fredagen den 25:e juni 2010

Sweden and the issue of human rights for trans people.

This is a part of the report from Sweden in the Periodic Rewiev of Human Rights concerning trans and gender variant people written by myself and submitted in november 2009 by RFSL/RFSU in Sweden.

It highlight the human rights situation for Sweden's trans and gender variant population.

In Sweden most transgender individuals are denied the right to change their legal gender. Under the provisions of the present law, Lagen om fastställelse av könstillhörighet i vissa fall ( SFS 1972: 119) only those individuals who have undergone treatment by one of the six regional gender teams will be granted the right to change their birth gender.

According to this law the applicant must be a Swedish citizen, unmarried and sterile and above the age of 18. With the application a statement by the treating psychiatrist must be submitted that the patient meets the criteria in WHO ICD-10 F.64.0 and that this condition has prevailed since the patients youth. This is in effect a stricter diagnostic criteria than that present in the ICD-10.

In Sweden such applications are handled by the forensic advisory board of the National Board of Health and Welfare. The main tasks of this board is to deal with various aspects of forensic medicine and forensic psychiatry. In case an application is denied the decisoon can be appealed to the Administrative Court of Appeal and the Supreme Administative Court. But permission to do so can be denied without explanation.

Only after the approaval of the Forensic board will a permission to undergo genital surgery be issued and after undergoing sterilisation will the applicant handed a decsion that will give him or her a new personal identification number corresponding to the new gender. All public records can then be changed, but there is still the problem with older records and records kept by a non officail body such as scools and other institutions of learning etc.

A person undergoing a legal gender change have no legal right to have his or her credentials changed in the new name and gender. The Naional Borad of Health and Welfare has been know to deny transgendered nurses, psychologists, psychotherapists etc. to have their professional license change which in effect will stop them from working in the professions they are trained and licenesed for.

A revision of the present law from 1972 is taking place and if this law is enacted will in some respects be more restrictve that the present law. In lieu of sterilisation will be a requirement of gonadectomy ( ie castration) and the proposal is that only those who meet the ICD-10 F64.0 diagnostic criteria will have the righ to apply for gender recognition. This will in effect strengthen the position of the psychiatrist in the treatment process and the pathologisation of transgender people in Sweden.

(UPDATE: This proposal is at present sidetracked and work is in progress to lobby for a different law, that entiltels all trans and gender variant people the right to legal gender recognition with demans for surgical, hormonal or psychiatric intervention.)

In order to approved for said treatment the applicant must be refered by either a a psychiatrist in a primary psychiatry facility. This can take considerable time due to a lack of resources, competence and funds at the six regional teams that are located in Lund, Alingsås, Linköping, Stockhol, Uppsala and Umeå.

Transgender individuals who do not fulfil the WHO ICD-10 diagnosis Transsexualism, F 64.0 will not be acceptet for treatment and hence will have no possibility of having their gender legally changed from their birth gender. As a consequence they will not be accepted for any form of gender reaffirming treatment such as GRS (genital reasignment surgey), breast augmentation, mastsectomy, ochiedectomy, HRT (hormonal reasignment treatment).

All treatment at the gender teams are based on a strict psychiatric protocol and the physician in charge of the patient must be a trained psychiatrist. Psychologists and social workers play a very limited role in the the process. Sweden does not adher to the Standards of Care (2003 version 6) adapted by the World Professional Association for Transgender Health.

The Swedish treatment protpcols do include a minimum period of 12 months of psychiatric evaluation before a recomendation for HRT can be made, in comparison by the 3 month period prescibed in the Standards of Care. A further evaluation period of at least 12 months are requered before the patinet will be given a recomendation for GRS.

One of the provisons for this recomenation is that the patient is regarded as a genuine transsexual and earlier the definition of was that the patient must be diagnosed as primary transsexual and secondary transsexuals and person with gender identity disorder not otherwise specipied (GIDNOS) would be denied treatment of any kind.

The process can take anything from around three years and upwards. All treatments for those who meets the approval of the gender teams are met by the Swedish Social Insurance on par with other treatments.

For those transgendered individuals that do not meet the very narrow and exclutionary treatment criteras in use in Sweden there will be no forseable way of changing one’s legal gender. Until the fall of 2009 this also was the case in being granated the right to name. Due to a decision by the Supreme Administrative Court in the case Madeleine Jan-Olof Ågren and the Administrative Court of Appeal in Sundsvall the deciosn was made that an adult Swedish resident can and will have the right to chose whatever name he or she wishes.

Still those underage (18 years) kids have no option doing this even with parental consent. This is a cruel and damaging tratment of you transkids and in my opinion in violation not only of their human rights but furthermore of the United Nations Convetion on Childen.

What furthermore puts a burden on the vast majority of transgender individuals in Sweden who do not meet the narrow criteria of genuine trassexualism is the fact that due to decision of the National Board of Health and Welfare’s body that oversees medical practitioners in Sweden, it is illegal for any physician to prescibe HRT to a patient that has not met the diagnostic criteria of F64.0 and that have a referral from one of the approved gender teams.

This practice leads to servel alarming health consequences for transgender people in Sweden such as an abundance of black market hormones as well as various unoficial souces of hormones and hormone blockers. The transgender persons using this form of treatment are risking their health due to overdoses and other problems. The very necessay monitoring of hormone levels by health professionals is not available and the Gatekeeprs in the system flatly deny their paitents request until a F64.0 dia.

Due to the long time of waiting before approval for HRT for those who are accepted by the teams most MtF TS and several FtM TS are already on unmonitored HRT long before this. According to the Standards of Care the unmonitored use of hormones is a criteria to approve HRT as soon as necessary blood level tests are made., however this is not the case in Sweden.

It is not uncommon that a patient waiting the 12 months for approval for HRT already is on hormone medication with out supervison while beeing sceened by the psychiatrist is he or she is a possible candidate for HRT. For those transgender people that have moved to Sweden and have transitioned abroad the requirement is that they also must go through the the Swedish Gatekeeping system before being able to access HRT under medical supervision. Sometimes this will lead to a situation that a post-op TS man or woman will be without any form of hormone treatment for months of years before being accepted into a program.

Transgender persons that are residents of Sweden going through GRS and other gender reaffirming tratments abroad have no legal right to a gender change unless being approved by one of the six regional teams. In extreme case this means that transgender men and women are forced to out the selves at every single instance they will have to identify themselves and they will not be legally be precscibe continuing hormone replacement therapy which presents a grave health hazard.

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