A person can nowadays change name and gender, but the lack of awareness and provision of specific health services is detrimental to transgender people’s well-being, according to research conducted by Bruno Zahra.

The first of its sort locally, Mr Zahra’s master’s study shows that a lack of support has seen transgender women “come out twice” – first as gay men and then as transgender people.

The study also shows that such a lack of support can sever the transgender women’s ties with their own families.

Rose*, one of the four research participants, explains: “You cannot have a decent coming out.

“The moment you start understanding yourself and realise you are different from most people, there is no one to turn to. You are on your own.”

The 35-year-old, who has undergone gender reassignment, confirmed that transgender people were suddenly recognised by law, but the health and education process had been overlooked.

Her comments come three weeks after the government told this newspaper it was planning to introduce free gender reassignment treatment “without delay”.

Equality Minister Helena Dalli was reacting to an article about the national equality commission’s call for a plan enabling free access to such services after Lauren Salerno filed a complaint against the Health Department.

According to Mr Zahra’s conclusions for his degree, completed within the Department of Gender Studies, the government is resisting the introduction of health schemes that allow sex re-assignment surgery locally.

“This is not cosmetic treatment or surgery, but a basic need. Research shows that the well-being of a person following the physical transitioning is 100 per cent positive.

“Internationally, only one per cent do not feel well after the operation,” he noted.

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The only people in his research who could afford the treatment themselves were financially stable, while another woman had depended solely on her parents, who in turn took out a loan.

People keep living in your own past, when you yourself have moved on.

Rose calculates that the expense runs into the tens of thousands, but the challenge starts from the very beginning: there is no psychologist or psychiatrist specialised in gender dysphoria and “you have to figure out things on your own,” she says.

When it transpired that her body was actually producing double the female hormones that a man should have, but much less the amount of male hormones, her psychotherapist asked her: ‘What should we do?’

“That was exactly why I had gone to him, but I left his clinic more confused than when I first approached him,” she said.

Mr Zahra’s research sought to investigate how health, education and law affect the satisfaction and well-being of transsexual people in Malta.

It follows his first degree, focusing on young people and transsexuality, which was completed in 2011 before the Gender Identity Act was enacted.

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Mr Zahra had felt the need for such research because of the lack of awareness and a sense of discrimination and frustration that had led to the death of someone he knew.

Mr Zahra wants to give a voice to transgender people within the academic sphere, and he hopes the recommendations are picked up by policymakers.

According to the findings, one of the main concerns is the lack of education.

All four participants expressed “great dissatisfaction” at the lack of information about health, psychological and social care for transgender people.

This lack of information hinders communication with their immediate families. Being never fully acknowledged as the gender they have transitioned to, this even makes it difficult for them to enter romantic relationships, as their partner often considers the gender they were born into.

“People – even people who did not know you before – keep living in your own past, when you yourself have moved on,” Rose said.

‘I was convinced I would grow into a woman’

By the time she was five-years-old, Rose “knew”, and by the time she received her first Holy Communion she was convinced she would grow into a woman.

“I probably took it for granted that some girls were born as girls and other evolved into girls. That was my reality.

“Sadly, you eventually realise that you do not blend in with the girls, even in a mixed class. The boys don’t want to hang out with you because you are different, and the girls don’t want to hang out with you either,” she said, recalling an incident in which a female student cringed as she passed Rose’s copybook.

Childhood was painful for Rose.

“By secondary school I knew I was in the wrong body, but at that time the word ‘transgender’ did not exist. I was terrified of break time – I was the laughing stock of the school, and I didn’t even understand what was going on.”

Meanwhile at home, Rose’s religious family made the process even harder.

Without any support to help her understand what she was going through, Rose at first thought she was gay.

When she finally came out to her family as transgender, it was “even worse”.

“Being transgender is not a choice you make. The only choice you have is to live a happy or a sad life,” she said, explaining that she only told her family the truth after having bought a house and setting up her own business.

She did not look back, finding support from her friends, receiving hormone treatment in Malta and undergoing sex-change surgery in another country.

But she feels like she wasted 10 years of her life – she could have transitioned earlier, had she found support from her family.

“I’m not urging people to come forward in public, but I want those who are feeling the way I did, to not waste a decade like me.”

Recommendations

▪ Set up a support group, totally separate from those for lesbian, gay and bisexual people (LGB), whose needs are different from those of transgender people.

▪ Set up a support group for family and friends.

▪ Awareness should start from early school years – not just among students but especially among the staff.

▪ Introduce health services immediately.

*Name has been changed.