Transgender Health Care in Europe

Different European countries (Armenia, Iceland, Czech Republic, and the UK) have been selected to discuss transgender health care in the respective country. Confirmed speakers are:

Dr. Karen Badalyan

Transgender health care in Armenia
Bio

Dr. Elsa Bára Traustadóttir

Transgender health care in Iceland
Bio

Prof. dr. Gary Butler

Transgender health care in the UK
Bio

Dr. Viktor Heumann & Dr. Petra Vrzackova

Transgender health care in the Czech Republic

From the perspective of a provider of the trans specific healthcare in the Czech Republic, I would like to address the issues associated with the system of medical transition and the quality of trans specific medical care in Czechia.

In 2018 and 2020, the Czech trans-led organization Transparent compiled two publications of research findings entitled The Hopes and Fears of Trans Persons (396 respondents) and Trans People’s Experience with Medical and Therapy Services (212 respondents) that unveil the perspective of transgender and gender diverse clients with medical services in Czechia. One of the most striking outcomes is the fact that those who reported negative, humiliating and discriminating treatment mostly stated that they have experienced this treatment from care professionals and in medical and care environments.

One of the problematic aspects related to the quality of care in Czechia that often manifests itself as pathologizing and dehumanizing methods applied by experts providing trans-specific healthcare (sexologists) consists in the clash between the old view and the modern approach to gender incongruence. The majority of sexologists still implement outdated diagnostic methods which are underpinned by the belief that the need for and surgery and sterilization is naturally an integral part of the transgender identity of their clients. That is also why the desire for surgical treatment is often taken as one of the key diagnostic criteria. Despite the international progress including the ICD-11 and Standards of Care 8, outdated terminology incl. the terms disorder, transsexualism is still used, and a “cure narrative” is followed that is based on the conviction that medical treatment and interventions such as hormones and surgeries will cure patients suffering from a sex identity disorder to become healthy men or women.

The prevalent approach also fails to cater to the individual needs of the clients and a standardized process for all is promoted: diagnostics, consisting of hormonal treatment and surgery, followed by legal change of the gender marker, birth number and name in documents. Nevertheless, what the clients need most – i.e. psychotherapy, sensitive and respectful support and guidance in the process of transition, is usually neglected.

One of the reasons of such a highly impersonal and objectivising approach seems to be the need to have tangible diagnostic data, therefore employing humiliating instruments such as the falo- or vulvo-pletysmograph as well as prolonged real life experience.
In contrast and in order to cater to the needs of the clients I based my medical practice on trust and respect to the experience of the clients and the model I follow is the informed consent model that represents an agreement between the provider and the client. This approach naturally leads to the improvement in overall health and wellbeing of trans and non-binary clients who seek medical support.

Bio

Viktor Heumann is the Co-founder of Czech trans-led organization Transparent, founded in 2015 to provide support for trans and non-binary people in Czechia. He is currently engaged in advocacy activities aimed at the improvement of conditions for legal gender recognition (abolition of forced sterilizaton) and improvement of trans-specific healthcare processes. Co-author of 2 research publications mapping the life of Czech transgender and non-binary people as well as healthcare and therapy services, and a handbook on the wellbeing of LGBTI+ communities.

After graduation from the 1st Medical Faculty of Charles University in Prague, Petra Vrzáčková worked as an obstetrician. She became a Fellow of the European Committee of Sexual Medicine (FECSM), which she studied in Oxford, Lyon and Porto. She completed postgraduate studies in Experimental Surgery with the topic of women’s sexuality after gynaecological surgery. She has psychodynamic and depth psychotherapy (SUR) training and couple and family therapy psychoanalytic training (IPPART). Since 2013 she has been working as a sexologist and therapist focusing on transgender and non-binary clients. She has been closely collaborating with organization Transparent and sharing her expertise in sensitive and informed client care.