As I’m waiting for my appointment at the gender clinic, I’m thinking a lot about the process I’m going to go through. Cis people I meet think that I’ll start hormone therapy at my first appointment, and my coworkers asked what would be different when I return from my parent leave next year. They were a bit surprised by my answer that nothing would have changed but at the same time they said that maybe it’s a good thing that the healthcare makes you wait a bit longer so you don’t do anything you’ll regret later. I wish I had the energy to tell them that waiting over 30 years is long enough and that hardly anyone change their minds. On the contrary I think that the gatekeeper system causes more people to push themselves into the binary boxes and I think that it causes more people to go through surgeries and/or other treatments that they don’t truly want, just to access the ones they need. The procedure here means that before I can access any treatments I have to go through roughly one year of assessments, intelligence tests and mental health evaluations. After this year of humiliation they continue by giving me a diagnosis, transsexualism, the key to all treatments. Then it will take about two to three years before the treatments are done/started and I can apply for a gender marker change on all legal documents. To change the gender marker you apply to a board consisting of retired doctors, psychologists and other random people who goes through all your medical files and then decides whether you’re allowed to have your gender marker changed or not. Then you can contact the authorities to finally change your gender marker in all systems. This system is just as intricate and stupid as it sounds and there’s much left to be said about it, but I’ll save that for another post. 

Instead I want to write about when you’ve gone through the whole process and finally landed on the other side, gender marker and all. You are still diagnosed with “transsexualism”, that key diagnosis. It’s true that you still are trans*, but since having a personality disorder diagnosis you can be excluded from anything that requires a clean bill of health. Like being a pilot, police etc. Of cause it depends on which doctor you meet when you apply, but they can require you to show verification that that you have recovered from your illness and that your diagnosis no longer poses a threat in your occupation. The issue with this is that you impose that transexuals are posing a threat to society and are unsuitable to do certain things. It also imposes that transsexualism is curable.

If you don’t want everyone who have access to your medical file to know that you’re trans, you can ask to be declared cured from transsexualism or you can require your medical file to be classified, or both. Personally I don’t see a problem with medical staff knowing I’m trans, on the contrary it can be positive. I believe that I will get better care if they know my full medical history. The only problem is that the diagnosis “transsexualism” doesn’t give any insight to my trans-medical history. It doesn’t help the staff at all if they need to do an ultrasound of my abdomen, nothing in the diagnosis gives a hint of what kind of treatments I’ve had for my transsexualism. Therefore I have to conclude that the diagnosis transsexualism is totally worthless. It’s a pathologicated name for what I am, not a description of what I’ve got, need treatment for or have had treatment for. I can’t be cured from transsexualism just as little as I can be cured from having blond hair or blue eyes.

I’m not saying there’s no need for a diagnosis. Trans* people do have issues we need help with, and a diagnosis is the key to access the right treatment for whatever condition you have. The diagnosis have a purpose in telling the medical staff why I’m having mastectomy, hysterectomy etc. It helps them treating and addressing me right. But I think the diagnosis should be something in line with Gender Dysphoria instead. At least that gives room for non binary folks and addresses the actual reason we seek medical treatment.

4 thoughts on “Diagnosis

  1. I am fortunate to have enough money and enough health insurance to finance a DIY transition – I’m also lucky that I can go to therapy, get top surgery, and if I want get hormones get them just with informed consent (no gatekeeping).
    I really bristle at having to justify (adult to adult) what I want to do and what I don’t want to do. I do not want to be condescended to by some MD who knows less about being trans than I do.
    I think therapy with a trans-knowledgeable and trans-friendly therapist can be very helpful in figuring out how to handle transition – and to give voice to all of one’s doubts – but it is a misuse of it to do gatekeeping and to use it to deny people health care (transition is health care). Therapy is useless if you have to make sure to give the “correct” narrative and answers to get permission to take hormones and/or get surgery.
    It is too bad that you have to wait and play the game, but it sounds like you will be granted your wishes, just not on your preferred time line. I sometimes ask people how they would feel if marriage had the kind of gatekeeping that transition has, since it has a much higher level of regret.

    Liked by 2 people

    • “therapy with a trans-knowledgeable and trans-friendly therapist can be very helpful in figuring out how to handle transition – and to give voice to all of one’s doubts – but it is a misuse of it to do gatekeeping and to use it to deny people health care”
      Spot on! What I’ve heard about the gender clinic I’m assigned to they have two different lanes – a slow lane for those who need to figure stuff out and a fast lane for those who, like me, knows what they want. Unfortunately they don’t seem to be all that open about which file they place you in.
      The good thing about our system is that it’s nearly free, the maximum cost for any medical care, except dental, is roughly $500 a year including meds. The bad thing is the gatekeeping, but I guess that when the stage finances your treatments they want to make sure you really need them. Luckily hardly anyone is denied care today and if they are it’s usually because they have an ongoing psychosis ore something similar.

      Liked by 3 people

  2. Here in the U.S., the gatekeeper system is not quite so strong. But it still exists, and we have all had our run ins with it. Although I have found my share of gatekeepers, I have been fortunate to find some medical professionals who do not even acknowledge to validity of the system with regards to trans medical care.
    The medical labels, now on supposedly “private,” permanent, electronic medical records is a very unfortunate thing. If I was ever feeling a little depressed, for instance, I would hesitate disscussing this feeling with my doctor, for fear that I would be branded with a permanent mark in my records.

    Liked by 1 person

    • There are ways around the gatekeeper here, but for me it’s not worth it to pay for surgery out of pocket when I know it’s covered and done by the best surgeons in the country. And you can’t go on T (legally) outside the gatekeeper system.


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