Transition Medicine: Danielle Smith's False Economy

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Red Tory Tea Girl
Transition Medicine: Danielle Smith's False Economy

Because my fellow leftists are never so happy as when they're confronting right-wing cissexism (instead of their own erasure), enjoy:

http://www.huffingtonpost.ca/valerie-keefe/danielle-smith-trans_b_162578...

As someone who's been politically involved, I try to make it a point to at least begin from the premise that what a politician (i.e. anyone ever making a statement as to how a group should govern themselves) says is to be taken at face value. I do this for two reasons: Very few people get into public service because it seems like it's a good gig (those who do are rather quickly disabused of the notion) and because then, any inconsistencies become instant and jarring.

Danielle Smith came out against Alberta Health Insurance funding genital reconstruction surgery. She said it was because she didn't want vital resources spent on elective medicine when there was important care to be paid for. Important care like insulin pumps. Not the insulin itself, because non-catastrophic pharmaceuticals aren't covered under Alberta Health Insurance. As a result diabetic Albertans must pay out of their own pockets for insulin, and trans women must pay out of their own pockets for spironolactone, an anti-androgen, estrogen, and progesterone.

If I can't locate the $100 a month that medicine costs, thus begins an existential nightmare the likes of which I cannot accurately describe. What I would do if I were denied medicine has been a scenario I have had a lot of time to think about, though mercifully, at the moment I don't face that challenge. I used to however, because Alberta Health Insurance has a de facto practice when it comes to transition medicine of extensive waiting lists, conditional provision, and gender policing. And it could all stop tomorrow. It would also save the province of Alberta a considerable amount of money.

Currently, a trans person expressing a need for hormone replacement therapy, has a very long road ahead of them. You go to a general practitioner first. There's no real information about the track you're on, no actual statutory requirement that you be evaluated any further than self-diagnosis, we're talking about estrogen here, not Oxycontin, but the standard practice is to refer you to one of Alberta's two gender clinics, where you'll meet with a psychologist. You can try to have the GP put you on an anti-androgen, because every day before the age of 30 is crucial for what endocrinology does do you, every day is crucial after that as well, but the ability of the body to respond well to a second puberty continues to decline with time. Despite that, I don't know anyone who managed to have a general practitioner prescribe an anti-androgen.

I myself tried to get spironolactone. It's a drug that also lowers blood pressure. At the time I had a blood pressure of 155 over 95. That's high. I was refused. For five months I had high blood pressure because someone had to decide that I was sufficiently not insane enough to get spironolactone. And how did they decide that? With a 50-minute consultation. I would have been referred instantly to an endocrinologist, but I came into my initial consultation wearing pants and a sweater. In January. In Edmonton. In July, eleven months after my initial consultation, I was given a prescription for estrogen and progesterone to supplement my spironolactone. A blood test was ordered to ensure my hormone levels were okay, and that's been the sum total of the medical end of my transition.

If I had been cis, if I'd been assigned female at birth, and wanted medical intervention to ensure that my endocrinology was within the normal post-pubescent female range, it would have taken five weeks. I'd go to the GP, who charges Alberta Health much less than a psychologist or an endocrinologist, request HRT, get informed of the risks, get an initial prescription, a blood test to make sure that we were in the proper range, and that'd more or less be the end of it.

Danielle Smith could save Albertans a lot more than the million a year she's proposing saving through defunding genital reconstruction for those trans people that need it. She could improve health outcomes, reduce the incidence of self-harm (because by the time trans people present for treatment, dysphoria is often at crisis levels), improve speed of delivery, and what is ostensibly most important to her: Save the province money and resources, because a GP charges a lot less than a GP and two specialists.

So why is Smith vocally against funding genital reconstruction but notably silent from the debate on moving hormone therapy to an informed-consent model? It'd be pretty easy to make it a contract requirement to either provide treatment or refer to a GP who will provide treatment. Would save the province a lot of money, considering there's about 20,000 trans people in the province based on the most recent prevalence numbers. So where is the source of Smith's economy of economization when it comes to trans medicine?

Well, I can't say for sure, as Smith has not responded adequately to repeated requests for comment. Either her ethics are situational, meaning that this is very much about being cissexist for the base. Or her advisers are cissexist, meaning they only brought a line on surgery to her without knowing anything about trans health care at all. Or Nobody at Wildrose Headquarters knows anything about transition medicine at all, and they just had a reflexive political reaction regarding the medical care that about 25 Albertans a year depend on.

It's difficult to choose between craven, coached, or incompetent, but given my money, I'd just note that as the American experience has shown, a libertarian tends not to get too far in a right-wing party by promising to make it easier for a woman to do what she wants with her body.

 

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eastnoireast

thanks for the writeup.  useful and interesting for someone like myself, who's really on the periphery of trans issues (so many important issues; though if you're living it i'm sure it's _the issue, in a way nothing else could be).

what's cissexism?  i could look it up on google, of course, but i try to do that only for things i can't ask someone about, or for technical info.

Ken Burch Ken Burch's picture

I think that the vast majority of leftists in Canada now support trans rights, RTTG.  Was it really necessary to work in the swipe at them for not being their for your cause in the past?

Excellent post otherwise, though.

Red Tory Tea Girl

I think that position needs to be backed up with some action, Ken. They talk a better game today, but as I said in my previous piece, talk isn't going to lead to much.

And yes, you should google cissexism eastnoireast, seriously, you're making it too easy for me to demonstrate that the organized left really could not give a shit-and-a-half about the rights of hundreds of thousands of Canadians. The last time they had a chance to do so, they decided a GST exemption for heating oil was more important.

Cissexism is the position that trans identities are less valid or more subject to cis approval than cis identities. Cis means identified and assigned sexes match.

eastnoireast

seriously, you're making it too easy for me to demonstrate that the organized left really could not give a shit-and-a-half about the rights of hundreds of thousands of Canadians.

no problem, just trying to help.

seriously tho, i think it's not nessessarily about "the left" "not giving a shit". i lived in a pretty cosmopolitan city for over 20 years, busted my ass for many "radical" causes (mostly peace, enviroment, native, and gender), had a _wide variety of friends, and i've only meaninfully crossed paths with maybe 4 trans folks.

not saying there weren't more around, or that if i'd gone looking i couldn't have found more.  just saying trans issues were't exactly popping up on my radar, other than an understanding of how it ties into everything else and of it's being a human right to live as who you are.

so if that was my experience...

The last time they had a chance to do so, they decided a GST exemption for heating oil was more important.

don't lump me in with that, lol.

 

Red Tory Tea Girl

Fair enough. And yes, we are a very invisible minority, especially when considering our prevalence is at about 0.5% and rising, because all of the incentives for those who are read as cis are to stay closeted, even in radical communities where our existences are problematized.

http://rabble.ca/babble/news-rest-us/our-genders-are-not-disordered

http://rabble.ca/babble/news-rest-us/our-genders-are-not-disordered-0

Treatment is denied oftentimes if we don't conform to cis expectations and then we are derided for being conformist, and those who don't conform are subversivsed as not actually being trans. Those who claim to be our allies avow respect for our identified sex, until it comes time to access the social and political prerogatives that implies. It's rather frustrating.

eastnoireast

holy nuanced long threads at the links!  not many short posts there.  got to let it percolate.  thanks.

Red Tory Tea Girl

Ken Burch wrote:

I think that the vast majority of leftists in Canada now support trans rights, RTTG.  Was it really necessary to work in the swipe at them for not being their for your cause in the past?

Excellent post otherwise, though.

We've had one year of New Democrat government, transition still behind gatekeeping, and up to a 2-year wait. So yeah, I think it was really necessary and your defense based on no evidence was really hackish.

And also, isn't ending sex-based oppression supposed to be THEIR CAUSE too?