Selected quotes related to themes*
| Theme | Quote |
|---|---|
| Justifying need for health care in the face of structural discrimination | |
| 1. “I started to try to talk to my GP, my family doctor at the time, about starting HRT. And she was pretty resistant because she didn’t know anything about it. Which I tried to push, you know, [local health organization] offers a free training like for doctors so that it’s not bottlenecked through their doctors. And she wasn’t really interested.” — Participant 11, trans man (he/him) | |
| 2. “Nobody is the expert of my body… I’m the one who lives it every day. And my voice is not centred in care. And that’s a problem.” — Participant 13, trans/nonbinary person (they/them) | |
| 3. “It’s like a burden on us to have to continuously put in that work when we do want to just be able to rely on our providers and our care team.” — Participant 9, trans man (he/him) | |
| 4. “Got approval for funding sometime later in the year. And then it’s only valid for 2 years. So you have to get into surgery in [city] within this 2-year timeframe.” — Participant 4, male (he/him) | |
| 5. “Then you get charged to ask your doctor to fill out the forms. And sometimes it’s $100, sometimes it’s $200, depending on how many pages.” — Participant 7, male (he/him) | |
| 6. “They’ll pay for [genital surgery], right. You have to do that electrolysis first. And that’s thousands of dollars.” — Participant 15, male (he/him) | |
| 7. “I had my gender changed on my card. So they had struggles with that because the [electronic medical record]. The card says X, and there’s no X on the [electronic medical record].” — Participant 14, genderqueer (they/them) | |
| 8. “It was definitely difficult showing up in a women’s ward as someone who’s masc-presenting.” — Participant 5, queer/nonbinary (he/they) | |
| 9. “I don’t know if it was just the fact that I didn’t get to have that in-person consult with the team, or if it was because it was a bit of a language barrier thing, but… I remember asking a nurse something about risk of hematoma or what I should look out for. And that word did not translate well, and she kind of just brushed it off.” — Participant 2, trans man (he/him) | |
| 10. “Nobody was speaking to me. Everyone was speaking in French. And I can’t speak French. I have nothing against Francophones. But you’re laying on the table, and you’re getting stuck 6, 7, 8, 9 times, and you’re like, ‘What the fuck is going on?’ And nobody’s talking to you.” — Participant 13, trans/nonbinary person (they/them) | |
| 11. “Because I’m trans, I had to go through that 2-letter process… that whole interview was nothing but invalidation of my identity and a complete ignorance to trans and non-binary folk.” — Participant 3, transmasculine (he/him) | |
| 12. “And [the mental health assessment to access gender-affirming surgery is] just a gruelling… it’s just a very ‘prove you’re trans’, type of thing.” — Participant 20, trans man (he/him) | |
| Fear and previous traumatic experiences | |
| 13. “I just have to deal with whoever I get, and hope to God they’re not transphobic.” — Participant 5, queer/nonbinary (he/they) | |
| 14. “On a broad kind of swatch of trans folks, many folks experience multiple forms of oppression. So why aren’t you operating from a trauma-informed lens? That doesn’t happen. And part of the reason why that is, is because it’s a shock. You’re literally moved like you’re on a conveyor belt from station to station.” — Participant 13, trans/nonbinary person (they/them) | |
| 15. “I feel like entering any type of medical setting, I’m always just a little bit on edge.” — Participant 20, trans man (he/him) | |
| 16. “And I hate say this, but… you don’t want to correct anyone too hard because you need their help.” — Participant 15, male (he/him) | |
| 17. “In terms of informed consent, I’m not sure that there is such a thing when you want something so desperately that you really can’t make [any other] decision.” — Participant 8, trans man (they/he) | |
| Community as a source of support and information | |
| 18. “It was so awesome to see other people who looked like me sitting in the waiting room. Representation is everything.” — Participant 15, male (he/him) | |
| 19. “I also just really liked being in a space with a bunch of trans people where, like, everyone was trans. And you could just be exposed to people like that, and feel in community, in little ways.” — Participant 19, trans woman, transfeminine (she/her) | |
| 20. “It all just felt, like, very normal. Like not there’s something different about me or that anyone was treating me at all differently… it was just: you’re a person, you’re here for a procedure, and we’re going to do it.” — Participant 1, female (she/her) | |
| 21. “I had to live with my parents for the first week after surgery. My dad wanted nothing to do with me during that week, and wouldn’t even be around me or wouldn’t really even look at me. My mom did help take care of me and get me what I need and made sure I was doing well. But it was tough because the surgery was really, really exciting for me and I just wanted to celebrate it.” — Participant 9, trans man (he/him) | |
| 22. “There isn’t really a focus in general on mental health when it comes to giving birth and stuff. But what is there is so gendered that I would then be triggered in a different way if I tried to approach that. Because a lot of women will talk about this stuff together.” — Participant 10, nonbinary transmasc (he/they) | |
| Impact of interactions with health care professionals | |
| 23. “Do you want to lose time getting health care because you don’t want to see a transphobic doctor? And you just put up with it? …It’s really horrible.” — Participant 14, genderqueer (they/them) | |
| 24. “I was misgendered the whole time in front of a whole room of people. I know my body was being stared at… I felt like I was that sideshow attraction, and I didn’t like it.” — Participant 3, transmasculine (he/him) | |
| 25. “It almost feels like the wait time is purposeful to some extent, where they want to give you that time to second guess yourself.” — Participant 12, trans man (he/him) | |
| 26. “In terms of trust within providers… referrals getting lost, things taking a long time, I feel a little bit jaded with the health care system.” — Participant 9, trans man (he/him) | |
| 27. “I’m always nervous about doctors…like how offensive will you be today? But she was really lovely.” — Participant 20, trans man (he/him) | |
| 28. “Not uncommon to have people react in ways that make you acutely aware that they’re having some kind of an emotional reaction that is distracting to them taking care of you for the reason that you’re there.” — Participant 8, trans man (they/he) | |
| 29. “I know what it’s like to go in seeking help, feeling really scared and vulnerable, and then you meet some person who asks you if you have feeling in your penis…is that really a pertinent medical question to ask right now? Is that relevant to the treatment that I need? Or is that just your curiosity? Like put a lid on it. You can think that, but you don’t have to say it.” — Participant 8, trans man (they/he) | |
| 30. “I never even thought about how affirming that would be to have someone say, ‘I’m sorry that this is being gatekept from you. You should be able to just go do this.’” — Participant 10, nonbinary transmasc (he/they) | |
| 31. “The room I ended up in was the room right across from, like, the nurses station, like meeting room for the staff. And so every morning I would hear them be like, ‘The patient in a room whatever goes by [name] and uses they/them pronouns. If anyone has questions about that, we can practise here. You need to get this right.’ And it was just so nice that people not only did it to my face, but they were doing it out of ear shot.” — Participant 17, genderqueer (they/them) | |
| 32. “Knowing that someone did that surgery on me because they wanted to makes me feel a lot better about my scars that I have. It makes me feel proud to have them because I was …excited, and the provider was excited.” — Participant 9, trans man (he/him) | |
Note: GP = general practitioner, HRT = hormone replacement therapy.
↵* Gender identities are presented using the participants’ own language.