It goes without saying that most women go to a gynecologist for an annual check-up. Cancer screening would also be important for Jamie B. But as a trans* male person, he feels out of place there. How he looks at healthcare and what he would change.
Jamie B.*’s shoulder-length hair is wavy at the ends. The young trans* male wears narrow glasses. He smiles sympathetically into the camera while we talk to each other via video call. The little fluffy dog Dobby sits on his lap. The companion looks around with interest. Jamie B. describes how 2018 changed his life. A radio report on the gender entry divers became a key moment for the 27-year-old. Although he already knew trans* people before, he was also in a relationship with a trans* man, but had never considered the fact that he could be trans* himself. It was only the radio report that opened up points of contact for him and showed him that there is more than just male, female and trans* male. “I also met a person who identifies as diverse. It was an eye-opening moment for me that a transition doesn’t just go from A to B, but is a whole spectrum in between and you can also stop on part of the route .”
Most would mistakenly understand trans identity to mean turning from a woman into a trans man and also undergoing gender reassignment surgery. But that is not the case. “A trans* man is a man as soon as he says he is a trans* man – whether and which procedures this person wants to have is up to them.” In early 2019, Jamie came out as trans*. However, he does not define himself as male, but as non-binary. A gender identity means that you are neither completely female nor completely male. He decides to undergo hormone treatment with testosterone in order to modify his body so that it fits the body image he has of himself. For Jamie B., this decision begins an arduous path that trans* people have to take if they want to change their body through a medical transition.
Others decide about Jamie’s body
“I don’t feel like I’m in good hands in the healthcare system and I’ve had a lot of experiences of discrimination. It’s a problem that there are a lot of gatekeepers, i.e. people I have to get past to get what I want. They’re allowed to make decisions about meet me. I’m not allowed to control my own body and say what I need to feel good about myself.” In order to start his hormone treatment, Jamie B. needed a referral letter from a psychologist. But the search for a practice with trans* experience and appointments in addition to his training at the time represented too great hurdles for Jamie B. Due to the long commute to work, he could not imagine doing therapy as well. “I was finally able to get appointments at a counseling center and thus my indication. If the place hadn’t existed, I probably wouldn’t have started hormone treatment to this day or would have gotten the hormones in a different way.”
Jamie B. would have accepted a high risk with that. According to the German Society for Endocrinology, hormone therapy is a massive intervention. The association warns against self-therapy with hormones. “If used improperly, it harbors significant risks for body and soul. These can be liver damage, hormone-sensitive tumors or mental illnesses such as depression”.
Jamie found an endocrinologist in Hamburg, but he has to travel two hours to visit there. In rural areas, the supply of specialists is poor, and even more so for trans* people who are looking for doctors who are familiar with trans* people and would be confident in treating them. From his work in a self-help group for non-binary trans* people, he knows that doctors sometimes do not trust themselves and refuse the treatments.
A healthcare system designed for two genders is a problem for non-binary people
But in addition to the hurdle of getting medical help at all, Jamie B. sees a structural problem in the health system: “The health system is designed for two genders. My endocrinologist assumes that I want to make a ‘complete’ masculine transition. I’m there I’m non-binary and am also aiming for a non-binary body. I know from the community that he has no expertise on non-binary transition possibilities. I don’t want to bring this up with him for fear he might refuse to proceed with me.” He informs himself in the community and determines the dose himself. He elaborates: “It’s a bit like being my own guinea pig and playing around with my own health.” But the decision for the hormone treatment was made. “It really came from a very strong psychological strain for me, where I said I need this, otherwise I can’t do it.”
But in addition to the big problems, it is also the supposedly small things that ensure that Jamie B. does not feel in good hands in the hands of doctors and our health system. His female name is still on his health insurance card, which means that he is repeatedly addressed with a wrong name or that people do not believe that it is his card. “I’ve actually only had good experiences with my family doctor. He’s over 60 years old and certainly hasn’t done any training on trans* people, but he manages to address me by my real name and treat me with respect.”
Fear of visiting a gynaecologist
Actually, Jamie B. should continue to have annual cancer screening, but he had had bad experiences with gynecologists even before the start of his medical transition. Now that he’s a trans male, he feels like he doesn’t belong there. “They won’t be able to speak to me properly, I’m looked at crookedly there in the waiting room – I’m out of place with a gynecologist. Such an appointment would cost me an incredible amount of energy, and I don’t have it right now .” The many discriminations in everyday life mean that he does not want to go into more such situations.
“I have this feeling that society doesn’t really care. And that my experiences of discrimination, my suffering in this system don’t count. That most people just don’t care at all and that there is such an indifference,” describes Jamie B.wie it happens to him. For better medical care for trans* people, Jamie would first of all like that the correct name and the desired salutation be used in every practice.
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In addition, general education is important. “The guidelines for treatment are there, but they are of no use to us if the doctors refuse to treat.” The various options for binary and non-binary transitions should be expanded and made visible. Physicians should not force their own ideas about transition on their patients.”
The everyday life of trans* people is not easy. A reduction in discrimination in the medical system would be a step in the right direction. “Trans* people should also have the opportunity to participate in our society without everyday discrimination,” says Jamie B.
* Jamie B. actually has a different last name. The editors know his name.