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Four requests to improve healthcare for trans people

The European Centre Right LGBT+ Alliance have compiled a status report about the health treatment of trans people in the 7 countries we cover. The result is striking, and the pandemic seems to worsen the situation even more.

Our mapping of the situation shows that only Belgium has a transparent care path for trans people. 

There are several options and possibilities within the Belgian trans health care, all brought together in a so-called transgender care path. This path was developed by the Transgender Info Point. The information, timing, and conditions as outlined briefly in the care path, are based on the Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People (SOC7) of the World Professional Association of Transgender Health. The Transgender Info Point also provides a care map with an overview of all known psychologists, psychiatrists, speech therapists, dermatologists, endocrinologists, surgeons, etc.

Belgium also has a convention of transgender care. This is an agreement between two hospitals (with expertise in this field) and the RIZIV (National Institute for Health and Disability Insurance; NIHDI)) and means that people who have a request for help with regard to their gender identity or expression, or who show symptoms of gender dysphoria, are entitled to be reimbursed for a number of (medical) consultations. For young people up to 16 years of age, 15 consultations with a psychologist, sexologist or social nurse are provided, which are almost fully reimbursable.

In very short, the situation in our other countries deviates from bad to worse:

  • Finland requires that people live as the gender they identify as full time to get a diagnosis. Still Finland demands sterilisation to change your gender, and only those who managed to change their legal gender are offered medical process and genital surgery if preferred. Finland has two trans clinics, one in Helsinki and one in Tampere

  • Germany offers treatment in every state, however there is a drastic undersupply of suitable physicians and therapists with appropriate qualifications. Leading to a long waiting time and slow procedures.  The diagnosis for transsexualism is also given according to the outdated ICD 10, and includes mandatory psychotherapy.

  • Ireland still uses ICD10, and a trans person is required to have a report from a psychologist or psychiatrist. There is basically only one hospital in Dublin providing the service, but they do not provide surgery. In recent years transgender people pursuing surgery were referred to the Gender Identity Clinic London, UK. This has now ceased and trans people from Ireland are currently being referred back to Ireland, actually to a healthcare system where at the present time there is a three year plus waiting time. Adolescents may receive support at the national Children’s Hospital, but this service does not provide “Blockers” and therefore is quite useless.

  • The Netherlands have recently decentralised the transgender care, making it available in more Dutch regions. At the moment, three university hospitals provide transgender care. The university hospitals are also supported by specialist mental healthcare institutions and independent (private) health care centres. Though the capacity has increased considerably in recent years, it is still inadequate. The vast majority of transgender care is reimbursed under the basic insurance. However, some of this will only be reimbursed after individual assessment. This leads to unpredictable and complex procedures when applying for an individual authorisation for hair removal and some types of surgical care. Also purchasing sufficiently efficient testosterone adds a substantial figure to the bill in many cases. A medical transition in practice can lead to their own costs above the deductible.

  • Norway adopted the new WHO diagnosis manual, transferring gender dysphoria to sexual health, already in 2019. However, the only hospital offering treatment, clearly states they follow the ICD10, and work according to this. The treatment is centralised in Oslo and is therefore not available to a large part of the population. Plans for decentralising have been made, but the national competence centre obstruct both treating regarding ICD 11 and decentralisation of treatment like hormone application and smaller surgery. Almost 80% of applicants are denied treatment, and for those who come through, the transformation can take up to eight years to be completed. Non-binary is not acknowledged.

  • Sweden usually has an 18-year age limit regarding gender correction surgery. Besides that, Sweden still follows the ICD10 and demands therapy for gender dysphoria before the therapists decide whether one is allowed to start the treatment with hormone blockers. Later surgeries depend on personal decisions of the person concerned. If a surgery then is still wanted, it will be granted. Sweden also faces problems with access to health care which leads to long waiting times for surgery and therapy, which have increased during the pandemic.

The European Centre Right LGBT+ Alliance and our member organisations find it unacceptable that trans people in many countries are seen and treated as mentally ill, and the treatments offered are inadequate. We requests the following of the governments of Europe:

  • Each government must ensure the WHOs IDC 11 regarding the treatment of gender incongruence are implemented and followed throughout the complete care path for trans people.
  • Each Country must establish a transparent trans care way point(s). The stations in the Belgian model shows how it can be done to create excellent trans care.
  • Treatment for trans people must be available within acceptable distance. Therefore, decentralisation must be advanced. In addition to this, medical health care capacities must meet the growing numbers of persons seeking treatment in accordance with ordinary legislation in a timely manner.
  • Trans people are among the most vulnerable population groups of our society. Treatment must not be curtailed or postponed in the shadow of the pandemic.