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Demanding Equality: Healthcare for Trans Individuals as a Right, Not a Luxury
published on 11 April 2024
Trans people are in danger. We are talking about a transphobic society whose rules and regulations make it increasingly difficult for trans people to get the care they need. It is essential – especially during a political year – to shine a light on the needs of trans people and how to support them.
Transgender people have long been victims of rules and regulations that have made it very difficult for them to get the healthcare they require. With this article we underline multiple aspects that need to change in order to improve the quality of life for trans people.
But first; what do we understand under transgender ? A trans person is someone whose gender identity does not align with the gender they were assigned at birth. To put it simply, their inner feelings do not align with the label of man or woman they were assigned at birth based on their primary sex characteristics. Transgender is an umbrella term that encompasses everyone that feels this way, not just trans men/women, but also non binary people.
In addition to support and respect, a central aspect of transgender people’s well-being concerns access to care. It is first of all essential to distinguish between the wrongly pathologization of transidentity and the need for psycho-social support.
Transforming Perceptions : Ending the Pathologization of Transidentity Transidentity has long been considered a psychiatric disorder (1). In Belgium, it was not until 2017 that transidentity was depsychiatrized in law. Before that, it was the 2007 law which governed the journeys of trans people through measures presenting transidentity as a pathology. It is, however, important to note that “this change in nomenclature cannot be presented as sufficient for the depathologization of health care pathways, which are still very often subject to psychiatric diagnosis (1).” As health sociologist Anastasia Meidani says, trans people have long been located “too close to diagnosis, too far from care” (1) and this vision still persists today.
It is important to repeat: transidentity is not an illness. However, members of the transgender community have an increased risk of facing mental health problems due to environmental factors. Several studies have shown that 50 to 90% of trans people will face harassment linked to their gender identity in their lives and at least 25% will be victims of attacks (2). This discrimination can occur in the public as well as in the private sphere. This discrimination also affects the employment and housing sector, which contributes to the precariousness of trans people.
A heavy toll on trans individuals’ psychological well-being
These multiple discriminations and violence are the source of psychological suffering on the part of transgender people. The study by Heylens et al. from 2013 showed that 60% of participants suffered from mood disorders (depression and bipolarity) and 28% from anxiety disorders. This prevalence of increased vulnerability in terms of mental health is even more prevalent among trans youth. A recent Danish study also found that the risk of dying by suicide is 3.5 times higher for members of the trans community (3). These alarming figures bearwitness to the effects of systemic discrimination and the neglect of the transgender community on the part of public authorities and the medical field.
The urgent need for a better psychological care of trans people
In this context, we ask the next government to propose in its program concrete actions and financial means to guarantee better care for trans people in the psycho-socio-medical system, in particular the increase in the number of reimbursed psychotherapy sessions. , a better reimbursement rate (or even free for certain social statuses such as BIM or VIPO). better training of health professionals regarding the specificities of trans people in the psycho-socio-medical environment, as well as better support for care dedicated to trans people from mutual insurance companies.
It is urgent to act, on the one hand at the federal level, to combat discrimination and violence against trans people, whether systemic or societal; and on the other to support trans people, whether in the challenges of their daily life or their transition journey.
Concrete means and actions must be implemented to combat the precariousness of trans people in terms of health. Having access to health care tailored to you is a fundamental right, not a luxury.
Empowering Self-Determination: Accessible Healthcare Choices for Trans Individuals
When talking about trans people a big focus is often put on medically transitioning (be it hormones and/or surgery), it is however important to note that not all trans people want to start hormone therapy and/or want surgeries. Being trans does not necessarily mean (medically) transitioning; It is imperative not to systematically and automatically medicalize their relationship to gender. However, it is equally important to make these choices accessible to those who wish to explore them. Especially with several studies converging on the observation that hormonal and surgical therapies for transgender people may be associated with decreases in rates of depression and anxiety, as well as an overall improvement in quality of life (4). Lastly it is important to note that not every trans person that chooses to transition does that in the same way. Some -as previously stated- might not feel the need to change anything, some might feel content with only socially transitioning (changing their name and/or pronouns), and others may feel the need to medically transition and use one of the many available options (hormones, surgeries, voice training, hair removal, puberty blockers, etc), but whichever one it is trans people should have the right to decide that for themselves and for their desired option to be available to them.
The problem lies in the fact that starting a medical transition is not as accessible as it should be. This is due to a few different factors.
First of all, even with access to information for trans people, a lot of medical professionals are not trained to deal with the demands of trans people and can therefore not give proper care. And it can be difficult for trans people themselves to find trained medical professionals who are able to answer their questions.
Then one of the biggest hurdles is the question of price. Medically transitioning is very expensive while it really shouldn’t be. Hormone therapy and puberty blockers are only partly reimbursed, voice training tends to only be partly reimbursed for a few sessions, surgeries are not reimbursed and neither is hair removal while both costs thousands of euro’s, and you can lose the reimbursement for gynecological/ andrological if you change your gender marker on you ID.
Advocating for accessible trans specific care
Today, although access to care no longer requires a diagnosis of transidentity as a pathology, this is not the case for their coverage by mutual insurance companies. Indeed, to have access to reimbursements and various trans-specific treatments, a psychiatrist must certify that the person “presents symptoms of gender dysphoria or has received a diagnosis, according to the DSM-5 definition” (5).
Although the 2017 law presents progress for the rights of trans people, a long way remains to be covered to achieve respectful and benevolent consideration towards trans people in psycho-socio-medical environments, particularly with regard to the pathways of trans children.
We are demanding better financial support for trans-specific health care as well as an improvement in the Belgian legislative framework with regard to transidentity. It is urgent to establish a fair and consistent reimbursement system for trans-specific health care. Beyond the current free changes of first name and “registered sex”, it is necessary for mutual insurance companies to cover specific trans health care, whether in terms of psychological support or possible medical transition procedures (hormones, surgery). etc.)
The change of “registered sex” must also stop being a barrier to reimbursement of gender-specific health care as is currently the case. Finally, it is essential to increase the number of reimbursed psychological support sessions. We also demand the right to self-determination of minors from the age of 16, whether this concerns the change of “registered sex”, the facilitation of the change of first name of trans children or the reimbursement of puberty blockers.
Carte blanche drawn up by RainbowHouseBrussels Sources : (1) Alessandrin, A. (2023). La santé des personnes trans. Questions De Santé Publique, 47, 1–8. https://doi.org/10.1051/qsp/2023047
(2) Newcomb, M. E., Hill, R., Buehler, K., Ryan, D. T., Whitton, S. W., & Mustanski, B. (2019). High burden of mental health problems, substance use, violence, and related psychosocial factors in transgender, Non-Binary, and gender diverse youth and young adults. Archives of Sexual Behavior, 49(2), 645–659. https://doi.org/10.1007/s10508-019-01533-9
(3) Afp, L. M. A. (2023, July 6). Pour les personnes transgenres, le risque de faire une tentative de suicide est près de huit fois plus important, selon une étude danoise inédite. Le Monde.fr. https://www.lemonde.fr/international/article/2023/07/06/pour-les-personnes-transgenres-le-risque-de-faire-une-tentative-de-suicide-est-pres-de-huit-fois-plus-important-selon-une-etude-danoise-inedite_6180851_3210.html
(4) Baker, K., Wilson, L. M., Sharma, R., Dukhanin, V., McArthur, K., & Robinson, K. A. (2021b). Hormone therapy, Mental Health, and Quality of Life among Transgender People: A Systematic review. Journal of the Endocrine Society, 5(4). https://doi.org/10.1210/jendso/bvab011
(5) Institut national d’assurance maladie-invalidité. (n.d.). avenant à la convention entre le comité de l’assurance soins de santé de l’institut national d’assurance maladie-invalidité et le centre hospitalier universitaire de Liège, pour le centre d’accompagnement de la transidentité de liege. in riziv – inami dienst
geneeskundige verzorging – service des soins de santé.