Trans Identity and Health

“I Don’t Think This Is Theoretical; This Is Our Lives”: How Erasure Impacts Health Care for Transgender People

For people who are transgender, transsexual, or transitioned (trans), access to primary, emergency, and transition-related health care is often problematic. Results from Phase I of the Trans PULSE Project, a community-based research project in Ontario, Canada, are presented. Based on qualitative data from focus groups with 85 trans community members, a theoretical framework describing how erasure functions to impact experiences interacting with the health care system was developed. Two key sites of erasure were identified: informational erasure and institutional erasure. How these processes work in a mutually reinforcing manner to erase trans individuals and communities and produce a system in which a trans patient or client is seen as an anomaly is shown. Thus, the impetus often falls on trans individuals to attempt to remedy systematic deficiencies. The concept of cisnormativity is introduced to aid in explaining the pervasiveness of trans erasure. Strategies for change are identified.

The Health of Ontario’s Transgender Communities: Prevalence of and Risk Factors for Depression, “Do-It-Yourself” Transitions, and Health Effects of Cross-Sex Hormones and Surgeries

The purpose of this thesis was to develop an understanding of the health and service access issues faced by trans (transgender, transsexual, or transitioned) Ontarians. The first manuscript outlines lessons learned from doing participatory doctoral research, and provides key recommendations. The second manuscript assessed the prevalence of and risk factors for depression among male-to-female (MTF) and female-to-male (FTM) Ontarians. Our findings indicate that depression is widespread among MTFs and FTMs. The third manuscript examined the extent of “do-it-yourself” transitions. While self-performed surgeries and current use of non-prescribed hormones were uncommon, this study indicates that trans people’s experiences with providers may have played a role in their willingness to seek hormones from non-medical sources. Lastly, the fourth manuscript explored the long-term positive and adverse health effects associated with hormone use and SRS. We found no evidence that hormone use among MTF and FTM people in Ontario conferred negative effects on health. While some conditions were relatively common (sleep apnea, high cholesterol, and hypertension), almost all other outcomes were rare. These results may provide health care providers with the knowledge to make treatment and screening decisions. More specifically, our findings show that the fear of “doing harm” by prescribing hormones to trans people is likely unfounded.