Catalonia, pioneer in the struggle for transsexuals rights
Catalan transsexuals do not need a psychiatric diagnosis of gender dysphoria to carry out a sex change operation through the public healthcare system. The Health Department implemented this pioneering system in Europe in October. LGTBI groups are satisfied with this new Catalan model in contrast with the last one, which treated transsexuality as an illness. Transsexual groups in Catalonia welcomed the decision for three main reasons. The first one is obvious: doing the sex change would be easier. The second one is related to the old Catalan model, mainly carried out in the Hospital Clínic, one of the most important public hospitals in Barcelona. “Doctors judged you in that hospital. They wanted you to be a standard transsexual, otherwise they said you had no gender dysphoria,” explains Carla Agulló, who went there to receive hormonal treatment and psychological attention. The third reason has symbolic importance. “We think transsexuality is a condition, not a problem,” explains Cristina Nadal, who is in charge of the health area of the Catalan Health Service.
Barcelona (ACN).- Imagine you feel you are in the wrong body. Imagine you do not match the stereotypes that society associates with your sex. Imagine you are also considered a sick person. This is the situation of transsexuals, those people who experience a gender identity that is inconsistent with their assigned sex. In Spain, transsexuality was considered an abomination during Franco’s dictatorship. Even now, in many parts of the world transsexuals are stigmatized and persecuted. Fortunately, some LGTBI (Lesbian, gays, transsexuals, bissexuals and interssexuals) organizations pressure governments to make changes and advance in the struggle for their rights. This is the case in Catalonia, where the Health Department decided in October to stop asking for the psychiatric diagnosis of gender dysphoria before paying for the sex change operation through the public healthcare system.
Transsexual groups in Catalonia welcomed the decision for three main reasons. The first one is obvious: doing the sex change would be easier. The second one is related to the old Catalan model, mainly carried out in the Hospital Clínic, one of the most important public hospitals in Barcelona. “Doctors judged you in that hospital. They wanted you to be a 'standard transsexual', otherwise they said you had no gender dysphoria,” explains Carla Agulló, who went there to receive hormonal treatment and psychological attention.
The third reason has symbolic importance. “We think transsexuality is a condition, not a problem,” explains Cristina Nadal, who is in charge of the health area of the Catalan Health Service. According to Nadal, gender is not divided into two variables; there is a wide spectrum from man to woman. “You may feel you are a woman but biologically be a man, but it is a problem only because our society thinks so.”
Why is this a pioneering model?
Catalonia is one of the first places where transsexuality is not considered a pathology and this is due to the Trànsit (Transition) unit. This is a specialized and public unit that is growing every year, especially since October. Trànsit offers a multidisciplinary team composed of a doctor, a gynecologist, a social worker, a nurse, and a psychologist. Despite the fact that transsexuals are not sick, psychological attention is recommended because society does not understand this condition.
“It’s important to talk to a psychologist because it’s easy to have problems with family or friends,” explains Agulló. Such is the case of Mike Oporto, who had many psychological problems during puberty, when his body started to change. “I have been trying to make my parents accept it, but at the moment it is impossible,” he explains.
The help of a social worker is also important because some transsexuals have many difficulties finding a job or even to keep it. “When I was working in a fast-food establishment, my boss told me I had to show my real name to the customers and it was humiliating for me,” says Noah Torralba.
At “Trànsit”, transsexuals do not need a psychiatric diagnosis to start hormonal treatments but it does not mean everybody receives this treatment. Experts evaluate every patient during two weeks to make sure they are transsexual as it is important to know if people who ask for the treatment are just in a moment of crisis that could confuse them.
“I know some people who are depressed, for example, and they are convinced they are transsexuals. This is bad for whose of us who are real transsexuals,” says Oporto. Cristina Nadal has a similar opinion: “Some disorders may confuse people. Many autistics say they want to do a sex reassignment but they are not transsexuals.” To avoid confusion, psychiatrists help them, but they are not the most important professionals in this new model.
There are some requirements to get on the waiting lists for sex reassignment surgery: to be in the specialized unit for two years, to be over eighteen, and to have been in hormonal treatment for twelve months.
Trying to improve the former model
This new model is completely different from the Hospital Clínic one, where patients had to convince doctors about their transsexuality. While most patients are satisfied with Trànsit, many of them were disappointed with the behavior of the doctors in the former system. “They told me I was not a transsexual because I had heterosexual relationships. It was not a good experience,” explains Carla Agulló.
Cristina Nadal did not like this system at all because she distinguishes between gender and sexual orientation. According to her, things that doctors asked for before (if patients played with dolls in their childhood, if they liked mechanics and even if they used nail polish) had no connection with gender identity.
Catalonia is very advanced with regard to the struggle for LGTBI rights. Same-sex marriages were declared legal in 2005 and the Catalan Parliament passed a law protecting the rights of homosexuals two years ago.
“Despite Catalonia being a tolerant region, there are many situations of transphobia,” explains Agulló. “Sometimes we pretend we are tolerant even if we are not,” she adds.
Oporto and Torralba think Catalan transsexuals have made progress because transsexuality is no longer a taboo. “We don’t hide ourselves like we did years ago, but some transsexuals (especially women) receive insults on the street,” explains Noah. “A person told me I wouldn’t be a man until I had a penis,” he adds.
Despite the fact that Trànsit is such a new model, there are still many difficulties in carrying out sex reassignment in Catalonia. Most transsexuals do not have operations through the public healthcare system because the waiting lists are too long. Torralba decided to do the surgery though private healthcare. “I was lucky because my parents could pay for it and I am free now.”
However, the Catalan Health Department allocated 274,000 euros for these surgeries last year, which means 30 operations will be made. “The Catalan Government is increasing its help for Trànsit and for surgeries every year, but we cannot solve the sex reassignment waiting list and leave other ones unattended,” explains Cristina Nadal.