“This has to do with the practical aspects of living life as the opposite gender,” Per-Anders Rydelius, chair of the maternal and child health department at Karolinska Institutet’s Astrid Lindgren’s Children Hospital, told The Local.
“They must be able to show their ID card without people thinking they are being deceived.”
Since 2001, Rydelius has led a team of doctors, including an endocrinologist, a reconstructive plastic surgeon, and a gynaecologist, which is overseeing a two-year long “real-life test” or “real-life experience” for young Swedes who think they may fit the clinical definition of a transsexual.
“Transsexualism has to do with having the strong feeling that one was born with the wrong gender and wishing to change to the right gender,” he explained.
Following parental consent and a thorough evaluation, young people participating in the trial start a regimen of counseling as well as hormone treatments designed to halt the onset of normal puberty.
“For example, a boy who views himself as a girl and wants to be a girl can stop being concerned about the growth of a beard, an enlarged Adam’s Apple, and a lower voice,” Rydelius explained in a letter to Swedish tax and health authorities requesting help with the ID card issue.
If the person is not found to be a true transsexual following the two-year real-life test, the hormone treatment is stopped, at which point “normal puberty proceeds again”.
While children and young people have long questioned their sexual identity, Rydelius said that it’s becoming more common for adolescents to take the additional step of seeking medical advice on the matter.
“People usually sought help when they were in their twenties or thirties, but with the advent of the internet and increased accessibility to media, more people are seeking help during their teenage years,” he said.
Despite the dramatic physical changes that can occur with the hormone treatment, Rydelius feels that administrative hurdles diminish the ability of would-be Swedish transsexuals to truly live life as the opposite sex.
“If a girl who wants to be a boy tries to go to a bank or a nightclub, his ID card can reveal that he really isn’t a boy,” he told The Local.
He also knew of several instances of young people undergoing their real-life test being denied bank services on suspicions of having presented someone else’s identification card.
In an effort to rectify the situation, Rydelius last autumn contacted the Swedish Tax Agency (Skatteverket), which oversees both Sweden’s national population registry and the issuance of identity cards.
In a December letter, he proposed the agency allow young people undergoing a real-life test of their transexualism to apply for special ID cards which let them hide their unwanted gender and the associated name.
“These young people should be able to have only their desired names spelled out on their ID cards, while their undesired names could be expressed only as initials,” he explained.
Thus, a girl who was initially registered as Birgitta Viola Svensson, but instead wishes to be named Lars during her real-life test, should be able to have an identity card with a picture where she appears more male and the accompanying name “Lars BV Svensson”.
While Sweden was the first country in the world to pass legislation formally giving people the right to change their gender, Rydelius regrets that the country’s administrative practices regarding names are lagging.
“It was only last autumn that a court ruled that a person should really have the right to whatever name they want, regardless of its traditional gender association,” he explained, referencing the case of a male cross-dresser from Luleå in northern Sweden who won a protracted legal struggle to go by the name Madeleine.
Rydelius, who also heads the Swedish Association of Mental Health (Svenska föreningen för psykisk hälsa) and the International Association for Child and Adolescent Psychiatry and Allied Professions (IACAPAP), said his Stockholm-based team now receives about eight inquiries a year from young people who suspect they are transsexuals.
“All told we’ve had more than thirty young people come to us for help since 2001, and all but five have ended up fulfilling the criteria allowing them to go ahead with gender reassignment surgery,” he said, adding however, that they must wait until they’ve turned 18 to actually undergo the surgery.
Similar teen-transsexual assistance teams have been formed more recently in Lund in southern Sweden and in western Sweden to assist youngsters in those regions wrestling with their sexual identity, although Rydelius wasn’t able to provide statistics for the two other groups.
While any measure allowing for special ID cards would affect a very small number of people, Rydelius nevertheless emphasized the importance of allowing young people to carry out their real-life test free from embarrassing situations resulting from presenting an ID card that doesn’t match a person’s outward appearance.
While he doesn’t expect to hear anything from the Tax Agency until the end of the month, Rydelius is hopeful a suitable solution will be found.
“The representative I spoke with agreed that this was an important issue,” he said.
“He agreed it would be good to clarify the matter once and for all rather than address it on a case by case basis.”