By Plamena Dimova
The protest for transgender* rights took place in front of Radboud UMC on the 30th of September, lasted from 7 in the morning until midnight. This is no coincidence. Currently, the waiting time for trans healthcare in the Netherlands is approximately 150 weeks (3 years!), which means 1050 days of waiting – and thus, 1050 minutes of protesting as a form of resistance. What is more, many people do not even receive medical care, or face further delays because they are non-binary, neurotypical (in which case, gender therapy is prolonged), overweight, or because of their addiction. In essence, transgender health care is assumed not to be necessary, when in reality it is literally life-saving.
With this in mind, the overarching theme of the demonstration was transgender people’s self-determination over their own bodies. Transzorgnu, one of the main movements that organised the protest, presented a list of five concrete steps (also available on their website) [1] that gender clinics can take to provide life-saving transgender healthcare in a way that also respects trans people’s self-determination. These include:
1. Allow transition without a pathologizing diagnosis, and make sure that full reimbursement is always available.
One way to achieve this is to replace the diagnosis ‘’gender dysphoria’’ from the DSM5 (which places a pathologising focus on suffering) with the somatic-physical diagnosis ‘’gender incongruence’’ from ICD11. Also, making agreements with health insurers to maintain full coverage for both diagnoses.
2. Ensure that people who are transitioning without the help of gender clinics are safe. This includes providing information to GPs who wish to prescribe HRT/puberty blockers. Furthermore, it means giving people who are forced to self-medicate while waiting for treatment (*3 years can feel like an eternity if you are struggling with gender dysphoria!*) access to blood tests and any necessary physical examinations.
3. Support non-binary people and validate their various identities.
Let them choose their own transition path, for example opting only for surgery without having to undertake HRT, and ensure that their non-binary identity does delay their treatment.
4. Allow young people to start puberty blockers as soon as possible after registration. Especially when someone is forced to wait for transgender care for so long, irreversible changes to their body can occur. This can be easily and safely prevented with the use of puberty blockers.
5. Do not restrict the access to surgery based on factors that correlate with health, such as BMI or smoking. BMI has no scientific basis [2]. Moreover, we should not create more barriers to transgender healthcare that we do not see in any other life-saving procedures. In case there are any risk factors, they should be discussed with the healthcare recipient, and they should be empowered to make their own decision.
6. Do not create additional barriers to transgender care for neurotypical people or people struggling with their mental health. For example, do not require someone to start treatment for depression in order to access transgender care. Let the person decide which treatments they would like to prioritise. [3]
One of the spokespeople of the demonstration, Eelke, made the poignant remark that currently, even the mental health care (also called gender therapy) that gender clinics offer is not proper care. This is due to the context in which gender therapy is practiced in the Netherlands. To be more specific, according to Eelke, trans people are now forced to wait approximately 3 years to see a psychiatrist who ‘’gets to decide whether they are ’trans enough’ for them’’. In other words – whether they deserve help or not.
This situation, coupled with the agonising reality of infinitely-long waiting lists, can be so anxiety-inducing that “people are afraid to criticise their psychiatrist on anything, or to be honest with them, or to assert boundaries when their consent is violated because this person, whom they waited three years to see, decides about their lives’’, Eelke reveals to us. For example, people who have experienced trauma because their families have rejected them are afraid to mention this. They are often times too afraid that this will ultimately delay their access to trans healthcare. How does this system, then, provide adequate mental and physical healthcare? It is more than obvious that so much easily preventable suffering exists simply because transgender people do not have power over their own bodies . So, what can be changed?
An alternative solution could be a so-called ‘’model of informed consent’’ which does not require the approval of a psychiatrist or psychologist, says Eelke. In this model, one can simply state that they know what healthcare they need and then access it, instead of being tested, over and over again, if they fit some pathologising psychiatric definition. Or whether they are ‘’trans enough’’, according to someone else’s standards, to receive crucial help at a crucial time for them. If this ‘’model of informed consent’’ existed, states Eelke, ‘’most of the waiting list would disappear overnight’’. And of course, if someone wants help from a psychologist or a psychiatrist, they should still be able to get it — on a voluntary basis.
Fortunately, ‘’there are more GPs who know how to prescribe hormones’’ Eelke continues, “there are more surgeons who are now doing surgeries [gender affirming surgeries]’’. So more and more alternatives are becoming available andthings are slowly getting better, although people still have to be ‘’lucky’’ enough to have access to such healthcare providers, and gender affirming surgeries still happen after an approval from a gender clinic has been granted. Navigating in the system can become much easier – especially if all the resources that are currently spent on this unnecessary testing system are redirected towards actual transition care!
Overall, this demonstration for trans people’s empowerment was not only about grieving and resisting the various ways in which the system makes it difficult for transgender people to receive help. It was also a celebration of being transgender, a collective self-assertion that, as it is stated on transzorgnu.org, being trans is a beautiful thing and transitioning can make trans people so incredibly happy.
It was also empowering. As it was pointed out during the demonstration, most of the actual transgender mental health care is done by trans people helping other trans people. ‘’This is where most of the actual life-saving work takes place’’, Eelke adds. So, to have a day with so many people from the community together, along with genuine supporters, was utterly amazing for many of us. As someone who is from Bulgaria, a country where transgender health care is not institutionalised or even possible, this event brought me an immense sense of hope for what is possible (and, of course, sadness, but perhaps the two always go hand in hand).
In short, we were there. We are everywhere, we are trans, and we’re not going anywhere! Trans healthcare now!
*I use the term ‘’transgender’’ as an umbrella term that includes various non-cisgender identities, e.g. not only FTM and MTF transgender identities but also non-binary and others.
References:
Raffia 