I’m gonna position myself at the beginning here and state that I’ve had a pretty lucky go at this. I am going to bitch vociferously, but know that I am acknowledging how much more shitty it is for some. And there is, I think some genuine shit here to gripe about. But I want to acknowledge that I’ve gotten this far because I’ve benefitted from certain privileges and advantages—being mobile alone indicates this. But alas, today, mobility is more of a reality than luxury. Anyhow, now that that’s out of the way, we can begin.
I want to experientially discuss three axes of oppression I think my situation highlights: healthcare, civic bureaucracy, and global mobility, the latter is highly entangled with the former.
I’ll start with health care. One of my primary reasons for moving back to the West was health care. The selection of the Netherlands was in no small part due to their seemingly liberal treatment of trans people. I also appreciate that I am approaching the system backward and I will touch on this when I discuss mobility. However, it’s fascinatingly frustrating that health care here is thus far, worse than Korea. I actually advised someone recently that Korea was not a bad place to transition, at least as far as access to the basics. Here, as seems to be the case all over the political hemisphere, centralized health care systems are failing trans people as they sag under the weight of demand. There are two gender clinics in the Netherlands and they have waitlists of up to a year. This means for me, I will have gone through potentially 18 to 24 months of my transition without seeing a specialist. Sure, I’m getting access to care, but it’s like taking my Volvo to get serviced at a Chevrolet dealer.
Furthermore, insurance is a real problem. In the Netherlands apparently laser is covered, but I have received a pretty poor response from my insurer—an insurance that was presented as mandatory for my student visa. Still, AON’s (my current insurer) response was at least not outright offensive, like my last insurer’s was (GBG). AON is attempting to not pay because my policy omits “cosmetic procedures.” Where GBG stated that my HRT was “elective sexual transformation.” I sent a long-winded appeal to the latter from the angle of HRT being a standard treatment protocol for dysphoria, as listed in the DSM 5. GBG had pretty good coverage for mental health. I was rejected after two appeals, but they did contact me to say they were going to review my case to consider possible future amendments to their policies to make them more inclusive. Such is insurance.
The issue with this is the procedures, medications, and therapy trans people need are essential to their ability to thrive and live productive lives. A vicious circle is created by denying us service. for example, let’s say I couldn’t afford laser myself—which thankfully, for the moment I can. If I couldn’t then I would have little chance of passing, without passing, I cannot get a job, and without a job, I cannot pay for necessary health services such as laser. This is just a simple example of myriad binds the system places on trans people.
Similarly, though many diagnostic and clinical manuals do now accept that transitioning via HRT, leading to SRS, is not for everyone, the system is still designed to facilitate this normative medical process. The issue here is that not only is the process long, pathologizing, and potentially distressing, it enforces normative gender embodiments. Thus, replicating a long-standing medical history of pathology and enforcing “wrong bodied” narratives. The recent CAMH scandal reveals how major gender clinics can gatekeep clients based on the preferences of the clinicians. Additionally, I’ve found that these clinical environments are ill-suited to adapt to the needs of anyone approaching them in an atypical fashion, say moving clinics in medias res. Thus, these are normative, procedural, bureaucracies that seem disinclined to accommodate difference—which is ironic considering the nature of the subjects they serve.
Depending on where you live, changing your gender marker may be as easy as getting a letter from a clinician, or maybe you need to be sterilized. Surprisingly, until a precedent-setting case this past year in France, the latter was largely the norm in much of Western Europe. This situation is changing quickly. However, again, the globally mobile subject may find difficulty even in the most progressive bureaucratic systems. Registry systems are often managed by national or even subnational entities, thus transnational subjects may be barred from access to this essential service. I myself am caught in this situation. I cannot change my name in the Netherlands because I am not a citizen, and I cannot change my name in Ontario because I am not a resident. Each respective political entity has the opposite requirement for changing my name and gender marker. This brings me to mobility.
Though by no means is it necessary to become a wayward global expat, it’s a reality for more and more of us—especially in the West as good jobs have evaporated in our current climate of wealth concentration and erosion of the welfare state under austerity. Personally, I went abroad to teach, as there was never any hope of getting a position in Ontario, let alone where I would want to live—Toronto. However, as a trans person, especially one without access to identification matching my gender presentation, this is a fucking nightmare. I only had to be stopped at the Chinese border while on a work conference once to be permanently scared of airports—I got stopped twice. Passports are the de facto identification card for all expats. And I get questioned whenever I use mine. This immediately places me in danger, or at least, in a position of embarrassment.
There are seemingly many obstacles to surmount in order for a trans person to achieve the status of a normative cisgender person. And of course, there are so many issues I haven’t covered, these are just ones that have intersected with my experience. It is clear though, that the deck is stacked against trans people, as there are systemic obstacles to our progression at most levels of society. I have of course omitted discussing transphobia, transmisogyny, standard misogyny, and cis privilege from this discussion. All taken together, the situation seems insurmountable. For me, it has exaggerated my mental health issues, which initially improved significantly when starting HRT. Some of my issues revolve around dysphoria that may not be 100% addressable with HRT, given my age and morphology. But, that has also improved. I would suggest that these exterior pressures are what’s pushed me from a position of improving overall mental health to one that is less than functional. It’s not my transition that causes me stress, but the conditions surrounding it. And my ugly face… 😉 Come on, I look like Dolph Lundgren.