It was an awkward phone call a year ago that forced Jeremy Barbosa to come out to his family as transgender.
Then living, unhappily, as a lesbian, the university student was sitting in the kitchen one day with his sister when the phone rang. It was his doctor calling back with a referral to a gynecologist. Barbosa couldn’t hide what the call was about and his sister asked.
"Holding a secret in, I couldn’t do it. So I finally told her. I got all teary and was like, ‘I have to tell you something’ and she pretty much knew already what I was going to tell her," said the 19-year-old. "Obviously she was mostly just worried that other people might not accept me, especially family members because we’re Catholic."
About a month after telling his sister he was transgender, during the Pride Winnipeg weekend, Barbosa came out to his parents in a letter. [Read the letter.]
"I was too afraid to tell them face-to-face. I knew they had handled the whole lesbian thing well but being trans is something completely different because I would no longer be their daughter, I’d be their son," said Barbosa, who went to a friend’s house for the night to allow his parents to process the news.
"There was a lot of tears for me and my mom, although mostly me. It was just overwhelming I guess because I had kept this secret for so long and now I was finally telling them."
Those conversations were the start of a journey more and more Manitobans are taking, one that involves altering their gender through surgery, hormones and ultimately a symbolic tweak to their birth certificate.
'There was a lot of tears for me and my mom, although mostly me.
Last year, Manitoba saw a spike in the number of people seeking to change their sex, at least on paper.
For most of the last five years, only nine Manitobans asked Vital Statistics to change the male or female gender marker on their birth certificate, typically the last step in someone’s transition.
In 2013, that number jumped to 21, with most people transitioning from female to male.
It’s difficult to know how many of those 21 people had the full menu of gender-reassignment surgery to alter genitalia or remove breasts. That number is tricky to tease out because only some of the many sex-change operations are done in Manitoba or covered by Manitoba Health. It’s one of the many gaps in the network of services that still stymie transgender Manitobans.
As part of a joint project between the Winnipeg Free Press and Red River College’s creative communications program, student journalists profiled three people in various stages of transitioning. Their stories follow below.
The three described a system that is considerably better than it was, but still forces trans people to travel outside the province for some surgeries, still saddles them with big bills and still imposes wait times that can be tortuous.
Ro Walker Mills, who began his medical transition from a woman to a man in 2011, said he’s never been happier with himself.
"But that doesn’t mean that it’s not scary, and that it’s not overwhelming, and that it doesn’t still give me anxiety, or that people don’t still bully me about it. You know the things that continue on afterward, after you’ve had your surgery and people are like, ‘you’re good.’ No! There’s so many things still happening and that’s where the resources are like, where are they?"
Mills is also an example of what can be the significant cost associated with transitioning. He took out a $6,000 loan to pay for top surgery in Florida because he said the surgeons in Manitoba would only remove breasts and not reconstruct them in a masculine way.
Ain’t none of us supermodels.
Trans patients who want to receive gender reassignment surgery — the most expensive and, for some, the most important part of the process — must start with one of the three physicians at Klinic Community Health Centre.
That’s where most trans people begin transitioning by first getting a psychological diagnosis of gender dysphoria. But, the wait-list at Klinic can be long.
"Our waiting list has been as low as four months and has been as long as eight months. Right now, it’s in the six to eight month range," said Dr. Ian Whetter. "We are doing whatever we can with the resources we’ve got."
For Shandi Strong, her transformation really began when she was a little boy and was pressured by friends to stop behaving like the girl she wanted to be. Later, as an adult, she struggled to keep her 20-year marriage solid while still living, at least part-time, as a woman.
"My life was spent as a woman," said Strong. "Anytime we socialized, anytime we went out anywhere, I would come home from work, throw some makeup on and go out."
Today, being a woman isn’t just a part time role that she takes on after work. She’s legally a woman and spends hours presenting herself as such, though children still will read her as a man.
"Kids, they don’t have that filter and they’ll go ‘is that a boy or a girl?’ I still get that," she said. "I want people to know that yeah, you’re going to have that happen. Ain’t none of us supermodels."
Transition story: Shandi strong
Shandi Strong, 52, is a local wedding photographer and is currently writing a book about her transition from male to female.
May 2009: Strong comes out as transgender to her employer of 15 years. She is fired that week.
June 2009: Strong’s wife leaves her. Strong hasn’t spoken to her daughters in about two years.
'The three people that I thought I would never lose, the three people that I was most worried about losing, are the people I lost.'
Five years prior to Strong’s wife leaving, Strong said they discussed how they would make her transition work.
"We made the decision that this is how we’re going to work together so that I can be me... For the entire almost 20 years that we were married I believed that this person was my soul mate... She left three weeks after telling me how proud she was that I came out... A few weeks after that I was kneeling on my kitchen floor trying to decide which knife to use to slit my wrist."
Strong first saw a doctor at St. Boniface Hospital who referred her to an endocrinologist who Strong said wasn’t familiar with the needs of transgender patients.
"I felt a bit like a guinea pig."
Strong said the endocrinologist wasn’t sure how the hormones would affect her. She then saw a doctor at Klinic Community Health Centre.
Fall 2008: Strong begins using spray estrogen.
"I had acne, pimples all the time, I had rosacea on my face, which I was using cream for, I was constantly having ingrown hairs from shaving my legs and stuff like that. As soon as I started taking estrogen, it all went away."
Aug. 2009: Strong changes her name.
'I’m going, ‘OK, you know what you’re talking about! Thank you. I’m now comfortable. Really comfortable with what’s going on with my body’.'
Feb. 2012: Strong receives bottom surgery in Montreal and it is covered by Manitoba Health. She paid for airfare and was reimbursed. Finding out that she wouldn’t have to pay for surgery was a huge relief.
"It relieved so much stress from my life.'
Feb. 2012: Strong changes the gender marker on her birth certificate.
She also changed it on her health card, passport and driver’s license.
"[It] was very straightforward. As long as I had a letter saying ‘hey, I’m going for some surgery’, they were happy to put the ‘F’ on there. I’ve heard of other people having more issues with that."
Transition story: Ro Walker Mills
Ro Walker Mills, 24, is a university graduate and a hip hop artist whose music addresses his transition from female to male.
March 2011: Ro Mills comes out to himself.
"That’s when I knew I needed to take steps towards finding out more information about trans, being transgender and what that looks like even."
July 2011: Mills calls the Klinic Community Health Centre to learn more about his options and speak to a psychologist.
"The first thing I did was call them, and got put on a waiting list. I was probably like number 25 and they could give me no estimate for how long it would take to get in and your expectation was to wait. So that was not fun."
After being on a waiting list for five months, Mills finally gets an appointment with a psychologist at Klinic.
"It took only one visit for her to write me a letter saying that I identify as male, that I have gender identity disorder, and that I qualify for surgery. I didn’t have to pay for that appointment. I got the letter and I was given a referral to a surgeon locally. But getting in took forever."
Aug. 5, 2011: While on the wait list at Klinic, Mills tries his family doctor, who is hesitant to prescribe hormones, unsure how to move forward and not trained to deal with trans patients. Mills takes matters into his own hands, something he wouldn’t necessarily recommend.
"Before I was ever given my own prescription of testosterone I did go to a friend and use his testosterone. I trusted this friend and went about it in a way that I was comfortable with."
After that, Mills’ transition from female to male moves relatively quickly. He returns to his doctor, tells her he’s begun injecting hormones on his own and the doctor offers him a prescription.
"It sped up the process real f**king fast."
Mills changed his legal name before starts taking testosterone
October 2012: Mills gets on a plane and flies to Florida to receive top surgery. In order to finance the operation, Mills takes out a $6,000 loan. Mills says he is happy with the results and the doctor was very well trained.
Mills doesn’t plan to get bottom surgery because he is happy with his body today. He also is unimpressed with the current results of bottom surgeries being offered.
‘It was awesome to see my chest for the first time.'
Today: Mills is going through the process of changing the gender marker on his birth certificate from female to male. He needs it in order to change his passport and feel safe while travelling. The process has been trying.
"It feels very accusatory. They’re so concerned about what? Like a terrorist changing their gender? What the f**k are they worried about, but they’re worried about something. They’re making you go through all these little hoops. It feels not very friendly, that’s for sure."
Transition story: Jeremy Barbosa
Jeremy Barbosa is a 19-year-old university student who is transitioning from female to male and is now completing a pre-veterinary program.
July 2012: Barbosa comes out to himself as transgender.
"Thinking that maybe I’m not actually who I thought I was for the past ‘x’ amount of years was scary because, that’s always scary."
June 2013: Barbosa comes out to his parents. ‘I wrote my parents a letter because I was too afraid to tell them.’ [Read the letter]
Feb. 2013: Barbosa contacts Klinic Community Health Centre and asks to see a psychologist. He’s told there’s a six-month waiting list.
In the meantime, Barbosa came out as transgender to his family doctor and asked for help, but the relationship was fraught.
"It felt like he didn’t fully believe that I was fully trans and that he thought I might be gender queer—somewhere in the middle, not quite sure where I fit in....
"He made me look in the mirror and he was like, ‘what do you see when you look at yourself?’ And then I was kind of hesitant. I wasn’t sure how to answer and then he was like, ‘don’t you think you’re a pretty girl?’ And I was kind of like, ‘I guess,’ but I wasn’t comfortable being a pretty girl because obviously I don’t want to be a pretty girl. I want to be a handsome-looking young man."
May 2013: Barbosa starts seeing a new family doctor. On Barbosa’s first visit, the doctor looks at his family history and prescribes hormones.
"It shouldn’t necessarily be that easy to get hormones. At the bare minimum you should have your hormone levels checked to see if they’re higher than normal because you don’t want to start with a really high dose and then your hormone levels will go out of whack."
Aug. 2013: Barbosa visits Manitoba’s Vital Statistics office, pays $130 to change his name.
'The lady I guess had had other trans people so she was knowledgeable. She wasn’t like, ‘oh, this is weird.’ '
April 2013: Barbosa speaks to his doctor about getting top surgery and gets an unexpected response. Barbosa claims the doctor called top surgery ‘mutilation.’
"I can get away with wearing a T-shirt without binding for the most part. So he had called it mutilation because it might not necessarily be something that I need in my life. But for me personally, and I had told him this, it is something that I want. It’s something that will make me more comfortable with my body. But he just kept persisting with calling it mutilation."
Oct 2013: Barbosa talks to a doctor at Klinic about getting top surgery. He is also considering a hysterectomy and bottom surgery to create a penis.
TODAY: Barbosa is waiting for a call from a surgeon for a consultation regarding a top surgery. He’d like to have the surgery by this summer so he can go to the beach and not wear a t-shirt. Barbosa plans to take a break from school next year to focus on his health.
WHO PAYS FOR WHAT
If there are surgeons in Manitoba capable of performing surgeries, Manitoba Health will not cover the expense to travel out of province for treatment. However, there are certain surgeries patients will be sent to Montreal for including: orchidectomy to remove the testicles, penectomy and vaginoplasty. Patients have to pay for the travel costs upfront and then get reimbursed.
The list of surgical procedures not covered by Manitoba Health is large. It includes thyroid cartilage reduction, breast augmentation, labiaplasty, phalloplasty, metoidioplasty to turn a clitoris into a penis, prosthesis, scrotal reconstruction, breast reconstruction-augmentation, chest contouring and any surgeries which would be deemed "cosmetic" in nature.
Hormones are covered by Manitoba Health in the same way as other prescriptions with partial funding.
Counselling and therapy with a psychologist is not provided free of cost through provincial health care.
The cost of transitioning can range between $30 a month for hormones up to $30,000 for each major surgery. So, depending on the procedures needed, that cost can be high.
Gender dysphoria: Refers to the unhappiness some people feel with their physical sex and/or gender role. The term transgender refers to the different ways a person may experience their gender identity outside of the categories of female or male. Statistics show that roughly 1 in 11,000 men and 1 in 30,000 women seek treatment for gender dysphoria at specialized clinics but these numbers are likely an underestimation of the number of adults who experience some form of gender dysphoria. The majority of individuals with gender dysphoria never seek treatment.
Binding: The process of binding breasts against the body to achieve a less feminine appearance.
Top surgery: For a female transitioning to male this means the complete removal of the breasts and some contouring to achieve male characteristics, particularly in shape and positioning of the nipple. For a male transitioning to a female this means breast augmentation and implants.
Bottom surgery: Females transitioning to male may elect to have a hysterectomy, which removes the uterus or bilateral salpingo-oophorectomy which removes of the fallopian tubes and ovaries. They may also consider reconstruction surgery such as metoidioplasty, the process of turning a clitoris into a penis and extending the urethra through surgery and hormone therapy. Male to female patients may consider the removal of testicles, removal of the penis and creation of a vagina.
Electrolysis: A form of hair removal. A probe is inserted into each hair follicle and removed with an electric current. Sometimes hair can take up to three insertions to die. Treatment can cost up to $50 per hour.