(I live in British Columbia, Canada, so the process for a BC resident differs from the process others may have to go through, so please don’t take this as the only way it’s done. The hoops I need to jump through are different from the hoops an Ontario resident needs to jump through, or someone from the US. Because I am unfamiliar with the process in other areas, I will only be talking about my own process here in BC.)
Let’s talk a little about what transition means. In the most basic way, it is the process that a person goes through when changing their gender identity. What comes to mind for most people when they hear about transition, or gender reassignment is the process of changing one’s physical body to match their true selves. The most common way of doing this is by doing hormone replacement therapy (HRT) or having gender reassignment surgery. But surgery and hormones aren’t necessary parts of transition, and there are many transpeople who choose not to transition and still feel whole in their gender identity without the permanent body alteration. Others don’t feel whole unless they have been on hormones for a long period of time, and have had all of their surgeries, and even then there are some who never truly feel whole at all.
Before someone is able to start their transition medically (in other words, begin HRT or have surgery) here in BC, they are required to go through a psychological evaluation with a psychologist or other mental health professional who is sanctioned by the province to perform said evaluation. In Victoria, we are lucky to have several fantastic psychologists who are not only knowledgeable about transgender health, but they are also huge advocates for the LGBT community as a whole. An individual is required to meet with one of these sanctioned professionals a minimum of 3 times, with 30 days between appointments. This is to determine that the individual is acting rationally, and not seeking transition as an impulsive change, because it is incredibly drastic and a lot of the changes are irreversible. If, for some reason, the professional believes there to be reason for more assessments before they approve transition, then the individual will be required to return for additional appointments, but this is on a case-by-case basis.
At the end of the assessments, if the professional feels that you are of sound mind and are truly “born wrong”, then they will write a letter stating that you are formally diagnosed with gender dysphoria – the medical journal’s name for the alleged mental illness or condition that causes a person to be transgender. That being said, very few trans* individuals or trans* advocates will agree that there is any sort of illness or underlying condition that causes one to be transgender, it is simply the way a person is born. However, in the province of British Columbia, because trans* related expenses and procedures are covered by the provincial medical insurance plan, it can be assumed that in order to rationalize why it should be paid for by BC Medical, there needs to be an officially diagnosed medical condition that requires treatment. At least that’s how I have come to understand it over the course of my transition thus far.
The letter is accompanied by a referral to an endocrinologist, a doctor who works with hormones. I can’t speak for other endocrinologists as I have only ever dealt with my own, but I will say that I genuinely look forward to my appointments with her. She is VERY trans-friendly, cares deeply for every one of her patients, and I always leave her office feeling wonderful about myself. My first appointment with her, on September 9th of 2013, was about an hour long and consisted of questions regarding my medical history, what my preferred name and pronouns are, what I expect from hormone therapy, a physical, and I left with a prescription for my first vial of Testosterone (in the form of intramuscularly injectable testosterone cypionate), a requisition for bloodwork (that I have to repeat every other month), and a list of the equipment I would need in order to inject the hormone solution (3ml syringes, 18g 1.5″ needles to draw up the thick solution into the syringe, and 22g 1.5″ needles to inject the medication into my thigh muscles). Because I have family history of poly-cystic ovarian syndrome (PCOS), I was also sent for a pelvic ultrasound to ensure that there was nothing wrong with my reproductive organs that might lead to issues with my body accepting and properly utilizing the testosterone. It was discovered that I suffer from PCOS as well, which explains why I have never had proper periods, even before starting hormones (I was lucky if I had one in a 12 month span, but averaged one period per 18 months since hitting puberty the first time around), but also helps with my testosterone levels because my ovaries won’t be able to convert the testosterone to estrogen before the testosterone is fully utilized.
I returned to my endocrinologist a week after my ultrasound to go over the results (neither of us were surprised, and she was not concerned), and for her to give me my first dose of testosterone!!! Most transpeople I know choose to start hormones as the first step of medical transition because it is the least likely to lead to any time missed from work or regular daily life. While technically speaking, hormones are less invasive than surgery in the sense that they don’t require hospitalization or recovery time afterwards, but they ARE responsible for the most changes! (More on what hormones control/change, and what changes I have experienced in my transition so far later.)
The next steps are different for every individual. For me, it’s top surgery (double mastectomy with chest recontouring, to be exact, but most transmen refer to it simply as top surgery). When this happens depends not only on the individual, but on the endocrinologist or other physician’s practices. In my case, my endocrinologist doesn’t make referrals for surgery until the patient has been on hormones for a year. This is because, from my understanding, it gives the body a chance to acclimate to the hormone-caused changes and gives them time to “turn back” if for some reason they decide that transition isn’t for them. I see my endocrinologist for my “1-year” appointment on September 17th, at which time she will go over the changes I have experienced, check that my levels are appropriate for the point in transition that I am at, and then put in the referral to the surgeon. Her in BC, only one surgeon, Dr Cameron Bowman in Vancouver, is covered by BC Medical and as long as a transperson goes through the proper procedures, their surgery is free to them – they simply have to cover their travel expenses. From what I’ve heard, from referral date to when you get in for a consultation with Dr Bowman, it’s about 6-9 months’ wait. Then another 6-12 months from consultation to surgery date. This may not be the most up-to-date information so I will update with new info as I can get it.
Bottom surgery (genital reconstruction) is a really complicated subject that I will leave to its own post at some point. At this time I do not plan on having bottom surgery in the foreseeable future and I do not know enough about the different options available to transmen at the moment to be comfortable talking about it. I don’t want to provide false information, so for now I will continue my research and revisit the subject when I am better able to provide correct information!
I am VERY excited for my appointment on the 17th and hope to have some helpful information to post afterwards!