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Harper MacAngus studied his alarm clock for the fourteenth time that night. If he were able to fall asleep right this second, he would be able to squeeze in three hours and twenty-six minutes of sleep.

Sleep did not come. Anxiety, nausea and headaches kept him awake well past his self-prescribed bedtime. The same thoughts haunted him each night. He tried to push them down and find peace in unconsciousness.

Instead of counting sheep, he was counting reasons he should not, could not, be transgender.

One: Self-realization and acceptance

Harper MacAngus accepted that he was transgender at age 17. MacAngus, born a female, realized that his sex was not matching up with how he saw himself: as a boy.

As early as the beginning of high school, he remembers he did not feel “normal.” He did not enjoy dressing femininely, found make-up to be a chore and, perhaps most notably, began seeing girls as romantic interests. To counteract these feelings, he tried even harder to fit into the status quo.

“I hyper-feminized myself. It made me really uncomfortable, but at the same time it made me less uncomfortable than to admit other things. I didn’t know the answer, and I was very ignorant,” says MacAngus.

When this didn’t work, MacAngus finally admitted to himself that he (at the time, she) was a lesbian. However, this still did not feel right.

It was not until he went to an openly transgender friend for advice that things he was feeling became clearer; he wasn’t gay, he was trans.

“I did a lot of the self discovery by myself. I think a lot of it was talking myself out of it, and then going to bed and being like ‘Damn it, I can’t talk myself out of this stuff.'”

Some transgender people seek out professional help from psychologists or psychiatrists to help them through their feelings of gender dysphoria. Gender dysphoria is the unnerving and stressful feeling of having one’s sex not line up with their gender identity.

Amy Otteson is a licensed psychologist who mostly works with children and adolescents. She saw her first transgender patient in 2011.

“I remember because I had no idea what I was doing. We hadn’t learned about transgender health in university and grad school or anything,” says Otteson.

Otteson recognized the gap within her knowledge and took steps to self-educate by contacting other medical professionals with more experience in transgender health care and by attending training sessions on diverse patient care.

Otteson kept in contact with some of the people she met in these training sessions, and they, among others, eventually formed the New Brunswick Transgender Health Network.

The Network is a committee made up of medical professionals, members of the community, trans people, school counsellors, university staff, etc. that are working to improve services across the province for transgender people. NBTHN worked with the New Brunswick Department of Health to develop the legislation that insures gender-confirming surgeries.

Otteson has seen more than 60 transgender patients during the past five years, the youngest being seven years old.

“That’s definitely not average. My colleagues would see maybe one or two (a year),” she says. “It’s definitely abnormal that I’ve seen that many people.”

Otteson believes she sees so many transgender patients because professionals are generally hesitant to work outside of areas they’re familiar with.

“I feel that once people got wind that I had been seeing these kids, especially the younger ones, they were more inclined to refer them to me because it’s a bit of an area of expertise,” Otteson says.

Two: Coming out

Light poured in through the third-story windows of the office, painting the office with an orange glow.

“Harper, is there something you would like to tell your mom?” asked his psychologist.

There were a million things he would like to tell his mom, but he doubted she would like anything he had to say. How can you look your mom in the eye and say you hate yourself? That each time you look in the mirror another piece of your soul breaks? That you wish you could tear apart the flesh your mother gave you, the flesh she made you out of her own body?

Saying any of this would break her heart. But feeling isolated and trapped within his own body was not an option anymore. He would not survive it.

He took a deep breath.


After discovering he was trans, MacAngus’ next step was sharing his new identity with others. He started telling close friends and trying out male pronouns to make sure they felt right. His biggest fear was how his mother would react to the news – her little girl was actually her little boy.

“I remember being absolutely terrified to tell my Mom. She was fine with me being gay, fine with me going through that self discovery, she was always there. But I remember it being pretty rocky,” says MacAngus.

He told his Mom in a meeting with his psychologist at the time.

“When I said it I was crying and I felt like I was getting this huge weight off my chest and my Mom was like, ‘Chill bro, I know, you’re good.’ It was a relief that my Mom was already on my side even before I knew she was,” he says.

Since jumping that hurdle, MacAngus finds it easier to tell others about his gender identity.

“With friends and family I make sure that everyone is very open about it and make sure that everybody is very supportive. If they’re not, I honestly don’t have a problem cutting people out, I really don’t.”

Three: Legalities

Music pulsed out of the club, sending vibrations through MacAngus’ feet. The song started out slow, but grew into a steady rhythm. It could not keep up with his fluttering heartbeat.

This was the most nerve-racking part of his nights out. He handed his driver’s license to the bouncer at the door. Security looked from the ID to his face, skepticism in his eyes.

“You don’t look like a girl,” he said.

MacAngus cleared his throat. “I’m trans and haven’t gotten my name legally changed yet-”

“Oh, I’m so sorry! I didn’t know, man. Go on in,” the bouncer cut him off.

MacAngus walked into the club and felt his shoulders drop, no longer bunched up tensely. He let out a long breath. He had made it through another door-checking without incident, without harassment and without violence. That was worth a drink, right?

He headed to the bar.


Some transgender people choose to legally change their name because they feel the name they were given at birth doesn’t align with their gender identity. Finding the right name can be a challenge for some, while others choose a name that fits them well right away.

Macangus says he’s tried to read through the information on the steps to legally change your name online, but found it confusing – all of the technicalities, paying a fee and waiting for the paperwork to be processed seemed intimidating to him.

“I don’t know the steps. I should know the steps of how to do it.”

Anyone, not just transgender people, can legally change their name – for a price. The real issues typically arise when it comes to gender markers. New Brunswick law says that transgender people cannot change the gender marker on government issued ID without first having gender-confirming, or “bottom”, surgery. This makes it impossible for transgender people who cannot have surgery due to medical reasons or who do not want to have surgery to change their marker.

Four: Hormone replacement therapy

Drip. Drip Drip.

The testosterone slowly filled the syringe. The hormone was thick; MacAngus thought it was taking forever. Eventually the small tube was full of yellow fluid. Some trans men called it “liquid gold”, some called it “T”, some called it “without this I would be dead.”

Now came the hard part. Inserting the needle got easier and less painful with practice, but stabbing yourself is never a pleasant experience. His was on edge at the thought of pushing the needle into his skin. He needed to relax – tensed muscles made it hurt more.

This is one step closer to a beard. This is one step closer to a deep voice. This is one step closer to loving myself.

He pushed the needle in.


Increased body hair growth, a deepening of the voice and fat redistribution. These are a few of the side effects of medically taking testosterone, the male growth hormone. Many transgender men take testosterone as part of their transition. The process is called hormone replacement therapy.

There is no one way of obtaining a prescription for hormones in New Brunswick. Some cities have clinics that accept self-referrals, while some doctors require a referral letter. Clinic 554 in Fredericton accepts self-referrals for hormone replacement therapy.

“I think it got to a point where even though I knew who I was, the physical attributes weren’t there,” says MacAngus. “I had a super feminine face. I really wanted facial hair. The clothes that I wanted to wear wouldn’t fit me because…I was curvier before, I had more feminine curves.”

MacAngus was curious about taking testosterone and had several transgender friends already on hormones who, for the most part, had positive experiences.

“Sometimes it doesn’t work for you, and I knew that was also an option. I knew I wanted to try it. …I needed it.”

MacAngus received his first shot of testosterone at Clinic 554 on Feb. 2, 2015.

“I think that once the physical attributes started coming, then mentally it was easier. It feels like it’s not going fast enough at first,” he says. “It’s slowly, and then all at once.”

MacAngus has decided to temporarily stop his hormone replacement therapy for different reasons, though mainly because of his anxiety.

“It has nothing to do with the needles or the hormones or anything like that. But thinking about doing my shot makes me so anxious,” he says.

There is no specific amount of time a transgender person must be on hormone replacement therapy to “fulfill their quota.” Most trans people take hormones for the rest of their lives.

Five: Surgery

When MacAngus heard that New Brunswick was going to begin paying for gender-confirming surgeries, he was relieved. He imagined a flat chest, something he had wanted his entire life. Smooth, tight and unmistakably male.

Then he remembered the surgery part. It was a major operation – scalpels, anesthesia, recovery time, the whole bit. And that absolutely terrified him.

The new coverage was a huge leap forward, but his dream chest was still so far away.


The New Brunswick government announced it would be insuring gender-confirming surgeries this past June. This coverage will provide access to a number of surgeries including mastectomy, vaginoplasty, hysterectomy and more. One or two referral letters from a medical professional are required depending on the surgery.

“I was doing a lot of referrals for hormone therapy, but a lot of people weren’t asking me to refer them to the clinic in Montreal because they weren’t able to afford to pay for that out of pocket. Now that the government provides coverage for that, I can write referral letters for people to have surgeries done both within and outside of the province,” says Otteson.

It can be difficult and take time to get letters from professionals who have a large client list, or who charge a fee for consultations.

“There’s things that need to be ironed out with the whole gender confirming surgery thing and the department of health. It’s a new thing so we really need to keep working on it and making it more accessible to people,” says Otteson. “There’s things that we can do to make the process better.”

MacAngus hasn’t yet received any surgeries, but knows he wants chest masculinisation surgery someday. He says he is not as certain when it comes to bottom surgery because of the lack of options.

“The research is there but the actual application of the research is not there. In my lifetime, it’s not going to happen for me,” he says.

Six: The Journey

MacAngus held his cell phone between his shoulder and his ear. The line perked up, and a friendly voice on the other end asked for the name on the account and what they could do to help today. After waiting for more than 20 minutes, he was grateful to hear anything besides on-hold jingles.

“The name on the account is Elizabeth MacAngus,” he answered.


“Are you sure that’s the name on the account…sir?” the voice asked.

MacAngus sighed. “Yes, I’m sure.”

At times like this, MacAngus knew he needed to remind himself of the bigger picture: he was happy with his transition, he was healthy, he was loved.

“Okay, sir. Er, sorry…ma’am?”

It took everything in him not to hang up the phone.


Otteson says she enjoys working with transgender patients because she is often helping more than one person at a time.

“The thing that I like about working with trans people that I don’t get to do too much with other people that I work with is advocacy. I can make a difference in sending an email to somebody that I know that works in the school system, or contacting so-and-so that works at the department of health that has the answer to the specific question that my patient has.”

On top of counselling, Otteson leads workshops and teaches others about trans health. She says there is still a lot of work to be done for the transgender community.

“I would like to see more education is done within the province for health professionals, law enforcement, teachers… people that are on the front lines.”

MacAngus knows he has a long way to go as well within his own transition.

“It’s never going to be over. I’m still going to be doing my shots forever, but I think things will stop drastically changing,” MacAngus says.

“And the big picture is fine and swell. I’m trans and I’m transitioning and I have people who love me and want me to succeed. It’s the smaller details that seem so insignificant that get to me.”

Calling the government or large companies makes MacAngus anxious because he is required to use his legal name. A short phone conversation with the bank can ruin his entire day by bringing up feelings of gender dysphoria.

Overall, however, MacAngus says his self-esteem has drastically improved since starting his transition, and that he is much more accepting of himself now than in years prior.

“I’m happy with how things have changed,” MacAngus says. “It’s who I am. It’s not everything about who I am, but it’s definitely a very big factor.”

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