Nurses helping break down barriers to healthcare

Despite significant barriers to healthcare, nurses are helping transgender Ontarians to express their true gender identities.

By Daniel Punch

Twenty-year-old Nolan Blodgett walked into a Peterborough health centre hoping to make his body look the way he felt inside.

It was September 2014, and he had come out as transgender the previous November. The 10 months since were the most difficult of his life. Since coming out, he had taken small steps toward living life as a man. He bound his chest to hide the breasts he felt shouldn’t be there, and changed his name to Nolan. But that did little to ease his debilitating anxiety and depression.

Finding little understanding from family and friends, he attempted suicide in February 2014. “I just hated (my body) so much I couldn’t focus on anything else,” Blodgett recalls.

He knew he had to explore medical transition if he was ever going to be happy with how the world saw him. For a transgender man, that meant taking regular doses of testosterone to make his physical appearance more in line with his gender identity. To do that safely, he needed a health-care provider.

That’s how he ended up in registered nurse Sheena Howard and physician Vanita Lokanathan’s Peterborough office. Covered in rainbow flags and trans-positive posters, it looked like a safe space. But he had every right to be skeptical. Transgender people face significant barriers to healthcare.

Nursing and medical school curricula barely cover trans issues, if at all. A 2010 U.S. survey by the National Center for Transgender Equality found half of trans people who received health care had to educate their care providers. About 19 per cent were denied health care because of their gender identity.

Blodgett remembers visiting a physician for an ear infection, only to be peppered with questions about his genitals. Another physician scolded him for wearing his chest binder, which got in the way of a stethoscope. And during a four-week stay in hospital after his suicide attempt, nurses often refused to use his preferred male pronouns, corrected others who referred to him as a man, and blamed all his mental health problems on his gender identity.

He carried the weight of all those experiences as he sat in a Peterborough waiting room that September day in 2014. But he quickly found out this experience would be different. Howard greeted him and they spent the first part of the appointment just chatting about life. She didn’t assume anything about his history or his goals for his body. She just listened. “(She) didn’t treat me any differently than everyone else,” Blodgett recalls. “That was probably the first time I experienced that.”

Howard and Lokanathan worked with their first openly transgender patient five years earlier, when the local medical officer of health recommended them as “friendly” care providers. They quickly earned a reputation among the local trans community. Before they knew it, they were getting referrals from as far away as Toronto, London, Kingston and North Bay.

Today, Howard works directly with about 75 of Peterborough Family Health Team’s 220 trans patients. She says her approach is no different than with any other health issue – check for contraindications, watch for side effects, monitor blood work, and adjust dosage as necessary. Above all, treat patients with respect and dignity. “Health-care providers are supposed to meet everyone with an open mind, an open heart, and a willingness to help,” she says.

She admits she’s shocked by the barriers trans people encounter accessing care. Patients tell her about being flat-out refused care by health professionals who say they don’t understand. The barriers are also systemic. Health-care professions have long viewed transgender people as having mental health issues. Gender dysphoria – the feeling one’s gender is different from what was assigned physically at birth – is still classified as a mental illness on the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders. For a long time, the only option for transgender people seeking medical transition was to undergo extensive evaluation by a psychiatrist, who ultimately decided if they qualified. It often took years before a trans person could access hormones, if at all.

Today, health organizations like Howard’s follow the informed consent model, as outlined in the guidelines from the World Professional Association for Transgender Health (WPATH) and Toronto’s Sherbourne Health Centre. Under this model, patients are taught about the benefits and risks of hormone therapy, and make the decision for themselves. The process takes weeks or months, instead of years.

Howard says this can make a huge difference for patients during a very difficult time. “From the moment you acknowledge to yourself you’re transgender to the moment you get the help you need, that’s your highest risk of suicide,” she says.

That was the toughest time for Blodgett, and he says struggling to find a supportive health-care provider was a trigger for his suicide attempt. Transgender Ontarians are at least 10 times more likely than the rest of the province to attempt suicide, according to a 2010 survey by the Ontario-based Trans PULSE research project. Blodgett thinks poor access to health care is a factor. “When people aren’t able to get (health care)…it’s kind of the last straw.”

Blodgett was eventually transitioned out of Howard’s clinic and is continuing hormone therapy with support from his primary care physician. He recently completed a psychology degree at Trent University, where he wrote his undergraduate thesis on trans people’s experiences in health care.

When he and Howard ran into each other at a Peterborough Pride celebration last year, she didn’t even recognize the bearded man in front of her. He identified himself, and she was flooded with memories of his first visits to her office when he was on the brink of suicide.

He thanked her, gave her a big hug, and told her she saved his life.

Howard’s voice wavers when she thinks back to that day. “That’s such a gift. (It) is precisely why I got into nursing,” she says. “Who wouldn’t want to have someone say that to you?”

Daniel Punch is staff writer for RNAO.This article was originally published in the May/June 2017 issue of Registered Nurse Journal, the bi-monthly publication of the Registered Nurses’ Association of Ontario (RNAO).