Tamara Loyer proudly wears a bright red lanyard around her neck, from which dangles keys to the modest office where she oversees a unique Downtown Eastside drop-in program for trans woman that she designed this year.
She’s come a long way in the past decade: from a despondent homeless woman trapped inside a body with male genitalia to someone who has undergone gender-confirming surgery and now has a home, goes to school and is employed.
“I’ve not been in an office setting since the mid-1980s,” laughs Loyer during an interview at Atira Women’s Resource Society, where she started the Beyond the Street drop-in for trans women in September.
Now 57, Loyer believes her internal war with her gender was at the root of her 30-year spiral into drug addiction, sex work and homelessness, and that the surgery she had in April 2014 gave her the confidence to start putting her life back together again.
“After surgery, I thought I don’t want to have to think about (gender) the way I did before. I can be part of the world. I can go and do things now without being self-conscious,” she reflected. “I walk around here and I don’t have to be afraid that what’s in my head and what people see aren’t the same.”
She is happy with her outward appearance, but is inwardly still haunted by gender dysphoria — a crippling unhappiness with one’s biological gender.
“After surgery, we all like to think that it will never bother me again. It still does. I think about it every day,” she said.
Her dark thoughts are often triggered by still-lingering male gender traits, such as facial hair and a low voice. “That bothers me still to this day. I’m not as critical, as I was, at what I see in the mirror, (but) it doesn’t go away 100 per cent.”
The Vancouver Sun documented Loyer’s story in 2014: the challenges of applying for the surgery and organizing the logistics when you have a vulnerable lifestyle, no fixed address, a panhandler’s income, and no family supports. At the time, B.C. funded sex-reassignment surgeries, but the only place in Canada that performed them was a private Montreal hospital, where Loyer was flown by a charity airline.
“I had nobody with me and it was terrifying,” she said. “It was daunting. There is so much red tape to go through.”
The number of B.C. patients that must endure that flight to Montreal is expected to decrease in the coming years. A new gender surgery clinic opened in Vancouver General Hospital in late September, where the Health Ministry anticipates full-scale gender-affirming surgeries will be performed, likely next year.
B.C.’s new gender surgery clinic
Two surgeons with specialized skills have been hired to work at the clinic, and since September have done repairs and revisions to previous surgeries, and performed parts of so-called “lower surgeries” — but not yet the entire procedure, the Health Ministry said in a statement.
Until this year, patients in every province had to travel to Montreal for “lower surgeries” — which include vaginoplasty for trans women and phalloplasty for trans men. In June, Ontario started to offer these complex surgeries at Women’s College Hospital in Toronto, and B.C. plans to be the next province to do so.
“The trans community has advocated over a number of years for improved access to care, including access to complex lower surgeries within B.C.,” Health Minister Adrian Dix said in November 2018, when he first indicated the services offered here would expand.
“For those seeking lower surgery, people were required to travel to Montreal or to the U.S., resulting in additional medical risks associated with travelling long distance after surgery and in receiving followup care if there were complications.”
The number of British Columbians travelling to Montreal has been on the rise, with about 100 patients annually in recent years. That number is expected to stay roughly the same in 2020, while the B.C. program fully ramps up, the Health Ministry said.
An estimated one per cent of the population identifies as trans, which includes a wide range of people for whom their gender is different from their assigned sex at birth. In B.C., the Health Ministry says, about 46,000 people identify as “trans or gender diverse,” but only a few will pursue medical or surgical services.
Offering the service closer to home will make it simpler to access and to allow friends to visit during recovery. That may encourage more trans people to consider surgery, especially those from marginalized communities like the Downtown Eastside, Loyer said.
And, she argued, it will benefit society in the long run to help more people feel in sync with their own bodies.
“You are going to get a person who is going to be more productive. Somebody who might want to go to school, get a job. Somebody who might want to join their family again,” she said. “You don’t have to live in despair, overwhelmed with what is described as an illness. You can be functional.”
Trans people face discrimination and harassment, which often leads to poor mental health and a greater risk for suicide, says the Calgary-based Centre for Suicide Prevention.
Loyer speaks softly when she remembers trans friends who committed “suicide, got killed, ran away, were never seen again, overdosed or became mental patients.” She hopes these tragedies will be less frequent among her peers with the new local access to medical help.
Another set of surgeries many trans people pursue — breast augmentation or chest construction — were, until recently, offered in only Vancouver and Victoria. Now B.C. has 16 surgeons who do this work, and these procedures have been extended to Abbotsford, Burnaby, Port Moody, New Westminster, Kamloops, Kelowna and Prince George.
The demand for these upper surgeries in B.C. has quadrupled in just three years, with 49 performed in 2015-16 and 254 in 2018-19. The Health Ministry anticipates 300 breast or chest surgeries will be completed by the end of this fiscal year, in March 2020.
And B.C. has a waiting list for this procedure with more than 200 names.
In 2015, the Provincial Health Services Authority launched Trans Care B.C., which offers details about health care and support for trans people or their families. Its service directory lists dozens of drop-ins and information groups across the province, including in communities outside Metro Vancouver such as Prince Rupert, Fort St John and Cranbrook.
She hoped B.C. would offer acceptance
So much as changed since Loyer first arrived in Vancouver in 1984, at age 23, leaving behind a turbulent childhood on a Quebec military base. She came here to seek acceptance. She assumed the name Tamara, found work as a computer programmer and continued to pursue post-secondary education.
But she faced discrimination, numbed her pain with drugs, and eventually worked the streets to earn income. In 1989 she began inquiring about a sex-change operation, but had no stability to pursue surgery.
She was homeless, sick and dejected in 2011 when an outreach worker took her to the first place she felt at home: a shelter for woman, run by Atira. Despite the obvious challenges of sharing communal bathrooms with the female tenants of the modest shelter, Loyer began to heal and, through a new network of support, was able to get her surgery in March 2014.
The Healthy Ministry paid $20,000 for the procedure and $2,000 for her post-surgery care in Montreal. Doctors removed her male organs and created a vagina.
The Vancouver Sun’s first feature on Loyer was published one month after the operation, when she was still healing and had modest ambitions to live a more stable life.
Today, she says that it took her about six months to physically heal from the invasive surgery while she lived in Atira-supported housing in the heart of the Downtown Eastside. There were infections that required cleaning, extreme tenderness, and a daily routine of using dilators to ensure her new vagina wouldn’t close up.
And there are post-operation steps that will be necessary indefinitely. Attached to her stomach is a patch that supplies very large doses of estrogen, a female hormone that her body considers a foreign substance and tries to reject.
But, overall, she is elated with the outcome of the surgery. “I wake up in the morning and I’m happy that I don’t have to encounter a body that is what I had. That was one of the most horrible things in the shower and the washroom and getting dressed. And that is gone.”
Loyer does not wear makeup, jewelry or fancy clothes, but rather prefers basic, gender-neutral garb.
“I am happy with what I look like,” she said. “It’s not the outside that’s the problem. It’s the inside that is giving me the problems.”
In early 2019, Loyer was upgrading her high school credits at the South Hill Adult Education Centre in south Vancouver, but she was also still panhandling, which she found increasingly demeaning, to supplement her disability pension.
“I didn’t want to be there. I wanted to be in school.”
Loyer appeared “isolated,” recalled Janice Abbott, the executive director of Atira, so she suggested Loyer open a drop-in for trans women. Atira offered space to hold the meetings, a small budget for food and communication, and the encouragement for Loyer to independently create a program that was needed in the Downtown Eastside.
“The trans community is complex, it’s not homogeneous in any shape or form. So I think that more opportunities for safe space in ways that trans women identify their own communities, I think that there needs to be more (of) that,” said Abbott, adding that Loyer’s drop-in is a low-key environment where people can make friends and share challenges.
“I think everyone in the Downtown Eastside needs an informal place, where you don’t have to come in and fill out a form that says I need social services. It’s a place to get a snack and have a cup of coffee and hang out for a couple of hours. And I think that’s part of what makes it beautiful.”
Beyond the Street trans drop-in
Loyer’s program, Beyond the Street, is among the first peer-led drop-ins for trans women in Vancouver. It has been holding two-hour sessions every Sunday afternoon since September.
It focuses on offering people help in three main areas: housing questions, such as dealing with transphobia while looking for an apartment or getting evicted; legal matters, such as how to change your name or marriage breakup help; and counselling issues, such as being trapped in a lifestyle that isn’t true to your identity. The program also offers fun activities like Thanksgiving dinner and movies.
“Sometimes trans women get stalled. Something happens and you stop. You can’t get anywhere, whether it’s housing or medical. The idea is to keep them going,” said Loyer.
The three-month-old drop-in has 12 regular attendees, but Loyer also helps women in other communities by phone or email.
She hopes the program can offer marginalized trans woman better options than they often faced in the past: “You end up on the street corner, or you end up in the alleys, or you break down and cry, or you suicide.
“We try to keep people from saying, ‘Oh well, this is what I get.’ Which is easy to think when you don’t have anybody saying anything different,” Loyer said.
Among Atira’s many social housing buildings, which accommodate more than 1,500 women and children every year in the Lower Mainland, up to 20 per cent of the adult female tenants identify as trans, depending on the building type and location, Abbott said.
Many trans women also use Atira’s SisterSpace, which is described as the first women-only overdose prevention site in Canada. Evaluation reports on Atira’s website quote trans women who say the “safe space” offers empathetic workers and an escape from transphobia.
Trans issues have increasingly been in the news. In a high-profile court case, a local father who opposes his transgender child’s pursuit of testosterone therapy fought lower-court decisions all the way to the B.C. Court of Appeal.
And the provincial government recently introduced SOGI, or sexual orientation and gender identity learning resources for elementary and high schools, which created controversy.
For Loyer, trans issues are not new. They’ve been bottled up inside of her for five decades. She hopes, though, that more attention will lead to increased acceptance.
Since her surgery in 2014, she said, her health has improved drastically. The hepatitis C she contracted in 1989 from intravenous drug use is now not detectable in her blood. She is drug-free and quit her 30-year smoking habit. She can walk without a cane, which she had used since her leg was broken in a nasty 2011 assault. Her sight has improved after a hole in her cornea, likely from a beating, was repaired. And she now weighs 165 pounds, up from the 109 she weighed when she arrived on Atira’s doorstep nearly nine years ago.
She no longer lives in supported housing, and has moved to a mixed-income Atira building where many of her neighbours have jobs and go to school. While B.C. Housing subsidizes her rent, Loyer must pay for utilities, internet, and other living expenses.
Perhaps she is most excited about the high school science and math courses she is taking to boost her marks so she can one day apply to the University of British Columbia for a combined degree in astronomy and physics. A downtown investment firm, who read about Loyer in 2014 in The Vancouver Sun, has told her it will pay for her tuition if she gets accepted to UBC.
But with that excitement also comes the fear of failure.
“I need to find a place to apply myself. But the science part I was really nervous about. I didn’t want to think that I could do something and find out that I made a total mess of it and lose confidence,” she said.
Loyer will need confidence to complete her academic goals. She has displayed confidence already, though, in the pursuit of her gender goals. And she has a favourite saying that has, in the past, given her courage and determination: It’s a song title from the movie The Rocky Horror Picture Show, which she saw in Toronto in 1978 after she ran away from home, at age 16, so she could start living as a woman.
“Don’t Dream it. Be it.”