Primitive or sick – doctors frequently turn down trans patients

Demokracia a ľudské práva, EEA, EHP, Fond pre MVO

The civic association TransFúzia was the first organization in Slovakia to map the struggles endured by people who want to have their gender identity recognized by doctors.

The most common problem of transgender people is to find a doctor. The research lead by the civic association TransFúzia monitoring the access to medical care for trans people has shown the complications and humiliation faced by people wanting to change their gender.

“Anything other than male and female gender is perceived as sick or perverse by society. The main gender marker are genitalia,” says Christián Havlíček, one of the authors of the research presented to experts on Wednesday.

Trans people are identified as people whose identity is different than the one recognized to them after their birth.

Havlíček himself went through the transition process in the past, as he did not wish to be associated with female gender. The co-author of the research, Romi Kollárik, does not feel comfortable in a man’s role or a woman’s role.

This is why they are often perceived as sick. “This is the general view on transgender people and there is an illusion that such approach is correct and normal,” says Havlíček. The society believes that the main gender marker are a person’s genitalia.

For five years, they have been trying to convince the public and doctors alike that trans people have the same rights to access healthcare as anybody else living in this country.

The research was carried out by means of interviews with 20 people from the trans community in various regions of Slovakia. Doctors and experts were also asked to talk about the topic. Authors wanted to know more about their experience from daily life, the most common struggles and possible solutions.

“We noticed that if you provide doctors or medical experts with research results, it tends to work and they are open for discussion,” says Romi Kollárik, explaining why they were the first organization in Slovakia which had decided to map what trans people experience in contact with doctors.

In the past, trans sexuality was perceived in many different ways, but never positively. The church believed it was a sin, public administration identified it as a crime, medicine looked at the people as patients with a congenital disease.

Normal is out

In the previous century, trans people were called psychopaths, in the 1980s, the term people suffering from a personality disorder started to be used.

“The name may have changed, but the attitude remained the same,” stressed Havlíček. At the same time, he appreciates that today, there are communities of such people, whereas twenty years ago, the topic could not even be discussed in public.

If a person wishes to change their gender, they need consent of a medical doctor and an officer of the Ministry of Interior. There are different ways how doctors try to medically identify a transsexual. However, the feeling of being a woman or a man simply cannot be diagnosed. The most controversial method is the attachment of a machine to the patient’s genitalia, making the patient watch various types of porno films. Their sexual orientation is identified based on sexual arousal.

A much more humane method of gender identification is a dialogue with a doctor. This method builds mutual trust and relationship. However, such cooperation is often hard to establish.

In practice, the opposite tends to be common. The research of the civic association has shown that doctors rarely accepted trans people as their patients or treated them with prejudice and stereotype.

Doctors used a variety of excuses, such as not being experts on the topic, having no capacity to take on new patients or the trans patient did not live in their district.

“One of our clients approached sixteen psychiatrists and sexologists and they all turned him down,” said Kollárik as an example of a respondent’s experience with experts. Once, a doctor did not want a trans person to be her patient, giving conscientious objection as a reason. Another doctor described the person as an extremely complicated case. However, the young man with cerebral palsy and autism studies at university.

Another significant limitation for trans people are stereotypes among doctors. They usually reproach trans women asking for gender change for not looking sufficiently as women.

“Just walk around in a shopping mall and see what women wear nowadays,” said a sexologist to one of respondents. On a different occasion, experts agreed to start with diagnostics only if she comes to the next meeting dressed “more like a woman”. They expect that patients will prove their identity in an extreme way in order to convince them.

Long waiting

They need to wait several months up to two years for health care provision. According to TransFúzia, it is useless and unpleasant for a person asking for help.

“Many people from the community have the same experience. They make an appointment at the doctor’s, the doctor asks them if they still feel as trans, the patient says yes and goes home. Sometimes the meeting takes only a few minutes and they get the next appointment scheduled several weeks later,” said Kollárik in the discussion.

There has been a complex legislation on trans people adopted in Malta, similar situation can be observed in Ireland, Denmark or Argentina. Many doctors are not familiar with medical standards and act against the law. One of such unlawful practices is forced castration obligatory for any person wanting their identity to be recognized by public administration bodies. Such practices are against human rights, they are denounced by WHO and they are against Slovak legislation.

During five years’ time, TransFúzia has been mapping more than four hundred stories of people struggling to have their gender identity recognized.

“Our aim is to ensure that fundamental human rights are respected in line with modern medical knowledge. Today, the fate of trans people is decided by doctors and officials and not by the ones who are personally affected by the change. We would like to change that, ” summarized Kollárik.