Yesterday, my coming out letter went out to my extended family. Friday, I have a laser hair removal appointment scheduled. In between, I have to get through a pile of schoolwork. All of this makes this my most stressful week of the semester.

What I’ve realized is that I can’t really deal with stress very well. Last night, I asked my gf to give me a back massage, and I was completely tense, especially in my shoulders. Now, I know I’m not the only one in my family who gets that level of stress…but it hasn’t really been this bad before. I suspect that this has become a much bigger problem now than before because, pre-transition, I had trouble caring about anything. In that state of mind, it’s hard to be too stressed. In fact, my stress levels were so low I had trouble doing work even right before the deadline.

As a result, I haven’t really developed good relaxation techniques. If anyone reading this has any good tips, please, by all means, let me know. In the long run, I’m planning on focusing on fitness – I’d really like to study Aikido, but it’s a bit problematic to be in athletic environments mid-transition. In the meantime, though, I’m not really sure what to do.

Fortunately, my grandma has given me her support wholeheartedly, so I have one less family member to worry about…but I’ll still need to deal with stress while I wait for the remainder of my family to respond.

Lambda Legal, a U.S.-based LGBT/AIDS advocacy organization, released the results of a survey of health care discrimination against LGBT people and people with HIV yesterday. Since most people probably won’t want to read the whole thing, I’d like to provide a selected summary. Here’s the trans respondents said:

26.7% said “I was refused needed medical care”
15.4% said “Health care professionals refused to touch me or used excessive precautions”
20.9% said “Health care professionals used harsh or abusive language”
20.3% said “Health care professionals blamed me for my health status”
7.8% said “Health care professionals were physically rough or abusive”

If you combine the people who agreed with one or more of these statements, you find that 70% of trans respondents faced health care discrimination.

But it gets worse. According to the study, “In addition to the overall rates of substandard care, respondents of color and low-income respondents (defined in this survey as having a household income under $20,000) in nearly every category experienced higher rates of discrimination and substandard care.” Given that trans people have disproportionately low incomes, income discrimination is a particular problem; furthermore, society often doesn’t acknowledge the existence of trans people of colour…and when it does, it tends to focus on sex workers involved in crime investigations.

Trans people also voiced fears of discrimination:
51.9% agreed that medical professionals would deny them care
73.0% agreed that medical professionals would treat them differently because they’re trans
89.4% agreed that there aren’t enough people “adequately trained” to treat them
50.5% agreed that there aren’t enough support groups for trans people
58.8% agreed that there isn’t enough substance abuse treatment for trans people
85.7% agreed that “overall community fear or dislike of people like them is a barrier to care”

And “thirty percent of all respondents stated that they fear medical personnel will treat them differently based on their gender expression and presentation.” This includes LGB people, as well.

No one should face barriers to care. No one should fear seeking care. Those statements shouldn’t be radical, but apparently, they are.

In the U.S., spironolactone is the most common anti-androgen prescribed for male-to-female hormone replacement therapy (HRT). But it doesn’t really work very effectively, at least for me – my testosterone levels when I first started HRT were still above desirable levels. So I switched to cyproterone acetate, which is a much stronger anti-androgen. I had to go on spironolactone for a couple weeks in January, since my doctor mis-prescribed me. I felt awful. I got depressed much more than I had for months previously, and I generally felt much less female (and, as a result, less like myself). I’ve only been on cyproterone acetate for a couple days, and I feel a lot better. In fact, everything seems much better…like life is working out better. That, to me, is a pretty strong indicator of which anti-androgen I should be on. Plus, cyproterone acetate is a progestin, which, according to studies, might improve breast development and “increase female libidinal feelings”.

The problem is that cyproterone acetate is unavailable in the U.S. I’m not entirely sure why, but that makes it much less likely that I’m going to go back to the U.S. later in life, since I want to have the best hormone treatment possible.

In the long term, it might be in my best interest to have my testes (at the very least) removed, since that would save me a considerable amount of money that would otherwise be spent on anti-androgens…and cyproterone acetate is quite expensive (something like 9 to 10 times more expensive than spironolactone). As it is, I’d be afraid of returning to the U.S. and not having health insurance, which at present puts a very big dent in my prescription drug coverage. And even if I had insurance in the U.S., I wouldn’t expect it to cover anything trans related.

This points to my main frustration with the U.S.: the lack of respect for crafting effective public institutions. While I’m skeptical of government power, like many Americans, I don’t take that to the extreme of believing that government can never provide services…or that we should cut funding to social programs. This belief that government services can never work is self-fulfilling, since the opposition to government programs is so strong that they can never be funded enough or reformed enough or made effective enough to show people how much better society would be with them than without them.

Canada doesn’t have this particular dysfunction. But then, this is a place where “peace, order and good government” reigns.

In the United States, eleven states (CA, OR, WA, NJ, RI, ME, VT, MN, IA, IL, CO, NM) and the District of Columbia, along with many municipalities, have enacted gender identity non-discrimination acts. (In Massachusetts and Connecticut, gender identity is protected under the “sex” classification.) In Canada, however, only the Northwest Territories and the city of Toronto have similar protections. Federal courts and Quebec courts have ruled that transsexuality is covered under “sex”, while BC and Ontario have even broader trangender protections under sex. However, this rulings are not codified, and it is possible, though unlikely, that judges in those jurisdictions could overturn those rulings.

What explains this discrepency? Now, I’m by no means certain. However, I do have two observations that might shed light on this. First, Canada seems to lack queer political mobilization. In this respect, it’s entirely possible that having a strong Religious Right has made it easier to gather Americans together locally to push for gender identity non-discrimination policies. In Canada, the only national organization that keeps coming up on my radar is Egale, and it hasn’t seemed to be particularly active since the establishment of marriage equality across Canada – which actually brings me to the second reason: the focus on marriage equality. When a movement becomes so focused on a single issue, it becomes difficult to sustain it. I fear that this will happen in the U.S. if marriage equality becomes the national standard; it might actually be better for trans people in certain parts of the U.S. for the marriage equality movement to stall so that people focus resources on entrenching gender identity non-discrimination policies, since many people might disengage from the movement after we achieve marriage equality.

However, gender identity is really not enough. Gender expression also needs to be in these statutes; without it, sexual orientation and gender identity classifications have no teeth, since employers and others could argue that they discriminated on the basis of gender expression…which isn’t illegal because it’s not covered. But I suspect that it will be a long time before “gender identity” and “gender expression” are both prohibited grounds of discrimination in both the U.S. and Canada.

I probably should have written this right after having my test patch done, but I’ve been rather busy since then. I’m planning on having my first laser treatment February 12th, which is a Friday (because I should have enough time to recover – 24 hours – before I absolutely have to see anyone). I’m getting a bit impatient, to be frank, but that’s mostly a product of knowing where I am now and how far I have to go.

I’ve scheduled a test patch for Wednesday morning. If it goes well, I’ll probably schedule another appointment at least three weeks later to start actual treatments. I’m excited to make progress on this front – it’s past time to do this, really.