Doctor's Article

[Zabrak]

Pinocchio’s Wish



It had been a typical workday for me…ear infections, asthma, some depression counseling, a laceration to suture. And then I opened the door of Room 3 and found the soul of a boy trapped in the body of a girl. He sat there in the corner of the room, slim, pale, and tense with emotion, twenty years old and fragile. Shaking, he opened his mouth and said, “I want a sex change. This is the first time I have ever talked to a doctor about it.”


Initially, I comforted Casey, listened a lot, and asked a few questions, while my mind raced ahead and around the corner, wondering what to do next. Family physicians learn to expect the unexpected after a while. And while we don’t always know the answers, we usually know how to go about finding them.


Casey told me he spent hours on the computer every day and had been a male online ever since the age of 12. He felt completely comfortable in this role. As a small child, he remembered wishing very hard that he would wake up as a boy in the morning…and also remembered the aching disappointment that waited silently for him every morning. This reminded me of the story of Pinocchio who used to wish to be a “real boy”, until the Blue Fairy finally granted his dream.


As I live in a small town, I immediately set to researching resources for him. And I hit a series of walls. Transgender issues? No, Mental Health can’t deal with this. Try the Transgender Program in Vancouver. And when I called the Transgender Program, I discovered that funding had been cancelled and it was no longer a referral center. I spoke to a transgender issues counselor who was very helpful and pointed me to a website containing hundreds of pages of helpful information. I sighed. It would be up to me.


I saw Casey once a week as he worked though this initial crisis and gradually got to know his history very well. A difficult childhood with an angry, critical mother. A loving grandmother who was the one family member supportive of him. An intelligent boy with college aspirations and a retail job. A boy with many computer friends but no local flesh and blood friends. A boy with a boyfriend in another country, who liked to stay in his room, away from the questions of others. He was patient with me as I tried to wrap my brain around these concepts. Ok…so you have a boyfriend? So that means you’re a gay man trapped in the body of a girl? He smiled. Yes, that’s right, Dr. Mandy. Ok, I get it.


So I sat down one evening and learned about the process of getting a sex change. I understood that the person has to be deemed psychologically and physically ready for such a change, as the hormonal treatments cause irreversible changes. I discussed all this information with the patient. He initially saw a psychologist in the nearest big city but the encounter did not go well. Casey returned to me in fresh crisis. This would take months of psychological assessment and he had no money with which to travel or pay the psychologist. He was considering ordering unregulated hormonal supplements over the Internet, feeling desperate that the system was not working for him. He was about to start college and wanted to begin his new life as a male. I spoke with the psychologist and took over the assessment myself, because there was nobody else who could do it in my town. I read many documents on the subject. We completed the full psychological assessment over a series of months and then I referred him to the endocrinologist who accepted him as her patient and could see we had followed the proper assessment protocol. I was so happy that Casey decided to be patient and work through the process with me rather than take dangerous unregulated substances from the Internet.


He began to live openly as a man, filling in the official forms for a name change.


Now, a year after I first met him, he is receiving biweekly testosterone injections and his voice is deepening and his neck is becoming fuller. As his outer appearance becomes more and more attuned to his sense of self, a new glow and confidence emanates from him. He is excited and hopeful about the future.


This experience showed me how difficult it is for transgender people, especially in small towns where there are fewer services. The system also makes it very difficult for people without money to access services. For instance, normally a psychologist charges the patient privately for the assessment. In this case, the patient could not afford to pay the psychologist repeatedly over a period of months and I took over this role myself. Without a formal assessment, an endocrinologist will not prescribe hormonal therapy. Access to the system is unjustifiably difficult and is undeniably one of the reasons why transgender people feel so marginalized and misunderstood.


The day is coming soon when Casey will wake up in the morning as a real man. The Blue Fairy finally came through for him.


By:
© Dr. Mandy Ruthnum