Transitioning to a universal healthcare system

From left: Devon Simpson, a street worker at Head & Hands; Caroline Trottier-Gascon, a Concordia PhD student; and Dr. Charles-Olivier Basile. Photo by Sandra Hercegova

Activists discuss challenges the LGBTQ+ community faces when seeking medical treatment

“The problem is not being trans, but being trans in a transphobic society,” said Devon Simpson, a street worker for Head & Hands, a Montreal-based organization that offers medical, legal and social services to youth. As part of Concordia’s first Winter Pride Week, the School of Community and Public Affairs hosted a panel on Feb. 27 titled “Universal Healthcare, Really?” to discuss trans people’s lack of accessibility to healthcare.

Canadian society has come a long way in the last decade with regards to LGBTQ+ rights. However, a closer look at Quebec’s healthcare system reveals significant systemic discrimination against trans people, explained Simpson, who establishes liaisons between trans people and Clinique 1851, a clinic on Sherbrooke Street known for accommodating trans people.

The panel’s mediator, Kimberley Manning, a trans youth advocate and principal of the Simone De Beauvoir Institute, focused the discussion on Quebec’s outdated healthcare system when it comes to doctor’s practices and the treatment of trans people.

According to panelist Dr. Charles-Olivier Basile, a family physician in Montreal who treats trans people, only a handful of clinics have a doctor who specializes in or understands trans healthcare, so access is limited. When he was in medical school, Basile said he realized there was a significant lack of emphasis on trans healthcare.

Gender dysphoria is listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which provides the criteria needed for a psychiatrist to make a diagnosis and allow the person to move forward in their transition. Therefore, going through the healthcare system in order to transition is a must, yet trans people cannot just walk into any clinic to receive hormone therapy. “Nevermind how hard it is to find a doctor, the access to care is very territorial and many [trans people] do not have the material means to get across the city,” Simpson said.

Part of the care trans people seek is an explanation of all the risk factors associated with a particular surgery or treatment so that they can give informed consent before proceeding, explained Betty Iglesias, a Montreal-based trans advocate and former outreach worker for Action Santé Travesti(e)s et Transsexuel(le)s du Québec.

For many trans people, the idea of seeking medical treatment, even outside of their transition, can be stressful and uncomfortable. “They even fear not knowing if their chosen pronouns will be respected,” Simpson said. As a street worker, Simpson gives their phone number to trans individuals in case they need help navigating these challenges.

Panelist Caroline Trottier-Gascon, a Concordia PhD student researching the history of trans communities, emphasized the fear trans people face when they have no choice but to go to an emergency room for an injury such as a broken leg. In those situations, trans individuals often must explain to a doctor why a certain painkiller or medication will not interfere with their hormone therapy or other ongoing treatments, Trottier-Gascon explained. “This delays the process of their treatment,” Simpson said, adding that these inquiries by doctors “may be in good faith, but sometimes it comes from ignorance.” Not having their physical appearance match the sex on their ID card can be another source of delay in these situations, Simpson said.

In addition to limited access, not all aspects of transitioning are covered by medicare, such as breast augmentation and voice therapy, Basile said. Even when certain treatments are covered, there are still additional hidden fees associated with transitioning which should be covered by health insurance plans, Basile explained. Although Montreal is a go-to destination for trans Quebecers to find a community and the healthcare they need, according to Iglesias, the system is far from perfect.

“It’s an active decision to not properly train medical professionals about trans healthcare,” said Trottier-Gascon, adding that, until this type of training is implemented, Quebec’s healthcare system will not be truly universal.

Feature photo by Sandra Hercegova

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