LGBTI Health

Health issues for LGBTI in Turkey

Toprak: “As a trans woman and a medical student, I want to be able to easily do my job”

Toprak, a 22-year-old medical faculty student, says, “I want a world where trans people are not burned to death, but a world where they are successful.”

Source: “As a trans woman and a medical student, I want to be able to easily do my job”, (Tıp Okuyan Bir Trans Kadın Olarak Mesleğimi Rahatça Yapabilmek İstiyorum), bianet.org, July 21, 2018, http://bianet.org/biamag/toplumsal-cinsiyet/199361-tip-okuyan-bir-trans-kadin-olarak-meslegimi-rahatca-yapabilmek-istiyorum

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Toprak is a 22-year-old medical faculty student. She has two more years before she graduates. She is trying to obtain a new identity card as a woman before she graduates because she wants her diploma to belong to her and not to state a gender identity assigned to her at birth.

Toprak was born in Antep. She attained a high score in the university entrance exam and came to Istanbul five years ago to study at the Istanbul Faculty of Medicine.

Toprak needs financial support in order to have gender reassignment surgery. She started a crowdsourcing campaign to accomplish this.

When she becomes a doctor she wants to be able to proudly hang her diploma on her office wall. She is worried that she will not get appointed and be discriminated against as a civil servant because of the male gender identity marker on her ID card.

Toprak says: “I want to break down prejudices and show people what transwomen can achieve. Transgender people are studying in many different fields. As a transwoman, I want to easily be able to do my job. I need people’s support to be able to have this gender reassignment surgery. I want a world where trans people are not burned to death, but a world where they are successful.”

As a transwoman and medical student, Toprak spoke with Bianet about her university life, future plans and her gender transition process.

Could you tell us a little bit about yourself?

My name is Toprak and I am 22 years old. I am a fifth year medical student at Istanbul Faculty of Medicine. I am a transwoman.

Have you always lived in Istanbul?

No, I was born in Gaziantep. I passed the exam and got into a science-focused high school and studied there for four years before coming to Istanbul for university. I have been living in Istanbul for the past five years.

How is university life?

The first two years were quiet because I hadn’t started my transition process yet and I wasn’t out. I was identifying myself as gay back then. A year later, being openly gay, I started experiencing difficulties, mostly with my family. These did not have much of an impact on my university life. Because of their educational and cultural backgrounds, I did not actually receive any negative reactions from professors or fellow students.

I had only one traumatic transition process experience.

We read about this on social media. A professor at Istanbul University made transphobic statements. Where you in that class? Could you tell us what happened?

Yes. A professor was teaching hypogonadism and talking about pituitary glands, endocrine hormones, testosterone, and estrogen. The topic had nothing to do with transsexuality, but I got the feeling that it was going there.

The professor brought up the topic of transsexuality and said “Men without ovaries come and say, ‘I’m going to be a woman.’ These people are psychopaths. Upon receiving them, we refer them to psychiatry.”

He took out his ID card from his wallet and said, “Here’s a blue ID card. They work so hard to get a pink ID card. There were 250 students in the lecture hall. I was sitting at the back and the professor did not know I was trans. About 70-80 students busted into laughter together with the professor.

I stood up and said, “who are you calling a psychopath? I’m a transwoman.” He was surprised because he did not expect that there would be a transwoman in the lecture hall. He turned around and continued reading from his slides.

I said he needed to explain his statement in front of everybody since he had said this in front of everybody. He said “come and see me after class and I will explain this to you.”

This person is an endocrinologist, meaning he is working in an area that concerns trans people. It really baffles me why nobody ever complained about him because he is an extremely transphobic guy.

Did anybody in the lecture hall say anything?

No. So I shared what happened. I did not expect this to get around so quickly. I assumed people in the LGBT community would hear about it and that people would know about this person.

Things took a different turn when the Turkish Medical Association (TMA) began to support me.

How did the TMA support you?

I shared the incident on Twitter. Doctors from the TMA saw my tweet. They invited me to their board meeting and were very attentive. Their support came a few days after the incident. During those four days, I experienced some negativity at school.

What happened? I’m curious to know how the administration and students responded?

Medical students have a kind of a political stance…Actually, they don’t have a political stance, and they are apolitical. They put their careers first and ignore everything else. They treat people neither positively nor negatively. They are neutral. The university has a similar stance. They choose to remove themselves from the current affairs of the country.

That is why they tried to maintain neutrality, but the feminist club at the university showed great support. They wrote a piece, collected signatures from 11 other clubs and published the statement. I did not experience bullying or any kind of verbal violence. Apart from Twitter, I received a great amount of support.

How did the university administration deal with this?

Initially, they started an investigation against me.

Why did they start an investigation?

Because I had disclosed what the professor said.

Did they warn the professor?

No, they gave him no warning until the TMA stepped in. They treated the incident as if we were in elementary school. They called me in and asked, “Why did you do this? This should have stayed between us. Why did you have to tell everyone?” I felt terrible and I cried that day.

Later, my phone rang and the TMA invited me to their board meeting. Once the news reached the TMA, people in the medical community heard the professor’s transphobic statement. Then celebrities heard about it and they shared their reactions on social media. I never imagined so many people would hear about it.

How did these events impact the investigation started against you?

I found out that the investigation was dropped and that an investigation against the professor had opened instead.

I was a witness in the professor’s investigation and he also gave a statement. Honestly, it felt good to see that he was waiting at the door to explain himself.

Then they said he was penalized.

What was his penalty?

I’m not exactly sure, but they said that the professor was no longer authorized to give oral assessments for internal medicine. Internal medicine is a very important field and to give the oral assessment is considered a huge honor.

During this process, solidarity felt great. When I saw the power of solidarity, I decided to get funding for my surgery. A friend, studying architecture, said she started a campaign for herself and advised me to do the same. I decided to start a campaign because I urgently need to have my surgery.

Why is this so urgent for you?

Unfortunately, currently my ID card has the male gender marker. Surgery is a requirement to change your gender marker on your ID in Turkey.

Without having a female gender identity marker, I worry that I won’t be appointed. Over the past two years, there have been state security investigations against doctors. I worry that having a male gender identity marker on my ID card will impact my appointment. I am a fifth year medical student who will be graduating soon. That’s why I want to have my surgery before graduation.

The main problem for trans people regarding their diploma is the name written on it. It is necessary to change your name before graduating. If you change your name after you graduate, then there is no indication that the diploma belongs to you, making it almost null. I changed my name on my ID card recently. I started my transition a year ago and everything progressed quickly.

Which area do you want to specialize in?

Internal medicine or gynaecology. Fields such as psychiatry and surgery are important for LGBT people, but you need to have really good grades to be in these fields. We’ll see.

You spent this year working. What was your hospital experience like?

We spend many years studying, but after our third year we get to work and I like that we get to be in direct contact with patients and not spend much time at school.

Many of my professors and other students support me.

There is a certain perception of trans woman in society and when you do not fit that perception, they do not call you a trans woman. So far, I have not experienced any negative reactions from patients because they do not know that I am trans.

I used to shy away from patients having seen how patients’ relatives attack health workers.

The other day, one relative of a patient hit a doctor on the head with a brick. Imagine what a person might do to a trans woman…

This is why I do not disclose my trans identity to patients.

Could you tell us about what the transition process is like as both a medical student and as someone experiencing this?

You apply to psychiatry at a public hospital. In Istanbul you can apply to Çapa or Cerrahpaşa. They observe you for at least six months and first refer you to psychiatry and then to endocrinology. At endocrinology you get a hormone test and then you start taking hormones. This process takes about a year.

Social Security Insurance (SSI = public medical insurance) covers everything except hormone medications. Hormone medications cost about 150-200 TL a month. Doctors have now started to write medical reports for hormone medications. As a result, SSI covers hormone medications too.

What is the hormone therapy process like?

(For trans women) You take out testosterone from the body and take in estrogen. The hormones impact you. Your emotions change. The hormone perceived by the receptors change, in other words, the codes change.

For instance, when the lecture hall incident happened, I was feeling very vulnerable because it had been a few months that I had been taking hormones.

This continues for the first six months before your body starts adapting. I don’t feel like that anymore.

Does the surgery process start after that?

The most important thing is the surgery. At this point, transmen are luckier because mastectomy (removal of breasts) and hysterectomy (removal of the uterus) are operations covered by SSI. Because these operations include removing of a part, the procedure is the same for any doctor. But surgeries such as vaginoplasty are highly risky since they involve creating something out of nothing.

SSI does cover this operation but there are no doctors who perform the procedure under this insurance. Even if there is a doctor out there who performs the operation under this insurance, it is really difficult to trust that doctor.

Why?

 

In medical school they do not teach you anything about transgender transition processes. If the person wishes, they self educate themselves after they graduate. If that person has no training, s/he cannot do the operation.

Doctors who specialize in these surgeries must be well known in the trans community then.

Yes. Because this operation is very important, I want to go to a good doctor to have my operation. One trans woman died at an operation two years ago. She was an activist and was living in Izmir. They said she died due to a complication that had derived from her. If the doctor had made a mistake, he would have been penalized anyway.

What kinds of complications arise during an operation like this?

There are complications that are repairable and complications that are more severe. Infections and clitoris dryness are the most common complications that are repairable. One friend didn’t go to a good doctor and got infected; had the surgery again and was hospitalized for three weeks. Another friend had clitoris dryness because the nerve cells were not stitched together well; she had a second operation and was hospitalized for a month.

I do not want to go through any complications. Also, I do not want to disrupt my studies. Attendance is compulsory.

How much does gender reassignment surgery cost?

About 20-30 thousand Turkish lira(3,600-5,400 Euro).

Homophobic lecture notes in the medical faculty of Istanbul University

The lecture notes for 4th year pediatric class in the medical faculty of Istanbul University refers to homosexuality as a disorder that must be treated.

Source: Aslı Alpar, “İstanbul Üniversitesi Tıp Fakültesi’nde homofobik ders notu,” kaosGL.org, 26 March 2018, http://www.kaosgl.org/sayfa.php?id=25407

According to the lecture notes which were posted on social media by the 4th year students in medical faculty of Istanbul University, homosexuality is introduced as a “Temporarily growing tendency towards same sex interest to be carefully monitored and corrected.”

The student who spoke to KaosGL.org, stated s/he had shared these lecture notes on their social media account right away after seeing it, and that they don’t know which lecturer wrote it.

The student indicated that during their medical education they have come across similar homophobic and transphobic statements before and said: “the professor teaching endocrinology to the 4th year students also used insulting expressions to refer to transsexuals and females.”

Homosexuality is not a disease!

Psychologists, psychiatrists and other specialists for mental health have concluded that homosexuality is not a disease, a mental disorder or an emotional problem. The American Psychiatric Association (APA) took homosexuality off their list of mental and emotional disorders in 1973. In 1975, the American Psychological Association also moved to support this perspective. Both these associations warned mental health specialists to stop associating homosexuality with illness. This stance was reaffirmed by both institutions with new research. Additionally, in 1992 the World Health Organization removed the classification of homosexuality as a mental disorder from the list of International Classification of Diseases. Turkish psychiatry also uses the version with homosexuality removed as a disease.

Here, you can find the Frequently Asked Questions brochure prepared by the Kaos GL NGO for frequently asked questions about homosexuality answered by specialists and life examples.

Transphobic Statement from the Pedagogy Association

The Pedagogy Association claims that with a set of methods, trans children can develop “a gender identity that matches their biological sex.”

Source: “Transphobic Statement from the Pedagogy Association”, (Pedagoji Derneği’nden Transfobik Açıklama), kasogl.org, July 19, 2018, http://www.kaosgl.org/sayfa.php?id=26300

The Pedagogy Association published an article claiming that trans children can develop “a gender identity that matches their biological sex.”

The Pedagogy Association does not see any harm in defining trans existence as “unusual” and as a “disorder”.

This comes in direct contradiction to the World Health Organization who 2 months ago removed trans identities from the “mental illness” category in the list of International Disease Classifications.

The association states that in a child’s gender identity development process, it is ‘natural’ for “a male to perceive himself as a male” and “a female to perceive herself as a female” and cases where this is the opposite should be medically treated.

Instead of acknowledging accepted scientific knowledge, the association continues to embrace the binary gender system saying that incorrect parental guidance and environmental factors are the reasons why children have gender dysphoria.

The association states that “for a person to develop a gender identity that matches their biological sex is natural” and continues the article saying, “sometimes a boy feels like a girl and starts behaving like a girl, and sometimes a girl feels like a boy and starts behaving like a boy. This shows that the person has not been able to develop a gender identity that matches their biological sex.”

“A Gender Identity that Matches One’s Sex”

The association defines trans existence as “unusual:” “For a child to develop a gender identity other than its own sex is an unusual situation. This should be addressed with care and the reason for the deviation in the child’s gender identity should be investigated. By seeking help from specialists when necessary, the child should be supported in developing a gender identity that matches their own sex.” The claim has no scientific basis.

The Pedagogy Association claims that it is a waste of time for parents of trans children to take their children to psychiatry specialists and that with intervention at an ‘early age’ the child can ‘recover:’ “…seeking psychiatry specialists for a solution drives people who experience gender identity issues into helplessness. Parents are told that this gender identity issue is normal and that it should not be intervened with. However, with early and appropriate interventions, a child’s gender identity problem can be resolved.”

Well, what does the association advice parents who have a trans child? Complete uncertainty! The association states that psychiatrists are not able to solve this ‘problem’ and that the solution is in “environmental, educational and therapeutic interventions.”

What Should Parents Who Have a Trans Child Do?

In the 143rd issue of Kaos GL Magazine’s “Health” themed file, in an article titled “Family and Transition Process in Trans Children and Adolescents,” Prof. Dr. Şahika Yüksel and Seven Kaptan offer suggestions to parents of trans children.

Yüksel and Kaptan advice parents to put gender binary constructs aside and to accept their child.

Yüksel and Kaptan end their article saying: “Parents pursue information so that they can understand and give the best response to what their children are going through. Ideally, while hiding their own emotional/intellectual experiences from their children, parents support their children, adapt to this process and try to recognize their children’s needs. Even though it is hard, parents, over time gain a new perspective on the concept of gender. Embraced acceptance may take years. What will be helpful to remember for the family is in fact general suggestions appropriate for all children: ‘Accept your child and love him/her’, ‘question traditional attitudes’, ‘create a safe space for your child’, ‘research acceptable activities.’ Forcing adolescents into dressing and behaving in a way that matches their biological sex will not shape them according to binary genders, but will increase their gender dysphoria.”

Trans female inmate Buse’s  “death fast” for her access to the right to health!

Trans inmate Buse started a “death fast” with the demand to have her gender transition surgery. Derya Özata of KADAV (Women’s Solidarity Foundation)  lists Buse’s demands. Buse has been in prison for 23 years and says “I don’t want to live with this body anymore. It’s not certain how long I will live or whether I will get out of prison”.

Source: “Trans female inmate Buse’s  “death fast” for her access to the right to health!” (“Trans kadın mahpus Buse, sağlık hakkına erişim için “ölüm orucunda”!) , Yıldız Tar, kaosgl.org, June 28, 2018, http://kaosgl.org/sayfa.php?id=26140.

Buse is one of the trans female inmates at Tekirdağ F Type Prison, for Men she has announced that she has started her “death fast” on June 5, through her lawyers.

Buse says that she has taken this decision due to the fact that her gender transition surgery has not been carried out. She is staying with Diren Coşkun, whose access to the right to health had been denied over the last months. Buse demands that her gender transition surgery is carried out immediately.

Derya Özata of KADAV has been following the violations against Diren Coşkun and Buse in prison and has explained what Buse has been going through, and what she demands to KaosGL.org.

23 years in prison

According to the information Özata gives, Buse was imprisoned at the age of 22. She is now 45 years old. She has been given a life sentence. She will be in prison for 20 more years. She had been in kept in isolation for many years, until Diren Coşkun was sent to Tekirdağ F Type Prison for Men.

The hospital sent a report, but…

Özata says she has been a penpal for Buse and tells [us] the recent developments in the process:

“Buse has been writing petitions to get a gender transition surgery for a long while. She has been struggling to have her surgery. We have written petitions together too. Lawyer Eren Keskin has been following the process too. Finally, Buse has written in a letter that the hospital has given her a report that ‘the gender transition surgery was imperative for her psychological well-being’ “. After this, another petition was written to the Ministry of Justice. However, Buse says that the ministry wrote to back to the prison saying ‘the surgery is imperative but not urgent’. Therefore Buse has started a death fast as of June 5, demanding her transfer to another prison and her gender transition surgery.”

(more…)

The constitutional court’s changes to Article 40 are now in effect

The Constitutional Court annulled a clause in the Turkish Civil Code’s Article 40 stating the requirement of “to be permanently deprived of the ability to reproduce” on Nov. 29, 2017. The decision is now in effect with its publication in the Official Gazette on March 20.

Source: Pembe Hayat, “AYM’nin Madde 40’taki Değişikliği Yürürlüğe Girdi”, 20 March 2018, http://www.pembehayat.org/haberler.php?id=1681

A trans man launched a case in 2014 at the Ankara 4th Court of First Instance for a name change as well as his gender transition process. He requested that the court investigate the Turkish Civil Code Article 40’s “mandatory sterilization” as being unconstitutional, that this surgery was not successfully performed in Turkish state hospitals and successful experts charged exorbitant amounts, that there was lasting irreversible damage after the operation affecting bodily integrity.

The Constitutional Court committee examined the file and annulled the requirement “to be permanently deprived of the ability to reproduce” from the Turkish Civil Code’s Article 40 on Nov. 29, 2017.

That change has been put into effect as of March 20.

No requirement for infertility anymore

The annulment of Article 40’s Clause 1 stating “to be permanently deprived of the ability to reproduce” means sterilization will not be required in gender transition operations. However, Article 40’s Clause 2 stating “the court will rule for the necessary changes in the population registry after an official health council confirms that the gender change surgery was conducted” remains in the law after the push for its annulment was rejected on Nov. 29.

“The effect of this annulment may be joint indemnity cases.”

Attorney Sinem Hun said she finds the decision to be positive and told Pink Life:

Though we don’t yet know the reason for the annulment, it may be a reflection of European Court of Human Rights A.P., Nicot and Garcon decision. The effect of this annulment may be joint indemnity cases as we have also seen in Sweden. Injured parties and associations may consider action as this practice lasted between 2002 and 2017. Of course the legal techniques should be evaluated and I reserve comments on the issue of techniques for now.

“This article was contrary to the Constitution’s Articles 17 and 20”

Pink Life’s lawyer Emrah Sahin said this incommensurable condition will no longer be sought in gender transition and added:

We see this decision as positive because this clause was contrary to the Constitution’s Articles 17 and 20. This decision also reveals that. With the annulment of this clause, the state will no longer seek “permanently deprived of the ability to reproduce” in gender transition.

Turkish Civil Code’s Article 40

Turkish Civil Code’s Article 40 regulates the “procedure” on “gender change.” The changed article is:

A person wanting to change their gender may apply to a court in person to request the allowance of gender change. However, in order to be allowed [to do so], the person needs to have passed the age of 18 and be unmarried, and document, via an official health council report from an education and research hospital, that they are of transsexual disposition, that it’s necessary to undergo gender change for their psychological health. The court will rule for the necessary changes in the population registry if an official health council confirms that the gender change surgery was conducted in line with the goal and medical procedures dependent on the granted permission.

 

 

 

LGBTI activist Kıvılcım Arat joins Diren Coskun’s death fast

Trans woman Diren Coşkun, incarcerated in Tekirdağ No.2 Prison, has been on a hunger strike for 13 days, asking for an end to rights violations in detention and for her right to surgery and treatment. Her friend Kıvılcım Arat, too, has announced her own hunger strike to help Coşkun’s voice be heard and to support her right to treatment.

This article was compiled from: ”Diren Coşkun 13 gündür ölüm orucunda, Kıvılcım Arat da aynı eyleme başladı”, Gazete Karınca, February 6, 2018, http://gazetekarinca.com/2018/02/diren-coskun-13-gundur-olum-orucunda-kivilcim-arat-da-ayni-eyleme-basladi/

Keskesor activist Diren Coskun, who was arrested in August 2017, has completed the 13th day of her hunger strike in Tekirdağ No.2 Prison.

Istanbul LGBTI Solidarity Association Board Member and spokesperson for Democratic Women Movement Kıvılcım Arat had announced that trans woman Coşkun has started a hunger strike against the prevention of her right to surgery and treatment, and the rights violations occurring in prison. Coşkun had declared her protest as follows:

“I’ve been subjected to many humiliating practices here. I lay my body to die, to gain my right to surgery and treatment, and to have this severe isolation abolished. I hereby declare to democratic public opinion that I have started a hunger strike as of January 25.”

As Coşkun’s death fast continues, Kıvılcım Arat announced that she has “started a death fast in order to reinforce Diren Coşkun’s voice and to make her demand for treatment heard”.

Kıvılcım Arat tweeted on February 6:

“In spite of our best efforts, we were not able to draw attention to Diren’s demand for access to treatment. Her trans identity cast a shadow over her protest and rendered it invisible. As of February 6 00:00, I have started a fast in order to reinforce Diren Coşkun’s voice and to make her demand for treatment heard.”

Arat stated that she will continue the fast until Diren Coşkun’s demands are met. Arat has criticized the LGBTI community for its lack of interest in Coşkun’s current situation and has emphasized that the oppression and violence against trans individuals remains invisible.

Anadolu: Turkish court annuls infertility requirement for gender change

Turkey’s state-run Anadolu news agency reports the Constitutional Court ruled to annul a stipulation in the Turkish Civil Code “to be deprived of the ability to reproduce” to allow gender change. This is verbatim translation like all our translations.

Source: Aylin Sırıklı Dal, “Cinsiyet değiştirmede ‘üreme yeteneğinden yoksun olma’ şartı kalktı,” Anadolu Ajansı, Nov. 30, 2017, http://aa.com.tr/tr/turkiye/cinsiyet-degistirmede-ureme-yeteneginden-yoksun-olma-sarti-kalkti/985974

The Constitutional Court decided to annul the legal requirement “to be deprived of the ability to reproduce” to allow gender change.

According to information gathered by Anadolu Agency correspondent, a homosexual opened a case in the Ankara 4th Court of First Instance after being unable to change their identity card due to not having had gender change surgery.

The court petition asked the court to evaluate the claim that the Turkish Civil Code’s Article 40/2 mandating the requirement of gender change surgery to change one’s identity card violated the constitution.

Ankara 4th Court of First Instance found the petition to be serious and took the file to the Constitutional Court.

The General Council of the Constitutional Court discussed the basis of the petition at its meeting. The Council rejected the annulment Turkish Civil Code’s Article 40/2 with a majority of votes stating “the court can make the necessary changes in the population registry after an official health institution confirms the gender change surgery was realized.”  

Annulment of requirement to be deprived of reproduction ability

Another petition on this subject was made by the Edirne 1st Court of First Instance. The court applied to the Constitutional Court to annul the statement “….and to be permanently deprived of the ability to reproduce…” in the second sentence of Turkish Civil Code’s Article 40/1.  

The General Council of the Constitutional Court discussed the basis of the petition and made its decision.

The High Court found the requirement “to be permanently deprived of the ability to reproduce” to allow gender change to be contrary to the Constitution and annulled it with a majority of votes.

The first paragraph of the law used to state, “A person wanting to change their gender may apply to a court in person to request the allowance of gender change. However, in order to be allowed, the person needs to have passed the age of 18 and be unmarried, and document through an official health council’s report from an education and research hospital that they are of transsexual constitution, that it’s necessary to undergo gender change for their psychological health and be permanently deprived of the ability to reproduce.”