Transgender EuroStudy – Legal Survey and Focus ... - ILGA Europe

67 April 2008
Proposals for Change
From the online survey data results it is possible to highlight several major concerns:
The current shortage of accessible, localised, access to specialist care for transgender and
transsexual people.
That current service provision, even if accessible, generally provides a very poor experience
for the trans person.
Many current service providers need to take action so as to provide a regularized service
that meets internationally recognised best practice (WPATH, 2001).
The issue of the rights of trans people to dignity in healthcare.
It is currently impossible to police the sort of single but complex multi-layered health care issue
which trans health is, within the many different European healthcare systems. At present, the few
specialists in this area are unevenly distributed and are usually concentrated in urban Western Europe.
Choice is often only available to those trans people with sufficient wealth to travel across borders and
to seek out more than one consultation.
Access to specialist services should be made available to trans people in all areas, regardless of
their local or national healthcare arrangements, or the individual’s financial status. Cross-boundary
coordination would be helpful as some countries do not have access to the most advanced treatment
and would need to contract such services. Access could be made possible for those patients who are
unable to receive services in their local area through an EU travel fund, as continuous substandard
healthcare can have harmful social, psychological and economic effects for the individual.
Furthermore, as transgender and transsexual Europeans move from one area to another due to
the freedom of movement afforded by EU citizenship, issues of continuity of care arise. Greater
practitioner education is required so that trans people in all areas of Europe have access to quality
treatment on a more equal basis and so that prejudice is reduced at all levels. Facilitating the exchange
of knowledge for both practitioner and patient would be an ideal way for the European Union to
promote higher levels of excellence and coordination.
An evaluation should be undertaken by each European country that will acknowledge and
address the needs of trans people in healthcare. This should take place in partnership with relevant
stakeholders: local transgender and transsexual communities, healthcare providers and healthcare
funding decision makers. These evaluations should be used to develop action plans that will propose
solutions to healthcare disparities and that will support further equalities work. Trans people require
policies that acknowledge human differences whilst recognising the right to appropriate treatment
without unnecessary delay. It is imperative that there is a top-down shift in the view that trans-related
healthcare is cosmetic or elective, and the needs of this patient group must be prioritised in line with
other important medical treatments.
There is also a clear need to move away from the view, as contained in Diagnostic and Statistical
Manual (DSM) IV and International Classification of Diseases 10, that transgender and transsexual
identities are the result of pathological mental illness. In order to reduce the stigma that currently
exists another space within diagnostic structures needs to be found, for example within endocrinology
or in surgery. This might seem impossible, when the main Diagnostic Consultative Committees of the
American Psychiatric Association (APA, 1994) and the World Health Organisation (WHO, 1994) are still
firmly embedded in the idea that to be trans is to suffer from mental disorder, even though they both