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.

Parenthood As a Right

"I don't think we can compare a surrogate mother to a sperm donor. The third party who is a sperm donor, his contribution is ten seconds. The surrogate mother's contribution is nine months and it raises fundamental ethical questions about the exploitation of women's bodies, about possible commodification of children, about the right of a child to know its origins."
"Technically it may be discrimination, but when you look in depth, you say, wait, maybe there is a reason for this discrimination."
Law Professor Alain Roy, family law expert, Universite de Montreal

"I am excited right now. I have a secret to tell you."
"Once we have made our payment, they send us a virtual catalogue, and there are about 200 mothers in it with pedigrees, personal stories, why they want to give eggs. We were uncomfortable, as if we were choosing our child like you would choose a car."
Montreal Radio host Joel Legendre

So he and his partner in gay marriage went another route instead. A friend who happened to be female made an offer they couldn't refuse; to be a surrogate mother to allow them to achieve parenthood. Though they would still be using eggs they bought from an American company (bypassing Canadian law that prohibits the sale of human eggs). The two married (to each other) men mixed their sperm to fertilize the purchased eggs which were shipped to Montreal in a frozen state.

The fertilization process was performed for them in a private clinic. There will be twins. And there will be a bit of a mystery with respect to whose sperm will have fathered the resulting children, though perhaps visible familial recognition may at some future date help to clear up that little mystery. They plan, once the two babies are born, to go before a judge along with the surrogate mother for a formal adoption which will declare the two men co-fathers.

"Being gay is not a choice", declared Mr. Legendre during an interview. "You do not choose not to be a parent. My feeling is that everyone has the right." And most certainly he believes that gay men have a perfect right to be parents. That being said, why should the public pay for gay men to arrange for the birth of children through in vitro fertilization? Any more so than should tax dollars be used to fund the procedure for any infertile couples, instead of focusing on life-saving surgery or pharmaceutical interventions in a hard-pressed public universality system of medicare?

The thrill of expecting a child to arrive to enrich the lives of these two men who clearly are not short of money of their own to fund their child-bearing procedure, is not particularly thrilling in the context of shifting responsibility to pay onto the taxpayer. Moreover, this radio host openly boasted of his persuasive powers in influencing Quebec's health insurance board to cover the $5,000 cost associated with the medical procedure ... all the more absurd since the province discourages surrogacy.

As far as family law expert Professor Alain Roy is concerned, Quebec's health insurance board was "completely premature" in allowing themselves to be persuaded to cover the cost of the medical procedure for Mr. Legendre and his four-years-committed partner, Junior Bombardier. Quebec's Civil Code explicitly states "any agreement whereby a woman undertakes to procreate or carry a child for another person is absolutely null". The woman carrying the child to delivery remains the legal mother, under Quebec law, in other words.

Quebec has just had a change in government from the Parti Quebecois to the Liberals. When the new Liberal Health Minister Gaetan Barrette was previously head of the province's federation of medical specialists, Dr. Barrette had been known for criticizing the IVF program as "an open bar" to misuse. An opinion that proved prescient. Now, as a member of the new Liberal government Cabinet, he states that the program is in need of clearer parameters, which he plans to undertake after receiving a report on the issue.

That "open bar" has resulted in a cash-strapped province facing a far greater demand for the service than had been anticipated when the province opened itself to paying for IVF in a spirit of social welfare commitment. The current annual $60-million price tag is double what the forecast was when Quebec distinguished itself through yet another one of its socially advanced programs to become the first province in Canada to fully fund IVF in 2010.

As far as Mr. Legendre and his partner are concerned he is entitled to having the costs picked up by the taxpayer, judging it unacceptably discriminatory that a lesbian couple could anticipate to have their IVF treatment covered by the province, and two gay men could not. His and his partner's yearnings to raise a family will be realized, when the two men begin to raise their two little girls, courtesy of the Canadian taxpayer.

For it is not only Quebec taxes that will be used to furnish the two men with what they believe to be their entitled right. Quebec receives the largest portion of the federal transfer of pooled provincial taxes through the handout called "equalization", ostensibly to enable each of the provinces in confederation to offer to their citizens a similar level of services.

However, in Quebec's case, the largesse extracted from the "have" provinces to the "have not" results in social services available in that one particular province far exceeding any that can be seen in the others. Including the "have" provinces. No word about whether they anguish over having to spend their own dime on the family car of their choice.

Pridefully Gay

One may be pridefully gay in some countries of the world. Oddly enough given Catholic Spain's religious heritage, it challenges Germany which once, in the 20th Century, committed gays to death camps. But those two countries, Spain and Germany, appear very receptive to homosexuality now, with a huge 80% acceptability rate among their populations. Outdistancing Canada -- which guarantees equality under the Constitution as an indisputable human right -- by a narrow margin.

As for countries which are most definitely unwilling to view homosexuals as equals, and use their laws to fundamentally target and persecute them, there are the usual suspects, the worst being Islamic countries, although Russia and China and South Africa have gone to great lengths to emphasize their distaste for such 'degenerate' gender proclivities. Still, it is instructive to concern oneself with the miserable plight of those living in the Middle East and Africa, as an example of gender-role intolerance.

• Sudan: Homosexuality is punishable by lashings and the death penalty, for men on a third offence;
• Mauritania: Homosexual acts between males are punishable by death if witnessed by four individuals;
• Nigeria: Adults convicted of same-sex sexual activity may be subject to execution by stoning, although no such sentences have actually been known to have yet been imposed;
• Yemen: Unmarried men are lashed, married men receive death by stoning as rewards for homosexual activities;
• United Arab Emirates: Homosexuality is banned, full stop. Some dispute remains whether the death penalty is applicable;
• Saudi Arabia: No "gay" executions reported since 2002, but homosexuals are flogged and imprisoned;
• Iraq: Homosexuality is not strictly illegal, but gay rights groups report hundreds of gay men killed since 2003 by "death squads"'
• Iran: Death penalty is believed to have been used against gay men in the last few years;
• Jamaica: A recent poll found 70% did not believe homosexuals should have the same rights as other Jamaicans. Sexual acts between men are punishable with up to ten years' imprisonment; sexual acts between women are deemed legal.

Global statistics appear to rate Spain, Germany, Canada, Argentina, Philippines, Chile, Mexico, the United States, South Korea, China, Kenya and Egypt as becoming increasingly more accepting of homosexual activities rights, with the former in the high range of increasing acceptability, and the latter four lagging badly.

Those countries whose acceptance rate appears fairly static with little change evinced either pro- or con-acceptance of homosexuality in their societies are Italy, Britain, Poland, Israel, Japan and France. 

Those countries identified as becoming less accepting of the prevalence of homosexuality among their populations are the Czech Republic, Russia, Turkey, Lebanon, Jordan, West Bank/Gaza, Pakistan, Ghana, and finally Uganda. In this category, less tolerance is less tolerance, but the last four named in particular are represented at the very lowest quotient of tolerance.

Of those countries named in a Pew Forum on Religion and Public Life - Global Attitudes Project 2013 and Angus Reid Public Opinion 2012, the countries named, range from Spain, followed by Germany, Canada, Czech Republic, Australia, France, Britain, Argentina, Italy, Philippines, Chile, Mexico, Brazil, United States, Japan, Greece, Venezuela, Bolivia, Poland, Israel, South Korea, El Salvador, South Africa, at the top of the spectrum and graduating downward.

And, at the bottom of the spectrum of acceptance of homosexuality the countries named in graduating descent are China, Lebanon, Russia, Malaysia, Turkey, Kenya, Gaza & W.Bank, Uganda, Egypt, Ghana, Indonesia, Jordan, Senegal, Pakistan, Tunisia, Nigeria.