You raise many excellent points here, Darach. It is true that many healthcare encounters for transgender people become centred around the transitioning aspects of their health (e.g. hormones, surgery, etc) at the expense of any other aspect of health. While this may be the topic of some interactions, sometimes it is just an ear infection, or a strained lumbar, or acid reflux – issues that can be explored without needing to obtain a full and detailed trans health history!

I also appreciate your comments on non-binary / gender fluid identification. If society and the healthcare system has begun to wrap its collective mind around the concept of complete gender transition, the idea of non-binary gender represents a further stumbling block for many. Gender expression and identification is varied for many and may not take the form of full masculinizing or feminizing using every available intervention. As health care workers, our understanding of a person’s gender can start with the simple open-ended question of “How would you describe your gender?” instead of trying to tick one of three available boxes.

We will get to where we need to be. Painfully slow at times, but I am certain we will get there nonetheless!

What could you see the ARNBC doing to further these needed changes?

The commentary above mentions the challenges of finding a receptive family doctor. A transman myself, I left my former family doctor when it was apparent that she was hostile to my newly announced status, and then I spent a number years without any replacement for lack of a way to find someone more compassionate. Middle aged, increasingly in pain from a work history of heavy labour, and so on, I could well have used a range of services that many middle-age people get to take for granted.

In hospital situations, special provisions may be needed to maintain the safety and confidentiality of transgender patients - who are at risk of violence from other patients, visitors or possibly even staff, if their identity were revealed. Several times I have lain in emergency departments, protected only by a thin curtain from the adjoining bed, having to announce my trans status clearly and repeatedly to each new nurse, doctor or technician who comes through - and wondering just who is hearing me on the other side of the curtain. As a nurse, my observation is that full confidentiality is a rare thing for many hospital patients - but for a transperson the effect goes far beyond a violated sense of privacy to questions of immediate, basic safety.

Provisions are also needed for dealing with non-binary gender variant people - who reject an either-or gender identity of any sort: how well prepared are healthcare providers to respect people's wishes for pronouns, for how non-binary people are characterized both socially and even biologically within medical care?

In healthcare research it seems that very few (if any) inquiries have been made into how exogenous hormones affect the body's own hormonal activities and broader health issues. For instance, I have no idea whether I should follow male or female guidelines for safe levels of alcohol consumption or daily vitamin and nutrient requirements. What hemoglobin level would a doctor consider normal for me, a male's or a female's? What considerations should be addressed in working with aging transpeople, in all kinds of areas of gerontological medicine and societal supports?

I also feel strongly that health care agencies need to have trans advocates/ombudspeople in a similar way as some have advocates for First Nations people. For instance, I need to have a particular cancer-screening procedure - and even though I am myself a nurse on a cancer unit, I have not been able to bring myself to book the appointment, for fear of having to face unkind, unsympathetic technicians and care providers. This is a very common problem for transgender people and I repeatedly wish I could call on the services of a support person/advocate familiar with trans issues, to have someone with me at the test to support me if I meet disdain, disrespect or aggression.

These are only a few of the issues that our healthcare services have largely failed to address or understand. Many thanks for the editorial.

Forgive me if I'm wrong, but your comment seems to redirect the conversation away from transgender people's needs and towards women's needs - a perfectly legitimate topic, but not the one addressed here. Transgender people do not somehow diminish women's issues or value by virtue of having their own issues and experiences of profound societal devaluation and erasure, not to say outright hatred in many cases. Sheila Jeffreys is well-known for her vociferous transphobia and cannot be relied upon as a commentator on transgender needs in healthcare or anywhere else.

Female erasure is something nurses should work toward preventing.

We have learned a few important things since then, about the barriers my kid is going to face, simply because she wants to be who she was born to be - a girl. 1) Legislative - that there are places in this world my kid can't travel to without fear or shame - and yes, I'm looking at you America, 2) That hockey leagues in BC have figured out how to have girls on the boys team, but not how to have trans kid on the hockey team, 3) That people ask stupid and inappropriate questions about my kids body. Would you ask me what kind of equipment I have under my clothes? Why would you think it's ok to ask me about my kid's genitals? And why do you care? 4) That health professionals have the same biases as everyone else, and that many just have no idea how to manage a hard-headed, strong-willed kid who knows exactly who she wants to be. It's hard enough to find a doctor in BC. Harder still to find one you like. When you're trans, and your mom insists on regular doctor visits, it's almost impossible.

Please think about this all of you remarkable, nurturing, caring nurses. Unless you're one of those ridiculous people who think my kid chose this difficult path (in which case, America might be a good option), please take the time to learn what my kid, and all the other trans kids, needs are. Get to know the amazing, smart, loving, funny people they are and I think you too will want them to be the best version of themselves. They'll make you want to cheer for them - and they'll make you want to provide the best health care possible. And here's a little secret - you can screw up and refer to my kid as 'he' if you forget - she gets that and will laugh it off. You should too. All that she'll remember is that you didn't judge. That you cared for her like every other person you saw. And that you looked at her and saw an amazing, emerging young woman.

Thanks for this post Zak. I would be interested in knowing what additional education you took. I wonder if ARNBC or someone could advocate for some sort of specialty certificate or certification or something like that? It's not the same as cultural competency, but there are similarities in that we need all health providers to start learning the very basics of human rights and human decency. I think a lot of us out here are interested and supportive, we just don't really know where to begin. Nice to see ARNBC and you reaching out on this important topic.