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What do we mean by gatekeeping?
We are against gatekeeping, but not against checks whether transgender people understand what they are doing (Informed Consent). By gatekeeping we mean: assessing whether a transgender person is allowed to have hormones or operations by other people than the care provider. For instance if a psychologist decides on treatments, or if a multi-disciplinary team does. You can read here how such an Informed Consent model for transgender people might work.
About this site
Welcome at the website StopGatekeeping.nl. On this website you can find information that encourages the self-determination of transgender people. We ask transgender persons and care providers to first read the disclaimer. Transgender people who don’t recognize themselves in our ideas about self-determination, would better avoid reading some of the advice on this site, to enable the psychologist to optimally do their assessing work. The pages this refers to have been marked with a big red bar with a warning at the top of the page. Because German investigation (*) has shown that 93% of TG-people like to have a strong influence on their own treatment we expect that only few people would want to avoid those pages.
Comorbidity (having mental disorders alongside being transgender) is often mentioned as an argument against self-determination. On this page we list some forms of comorbidity that often occur and about which it is not so certain that they should lead to a different treatment for transgender people. To us as a group the dividing line between giving a treatment or withholding it is very simple: if the transgender person knows what he or she is doing, they can sign an informed consent and after that the treatment can take place at the pace and in the way he or she finds most suitable. This means that a transgender person should always be in the lead (some exceptions in case of guardianship left aside).
It is important to recognize that psychologists who decide on treatments frequently have multiple roles and that gatekeepers often do not have the same interests as the trans person. We explain why this is the case on this page.
To many hormone therapists and doctors in the Netherlands, the idea that the role of the psychologist in deciding on treatments can become a lot smaller may take some getting used to. To us it is obvious. Many transgender people already get hormones via internet before see a general practitioner or a gender team for the first time. The story of one of them can be found here, because it shows that there are other possible orders of succession that can lead to a good outcome than first the psychologist and only afterwards the hormone expert or surgeon. On the same page you can also read other examples which prove that the assumption that "transgender people only want to rush ahead and do not think without the aid of a mandatory psychologist" turns out to be untrue.
Once you understand why the current assumptions are incorrect, you may ask yourself how transgender care should be organized instead. We explain that on this page. On the following page we explain to psychologists how we see their role in the future.
People who want to know what problems the current way of working causes can refer to this part of this site. After a personal story from a transgender individual we will look at the results of an earlier initiative (FreePATHH) and some investigations (the Transvisie report, the report by Principle 17 and the report from Trans United).
We know that in it foreign countries relatively many transgender people get care from their general practitioner instead of a gender team. In the Netherlands this is unfortunately not true, because VUmc is spreading horror stories about "prudence" and about transgender care being very specialist work. Because most people also life within a reasonable traveling distance from VUmc or UMCG most general practitioners see no problem in referring people to the gender teams. On these pages we give information about which alternatives there are in the Netherlands and which alternatives are missing.
We believe that people should not be hindered by a gatekeeper. And at the moment they are. To help all the people who are hindered by a gatekeeper we have listed all recommendations. This (unfortunately) still doesn’t bring complete self-determination, but it can help us to be (more) independent from these gatekeepers.
We hope this section of the site will also make the gatekeepers think: if the “diagnostic phase” is so easy to circumvent, why would psychologists keep doing it anyway? Wouldn’t it be better for psychologists to invest their energy in better eduvating people who still have unrealistic concerns about transgender people who are very well capable of taking care of themselves? Is the care for transgender people really so special that is cannot be left to general practitioners?
We will not stop here, with just this website. We have requested to organize a workshop at the April 2017 EPATH about the disadvantages of gatekeeping, hoping that hormone therapists and surgeons would start working according to Informed Consent. Unfortunately we have not been granted permission to do this workshop. You can read our request and the reaction from EPATH on this page.
It appears very strange to us that transgender people have to suffer all the disadvantages from the gatekeeping, while the gatekeepers enjoy all the advantages. The least you can do is file a complaint at your hospital about the incorrect way in which you have been treated. We give tips and advice on this page.
During the week of IDAHOT (IDAHOT = International Day Against Homophobia, Biphobia and Transphobia, annually held on May 17th) we have started the campaign "Niet goed! Geld terug?" (Money back Guarantee). It doesn’t feel right that psychologists (at least financially) gain from the mandatory care for transgender people, while we have only been damaged by that. On the "Niet goed! Geld terug?"-page you can find two example letters you can send to your psychologist, in which you ask him/her to transfer the money the psychologist has earned for consultations that were useless for you to the bank account of a charity organization.
In 2017 we will do a Tour of the Netherlands to persuade general practitioners to start working with Informed Consent for the supply of hormones. As soon as dates, times, and locations are known we will announce those on the main page of this site. You can find the places we have visited already here. You will also find information about meetings and workshops targeting transgender people.
We may organize more actions in the future.
Finally: We are very curious about your reactions to this site, under suggestions and contact you can find ways to contact us. We are also willing to give advice to individuals if they need it. If you are a care provider yourself and you want to give advice anonymously, refer to this page with information on how to do that.
(*) NEEDS AND CONCERNS OF TRANS INDIVIDUALS REGARDING INTERDISCIPLINARY TRANSGENDER HEALTHCARE: A NON-CLINICAL ONLINE SURVEY
Timo Nieder, PhD, ECPS; Andreas Koehler, B.Sc.; Jana Eyssel, M.Sc. Interdisciplinary Transgender Health Care Center Hamburg; University Medical Center Hamburg-Eppendorf,