Gatekeeping in Denmark

Watching Hbomberguy’s stream raising money for a trans charity in the UK inspired me to write about trans issues, specifically trans healthcare in Denmark and my experiences with it. This is because it is basically unknown outside of Denmark and whenever I speak about it, people are shocked. So I’m writing this to raise awareness and also to have something to refer people to in the future. I will also have to preface this article with a warning that I’ll be talking about medical abuse that was sexual, psychological and emotional in nature plus a lot of transphobia, so trigger/content warning for all of those.

In Denmark trans issues until very recently focused on one specific clinic called Sexologisk Klinik (Sexological Clinic), often shortened to SK. Sexologisk Klinik was the only place you could get HRT and/or SRS until 2018 and later that same year it stopped treating trans people. It is also a gatekeeping clinic, which is a term that I will have to give a quick explanation of for those who don’t already know it.

When it comes to trans healthcare there are basically two options, Gatekeeping or Informed Consent. You might have heard gatekeeping used in other contexts but when it comes to trans healthcare it refers to something very specific. Gatekeeping is when you don’t decide whether you get HRT but instead, one person or a council decides it, which essentially means that you have to try to convince those people that you are trans. They have complete power over you in this arrangement. Informed Consent is where you work together with doctors and are provided the all the information you need. Then you discuss it with them, including talking to psychologists and then you make the decision yourself. This generally happens by signing a document saying that you understand the effects of HRT. This is the method that every qualified group and doctor on the subject supports and the only one supported by research.

So SK is a gatekeeping clinic, this means that you have to convince a medical council that you’re trans, which fucking sucks. You will talk to a few psychiatrists and psychologists while you’re there and it’s a horrible guessing game of trying to figure out if you’re saying the right thing. Having to do this upwards of several times a month for 2 years, in my case, will destroy your trust in medical professionals. It’s emotional abuse and nothing else.
Basically, they’re looking for a very specific stereotype that you have to fit into as a trans woman, which is basically a 50s housewife. You aren’t allowed to deviate from this stereotype and if you do, it is harshly punished. I’m pretty feminine in many ways, my clothing style is very feminine and I enjoy some things that are traditionally considered feminine; however, I’m lesbian, interested in engineering and history, and politically on the left. When I started at SK I was a Social Democrat exploring socialism and a strongly committed feminist and by the end, I was an Anarcho-Communist and only a stronger feminist. These traits were not looked on favourably by my psychiatrist, who was also the head doctor at the clinic. It’s hard to talk about what happened in regard to that as it was traumatic, I was manipulated, abused and threatened into giving up my lesbianism and was forced to develop a fake attraction to men. It took me over a year to realize what had even happened and I’m still not even close to recovered from it. I haven’t talked to anyone who has specifically gone through gay conversion therapy but I think something similar happened to me, at least the effect was the same.
Then there was also the fact that me being in any way progressive was frowned upon, or rather that I was critical of society. At one point the psychiatrist asked me in a very clear tone “You don’t believe that there’s sexism in Denmark right?”. And obviously there is sexism here, and I recognized that, like it’s rather obvious. I mean, that same psychiatrist had been pushing so much sexist shit. But of course, I couldn’t debate this, she was always holding the threat of not getting HRT over my head so I had to comply and try to come up with the best sounding centrist bullshit I could. That was the least traumatic part, but it’s also utterly fucked up that you have to have certain political stances in order to be allowed to transition. But it ties back to the 50s housewife thing, you couldn’t have me suddenly questioning my husband, could you? Another part of this was that I had to agree that gatekeeping was the best way to treat trans people. If I didn’t I would be seen as not responsible and rational as obviously the lowly trans woman couldn’t possibly make choices on her own and had to be guided by the benevolent cis. And if I wasn’t seen as responsible I wouldn’t be able to get hormones. This also then carried the implicit threat that if I tried to change things and push for better conditions I was no longer responsible and therefore wouldn’t receive hormones anymore.

When they weren’t trying to get me to fit into stereotypes, they were abusing me in other ways. The justification for gatekeeping often is to prevent regrets, however, this is a smoke screen. The real point of gatekeeping is to prevent people from transitioning and eliminate queerness. This is illustrated in what I mentioned before and in how much time was spent trying to make me not transition, constantly telling me that I had to question it and telling me horror stories, this is pretty obviously emotional and psychological abuse. While asking someone if they’re sure is rather benign, continually asking and never accepting “yes I am” as an answer for years while constantly demanding new reasons for being sure would definitely fall under gas lighting. It’s basically the reverse of continuing to ask someone who has said no in order to get a yes from them. Ironically though by telling me those stories they also illustrated that gatekeeping didn’t even fulfill its stated mission as these were people who went through gatekeeping clinics and regretted, though ironically while doing this they never actually mentioned the medical side effects of HRT, which would be the one area of actual danger. It also becomes pretty obvious how IC would prevent this. Gatekeeping doesn’t actually give you an environment to freely question and explore. First off, you’re only allowed to express yourself in stereotypical ways and secondly, any questioning will be jumped on like wolves to the slaughter. If you show any signs of being unsure, that will lead to it taking longer to get treatment and by longer, I mean potentially years. That means that you’re not allowed to actually question and if you do, you have to suppress it in order to survive the cross-examination the psychiatrist will put you through multiple times a month. With IC however, you can try hormones and see if they work for you, and if they don’t, stopping is easy, painless and carries no consequences, but if you’re at a gatekeeping clinic it will take years to even get the hormones in the first place so the sunk cost fallacy might set in. But also if you do stop then getting back on them again will be much harder so you won’t stop unless you’re absolutely sure. In this case, gatekeeping actually very obviously backfires as you’re instead making sure that anyone who would on IC would have just stopped now will stay on hormones much longer. Add to that the immense pressure to fit into stereotypes comfortable to the heterosexual man and people might get SRS more out of pressure to conform rather than because they actually wanted it.
Another form of abuse that I experienced was sexual abuse, when I started at the clinic I was 17 years old and right off the bat the psychiatrist started asking me invasive questions about my sex life. Questioning me about how I masturbate, how often, what porn I watch, if I had, had sex, with who, whether I wanted to, trying to pressure me to have sex before transitioning etc. I did not like this at all and didn’t want to talk about it and said so repeatedly, but I was forced to tell a psychiatrist who was possibly over 60 years old about all of this. This didn’t just happen once, it happened multiple times and every time I’d try to say no and every time I’d be forced to talk about it anyways, which was really fucking terrible. It felt degrading and humiliating and invasive, walking out of every appointment I felt like I had been sexually assaulted and I say that from experience.
Now only one thing could make this worse and that is if this clinic was also the same one that treated rapists and pedophiles and guess what it did. It was a really fun experience to sit in waiting rooms being almost certain that there was in fact at least one predator there especially when you were about to be sexually abused at this appointment. It also sends a pretty strong message about their views on trans people.
The last fucked up thing was that as part of this, I had to take an IQ test. I didn’t really think much of it at the time, but as people have pointed out, it’s fucked that in order to get hormones you have to have a certain IQ. It very obviously shouldn’t be barred behind that (or any of the other things I have mentioned) but of course, it is.

The cherry on top of it all was the fact that all along the walls were pictures from early feminist and sex liberation movement, clearly indicating that the clinic thought it was carrying on this legacy of fighting for the liberation of sex and the rights of women. This belief is the height of arrogance considering that they were the biggest oppressing force of both of those two in Denmark. It’s insulting to the work of those pioneering feminists, and feminism as a whole, and a testimony to how little they are in touch with reality.

I wanted to give an account of these events and I think I have done this. I don’t know what would be a good way to end this other than that I hope the reader will consider all of this and remember it. Trans issues around the world are very different and I don’t want the online conversation to focus entirely on the US and UK. I also hope that this will also make people realize that Denmark is not as progressive as they might have thought, and really all of Scandinavia, as what I have talked about is not an unusual experience for trans people in Scandinavia or even the Nordics as a whole.

• Amber