06/26/2012 04:59 EDT | Updated 08/26/2012 05:12 EDT

Danielle Smith and the Trouble with Trans Medicine in Alberta

As someone who's been politically involved, I try to make it a point to at least begin from the premise that what a politician (i.e. anyone ever making a statement as to how a group should govern themselves) says is to be taken at face value. I do this for two reasons: Very few people get into public service because it seems like it's a good gig (those who do are rather quickly disabused of the notion) and because then, any inconsistencies become instant and jarring.

Danielle Smith came out against Alberta Health Insurance funding genital reconstruction surgery. She said it was because she didn't want vital resources spent on elective medicine when there was important care to be paid for. Important care like insulin pumps. Not the insulin itself, because non-catastrophic pharmaceuticals aren't covered under Alberta Health Insurance. As a result diabetic Albertans must pay out of their own pockets for insulin, and trans women must pay out of their own pockets for spironolactone, an anti-androgen, estrogen, and progesterone.

If I can't locate the $100 a month that medicine costs, thus begins an existential nightmare the likes of which I cannot accurately describe. What I would do if I were denied medicine has been a scenario I have had a lot of time to think about, though mercifully, at the moment I don't face that challenge. I used to however, because Alberta Health Insurance has a de facto practice when it comes to transition medicine of extensive waiting lists, conditional provision, and gender policing. And it could all stop tomorrow. It would also save the province of Alberta a considerable amount of money.

Currently, a trans person expressing a need for hormone replacement therapy, has a very long road ahead of them. You go to a general practitioner first. There's no real information about the track you're on, no actual statutory requirement that you be evaluated any further than self-diagnosis, we're talking about estrogen here, not Oxycontin, but the standard practice is to refer you to one of Alberta's two gender clinics, where you'll meet with a psychologist. You can try to have the GP put you on an anti-androgen, because every day before the age of 30 is crucial for what endocrinology does do you, every day is crucial after that as well, but the ability of the body to respond well to a second puberty continues to decline with time. Despite that, I don't know anyone who managed to have a general practitioner prescribe an anti-androgen.

I myself tried to get spironolactone. It's a drug that also lowers blood pressure. At the time I had a blood pressure of 155 over 95. That's high. I was refused. For five months I had high blood pressure because someone had to decide that I was sufficiently not insane enough to get spironolactone. And how did they decide that? With a 50-minute consultation. I would have been referred instantly to an endocrinologist, but I came into my initial consultation wearing pants and a sweater. In January. In Edmonton. In July, eleven months after my initial consultation, I was given a prescription for estrogen and progesterone to supplement my spironolactone. A blood test was ordered to ensure my hormone levels were okay, and that's been the sum total of the medical end of my transition.

If I had been cisgender, if I'd been assigned female at birth, and wanted medical intervention to ensure that my endocrinology was within the normal post-pubescent female range, it would have taken five weeks. I'd go to the GP, who charges Alberta Health much less than a psychologist or an endocrinologist, request HRT, get informed of the risks, get an initial prescription, a blood test to make sure that we were in the proper range, and that'd more or less be the end of it.

Danielle Smith could save Albertans a lot more than the million a year she's proposing saving through defunding genital reconstruction for those trans people that need it. She could improve health outcomes, reduce the incidence of self-harm (because by the time trans people present for treatment, dysphoria is often at crisis levels), improve speed of delivery, and what is ostensibly most important to her: Save the province money and resources, because a GP charges a lot less than a GP and two specialists.

So why is Smith vocally against funding genital reconstruction but notably silent from the debate on moving hormone therapy to an informed-consent model? It'd be pretty easy to make it a contract requirement to either provide treatment or refer to a GP who will provide treatment. Would save the province a lot of money, considering there's about 20,000 trans people in the province based on the most recent prevalence numbers. So where is the source of Smith's economy of economization when it comes to trans medicine?

Well, I can't say for sure, as Smith has not responded adequately to repeated requests for comment. Either her ethics are situational, meaning that this is very much about being cissexist for the base. Or her advisers are cissexist, meaning they only brought a line on surgery to her without knowing anything about trans health care at all. Or Nobody at Wildrose Headquarters knows anything about transition medicine at all, and they just had a reflexive political reaction regarding the medical care that about 25 Albertans a year depend on.

It's difficult to choose between craven, coached, or incompetent, but given my money, I'd just note that as the American experience has shown, a libertarian tends not to get too far in a right-wing party by promising to make it easier for a woman to do what she wants with her body.