'The gender thing': Barriers to health for trans New Zealanders

by Jenny Nicholls / 22 October, 2018
US model Rain Dove signed with an agency that allows her to appear in both men’s and women’s shows. “For me, that was so important, because I didn’t feel like I was male or female,” Dove said. “I just felt like I was I.” Photo/Getty

US model Rain Dove signed with an agency that allows her to appear in both men’s and women’s shows. “For me, that was so important, because I didn’t feel like I was male or female,” Dove said. “I just felt like I was I.” Photo/Getty

RelatedArticlesModule - Gender

Two new studies promise to throw a lifeline to trans New Zealanders.

“I mean, my body is sometimes this thing I look at and think, ‘What strange, alien thing grew around my consciousness?’” US model Rain Dove told The Guardian in a recent interview. “It’s like this weird fungus that’s just there.”

Dove was born female, but “passed” as a male firefighter in Colorado for 11 months before becoming a model. She has quite the backstory, and dazzling looks – but it is, perhaps, her insights and intelligence transfixing the press.

Although her Wikipedia entry uses the gender-neutral pronoun “they”, Dove told The Guardian to “use she, he, it, one, they. You could call me mow mow and I honestly don’t care. A pronoun is just a sound. All I’m listening for in that sound is positivity.”

Her tranquil wit – “I went to whatever bathroom was the shortest line" – sets journalists to furious scribbling and suggests it’s all been a doddle. In fact, as she admitted to one writer, she has been pepper sprayed by someone who thought she was in the wrong bathroom.

Doves modelling debut was certainly a memorable one for her booker: “They handed me some underwear and said, ‘Go put on your outfit.’ I said, ‘Okay, but where do I get the outfit?’ and they were, like, ‘That’s it.’ Just the underwear. It was a men’s underwear show!”

The newbie had been booked by an agent who hadn’t realised the 1.9m (6ft 2in) Dove came with breasts attached. “I could [have said], ‘Hey, there are some things in my body that don’t align with the particular marketing scheme you have in mind for this garment.’”

But she didn’t.

“I walked out topless. The casting director looked like he was going to shit himself.”

Brave, but not career-ending. Dove now appears in women’s and men’s fashion shows – she says she wears an “angry face” when modelling menswear – has shot ads for the likes of Chanel, models for Vogue, and is dating #MeToo activist Rose McGowan. She is one of a number of gender-fluid pop-culture stars whose success might lull us into thinking their life is easy, or all about clothing.

Dove now appears in women’s and men’s fashion shows. Photo/Getty

But this is not remotely true.

“Public health researchers are becoming aware that trans persons represent one of the most marginalised and under-served populations in medicine,” warned US researchers Tiffany Roberts and Corinne Fantz in 2014 in the Clinical Biochemistry Journal. They felt the need to explain the difference between sex and gender on their paper’s second page.

“It is important to understand that the terms ‘sex’ and ‘gender’, while often used interchangeably, have specific medical and psychological meanings. ‘Sex’ commonly refers to physical characteristics whereas ‘gender’ represents identity and self-image.” As Dr Jaimie Veale, a lecturer in psychology at the University of Waikato, explains, “Gender is what’s in your brain and sex is what’s between your legs.”

Biology 101 tells us human men and women have different chromosomes: XY for men and XX for women. But biology 101 oversimplifies. Sex can be assigned by a blizzard of bodily forces – anatomy, hormones, chimeric cells and chromosomes – and these can clash.

“Nature loves diversity,” says Veale, “but society doesn't, always.”

Biologists versed in human gender now see human sex as a spectrum. As an article in Nature proclaimed in 2015, “The idea of two [human] sexes is simplistic.” A fun Twitter account to follow is “gender of the day”. Sample tweet: “Today’s gender is the sound of thunder in the distance” (73 retweets, 166 likes).

And so the old gender certainties are shrugged off, although it’s really no laughing matter. There are plenty of international studies on what we do to those born into a sex they don’t want or understand.

A 2013 Canadian study, Reported Emergency Department Avoidance, Use, and Experiences of Transgender Persons in Ontario, Canada, revealed that dealing with medics leaves many trans people with a dislike of hospitals so intense they avoid emergency departments.

Surely this wouldnt happen here? North & South can testify that it does. A trans person we know was involved in a serious accident. The thought of going to hospital was so scary she lay at home for days without seeking care. When admitted to hospital, she was initially too zonked to realise that while painkillers were being generously supplied, the hormones prescribed by her GP a year earlier were not. When she was able to raise this with the nursing staff, she told them an earlier attempt to go off them had resulted in her having suicidal feelings. However, no hormones were supplied and she was unable to continue her treatment until she went home after being discharged.

A 2015 paper by Dr Veale and Dr Frank Pega from the University of Otago notes that in overseas surveys of trans people, up to a third reported attempting suicide. A US survey of 6450 trans people in 2011 revealed that 41% reported attempting suicide, compared to 1.6% of the general population.

Despite disturbing international data like this, published research into trans welfare in New Zealand is almost non-existent. Our best data comes from a single survey of teenagers. In the Youth’12 health and wellbeing survey of 8500 secondary school students, 1.2% described themselves as transgender. These young people were five times more likely to report attempting suicide than other students.

What happens to these kids when they grow up? A 10-year-old series of interviews by the Human Rights Commission gives us some clues. One trans man who returned from the US called it a “utopia” compared to New Zealand.

The commission’s report concluded that, in this country, most trans people cannot access the services necessary for them to live “in their gender identity and appropriate sex”.

Since then, little has improved. We know this because Gloria Fraser, a PhD student at Victoria University, is studying trans health care in New Zealand. She hasnt finished her analysis yet, but her work points to wide variations in the care offered by different DHBs.

“There are huge structural barriers to accessing gender-affirming care,” she says. “My participants shared with me how difficult it is to find providers, including GPs, who are knowledgeable about transgender health. Those that are, tend to be overwhelmed with demand. Many services are dependent on age, so gender-diverse people age out. Evolve, for example, is a queer- and transgender-friendly service in Wellington, but they are only funded to support people until the age of 24. So for lots of patients, coming up to that age is scary. There are fewer transgender-friendly services once people get to their late 20s and older.”

Some DHBs, she says, report they have no dedicated funding for services like hormones or surgery, at all. The ones that do often demand a mental health assessment before a trans person can even chat with an endocrinologist (a specialist in hormone-related conditions). While many DHBs provide funding for this mental health assessment, some DHBs require patients to access it privately, often at a cost of $500-$1000.

Veales project, Counting Ourselves, an anonymous survey for trans and non-binary people, has just closed. More than 1000 people responded.

The survey results, out next year, are likely to show, she says, that trans people are still being treated poorly by the health system, still being refused care, and still fear being mistreated. And many are saying – as they did a decade ago to the Human Rights Commission – that they have to educate every medic they interact with about the basics of their care.

A new era may be dawning, though, with a pilot Gender-affirmative Hormone Clinic in Wellington set up to side-step ponderous DHB systems – and promising trans-led initiatives in Auckland, too. Because it just shouldn't be that hard.

GP Cathy Stephenson is a member of the working group behind the Wellington clinic. She says the vast majority of patients need either support and advice, or to talk about gender-affirming hormone therapy. Most won’t be thinking of surgery – possibly because it has been too hard – but also because they may not want that.”

For a treatment that is so transformative (and possibly life-saving too), hormone therapy is cheap. The highest dose of oestrogen (a feminising hormone) costs $40 for a three-month supply. Testosterone blockers (often part of the same treatment) cost less than $20. With testosterone injections, says Stephenson,it depends on what you have, but the three-monthly option is around $90”.

She believes it isnt cost that’s the problem in getting health funding, but awareness of the importance of this type of treatment for these patients”.She calls her work with the clinic one of the most rewarding things I have ever done. It isn’t complex from a medical point of view, but is life-changing for patients.”

Trans experience has, surely, much to teach us, including insights into sexual bias. Take the female-to-male Stanford neuroscientist who, having recently transitioned, heard a fellow academic say, “Ben Barres gave a great seminar today, but then his work is much better than his sister’s.”

Dove has a brave manifesto. “The gender thing doesn’t exist,” she told BuzzFeed News. “It’s a social construct you don’t have to fit into.” Her implication – that gender is a choice, freely made – is one few of us, trans or not, might honestly agree with.

Family Doctor has a guide for trans patients, GPs, friends and family here

This article was first published in the November 2018 issue of North & South.


How this remarkable native insect is being saved
104836 2019-04-20 00:00:00Z Planet

How this remarkable native insect is being saved

by Jenny Nicholls

Principles of bird conservation are helping to save another remarkable native you’ve never heard of.

Read more
Environment Ministry 'unashamedly proud' of bleak report's honesty
104868 2019-04-20 00:00:00Z Planet

Environment Ministry 'unashamedly proud' of bleak…

by RNZ

The Secretary for the Environment Vicky Robertson said she was proud of the report's honesty and it was an important stocktake for the country.

Read more
The new What We Do in the Shadows is more dad joke than demonic
104712 2019-04-19 00:00:00Z Television

The new What We Do in the Shadows is more dad joke…

by Diana Wichtel

Diana Wichtel reviews a new American TV series based on the hit Kiwi comedy.

Read more
Louis & Louise is a satisfying exploration of gender and identity
104230 2019-04-19 00:00:00Z Books

Louis & Louise is a satisfying exploration of gend…

by Brigid Feehan

In her latest novel, Julie Cohen traces the parallel male and female lives of a single character.

Read more
Win a copy of Sir David Attenborough's Life on Earth: 40th Anniversary Edition
104844 2019-04-19 00:00:00Z Win

Win a copy of Sir David Attenborough's Life on Ear…

by The Listener

To celebrate Sir David Attenborough season on Sky, we are giving away copies of his book Life on Earth: 40th Anniversary Edition.

Read more
The Kiwi behind the powerful Aspen Institute's Queenstown launch
104788 2019-04-18 09:00:50Z Profiles

The Kiwi behind the powerful Aspen Institute's Que…

by Clare de Lore

Thanks to the determination of Christine Maiden, NZ has joined an international leadership network that aims to work on issues important to the future

Read more
Science must trump ideology in the GE debate
104784 2019-04-18 08:52:29Z Politics

Science must trump ideology in the GE debate

by The Listener

A New Zealand-developed super-grass that appears to drastically reduce greenhouse gas emissions might be blocked in this country by the Green Party.

Read more
Simon Bridges hails PM Jacinda Ardern's capital gains tax u-turn as victory
104803 2019-04-18 00:00:00Z Politics

Simon Bridges hails PM Jacinda Ardern's capital ga…

by Jo Moir

The National Party is calling the u-turn on a capital gains tax a massive failure for the Prime Minister.

Read more