Gender-Confirming Surgery

"It's very sad for the whole trans community and it affects a large number of people. [Regardless of the number] someone just cut off health-care access [to hundreds of thousands of people."
Rachel Lauren Clark

"We built something great I think ... and now someone is trying to hurt us."
"For the common patient, they're not rich. They have their own difficulties, and family issues and work issues. They don't make [the] covers of magazines [like Caitlyn Jenner]."
"It's a very demanding surgery. If you want to be good at something,  you can't perform a surgery once a month or something."
Dr. Pierre Brassard, Centre Metropolitain de Chirurgie, Montreal

Montreal police are looking for a man suspected of arson at the Centre Métropolitain de Chirurgie in Ahuntsic. (Google Maps)

The gender identity clinic at the Centre for Addiction and Mental Health in Toronto, was, until recently, the only referral point in Ontario for people awaiting surgery that will enable them to have a physical gender presence that matches their psychological gender attachment. An estimated 1,500 people are on its wait-list, resulting in years passing before someone is able to be assessed and assigned for surgery in Montreal at the only clinic in Canada offering complex types of sex reassignment surgery.

The provincial health authorities have only just recently given allowance for more doctors to be able to refer patients seeking trans treatments, whether of a hormonal application or taking the surgical route. "What it resulted in [only one referral site, in Toronto] is a few people controlling trans people's access to  health care", noted Susan Gapka, chair of the Trans Lobby Group. "That's changing, but for some of us, it's not fast enough."

Dr. Brassard, who has been the sole trans surgeon at the clinic since 1993 was trained by Dr. Yvon Menard who retired. Now, 23 years later, Dr. Brassard is himself training another surgeon who will share in the work, Dr. Maude Belanger. Some 60 percent of their time is spent performing surgeries; in total about 300 of such surgeries annually. A decade ago the trans community had to cope with discrimination emanating even from within the broader queer community; acceptance comes hard for this minority population.

The TransPulse Project speaks of an estimated 0.5 percent of Canadians as being trans. That percentage breaks down to 175,800 people, males and females who feel that nature failed to match their gender psychology with their physical presence, leaving them looking like a male with a female mind and orientation, and vice-versa. That's a lot of people left disoriented, uncomfortable and desperately seeking a solution to the dilemma of their life-gender-mismatch.

Wendy Longlade for the National Post    Dr. Pierre Brassard performs a sex reassignment operation — or a gender confirming procedure — at his Montreal clinic in a file photo. 

 

Most doctors, like the general public, find themselves incapable of accepting the premise that an individual's physical presence is not matched by their mind and their perception of themselves and their feelings that place them in the opposite gender. Gender identity, it can be fair to say, is a matter that presents as a puzzle to most people for whom the issue seems contrived and arbitrary. The trans community has been fighting an uphill battle for legitimacy and acknowledgement of their medical gender condition.

Most people who are trans will not necessarily choose surgery for themselves. Hormone therapy or simple aesthetic procedures like electrolysis or facial contouring are often the routes they choose, to present as the gender they prefer. Those deciding for surgery to express how they feel and what they insist they are, have chosen a long and difficult route to lead them to their aspirational presentation as a male from a female persona, or a female coming out of a male cocoon.

Dr. Brassard notes that demand for surgical services has grown over the last five years in step with heightened awareness, final acceptance, and provincial funding. Still, the surgical procedure is confined to those who have gone through the arduous wait seeking the services of a very limited number of medical professionals skilled in that very particular surgery. "Gender confirming surgery" is a painful, delicate procedure where vaginoplasties or phalloplasties, surgical protocols creating a vagina or a penis for a patient is the goal.

Wendy Longlade for the National Post    Dr. Pierre Brassard consults with a pre operative patient who had some questions and concerns in a file photo. 

 

And on Monday it all came to a screeching, albeit temporary halt. An interruption that will leave its mark on the waiting list, creating further anxieties. Some ill-wisher entered the clinic's side door to sprint up stairs and race through the hospital corridor into a surgical unit where he set off an "incendiary device", before racing back out as a fire alarm went off and overhead sprinklers dowsed flames  until firefighters' arrival.

No one was hurt. In that pristine surgical theatre sat a plethora of flammable, potentially explosive materials. For the time being, the only clinic in Canada dedicated to the most complex forms of sex reassignment surgery has been the recipient of a social message resulting in a clean-up of the premises, refurbishing of equipment and likely enhanced security before the unit will be once again operational.