Heeey everyone.
I found this site awhile ago but haven't been active yet :/ thought to start with this looong post about how things are done here in the cold North. Now this is a repost which I wrote to tgboards time ago, but since this forum looks way more active I thought.. why not.. I know that this is mostly US based board too, but I think it may be interesting to hear how things are done far away from the States.. May be.. I don't know? You decide
(Side note, I'm not native english-speaker so try not to bash me if I use wrong terms.
they differ a lot in Finnish and English.. + we don't have different he/she! our language is unisex
).
First I'm afraid that I've to start with basics as our healthcare system is fairly different than yours. Finland has both public and private healthcare sectors. Public side is which every Finnish person (or anyone permanently living here) is entitled to and is mostly covered either fully, or at least 60-80% (depending of the operations) by the state. Public sector does every operation that relates to persons health and well-being, but doesn't do plastic surgeries for example, as they are categorized as cosmetic operations only. Public side also has longer queue's (they prioritize, life threatening situations n:o 1 obviously, those in great pain come after, and all the rest have to wait.) and their priority is generally get persons up to their feet again as fast as possible so.. how do I put this.. They do good job, but due to long queue's they tend to be more fast than gentle
All the "major" operations are generally done in this side too, and ambulances take people to public hospitals always. So not like you'd carry any insurance cards with you, it's always the same address if something happens. So, we don't have health insurances at all like in the States, but it's all government funded system.
Private sector, on the other hand, is where one pays after leaving the clinic. The state does not cover any costs from using private healthcare, (some companies however have deals with clinics so their employees can use private sector free of charge. "Healthcare benefit"). Private sector does plastic surgery, cosmetic dentist operations, as well as any normal operations with better equipment and more.. "patient friendly" attitude as they need to be nice for patients to get them coming back instead of going for public side next time
private side is considered to be expensive here, and all the "major" operations are done in public side anyways so private clinics don't even have equipments for treating cancer or doing major surgeries. They are clinics where you can go if you can walk on your own, get slightly better treatment than in public side and pay the bill when leaving.
So if one breaks an arm, public side is generally way to go as they do good job and with those situations one passes the queue's fairly fast due to higher priority. If sick, I personally like to go to private clinic so I don't have to queue for 4 hours before getting into the doctor, simple visit like this doesn't cost that much (30-40usd maybe) and they'll take better care solving the cause of sickness and prescribing the right meds whereas public side tends to give the same antibiotics and ibuprofein painkillers for everything.
Dentist operations I also get done in private sector as I'm afraid of those and public dentists have priority in speed, not in patients psychological well being during the operation
private side also has better equipment in this field, laser drills for example.
So.. with this system explained I can finally get into the point. I'm MtF trans something, and in the very beginning of the realizations and the process for getting better and leaving this confusion and depression behind. So the long road we have to walk in this country begins with going to a doctor. Public or private side, there is no difference (except that private side costs for the patient). In before it is highly recommended to print out a part of our law which, roughly translated reads
"If a person feels that he/she might have symptoms of GID, he/she must be sent to specialists in either Helsinki University Central Hospital or Tampere University Central Hospital for further evaluation ASAP." These are the two places in the whole Finland where we have trans* people specialized staff (actually a whole hospital wing in both places existing solely for us ^^). In addition, one should print "info sheet for doctors" from our LGBT organization website which contains additional information such as that this is not a form of mental illness and by law they are not even allowed to send me anywhere else than either HUCH or TUCH (HUCH for me, it's closer
).
Printing the documents before-hand is highly recommended as no regular doctor usually knows what to do with our cases, where to send us or when. Without them, the most common case I've heard is that people have been sent to mental clinics to see shrinks who in turn refer them to T/HUSC, which is just another delay in the process. But with the papers, it's fairly simple. They read all the addresses, the law, the fact that the regular doctor is not allowed to do anything else but to send us immediately to specialists. Fast and easy, my doctor thanked me for bringing the info sheet with me as he said that he would've had no clue what to do with me otherwise.
With the letters from regular doctor, one waits for his/hers first appointment in either HUCH or TUCH. First appointment was.. well.. introductions and scheduling more appointments, usually 2-3 times/month. This is the point where I am currently, I've my letters and was in the first meeting but I had to drop out for a while due to mental stress and will be going back when I've other aspects of my life (like a new apartment :roll:) fixed. Therapy can include bringing in your parents/friends/partner/whatever to make it easier for them to deal with changes if one wishes to, but not if patient does not want.
Usually after 6 months of running in the clinic it's possible to get the diagnosis which is needed to start HRT. In before that one has been running in 2 different specialized psychiatrists, one psychotherapist (I don't even know the difference between these) and one doctor who takes MRI scans, EEG brainwave scan and other similar physical tests. The system is created to both give patient time to think that it's what he/she really wants, and "to search for other factors that might cause GID-like symptoms and verify the diagnosis" (don't ask me what those other factors might be, but..) If the doctors do not approve starting HRT, treatment and therapy continues with different ways depending of the case. Eg, for someone who's body for some reason can't tolerate hormonal changes at that moment, those problems are treated before HRT can begin.
All the visits are covered by public healthcare as are the traveling costs if living further away from Helsinki or Tampere.
Boom. If lucky, immediately after 6 months one finds "Confirmed GID" diagnosis papers from his/her hand and is sent to "woman's disease and birth hospital" for prescription to hormones. During HRT, the visits in T/HUCH clinic decrease and one runs now in woman's clinic for blood testing and checkups. I've heard that this is the address for FtM persons as well, since woman's clinic apparently is the only place here doing hormone checkups and having staff specialized to that.
Hormones are generally covered by the public healthcare system, with these regulations:
- Estrogen/testosterone is fully covered by the state, only 3€ / package is paid by the patient (processing/handling costs for pharmacy as they usually have to order these drugs from elsewhere, it's not in shelf regularly. The drugs themselves are free.)
- Anti-androgens are 35% covered
While on HRT, one can also get various other treatments required for the process such as hair removal (maximum of 7 visits in laser are covered by the state. Beyond that one pays additional visits him/herself) and voice therapy (I don't know (yet) how many visits are free for patient, but know a person who ran there for around 4-6 months so at least some). FtM persons can also opt for breast removal surgery in this point, which is also covered by the system.
Changing name to match the correct gender requires person being diagnosed GID and having started HRT. It is usually done while starting our "real life test". This requires once again approval from psychiatrists in T/HUCH trans* staff, and usually there is no problems. Possible problems that may prevent one from changing name would be that he/she hasn't decided to live in chosen gender yet in public, has started to regret the treatment and so on. So anyone who really knows what he/she is doing and wants to push on does not have problems with this. Changing name costs something like 10-20€ if I recall right. (+ new credit cards, driving license, passport and such).
Our "Real Life Test" starts at this point as well when the hormones take effect and person feels confident going full-time (or when hormone effect is so radical that problems start to occur when trying to present as "wrong" gender). This generally means the time where person goes living full-time and "integrates back to society" as a member of his/hers chosen gender with assistance if required, throwing away the wrong gender, changes names from bank accounts, insurance companies, whatever there is and so on. During RLT, therapists are visited to report how one is doing and so on. There is no real requirements for this such as "one has to find a job" or "one has to dress in certain way". Rather it is only living life as one wants to. It lasts for a couple of months, depending of person and the troubles he/she encounters and is "passed" when therapists are convinced that you can survive in the society in your desired gender.
RLT is slightly criticized here as for some who've gone full-time earlier it's just another waiting period before other things can start to happen. Tho therapists and hospital staff are convinced it is useful and generally they don't think it harms anyone. The two things it delays are SRS and change of social security number from which the former can be done overseas if rich and impatient.
Changing social security number (below) however requires "passing" the RLT.
Changing the letter M to F (or otherway around) in legal documents as well as changing the social security number which is unique identifier for every finnish citizen and constructs differently for females and males, requires going through the whole system described above. Yes, one will have for example female name and letter "M" in passport simultaneously for a while as name changes before the sex and social security number. For changing these two things to match the correct gender, following criteria must be filled:
- Approval of the H/TUCH trans* clinic
- Proof of permanent infertility. 12 months of HRT is enough to meet this criteria because well.. that's what it does in a long run. (we also have progress of removing this criteria completely as it is degrading).
- "Real Life Test" completed.
- Name changed before
- Again new paperwork for a new passport, possible drivers license, ID card, credit cards (if not changed when one changed his/her name. CC's don't have M/F identifier but full name printed on them) and so on.
At this point, one is finally identified as a chosen gender by the government. There will be no traces of past life others than police can ever find out about if one wishes so. With legal documents changed, therapy usually ends.
After being legally recognized as a member of his/her correct gender, one can apply for SRS queue in Finland, which is also covered by the public healthcare system. Queue here is considered to be long (usually more than 6 months) and is done only in Helsinki. Being part of the public healthcare, SRS is free (some fees from staying in the hospital for recovery must be paid, but I recall the total cost for the patient was something like 200-500€). I don't know about the quality of SRS done here but it should be OK from what I've heard of. Some people still go to Thailand for getting SRS earlier or for even better quality. Public healthcare system does not cover the costs if person decides to fly oversees for his/her treatment. The six month waiting for SRS is what they are aiming at now. When the SRS became covered by the public healthcare at 2003 they didn't expect to see so many people in queue as there "suddenly" were, and at first years I've heard one had to wait significantly longer period if unlucky. Now the queue is somewhat unwinded and the doctors have gained more experience in doing such operations, so it's going much smoother. (considering the fact that there's only one hospital in whole country doing these operations and for "free" in patients point of view, 6 months is definitely not a long wait.)
FFS is considered as cosmetic operation and is not done in Finland as part of the public system nor its costs are covered by it (if done at all, I've never heard even a private clinic doing FFS here either, so Thailand is the address for that.) However those cosmetic operations that make the difference between the genders are covered by the state:
"shaving" of the adam's apple and possible vocal cord surgery is free for the patient.
Breast implants may be covered by the public healthcare system if "person's natural breast growth is clearly deficient to fulfill female characteristics" but since usually HRT affects breast growth even a little, it's rare to have this done inside the public system here.
Long Story Short (fastest possible way);
6 months of therapy -> HRT 12 months -> legal document changes. Name change in somewhere between the latter two. SRS adds 6-12 more months if done in here. 0 if done oversees.
In reality, some delays may occur since one may need to wait for being sent from one clinic to another and so on. The typical time for the whole process without SRS is closer to 2-2.5 years, but for lucky ones 1,5.
So yeah, that was my explanation of how things are done in the Cold North.
<3 Sara
EDIT: I hope this was the right subforum to post this, if not, please move where it belongs ^^
