Joana Cabrera, transgender doctor: “Now there are more consultations with trans children than before because there are more rights”

Dr. Joana Cabrera Bergel is a specialist in family and community medicine and the first trans person to be registered as a non-binary gender. Cabrera analyzes the situation of trans people in Spain from her point of view as a doctor and with a humanistic point of view in which she is clear that the model of accompaniment of trans people in the health system must change. Cabrera gets involved in the most controversial issues of the Trans Law, which divides the government partners (PSOE and United We Can). For example, in gender self-determination. This concept refers to the right of trans people to change their name and sex on their national identity document (DNI) without the need to provide medical reports or receive hormonal treatments or undergo any surgical operation. The previous law, passed in 2007, required that anyone who wanted to change their sex on the registry be diagnosed by a medical professional with gender dysphoria, an identity disorder that occurs when a person does not identify with their biological sex. Ask. What happens with the Trans Law, why doesn’t it finish advancing? Answer. This law that has now been stopped is urgent and necessary. We cannot legislate the rights of a part of the population, in a democratic society, based on regional laws and trusting in the powers transferred from the autonomies. This is how it happens, that there are trans people who live in an autonomous community who see all their rights and the services they need recognized, and in other communities trans people are third-class citizens. It is urgent to legislate at the state level the rights of trans people.P. One of the most controversial points of the law is gender self-determination, what do you think? The problem is that we don’t name things by their names. It is aberrant that sex wants to be equated with gender. Sex is the biological condition assigned to us when we are born based on our genitalia. They are the sexual characteristics of a person, those that define the reproductive possibilities that they have. Gender is the self-perception of belonging to a group in a society. Therefore, sex does not define gender, because then, a person who has their breasts removed for a medical problem, ceases to be a woman? It makes no sense. Not defining things well or delimiting them does a lot of damage to the discourse. P. What happens with minors, another of the points that is being talked about the most? R. I think that trans minors are being used as an excuse to cover up other deeper problems such as the fear of any change in progress in this society. We cannot think that trans youth all have the same problems, it is not so. Trans minors are diverse, they can be good or bad, they can study or not, commit crimes or get tuition. Being trans is one more part of your life, but it is not the axis of your life. It is the axis of your life, when you have to fight again and again for your rights to be recognized. The problem is the transphobia that continues to exist today. P. There are recognized psychiatrists who speak of “an outbreak of pseudo-cases of those who see a solution in being trans.” What do you think? R. I see many trans adolescents and I accompany them in their process and it is not like that. We are having a social problem with what we have done with adolescents in the pandemic. And putting it in the trans spotlight is a huge mistake. I think that in the pandemic adolescents have suffered a lot. They have taken part of the blame, we have blamed them, we have locked them up at home at a time when their body changes, their minds go to a thousand and they have a moment of disruption with the family. The health of adolescents in general is very damaged, not only that of trans. If we look, they have increased suicide attempts, admissions to psychiatry, mobile phone addiction, and everyone is suffering. What are the trans suffering?, too. Q. It is not easy being transR. It is very important to say that trans people have an added problem and in the midst of this mental health problem for young people, being trans is not easy. They have some added comorbidities in addition to the pandemic. For this reason, these people who suffer may not have the time to make decisions so quickly, but that is what holistic health services are for. To see what the real problems are. You have to work on these symptoms and also the trans accompaniment. In medicine they do not do crazy things. Many want to burn, as has happened in other social changes. P. They insist that now there are more trans minors than before…R. Evidently there is a change in the incidence of trans people. If there are more rights, things are accessed sooner. I have patients who have spent 40 or 50 years considering coming out. Now there is more visibility and social rights are more protected, therefore more people dare to say so. Advocacy is a way of socially requesting something that will depend on how much you allow that something to express itself. In the 1970s, the incidence was much lower than it is now, but if you get jailed, you might not want to say it. Q. How is the Canarian Health health system in terms of trans accompaniment compared to the rest of Spain? A. In Spain there is a health barrier for trans people. For this reason, right now there are two autonomous communities, Catalonia and the Canary Islands, that have opted for a transpositive model of health accompaniment, in which we stop considering that at the health level all trans people need the same thing and we begin to listen to them. What do you need in your transit? Sometimes they need hormonal treatment, but other times they don’t. Sometimes they require surgery and other times they don’t. Others demand psychological treatment for transphobia and others need family support. This protocol contemplates care for trans people at any stage of their lives, making special mention of the reality of trans childhood and adolescence. P. What have you noticed in the two years that you have been with this protocol? R. This model of transpositive health is not, as many say, a vending machine for hormones, nor do we mutilate breasts, or anything like that. We only work with holistic thinking at the primary care level in which we see the person as a whole because a trans person is also their family, their community, their future. In these two years we have helped many people transit and we have not found the monster that revolves around us, what if you regret it? No way. Of course there are people who make mistakes in life, but not only trans. How many people have undergone cosmetic surgery and are not asked for two years of psychological or psychiatric treatment. And there are people who regret having put on their chests or lips and there is no drama in society. There is with trans people because they make the patriarchal system in which we live uncomfortable. Q. How has your transit been, as a doctor and as a trans? I have been defending all my life that medicine is there to support the vital accompaniments of people and the importance that mental health specialists should be there, because transphobia exists and trans people have many sociopsychiatric comorbidities due to that transphobia. I have lived it and I know what it is. I’ve been lucky. I haven’t had to lie to anyone to make my transit, with the privilege of being a doctor? Yes. And that makes me wonder why only a few privileged people have access to this. That’s not fair. That is why I have fought so that, in the Canary Islands, where I live, trans people could have the right to be in a consultation and have trans accompaniment without having to lie. If we continue promoting accompaniment models where standards have to be followed depending on who has done them, if we focus only on that, people will continue to lie to get there.