I belong to a great running club at the uptown Waterloo Running Room. We run, we talk about running, we run some more, and then we go home. Over time, friendships form as we learn a little more about each other’s lives outside of the club. This past year I’ve watched and learned as one of my running mates has been making a gender transition from male to female. I was curious about Stevie’s gender journey, and some of the health aspects related to being transgender in KW. Stevie was gracious enough to grant an interview so I wrote the following blog article as an exploration of Stevie’s experience to share her insights and reflections …
Just last year, endurance athlete Stevie Chapple was living a fairly typical Kitchener life with a house, a job, a good marriage, two grown children and an active, healthy lifestyle. But something felt wrong, out of place. “When I would get dressed in the morning and look in the mirror, there was this guy looking back. I always felt depressed about that, and I didn’t know why”. Chapple had these strong feelings that a big change was needed but was confused and uncertain about just what. “I’d wake up in the middle of the night and I’d go down on the internet and I’d try to figure out “what is going on? What am I? I’m not gay, but what am I really?’” Then one night in December 2016, Chapple came across a drawing somebody had posted online and the pieces fell into place. The drawing was depicting someone’s experience being transgender. It showed a woman looking into a mirror and a man looking back. “That was it! That was me! It was so powerful, just a eureka moment”.
Being transgender means your gender identity does not match your biological sex from birth. For people like Stevie, their biological sex is male, but their gender identity is female. The pronouns Stevie uses are “she” and “her”. In others, their biological sex is female, but the identify is male. And for non-binary (or gender-queer) individuals, they don’t identify as exclusively masculine or feminine — they could identify as a 3rd gender, or outside our understandings of gender altogether. In many (but not all) transgender people, the experience of being in the wrong body can lead to significant emotional distress about this identity or gender dysphoria. Gender dysphoria replaced the previously used diagnosis of gender identity disorder that categorized transgender people as mentally ill. Gender dysphoria describes the distress a person has with their gender until it is corrected. This distress can be anything from the way a person’s body looks, feels, fits into clothes etc. The feeling of depression that Stevie experienced is unfortunately not uncommon in the transgender community.
According to the Journal of Psychiatric Clinics of North America, anxiety, depression and distress are more prevalent in transgender individuals. In fact, the 2011 Trans PULSE research study found that almost ⅔ of male-to-female transgender individuals in Ontario had symptoms consistent with clinical depression and high levels of anxiety. 77% seriously thought about suicide, and 43% had a history of attempting suicide. I find these rates disconcerting. So for further insight, and for other questions I had about the transgender community, I talked to Allisa Scott, a social worker, consultant and trainer in private practice who has been working with the local transgender community for nearly 7 years. According to Scott, “These rates are explained due to the extremely high levels of transphobia, discrimination and lack of acceptance of transgender people in Ontario”. Stevie says she herself has noticed a high prevalence of depression in the transgender community. And she said “it would have been a suicide” if she hadn’t come out.
Stevie’s distress and questioning dates back to childhood, but at that time, she didn’t know how to express it. She always felt out of place, especially during puberty. She says that she felt more feminine than other guys she knew. Her dad was a military man and ran a strict household. “You were not allowed to have an opinion. Open thinking was not allowed”. He was both verbally and physically abusive to Stevie and her family. In college, Stevie wondered if she might be gay. But when she explored that further, it wasn’t really the right fit and she didn’t know why. Questioning her gender identity wasn’t even conceivable to her at that time. The only images she saw in the media were negative ones of “transvestites on drugs or as prostitutes”. Stevie felt a lot of pressure to find a partner, settle down and follow a traditional life path. So she soon married and had two children. The first marriage fell apart, but then Stevie met her second wife and they were together for 20 years. During this time Stevie kept herself very busy. She worked overtime hours, took evening classes, worked on house projects, and she found a passion for endurance training – running, swimming and cycling. Since 2002, Stevie has had an extensive racing career. She has competed in several marathons and ultramarathons. She also completed 3 full Ironman Triathlons and at least 20 half-ironman competitions. Training has not only kept Stevie in top shape, but the 20-30 hours per week spent exercising provided a necessary distraction. “Keeping busy kept me from looking inside all the time.” This strategy worked for a few years. But in the last 5 years the confused feelings were coming up again. Says Stevie, “the last time [the feelings] came right to the surface just like a tidal wave”. That led to her eureka moment and coming out as transgender.
Gender transition refers to the emotional, physical, medical, social and psychological changes a person needs to make in order to become their true gender. Transition looks different to everyone. Some people will change their name, gender expression and pronouns but not their body. Others have surgeries so their body and identity are more congruent. The question of surgeries and type of transition is very personal and diverse. For Stevie, sitting down and coming out to her wife in January 2017 was the hardest thing she’s ever done. “I was embarrassed about it, I felt so ashamed”. She was in tears. Stevie hoped that they could work through it and they could stay together. But that didn’t happen which was painful for Stevie. They soon split, Stevie got a new apartment and they sold the house. Stevie turned for medical support for her transition. She found a therapist in town who specializes in gender and sexuality. The therapist only needed to ask a few questions to confirm what Stevie was thinking. They readily provided a letter of consent that Stevie took to her family doctor. Her doctor, in turn, needed to provide a referral for an endocrinologist before Stevie could start taking hormones. Her medical doctor didn’t really know where to refer her, so Stevie consulted a transgender chat group. There she learned about an MD in London who had a fairly short waiting list. According to Stevie, this doctor has been a great support, really taking the time to explain the options with her. “He had the best bedside manner I’ve ever seen”. According to Scott, until very recently, very few medical professionals understood, accepted or knew how to work with transgender people in Ontario. Says Scott, “It often resulted in many people not getting the medical supports they need for transition which would put them back in the closet.” With changes in training and work to build a more supportive community, access to medical and physical transition has started to become easier for many people. Unfortunately, there are still long wait lists which can result in increased anxiety and depression as well as delayed transition for people.
The endocrinologist put Stevie on Suprefact (a Testosterone or T-blocker), estrodiol (a form of estrogen) and progesterone. The T-blocker is a nasal spray that goes directly to work on the signal from the brain to the testicles. The progesterone was recommended for breast and nipple development. According to Stevie, her body is really responding well to the hormones. Within a week, she noticed her hair and skin were softer and then her breasts “fired up”. She had a continuous burning sensation in her chest as her breasts developed. At the 2-month mark, she already had A-cups. And her hips got bigger as well. Scott refers to these changes as “experiencing a second puberty” and says it is often part of the joy of transition. Says Scott, “It gives them a chance to experience puberty as it felt right to on their terms.” Since being on hormones, Stevie went for an eye exam and was pleasantly surprised to find that her previous astigmatism has corrected itself. Stevie’s optometrist suggested that the hormones could be the reason for the correction. Stevie has noticed emotional changes as well. “When I first went on the hormones, it was a calming effect, almost like a relief. This is where I need to be. OK, finally, I’m on the right track.” She also finds herself more easily upset. Before the treatment, she cried only four times over 20 years. “Now it’s four times per week! I just think about something and I just start crying”. She said her thinking has changed too. Before the hormones, Stevie was more independent of others and did what she wanted at work. “But now, I ask people more for their opinion and I don’t want conflict”. She tries to make more compromises with people. Things are changing for Stevie sexually as well. “It’s not like the old male self, when you look at someone and you get a sexual urge. Friendship is more important first and then it’s the sexual intimacy part”.* I was not sure if the emotional changes that Stevie attributes to the hormone treatment are typical. So I turned to Allisa Scott for their expertise. Says Scott, “this is very, very common, and something that professionals discuss prior to going on hormones.” They continue, “In our local transgender community, there are many support groups who spend time discussing this because the emotional changes are quite drastic in people’s lives. In addition, it changes the brain and creates new neural pathways that have a lasting impact on people when they medically transition.” The research on the effect of testosterone and estrogen on our emotions and behaviour is controversial. Whether or not there is a biological sex difference for personality is beyond the scope of this article.
Other Medical Treatments
Stevie is also undergoing electrolysis, laser therapy, speech therapy and, at the time of the interview, has two surgeries planned: The first is in October of this year – facial feminization surgery (not covered by OHIP) to have her adam’s apple shaved and her jawline altered. She also has plans for bottom surgery, but she has to wait 12 months of being on hormone therapy and being fully out in the community before she can even apply to surgery. Then she will apply to have sexual reassignment surgery covered by the Ministry of Health and Long Term Care by way of CAMH’s (Canadian Association for Mental Health) approval. The typical wait time to obtain surgery after completing assessments with CAMH is 1 to 3 years. In Canada, there is currently only one doctor who performs bottom surgery for transgender people. He is training other doctors so this waiting list should be shorter in the future. In addition, other surgeons are becoming accredited to perform surgeries to reduce wait times.
Transphobia has been an unfortunate part of Stevie’s experience. She worries that when she goes out in public, she is not going to “pass” as a woman. “My feeling that I’m going to be judged on who I am. It’s their looks – I know I’m going to get that reaction, it makes things difficult.”. She even had one person in a wheelchair rotate around to take a second look at Stevie. “How obvious can you be!” she laughs. The accumulated stress experienced by transgender people due to transphobic incidents results in “minority stress”, a specific type of stress related to identity and navigating society as a transgender person. Although she has received a lot of positive support from the running community, Stevie has also experienced some negativity. Other runners have expressed their concern that she is competing as a woman when they know she was assigned male at birth. The rules about transgender competition vary depending on the association and the location. But the International Olympic Committee (IOC) and now the Ironman Competition state that she just needs to be on hormones for 12 months. For her two most recent races, Stevie contacted the race committees beforehand and explained her situation. For both races, they were very accommodating and she was able to run as a woman.
Being Out at Work
Stevie is a maintenance manager for a retirement home, and her coworkers and manager have been very supportive. They all use the correct pronouns and gender terms when talking about or to her. Some have commented that she’s now more outgoing and seems more comfortable with herself. Says Stevie, “I think it’s the coming out process that does that”. When you no longer have to hide yourself, your true personality comes out. At work, Stevie hires contractors to come in for special jobs and for the most part they’ve been really understanding. “I have electricians, plumbers who just ask what’s going on. I tell them and they say cool”. One time a fire safety officer from the City of Kitchener made some snide comments and refused to work with Stevie. She reported it and soon received an apology from the fire chief.
The Role of Stress Management
A lot has happened for Stevie in the last 12 months. She has not only been adjusting to a new identity, but she went through a relationship separation, moving to a new home, and she has been juggling medical appointments and support group meetings. I was curious how she was handling the stress of it all. “Stress has gone through the roof. I’m definitely sleeping less.” Stress can be a significant factor in any person’s transition. But there are many things that can help. Fitness has been important throughout Stevie’s transition. “I did a lot of running with the run group this year – including three 50 KM races. But lately I just run by myself. It clears my mind and it makes me feel better”. She’s also changed her diet for the better. She cut back on processed meats and now eats more vegetarian meals. A local support group called Gender Journeys* has been an invaluable foundation for Stevie’s transition. It’s a free 10 week program that provides people like Stevie with guidance and resources and an opportunity to discuss what they’re going through. Stevie says that the group “runs 2 and half hours and that time just flies by”. Through Gender Journeys, Stevie has made connections and friends in the KW trans community. “The circle just gets bigger and bigger and I get more support from that”. Massage therapy can be a great stress relief for those transitioning. Raven Parkinson, the massage therapist here at Healing Path is a trans woman. She says “basic relaxation treatments can boost dopamine and other hormones which can help those with anxiety and depression.” Also, if someone with gender dysphoria has a therapist like Raven, who is open and supportive of their transition, regular massage can help them “feel a bit more comfortable in their own skin.” Raven agrees that transitioning can be stressful. This is especially true for her early on in her transition, when she was getting out and meeting people for the first time as a different gender. “You tend to worry that others are going to react poorly”. Without proper support in place, that experience can affect a person’s mental health.
Getting to know both Stevie and Raven has been a real inspiration for me. It was quite powerful to hear their life and health challenges. I asked Stevie what she thinks she gained from her transition:
“I think I have been unchained totally. The mental barriers are all gone. I still get the dysphoria and some transphobia. But I can now get up in the morning and I can be who I want to be. Now when I look in the mirror, I’m accepting of myself and I’m free. I really am.”
And is there anything else she would like people to know?
“Transgender individuals are people first. Just treat us the way you want to be treated. Don’t use religion and politics as an excuse to discriminate. We’re just people trying to get by, like everybody else. We’re not evil!” (she laughs)
*GENDER JOURNEYS offers support in exploring the social, emotional and physical changes related to gender transition from a psycho-educational and peer perspective.It is an inclusive group, so everyone from across the gender spectrum can attend – regardless of how you identify. You do not need to be medically transitioning to participate either. It is a partnership between Langs Community Health Centre in Cambridge and Allisa Scott’s business Inclusive Counselling, Consulting & Training. More information about their services can be found on their website here: http://www.inclusive-cct.ca/. If you or someone you know is interested in this group, contact Allisa Scott at: firstname.lastname@example.org. You must be 18 years or older. There are a number of great websites to visit for more info including: https://youtu.be/NRcPXtqdKjE – Understanding Gender Video http://itspronouncedmetrosexual.com/#sthash.4H2bzciC.dpbs – Gender Education Website (same person as the above video). http://transpulseproject.ca/ – TransPULSE Project Website www.rainbowhealthontario.ca – Rainbow Health Ontario – Canadian Transgender Health http://www.trans-health.com/ – Trans Health Website (US) http://www.tsroadmap.com/start/tgterms.html – Terminology
A big, big thanks to all those who helped with this article: my naturopathic colleague Caroline Meyer, the Gender Journeys facilitator and local social worker, Allisa Scott, massage therapist Raven Parkinson, and especially, the fabulous Stevie Chapple.
By Dr. Michael Torreiter, ND