THE FIRST "TRANS" WITH REGRET CHALLENGES THE PUBLIC HEALTH SYSTEM

02/22/23

The young Galician, diagnosed when she was only 15 years old, had her breasts and uterus removed without psychiatric supervision. The specialists did not detect her autism either. "And how do you fix this now?" her mother laments.

Susana Domínguez, 24, at the Riazor Beach in A Coruña

When she told the psychologist, who authorized her sex change, that she regretted it, he replied: "You manipulated me by crying."

In 2020, Susana Domínguez, then 21 years old, went back to see the psychologist who six years earlier had given her the green light for sex change treatment and had allowed Public Health later to remove her uterus. She wanted to explain to him that both had made a terrible mistake.

She was convinced that years ago, in those conversations between them, both she and the psychologist had been wrong.

She was not a boy in a girl's body, as she had told him when she was only 15 years old. The hormones and the operations had been a tremendous mistake. It had taken Susana six years to realize that perhaps her mental problems, which included depression and schizoid disorder, had made her incapable of making a sound decision.

Actually - she told the psychologist - she was and always had been a woman, but a woman with serious disorders that had nothing to do with transsexuality. She had suffered disorders that he, a mental health professional, had not recognized in time.

"And then the psychologist told me: We've already started, we've already started," Susana recalls today. "He seemed to be bothered by my problems... I was a troubled teenager and he was my therapist."

The toll of such a mistake has been enormous.

Taking one step at a time during those six years, Susana’s breasts and uterus were removed, and she received an avalanche of male hormones. Her body has been irreversibly changed.

At the same time, there was another process happening. Despite Susana’s not receiving psychological support during her sex change, She and her mother had not stopped looking for help for the girl's struggles, on their own. She had suffered through several suicide attempts. Eventually , what they believe could be the cause of her struggles emerged, traits of an autistic spectrum disorder that the first professionals never noticed.

Neither the psychologist from the Galician Health Service nor another Public Health psychiatrist she had seen, evaluated Susana's genetic background: at least six people in her immediate family–including her mother and two brothers–suffer from mental health problems. However, the specialist relied upon the adolescent's self-diagnosis, which was influenced by internet forums, rather than upon scientific evidence.

So in 2020 Susana, terrified by the mistake made and deep in her mental problems, blamed all this on that professional. And he answered her, according to what she told this newspaper: “You cried and you manipulated me. You manipulated me by crying, but I knew that the sex change was not going to make you feel better.”

“You cried and you manipulated me. You manipulated me by crying, but I knew that the sex change was not going to make you feel better.”

Susana, today, recounts that clash with reality:

"Not only that. I also went to the first psychiatrist, who referred me to the psychologist, who took for granted that I was trans. Now, years later, she only says:

‘Oh, but if you were very sure, you were very sure.’ I was 15 years old. How did they let me do that? How could I be sure of what I wanted?”

Her mother interjects “And now, what do we do? How do we fix this?” Her daughter no longer has a reproductive system either female or male. She has been taking masculine hormones for years and now will have to take feminine hormones to return as much as possible to her original state. The damage is practically irreversible.

How did they let me do that? How could I be sure of what I wanted?”

Gathering all the strength that they are capable of, after three years of feeling overwhelmed by the errors committed and without a solution from a scientific perspective, Susana Dominguez and her family have filed a claim against the Galician Health Service. Specifically, they denounce an incorrect diagnosis of gender dysphoria – the technical name for I'm-in-the-wrong-body– and for the absence of psychological support to the girl during her transition from woman to man.

They denounce an incorrect diagnosis of gender dysphoria – the technical name for I'm-in-the-wrong-body– and for the absence of psychological support to the girl during her transition from woman to man.

This is the first [case] of its kind presented in Spain. It is the step prior to a potential lawsuit, limited to commenting on the courts and is based on the obligation of the State, and its doctors and physicians, to protect the health of citizens and not cause them unnecessary harm. In 2020, Keira Bell, a woman in the UK presenting facts similar to these, won compensation, legislative changes and the closure of the clinic where they changed her sex. The Courts decided there, that at the age of 15, the same age as Susana’s when she began her process, Bell was not mature enough to make such a far-reaching decision.

Susana's misadventure occurred thanks to the Galician law on non-discrimination based on sex, which dates from 2014. At that time, Alberto Núñez Feijóo was regional president - and the legislation was approved with the votes of PP; PSOE and BNG. The legislation does not include any provision for psychological support in these processes, and it allows patients to choose to change their sex without any oversight of this decision.The same is true of the Trans Law recently approved in the Congress of Deputies, which extends this model to all of Spain and explicitly prohibits, contrary to the opinion of practically all Spanish scientific societies, that any mental health professional should affirm any patient who self determines that he has a sex other than hisown. It only provides for psychological support if the patient demands it, to help him with the upheavals of hormones and surgeries.

This design of the legislation is intended to prevent any doctor from trying to cure anyone's transsexuality. However, European countries such as the United Kingdom, France, Norway and Sweden have already reversed similar legislation when it was proven that, due to this lack of oversight, minors without the necessary maturity and mental health were allowed access to these treatments when they weren't actually transgender.

The very psychologist who gave his approval for Susana to undergo hormones and surgery wrote in his report: "Due to her avoidant traits, the evaluative and psychotherapeutic work develops very slowly, she has not yet begun her real life experience." He saw the immaturity in her, but that did not prevent him from referring her, after "less than 10 sessions," to an endocrinologist who started the hormone treatment. And from there to the operating room.

" He saw the immaturity in her, but that did not prevent him from referring her, after "less than 10 sessions," to an endocrinologist who started the hormone treatment. And from there to the operating room.

The Galician Health Service, answering questions from this newspaper, has limited itself to commenting on the matter that "all protocols were followed" and that "a clinical committee evaluates each case."

Susana changed her name in the Civil Registry, and was renamed Sebastián making use of the so-called gender self-determination. Until now, though she wants to be Susana again, the law has not allowed her to do so, and is asking for justifying medical reports. The new Trans Law, after its publication in the BOE, will facilitate these procedures.

Though she wants to be Susana again, the law has not allowed her to do so, and is asking for justifying medical reports. The new Trans Law, after its publication in the BOE, will facilitate these procedures.

"We were at home when she told me that she felt like a boy," her mother, who prefers not to give her name, begins to tell the story. “I did not expect it at all, but I told her that we would go to the psychiatrist who was already treating her for depression and anxiety. I thought that the psychiatrist was going to tell me that she had a mental illness, but the surprise was that she told me from the first moment: 'You have to accept it. If he feels like a boy, it's because he's a boy. I had never thought that Susana was a boy. In fact, my youngest son has always worn dresses and headbands, and has always painted his nails, I think imitating his sister. I never thought he was transsexual... But, well, I asked the psychiatrist if maybe that was why she had been in so much trouble. She told me, 'Sure, it would be that.'"

Susana Domínguez was thus referred to the Hospital Marítimo de Oza, where the psychologist, a Gender specialist, ruled that she needed to take hormones. “Actually,” says the girl, now 24 years old, "it was all from watching YouTube videos of people who had changed their sex and said that their mental health had improved."

Her mother: ”She spent the day crying, saying that she needed testosterone and surgery, that only that could help her... And I feel very guilty, because then I would repeat to the doctors what she asked me to repeat. And then when she backtracked, everyone told me how come I didn't realize the mistake... Oh, my God.”

The public endocrinologist, from the Teresa Herrera Hospital, began to give Susana hormones when she was 16 years old. That is, even while being a minor. "At 18 she had a mastectomy, they removed her breasts," says her mother. “As Public Health was not doing that at that time, the endocrinologist gave us two names of hospital surgeons who performed surgeries in the private one, and we did so. It cost 6,000 euros.”

Right then she went to the Civil Registry and changed to Sebastián. "I could never call her that," says her mother. "I referred to her as a boy, I was afraid that it would hurt her to continue treating her as a girl, but I couldn't call her that."

A year plus later, given that Susana continued to have her periods despite taking hormones for more than three [years], "the endocrinologist recommended that I have a hysterectomy," says Susana. She had her uterus and ovaries removed at the University Hospital of A Coruña.

This second intervention was the great turning point in her mind: "She began to feel terrible. She just wanted to be admitted into a hospital." Susana was not yet 20 years old. "Since we had no help, we went to a private psychologist," recalls the family. "Shortly after, Susana told me that she no longer wanted to be a boy, that she was a girl."

How does she explain that change? “When I was transitioning, I still felt bad. Sometimes I thought that maybe I was wrong and that maybe I was just a girl with mental problems. Then I found the Detrans forum on Reddit for people who regret transitioning, and I identified with what they posted. I felt anger against that psychologist who made the reports on my behalf knowing that this was not going to help me. I wanted to die.”

When Susana regretted it, the endocrinologist even told me to convince her to keep going. I guess they didn't want to admit that they had been wrong

Mara Parellada, a psychiatrist at the Gregorio Marañón Hospital in Madrid, an autism specialist who suggests a link between this disorder and the self-diagnosis of transsexuality, interjects here: “Solid studies show that there are many more people with autism spectrum disorders going to sex change clinics than the average for the general population. And the same is happening in the care of people with autism: there are also more with gender dysphoria than among the general population.”

Is there a scientific link between the two fields? "Nothing direct," says Parellada. And she mentions hypotheses: “Autism brings a lesser understanding of social conventions and a propensity not to adhere to them, and gender has a lot to do with convention. There is also a slower development of identity in many cases. On the other hand, the autistic person suffers from a certain social maladjustment, which can lead to seeking that adaptation in different ways.

"When Susana decided that she did not want to be a boy, I called the endocrinologist to tell her," explains her mother. “She told me to try to convince her to continue, in front of her, that she should not change, because it would be worse. I imagine that she did not want to admit that they had been wrong.” The girl stopped taking male hormones and now she is going to have to take female hormones for the rest of her life since she can no longer produce them naturally.

Until they found the Amanda Association, of mothers with children with rapid onset gender dysphoria, Susana and her mother found it difficult to start [the legal process]. "No regional law, not even the one that has just been approved, contemplates what to do in these cases," they say in Amanda. “And the Trans Law strictly prohibits any psychological approach that is not affirmative, under penalty of a fine of up to 150,000 euros. The law can even cause parents who choose a non-affirmative approach to lose parental authority.

The legal claim on Susana’s behalf is presented by Attorney Carlos Sardinero and is valued at 314,000 euros --according to the usual legal scales. If approved, it would be paid out of the public treasury. It includes the claim that the hormones aggravated Susana's mental problems: adverse effects of which the prospectuses for these drugs warn.

And now, what can be done? Is there any surgical way to retrace the steps? "They have only told me that they can give me implants," Susana simply says.

Susana speaks little. During the photo session, on the beach in A Coruña, she does not speak to the photographer. If she is asked in writing about her feelings, she says: “I was doing very badly. I could not relate and make friends. It was difficult for me to talk to the psychologist and even so he made the reports for me to receive the hormonal treatment and the surgeries. If he didn't know how to help me, he could have sent me to someone else instead of ruining my life. The last time I went to his office, he began to shake, threw us out and told us to go to the legal department of the hospital.”

How is her life now? "Awful. Psychologists and psychiatrists have never helped me and I still have the same problems. The psychiatrist now says that I do not have any mental illness, that mine is not cured with pills, but she continues to prescribe pills and make cut-and-paste reports.

Susana Domínguez, finally, speaks most clearly about that psychologist in her anonymous but very active Twitter profile. There, many of these young people live a parallel life that, sometimes, they believe is more real than the truth. There, she became convinced that she was trans. There, Susana writes: "That guy raped my soul."