The Clarke Institute in Toronto (now CAMH) was the world’s most notorious clinic for its pathologization of sex and gender minorities. According to patients forced to use the Gender Identity Clinic at the Clarke, it was just a two-day-a-week operation and a sub-unit of the sexology department, whose main job was to work with convicted sex offenders. Trans patients had to go into the locked, secure, 4th floor section, where the convicted sex offenders were held. Patients used the same hallways, waiting rooms, and offices as sex offenders, and the people who saw you simply changed hats depending on who they were seeing.
In order to receive federally-subsidized mental and medical services, patients had to submit to various types of sexualized testing given to criminals, including detailed descriptions of masturbatory fantasies and in some cases penile plethysmography. Not only is this questionable scientifically, it is potentially as unethical as a lawyer forcing clients to submit to similar testing in order to receive federally-funded professional services.
The following submissions came in following my 2003 request for first-hand reports:
- Sharon (mid-1970s)
- Ruth (1977-1995)
- Lesley (200-2003)
Sharon’s experiences (mid-1970s)
In the mid 1970âs, when I was in my early twenties, I sought the assistance of the Clarke Institute of Psychiatryâs gender identity program.
The conflict between my gender identity and my sex arose at about age 9. By age 12, I had come to understand that I was in fact a girl, and that I needed to change my body to conform to the way I felt inside.
At about this time, the newspapers reported the first experimental organ transplants, and the enhancement of topless dancersâ breasts using silicone injections, which led me to speculate whether or not the same methods could be used to make my body female.
Unfortunately, I was very tall for my age â already over 6 feet, and still growing rapidly. I knew that this would be great obstacle to passing as a woman, and it was a tremendous source of anxiety.
I needed to start shaving at a younger age than most boys I knew. Had I been a boy, this might have been a source of pride and self-confidence, but I was a girl, so it was hell.
At about age 13, I read a newspaper article about transsexualism, and the existence of endocrinological and surgical treatment. It was a great relief to know that I was not alone, and that medical treatment existed. Through my adolescence, I never wavered in my desire to be female in all respects.
The Clarke made clear from the outset that research was the major focus of their program. I was supportive of their conducting research, but I soon realized that they offered precious little in the way of treatment, and then only to the small fraction of applicants they accepted into their program.
They scheduled numerous appointments for all manner of tests and interviews. I was interviewed by at least two of their staff psychiatrists, including Dr. Freund, who tried to console me by pointing out that this problem was not my fault. I already knew that. The other psychiatrist focused a lot on my height, and pointed out that I would have a lot of problems, which of course, I already knew.
Several of my appointments were at nearby hospitals for various medical tests. I recall that one of them involved some sort of an imaging scan. I handed the test form to the technicians, one of whom giggled when she read on it âtranssexualâ, Fortunately, all other medical professionals I encountered at the hospitals treated me with respect.
My assessment by an endocrinologist led to the one bright spot in my Clarke experience. He was new to their program, and I recall that they talked him up as being a leader in his field, and something of a coup to have on their team.
I found him understanding, and willing to help. As part of his assessment, he asked to see me completely in the nude, so that he could get a sense of what hormones might do for me. While acknowledging that my height was an obstacle, he expressed the opinion that my body could be successfully feminized using hormones. This was music to my ears!
Even better, he offered to start me on estrogen right away, and I was thrilled to accept. At my first opportunity the next day, I presented my prescription to a local pharmacist, but there was a set-back. I was told that they could not provide the prescribed dose. At first they refused to explain the problem, but eventually told me that the unit of measure was out by a factor of 1000, e.g. micrograms vs milligrams. Fortunately, they were able to reach the endocrinologist by phone and quickly resolved the problem, but it was a nervous moment.
It felt wonderful to start on hormones. Soon, I had a follow-up meeting with the endocrinologist, at which he asked me a favour â would I be willing to meet some of his medical students, to provide them an opportunity to meet someone like me. He wanted to include that experience in their training, in the hope of promoting better understanding. Recalling the giggles from the imaging technician, I could see the potential benefit, so I readily agreed. We had the meeting, and it went very well. Needless to say, I was feeling much better about the Clarkeâs program.
With the completion of the medical tests, my appointments reverted to the Clarke. As I recall, one of the staff asked how I liked their new endocrinologist. I responded very positively, and expressed my joy at finally having been prescribed estrogen. Upon hearing this, the staff member freaked, and next thing I knew, I was confronted by more senior staff, who told me that the endocrinologist had not been authorized to prescribe the hormones to me. They demanded that I turn over the unused portion of the drug, else they would drop me from their evaluation.
I felt I had no real choice in the matter, so I reluctantly complied. It was a huge let down, and from that point, the Clarke experience was just something to be endured.
One of their evaluations required that I present myself dressed as woman for an interview with one of their staff, which was to be videotaped. Since I had not transitioned, and would not have passed in public, they agreed that I could change into my feminine attire on the premises. They left me alone to change in the studio where the interview was to be taped, but soon I noticed the cameras slewing to aim at me. The bastards were taping me dressing! I complained, afterward, but they just sloughed it off. It was now becoming clear that I was much more of a test subject to them, than a human being.
One of the final tests involved the plethysmograph. A contraption designed to measure penile response while the subject is shown various pictures. I was told not to speak, and to focus my attention on the pictures. I was surprised to find that some of them were from the session for which I had dressed as a woman. I remember little else about the test itself.
Afterward, I chatted briefly with the test conductor, as we walked down the hall. Trying to make the best of the awkward situation, I commented that I guessed it was valuable to have the opportunity to obtain scientific data on transsexuals. To which he responded that few true transsexuals were available for study, in contrast with homosexuals, who were available âby the wheelbarrowâ. Clearly, I was just a data point to him.
Finally, I met with Dr. Steiner and several other of the staff, who told me, âYou are not a transsexual, and you do not need a sex-change, at least not now.â Dr. Steiner warned against rushing to feminize myself on hormones, because in her opinion that accounted for most of the sex-change. I was told that I required years of intensive psychotherapy, and they offered to recommend some doctors. I told them, âthank you for nothingâ, and walked out. I was little more than a research subject to them â research that spawned such nonsense as Dr. Blanchardâs theory of autogynephilia.
Within a year, I found a gynecologist who readily agreed to my request to begin hormone treatment. My body responded wonderfully to estrogen, and within two years, I had a pleasing bosom, and my hips had filled out â finally skirts fit properly! Having greater access to my female emotions was great, as was losing my male sex drive.
In the end, I found the prospect of transition too daunting. I was not at all confident that I could overcome the problems of my great height. I did not have the emotional strength to deal with the rejection of family, and the abuse of strangers. Living as a man is hell for a woman, but living as a woman seen by everyone as a man, likely would be even worse.
Nevertheless, I completed facial electrolysis, and I love the softness of my skin. My hair is shoulder length, femininely cut, and I love it! I have never for a moment regretted feminizing my body. After twenty five years, I could not imagine not having breasts. For me, some feminization has proven much better than none. It made my life bearable, though far from happy. Successful transition is the only way to have a chance at true happiness.
I am fortunate to have meaningful and intellectually stimulating hobbies, into which I can escape for brief periods. I am also fortunate to have a few good friends.
Sharon
Ruth Bramham experiences (1977-1995)
My first experience of the Clarkeâs Gender Identity Clinic dates back to 1977.
To set the scene, I was married with a 3 year-old son and my longstanding GID conflict was definitely causing much stress in my life, to the point that my wife spilled the beans to our family doctor. To my great surprise I found a sympathetic ear. My past experiences with the medical profession on this subject had definitely not been happy. (Oh go get married you silly little boy and it will go away! I did, âitâ didnât.) The doctor contacted the Clarke and I was promised an appointment.
It was almost 6 months later when I was notified of the December appointment dates and times. I was given 10 days notice for a series of interviews that would take up four full days. I held a senior position in a major construction related company. The week of the interviews I had annual meetings and seminars already arranged. Needless to say I told them I was busy. Their attitude was to treat me like a recalcitrant child and put me to the bottom of the waiting list.
I am known for a my acerbic wit in letter writing when the need arises. I let them know I was not amused, not a know-nothing, and certainly not going to wait for another six months. I received new dates within the time frame I âsuggestedâ (February).
Those interviews and the procedures I had to endure were a shock. It was as if I was a sex offender being evaluated for serious sexual deviations. The line of questioning was all about my sexual experiences, masturbation, fantasies, etc., as related to crossdressing. The penile sensitivity testing was particularly demeaning as were the photographic sessions. Six weeks later I received the results of this âevaluationââI was deemed to be a transvestite with transsexual tendencies. They told my wife that with psychotherapy I could learn to control my âurgesâ. At the time I kept a diary of everything that went on in my meeting with the Clarke staff. It would have made interesting reading today. My wife found it years later and consigned it to the garbage, along with everything she could find of mine related to transsexuality.
I endured about a year of psychotherapy, becoming more and more depressed. I knew I wasnât a transvestite, but back then, if I was married with a child, I couldnât possibly be transsexual. After all, true transsexuals had to be homosexual and attracted to men. (It was odd that female-to-male TSs were never, ever mentioned.) Everything came to a head when my wife finally decided sheâd had enough and I was told to leave just before Christmas 1978. I had never lived alone in my life.
The Clarke psychotherapist was no help. In fact he hardly uttered a word during our bi-weekly sessions. The only direct suggestion I ever received from him was: âIf you want to be a woman, you have to go out and be one, full time, for at least a year.â There would be no help or guidance. That was counter-productive to proving I was really a woman. At the time, I was 34 years old, 6′-0″, 170lbs, very athletic and extremely hairy with a noticeably balding head. I also had a fairly deep baritone voice. In my mind, there was no way of accomplishing the switch to their satisfaction. I tried for one day. I shaved my arms and legs, âborrowedâ one of my motherâs wigs and got dressedâyes, I had a fairly reasonable wardrobe of conservative clothes. I made one trip to the local mall, was read by a couple of local yokels (mid-town Toronto) and had to run for it. I was scared silly. My psychotherapist just laughed at me when I told him. âWhat did you expect?â he asked. âThereâs no way youâll pass for a woman.â I was crushed.
Later I learned that the Clarkeâs idea of passing successfully was limited to the so-called homosexual TSs. It was inconceivable to them that a âsecondaryâ TS could ever pass successfully 24/7. Part-time passing was not acceptable. Blanchard then was but a twinkle in Dr. Freundâs eye….
Early in the morning of March 25th 1979, I tried to commit suicide. God had other ideas. I had a profound, religious experience that left me exhaustedâand sleeping like a baby for the first time in many months. All the pain, stress and the obsessive nature of my GID was gone when I awoke the next morning. What was still there was my distinct sense of self-identification as a woman. The psychotherapist was very skeptical as I explained what had happened. I never saw him again. I did rejoin my family, now able to cope with my sense of self.
In fact I didnât return to the Clarke for another three years after my wife and I broke up and divorced in 1982. For the next three years I saw Dr. Betty Steiner every six months and was allowed to have a âpalliativeâ dose of hormones (a contraceptive pill called Ovral – 0.5mg Estradiol + ). This was my âstand patâ period. Despite being discouraged from doing so by Dr. Steiner et al, I met many more TSs, helped run a support group, wrote articles and generally educated myself like never before. Boy, did I ever have my eyes opened!
And I met Dr. Ray Blanchard and Len Clemmensen. However, I was never invited to their early group therapy sessions which began somewhere around 1983. At the support group meetings Clarke bashing was the sport of choice…. yes, even back then! Generally, the most common complaint was their intransigence over diagnosis. It was always âProve itâ. âShow us you really are a woman by living and working full time. Bring us your pay stubs and documented proof you are working in the gender you aspire to. And weâll see you every six months.â
Dr. Steiner retired in 1986 (I think) after producing the infamous tome that was the first attempt to bring together the collective âwisdomâ of GID research to that date. âGender Dysphoria: Development, Research, Managementâ. I recognized myself as one of the anomalies mentioned! No wonder she wanted to see me regularly for so long! Messrs. Blanchard, Clemmensen, Freund, Zucker et al all had a hand in its writing.
In 1985 I somewhat reluctantly reunited with ex-wife and son as he was definitely âoff-the-railsâ. Being both Christians, âliving in sinâ was not an option. We remarried, and I was forced to cut ties with both the Clarke and the TS community. All items of my âsinfulâ nature we expunged from my life. My wife made doubly sure not even a single scribbled note remained. Thus began a period of enforced self denial as my son was put back on track.
My relationship with my wife was purely platonic. I had no interest in sex. In fact Iâd always had a problem with sex. I found it a real chore, distasteful and not ârightâ. The word for it is âasexualâ. It was a condition, I learned, that the folk at the Clarke took with a large grain of salt. After all, I had fathered a child, hadnât I?
This marriage lasted five years believe it or not, the last two with me living in the basement. During those two years, I was finally invited to join the Blanchard/Clemmensen âGender Solutions Groupâ. What a farce! It was basically meant to explore alternate solutions to surgery, accepting your chosen âlifestyleâ, and discussing ongoing daily difficulties. Most of those attending were not transsexual, being a mix of crossdressers, she-males, non-ops and up to four TSs. The views of the TSs were rarely heard above the aggressive cacophony of the CDers and she-males. It was definitely an âus vs. themâ atmosphere played to the hilt by the âgood cop bad copâ routine of Blanchard and Clemmensen, the latter usually being the âgood copâ. He received much teasing from the others because of his relatively quiet manner (like us TSs…). Of course our Mr. Clemmensen was hiding a deep secret of his own. Today âheâ is known as Maxine Petersen.
It was during this time that I met Dr. Steinerâs replacement as head of the Gender Identity Clinic, Dr. Robert Dickey. He would not authorize me taking hormones again, despite my previous record with Dr. Steiner. âThings have changed,â he said. It was also early in this period that the clinic was moved to the 4th floor of 250 College Street, apparently to consolidate all the departments within the Division of Forensic Psychiatry. We now met with the staff in a high security area behind locked doors. As you will have gathered by now, the Clarke Clinic staff had no interest in looking after the needs of their patients. Seeing the regulars every six months was adequate and the others could be viewed during the group therapy sessions. Yes, the Clarke Clinic is purely a research establishment, with staff working mainly on their Forensic Psychiatry duties and part-time on Gender Clinic duties. With no unauthorized access allowed, there was no possibility of forming any sort of benign, helping relationship. It is the epitome of a âgatekeepingâ establishment.
Fast forward to 1992. I was working in London Ontario and had met âKarenâ, a postop TS woman who had a horrendous story to tell about the Clarke. I now saw another side to the rigidity of their position. But thatâs another story. The Fall of 1992 saw me out of work (the recession) on hormones at last through an independent endocrinologist introduced to me by Karen. Dr. Dickey was not amused.
Then, in November, I was diagnosed with Mycoplasmal Pneumonia with Pleurisy. Part of the symptoms for this consists of coughing up some blood in your sputum. I was. Frequently. Two series of anti-biotics failed to clear it up as it went from one lung to the other. By Christmas I was well enough to have Christmas Dinner with my father. I relapsed shortly thereafter. By the end of January, they didnât know what to do, so I was sent to see a pulmonary specialist. After a lung scan revealed multiple (20+) blood clots in both lungs, I was hurriedly admitted to hospital. After some further discussion, the hormones were targeted as the culprit, and in turn, Deep Vein Thrombosis in my right leg. Nobody had warned me that taking hormones had potentially nasty side effects. Obviously I recovered. Obviously God wanted me around a little longer!
On leaving hospital at the end of February, I made the decision to begin transition full time 24/7, cold turkey! It was now or never. My next appointment with the Clarke Clinic was only a week away. So I showed up in âRuthâ mode dressed appropriately. Another quirk of theirs was the insistence that we MTFs dress unambiguously, that is, we show up for appointments there in a skirt or dress, not pants.
I expected to see Dr. Dickey. Instead an intern appeared to interview me…. as if this was my first visit there! And yes, he asked all the most inappropriate sex centred questions, about fantasies, masturbation, etc. I told him not to waste my time as those questions had been asked many times before and to please read my file! He actually commented to me that he was new to this and to be patient with him. There was no supervisor with him. I had to remind him to note that I was now presenting in the female role full time. It was before this visit to the Clarke that I learned that Len Clemmensen was now Maxine Petersen. I met with her briefly in the corridor. She had stayed on the job during transition. Talk about the ultimate, benign employer. Basically she was her own supervisor with help from Blanchard and Dickey.
In consultation a few weeks later with my endocrinologist, we discussed how I could resume taking hormones. Since the hospitalization I had been taking Warfarin to keep my blood from clotting. Now he suggested I could resume hormones at a low dose level coupled with the Warfarin. To be on the safe side, he suggested I undergo an bilateral orchidectomy, so that the low dose would have a more significant effect… i.e., cut off the source of the dreaded testosterone. Being in Canada and covered by a pretty comprehensive government medical plan, I was able to have the cost covered. By July, I was back on hormones (Premarin @ 1.25mg.).
Needless to say when Dr. Dickey found out I was reprimanded for not informing him prior to the surgery, as he frowned on such surgery so early in the transition. It was irreversible you know! I then discovered he had not started the clock ticking for the official two year transition period to qualify for government funded SRS. I had not provided proof that I was now working, or going to school, or volunteering full time. He wanted signed timesheets or pay stubs or school attendance records! Fortunately I had started volunteering full time at the local Employment Help Centre. So I had to arrange with the office manager to fill out time sheets every week (being volunteer based they didnât usually do that). I could see that the Clarke Clinic was going to make my journey as difficult as possible.
The bout with pneumonia and DVTs had left me with a severe depletion in lung capacity. I was out of breath after walking up four steps. Working full time three months after discharge, even as a volunteer, was exhausting, but I knew I had to do it, or wait even longer for surgery. (We were still deep in a recession with no hope for paid work even if I had the stamina for it. My unemployment benefits expired and I was forced on to welfare.) I was seen twice more over the next year (1993-94). They tried to question my records, but my supervisor wrote to them confirming everything. I had let the other staff in on what I was going through. The support I received from them was nothing short of exemplary.
The second year, I took a government self employment programme, being one of the 12 selected from 120 applicants. Dickey had told me bluntly that self employment was out of the question as I could not satisfy the third party verification. Again I had to bare my soul to the supervisor, and again I received full cooperation, even to the extent of a custom designed reporting form especially for the Clarke!
My two year Real Life Test was officially completed in July 1995. In June, I tried to arrange for the final interview. I was ignored for three months. My letters, faxes, phone calls went unanswered. It was as if the place had shut down for the Summer. Finally, mid September I received a short note confirming the date for September 29th. I would see Dr. Dickey and one other. My appointment with Dickey was for 8:00 a.m. Although I had to drive into Toronto from London I didnât argue. However, by 11:00 a.m. he still had not shown up and his secretary could not locate him. I was sitting in the lobby of the Forensic Psychiatry department at times in the company of very suspicious characters under escort. He finally breezed in, unapologetic, at 12:15 p.m. The meeting was over in just 15 minutes. I had his blessing. The second appointment was at a different location with, guess what, the same neophyte doctor (then an intern) who interviewed me two years before. He didnât remember me. And he started to ask me the same old questions! I couldnât believe my ears! So I gave him a quick lessonâGender Identity 101âincluding a lesson on the Harry Benjamin Standards. Response? âOh yes, I heard there were some sort of guidelines for this. You know more about them than I do…â I nearly fell over. Here was the doctor responsible for my second letter admitting he knew next to nothing about the subject! I bit my tongue.
Two weeks later, Maxine Petersen gave me the SRS surgeonâs name (Dalrymple in London England) and permission to make initial contact with him. I did, via fax, the same day. Of course he knew nothing about me as the Clarke had yet to send any paperwork. Despite this we set up a tentative surgery date for November 29th. October expired and November was well under way with still no formal authorization letter from the Clarke. I started a fax and phone blitz. At last I was contacted by the government health plan office to tell me they had just received the paperwork from the Clarke (November 10th). The letter I was to carry with me to England would be mailed to me. Five days later I received a faxed copy, but it wasnât until the 20th that I received the actual document, just one week before departure for England. By the way, the government plan only covered the surgery itself, not the travel and hotel expenses. Fortunately my dad, God bless him, came up with the money for that.
I returned to Canada on December 9th, sore but very satisfied. The Clarke had done their best to prevent or at least delay the inevitable. I was now free of them. At last I was comfortable in my own skin, the woman I was meant to be. I did see Dr. Dickey once more but they havenât bothered to follow up since.
Update 25 May 2003
One last thought:
When I first went to the Clarke, I was calling myself Kim Kershaw (Kershaw was an old family name that my grandfather had dropped). I was told quite bluntly that was not acceptable. My name must be unequivocally female. Androgynous names were not allowed. I believe this still holds true today. My family was not keen (understatement!) on me continuing to identify as a “Bramham,” hence the complete change.
Once I was independent of family influence (1990) I resolved not to give in to that type of pressure any more. So I just changed my Christian
names to appease the Clarke and maintained my surname. Besides I really like the name “Ruth”! It’s biblical too! I am Ruth Deborah Bramham, Clarke survivor.
Lesley Carter experiences (2000-2003)
Editorâs note: Leslie has graciously honored my request for submissions from women who had dealings with the Clarke Institute in Toronto. Leslieâs story tells the sad tale of the Clarkeâs faded glory. Now that they do not hold any purse strings, they have no power to speak of over local transgender populations. Leslie found them to be âa bunch of dirty old men, masquerading as clowns⊠stuck in the âivory towerâ mentality of an old, fossilized institution which has grown arrogant and believes it is above questioning.â
âThe Clarkeâ may have changed their name to Centre for Addiction and Mental Health (CAMH), but they remain as out of touch as ever with the patients they purport to help.
Thanks to Leslie for sharing her important story with such thoughtfulness and detail!
My Experiences with the Clarke Instituteâs Gender Identity Clinic
First let me say that I did not have a bad time during my 4 visits to âthe Clarkeâ. On the first occasion they were helpful; the second, polite and mildly complimentary; the third depressing because it was the support group full of depressed people and the last, just plain irrelevant.
I have always been a woman, but was in denial until September 2000. Once I admitted that my condition was gender dysphoria I had to do something about it. Three friends had been to the Clarke Clinic and I knew of no other place where the condition was dealt with. After almost a year of trying out herbals, which did nothing, I had a check-up with my family doctor and broached the subject. He readily agreed to refer me to the Clarke. That was in August 2001 and the appointment came up in April 2002.
During the intervening months four things happened. A friend offered me a bottle of Premarin and I eagerly began taking it on October 9, 2001. From a Yahoo group I found out about a doctor in Toronto who would prescribe hormones. He in turn found me a caring psychiatrist. I was forced out of my home by my family. So when I went to the Clarke it had already passed the time when I needed them for anything.
The biggest crisis in my life came on Valentineâs Day 2002. I was forced out of my home by my adult son, with my spouseâs agreement. They were extremely unhappy that I was âcrossdressingâ â never in front of them and never to the extent of interfering with my familyâs welfare. They refused to consider any information I gave them and wouldnât talk about it. Being ejected without warning was a total shock to me, and I looked around for help and support. The Clarkeâs information package said they could help in a crisis, so I e-mailed and got an appointment with their only TS employee one week after my ouster.
First Contact
I had female clothes, but since the issue with my family seemed to be the clothing I wore, albeit always outside of the house, I stayed in self imposed male clothing for the first month of my separation from my family. I went to the appointment, February 21, 2002, dressed as a man, but still on hormones and still knowing I was a woman. I was received courteously by Ms Maxine Petersen and given ample time to tell my story. Her reaction, and that of everyone else, was that it was plainly wrong for this to have been done to me. I explained that the combination of my spouse and adult son against me made continuing to live there impossible. I was not about to get into a fist fight, something I had never been good at.
I remember asking if it was possible to be a transsexual and live as a man all or most of the time for the rest of my life. She said she didnât know⊠which was a wise answer. We discussed an appointment for my spouse, but she said it would be better for her to see the social workers. Maxine felt unable to deal with irate wives herself. She told me my spouse would be able to come to my April evaluation days as long as I signed a release. While I passed this information on, I found that she had no wish to be involved in either way.
I felt affirmed and relieved that my personal understanding of my enforced leaving home was a sound interpretation. Of course, nothing further could be done to help me get back home without at least minimal cooperation from my spouse. Sadly, that was not forthcoming.
Second Contact
By the time my official evaluation came up I had seen my psychiatrist a couple of times and found him professional, caring and very helpful. He had counseled about 65 Trans patients during his long career. By this time I had given up hope of ever being re-united with my family and had transitioned to full time living as a woman, on March 13, 2002.
April 15 and 16, 2002, were my days at the Clarke. I didnât know what to expect, and was prepared to walk away if I didnât like what I found. I was pleasantly surprised. They no longer put sensors on the genital organs and show dirty pictures to test for gender dysphoria. That would have been sufficient for me to walk outâŠ
First, I saw Maxine and was greeted warmly. I felt a lot more confident than at my last visit, as I was reconciled to probably losing my marriage, though not by my choice. I gave her my two photos as requested, âcrossdressedâ (actually neither was that as they both showed me as a woman), my questionnaire and my biography. We chatted for almost an hour and she rather apologetically asked me what turned out to be the key question at the gender clinic: âWhat do you think about when you are masturbating?â I told her. I was rather amused that they considered masturbation habits to be relevant to the diagnosis of gender identity.
My next interview was with Dr. Choy. He was also friendly and apart from saying with a smile that I had jumped 2 or 3 steps ahead of where I should be it was a pleasant experience. He also asked about my masturbation fantasies and I told him the same story.
Finally I was seen my Dr. Dickey, chief psychiatrist of the gender clinic. He was accompanied by his nurse, an older woman. He was very relaxed and gave me his opinion that gender dysphoria was a condition from birth. He also asked about my masturbation fantasies and I gave him the same answer. That was the most significant question I was ever asked, but clearly shows confusion between gender and sex. Or, perhaps an attempt to prove the validity of the autogynephilia theory of Dr. Ray Blanchard.
He asked me what I did about facial hair removal and I said I shaved. He advised me to start my electrolysis now. It wasnât bad advice, but I didnât have the money and they of course pay for nothing. It amused me that he felt he had to tell me that women donât have facial hair! I was offered a piece of paper that he proposed was a âpretend ticketâ for sexual re-assignment surgery and asked if I would take it. Of course the answer was yes â a no-risk, no-brainer decision since they didnât fund it any more anyway. I guess I passed the test.
He asked me for any comments on their service to me and I had to mention that it had taken 7 months to get an appointment. He pulled a sad face and I sympathized that they had budget and staff cutbacks. He seemed glad to have the understanding and support from me⊠say, who was the therapist here?
In response to his inquiry as to any final questions I might have I asked this: âI donât mean to be impolite, but can you tell me why I might ever want to come here again?â He took it well, thought a minute and came up with three possible reasons. First, if my psychiatrist didnât work out they could provide that for me. Second, if I needed a letter for surgery, after a full two years of full time experience of course, they could do that for me, or provide the supporting letter. Third, I could attend their support group.
I had not heard the last item mentioned yet that day, but now it had become the âJewell in the Crownâ. I knew about it, so I said, âBut, I canât go there yet.â He seemed taken aback and said, âOf course you can go. You can go as a man; you can go as a woman; you can go dressed as a bunny rabbit!â While I was amused, and I think it was just his wacky but well meaning way of telling me that there was no dress code, it did make me wonder about this man. I later characterized them all as a bunch of dirty old men, masquerading as clowns!
After the hour the nurse walked me out to the locked door â this is a high security facility. She asked me if it was my own hair (no, Iâm bald) and complimented me on my good taste in clothes (white blouse and tan knee-length skirt). She spoke rather distastefully of the âcrossdressersâ they sometime saw who dressed too flamboyantly.
The next day I was scheduled to see Dr. Betty Chan, Endocrinologist and Internist, at her office away from the Clarke. I say scheduled because even though the printed copy I had with me said 10, they had me down for 11 am. So I went and had a coffee first.
I had brought a photocopy of my latest blood test results, which she seemed glad to have. I was interviewed briefly about general health, and my HRT regimen. Then I was asked to strip down, in private, put on a paper dress and lie down for a physical examination. She was very discreet and gave me the same courtesy she gave all her female patients. She checked my blood pressure and said it was too high so I should ask my doctor to double my spironolactone and halve my Premarin. (The first my doctor agreed with and did, but he laughed and dismissed the second as typical of the Clarkeâs extreme conservatism.) When I was about to leave I asked for my blood test results back and she seemed a bit taken aback that I wanted them, but photocopied them and returned my copy. She told me I didnât need to come back, which was good as I had no need or intent to return anyway! To be fair to her, I should mention that she had a cold and was probably not feeling well.
The months went by and I was busy moving and re-establishing myself as a woman, in my new community. I knew the support group didnât meet in July and August, and I had nothing back from the evaluation days. I e-mailed Maxine on May 14, 2002, asking about both and received no answer until late July. She told me then that she had been very ill and off work, which I sympathized with in my return mail. The recommendations following from the evaluation had not been sent out during her time off to recuperate, but she said they were the standard ones: continue transition; be under medical supervision for HRT; wait full 2 years before surgery. She gave me the date of the first support group meeting, and I resolved to attend it.
Third Contact
Wednesday September 18th, 2002, at 6 pm I went up to the 4th floor of the CAMH building and found over a dozen people waiting to be let in behind the locked door for the first meeting of the season. All were male to female types. One of them I knew already and said hello to her. I wore womenâs cargo pants and a top and most were similarly dressed. A couple wore skirts and blouses, conservative and tasteful. Many made no attempt to look like women. Some looked scared.
We were taken to a crowded room which had about 18 chairs, for 16 of us. There was no coffee or other refreshments. We were asked to sign a confidentiality agreement. Nothing that took place in that room was ever to be revealed outside or we would be banned! Was I joining a secret society? I could understand that since this group was open to every variety of crossdresser, transgender and transsexual, privacy was important for some. Maxine was in attendance, but said little. She introduced a student who was really to be in charge, a nice young woman who was pleasant, but detached. I had the feeling that the prevailing atmosphere was, âWe know you arenât really women, and you know it too, but we will all pretend so you can feel good about yourselves.â I didnât feel good. I knew I was a woman and found them condescending and oppressive.
We went around the circle introducing ourselves. There were 2 or 3 post-ops but most had not transitioned yet. Some were depressed, some hostile, some paranoid. I felt uncomfortable as I had none of these problems. My intro was brief and to the point: hormones begun October 9, 2001, transitioned March 13, 2002, surgery scheduled November 21, 2002. Most of the people told stories of doom and gloom. Problems in womenâs washrooms, hair removal that hadnât worked, rejection by families, severe depression not fully responding to treatmentâŠ
I told my little story about the two Pentecostal evangelist ladies who had visited me a few weeks before and didnât understand what I meant when I said I wouldnât be acceptable in their church because of my âgender dysphoriaâ. Iâd had to say something to enlighten them, so I made the explanation that âI used to think I was a man, but I havenât had any surgery yet.â They immediately told me that I should remain the way God made me and not do anything to alter my body. They took my hands and prayed for me very movingly, always using âherâ and âsheâ. I had initially marveled that these were so untypical of many Christians who criticize and ridicule transsexuals. It struck me several hours later that they were convinced I was a genetic female who had at one time been tempted to masculinize myself!
I made the point that while I have a very femme body and pass easily, I believed that the most important ingredient was confidence. It could have happened to any one of them if they just believed in themselves. A few people were impressed favourably. Most just sat there⊠they preferred to tell their sad takes of woe and receive sympathy. The leaders did very little to guide the discussion or give helpful advice to anyone. They looked bored. They told one woman that she transitioned backwards because she did it at work before she transitioned at home. I felt sad for her. It wasnât a confidence builder. I felt very much out of place. Iâd gone into every possible situation before and since my transition and felt completely at home, but I wanted to get out of this artificial and stultifying place. When it was announced that our time was up at 7:30 pm I was glad to get out of there, and never went back. They had nothing to offer me. If I went weekly I would have been depressed!
A long time Clarke girl told me later that the Clarkeâs method was to deliberately intimidate, so you would be able to stand up to the scorn and ridicule of the outside world. I found that strange as the outside world was a very comfortable place for me to live and be at ease in. Only the contrived Clarke atmosphere was hard to take. There is such a thing as anticipating trouble, so that it becomes a self-fulfilling prophesy⊠I think they do their clients no favours by this âprogrammeâ.
Fourth Contact
I was expecting a 6-month recall interview and sure enough, a week before I went to Thailand for my surgery the envelope arrived. It had been sent to my old address in Bowmanville. I checked, and I had advised the Clarke of my current address in August. More surprises ahead! Inside, the letter said, âDear Andrewâ, which was never a name I owned or used. Furthermore, the date of my appointment was to be November 20, the day before my surgery, when I would already be in Thailand. I had mentioned that at the support group, but obviously it hadnât made it into the system.
I phoned and left a message explaining why I wasnât going to make it on that date on their voice-mail, then e-mailed and ccâd to Maxine. Within 20 minutes I had a reply, apologizing profusely and thanking me for my âgenerous offerâ to keep in touch after my surgery. Since it was worded so winningly I decided that I would contact them on my return, once I felt up to it.
You can read my surgery story at http://www.kindredspiritlakeside.homestead.com/lesley.html .
In early February I e-mailed Maxine and said that I was ready have the interview. She asked me to come in on February 28, 2003. I told her I was the biggest success story she would ever have sitting in her office. I showed her my psychiatristâs letter to my surgeon, and my surgery photos. I offered to e-mail them to her, and did so at her request. She was interested in my psychiatrist and said she would invite him to join their new advisory committee. I told her I knew about it, but I wasnât interested in applying to join the committee.
I discussed âwhat the Clarke could do for peopleâ and asked why they doubled the Harry Benjamin standards. She told me about a few F to M TSâs who had dropped out of the programme and come back years later to thank her for not giving them hormones and thereby causing permanent sterility within months. That was the basis of their âhigherâ standards. I mentioned that a few handouts would really help clients: steps in transitioning; friendly electrologists; legal name change etc. She agreed it was a good idea. But after over 25 years in the business of âhelpingâ Trans people they had nothing to give them.
Maxine was surprised to hear that the SRS surgeons in Thailand donât follow the Harry Benjamin Standards. I was surprised that she was so unaware of that fact, and that many hundreds of people from all around the world prefer to go half way around the world rather than submit to the humiliation of the treatment gender clinics like the Clarke mete out.
I told her I try to steer as many people as possible away from the Clarke and to my own doctors, who give excellent service. She just shrugged. In light of their meager resources and diminishing budget I asked if I could volunteer and help them in some way. She said no, the only possibility was the advisory committee. I suggested that since they were not my support group I thought they should at least pay for parking, since I was aiding in their research. I was frostily told that they never did that.
So we didnât part on the friendliest of terms, which was not my intention. She is a nice woman and as helpful as she can be within the restrictions the institution places on its staff. It seems the idea of being responsible to their clients is offensive to them. They are stuck in the âivory towerâ mentality of an old, fossilized institution which has grown arrogant and believes it is above questioning.
In ConclusionâŠ
When they were the gatekeepers for government funded SRS they had great power. Now they are irrelevant, but still keep on in the same authoritarian way. Perhaps it is a good thing to have them to care (?) for those with serious co-morbid conditions beside gender dysphoria. It seems that many in the âsupport groupâ have fallen through the cracks of the health care system and they at least have something there. I know several people personally who went away from the Clarke weeping, yet found help elsewhere. There is no way of knowing for sure, but I believe the number may be quite high. They are success stories in the Clarkeâs book, because they left the programme voluntarily and didnât make the âmistakeâ of transitioning and SRS. At least the Clarke interprets it this way as they have lost touch with them. Iâm told some former clients have committed suicide in despair of ever getting help, but I canât verify that.
Would I go back if invited? Probably, but they wonât like the questions I ask and I doubt if I will hear from them again. I am not going to be put onto their committee and thereby neutralized as a critic of their practices and policies. Itâs too bad they are so insular as they are the only âofficialâ gender clinic in the province of Ontario. This means that every doctor has them in his reference book, and will send patients with gender issues only to them, unless they have specifically asked for another doctor.
I got what I wanted and needed without any help from the Clarke. It felt pretty good that I had gone through the evaluation and was treated with courtesy and compliments. Itâs easy for me to âblend inâ with feminine features and only 5â8â tall, but I wonder, do the big, angular girls have such a good experience from the Clarke?
Maxine did admit grudgingly that âmaybeâ I was one of the ones who didnât need a full 2 year âreal life testâ. Iâm told she took more like 5 years to make up her own mind. I knew after a week that this was the only life for me. I resent the fact that these people deliberately hold back very promising candidates for hormones and surgery just because they wonât treat them as individuals. Itâs a âone size fits all approachâ but we are not all the same! They donât trust us to tell the truth about our transition dates. You have to change your name to an unmistakably female name (mine wouldnât do) and show education receipts or pay stubs to prove you have lived it. Apparently âBig Brotherâ knows best⊠in their book.
I was 3 months on hormones before I found my hormone doctor and only 5 months full time before my psychiatrist recommended me for surgery. That would be considered irresponsible by the Clarke, but for me it was appropriate and worked. I like the way my psychiatrist put it better: âAny nurse, or secretary, can go down a check list and tell you when you have qualified for hormones or surgery. I assess you on the basis of my 23 years of working with trans clients and you are a classical transsexual.â I would never have heard that kind of statement at the Clarke.
My surgery experience is posted at http://www.kindredspiritlakeside.homestead.com/Leslie.html
Sincerely and lovingly,
Lesley Carter
Lesleycarter2000@yahoo.com
Update â November 2005
Iâm now 3 years post-op and living a happy and anonymous life in the community with my partner. I accompanied her just a year ago to the same SRS surgeon I used and her results have been equally good. Iâve had little contact with the CAMH Gender Clinic but sometimes talk to their clients.
One girl who went on their advisory board confided in me that they were still rigidly standing by their old principles and she doubted they would ever change. I had anticipated that. Another contacted me because she was due for an appointment and couldnât get a reply back from them. She eventually did, and I had lunch with her in the CAMH Cafeteria. Itâs a huge 12 story building with all sorts of addiction and mental health clinics. It might have been my imagination but I thought we got a lot more rude stares from passers by than I had in other restaurants.
My opinions of this venerable old institution have changed very little in the intervening years. I still think they do more harm than good, but in a time of penny pinching by the government perhaps that problem will solve itself. What we need is more private physicians and psychiatrists who will give proper care to those who wish to transition and the means of finding them easily. Too many doctors would rather not touch anything as controversial as feminizing transsexuals. Even the Clinics who do give care to transsexuals are notoriously conservative. One of them has a used needle disposal system in their patientsâ washroom, with a notice that they operate a needle exchange. However, they still insist on a minimum 3 month wait after first contact before prescribing hormones and have turned some down. One candidate who was turned down for health reasons came to me for information. She has been happily on âoffshoreâ hormones for 6 months with no ill effects and is planning on SRS next year. Why are hormones considered more dangerous than illegal injectable heroin?
Our provincial government is considering re-listing SRS as a surgery that is funded by our health care system, but moving painfully slowly in that direction. If they do I want 3 new standards built into the plan: 1) free choice of the preferred surgeon (with a reasonable maximum limit on the price of course), 2) approvals by nothing more restrictive than the Harry Benjamin Standards â http://www.hbigda.org/soc.htm , and 3) allocation of sufficient funds to clear the 7 year backlog and provide enough surgeries to meet the real needs, not the 10 a year that it averaged before. Not to be too much of a pessimist, but I have my doubts that they will ever actually pay for it again.