Gender reassignment through the eyes of a trans man Paul: "Diagnosis is as fake as in the 1950s and phalloplasty is difficult and without guarantee of results"
Paul, when did you first become aware that you were a man in a woman's body?
I knew that something was "wrong" since I was about three years old, he kind of perceives that he is not treated as he would expect. But as a kid, you don't really worry about it because it's not important at that point. The problems gradually come and start to escalate before puberty...
But for you, the road to discovering that your "problem" was transsexuality took a bit of a detour...
I didn't even know transsexuality existed at the time. I didn't have a name for my problem, so I thought I was a lesbian. But my relationships with girls didn't work out, in retrospect it's quite clear - because I was constantly putting myself in a male role. Finding out what my problem really was then was actually a matter of chance. A friend of mine had another friend, and he had already made the transition. I confided in him what I was going through and he directed me to the professionals.
So what steps does a person who concludes they are "trans" need to take?
The first step is to see a sexologist. In Prague it's Hanka Fifková, that's where most people go. Actually, I don't even know of anyone else who focuses on trans people in Prague. Personally, I was also quite shocked when Hanka Fifková told me that I had to have a hysterectomy and then go before a committee. I thought I was going to be arrested, I thought I would have an "M" on my papers and a male name. The system's been in place for a hundred years. Why is it possible elsewhere and not here? Otherwise, on her first visit, Fifka's putting in a request to see Weiss. That's where you have to go to get your diagnosis confirmed so you can start taking hormones.
How do you "confirm" a transsexual diagnosis?
It's a horrible "ass", sorry, you have to fill out some fake IQ test that looks like it's from the 1950s, it's yellowed sheets of paper and the test is designed to test your imagination. There's circles, rectangles... and I don't know how anyone's technical imagination is used to determine identity. Specifically, Weiss then relies on one of the "test" methods. If you draw a figure of the opposite sex, he diagnoses you as transsexual. That's common knowledge now, so everyone's taking different advice on forums. When I drew a guy, they said it was because that's how I felt. Funny thing though, if it wasn't for a friend advising me, I would normally draw a woman because I'm into women. But if I drew a woman, I'd probably "kick myself in the sandals". Plus, I have a feeling Weiss doesn't recognize anything other than "man" x "woman". I don't think I'd even pass for a macho man right now. A lot of FtM guys still have a bit of that feminine energy in them even after transition, but with Weiss you can't talk about it or you probably wouldn't get the paper... I know FtM guys who aren't gender specific sexually, but they're all about the character of the person. And apparently Weiss doesn't recognize that at all.
So 21st century medicine in our country has come to diagnose transsexuality by the "correct" picture drawn and the made up stereotypical idea of a woman and a man?
Well, almost. It's all very absurd. Like, Weiss keeps asking about sexual fantasies and stuff, I can kind of understand that, that can be pivotal...But it seems to me that he's giving everyone a hard time about his famous book, which you can't buy today because it's already been dismantled in the stores. And until one reads it, it looks like Weiss won't confirm his diagnosis. I've talked to other people about it, of course, and we all feel that way. I mean, I haven't read the book, except maybe the first few pages, but of course I told him I'd already studied it front to back...just to be sure.
Okay, you drew the right character and claimed to have read the book, that opened the door to hormone treatment - what does that entail?
I was really looking forward to the hormones. But their effect is very individual. You start on the pills first, that lasts about two months. It's kind of a raid where nothing really happens, then the injections follow. Specifically, I waited three quarters of a year for my voice to change, but then when I changed the type of injections it went faster, usually the first changes appear after about three months. Then you're on hormones for at least a year, proving to the environment and especially to psychologists that you really feel like a woman or a man. After that, there's this ridiculous committee...
There's been a lot of talk lately about the sex-change committee. Mostly in a very negative way, so what's your experience?
I was so stressed, I don't really remember. We were all waiting in the same corridor, like a herd for the slaughter. We were called in turn and the whole show lasted about ten to fifteen minutes. I think there were at least ten people there, all sitting at a table, and some woman from the Ministry of Health asked me if it was okay in my family, if I really wanted to go through with the operations. Because it's the family that a lot of people have a problem with during the transition. And so they normally lie to the board because there are stories about how even because you don't have family support, they'll brush the papers off the table. Then they told me to go out for a while, and when they called me back they just glared at me. I was already scheduled to have my breast removed, so I asked if I could pick up the decision early. And the woman let me off the hook, saying they didn't know if they were going to give it to me yet....
That doesn't exactly strike me as "gentle" treatment of a person in a not-so-equal life situation...
I had a nervous breakdown, you just need a stamp of approval from the commission for all those operations...but if they didn't give it to me, I was really in a state that I would probably kill myself...especially it's pretty crazy when your life is decided by a group of strangers who don't know you and have never seen you in your life. They just don't have the right to make such sweeping decisions about people's lives... I have no problem with professional supervision in the therapy of trans people, it's definitely important. But it should be supervision like any other patient. There's still a stigma attached to trans people, unfortunately, even by some professionals.
I'm told you also have to provide documentation to the commission with a neutral name - is that supposed to help trans people specifically in what way?
Absolutely nothing. It's an abomination. You have a neutral name in the year you're tested, you can't have an "M" on your ID because you're not sterilized, and you can't have a female name because you're already in that transition period. So I was actually SOMETHING, THAT. Neutral names are usually pretty bizarre. It makes you feel ashamed to show your ID. Plus, it's actually a "scam". You have a foreign name on your papers, you weren't named that, you're not named that, and you won't be named that after the transition...not to mention that what your specific name will be hangs on the registrars too. Even though I had some list of neutral names from Fifka, I picked one that the registrar said was out of the question...And changing documents is a crazy round of the offices, but it doesn't get you anything. You just change your name to go before the board. And then you can start over.
Doesn't that unusual neutral name draw unnecessary attention when you present your papers?
Every time you show a neutral name at work or anywhere else, you totally give yourself away. You want to be perceived as the opposite sex, you want to be addressed as such. But in addition to the weird name, your ID says you're the gender you don't want to be, which, thanks to hormone treatment, no longer fits. I've had problems with this, especially at routine check-ups, when there were some embarrassing situations in the waiting room.
The story of Tereza Španihelová, who was not given the necessary stamp by the commission because she didn't have a neutral name on her ID card, has resonated in the Czech media in the past... Is the system really that strict?
Tereza used to be Jakub. Even though she took all the steps she should have, she posed as Tereza everywhere and the neighbourhood and the public had no problem with it. So she kept the name James on her ID because she didn't think it was necessary in her case. Is that a reason for someone on the board to feel she wasn't girl enough? I have no idea, but as far as I know, Petya Nitka, for example, didn't have a neutral name on her ID either and passed. We kind of see the reason in this case elsewhere - it smacks of revenge. Tereza said in one video how it is with operations in Motol, that girls take a long time to recover and that in Opava they can do it better with a much shorter recovery ...but there were people in the commission who brushed her off out of spite. Actually, I'm not surprised...
But you told me that nobody with the instinct for self-preservation would undergo surgery in Motol...
The reputation of Motol is really bad, for example, guys don't go to Motol for phalloplasty because they do it, sorry for the vulgarism, "for shit". One guy had his whole life ruined a few years ago. So everyone goes to Brno, where Prof. Vesely does it. He has a different method than in Motol, where you're more like a guinea pig. Specifically, Veselý does phalloplasty from the back muscle, that's why there is also motor skills and as far as appearance is concerned, the results are also quite good. In Motol they do it from the groin flap, so then there is something hanging between the legs and the appearance is really not very good, nobody tries to model anything... But when Veselý is finished, it will be a problem, because he has no successor. As the nurses at the dressing room told me, there is no one to take over from him...But not to smear the soot, Mr. Frajer made me a luxurious chest in Motol. I'm still grateful to him for that. On the other hand, we have more experts on "tops".
But phalloplasty only means modeling the penis - "some skin", what about the urethra?
Well, that's just complicated enough. They take a graft from the arm, from the forearm to the wrist, and then they create a big keloid scar that's hard to heal. The problem is that the tissue doesn't water very well, it often forms fistulas, even repeatedly. A lot of people don't do it because of these complications, and there's no other way available to us. If they do it better abroad, I don't know, but I wouldn't have the money for it anyway. Supposedly the surgeries I've had alone would cost around a million. However, phalloplasty is a three-part procedure, with 90% of each operation being reoperations due to complications. So it's a really difficult and long road. I just need the basics. I don't need the testicles yet, and the urethra is risky.
Do MtF girls have similar problems?
I guess they have no choice but to go through the whole thing. Mainly - MtF girls usually have such a distaste for their original genitalia that they're happy to have the surgery. And if they're gonna have their testicles removed, they're gonna get the whole thing done. That way they can have an official conversion. All I needed was a hysterectomy to have an official sex change. By the way, for me, the sterilization requirement is also nonsense, you can't force someone to have surgery against their will...I might have the hysterectomy eventually, but certainly not just to be recognized as a man, even though I already looked like one. But the system literally pushed me into it. Actually, there are plenty of guys who just need chest surgery and that's all they need. They look like men, but they're not legally recognized as men. But they still need board approval for a mastectomy.
Specifically, the issue of removing the need for sterilisation for sex reassignment was to be covered by a government amendment responding to recommendations from the World Health Organisation and also European bodies...
Yeah, but the amendment hasn't passed yet. If we were to pass it, then sterilisation would not be a condition for sex change, and we could change documents without it... But unfortunately, we are being decided by a handful of people, a generation of sexologists who are still crippled by the communist regime and have rather rigid views. Take Zvěřina, for example, who is the president of the Czech Society of Sexology and a fundamental opponent of the amendment. Similarly, the vast majority of our society is changing its views only very slowly. It will take two more generations and then hopefully it will be all right. For now, it's about us without us. But the flaws in the system are why we need to point out...
