Jan 27, 2020
By Eva Légaré-Tremblay

I have a condition that was missing from my nursing education

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Take away messages

  • Nursing and other health care professions aim to address health inequities and inequalities, but have not addressed a condition that affects an estimated 175 000 Canadians.
  • For nurses and other health care professionals, there are currently only stopgap measures they can take to help them address the health inequities and inequalities that are part of having this condition.
  • This condition must be addressed by introducing it in textbooks, curricula, and care supports.

I have a condition. It’s not exceedingly rare, but it doesn’t seem to be mentioned in any nursing textbooks or nursing curricula.

With my condition, I’m regularly faced with long stares from other health care practitioners. My former nursing colleagues don’t seem to know how to approach me since my condition has become more apparent. For those health care colleagues that do have some sense of comfort with me, I’ve been faced with numerous questions that are often very intrusive, clinical, and undignified.

I’ve seen physicians about it; the first one was a family physician who happened to offer treatment for my condition on the side. He was kind and empowering, but his treatment plans didn’t always reflect what little is known about this condition.

With my condition, I’m regularly faced with long stares from other health care practitioners.

In order to see a second, more knowledgeable family physician, I was confronted with some barriers that left me waiting about a year to be seen. Where I live, a city of over one million, these two physicians are the “go-tos” for this condition. Even specialized physicians here don’t seem to specialize in the treatment of my particular condition.

Medication and treatments

When I pick up the medications for my condition, the pharmacists shyly hand over my prescriptions. I’ve never been asked if I had any questions about the medications I’ve been prescribed.

My guess is that it’s not entirely the pharmacists’ fault. Despite the serious effects these medications have, official sources of pharmaceutical information do not list my condition as an indication for any of the medications I need. The condition I have isn’t described on their website, and likely isn’t part of their education.

For people with my condition, surgery is a viable option; the technique and recovery are very complicated and, again, not something you'd find in textbooks. The process of arranging such surgery is a long, convoluted process where people fly across Canada after waiting two or four years for the definitive care. If one chooses this surgical route, they have to sign an agreement stating they won't publicize the outcome of the surgery. If money wasn’t an option, people with my condition could possibly do some medical tourism to have their needs met. On the matter of money, there have been several costly aspects involved in treating my condition that I’ve had to pay out of pocket.

Going through nursing school with my condition has been a truly remarkable experience. Nursing students learn so much about professionalism, the human body, the human spirit, pharmacology, holistic patient-centred care, and the determinants of health. Yet none of that seems to touch what I, as well as an estimated 175 000 Canadians, go through on a daily basis. How can this be?

A turning point?

I think that now we are at a turning point. Treatments for my condition have been slowly getting safer and maybe even healthier. Consequently, many people who share this condition are coming forward for treatment. The research is unclear as to whether the proportion of the population that shares my condition is growing; however, it seems to have become somewhat of a contemporary health care issue.

When my health care colleagues ask those intrusive, clinical questions, it’s certainly not because they don’t believe I deserve dignity or privacy. People in health care want to know more about the condition I have; they want to be informed. Times are changing.

What is my condition, which seems to be largely unappreciated in health care? I am a trans woman. I am pathologized, stigmatized, politicized, and objectified. This is my “condition.”

The trans population needs the same proud, effective nursing approach we offer to people with any other rare condition, yet we lack the formal education, policies, and care supports we need. What, as nurses, can we do?

The way forward

I could suggest that asking for—and using—your patient’s gender pronouns and chosen name is one of the simplest and most effective ways to establish rapport and psychological safety when working with trans individuals.

Advocating for trans-informed workplace training can be helpful; writing to your MLA or health minister when access to gender-affirming care is deficient or regressed also helps.

Having a good understanding of the role that political leadership plays in supporting diversity and providing accessible and appropriate trans health care is relevant.

Attending LGBT Pride events, and donating to organizations that support trans people, are important.

I might also recommend that you read about trans realities, or learn about transition-related hormone replacement therapy, even though this information is often fragmented or inconsistent, and incomplete.

Because trans health care is such a contemporary health care issue, there are increasingly some conferences, courses, and seminars being offered. These are, I think, the best sources of information a nurse can get. So, in the absence of textbook information, official health care literature, or curriculum-driven learning, my suggestion is to engage with these courses and seminars. Look specifically for ones that are trans-informed and supported by sexual health authorities in your area.

Although self-directed education can be effective, I see this approach as a stopgap measure. Because being trans is just another way of being human, we need information about it in our textbooks and curricula, and I would encourage those developing such material to draw on the expertise of trans nurses and members of the transgender community as experts in their own experience.

Our nursing bodies describe gender expression and gender identity as potential sources of discrimination. That’s a great start. But without the education behind it, what does it really mean? Frankly, it means we are at risk of being the oppressors.

I’m starting my career as a registered nurse, and I feel very alienated. My identity has been labelled as a medical condition. As part of my transition, I have become a regular end-user of health services: psychology, physicians, laboratory services, psychiatry, and perhaps surgery.

It doesn’t feel good to start a career in health care, where my own health care isn’t part of regular training. In the past, I've actually avoided health care as a trans woman, knowing that I’d meet the same lack of trans-aware, trans-friendly services that other trans people experience.

I know I’m not alone. Things need to change.

Disclaimers:

  • I use the word “condition” for illustrative purposes; my intention is not to pathologize being trans.
  • For the sake of brevity, I stuck to the word “trans” to refer to any instance of being trans, transgendered, two-spirit, or non-binary. Many other words exist to describe the various ways in which people experience their gender identity. Each person uses language that they prefer, and their language should be upheld above all else.
  • Not all people who are trans need or want medication.  The medication I was referring to is part of my hormone replacement therapy - a regimen that has allowed me to achieve some congruence between my body and gender identity.
  • The surgery I refer to is commonly known as “bottom surgery” or vaginoplasty (which involves vaginoplasty, labiaplasty, and clitoroplasty). Surgeries are not something every trans, non-binary, or two-spirit person pursues. Surgeries require a lot of time and out-of-pocket expense, in addition to the possibility of complications. Furthermore, surgeries do not “complete” a transition or make a transition more valid.

Additional Resources

Rainbow Health Ontario: Guidelines and Protocols for Hormone Therapy and Primary Health Care for Trans Clients

Trans Care BC

Trans Care BC Primary Care Toolkit

WPATH Standards of Care

Eva Légaré-Tremblay, RN, works in Calgary (known as Mohkinstsis in local Blackfoot language) on Treaty 7 land in Alberta. Eva practised as a primary care paramedic for several years before becoming a registered nurse. She hopes to combine her knowledge and experience in diverse health care environments with her lived experience of being trans to improve trans health care and promote health in the trans community.

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