In my clinical work I have gotten to know many transgender people—that is, people who do not identify with their biological sex, but rather with the opposite sex in many cases, and in some other cases, neither sex (non-binary persons).
With great astonishment and a certain disbelief, I read Dr. Ingeborg Kraus’ article and listened to the associated TV interview. In the latter she mentioned having the authority to write corresponding appraisal letters. What she apparently was referring to are psychological letters of indication, a prerequisite for hormone therapy and gender-aligning surgical measures. This authority is one which every psychotherapist is entitled to. Per her own testimony, in her career up until this point she has treated just four transgender clients.
Dr. Kraus describes the Selbsbestimmungsgesetz [self-determination law] as ‘dangerous’. It has supposedly led to ‘misdiagnoses with devastating consequences’. It is important to emphasize here that the self-determination law only allows for a change of name and gender marker at the residency registration office [Einwohnermeldeamt] without a letter of confidence from a mental health professional.
This law does not make access to hormone therapy and surgery possible—these still require a thorough diagnosis, necessarily including a written confirmation from a psychotherapist.
…she speaks of ‘very many’ patients who regret their decisions. She neglects to mention that she only has personal experience with four clients…Each individual who crosses the threshold of a psychotherapy practice for support in their gender identity has the right that the issue at hand as well as their psychological condition be regarded and understood individually—generalisations have no place in this subject.
As such, ‘devastating consequences’ could not, from my perspective, be attributed to the new law. If a person realises after some months or years that they are not transgender after all, their first name and gender marker can be changed again. The earlier process which required two expert opinions was often costly and burdensome for those affected. Expert opinions from doctors and therapists involved in the individual’s treatment were generally not accepted, meaning that one had to present intimate information to an additional two strangers. In my opinion, this was not a reasonable approach, and I view its abolition as great relief for those concerned.
‘Schools oversimplify the matter,’ says Ms. Kraus regarding gender transition, supposedly ‘luring [them] toward the path of transexuality’. I consider education in schools (yes, including with regards to sexual orientation and gender identity) as presently of absolute necessity. I do not see how this form of education could be considered ‘luring’. After all, schools offer—rightly so—education on drug use.
‘In my practice, I pretty much only came across transexuals who were not happy with the results of their surgeries,’ claims Dr. Kraus. Regrettably, she speaks of ‘very many’ patients who regret their decisions. She neglects to mention that she only has personal experience with four clients.
That there are ‘very many’ who regret their decisions does not adhere to my experience. Nearly every person who I have accompanied in transition felt a weight had been lifted off them through hormone therapy, top surgery or genital surgery among other measures. Each individual who crosses the threshold of a psychotherapy practice for support in their gender identity has the right that the issue at hand as well as their psychological condition be regarded and understood individually—generalisations have no place in this subject.
Additionally, studies show that the risk of suicide among transgender people is extremely high. This shows the extent to which gender dysphoria (meaning the distress that arises from living with misattributed gender roles and a body incongruent with one’s experienced gender) can present as a massive stressor and and how great the need is to take this distress seriously.
That is why many transgender people choose to transition, meaning adopting new gender roles (typically in tandem with a new name and the wish to be referred to using the coinciding honorifics and pronouns) and adjusting their outer expression (often, but not always, through hormones and surgery). My clinical practice has repeatedly evidenced how drastically suffering is reduced and quality of life increases through these interventions. Depressive symptoms and social anxiety or discomfort with other people also tend to decrease significantly. Transition regret and detransition—pursuing (limited) efforts to reverse the process—do arise, albeit in very few cases (I have yet to see a single such case in my work). A critical approach to one’s own gender identity and the choice to decision should therefore always first take place as part of a psychotherapeutic treatment, during which other factors that may falsely lead to someone believing they are transgender must be excluded.
According to her, one should not “respect trans activists false jargon”. Does she mean the terms that were adopted to replace earlier transphobic and discriminatory language?
This course of treatment is an essential part of the letter of indication without which there is no access to hormones or surgical measures. ‘The self-determination law’s manner (from a clinical point of view) of never questioning anything again” as Dr. Kraus writes, is non-existent. Critical, clinical examination remains requisite.
In particular, the surgeries in question here are both highly invasive and complex. Before undergoing them, patients need to thoroughly examine scope and associated risk of these procedures. Patient education should also be provided to support the process. I see room for improvement in this area in some clinics, as the affected have the right to making a well-informed decision. Nothing here is changed by the self-determination law. Name and gender marker changes, however, will be less complicated thanks to this new law.
Furthermore, Dr. Kraus’ performance suggests that trans women and men aren’t ‘real’ women or men. According to her, one should not “respect trans activists false jargon”. Does she mean the terms that were adopted to replace earlier transphobic and discriminatory language?
In summation, I find my colleague’s testimony misleading and prejudicial. I hope that with this statement, I have shed more light on practical experience in treating trans people.’
Dortmund, 08.11.2024
Dr. Lara Werkstetter
Translation: Shav MacKay. Reproduced with permission
