The great majority of us tend to think of sex and gender as something quite settled and immutable. There are males and females, women and men, and you are born one or the other and that's the end of it.

We think this because most of us have no problem living in our birth-designated sex, and from the moment the nurse declares, "It's a girl!" or, "It's a boy!" everything seems to follow quite naturally. What we don't realize is that we are the lucky ones. We do not have to struggle to pretend to be a gender that that does not fit, that feels unnatural and artificial. We are not mired in despair at not having a body that matches our mind. We are fortunate. We are not transsexual.

Ten years ago the Conservative government of Ontario removed SRS from OHIP. SRS is sex reassignment surgery, and it involves reconstructing an individual's genitals from a penis to a vagina, or the creation of a penis where a vagina was. In addition to other therapies such as hormone treatment and electrolysis, it is part of the process transsexuals undergo in order to become the person they know themselves to be. Failure to do so means, for these persons, a life of pain and despair.

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A contestant prepares for a transsexual beauty pageant in Thailand. It is easy to think of gender as something that is black or white, on or off, boy or girl, but it's not like that, writes Michael Gilbert.

Recently Health Minister George Smitherman announced that Ontario would once again cover SRS for that small group that is eligible.

In response, Nepean-Carleton MP Pierre Poilievre has declared that the federal government should hold back any health fund transfers used for this purpose. One reason that Mr. Poilievre's reaction is strange, is that most provinces, including Alberta, already cover SRS, yet he has heretofore said nothing. So, unless this is a blatantly political move designed to embarrass the McGuinty government, we can only assume that Mr. Poilievre is also going after Alberta and all the other provinces to demand a refund of the money spent on SRS for the years since the Harper government was formed. I find that unlikely.

Mr. Poilievre's plan is both ill-considered and discriminatory.

Ill-considered because it would likely cost more money to administer the pay-back of federal funds for the comparatively miniscule amount spent on sex reassignment surgery than to accept it. (Mr. Smitherman sets the amount at roughly $200,000 out of a $40.2 billion OHIP budget, a percentage so small I can't figure it.) Indeed, the money that will be spent on the psychiatric care of those who suffer from gender dysphoria will end up costing more than the surgery.

The plan is discriminatory because it rests on the idea that if I don't understand something, then it's wrong. If it's not my custom, my viewpoint, my tribal practice, then it doesn't make sense. Mr. Poilievre is arbitrarily selecting a small defenceless group and attacking them without understanding their situation. Every province views gender dysphoria as a serious and legitimate psychological malady, as does the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association, the book that lists and describes all mental illnesses.

The thinking behind Mr. Poilievre's view is the same kind of thinking that called post traumatic stress disorder cowardice. When we did not understand the inner workings of the human mind as much as we do now, it was thought that a soldier who could not go on or who exhibited signs of abnormal behaviour was shirking or malingering. Indeed, during the Second World War, soldiers suffering from PTSD were executed for cowardice, and recent governmental apologies do little to assuage the pain and humiliation suffered by those men and their families.

We understand better now that the mind is complex, subtle, and magnificent, and that any number of maladies that were thought to be dismissed or cured by pulling up your socks, are real, and their sufferers in acute anguish.

Mr. Poilievre has said that SRS is "unnecessary surgery." Does he believe that those who need it are faking their distress? Does he believe that these people could live happy and productive lives without the surgery?

Well, let me tell you a secret: No one who has been psychiatrically approved and wants sex reassignment surgery does not desperately need it. No one goes through the years of jumping through hoops, of dealing with family, friends, employers, and society at large on a whim. You have to want it so bad that if you do not get it, you may well end your life. And that, Mr. Poilievre, is what it is really all about.

It is easy to think of gender as something that is black or white, on or off, boy or girl. The truth is that it is not really like that at all. The best model for gender is not nearly so simple.

I like to think of sex and gender as similar to eyesight. Some people are right at 20/20 vision, but a great many of us are not. We need glasses or contacts or surgery to see in an average way. Other people are at the extremes, and may be blind or be able to see a dot at 25 metres.

Think of it this way: most of us get along being the gender we were told we are, but many of us still have some difficulties. Maybe you don't think you're masculine or feminine enough; maybe you're a guy who's too emotional; maybe a woman who disdains lace and is totally into sports and auto mechanics. You might suffer a bit here and there, but, more or less, there's room for you.

Now consider the extremes: at one end you may have Rambo and Barbie, but at the other you have transsexuals whose internal sense of identity is completely at odds with their bodies. Imagine what that must be like. Imagine that everyone - your family, your friends, Mr. Poilievre, and the whole world is saying you are not what you believe yourself to be, but just the opposite. You're not a man, but a woman; not a woman, but a man. That's being a transsexual.

There's more. If you are living as a member of the opposite sex, but have not had SRS, how do you get a passport that has a sex designation that looks like you? You look like a man, and you feel like a man, but down below you've got an innie and not an outie. Can you change your birth certificate? Can you get a passport?

If you were born male but have been living as a woman for 10 years, have breasts, no facial hair, and move about the world as a woman, what happens in bathrooms? When you show your passport and the designation is "M" will you be strip searched? Will you be publicly humiliated? Probably. And why do I think that Mr. Poilievre would be the first one to insist that no one can change their papers without SRS?

Sex reassignment surgery provides relief for the small number of people in our society who are incredibly distressed by the mis-match between their personality, psyche, and genitals.

Our culture is highly genital-based, and suspicion that someone's gender presentation does not match their genitals puts that person in both psychological and physical danger. Failure to support those in need is every bit as callous as failing to support any other fellow citizen with a pressing medical issue.

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