Ashton Schofield came out as transgender in the summer of 2016, just after the Pulse nightclub shooting in Florida, which moved him to speak more openly about his experiences as a gay transgender man.
Schofield, a second-year Algonquin student, has been taking hormones for nine months, about the same amount of time it took for him to initially get a prescription for them.
“Some people have known they were trans since they were really, really young, and then they finally get the courage to come out, and they have to wait another six months, or it can sometimes be years to start their transition,” Schofield said.
He said that he was referred to a popular Ottawa gender therapist by his family doctor after expressing his decision to pursue hormones.
Since the therapist was so busy and only worked two days a week, Schofield said he had to schedule three appointments, each a month and a half apart. It took him six months before the gender therapist referred him to a local endocrinologist—a doctor who specializes in hormone therapy.
Schofield said once he was referred to an endocrinologist, he immediately realized that the gender therapist who he first saw had prescribed him the wrong hormone medication.
“She wrote a suggestion for what medication she thought I should be on, and then when my endocrinologist saw it, he was kind of like, ‘What the fuck, this is not for someone who’s 16 years old. I don’t know why she would suggest this,’” he said.
Schofield knows of other people who had the same experience.
Studies show that LGBTQ+ populations experience disparities and barriers related to their sexual orientation and gender identity in the health care system.
The Ottawa Hospital was contacted on multiple occasions for comment on this story, but said their spokesperson was unavailable.
Michaela Schreiter, communications coordinator for the Ottawa Hospital, relayed the following statement in an email:
“Through our Patient and Family Advisory Council, we work closely with representatives from all backgrounds, including transgender individuals, to ensure our services meet the unique needs of all who walk through our doors,” Schreiter said. “We welcome feedback from all patients who identify as transgender with regard to their experience and perspectives in the health-care system.”
Barriers in accessing health care
Despite the progress the government has been making to address these barriers in Ottawa, and across Ontario, they are still an issue for transgender and gender-diverse people.
Fae Johnstone is trans-feminine and a core team leader for the recently developed Foundations and Pathways Ottawa (FPO), a peer support program for trans people, by trans people.
FPO offers help to trans individuals who are trying to look for gender-sensitive mental healthcare providers, who are trying to access primary care to gain access to hormones or to start the work on accessing gender-affirming surgeries.
“A lot of folks don’t know where to go and don’t know how to go when it comes to accessing any kind of service related with their trans identity,” she said.
As part of their mandate, FPO also works to eradicate transphobia in the healthcare system by providing training and support programs to medical centres in Ottawa.
“We still do not live in a society where physicians, doctors, nurse practitioners, social workers, most healthcare and social service providers still don’t have trans competency training,” she said. “They’ve never actually sat down and learned—how do we affirm trans clients?”
Ernie Gibbs is an LGBTQ+ youth counselor at the Centretown Community Health Center (CCHC), and has been working with trans youth ages 12 to 25 for 16 years. According to him, there is a big lack in resources for trans youth in Ottawa.
Currently, Gibbs supports 17-year-old and 18-year-old trans youth who are looking to start hormone-treatment, or just looking for mental health support.
According to him, CHEO’s Diversity clinic for children and youth has a waitlist of up to six months to see a specialist. To help reduce these wait times, Gibbs helps treat some of these patients, so they can be referred for treatment more quickly.
But, according to Schofield, not a lot of trans youth are aware that resources like FPO and the CCHC exist.
He said that he received most of his information about transitioning online, and that most transgender people he knows, had to do their own research because of a lack of access to resources.
“We’re such a small community of people, being able to find that info online is really important because it’s not coming from cisgender people, it’s coming from transgender people,” he said.
Schofield added that he thinks a big part of transgender Ontarians not knowing how to access resources, stems from the fear of not knowing whether somewhere is a safe space.
Gibbs also said that because of the historical discrimination that trans people have faced in the past, people still feel deterred from accessing health care.
Importance of safe spaces
A safe space refers to somewhere that is openly free of bias, conflict, criticism or potentially threatening actions, ideas or conversations.
“I think the lack of education about trans people makes me feel like I’m not sure whether or not I’m walking into a safe space,” Schofield said.
Gibbs said that although he does think there has been a positive shift towards trans people in the medical community, some of his clients still experience discrimination.
“I had someone last year who was assigned male, who wanted to transition to female, who was attracted to females, so the provider of that person said, ‘You’re not a true transexual,’ so you’re not allowed access to hormones. This is language from the sixties—that’s not appropriate.” – Ernie Gibbs, LGBTQ+ youth counselor at the CCHC
Schofield also explained that he found some of his healthcare providers to be outdated in the language they used around the LGBTQ+ community, and that he thinks that issue stems from a lack of education about trans and gender-diverse people.
“The gender therapist I found, and heard from other people who’ve also seen her, to be a little bit outdated in terms of her language,” he said. “So it wasn’t the most safe space.”
According to Schofield, being educated about what language to use is a good step towards ensuring a safe space for the LGBTQ+ community.
“You could try to teach people as much as you want, but I don’t think that necessarily means they’re going to change,” he said. “I think that a lot of people see trans people as ‘others,’ but I would really appreciate if people could try to sympathize on some level.”
Gracie Cooper, a second-year nursing student at Trent University, grew up in suburban Kanata, just outside of Ottawa and said she has always felt passionate about LGBTQ+ issues.
She said it was surprising that despite Trent’s high population of LGBTQ+ students, they don’t learn a lot about supporting trans and gender-diverse people in the program.
The focus at Trent is to be respectful of everyone, and support their medical goals no matter your personal opinions, according to Cooper, but she said there isn’t much education about LGBTQ+ healthcare other than that.
“In Peterborough, we have a high statistic of homeless, and they teach you lots of resources for that, that I could list off the top of my head, but in terms of LGBTQ+ resources, I can’t think of any.”
Creating safe spaces, increasing funding
According to a 2013 report by the Gay and Lesbian Medical Association, displaying things like rainbow flags, LGBTQ+ health brochures, and LGBTQ+ posters, and being more open to feedback would also be good steps for medical centres to take.
The report said intake forms should start using terms such as “relationship status,” instead of “marital status,” and adding a “transgender” option to the male/female check boxes.
These are all important steps, but Gibbs said that making a medical centre a safe space should be a process, not a check-box.
According to Johnstone, making meaningful changes around accessibility and education are key. Another important factor which will aid the whole process is an improvement in funding.
“There aren’t a lot of well-funded trans programs in this province or in this country,” she said. “So, there hasn’t been a funding commitment from the provincial or federal government, or from any institution, as of yet, that has said we’re going to make this a priority.”
Gibbs said FPO represents an alternative way that people are making a difference in the trans community, by starting their own programs instead of relying on funding.
“The exciting thing about FPO is these are trans and gender-diverse people who are developing their own programming and providing that as peers,” he said. “That is very powerful, and that’s going to be a game changer for services in Ottawa, hopefully.”
Improving accessibility, Johnstone said, includes reducing wait times, making medical centres more welcoming, and funding more medical professionals dedicated to trans health.
“There’s a doctor at CHEO who can do certain kinds of top surgeries, but most of the time you have to go to Montreal or Toronto,” Johnstone said.
She added that government policy will play a big part in changing accessibility. For example, OHIP doesn’t always cover everything involved in top surgery. Cosmetic reconstruction after top surgery, is one procedure she said some trans people have not been covered for under OHIP.
The Ontario government has made movement over the past two years to reduce barriers involved in accessing gender-affirming surgeries, including reducing the number of doctor approvals required to qualify for coverage.
Even though the government has been working to reduce the red-tape around funding for gender-affirming surgeries, according to the Ontario Ministry of Health and Long-term Care, currently, there is only one site in Canada that performs genital sex reassignment surgery.
Although there are a lot of steps involved in accessing transition-related healthcare, and many are pushing for faster access to it, Schofield said it’s important to let people do things at their own pace, and explore other things you are passionate about.
“Just because your friend or someone you heard about in the news did something a certain way, doesn’t mean that has to be your way of doing things,” he said. “It’s important to do things that make you happy outside of having a physical transition to really understand that there’s so much more to you than just being trans.”
Editor’s note: A previous version of this article mistakenly described Fae Johnstone as “male to female transgender.” This phrase has since been removed. Johnston is also a core team member of the FPO and not a peer supporter as previously written. The Charlatan regrets the errors.
Photos provided, graphic by Paloma Callo.
