Lost in transition

The story of a 12-year-old trans girl who might be locked up has reignited the topic of trans pathologization, a problem for many trans people in Berlin.

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Photo by Astrid Warberg
Alexander was two years old when he sat up in the bathtub next to his baby sister and declared “I’m a girl, too.” His mother Anna thought little of this and replied simply, “No, you’re a boy.” Still, Alexander insisted, so Anna told him, “Look between your legs. See. You’re a boy.” But Alexander saw something else, something his mother would learn to understand but his father never could. “I’m just a different type of girl,” he would later say. That early statement marked, as much as any single moment could, the beginning of Alexander’s struggle. When his parents bought him toy aeroplanes to play with, he would decorate them with frills and lace and give the mini fuselages names. Unhappy with boys’ clothes, Alexander would steal his sister’s prettier ones to wear. “I used to just think my son was a softie. Then I thought Alexander was a boy who would like to be a girl,” Anna remembers. “It took me a long time to understand that he actually already was one.” For Anna, that moment came when Alexander was six and Anna finally allowed him to go by the name Alexandra and enter school as a transgender girl. “Of course people were shocked by the change,” Anna says. “But before then he was just too miserable. It wasn’t until Alexander became Alexandra that she really came to life. That’s when I decided I was going to do everything I could to make sure she could stay that happy.” Unable to cope with these changes, Alexandra’s father moved out in 2002. “I think my dad really wanted a son and was sad to have lost his,” says the now 12-year-old Alexandra, a slim girl with long hair and bright eyes. “Even as a young child, I always felt like a girl, even though I had a boy’s name. My father couldn’t accept that…” Last year, she and her sister broke contact with him. “We wrote him a letter outlining why and how we would like him to change, but it didn’t help.”’ Family feuds are difficult at the best of times, but in Alexandra’s case they led to more complicated consequences. Unable to resolve their battle over their child’s transgender identity, a youth office in Berlin took the responsibility for Alexandra’s healthcare away from her parents in 2007, assigning a social worker to the case. In 2011, that social worker was replaced with one Anna prefers to keep unnamed. After only a 30-minute talk with Anna and a one-hour conversation with Alexandra, the social worker decided Alexandra’s transsexual identity had been “injected” into her by her mother. After hearing this opinion, the youth office ruled that Alexandra should be removed from the care of her mother (who was no longer responsible for Alexandra’s healthcare) and put into the Charité’s psychiatric ward for up to three years, to the outrage of gender rights activists. They pointed out that no psychiatric assessments of Alexandra or Anna were conducted on which to base the decision. Instead, it rested on the opinion of a social worker with no medical background, and on very brief observations made of Alexandra in the Charité back in 2007 (when she was seven years old). As Anna’s appeal of the decision is being reviewed, Alexandra anxiously awaits a decision from the experts who will pass sentence over her future. She still lives at her mother’s home. But for how long? Alexandra’s tale mirrors more clearly what happens when a child is plucked from the protective wing of a parent and subjected to the bureaucratic nightmares and pathologising process many transgender people face in Berlin. Pathologising a way of life “Every person has a right to a gender. Yet transsexuals are told they are sick to want to live in a gender different to the one they were born with,” says Emily Navina, herself transgender and now an expert with Aktionsbündnis Alex, an alliance of activists formed in January to contest the forced institutionalisation of Alexandra. In fact, ‘transsexualism’ was introduced in the Diagnostic and Statistical Manual of Mental Disorders III (DSM) in 1980 and was replaced by ‘gender identity disorder’ in the DSM-IV in 1994. This is where the problem starts: once being transgender is classified as a disorder, some doctors take the view that individuals should or can be cured. “Transgender identity needs to stop being seen as a disorder,” says Navina. As the absence of Alexandra’s testimony in her own case shows, this has important consequences. “If a person is seen as disabled, as having some kind of pathology, then I’m going to listen to him or her in a completely different way than I would a healthy person,” says Navina. The harrowing path to transition The process of gender reassignment transsexuals go through is known as transitioning. “It’s a harrowing, life-altering process,” says Finn Ballard (photo), a trans man (woman to man) who started transitioning in the UK at age 25. “The problem is, to begin the process your identity needs to be validated by a medical authority first, who has to tick you off as being trans enough – a completely arbitrary concept.” If deemed not “trans enough”, therapists may try to counsel transgender people back to their biological sex – a possibility now facing Alexandra. Once validated in Germany, transgender individuals can commence hormone treatment. This is accompanied by therapy, either with a psychologist or psychiatrist. Both treatments are covered by health insurance – but only after transgender individuals have “agreed they are sick”, says Navina. This is an unacceptable precondition, she argues. “We have a right to see doctors, but not under those circumstances.” Transgender people who wish to change their first names can expect a long wait, as only one judge handles all cases in Berlin. “It’s all extremely complicated and bureaucratic,” Navina says. Especially the matter of gender reassignment surgery, where some procedures (those involving primary sexual organs) are more likely to be covered than others (e.g. facial surgery). “There is another extremely demeaning, two-hour consultation for surgery. That’s why a lot of people who can afford it just fly to Thailand to get operated on,” says Navina. Non-autonomous bodies “For trans people the crux of the matter is that society doesn’t really believe they should have autonomy over their own body,” Ballard says. “Medically speaking, we are seen as disabled, as a sort of liability.” Ballard, an eloquent and elegant 29-year-old from Northern Ireland who recently finished his PhD in film studies at Warwick University and founded Queer Tours in Berlin, looks nothing like a liability. Yet when he decided to have to his breasts removed at the Klinik Sanssouci in Potsdam in 2010, the support people had shown when he started transitioning wavered. “Many said it was a mutilation and a sin to remove healthy parts from my body.” People failed to understand that to Ballard, his chest was the opposite of healthy; it was a constant reminder that his self-image and physical self did not correspond. Ballard paid for his chest reconstruction procedure privately and was treated well. But doctors reacted sceptically when he declined what he calls their “grotesque package deal surgery” for trans men to go in as anatomical women and leave as men. “They told me ‘You’ll be back’, as if they were selling me extras on a car.” Ironically, although trans people are classified as having a disorder, the treatments they undergo are seen as analogous to cosmetic procedures, not as pressing medical needs. Without treatment, however, suicide rates among transgender people skyrocket, with some estimates being as high as 50 percent. For Alexandra, the onset of puberty is rolling nearer. Her first facial hairs are growing, and soon her voice will break. “I really want to go on hormone blockers,” she says. “But at the moment doctors especially don’t listen to what I want.” Trapped in the limbo of court battles, Alexandra does not know whether she will be able to obtain hormone blockers in time to stall the biological changes to her body she fears. Transgender children Dr. Alexander Korte, child psychiatrist at Munich’s Ludwig-Maximilians-Universität clinic, has argued against transgender children receiving hormone blockers before puberty. His reasoning: a transgender child’s identity could possibly develop into homosexuality during puberty through age-specific experiences and developing sexual desires. Yet psychiatrist Dr. Bernd Meyenburg, an expert on transgender children and adolescents (who handled the case of Kim Petras, a 16-year-old girl who became the world’s youngest known transsexual in 2008), disagrees. Meyenburg believes there is an innate component to transgender identity, one that never goes away. “It is also possible to distinguish fairly well between transgender and homosexual children,” he says. Transgender children typically reject their primary and secondary sexual organs, whereas homosexual children do not. “During puberty, this will be to the point where particularly girls torture themselves. Breasts are harder to hide than a penis. So some girls bind them constantly,” says Meyenburg. Children like Alexandra, whose transgender identity seems to have been clearly identified from an early age, cannot be brought back to their biological sex through therapy, according to Meyenburg. “Any attempt to do so will only make them suffer.” Instead, he would suggest regular therapy and hormone blockers. “Physically speaking, their effects are reversible. What isn’t are the steps that come afterwards, which are oestrogen or testosterone treatment, and eventually surgery, if that’s what the individual wants.” Those next steps are a lot easier having previously taken hormone blockers. Uncertain future Meyenburg submitted his opinion to Berlin’s court that it would be wrong to remove Alexandra from the home environment in which she prospers. For the past four years she has been elected class speaker and currently has the best grade average in her class. Small comforts to Alexandra, who does not know how much longer she will be allowed to live at home and feels terrified by her own future. “I know it’s called gender identity disorder, but I also know I’m not sick and that I don’t need to be cured,” she says, “It feels like I’m just this normal girl who’s going to be locked up in a psych ward with crazy people. How am I supposed to deal with that?” This is the question stirring many people into action. Berlin’s transgender community organised two demonstrations in March and April to show their support for Alexandra. In March, English trans woman Katrina Swales started a petition on directed at Berlin’s openly gay mayor, Klaus Wowereit, demanding that he stop Alexandra’s forced institutionalisation. Over 30,000 signatures have been collected so far. After losing the case before Berlin’s Kammergericht on March 22, Anna’s lawyer plans to take the case before the Federal Constitutional Court. “This fighting is ruining our lives, but what choice do we have but to continue?” Anna says. “Sometimes I worry it’s too late for Alexandra, but maybe it’s not too late to keep something like this from happening to someone else.” Finn Ballard hopes the public outcry will help Alexandra, while he personally deals with his own life as a ‘different kind of man’. Ballard has no intentions to have a phalloplasty, and was flabbergasted when he was kicked off the online dating site Gay Romeo for not having a penis. “I find this obsession with genitals ridiculous, but I guess most people still see gender in this very binary way. In my utopian world that would change, and transgender people would be accorded the same autonomy over their bodies as other people have.” As Alexandra’s story shows, Berlin’s reality is still a far cry from Finn’s utopia. It remains unclear how much longer Alexandra can continue her life as a ‘different kind of girl’ outside of the Charité walls.