LGTBIQ+ associations demand from the Basque Parliament dignified and respectful healthcare for trans people
A clear and urgent demand has been heard again in the Basque Parliament: the public health system must guarantee dignified, accessible and non-discriminatory care for trans people. Several associations of the LGTBIQ+ collective—Anitzak, Loratuz Lotu, Lumagorri HAT and SuminTrans—have publicly denounced the barriers faced by the trans community in Euskadi, with special attention to the situation in the Gender Identity Unit (UIG) of the Hospital de Cruces.
Far from seeking confrontation, the entities have stressed that their objective is not to destroy, but to build a more just and humane health system. They have asked to actively collaborate in the preparation of the new health guide for the care of trans people, planned by the Basque Government, with the hope that this participation will serve to correct the failures of the current model.
Vaginoplasties, mastectomies and eternal waiting lists
One of the most alarming aspects included in the report presented is the time that passes from when a trans person requests a surgical operation until it is finally performed. In the case of vaginoplasties, the data points to an average wait of up to five years. Among those who began the process in 2019 and 2020, some are still waiting without even an estimated date for their intervention.
Of the 16 trans people surveyed who requested this operation, only four have received it. The situation with mastectomies is hardly better: although 20 people have undergone this surgery, many others remain on the list with no clarity as to when they will be seen. In some cases, the wait has lasted up to four years. And there is no official explanation about the criteria that determine these deadlines, which vary even between people who entered the system the same year.
These delays are not simple logistical failures: they have a real impact on the physical and mental health of those waiting. Many people live with anxiety, frustration or pain, while feeling like their lives are on pause.
Compulsory psychiatry and pathologization
One of the most controversial aspects pointed out by the associations is the mandatory passage through Psychiatry. Despite legal advances, in practice trans patients continue to be required to have a psychiatric diagnosis to advance their medical transition. This perpetuates a pathologizing logic that many voices consider obsolete.
Numerous testimonies collected in the report speak of humiliating treatment, offensive questions and an approach that questions their identities from a heteronormative prism. How can we talk about inclusion when medical decisions are still based on a binary and stigmatizing view of gender?
Fatphobia and exclusion of non-binary people
The report also puts on the table other forms of discrimination that are exercised within the health system. Episodes of fatphobia have been reported, in which patients with non-normative bodies have been pressured to lose weight, often without clear medical explanations or adequate support. The exclusion of non-binary people has also been noted, who, according to testimonies, find their access to treatments hindered if they do not conform to traditional gender expressions.
Should the health system dictate what a person must look like to access their rights? Or should we rethink these criteria to ensure that no one is left out because of who they are?
A system in transition?
Despite everything, the associations insist on their desire for dialogue. They have offered their hand to Osakidetza to participate in the construction of a health guide that, as established by Law 4/2024, reflects the diversity of the group and respects their dignity. This guide, announced by Lehendakari Imanol Pradales, seeks to articulate a closer care network, with new Primary Care Services specific for trans people in each province.
From the Basque Parliament, the main political groups have expressed their support for these demands. The PSE-EE reaffirmed its commitment to trans rights, underlining the need to listen to those who experience these realities firsthand. EH Bildu went further and directly denounced “institutionalized medical violence.” For its part, the PNV recognized the legislative progress achieved and assured that the associations’ proposals will be taken into account in the final preparation of the guide.
A real commitment or a political gesture?
However, not everyone completely trusts these promises. Is it enough to announce a new guide to resolve years of abuse, neglect and silence? Can a system truly be reformed from within, when discriminatory practices remain normal in many consultations?
There are those who fear that this process will remain a symbolic gesture, useful for headlines but insufficient to change the daily experience of trans people within the health system. For this reason, citizen surveillance and the active participation of associations continue to be key. Because without critical voices, changes can remain halfway.
