School's Out: Rainbow Health Ontario & the Trans PULSE Project

Yesterday I mentioned that I was on the road to the Rainbow Health Ontario conference and now I’m here! This morning’s plenary session was amazing. It feels wonderful to be in a place created by LGBTQ people and allies for LGBTQ people and allies. And the fact that it’s health-focused has been more relevant for my thinking than I could have imagined, because this is a place that cares deeply about the social determinants of health. Just after I posted yesterday’s blog at a coffee shop pit stop, my partner and I arrived at the hotel in downtown Ottawa (right by our Parliament buildings!) and what did we see when we walked into the conference area? All the washroom door signs had been papered over with gender-neutral symbols!

Shannon's cameraphone photo of a dark brown wooden bathroom door with the conventional gendered washroom symbol or name papered over with a dark blue and white sign that shows an icon of a person in a dress beside an icon of a person not in a dress, separated by a line, and captioned with the words "washroom | toilette"

Well, perhaps it could have been more neutral —what’s been done with this sign is great, but a critique I have is that it still binarizes gender by setting the two conventional images side by each and visually reinforces a separation with the line between the bodies. I wonder, why not just have a sign that says “washroom”? I made the journey myself just now and noticed that some of the little “male” and “female” brass figures pointing the way to the bathroom doors (whose gender symbols have been papered over) are still mounted high up above the French doors to another area of this hotel floor and it’s producing an interesting bifurcation of conference-goers.

Anyhow, I wanted to share a few things about urgent needs around trans youth, healthcare, and education that I learned this morning from “Improving the Health of Trans Communities: Findings from the Trans PULSE project.” This is a project that had some of its origins in a collaboration between Kyle Scanlon at Toronto’s 519 and Anna Travers at Sherbourne Health Centre’s program for LGBT primary health care. According to the 519’s website:

The 519 Church Street Community Centre is the hub of community life in Toronto’s diverse Church and Wellesley Village.  Lesbian, gay, bisexual, transsexual, transgender, two-spirit and queer (LGBTTQ) communities and our allies and friends have always found a welcoming place at The 519.

We offer a wide range of internationally renowned Programs and Services that operate from an anti-oppression framework. Our public meeting space enable groups in our community to organize and find support as well as find enrichment through arts and culture.

The idea was that a study capable of producing statistics and other empirically grounded information could be used as a way to get more funding for existing services and in the creation of new services for trans people. Of course Scanlon and Travers already knew there was a pressing need for better health services, but they had to find a way to formalize and support what they already knew so that the government would have a harder time ignoring their requests.

With a community-based research model directed in significant part by a community engagement team of trans people, researchers Greta Bauer from the University of Western Ontario (my alma mater!) and Robb Travers from Sir Wilfrid Laurier University were (rigorously) interviewed and hired to help out on the project with the provision that they met a specific set of criteria, one of the most important being their ability to let trans people be experts in their own issues. Trans PULSE has used respondent-driven sampling, where access to a comprehensive online or paper survey is shared through networks of trans people who already know each other. This method allows the project team to access an appropriate sample of what they’ve called “hidden populations” who can’t be randomly sampled. (The study was disseminated only throughout Ontario and its n= 433, in case you were wondering.)

So what has the Trans PULSE project found out so far about the needs of trans youth?

When respondents were asked about the age at which they first became aware that their gender did not match their body, 59% said they were under age ten and 21% said they were between ten and fourteen years old. These periods of youth, noted today’s presenters, are among the riskiest times in terms of vulnerability to self-harm and suicide. Pretty well all respondents reported high levels of transphobia, which have been shown to be clearly related to reporting symptoms consistent with depression. And depression is, as panelists noted, something that doesn’t just mean sadness—it is something that can tear our immune systems apart and can prevent us from finding and keeping work. Over 60% of both MTF and FTM respondents self-reported symptoms consistent with depression, which is a striking prevalence when you compare it to an incidence of around 6% for the “general” population.

Among all trans Ontarians surveyed, ¼ of those in the planning stage of transitioning had attempted suicide in the past year. Recent consideration of suicide and recent attempts of suicide were higher among youth than among adults 25 and older. Project team members mentioned that some new research coming out of the Netherlands shows that transitioning before adulthood drastically improves mental health outcomes. Access to general healthcare is of critical importance and access to transition-related health care is literally life and death. This knowledge has to be taken into account in youth suicide prevention programs. As panelists noted, there have been numerous highly visible discussions on LGBT youth and suicide in the past year or two, but the folks at Trans PULSE are alarmed that trans youth have been very much left out. In fact, panelist Jake Pyne suggested that some doctors are beginning to consider the idea that failing to provide transition-related health care to youth may actually constitute a violation of the Hippocratic Oath.

With stats like these, it’s plain to see how health vulnerabilities and social adversities can mutually and cyclically reinforce each other. Problems compounding problems—none of which are inevitable, the panelists stressed, if we start really paying attention to trans lives and trans needs.

So, as the title of one of the presentation slides asked: what can be done?

The Trans PULSE team came up with several recommendations to publicize as “take-home messages” for everyone involved in the provision of health and social services for trans people, and two of them addressed youth needs specifically:

1. Youth-serving agencies must become aware of the issues facing trans youth. 2. School officials need to be made aware of the urgent vulnerability of trans youth.


Robb Travers commented on this recommendation by noting that his research about GSAs in Waterloo is showing that trans youths’ issues are consistently made dangerously secondary to gay and lesbian youths’ needs.

Kyle Scanlon closed the session by saying that if one of the going slogans is “It Gets Better,” the Trans PULSE slogan could be “We’re Making It Better.” And there’s still so much to be done.

Previously: The Bathroom Debate, The Real World?

by Sharday Mosurinjohn
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7 Comments Have Been Posted

This is a comment that refers

This is a comment that refers to nothing past the first half of this post: While I'm totally with you on the "this symbol still isn't great" thing, I have to say that worded signage wouldn't work well in Toronto. In addition to the French-English aspect of the country, there's also the fact that Toronto has a huge population of immigrants from all over the world who collectively speak every language but English. I think a different symbol (a toilet, for example, or even the British-style "WC" in a box, which at least eliminates words) would be more appropriate.

A - I actually wondered about

A - I actually wondered about a similar set of considerations. I was thinking about both literacy in general and language issues around translation. There's definitely a primacy of the visual in dominant North American culture (to speak only of a context where I have some cultural competency) and I think the desire to visually symbolize can be an extension of that, and it can be ableist in that way. But at the same time, there is also a privileging of English and so the visual can be another very important way to communicate across languages in a pluralist society. It's interesting stuff. Related to language concerns - I noticed that one of the big critiques of TransPULSE in this morning's session was around the fact that Ontario has a significant francophone population as well as others who wouldn't identify is francophone but also speak, read, and understand French, but the project didn't have any francophones on the community team. The survey was available in French and other languages as well, but there was a definite skewing of data collection and reportage that didn't really attend to the specific needs, issues, and vulnerabilities of non-anglophones. Good points to think about. Thanks for your comment!


Just a heads up -- it's RobB Travers (with two Bs!) and WilfrId Laurier University (with an I, not an E!). Sorry, just a stickler for correct attribution.

Thanks so much, Kate K! I,

Thanks so much, Kate K! I, too, believe in the precision of language. I had only heard Robb's name spoken, but as for Wilfrid Laurier U, that was an unfortunate mistake on my part. Especially being someone from Southern Ontario. The post is edited now, thanks to you!


Thanks so much for posting this - Trans PULSE is an important and valuable research project. And 519 does awesome work.

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