A Success Story: advocacy against a hospital denying hysterectomy surgery for trans men 

Source: “Rejection of hysterectomy in Cerrahpaşa, prosecution process and success of advocacy”, (Cerrahpaşa’da histerektomi ameliyatı reddi, dava süreci ve savunuculuğun başarısı), Emirhan Deniz Çelebi, KaosgL.org, 10 July, 2019

https://kaosgl.org/sayfa.php?id=28513

I guess it was early February in 2017 when a friend texted me: “Emirhan, did you hear that Cerrahpaşa no longer do our surgeries?”. When I first read the message I was taken aback and then called my friend to learn more about what’s going on with Cerrahpaşa. 

This is how the story begins: My friend was barely able to get a date for their surgery next week. A member of the staff at Cerrahpaşa OB-GYN department says: ‘ Due to a decision taken by the academic committee, we no longer do the laparoscopic hysterectomy of trans men, we have to cancel your surgery date’. My friend could barely hold it together at that point. In Turkey one of the most excruciating parts of the legal process in changing your assigned gender and your name on the ID is to make the post-surgery reports in time for the day of the hearing. If there is a lag, the court may adjourn your case to two or three months later.

After receiving this news, I wondered ‘Hang on, what will they say about surgery day if I call them?’ and I picked up the receiver. I got the same answer and so I asked ‘When did you start making transphobic decisions that concern public health in your academic council meetings?’. There was no answer. When I asked them to send me a written copy of their reply, I was already sure that I would not receive that either. Nevertheless, I gave them a shot and waited 10 days. No news. Was I surprised? No. I called them again and asked for a written reply. They hung up after saying ‘We can’t send you any reply sir’. That’s what drove me wild. Yeah, as if you can’t, you will  have to respond. 

I sat down and wrote a complaint to BİMER* (now it’s called CİMER):

To whom it may concern,

When trans men in our country submit their request to change their name and gender to a court, they are referred to OB GYN departments of hospitals as Article 40 of Civil Code requires them to be permanently deprived of reproduction [reproductive capacity]. Cerrahpaşa Medical Faculty OB GYN Department was one of the institutions which undertake these surgeries [hysterectomy]. That was the case until I was told that these surgeries are no longer done based on an academic council decision…This decision results in transsexuals not being able to undergo the legally required surgeries. Many people had their court date adjourned and were victimized. If you require us to do so, we can submit a joint petition. Last week, in a meeting with around 30 trans men, many of those who have their surgery dates approaching brought the issue up. 

I would like to ask you three things: Is it only the trans men your hospital is not doing the laparoscopic hysterectomy and salpingo oophorectomy operations on? If that is the case, on what grounds? Are you currently allowing your cis-gender female clients to undergo these operations?  

In sum, I kindly request you to send a written reply, including the reason for the decision and the minutes of the academic council meeting.

I wrote this on March 13, 2017. On April 13, 2017 I received an untitled e-mail, it read ‘[Our] respond to your application is attached’. Here we go. Check this out:

The request and complaint submitted to Prime Ministry Communication Center (BİMER)  by XXX Çelebi was examined. The Academic Council meeting on February 15, 2017 ruled against these procedures as the examination of these cases of voluntary castration (hysterectomy and ooferectomy) surgery done on genitally healthy individuals who are phenotypically and genotypically female and organically have the reproductive capacity lead to irreversible organ failure and loss of function which can lead to medical, ethical and legal problems; due to the problems the admission of male-looking patients causing problems in OB-GYN wards,  and because emergency and pregnant patients are prioritized during the relocation of our department. According to Social Insurance Institution regulations, people have no right to apply to another hospital. Attached is the relevant Academic Council decision.”

I read these words in a breeze and I began to feel numb starting with the bit about ‘these cases’, climaxing at ‘male-looking patients’. The pregnant patients are to be prioritized…as if it is only cis-women who give birth! The whole reply is oozing transphobia. 

I calmed down a little and decided to take this opportunity. In that period, there was another hospital which did hysterectomy operations of trans men, they would refuse to do the operations every now and then. It was time to get the rights advocacy going. I printed out the documents and ran to the attorney Rozerin Seda Kip.

Together with my attorney Rozerin, we applied to Istanbul Administrative Court. In the petition, Rozerin indicated that these attitudes were transphobic and discriminatory. Rozerin also reminded the court of Article 40 of Civil Code and the European Convention on Human Rights. The petition demanded the halting of the execution of the ruling, stating that the administration’s refusal to carry out the ‘sterilisation’ surgery of the trans individuals is arbitrary and unlawful.   

Following this application on 2017, what did the Istanbul University Rectorate** do? Of course, it asked the case to be dismissed. The first court in charge was Istanbul 10. Administrative Court, and this court stated that the hospital can not refuse to carry out the surgery, reminding them that the hospital itself penned a report that suggests the person needs to undergo gender affirmation surgery.

The University made no surprises and filed an appeal to Council of State. Finally this year the Council of State 10th Chamber ruled against the appeal. Thus, the legal struggle beginning in 2017 certified that the hospital’s refusal to carry out the surgeries of trans men was unlawful. 

The struggle starting with BİMER and ending at Council of State is an example of the importance of advocacy. In this way, the judiciary too, confirmed that hospitals have no luxury to deny the surgery. During our advocacy action, cancelled the requirement to ‘be permanently deprived of procreation’ from Article 40, even if this is not the practice in reality…We have a long way to go! May this decision be a beacon to us all! 

*Translator’s note: BİMER is Prime Ministry Communication Center. Currently, CİMER (Presidency Communication Center) is used by citizens to file complaints about any state department.

** Cerrahpaşa is a training hospital under the administration of Istanbul University Faculty of Medicine. It is the sole authority in many state sanctioned surgeries, like the gender affirmation surgeries.

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