Southern Comfort

Health Care in the Trans-Community

Recently I watched a documentary entitled Southern Comfort — http://www.youtube.com/watch?v=x2AvlDKc8so. The film follows the last year of life of Robert Eads, a female-to-male (FTM) transexual who died of ovarian cancer because he could not find a medical provider who would treat a transgender/transexual patient. Not only does the film tell a powerful story about Eads, his family and friends, but it is also a revealing example of healthcare discrimination trans-individuals often face in the US. Of note, transgender is a broad term used to describe a wide range of individuals who have “atypical” experiences of gender or unconventional gender presentations. This documentary inspired me to touch on some of the health issues transgender people face in the US and how psychometrics could be used to improve them.

Interestingly, health care can play an dichotomous role in the transgender community. For some, it offers a key step in their transition process, for others it becomes yet another source of oppression. One of the first discussions in the film, for example, centres around the failure of health care professionals to adequately care for the transgender community — an injustice largely rooted in the fact that trans-identities and lifestyles are often not accepted in society, or are accepted only under specific circumstances. While one would hope health care settings would be exempt from such transphobia, it appears that in certain areas of the states many health care professionals are unprepared to separate their personal beliefs to treat trans-individuals equally and effectively. The discussion in the film broaches the subject of bad surgeries and the atrocious aftercare some trans-individuals have experienced, and points out the absence of such injustice in non-trans populations. Female-to-male (FTM) trans-individuals receiving a mastectomy, for example, often suffer botched surgeries resulting in disfiguration, while those receiving the same surgery for breast cancer receive careful incisions and minimal scarring. The most distressing part of this discussion, however, regarded the complete exclusion of trans-individuals to proper medical treatment, which in the case of Eads’, could have improved the quality of life in his final years and potentially extended it a bit.

My goal here is not to disregard the inclusive health and social policies that do currently exist in Canada and the US, but rather to point out that the remaining oppression is problematic.

So what are some solutions?

For starters, nondiscriminatory policies.

Sure this means large scale policies, but it also encompasses smaller ones that would ensure trans-individuals are seen as equals. One strategy, for example, is identifying trans-individuals respectfully. While the term transgender is generally accepted as a political label, is not widely accepted as an individual one. We need to keep in mind that labels are imprecise and should not be used to density the identities of anyone. Regarding those seeking health care services, it is important for health care providers to use the gender pronoun the individual prefers. Support services should be developed for the trans- community not only in urban centres or in the form of conferences, but in rural areas as well. And, of course, more education needs to be done in clinical settings to remove the discriminatory barriers to health care access.

But here’s the kicker — before we can do any of that we need to better understand the trans-community in health care settings. One way to do this is of course through psychometrics! Needs assessments, for example, have been used to explore the status of health care utilization in the trans-community. Most of the research, however, has been done in male-to-female (MTF) transgendered groups. Little is known about FTMs and it is unfair to assume that data from MTFs should generalize to FTMs when they are two distinct populations. While FTM specific needs assessments are clearly needed, more research also needs to be done regarding the relationship with physicians, ratings of care received and health care options, transition choices (i.e., hormones & surgery), and adaptation in the trans-community.

I realize change is not so simple. But who knows, perhaps improving the psychometrics in this area of health care and research could help us get back to that good ol’ Southern Comfort that we seem to have lost.