How can I stop regretting being gay?

TranssexualityI am trans. For sure?

Johanna Berling stands in the kitchen of her 2-room apartment and puts the leftovers from breakfast in the dishwasher. She just turned 20. Until a year ago Johanna Caspar was:

"I was anorexic and was therefore in the hospital. When I was healthy again, I still felt totally uncomfortable in my body. So I thought: something is really wrong with my body: maybe I'm trans."

The acceptance for trans * people is increasing. For many young people this is an opportunity. But the numbers are developing so rapidly that youth psychiatrists have doubts as to whether they are really only dealing with a liberation movement. The way back is quickly blocked.

"Being trans" as an "easy solution"?

"I was hoping that being 'trans' would be the 'easy solution' for me too."

Johanna lives a little outside of Stockholm city center. In the sparsely furnished living room, she pulls a photo album from the bookshelf:

"My mother took a picture of me every month. Here - I'm 15."

The picture shows a pretty girl with long blond hair. In the next photo, Johanna wears her hair short. There are dark shadows under her eyes.

"Here - I felt very bad there. I was 15 when it started."

Johanna becomes anorexic and has to be treated in the hospital. She'll get well again. And relapses. When she was 17, she began to dress manly. She dyes the raspy short hair blue and calls herself Caspar.

"Back then I came into contact with trans people and the trans movement. And I was so happy to see that everyone who had gone through the transformation was so satisfied."

First Johanna, then Caspar, then again Johanna Berling (Johanna Berling)

"Drastic increase in patient numbers"

Johanna Berling is one of a growing number of young people who want to change their gender. Treatment methods have improved. And more and more people are making use of it, says Alexander Korte, senior physician at the Munich University Clinic for Child and Adolescent Psychiatry and Psychotherapy:

"What we have been observing for years has been a drastic increase in the number of patients, especially among young women in early and middle adolescence."

In 2019, five times more young people came to Korte's special consultation than in 2013. His specialist colleagues observe something similar.

"If you look at the statistics across actually all age groups and across different countries or cultures, there were more and more man-to-woman transgender people. In a ratio of at least two, if not three to four to one . So three to four times as many biologically males who were identified as being of the opposite sex as biologically females. "

Chelsea Manning, formerly Bradley Manning, exposed US Army war crimes and underwent gender reassignment therapy while in custody (imago stock & people)

Gender balance has turned around

The gender ratio has shifted significantly within a few years. Not just in Germany. Korte:

"What we are currently observing in the youth sector - and that is not denied, not even by my colleagues in other treatment centers in Germany or internationally: At the moment we have a ratio of five to eight to one. But, mind you, five to eight girls to one biological boy. And that's a development within the last five to ten years. So in a decade it has changed so much without our being able to explain it sufficiently so far. "

In Sweden, the number of young women who want to change their sex has increased by as much as 1,500 percent in the past 10 years. Doctors there have already sounded the alarm. And Alexander Korte also sees a worrying trend:

"We have known for a long time that puberty is more of a challenge for girls than for boys. And that many more girls with or at the beginning of puberty feel significantly more uncomfortable with their bodies and in their bodies. What then comes is that girls or female adolescents also have to deal more with the current ideal of beauty and slimness in our society. And I believe that with this clinical picture or this preformed template: "I am trans" something is on offer where girls use it more often. "

Johanna becomes Caspar

"There are quite a few pictures of me. Here - that's where I started to dress manly."

Johanna wears baggy clothes and sneakers in the photos. In front of her friends and at school, she comes out as a man.

"I was hoping, okay, if I do these gender reassignment surgeries and take testosterone, I will automatically become happy. It was wonderful to come to that insight and think, now everything will be better."

Johanna wants to change her body as quickly as possible. She has her doctor refer her to the special outpatient clinic for trans * young people at the Karolinska Institute in Stockholm.

"As soon as I came out as a man, I said: I have to start with testosterone right now. I just have to do it. Of course, because I thought I had finally found the solution to all my problems. And if you can The solution is presented so clearly: Why not take the chance. And I think that is also a great danger for other people. Especially when you are in your teenage years. "

Surgery and hormone therapy have far-reaching consequences

Unlike experimenting with clothing styles or sexual orientation, the consequences of changing sex are far-reaching.

Many trans * adolescents use opposite-sex hormone therapy. Some trans men have their breasts, ovaries, and uterus removed; some trans women have their penis and testes removed. For many years, transgender organizations have campaigned to make such treatments more accessible. But there are also those affected who want to return to their original gender. They are called "detransitioners" in the English-speaking world. Looking back, Aleksa Lundberg also thinks differently about her decision, which she made 18 years ago:

"I probably wouldn't do the sex reassignment surgery and hormone treatment today."

Gender role pressure when entering school

Aleksa is an actress and lives in Stockholm. Today she is 38 years old. Even in kindergarten, she dreamed of being a little princess.

"I knew I had a penis between my legs and I had no problem with it. But I didn't like being pushed into the gender role of a boy."

It only became problematic when Aleksa, who was still called Mathias at the time, started school:

"I can still clearly remember that my mother said to me at the time: 'So Mathias, now you are going to be a big boy and it is time to put your theater clothes in the box.' For my mother it was theater what I do I was supposed to cut my hair, put on workout clothes and act like a real boy. But I just wanted to swap colorful glitter pictures with other girls, I loved 'My little Pony' and I collected erasers that smelled of fruit was just a real sissy. "

Aleksa Lundberg advises to think very carefully about whether a body-altering operation is necessary (Aleksa Lundberg)

What are the motives for wanting to change your own body?

At 16, Aleksa came out as homosexual. She makes new friends in the gay scene, experiments with clothes, wears high-heeled shoes and puts on make-up.

"In 1999, when I was 17, I met a group of very pretty women at a Pride Festival in Stockholm. Breasts in push bras, high heels, standard women, so to speak. They were transsexual and had treated the opposite sex. And that was mind blowing to me. All of a sudden I understood that there are options. There are opposite sex treatments and there was a word for it; and that was transsexual. "

Aleksa takes hormones, has her penis removed when she is 20 and campaigns for the rights of trans * people. But their story also has a downside.

"It was a very long process for me to come to this realization. I started to wonder why I couldn't just have lived as a gay man. Why did I feel the need to change my body back then? What is." it actually exactly what makes a man and a woman and why do some people feel like they are living in the wrong body? What is left of it when you decouple it from the requirements for gender roles? I myself have come to the conclusion that I am a feminine, homosexual man who at the time felt that he had to change his body in order to be accepted. "

"Detransitioners" speak about their doubts

Aleksa isn't the only one who speaks publicly about her doubts. Trans * people tell their stories, especially in English-language media. They have gathered on websites, founded groups on Facebook and have their own YouTube channels. Their reports deal with role expectations, hasty decisions and social pressure:

"Hi! I'm Laura, formerly Fritz, before that Laura." "Hi folks, I want to talk about the reasons for my 'detransition' here." "I just know that I would have liked my therapist to have said to me, 'You can be transgender, you can identify yourself that way, but let's try first to get to a point where you don't hate your body.' "

In Berlin at the counseling center for trans * people "Live Queer", Mari Günter is familiar with these reports. However, she does not like to speak of a movement:

"Overall, there are very few people, based on what we can perceive. But they are given an unbelievable amount of attention in research, in the scientific discourse. On the one hand, and one has to say, they are instrumentalized in order to continue to establish gatekeeping And it is actually said that this is an argument from more traditionalists who say: Just because we have checked and monitored the transition processes so heavily for decades and have denied so many people the opportunity, that is why there are so few who are wrong. This is, of course, a perfidious construction, which at first only speaks of lust for power and of its own fearfulness that lies behind it. "

Physical changes are largely irreversible

On the other hand, parents and medical professionals who accompany those affected through the process have a great deal of responsibility.

A diagnosis can never be made with 100 percent certainty. And the physical changes that occur after an opposite-sex hormone treatment can for the most part not be reversed. A deep voice will remain forever, in many cases hormone treatment leads to infertility. Young people in particular may overlook the price of sex reassignment surgery. Aleksa:

"It's impossible to undo the treatment. Definitely not when you're doing gender reassignment surgery like me, man to woman. You can't get your original penis back."

The surgeon Marci Bowers - herself a trans woman - is regarded as an expert in sex reassignment surgery (imago stock & people)

Surgical methods have improved and the cosmetic results are satisfactory for many trans * people. This is shown by studies in which people were asked about their experiences. But trans women in particular report that their sex lives have changed. Aleksa:

"That is also an aspect: with the operation you lose part of the sexual sensation and the sensation during orgasm. At least a certain percentage. And that will never come back. If there is one thing that I suffer from, it is that: That I'll never know how it used to feel and that I can't feel it the same way anymore. And to say that it can be undone is absurd. It's not true. "

How reliable are quality of life studies?

The data situation on the "quality of life", that is to say on the quality of life of trans * people after opposite-sex treatment, is thin. But there are a few studies in which trans men and women were asked about their experiences. Florian Schneider from the "Center for Reproductive Medicine and Andrology" at the University of Münster knows the examinations:

"We see in the data from Belgium and Holland that the patients also have an increase in the 'Quality of life' scores, that they feel good, that the opposite-sex hormone therapy is going well, that the gender reassignment surgery is going well when the before - and follow-up support is going well. The data situation is very clear. "

Such "quality of life" studies on the quality of life are usually carried out on the basis of questionnaires that are sent to trans * people. But those who wish to retire or who are dissatisfied are hardly recorded, replies the Munich youth psychiatrist Alexander Korte:

"Well, there is one very important point to consider first. We are most likely dealing with a classic publication bias. In other words, the majority of the time positive treatment and long-term courses are published. Neither the doctors nor the vast majority of patients and patients have an interest in publishing when something doesn't end so well. "

Long-term effects of hormone treatment unclear

Aleksa: "Well, I'm fine and I hope that I will have a long life. But of course I have the thoughts somewhere in the back of my mind: How many years will my life be shortened by the hormones? Will I get breast cancer? And so on Of course I'm a bit worried about that. I'm still quite young, only 38, so I don't have to worry too much. But the older I get, the greater the risk. In the back of my mind these thoughts resonate. "

Antiandrogens are used in hormone therapy for gender reassignment (www.imago-images.de)

In the counseling sessions, young people are informed about the risks and possible side effects of opposite-sex hormone treatment. But for many preparations that are used today, there is hardly any data on the long-term effect, says Mari Günter from the advice center "Queer Leben" in Berlin.

"That is actually a dilemma in these educational talks, which I always point out when I say: There is still very little research that can give a prognosis for the future: So how are you doing with hormone therapy in 20, 30, 40 years? And there are various statements and statements about cancer risk and so on in the guidelines, but you always have to make it clear that this research is a bit older, that it is based on a medical system that does not correspond to the German one. And older, above all, also means that other active ingredients have been used. For example, the current medication, its effectiveness and its risks, cannot be researched in this 20 or 30 year course of the year, because it is not yet so long there. "

Discussion about the minimum age for operations

It is known that female estrogens increase the risk of pulmonary embolism in trans women and lead to high blood pressure. The risk of cancer also increased - at least with the older drugs. Reproductive medicine specialist Florian Schneider:

"You have to say that there is always a big trade-off with the hormones. The data is currently still relatively opaque or not entirely clear. In general, it can be said that hormone treatment is safe if it is carried out by an endocrinologist. And the patients Those who take the hormones are also honest about co-medication and previous illnesses and possibly other medications that are being taken. Then it is relatively safe. "

The Danish painter Lili Elbe (1882-1931) is considered to be one of the first trans * people to undergo gender-changing surgery (imago stock & people)

In Sweden, politicians have discussed whether the minimum age for gender reassignment surgery should be lowered to 15. The proposed law provided for such interventions to be made possible in exceptional cases without the consent of the parents. But can young people at the age of 15 foresee the consequences of their actions in all their consequences? For example, that it is very likely that they will no longer have children of their own? Aleksa:

"I know it will upset a lot of people, but I don't think a 15-year-old, not even an 18-year-old, can know for sure whether opposite-sex treatment is the right decision for a lifetime.That is why I would find it understandable if the decision - in any case to have an abdominal operation - is only made when the brain is fully developed between the ages of 22 and 25. I'm not saying it has to be that way, but I think we should have a discussion about it so as not to cause harm. "

Controversial time savings through "puberty blockers"

But at this point, medicine is in a dilemma: During puberty, physical changes occur that are no longer reversible. That puts a lot of young people under a lot of pressure, says Mari Günter:

"Well, this is really a massive challenge for young people and I think some would be happy if they could say that if I had to clarify this in ten years, that would be nice too. But they also notice that their physicality is putting them under massive pressure implies that they say: I now have to find a solution that is at least a good idea for the next few years, maybe decades. "

There is the possibility of stopping the physical changes with so-called puberty blockers. These hormones prevent sexual characteristics from developing. They are used by young people to buy time. But Alexander Korte thinks this is questionable:

"I have clearly positioned myself there and am very critical of the use of drugs that block puberty. This is because the previous studies consistently show that almost all children who take puberty blockers decide in a second step to take hormones of the opposite sex This indicates that the course is set at a very early point in time, although the diagnosis has not yet been confirmed, because the psycho-sexual development of the child in question is not yet complete. And time can be gained A puberty-blocking treatment, which the proponents portray as medically harmless, according to what we know, possibly - or I would say probably - a transsexual development and at the same time obstructs other, alternative development paths Example a homosexual les coming out. "

The fact that trans * people are free to choose their gender is a socio-political achievement (imago stock & people)

Relationship between doctors and trans * community strained

For many years, transgender organizations have fought for recognition. Until 2011, sterilization was compulsory for trans * people who wanted to change their civil status. In Sweden even until 2013. Quite a few trans people find it paternalistic that doctors decide whether or not they are allowed to undergo treatment. This puts a lasting strain on the relationship between treating doctors and the trans * community, says Mari Günter from "Queer Leben":

"There are still such narratives being established that one says that it is now the one or the irreversible decision, that one has to examine it very carefully, because it only works once in a lifetime and then it has to be very convincing, so it will be Such a whole-or-not-at-all construct was brought up to the young people, and I find it very gratifying that they have now seen through and say: This gender dichotomy simply doesn't have much to do with my life and my current life situation. That's nice . "

Transsexual diagnosis "often much too fast"?

Many hurdles on the way to gender reassignment treatment have been overcome. The voice of the trans organizations is heard in many countries. The downside is that medical professionals are sometimes confronted with the accusation of being transphobic even if they refuse therapy for good reasons. Meanwhile, the special outpatient clinics are getting more and more visitors, which they can hardly cope with. Alexander Korte sees this development more critically than many of his colleagues:

"I already have the impression that nowadays this definition is a matter of transsexuality, that it takes place more quickly than in the past. And that that is no longer questioned. Not every young person or every young person who categorizes themselves as transgender , is inevitably transsexual. I think it is often much too fast these days that you then advise them unilaterally and initiate gender reassignment measures at a point in time when they should actually be postponed again. "

Johanna Berling has to wait a year for her appointment at the Stockholm special outpatient clinic for trans * young people. During this time she speaks regularly with a psychologist. Your parents will pay for it.

"We talked a lot about what the chicken or the egg is for me, so to speak. Did the anorexia make me think I was trans *. Or did the feeling of living in the wrong body make me sick "My psychologist got me to think that if you dress masculine and reject your body, it doesn't automatically mean to be trans *."

Returning to the previous sex also requires courage

Doubts grow in Johanna. And she hopes to find the answer to her questions in the consultations with medical professionals:

"At the first meeting with the doctors, I was asked what kind of treatment I would like to have when the examination is finished. I was completely amazed because I thought I would be advised there. I wanted a professional assessment of whether I was really trans or not. And then they sat across from me and had already made up their minds. "

Johanna breaks off the medical examination. She comes to the conclusion that gender reassignment is not the way to go. She has another "coming out". This time as a woman. For a while she quarreled with herself and her decision. She is afraid that her friends will not take her seriously.

At the end of the "trans journey", Johanna Berling feels that she has arrived at herself (Johanna Berling)

"That was also difficult for me: I had the feeling that I was behaving disrespectfully towards all trans * people who fought so hard for their rights. I know that my story is pouring grist on the mill of people who are transphobic Such people wrote to me and said: 'There are no trans * people and you are proof that that's true.' No, that's absolutely not what I want to stand for, just because I came to the point That I am not trans doesn't mean that it is the case with all trans * people. "

In retrospect, Johanna does not have the feeling of being "lost". But she is relieved to have turned back in time:

"Absolutely! I'm really happy about it. I would be devastated now if I had done all these treatments."

The goal is to arrive at yourself

At the same time, Johanna does not regret having undertaken what she calls her "transit trip". In the end, she has the feeling that she has arrived at herself:

"I'm doing very well now. I feel more secure with myself than ever before. Because I don't perceive any compulsions. I have the feeling that I've grown a lot as a person in my time as Caspar. And with my story, I want everyone Reach out to young people who are in the same situation as me: Try to explore all the possibilities and expose yourself to uncomfortable situations. Do not commit yourself to an alternative if you realize that you are wrong. You don't have to be ashamed of yourself it's your way. It doesn't matter whether you end up as a trans * person or in your original gender. The most important thing is that you respect yourself. "

Aleksa also has no regrets about the decisions she made at a young age. There is one main reason why she is now making her doubts public: She might want to complete the sometimes somewhat glorified picture that young people have of life as a trans * person:

"The young people should absolutely do a trans * counseling and find out what is right for them. But they have to know that hormone treatments and operations are irreversible and cannot be undone. I would advise them: Listen to my story and think about it one, two, three extra times. In the end, the treatment has to be just right for you. And see the hormone treatment and definitely an abdominal surgery as a last resort out of your situation. Because it is absolutely not certain that you will do the rest of yours too Will feel like right now. "