Money and Sex (or Gender... or... whatever...)

[bcholmes]

First up, w00t to California!

Second, this announcement has been making the rounds on my friends list: OHIP (the Ontario Health Insurance Plan) will be re-listing sex reassignment surgery (SRS). While that sounds like a good thing, there are some seriously icky footnotes. First, they only expect to cover between 8-10 surgeries a year. That's not a big number. Seriously, I know about twice that many trans people who probably want OHIP-covered SRS, and I'm sure that I don't know even a sizable fraction of the total trans folk in that category.

Second, the Centre for Addiction and Mental Health (CAMH) is gatekeeping the process. CAMH is just the new name for the (Jurassic) Clarke Institute, which is not well-respected by many trans people I've met. Of all the people I've known who've had dealings with the Clarke, I know exactly one who didn't hurl chunks at their programme.

For my part, I had SRS in the period when it was delisted. OHIP coverage for SRS was ended by a former "Progressive" Conservative government under Premier... (wait for it)... Mike Harris. The delisting was mostly the result of noise that came from two Tory MPPs, Frank Sheehan and Marcel Beaubien. Marcel Beaubien applied his political skills toward lofty goals like pressuring the provincial government to do something about the uppity natives occupying Ipperwash National Park

I've had three trans surgeries. I had an orchidectomy in around 1998/1999 (more often called an orchiectomy in the States, I'm given to understand). It was quite a hassle because Ontario had just delisted SRS and the surgeons I spoke to were very concerned about political fallout if they tried to perform the orch in a public hospital. I ended up spending (I think) $1500 CDN -- about half of that cost went to rent an operating theatre in a private plastic surgery clinic.

I had vaginoplasty in November, 2002. I had vaginoplasty in Portland, Oregon and my surgeon was Dr. Toby Meltzer. At the time I booked my surgery (which was about a year and a half earlier), I had seen a number of surgeons present at trans conferences, and one of the big factors, for me, was his technique for constructing the clitoris, which just... hmmm... sounded the most sensible to me.

Vaginoplasty cost me (if memory serves) USD $15,000. Kate Bornstein once remarked that her vagina cost more than her car, and while I can't quite make the same claim (the Prius doesn't come cheap), this is easily the largest expense I've ever had other than the Prius and the various places I've lived. And at the time I paid for SRS, the exchange rate from Canadian to US dollars was abysmally low, so really, the expense was half-again that amount.

Lastly, at the beginning of April, 2003, I had my third surgery, labiaplasty. I'm pretty vague about the cost for labiaplasty but somewhere in the neighbourhood of USD $6,000 is ringing a bell. Dr. Meltzer performed my labiaplasty, but by that month, he'd just set up his new clinic in Scotsdale, Arizona.

I haven't factored in costs for hotels, flights and other transportation, required therapy sessions, hormones or other drugs (I still have leftover Vicodin from my vaginoplasty). (Of them all, hormones have been the least of a burden, as my insurance plan covers them). And electrolysis. I have had more fookin' electrolysis than I care to say. Name a body part and chances are that I've had electrolysis there.

I'm fortunate in that I didn't need breast augmentation, nor did I partake of facial feminization surgery (FFS). And no vocal surgery, hair treatments or shaving of the adam's apple (my adam's apple has never really been visible). And no "revisions" to fix up anything not quite right the first time around.

But those aren't trivial expenses. Now, I've got a good job, and I could afford to pay those expenses. But I have reason to believe that I'm not a representative trans person in that regard. I know too many trans folk on welfare or disability. Or just chronically underemployed.

Now, despite how much I dislike the idea of two-tiered health care, I'm grateful for the fact that I could sidestep the official OHIP process, and hire the surgeon of my choosing. The records of the surgeons in Canada, the US and southeast Asia are fairly well-documented in trans communities. CAMH, if they follow their previous practice, will send the 8-10 transfolk whom they approve to publicly-funded surgeons in England rather than, say, send them to a private clinic in Montreal. I think that's a little dumb, personally.

I was at a Queer Open Mic night in San Francisco the other night, and there was one performer who spoke about body issues and about the pressure for women to remove hair. And at one point she said something like, "I'm sure I don't have to convince this crowd about the huge problems of plastic surgery..." And I know what she means. And yet... I sum up the money I've spent on changing my body. I know I can just say, look, this is different. But there are fuzzy edges. (Am I insufficiently feminist because I've had the hair on my legs permanently removed?)

It occurs to me that I don't tend to talk about this sort of thing very much. In many trans circles, it's all one can do to steer a conversation away from hormones and surgery. And in non-trans circles, well, it scares the horses.

Comments

[lovecraftienne.livejournal.com]

Sounds like we took similar paths; I was on the list when they de-listed, and eventually found private resources. While I think it's wretched they reset the Cluck as the gatekeepers, I think some movement's better than no movement.

Also, word is that those in our boat (who were listed already) may be able to make a claim for reimbursement. I'll post if I get details.

[kalmn.livejournal.com]

i think plastic surgery is inherently problematic. however, i did have a plastic surgery consult this morning, so that's where i'm coming from.

[kalmn.livejournal.com]

and i am fine with talking about hormones, surgery, etcetera. just please, for the love of pete, don't talk to me about problems finding a bra that fits well. 38j me who is going to stay 38j me a while longer after that consult this morning does not want to hear about *anyone's* problems finding bras unless they have heard the magic words from the nordstrom's (or whoever your local high end department store with the good bra fitting ladies in it is) lady who has just ducked out of your dressing room to bellow "hey, does anyone even *make* a [insert your size here]?"

ahem. which is not at all an issue that splits along a trans/nontrans line, i don't think.

[witchicist.livejournal.com]

36ff. I feel your pain.

Although I had a breast reduction, that got them down to a c, i've then had 3 kids, so they're back to an e. but i'm still nursing, so i have hope that they'll go away again at some point.

[sonjaaa.livejournal.com]

With 8 to 10 people per year, I'll get my turn in 2083, woohoo!!!

[mizalaina.livejournal.com]

Like you, I have mixed feelings about it, but I can sum up most of them like this: it's great news, and CAMH can kiss my ass.

[sonjaaa.livejournal.com]

If I go to the CAMH, they will ask me to dig up a photo of me from the 90s so they can understand my manliness and store it on file!

[sonjaaa.livejournal.com]

Wow, I just assumed they'd use a Canadian surgeon like Brassard. Who's in the UK??

[nex0s.livejournal.com]

Plastic surgery is problematic - and there *is* a difference. In fact, I have had plastic surgery - to fix the fact that I got knifed in the face. So, yeah, thank god for a great plastic surgeon - but there's a difference between the surgery I had, and women who plump their lips due to age.

It's so hard to talk about - but there is a difference and I get what you mean, and what the woman at the openmike means too. :/

That said, I really appreciate this post. I knew you'd had SRS, but didn't know the details of that, and while being curious am far too polite to ever ask! Also, "orchidectomy" is an amazing name. Wow.

N.

[redbird]

Part of what's problematic, I think, is counting all plastic surgery as one thing: there's a real difference between fixing a cleft palate, or major scars left behind by an assault, and someone deciding they want a smaller nose or to remove wrinkles near their eyes. It seems to me (as someone who has had none of these things) that what you had done is somewhere in the middle.

Also, it might seem weird to me if all you had had done was to permanently remove your leg hair. But "weird" isn't a political position, really, and nobody trans I'm aware of has chosen only electrolysis or laser hair removal, and no surgery or hormones. (Cisgendered women are as likely to have had electrolysis to remove their chin hair; some probably think it's weird that I haven't.) It's your body, not mine: that's a pretty basic feminist position, I think.

[rbowspryte.livejournal.com]

My Orch was limitedly covered by OHIP. I've had my horrors with the "cluck" too. I still think it's a great step.

[aquaeri.livejournal.com]

It's very odd, because I know there was a time when plastic surgery and SRS felt very similar to me and I'm pretty sure you were exposed to that. And I'm sorry about it now.

Because they largely don't feel the same anymore. I don't want either for myself, but I can wrap my head around the usefulness of SRS, and breast reduction surgery, and other plastic surgery in very particular cases. (The underlying rule has to do with whether something is primarily about appearance or not, and it seems SRS has moved categories in my brain at some point.)

I'm very sorry about how restrictive the re-introduced SRS is. It doesn't seem like anything much to celebrate.

[firecat]

Yeah, I think it's different.

I guess where I draw a line around plastic surgery is when I start feeling that a whole lot of women (because so far I think it is women who get the brunt of the pressure) are basically required to have it in order to keep certain types of jobs or to be part of certain social classes.

Getting glossy botox brochures from my opthalmologist just bugs me. Somehow I doubt your decision to get labiaplasty or any other procedure was driven by receiving glossy brochures in the mail that you didn't opt into.

[the-siobhan.livejournal.com]

There is now a botox ad in my doctor's waiting room.

That was definitely not there last time I went and I have been debating bringing it up wiht her. She works out of a clinic, and it's entirely possible they now have a cosmetic surgeon on staff. It's just... so incongruant with all the eat healthfully/move your body/manage your diabetes/take care of your heart/vaccinate your kids posters that are surrounding it that I find it incredibly jarring.

[indefatigable42.livejournal.com]

Yyyeah, there isn't really a good catch-all word for appearance-changing surgery that has nothing to do with fashion. 'Plastic' carries the connotation of fakeness, while 'cosmetic' makes it sound frivolous.

There are plenty of such procedures that are done to correct a true disorder or deformity, as opposed to being done for fashion. Some of this stuff is called 'reconstructive' surgery, even when nothing is actually being reconstructed (such as building a face for a kid with Treacher-Collins syndrome). From this outsider's perspective, SRS fits pretty well into that camp.

[wild-irises.livejournal.com]

Generally, the folks above have said what I would say, but not completely.

To me, the key word is "cosmetic." I don't object to plastic surgery: burn victims come immediately to mind. I do have doubts and reservations about "cosmetic" surgery. And I do not consider SRS or any of its concomitant pieces "cosmetic."

[epi-lj.livejournal.com]

I think that there *is* a difference between getting plastic surgery to fix an issue vs. getting plastic surgery for what "frivolous" reasons. But when you say fuzzy edges, I can see what you mean in terms of the definition of the phrase, "fix an issue". I mean, is getting old an issue to be fixed? I guess how I'm modelling it in my mind is that I think plastic surgery is unproblematic when the goal is to put people's appearance in line with what would be considered "normal" for a person of their various vitals, and yours seems to fall into that, whereas a lot of elective plastic surgery doesn't (but some of it does). But then, "normal" is again such a problematic term.

Do you think the OHIP coverage is a step backward, or just not-a-very-big-step-forward (or a step sideways)?

[lcohen]

i would try to make some sort of "form vs. function" statement with SRS on the side of function, but a friend just had reconstructive surgery, post-breast cancer and i totally understand that, too, though one can function fine with one breast and that reconstructed breast will not "function," per se. which leaves me firmly in the "i know it when i see it" camp, and isn't *that* helpful?

but mainly, i'm the sort of person where, if a friend told me they were getting injections to plump their lips up i might think "well there's something i would never bother to do" but it's not like i'd criticize them. what other people do with their own bodies is something i try very hard to keep off my "i'm going to get all judgmental on your ass about this" list.

[bcholmes.livejournal.com]

*nod*

I also think there's something about respecting the choices of an individual while still frowning upon the way a large segment of society makes the same choices.

[peculiaire.livejournal.com]

I think that if someone wants any sort of plastic surgery, for form or function, they should go for it - but function should be covered under insurance and form, probably not. I'm not comfortable telling someone that they shouldn't do whatever they want with their bodies.

The problem is that it's so hard, sometimes, to separate out societal pressure to conform to an ideal and an actual internal desire to look a certain way (on the form side. I'm of the opinion that SRS for transfolk is on the function side of the spectrum.) I had someone try to tell me that he knew a woman who got breast implants, because she wanted them. She happened to be married at the time, too. And then she had them removed when she got divorced. I asked if her husband had liked them and encouraged her to get them, and he had to admit that he did. Yeah...