Informed consent is the only way to go with people who are legally and factually able to decide for themselves how their life, their body, their gender should be. that does not say those who are somehow not able to express themselves (in this area) should be excluded for not voicing their need. They are just mostly not understood. Each and every psycho/medical intervention needs to be for the benefit of the one who needs it. Using medicine differently equals cruel, unusual treatment or even torture. Like forced sterilisation of women because they are of the wrong class and ethnicity.
Nor do we call for the abolition of any and all social, psychological or even psychiatric involvement in the decision process towards social and physical gender transitions. However the respective professionals just not have a decisive nor obligatory and coercing role. They must be there if we need them, when we need them, as we need them.
Yes, this is a first attempt to sketch an ideal situation and it is of course a situated one, from a situation where there is in principle a well organised health care system. Without this being available and accessible other practices will develop that may be just as valid. In all cases the free will of the applicant (better than client or patient) is leading. Not a medical or state requirement.
Medical requirements are only acceptable in so far as they area a technical requirement. Like blood works before starting transitional hormone treatment. Classically called sound grounds for a certain order are not merely technical but often also moral. Like testosterone use before chest reconstruction. Professionals have to get used to a multiplicity of body images and gender identities.
Trans* and gender variant people may have mental health problems – like so many others. In that case these issues need to be attended – as with everyone – but they are not be default a game breaker for medical assistance in gender transition. Not even for scrutiny – other than with everyone. Trans* and gender variant people demand equal and just treatment to all others (ought to have). So away with required psycho screening before entering medically assisted physical gender transition.
The question that leads me to writing this article is why the hell do they (the legal and medical professionals) still wish to treat us differently? Why the hell don’t they listen to our strong wishes and our pain of living the ‘wrong’ life, our stories how our lives so often are prevented full bloom by restricting, refusing norms and values in society that we call cisgenderism and transphobia.
All over the world doctors and psychologists have learned to be the expert. But expertise does not come from applying text book knowledge but from listening to real people with an open ear and an open heart. Stand next to your “patients” instead of hovering over them with an attitude of superiority.
Politicians and lawyers need to stop legislating what does not need legislation. Only in a conservative model that refuses the basic equality of people often codified in constitutions and for sure in human rights treaties, there is a reason not to.
The world is changing, dear doctors and lawyers and politicians. And the world has always influenced lives so don’t be so surprised that we suffer from injustice. Instead become a bit more modern and realise the ivory tower is crumbling down, being permeated by the real world. You can try to contain all variation, but you can not extinguish it. Reason why legislation and practices like in Uganda, Nigeria, Russia, Lithuania, attempts by the Catholic Church and narrow-minded US religious ‘leaders’ are not only unjust, inhuman and discriminating, but in the end also futile. Just: to the cost how many lives? How many people will it take until those powers that be realise they better modernise? Or didn’t we grow over slavery and patriarchy? Don’t we have human rights discourse and legislation that all oppressed take as their tool of preference, their common discourse for change?