Gender – Only female or male was once

“By the time I was seven or eight, I was already certain that I was actually a girl,” says Conny Felice. “Although there were no role models back then, in the late 1960s and early 1970s – and keeping silent was a strategy to secure family affiliation.” Probably one of the main reasons why Felice was a “late decision-maker”, as she calls herself: it was only when she was over 50 that the biologically male born “gave a new framework” to her life and now lives as a woman.

Felice has been in charge of the Homosexual Initiative (HOSI) Salzburg since last year. As a trained systemic mediator, her own experiences help her, especially with the educational offers on the subject of diversity, she says. A lot has changed, is addressed and discussed. However, there is still a lot of time between the inner and outer coming out. It is more than four years for young trans men and almost seven for trans women.

According to the sex therapist Johannes Wahala, what is striking here is that the number of the former in particular has increased by leaps and bounds. So the trans men who were biologically born as women and who define themselves as men. The head of the federally funded sex counseling center Courage for LGBTIQ (lesbian, gay, bisexual, trans, intersex, queer) people and their relatives not only counts more and more young people “and actually children who are experiencing gender dysphoria” – himself so cannot identify with the sex assigned at birth. While that was around 90 people in 2009, today it is 560 a year. In addition, the desire for transformation has also shifted, he says to the “Wiener Zeitung”: “While in the past more men who wanted to become women turned to the advice centers, today there are four times as many women who want to make a transition to becoming a woman aspire man.” Why this is so is a mystery even to experts. “Maybe because the masculine is still in the foreground,” speculates Wahala.

Still binary polarized

Male, female, female, male: Society is apparently still polarized towards these two genders. However, many no longer want to be forced into one of these norms – but find themselves somewhere else. Either somewhere in between or completely without gender. Definitely nonbinary.

There are no concrete total numbers of people with gender dysphoria for Austria. Sex educator Gabriele Rothuber, who is intersex officer at HOSI Salzburg and head of the “Department of self-confidence” offers sex education workshops in schools, puts it this way: “In every big school there is probably a transgender or a non-binary child and an intersex child, and in every class there are one or two homosexuals.” As a result of this diversity, Rothuber’s workshops are no longer held separately by gender, but in so-called feel-good groups for everyone.

The step towards sex-adapting hormonal therapy or surgery, however, is only part of it. according to the Department of Health recommendations for the treatment process for gender dysphoria in children and adolescents This dysphoria persists into adulthood in about 20 percent. Gender reassignment operations are only permitted in Austria from the age of majority and only for intersex people who are born without clear sex characteristics, from the age of 14 when they are able to consent. Targeted hormone therapies with estrogen or testosterone and also breast removal are generally possible from the age of 16 and puberty blockers from the onset of puberty.

However, none of these treatment steps are possible without diagnosis by a clinical psychologist, psychiatrist and psychotherapist, says Stefan Riedl, who heads the outpatient clinic for variants of gender development at Vienna General Hospital. When you go to him, this diagnosis is usually already available. Riedl also noticed a change. “15 years ago, my predecessor looked after a handful of patients. Today I have more than 200, and one or two new ones are added every week.” Originally, it was mainly intersex people who were cared for in the outpatient clinic. Today the circle is much more diverse.

More time through puberty blockers

According to Riedl, many of these simply need more time. Time to find your own gender, to become aware of your gender identity and to stand by it. The drugs that block puberty at the beginning can help here, as they inhibit secondary sexual development and delay the breaking of the voice or the onset of menstruation and breast growth. If you stop taking them, puberty sets in – its effect is therefore reversible.

Not so with targeted hormone therapy. If you take testosterone, for example, and your voice breaks as a result, your voice will remain low. And the stubble keeps growing back. The decision to use hormone therapy is therefore more final, says Riedl. And: “Just like sex reassignment surgery, it means medicalization that requires regular medical checks.”

Nevertheless, more than two-thirds of his patients are “clearly satisfied” with the treatment, according to Riedl. Around half had previously suffered from depression, and around a third had taken antidepressants. Depending on their family environment and circle of friends, many also lived withdrawn and socially isolated. After all, classmates and teaching staff rarely had a problem with gender reassignment. “They are often very open-minded,” says Riedl. The older generations could sometimes not understand it. In less than a third, the problems remain unresolved even after gender reassignment. “The situation is noticeably more complicated and the basic problem is not just gender identity, but more complex.”

All those who define themselves as neither purely male nor purely female must be accompanied with the aim of strengthening their gender identity so that they accept themselves, says Wahala. A lot has happened officially since the 2000s. In 2011, for example, the globally recognized recommendations for the treatment of people with gender dysphoria were expanded and reformulated many times over. The disease and diagnosis catalog DSM-5 from 2013 no longer speaks of a “disorder of gender identity”, but of gender dysphoria, and the new diagnosis code ICD-11 of the WHO from 2022 defines for the first time that there is also a non-binary gender identity. “The topic has been largely depathologized in recent years,” says Wahala – if gender identity differs from biological sex, it is no longer seen as an illness.

Third gender since 2019

There has been an additional gender entry in Austria since 2019: After Germany and after the Constitutional Court had determined when examining the civil status law that intersex people have a right to a corresponding entry in the civil status register and in documents, the third gender has been an option here since then. Since 2020, they can also choose between “diverse”, “inter”, “open” and “no entry”.

With all these developments and possibilities, the range of gender identities is of course also gaining substance, becoming more tangible and sometimes moving into one’s own reality. The question of where one belongs becomes a conceptualized conflict. In addition, there are role models such as Conchita Wurst or trans women as fixed starters at top model casting shows. Could this have made gender dysphoria a fad? Could it become a means to an end for youngsters to be special?

Rothuber defends himself against these terms. “If a child doesn’t identify with the gender that is on their birth certificate, it should always be taken seriously. The associated fear leaves no area of ​​life untouched – from the question of where you can take part in gymnastics to the decision between girls’ and boys’ toilets .”

For those affected, it is “life-determining if you wake up every morning and don’t know who you are,” says Felice. She therefore invites the Austrian health insurance fund, as she says, to fulfill its mission of maintaining health and to make a financial commitment to expanding the range of advice and education. Any subsidies are currently coming from the social sector – and thus from those “who have problems”, as she says. Funding to prevent problems from occurring in the first place due to a trans identity would, however, be invested much more effectively.

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