Good afternoon, Mr. Chair and members of the standing committee.
Thank you for inviting me to participate in this important meeting on LGBTQ2 health. My name is Giselle Bloch, and I'm honoured to be here today.
I'm not a scientist, a researcher or an expert; I'm a parent, and I love my three children, two of whom are LGBTQ2.
As I accompanied one of my adult children along his journey of transition, I quickly learned how poorly society views transgender folks. I resolved to be an ally by supporting this community. Since my personal experience is mainly with trans folks and their families, I will focus my remarks on that segment of the LGBTQ2 population.
I'm a board member with Toronto Pflag, a volunteer-run charity whose mission is to promote the health and well-being of LGBTQ2 people and their families through support and education and to keep their families together. Over the past four years I have heard hundreds of personal stories from transgender individuals and their families, and I will share some of their perspectives today.
The first area that I would like to address is access to services.
Family physicians are typically the first point of contact for patients regarding their health care. Many are reluctant to provide their trans patients with comprehensive health care. Some will flatly refuse to treat them, and some will continue caring for them but are reluctant to prescribe hormone therapy. While many family doctors may claim that hormone therapy is outside their realm for transgender patients, they will routinely prescribe hormone therapy to cisgender patients.
Trans patients are usually referred to an endocrinology specialist, for which the wait time can be six months or longer. Because the highest risk of suicide for a transgender person occurs during the time between declaring their trans identity and actually beginning to transition, this lengthy wait time may be life-threatening for some folks.
Coverage for medical interventions and surgeries varies widely across provinces and territories. The onus rests on the trans individual to find out precisely what the requirements are, to obtain the appropriate letters and sign-offs from their health care practitioners, and to ensure that everything is submitted to their ministry.
Some trans individuals have to fly across the country for their surgery. Should complications arise once they return home, they are forced to go to their local emergency departments, where there may be a lack of competence in treating trans patients.
This past week, a young man very happily told me that he was just approved for his top surgery. He was so excited to be seen as his true gender when he starts university this September. When he called the clinic to book his appointment, he was told to call them back in July just to schedule the consultation, which will likely be in November or December, and the surgery itself maybe six months to a year after that. He broke down in tears when he found out that he may have to wait another year and a half to two years before he can have this surgery he so desperately needs.
The second area I would like to address is respectful treatment.
Some of the personal stories I've been privileged to hear have been very positive, while others have been those of emotional pain, discrimination and trauma. Many health care providers lack the appropriate knowledge or skills to treat and care for trans patients. Some are insensitive or even demeaning to trans identities. Some practitioners will continue to use the wrong name and pronouns even after being asked to use the correct ones when a trans patient's presentation does not align with the sex listed on their health card.
Some trans patients experience overt aggression. I've been told that folks have been ridiculed when their identity has been discovered. They've heard remarks like, “So do you like both men and women?” or “Oh, so you're not a real man.”
Trans patients have heard health care practitioners openly discussing their bodies and their gender identity with other staff in front of patients. Some are asked inappropriate questions unrelated to their visit. One person told me that a technician setting a cast on her wrist asked her how she had sex.
Just a few months ago a woman told me about the time she went to a lab for some blood work. She presents feminine, but she hasn't received her new ID yet. When she handed in her requisition and ID to the receptionist, she politely asked if the technician could please use her new female name when she was called. When the technician bellowed out her old male name, she froze. The technician called the name again and she was immobilized. Then the receptionist stood up, pointed to her and said loudly, “That's him.” Most of the people in that overcrowded room turned and stared at this woman who was just called “him”. They started whispering to each other and she just sat there crying into her hands until she finally found the strength to run out of the lab without getting her blood work done.
These acts of discrimination and transphobia have detrimental effects on trans individuals and deter them from accessing proper health care. They may feel that their health care needs are not as important as those of their cisgender peers.
Many health care practitioners are also unaware of, or choose to disregard, organ-specific screening tests that must also be performed on trans patients, such as Pap tests or PSAs, which may trigger gender dysphoria. As a result, they may neglect their health care altogether, so that when these cancers or illnesses go undetected, it places a greater burden on our health care system in the long term.
The third area I would like to address is the impact on transgender individuals.
Regarding mental health, our society burdens trans folks with stigma and shame. Couple that with discrimination, harassment and even violence. The high level of vigilance that transpeople are forced to maintain takes a big toll on their mental health.
The suicide rate in the transgender community is extremely high. Mental health issues are high and so is substance use, physical and sexual assault and harassment. There is also discrimination in housing, employment, access to health, education and social services, as well as poverty.
While 4% of the general population will attempt suicide, over 40% of the trans population will attempt suicide, yet trans folks comprise only about 1% of the total population. Why is this number so disproportionately high? It's clear that the manner in which our society perceives and treats its trans members takes a very large toll on their mental health.
Regarding emotional well-being, some parents of trans youth have told me that their kids are suicidal, since they think everyone hates them just because they are transgender. Some parents say their kids can't go to school because they've been bullied or assaulted and have anxiety or depression as a result.
I've been told by trans folks that they have been spit on, verbally abused, taunted in public, threatened and physically forced out of washrooms. One woman told me that someone once walked past her on the sidewalk and then turned around and assaulted her from behind, while calling her names that I won't repeat here. Whenever she walks down any sidewalk alone, she is terrified. No human being deserves to be treated that way.
Regarding relationships and family, the strongest indicator of the future success of a transgender person is family support, yet far too many transgender people are rejected by their families when they reveal their trans identities. Some parents may begin to accept their kids after a few years, but especially for youth, the critical time is right at the beginning.
In Canada, 40% of youth experiencing homelessness are LGBTQ2, yet only 10% of the population is LGBTQ2, while 47% of transgender youth consider suicide, but that number drops by 93% when they are supported by their families. These numbers speak for themselves.
Trans youth lacking family support, or any transgender person lacking social support, will often encounter barriers in accessing care and too many of them are unable to advocate for themselves.
I propose that we take a coordinated approach to creating a culture in Canada that is inclusive of gender identity. Gender identity must be taught to all students in schools across Canada, beginning in kindergarten. As a result, transgender identities will not be stigmatized when these youth become our future health care professionals and leaders.
Trans-competent care must be incorporated into the curriculum in medical and nursing schools, as well as in specialty and technician positions.
Members of the transgender community must be involved in the development and implementation of this inclusive curriculum and the protocols for culturally competent care.
Non-discrimination policies must be mandated and prominently displayed in all health care areas and enforced. These facilities should have gender-neutral washrooms and changing spaces should be non-gendered and private.
As an incentive to be more inclusive, federal grants could be awarded to institutions and programs that teach postgraduate-level trans health care.
Finally, as a society, we need to build up a strong system of supports and resources for trans individuals and their families. We need broader community engagement and education. We need transgender-specific mental health services and we need medical care support and mental health services that are readily available and easily accessible.
Thank you for this opportunity to participate today.