Transgendered represent a cross-section of society

The Edmonton Journal April 16, 2009

I am disappointed by the government's decision to delist sex reassignment surgery (SRS). The delisting was done without any prior discussion with professionals to determine the impact it would have.

I am virtually the only psychiatrist in Alberta who has an interest in this area. A few years ago, there was a gender clinic in Calgary, but it closed.

I have been seeing transgendered individuals since the late 1970s, with the first individual being funded to have SRS in Brussels, Belgium in 1984. I have always felt very good that Alberta provided funding for the surgery, even during the major health-care cuts in the 1990s. I believed that the government actually felt concern and compassion for this marginalized group.

Between 2001 and 2008, I have seen about 250 transgendered individuals at the gender clinic that I run. Not all who are assessed are appropriate for or want SRS. However, about 60 per cent do go through the required process and many wish to have SRS. Others, usually for social reasons, are happy just to be on appropriate hormones.

Of the group who wish to have SRS, about two-thirds are male to female and one-third female to male.

They represent a cross-section of our society. Transgendered individuals come from every socioeconomic class. The majority are employed or going to school; 60 per cent have a college diploma, trade school certificate or a university education. I have seen transgendered individuals who are physicians, teachers, nurses, engineers, lawyers, professors, mechanics, electricians, carpenters and so on.

Many are successful business people, some are retired and an increasing number are still students. I also see, with increasing frequency, children as young as seven, being brought in for assessment by concerned and very supportive parents.

I have conducted a number of satisfaction surveys after SRS on the individuals that I see and all patients are happy with the results of their surgery and have no regrets, which accords with larger international follow-up surveys.

Transgenderism (gender identity disorder) is a condition that is listed in the American Psychiatric Association Diagnostic and Statistical Manual and recognized by the Canadian Psychiatric Association.

Transgenderism is a biological state due to hormonal events that occur during intrauterine development. There is scientific agreement on this.

It is not a choice. Gender, including transgenderism, is established at birth although does not express itself until the age of four or five or later.

Awareness of a gender-body incongruency can occur at a very early age and becomes stronger with time. Depending on the family environment, the condition can be expressed or hidden because of parental disapproval. If this occurs, it can lead to considerable angst and even depression in adolescence. A hidden gender identity in an adolescent can lead to dropping out of school, sexual promiscuity, alcohol and drug abuse, depression, and suicide . The cost to the health-care system for such events can be considerable and far more than the $700,000 that was previously allocated for SRS, to say nothing of the ruined lives of young people.

Many provinces deal with SRS on a case-by-case basis. Ontario delisted SRS a few years ago, only to relist it recently after losing a class action discrimination suit. Likewise, British Columbia delisted SRS a few years ago only to relist it after public pressure.

Speaking about seniors, Health Minister Ron Liepert said, "We want to ensure that we look after the most vulnerable in society."

However, transgendered individuals are also a very vulnerable and group in our society. What has happened to our compassion for them? Also, what message is being given to transgendered youth and adolescents? They need support and to be secure in the knowledge that help is available for them when they need it and that they will not be treated as second-class citizens.

Lorne Warneke, clinical professor, psychiatry, University of Alberta, and director, Gender Clinic for Alberta
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