has been able to shed the day-to-day distress and has usually achieved a point of stability, which is why contributing to the process by doctors at any level can be invaluable.

   Gender Reassignment Surgery and related surgeries are governed a little more specifically, in Saskatchewan, and often far less attainable for most trans* folk. GRS is recognized as medically necessary, as stated by most professional health associations. Therapists at CAMH or Dr. Warneke in Edmonton must sign off on approval for surgery, in order for Sask Health to partially cover the procedures (for GRS surgeries, Sask Health reimburses only 30% of the cost, and only if done by Dr. Brassard at his GRS Clinic in Montreal). Procedures might include male-to-female GRS, male-to-female orchiectomies, female-to-male GRS, female-to-male mastectomies and female-to-male hysterectomies/oophorectomies. For the two GRS procedures, Sask Health refers most patients to Montreal. The other procedures can be done locally when possible, although it is sometimes difficult to find doctors willing to perform them on transgender patients, because of societal misunderstandings on what transsexuality is, or because of not realizing how important the need is. Currently, Dr. Saul Gonor at the Urology Associates in Saskatoon performs orchiectomies for male-to-female, and Dr. John Thiel in Regina (2631 28 Ave, 306-586-1800) performs laprascopic hysterectomies/oophorectomies. Most plastic surgeons can perform mastectomies, but chest reconstruction is often preferred by female-to-male. There are currently no surgeons who perform chest reconstruction in Saskatchewan.

   If a patient decides for any reason to forego Sask Health coverage, most GRS surgeons still require at least one letter from a therapist asserting GID. In these cases, it may be possible for other therapists to write the letter -- stipulations will depend on the requirements of the GRS surgeon(s). Some of that information may be culled out at the TS Surgery Guide.

   Sask Health does not currently cover procedures that it considers cosmetic, including Facial Feminization Surgery (FFS), breast augmentation, tracheal shave or facial hair removal via laser or electrolysis. We would tend to disagree with at least the latter two cases, which are often crucial for male-to-female patients to successfully present as their identified gender, and as such becomes more than just cosmetic. Surgeons in some of these cases (i.e. FFS, BA) may sometimes require a letter asserting a diagnosis of Gender Dysphoria, but stipulations on who writes the letter can vary per surgeon.

   Sask Health does typically cover voice therapy. Christie Ife at the Adult Speech-Language Centre in Saskatoon City Hospital (306-655-8181) provides speech therapy to both trans women and trans men. This is an 8 week service (2 hours/week), and is offered once per year when a group of 6-8 clients has been established. Christie Ife takes self referrals (you don't need a doctor's referral).

 

The Trans-Friendly Doctors List

The TransSask community maintains a "trans-friendly doctors" list, encompassing family doctors and specialists, so that people in the community know where they can go to be medically treated, as well as respected. To be included on the list, a medical professional must:

• be willing to see trans patients,

• treat according to the WPATH SoC rather than advocating harmful routes such as aversion therapies,

• make an effort to respect transsexuals' gender identity and use appropriate pronouns, and

• make an effort to ensure that one's clinical staff also respect patients' adopted names and gender identity (we realize that you cannot always control or predict your staff's behaviour, but an effort should be made to educate them and to deal with conflicts that arise -- this website can be given as one such tool to help educate staff).

If you pledge to meet the above, you can gain inclusion on this list by contacting us.