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Dossier: Sexuality

“Trans people know what is best for them”

What is meant by transgender? How can families of transgender people best offer support? And what changes do health insurers need to make? We spoke to activist Eneas Pauli.

Text: Miriam Suter

Eneas, what is meant by the term trans?

Trans is a broad term that can be used to describe people whose gender identity is different from the gender they were thought to be when they were born. It is also an umbrella term and includes two further categories: binary and non-binary. Binary trans people are trans men and women, while the term “non-binary trans” covers all other gender identities. 

Such as?

There is the agender gender identity, also known as genderless. Agender individuals find that they have no gender identity, although some define it more as having a gender identity that is neutral. It also covers identities such as bigender, genderqueer or gender fluid. It is also important to know that gender is not always fixed, it can vary.

What is gender fluid?

It can mean, for example, that you feel a little more feminine one day and a little less feminine the next. Or that you don’t feel you are either gender for a time and then a week later you feel totally masculine. Once you understand the concept, you will notice that there are actually quite a lot of people who are gender fluid.

What is trans not?

It is important to know that trans does not always involve transition. In other words, when a trans person comes out, it does not automatically mean that they want to change their name or undergo sex reassignment surgery. Put simply, trans means: I am trans. I do not identify with the gender assigned to me by the medical professional at my birth. 

The best way to offer support is to accept that the coming-out is down to the trans person him or herself.

How can relatives best support a trans person when they come out?

The coming-out process for a trans person is extremely personal. Perhaps they don’t need any help at all. The best way to offer support is to accept that the coming-out is down to the trans person him or herself and has nothing to do with friends or family. So it’s best to ask what support they need. If the trans person says they are fine and don’t need any help, then you should leave it at that. It’s also a good idea to read up about on the topic of transgender identity yourself – don’t make assumptions. 

What do you mean by that?

If a person tells you that they are a trans woman, don’t automatically assume that they want to grow their hair out or wear make-up. Simply ask what they need and want and listen to what they say. Trans people know what is best for them. It is also important to accept if the person does not want to come out in public. Then you should continue to use their old pronouns and old name – even if the trans person has already chosen a new name and wants to use new pronouns with family. 

All trans people suffer discrimination.

Why is that important?

If you start using the new name of a trans person in public, you out them without giving them the opportunity to decide for themselves. And that’s the worst thing you can do to a trans person. This can lead to new trauma, depression or suicide. It can really put their life in danger.

Why?

All trans people suffer discrimination. Some more than others. The less you look like a trans person physically, the safer you are. Transfeminine people in particular sometimes have to continue with their old gender in order to keep their job and pay their rent. Or so that they are not subject to abuse on a daily basis. Outing a trans person in public without their consent is very intrusive and can even put their life in danger.

How can a trans person find a good expert, e.g. a psychiatrist?

It is practically impossible. Most medical professionals don’t understand trans issues. As a result, trans people are also subject to discrimination by professionals, particularly when it comes to their mental health. We are told we are not trans if we don’t meet the right criteria. And if you’re not classed as a trans person, you don’t get an official diagnosis, which means you don’t have access to hormones, surgery, etc. And without this official classification, health insurance doesn’t cover the costs.

So, we need a psychological diagnosis to be able to take the next steps. Until recently, trans people weren’t even able to change their name without such a diagnosis. And that’s absurd: a total stranger has to confirm that you’re trans and write it on a piece of paper so that you can start to live a life that is right for you and makes you happy. That’s why networking within this community is so important. It’s worth taking a look at Checkpoint or getting in touch with the Transgender Network Switzerland.

What changes do health insurers need to make?

Health insurance only covers the cost of a very specific type of transitioning. Either you want to be a man and then you have to take the full dose of testosterone, have a mastectomy, a hysterectomy and penis construction – otherwise you don’t really want to be a man! However, if you only want to take testosterone (or oestrogen as a transfemale person) in small doses, you already run into problems with the cost coverage. If you don’t have an understanding endocrinologist, you have to cover the costs yourself. And, depending on your circumstances, this can be as much as 100 francs a month, which not everyone can afford to pay. Change is urgently needed.