Alexander Howard

Supervisor: Jane Schulz

Project: Barriers in accessing surgery for transgender care: A qualitative study


Whitby, ON

Degree program:

Doctor of Medicine

What's been the best part of your experience so far?

Enrolling our first patient participant in the study! After spending months carefully researching our literature review and developing our research protocol, it was really gratifying to pivot to explaining the study to an actual person and to get to hear their reasons for wanting to participate in it.

What impact do you hope this project makes once completed? How will this contribute to improving the health of women?

I hope that documenting trans and nonbinary people's experiences as they try to access provincially funded surgical procedures can help to motivate policy change to make these procedures more accessible in Alberta. In concrete terms, I think that this would help to improve the well-being of trans women who want bottom surgery! 

However, I also believe that when we build knowledge and capacity around the best way to provide gender-affirming health care, we improve care for more than just trans people. We help ensure that medical care proceeds from a recognition of every person's unique circumstances, rather than outdated or even harmful ideas about what a “female” or “male” person is like or how different bodies should be valued and treated. That commitment to nuance and specificity lies at the centre of patient-centred health care, whether the patient in question is cis or trans.

What interested you in the WCHRI Summer Studentship Program?

I've done humanities research in the past but didn't have prior experience with health care research before starting medical school. I was encouraged by WCHRI's explicit commitment to supporting trainee researchers at every stage of their development and hoped that a summer studentship would give me the opportunity to explore which of my existing skills would translate in this new discipline while also developing a new skill set for investigating research questions in my future career.

What's one piece of advice you received from your supervisor/mentor that resonated with you?

I don't know that my co-supervisors Drs Schulz and Flood have given me this advice explicitly—but in working with them, I've been really struck by their trust in and appreciation for their team. I've been lucky to spend time with a few different members of the interdisciplinary urogynecology team at the Lois Hole Hospital for Women, and I can see how their respect for one another creates an environment where it's easy to ask questions, work collaboratively and provide the best possible patient care.

What has the support from WCHRI and the Alberta Women’s Health Foundation meant to you?

I've been really excited to be supported by WCHRI and the Alberta Women’s Health Foundation this summer. It's great to see WCHRI investing in transgender care as part of its mandate to improve healthcare for women and children. Additionally, as a person who's new to qualitative health research, I've also really benefited from WCHRI's commitment to supporting trainee health researchers and students. I've received such generous guidance from WCHRI staff at every stage of this project and feel very grateful to be learning in such a supportive environment.

Lay abstract:

Alberta lacks a local surgical centre that performs gender-affirming surgeries such as vaginoplasty, phalloplasty, and metoidioplasty (“bottom surgeries”) for transgender patients. Thus, transgender Albertans must fund their own travel out of province to access these publicly-funded procedures. 

Although existing research indicates that financial costs and access to supportive physicians pose challenges for transgender patients seeking gender-affirming surgery, there is no literature on how travel amplifies financial or access barriers or how it impacts the surgical experiences and outcomes of Albertan transgender people. 

To address this gap, this project will survey the transgender patient population of the urogynecology clinic at Edmonton's LGBTQ+ Wellness Centre. A qualitative survey will assess how long-distance travel for assessment, surgery, and post-operative care intersects with financial and social barriers. Patients will be interviewed and the data assembled for publication with the long-term goal of contributing to the development of an Albertan surgical program for transgender care.

Read more about Alexander's project in: Exploring barriers faced by transgender Albertans.