GP-led trans healthcare in Canada

Hi everybody. I’m here with Marianne as usual, and we have a very exciting guest with us today who’s from quite a long way away. I’m with Sophie Lasiuk, and she’s in Toronto. I’m not going to tell you anything more about her. I’m just going to pass you over as I like to do. Sophie, introduce yourself, tell us why you’re here and give the listeners and a little taste of what we’re going to talk about.

Of course. Well, first of all, I’d like to thank you for inviting me to your podcast today. So, I’m a fifty-two-year-old woman, as you said. We live in Toronto, Ontario. And I’ve been following your posts at doctor for several years now and reading up on some of the problems that people tend to have when transitioning in the UK. And it occurred to me as I went through my own transition over the last three or four years that the systems in place in our two countries are markedly different, and I wondered why that was, and I can’t figure that out. The system in place in Canada has been so welcoming and so user-friendly, for lack of a better word. And I just wanted to reach out to you and express how the differences have been helpful to me, and perhaps start a conversation on your side of the Atlantic about how things can be improved over there.

Well, I think that would be amazing. And I want to say thank you to you for reaching out to us in the first place and for making that first contact. You sent me some brief messages, which I always love receiving. And then you wrote a blog for our website just explaining how it was for you. So, if anyone hasn’t read that yet, then there’s maybe some spoiler alerts in there. And I was astounded. I was like goodness gracious me, this is what we’ve been campaigning for the last kind of five years, and you’re there already. So just outline how—you said that you are in your fifties. How did it go from the first time when you actually wanted to go and ask a doctor about this.

So, my truth is that I have identified as female since my earliest memories. I’m in my fifties now. Still three or four years of age, I had this innate understanding of my gender, and I’ve carried that with me all my life. And society certainly has had some catching up to do and over the last ten years or so, certainly including my wife and discussions, we decided it was the right time for me to move forward with my gender transition. So I did approach my doctor in 2016, I believe it was, early 2017 to get assistance, medical assistance to move forward. And I’ve had nothing but good assistance and helpful assistance from the entire medical establishment and has certainly made my life a lot easier to do so.

Well, that just sounds a bit too easy to be true, doesn’t it, Marianne?

It doesn’t compare to my experience here in the UK if I am honest. So, I think I went in 2013 to see my GP, and I didn’t get to have another conversation about anything until 2016 and then it still took another eighteen months before any treatment. And it was arduous. I can’t say any more than that. So just listening to you talk, listen to your experience, yeah, I’m envious, if I am allowed to say that.

Marianne, what happened in those three years between 2013 and 2016?

What happened was a black hole of nothingness. There was no contact. I got a letter one month after I got referred to the gender clinic. I got one letter just say acknowledging the referral, and they got me to fill in some details, preferred name and you know, I don’t know, pithy stuff really that I would expect them to have known anyway. So, I filled that and sent it back, and I just waited and waited and waited. And eventually, I got a phone call, it was just before Christmas to say that there’s been a cancellation and did I want the appointment. You know I was in the privileged position that just been I’ll say yes was the day after the phone call. But yeah apart from them two interactions, there was this black hole of nothingness. Which was, you know, it isn’t nice. I think one of the things I would say is that some people say no news is good news but when you’re trans way to journey and so in medical transition that that nothingness is bleak. There’s no other way to describe it. I’m dominating there. I apologise, Sophie.

No, no, I’d love to interject it and tell you a bit more about how things played out with me. So prior to 2016 in Ontario, our trans healthcare system was kind of structured on the British system where we had one gender identity clinic located at the Centre for Addiction and Mental Health in Toronto. So, a mental healthcare centre. So right away that was a bit of a put off for a lot of people approaching that centre. You had to be referred by your GP. And that centre the only centre for nine million people was notorious for waitlists that went from months to years, and it was absolutely unacceptable. We went through a new provincial government earlier in the twenty-tens, and they were approached by advocates within the system and pleaded with to change the system. So, they looked at best practices and so well why do we need this system in place why do we have to go? Why do we have a gender identity clinic? Why can’t this be bound with the healthcare provider that people are most used to, our GPs? We have had the same doctor family doctor for close to twenty years. So she knew me very well, and I had a very good rapport with her. So when I approached her, in I believe was January of 2017. I said like I haven’t been entirely truthful with you. I identify as a woman, and I am trans, and I need your help to move forward with my transition, and she said absolutely. She said I don’t have a lot of help a lot of experience helping male to female patients. She said I’ve had you know maybe a handful of female to male patients, but I will look at best practices and I gave her some information that was available from our Ministry of Health already on the internet, it is available to everyone. And I provided her with that. She asked me for a couple weeks of breathing room to figure out what’s going on, how she can’t help me in the best way. We made another appointment for two weeks after that. I came back. In the meantime she said, well you’re going to need blood work if you’re going on hormones. So she gave me a complete book blood work that was part of my yearly physical anyways. So that was in place in two weeks, and she said okay we’re moving forward. If this is what you want. So she prescribed me a started dose hormones, oestradiol. She put me on spironolactone as a T blocker, and she gave me a referral to a well-known endocrinologist in the city who has experience working with trans people. I reached out to that endocrinologist myself and got on their waitlist and luckily they had an opening within two months. I got into to see them, and so two months later, I was on a full dose of HRT and moving forward. And it’s been nonstop since then.

Oh, I mean just I just had a warm feeling thinking that your GP that knows your best, that has known you and your family for twenty years was the one to have that privileged secret. I feel really warm about that actually. And also that you have such a lovely response because we don’t always get that response from GPs. We often hear the GP saying, oh, I don’t know that I haven’t got much experience on that one. We often hear that, and we often hear about our patients being armed with you know sheets of information and what have you for their doctor, but some people just don’t get that warm response that you had from your GP. I often give a high five on my podcast. I’d like to give a really nice high five to your GP for that for doing that with you and helping you. It’s lovely. I’ve got a question, you mentioned best practice a couple of times, and I can almost hear my GP colleagues over here saying oh no, this is not about best practice. What we want is research. We want evidence we want proof. We cannot possibly entertain such an intervention as this on best practice. We need more figures and stats. So I don’t know whether you have any insight into how what did you mean by best practice when you were talking about that?

So the Ministry of Health in Ontario put together online resources for the GPs, knowing full well that a lot of GPs and nurse practitioners would have very little experience providing assistance to trans patients. So they have a very good online resource in place, and they have information available, through I believe a one eight hundred number over here where if the GP has any questions they can contact the Ministry of Health and sort those out one on one. I don’t know how the medical establishment determines what best practices are other than the fact what is already working for the thousands and tens of thousands people that have already transitioned and are on HRT and are just living their lives. I mean it’s just that you find that from watching people with their lives. So the medical establishment would be better suited to answer that question, as to how it’s been determined that this is the best way for it. I know I did a lot of—decades of research and once the internet came on the scene in the early two-thousands. It was a good and bad resource. There’s a lot of bad information out there. But you sift through that, and you listen to people, and that is successful in the transition and are happy their transition and what worked for them. And a lot of people individuals put their systems on the internet and so this worked for me. This is working for me. So perhaps that is how a medical establishment has gotten their data. It’s certainly something that I’ve been thinking about as I said all my life. So, to tell me that I would need to wait for another two, three, four years, well they made sure I was sure of who I am, that doesn’t make sense. I thought about this for years. I thought about this for decades. It took a lot of a lot of fortitude to tell my doctor my truth. Especially knowing how people had to be treated in the past by the healthcare system. When you are at that point where you have to move forward. You have to, and I had to move forward. This is simple, we’re ready. We just need you to point us in the right direction we don’t need you to hold us back. I had very good psychological help I had trans centric therapists that I had hired a couple of years before that. They helped me work through some of the questions I had, and they helped assure me that I was going to be fine. And that was very important to me knowing that yes this wasn’t going to destroy my life that there was a light at the end of the tunnel for me.

I was just going to reflect there that this is something when we go to see the doctor. I’m not sure, Helen will know a little better than I do, I’m not sure what it is, but it’s a terror. It’s a terrifying but a life-changing moment, and sometimes I think people don’t actually get the magnitude when we share this information with them, the magnitude of that privilege. I don’t know about you, but I wasn’t going asking them to determine whether I was trans or not. I was going telling them that I was trans and needed help. I didn’t want somebody else to then validate that for me. I think that’s the trouble sometimes when you approach somebody, they automatically will need to get that diagnosed.

Yeah.

We can’t help you till you diagnose that. And I don’t whether that’s medical training. I’m sure Helen would know more about that or whether that’s just panic and just default to that. I don’t know about that I wasn’t going for somebody to validate my gender I had already done that myself.

And I agree yes, I was in the same boat a hundred per cent. And it would have been off-putting if my doctor said to me, well, I’m going to have to figure this out for myself and confirm that you’re trans. I already knew I was trans. I knew my identity. And the professionalism in the compassion that I was presented with all along the way it. It startled me; I was expecting a lot worse, and it is emotionally even thinking of the assistance I got and to hear people that don’t have it as good as I’ve had it. I know I’m very privileged. I was very savvy about how to navigate our healthcare system. Younger people, people that are new to the country, they won’t have that knowledge, and of course, their situation is gonna be a lot more difficult, and we need to assist those people more, just as much as people who are used to our healthcare systems and make sure that they are given the guidance and the assist moving forward that they require.

Yeah. Marianne, you were going to say something?

I was just gonna say I couldn’t fault the professionalism of the doctor that I spoke, he handled it sensitively. What defaulted to we’re going have to refer to the gender clinic. And actually, I was only ever after HRT and never wanted surgeries through the NHS. Doesn’t mean I wouldn’t do in the future, but you know that was the get-up, and he did handle it sensitively. But yeah, I think I’d have preferred to have the response that you had.

I think it’s really interesting in both of you ladies are of similar age and not giving any ages away. Someone’s just had a birthday by the way. And you know you both told me the same story that you knew who you were from when you were very little, so you know, everyone else thought you were a boy but actually you knew that you weren’t. And then there were years of not addressing that. And then there was the time before you ever first went to the doctor to ask, you know, for that snap decision that we people seem to think is what trans people make. There were years and years of internal reflection, wasn’t there, to work out what that was the right thing for you, for your wives, for those around you? And you know, Sophie, you said you did your own research and what your research was into you, and your gender and how you could make this work for you and I think that’s a really good point that doctors are asking for research for medical research. But the research that you people do to find out that this wave is huge. You don’t just wake up one day and go like, what, I think I might try a little bit of HRT and see what it feels like is it?

It certainly was not for me. There must be other medical situations where the doctor does not have a lot of experience dealing with the patient that’s going through that situation. And I would hope that they don’t hold off from provide didn’t care for years in turn for these other situations because the outcomes must be dire. The research that I was able to call together, of course, was outside of the medical establishment, and just people are putting their own stories online. And perhaps a few papers that have been published over the years and made available on the internet. Other than that, you grow up, and I grew up in the seventies and the eighties, and it’s simply the terrible things you hear on TV. The terrible things you read in the mainstream media, the newspapers. And you learn very quickly to keep that hidden. That part of you is hidden. And society at least Canada has caught up with us where now they understand that we are your sisters, we are your brothers, we are your wives, we are just your coworkers. We are no different than you. Allow us to live our lives, allow us to be active members of society. That’s all we ask for. We’re not asking for anything special. Thankfully in Canada, we now have in place a Canadian Human Rights Act and our provincial Human Rights Act firm protections for trans-identified people. And I did a lot of research before I came out at work with my coworkers making sure I knew what my protections were. And I had that in my back pocket, but thankfully I never needed to use that because society has caught up with us and they realised that we’re no different than anybody else. and people that state differently, they seem silly now when you listen know these people voice their disagreements with our lived experience. So most of our coworkers, most of our friends, most of our family get and they’re fine with it. And hopefully, the NHS on your end can see through to that an and also move forward with society.

But I think you may it a very good point at the beginning of that little section there, saying I wonder whether there other situations where the doctor doesn’t know much about it. And actually, you know as a GP, GPs know a little bit about everything and a specialist knows a lot about a few things. And so actually this model that you described by at the beginning Sophie, where you are saying that you went to your GP and your GP started you off on a small, safe, unscary treatment, and then you went to the secondary care, the specialist for the kind of a full package. It’s exactly the same as any other health problem. You know if someone has bad arthritis in their knee, I can give them anti-inflammatory and painkillers, but I can’t do any I can’t do even do a scan or an x-ray. They have to go to the hospital. I certainly couldn’t do enough an operation, you know. So it’s the same for everything. But for some reason, and I haven’t met it in any other branch of medicine, for some reason, trans healthcare doesn’t seem to fit this model. The GP feels allowed to say I know nothing, and I won’t investigate any options for you. And secondary care, which is your local hospital, has been skipped entirely. And patients who’ve been referred to their secondary care hospital, like you went to your endocrinologist, if they are referred there, the referral is sent back saying we don’t deal with that here. You have to go to this super, super, super, super-specialised clinic. So we have seven in the UK, you had one in Canada. And of course, as you said, the waiting list is just—they can’t cope, they can’t come out with that many people. So what we really, really, really need is exactly the model that you’ve just described where the GP can start off just a little bit of something that they feel comfortable and safe with, and then it can get fine-tuned at the hospital actually if that’s what we need. And it’s a model that’s worked in healthcare for many, many, many, many years, and we just need to do that. The other thing, Marianne, I was thinking when Sophie was talking is that there’s been a lot of government help here, hasn’t there? There’s you know the resource basically they saw that this was gonna be a problem. They saw that GPs wouldn’t know much about it and endocrinologists as well, I imagine. And they’ve they thought to themselves, right we need to put some stuff in place here. And that’s what we could—that’s what we need in our country isn’t it, Marianne?

Without question. I mean, the issue we’ve got at the moment it is a lot of talk of rolling back trans rights in the UK. My gut feeling is it’s not going happen. There’s a lot of rhetoric, not a lot is going to happen. But in terms of health care, I think the trouble is there are too many profits from the old system. It was always dealt with us a mental health issue. You said in Canada that’s what they were trying to do, treat it as a mental health condition and what they don’t thankfully in Canada, or hope whatever happened in Canada spread across the Atlantic, they saw that actually these people are just somebody’s father, brother, sister, mother, and that we are actually just people and actually were not crazy, that we have not got a mental health condition and just need some medical support through medication. And getting that to change here just feels like an impossibility at the moment, but my gut feeling is that it’s got to change because the waiting lists are going to force it to change.

Well, certainly in the early twenty-tens we had the perfect storm of a compassionate provincial and a compassionate Federal government, who both listened to trans people and trans health advocates, and they removed as many barriers as possible to make these changes just happen. And that was a lucky period of time where we were able to take advantage of it those that compassion within the levels that government. Thinking back at fifteen or twenty years previous to that in the province of Ontario, we had a very of provincial government in place than actually removed a trans healthcare, delisted trans care from our provincial healthcare system, and I’m sure it caused untold grief for people at that time. And again, you know, I was just starting to consider moving forward with my transition and the message I got for my government was no, it’s not worth helping you. So luckily that government is no longer in place, and we had the government support in early twenty-tens that was able to help us move forward, but we are at the whims of our government, unfortunately, no matter where we are. And you know it’s easy to say, we just have to wait it out it. It’s really hard when you’re the person waiting out, and your soul’s being torn apart waiting to move forward with your life .and I feel so sorry for people that are still in that position.

Yeah. The words that you described, both of you actually, you said it a lot of are living their lives just living their life. We’re not asking for a lot here, you know we’re not asking for, I don’t know what to compare it with, but we’re just asking to be allowed to live your life in the way that makes you and the people around you feel happy and comfortable. So that you can get the best out of your life which actually as we know as we get older becomes quite short and time starts running out. And that’s really important. It’s scary that it can be so governed by somebody at the top. I was reading actually something quite interesting recently that—cause obviously, healthcare being so big, it’s sectioned off geographically, even in the United Kingdom which is not huge geographically not huge, sectioned off. And actually, doctors on the ground floor will ask someone higher than them or some with some of more with more power than them for permission. They might ask their local clinical commissioning group. You know, what am I allowed to do here? Am I allowed to do this? And what the head of typical commissioning group in one area might say something completely different to another area. And if you have someone a bit like your previous government who has a negative view towards providing gender-affirming care, that can then filter down to ever such a lot of doctors on the ground floor. And that’s a really scary we thought that that one person’s influence can have so much power or over so many lives and it’s quite scary. For me as well it’s also about you know that that permission, always it sometimes a bit of an excuse where doctors can say I don’t know if I’m allowed to let me ask, or I don’t think my insurance would let me do this. I don’t think my regulator would let me do this. I don’t think my boss would let me do this. And then sometimes, think, come on you’re the doctor here you’re the one with with a medical degree, you can look this up you can feel confident that you’re providing the best care for your patient. Is it excuses, or is it permission that they’re looking for? I don’t really know. If there really got any doctors out there listening to this or cross with what I am saying, please comment and let me know.

I know how fortunate I was to have a compassionate doctor and that’s when I was originally choosing a GP, I’d gone through two or three different ones who I had a feeling moving forward that if I did come out, I wouldn’t have gotten the support I needed to get. So I chose well. I urge people to choose their GP well. And you usually get a could feel for that person as a person, not just as a doctor. And if they’re not the right fit for you, I urge you to look for someone else. I’m not sure how the system works in the UK, but we certainly are allowed to shop around for lack of a better word for a GP that clicks with us, and I was so fortunate to have one, and I do realise that a lot of people aren’t in that position, especially as smaller towns where you may only have one doctor’s practice to go to. At that point, what do you do? You’re in a city of three million people. I have endless doctors that I can search out. A lot of people especially in rural Canada, and I’m sure it’s the same in the UK, you have one choice soon if you don’t like that choice in GP, you’re travelling two or three hours to find someone else. And if you’re a minor if you’re someone that doesn’t have the means the financial means to make that travel you’re really stuck and I feel for those people.

I was just going take you back there, Helen, as well you said something earlier it’s just been going around the mind since you said it, that if somebody came into your surgery with arthritis on the knee, and they went in, and they sat down you wouldn’t send them out without some kind of help even if it was only the anti-inflammatory and painkillers and saying you have to wait for the specialist to help you. I think, and I find out about this, so I apologise to the listeners, probably I get it in every podcast we do, but when we were working there, we are in pain. And the doctor is actually sending us out without any help. And you would not do—just because we didn’t limp in, what they see in front of them is what our family are seeing at home our disengagement with society. That our world’s becoming smaller and smaller. And that the pain that was causing upon our family, and the worry that we start causing them just to send you out the surgery without any help, it’s not good doctoring, I would have thought. Failing to see the pain and recognise it.

I couldn’t agree more. And you know, psychosomatic pain, which is pain from inside not from a physical organ but from a pain which really really hurts. I will have said this before to you, but you know psychosomatic pain is very, very, very real. It’s like when you have a broken heart when your boyfriend leaves you, it hurts. It’s a real physical pain in your heart, and we have to understand that this pain is really, really there. And Sophie, I love the way that—I wonder if your doctor knows that you chose her. Is it her, I don’t know?

It’s her, yes, it is.

That you chose her, you actually chose her twenty years previously just in case.

Just in case.

I love that image. I’ve got goosebumps just thinking about it. And Marianne, again isn’t it, we shouldn’t have to choose our doctor or our therapist because of their trans-affirming views, and you’re right, Sophie, sometimes we have to. And sometimes the advice you just need to give people is if your doctor won’t help you, just find one that will, because you’ve already got enough battles ahead of you and the hills to climb. So don’t make another battle but we shouldn’t have to, Marianne, shouldn’t we? And you know, finding the right counsellors at times, the right therapist, finding the right doctor seems that’s such a hard thing to do when actually you’re in pain, and you need some help.

It’s a little bit invalidating, as well, the thought that actually you’re going have to fight to be heard, you know. You want to go on seeing the doctor. I don’t know, I might be naive about you know going into surgery. It’s the sanctity of security where it’s there purely to help and actually to go in there and be made to beg almost, and it’s the same in the therapy room, how anybody could ever walk in front of a therapist only to be told I don’t know anything about gender. Everybody knows about gender, we’ve all got one, you know. I mean it isn’t something that we have an all experience. We just experience in a different way, that’s all. So yeah, and you said about the battles, my heart sinks, the thought that we even have to think about this as a series battles just sounds like something wrong.

Yeah, even up to about three years ago. When I first went into my therapist office, I begged her to teach me coping skills. I didn’t think that I would be able to transition at that point, and she laughed at me. She apologised for laughing afterwards, and she said, you don’t understand how this is moving forward. You have such, you’ve gone such a far away just to get into this office, I will tell you that you are well on your way to transitioning already. and I will help you do that, and it’s not the sense of coping skills and discipline. It’s living your true life and all the pain that you’ve felt since then over the years. And she was right, and I put in the blog that I was in the driver seat I and I still feel that they didn’t push me in a certain direction. But they heard the direction I wanted to go even if I wasn’t listening to myself, and they were there with the right answers every step of the way. And you know, my doctor, my therapist, my endocrinologist, they’re all, every time I see them they go how are things going? Are you happy with the way things have progressed? And if there is a smile on my face, that’s the answer they need, that sense of elation and sense of happiness. Even my wife says that I’m a much happier person than I used to be, and we’ve been together for more than thirty years now, so she knows me better than anybody. And yeah, that’s how it is.

Oh Sophie, I don’t know about anybody listening out there, I mean, I defy anybody not to have a massive smile on their face at the moment, because I know Marianne has one cause I got the privilege of seeing her in front of me. And I certainly have it. I don’t think I could be smiling more broadly just at that thought of those three people giving you that chance to live your life in the way that you do. And actually caring about it afterwards. Keep on asking how is it going for you. I think that is, you know, just lovely. I was just wondering, not personally at all, what about things like voice therapy, laser therapy, surgery, fertility preservation, things like that? Is that easy, are you going to chock me and say how easy that is as well, or?

So, the provincial healthcare system pays for certain things and don’t pay for other things. Voice therapy I did undertake at a local hospital with a voice coach, I had to pay for that. But that was reimbursement through my employer’s health plan. So I didn’t really pay for that at all. Hair removal, that’s something that is out of pocket, and I have been going to a dermatologist for that since 2013. So it’s been a long effort, and that is possibly one of the most costly parts of the entire transition. In terms of surgeries, that is covered by the provincial health care plan in Ontario, and I guess the same in the rest of Canada. You have to be living in your true gender for one year before your GP can apply to for provincial to help me forward the surgeries, and she did fill the paperwork for me. I required the GP’s authorisation on that, and I also required the word of two therapists, two separate therapists. And that was very easy to get. I’d had already been going to see one for several years at that point. The paperwork gets sent to the provincial Ministry of Health, and I got a reply back in two months okaying the money. And that gets cc’d to the surgery healthcare clinic in Montreal. Their healthcare team, a pre-surgery assessment. That took probably about three months. And then they called me back with a surgery date, which was two months after that. So all said and done, from the start of my transition, the surgeries I needed for me were completed within two years. And that seems to be on par for this province. So there are other situations where you may not be medically in the best medical shape for surgery. Again and then, of course, you know, everyone’s situation different, but for me, everything fell into place thankfully, and I was able to move forward in a timely manner.

Yeah, that’s amazing, isn’t it? I mean so many questions come through our website saying what do I need to do to get surgery? Do I have to go through the gender identity clinic? Is my GP allowed to refer me? And a bit like you allude to, Sophie, but not all surgeries involve the really, really, really most detailed ones that are available. Some people just want some minor we just align their body with their gender, but no, you know. It’s almost I said this before I know, but some years ago somebody wanted to have some work done on their nose, and that was what that disposal was really strong about their nose. And they had booked themselves into a local private plastic surgery hospital, along with all the other people who wanted to have a better shape nose for them. And everything was going smoothly until the doctor surgeon realised that this person was trans. And then they were like well, no, hey no, we can’t do this for you today. No, absolutely, no way. You have to go away, and you have to get two letters. You have to validate your gender, Marianne, you have to prove to me that you’re trans. I can’t possibly do this nose reshaping for you. I just hold my hands up and say goodness, whatever is going on? And you know in the UK, GPs are not allowed to refer for gender-affirming surgeries. We go a long way to do that one.

I almost wonder if, it sounds like there’s a fear that’s instilled in GPs and in the medical establishment in the UK where people are afraid to assist. And I was wondering, doctor, if that’s a true feeling that I’m getting that that you’re told in medical school that this is witchcraft or something, or you shouldn’t touch or you might lose your practice or something. I don’t understand that that mind.

Well, you know that is honestly a really, really good question because what happens in medical school is nothing. So I wasn’t taught anything about gender identity at medical school. I expect I was taught that there were a male and a female and you’d govern that by looking at the generals at birth, and sometimes it might be a bit confusing from looking at the generals. But that was as far as my medical school training will have gone. And unfortunately, twenty-five years later we are, in a sense, in a very similar position. Gender is not talked about. And if you look at post postgraduate medical education, we have our curriculae. So we have a curriculum for psychiatry training and a curriculum for cardiology training, a curriculum for endocrinology training. If you look at the curriculum for endocrinology training, transgender is not mentioned. If you look at general practice training, there is one reference to the word transgender, and that is in explaining what LGBT stands for, you know. So we are very, very, very limited in our education. So why are doctors scared? It’s not because they’re told in their medical education not to do this. They may have had kind of a personal opinion during their medical education from someone who was supervising or training them, we don’t know about that. But we’re floundering here because we left it to the media and what what you read online and what you read in the newspapers. And actually, in the UK, a very high proportion of doctors who provide transgender gender care have come under investigation and suspended from practice, just like myself—which, you know, that’s scary, that is scary. Who would ever want to do anything that might put your license at risk or put you through the courts?

Yeah, of course, it’s—and you mentioned the media, and I do follow the British media. It is astounding vicious against trans persons. And as a Canadian, I don’t understand that point of view and what the impetus is for that. The Canadian media, the Canadian newspapers, they don’t even talk about it. It’s not an issue because it’s no longer an issue in Canadian society. We’re just your neighbours. It’s no more of an issue than talking about gay people or any other person on the LGBT spectrum. No one would read that column. It would be considered below a paper of record to put something like that in their pages. So it’s very interesting to follow the British press and the viciousness that still exists over there. I don’t understand it as someone looking from away.

I think the issue that we’ve got in the UK is that this is social change that we’re going through. And we went through in the nineties with the lesbian and gay movement. Certainly where age was concerned, the dehumanisation of gay men. And I kind of equated it to that. I don’t know why the only thing that does is the more visible would be becoming, I think certain parts of society a bit try, I think overwhelming and again, to the listeners of this podcast, just when I go out and about, I don’t feel anything but love. You know, touch wood, but I have not had a bad experience here. I’ve had awkwardness. I’ve had sometimes somebody misgendered me, and there’s a bit of an awkward pause. But generally speaking, what we need in the papers is what always I experience in the street. And I’m sure there we some people out there screaming saying that they have, but I’ve not. I just wanted actually as the times going on, if you don’t mind, but it’s taken me a long time to ask this question, but how important was therapy for you in having a good translation, if that is not the wrong question to ask?

No, that’s a very good question. And that was probably the most important facet of my entire transition. And one of the first persons that I approached was the therapist before I even approached my GP. Being trans certainly weighs on you heavily, it weighs on your soul, weighs on your psyche, and there’s a lot to sort out there. And we spent a good year talking about trans-related issues and how they affected my life and my outlook life. And as a basis for talking about certain other problems in my life, where you’re one package of a person and being trans is just a small part of that. But without that that therapy assistance and having a really good therapist—and I searched after just like a search for my GP and I made sure that they were a trans therapist where they the advertised that they were really supportive of LGBT persons. And that was so important that I wouldn’t be where I am now was that that woman’s assistance. And it’s just part of the entire healthcare system. You have the medical side of things, you have the mental health side of things, and they have to click together, and you can’t have one without the other. They’re both equally as important in my mind.

I saw you put your hand. Anyone who didn’t see Marianne put her hands up in the air and wave them, really delightedly there. Sorry, Marianne, go on.

It just validated my existence there. The truth of the matter is that I do get people coming to me and I’ll never forget this just this one person who was about to embark on transition, and I like a good metaphor, and they just said that I feel like I’m holding a hand grenade, and if it goes off, it’s going to blow my life apart. And as a therapist, I said, shall we keep the pin in, and we’ll talk about it. And if it does have to go off, let’s try and minimise the damage. You know it doesn’t have to blow your life apart. It might hurt certain parts. You don’t need to go apart. And I just thought that was a great way to describe how people feel embarking on this journey, that this is going to blow my life apart. And it doesn’t have to. Again, seriously, it doesn’t have to. I think, obviously, I’m going to be pro therapy. I think that therapy can help people to see that and manage it in a way that they can minimise any potential damage. So it was nice to hear you say that.

Very nice. I’m aware of the time. And I’m sure we could talk for hours. I wish we could sit there and talk for hours, but we can’t. Sophie, it’s been really lovely talking to you. When I came on, I thought okay we’re going to just repeat the podcast and expand on a little bit. But we’ve covered so much ground. It’s been really useful. And what I’m going to do is, I’m going to ask our doctors over here to listen to what we’ve talked about today, and listen to what impact a small prescription of belief and a small prescription of HRT, just a small one, and what a difference that could make to allowing someone like you to live your life. So thank you so much for that. I’m going to thank any doctor that is empowered by listening to this to help their patients. I am going to thank you on their behalf as well. And a quick high five to your therapist as well.

Yes.

So, Marianne, join me in saying thank you for joining us from so far away and for sharing your experiences. And I hope that we are all alive when the UK catches up and brings your model.

It will be there, and have faith you will move in the right direction. And it’s the only way to move. It will happen. Thank you again, to both of you, for having me on today. It was a marvellous experience telling you my story and expressing a bit about how things are done over here.

It’s been a privilege, Sophie. Thank you for joining us.

You’re welcome.

Thanks so much, bye-bye.

Okay. Bye-bye.

Bye.