Making a smooth transition
JEFF GARD Northumberland Today Registered child and family therapist Linda Farrell, who has an office in Cobourg, says about 15 to 20% of her case load deals with transgender-related issues. That's a high percentage for an area of this size, she believes.
The following is the second article of a three-part series looking at transgender in Northumberland.
Having worked in much larger cities such as Kitchener-Waterloo, Guelph, London and Woodstock, registered child and family therapist Linda Farrell wasn’t surprised to encounter a few transgender cases over the years.
When she and her husband Aaron (a clinical psychologist) set up their practice, Farrell & Farrell Therapeutic Services, in Cobourg about three years ago, she was astounded by the number of transgender-related cases in Northumberland.
“Over the last three years it has built to where I would say 15 to 20% (which is quite high for an area of this size, she noted) of my client case load is around transgender issues — so that could be a transgender client, but it could also be a family member that is trying to support their loved one that is going through the transition,” Linda Farrell says.
“When I came to the quaint little town of Cobourg, population 18,000, I was very surprised, and in a positive way because I think it’s awesome that people are willing to open up and explore this. I have been in awe of the parents of kids I have seen, especially, because the bottom line is these parents love their kids.”
Farrell says she has worked locally on transgender issues with children as young as six and adults into their 60s.
“It’s been a vast range, but if I had to look at the percentages, probably the highest percentage is in the teen years and that’s when kids are figuring out their sexuality,” she says.
What might start off with someone determining whether they are attracted to the same or opposite sex can lead to the question of whether they are comfortable as a member of their own gender to begin with.
That aside, most younger clients don’t present with transgender issues to begin with, Farrell says.
“They present with things like anxiety, depression, social isolation, and parents are really worried and concerned about them,” she remarks. “They will come in and once trust has been established with these teens, these things will surface.
“A lot of work is working with parents to help navigate this path,” Farrell says. “It’s a long path. It takes a lot of help; a lot of professionals. It’s step-by-step because obviously nobody is going to rush into this decision.”
Farrell says deciding to live your true gender (what you know internally) is the first step to transitioning. Then there are things to consider such as changing your gender legally, changing your name, hormonal treatments and possibly a series of operations.
“It’s a life-long connection with the medical system and those service providers,” she says. “It could mean voice lessons, it can mean coaching around walking and demeanor; for male-to-female it’s huge process even around laser and electrolysis and hair removal.”
The fact that younger people are coming forward speaks volumes to Farrell about their family relationships.
“If we look historically, there has always been transgender people. There always will be,” she says. “But for kids to come forward at a younger and younger age, that means to me, the way I interpret that, is that they belong to a loving, healthy family. They know they can share their true self because their parents are going to hear them.”
More startling for Farrell is the older clients she encounters, for those who have lived in the ‘wrong body’ for much of their lives.
“If you think they have spent 50 of their years living in the wrong body and how torturous that must have been and they have done everything to fit in,” Farrell says. “(In many cases) they have done the marriage, they have had children, they have done what is expected — so how brave is that, at that stage in life, to say, ‘I can’t do this anymore’ and ‘it’s time for me to be authentic,’ knowing that they are going to upset people and knowing that they will probably have some losses, and that they will cause other people pain by their decision, but knowing they have to.”
That is why Farrell often meets with spouses and other family members as well. Not all marriages can survive such a drastic life change, but some do.
For those serious about exploring the transition from one gender to the other, the path is long but the support is available.
Many from this area would seek a referral to the CAMH (Centre for Addictions and Mental Health) Gender Identity Clinic.
For many, like 12-year-old Julia who was featured in part of this series on Wednesday, the process is underway to determine what the next steps in the transition will be. In her case, it might end up being hormonal treatment to help block puberty until she is of legal age to make a decision about surgery.
For others, such as James Spencer who will be featured in Part 3 of the series on Friday, the wait can be much longer.
Dr. Nicola Brown, a psychologist from CAMH’s adult gender clinic, says overall the wait list to get in for the initial assessment is at about a year right now.
Brown says she is not in a position to comment about the increase in transgender cases from 10 or even 20 years ago, “but in terms strictly of the number of referrals that are coming in I think it’s the highest we have ever seen.”
“I think as we see greater resources develop and more social acceptance, more social visibility, I think people are both being able to clarify their identity at younger ages and also feeling more brave to come out and really consider transition as a feasible option,” Brown also says.
At the first assessment, clients will meet with psychologists and psychiatrists, Brown says. There is a life history interview, which covers whether the individual has a history of gender issues, a current dysphoria, if the individual wishes for transition as well as current family circumstances and support.
There are certain steps of criteria, Brown says, when heading in the direction of surgery, including eligibility — which for some surgeries means a certain amount of time spent on continuous hormone therapy — as well as readiness criteria — which is more complex and includes general aspects of readiness including making sure people have appropriate internal and external resources to manage the surgery.
Whether you’re considering transition at an older or younger age, there are advantages and disadvantages for both, Brown says.
“What we find is for some of the younger folks… often hormones are more effective at younger ages so they often get better physical results and that can also influence how much social acceptance they may have.”
Disadvantages for younger clients centre more around parental support and the ability to support oneself financially.
“It really makes a big difference if you have a supportive family or not,” Brown says. “Sometimes the advantages of being older are you are more established and more financially secure that you’re able to pursue some of things more freely, in terms of transition. Some of the disadvantages are in some ways a doubled-edged side of that, where people talk about being very established in their lives. They’re sometimes looking at very significant social losses — leaving marriages or disrupted relationships with their children or having to come out at work when everybody is very used to them, looking or referring to them, in a particular way.
“We definitely have both younger and older clients who have had very smooth transitions and some also from both groups that have had more significant challenges,” Brown continued.
At CAMH, Brown believes there are still more male-to-female transgender clients, though she said “I definitely think that gap is closing.”
Asked if any research has shown why people feel like they were born in the wrong body, Brown says the question has still gone relatively unanswered.
“Certainly there have been a number of theories that have been investigated over time and none have consistent evidence,” she says. “The truth is we don’t know, but what we certainly do know is that for folks that are ready and good candidates, the medical interventions do make a big difference in their sense of selves and often improve the quality of their lives.”
In Part 3 tomorrow: a feature including interviews with former Cobourg high school student James Spencer — who was born female and is now living as a male and attending Clarke High School in Clarington — as well as Cheri DiNovo, a Toronto MPP and transgender supporter.