Unprecedented legal victory as health service is made to cover gender reassignment

For the first time ever, Spain's Supreme Court has ruled in favor of a woman trapped in a man's body, and against a regional government that had been denying her the right to a sex change, paid for by the public healthcare system, for the last six years.

In the wake of the court decision, Galician authorities will have to plan pre- and post-surgery treatment for C. T. G. A., who is aged 40 and goes by the name of Charlotte Goiar on social networks. She also uses that name on a website she created seven years ago to raise awareness about her rare condition, which is known as Harry Benjamin Syndrome. The public health system will also have to pay for complicated gender-reassignment surgery, which costs anywhere between 15,000 and 25,000 euros outside Galicia. It is not currently performed at a public center within its borders, which was the argument used by the Galician regional health department to deny her the operation.

Following the favorable legal precedents for patients with gender identity disorder, from two 2003 rulings by the High Courts of Catalonia and Madrid, in February 2012 the High Court of Galicia decided that the regional government would have to pay for the operation. But the Galician government managed to lodge an appeal with the Supreme Court, even though it was filed after the deadline.

In May of this year, the Supreme Court confirmed the lower court's decision, but C. T. G. A. decided to keep quiet about her victory until now, waiting to see whether the Galician government got in touch with her to start setting some dates. She is still waiting to hear from them.

I haven't been happy for a single day in my entire life"

"We will not make any statements about this case, but obviously the Galician health service respects all court rulings," an official told EL PAÍS.

The case could set a precedent in a region where no one, until now, has managed to secure gender-reassignment surgery on the public health service. When Spain was under the Socialist government of José Luis Rodríguez Zapatero, the Galician administration included such surgery on its list of public services, but it never got around to certifying which centers were accredited to carry out this procedure. This lack of official centers has been the basis for the Galician government's refusal to assist C. T. G. A.

This is not the first battle that Charlotte Goiar has won. Diagnosed at the age of seven by the school psychologist as "a boy who feels like a girl," by the time she was 16 she became the first person to undergo hormone therapy at a public hospital in Vigo.

"I haven't been happy for a single day in my entire life," Goiar says. She was unable to complete her high school studies because of the constant derision from both students and teachers, she explains. "They would spit on me. There was only one girl who talked to me." Since 1991, C. T. G. A. has been in psychiatric treatment, and has made one suicide attempt. Isolated, without friends or a job, living on a welfare check that "doesn't even pay the rent" and forced to eat at a soup kitchens, she finally found a court-appointed counsel who helped her take her case to the courts. In 2008, a Vigo judge recognized her problem, admitting that her "anxious-depressive syndrome" was caused by her discomfort with her own body. But the court still dismissed her request on the basis that the Galician government was unable to carry out the necessary surgery.

Only her mother stood by her when still a teen, Charlotte started dressing like a girl

The first victory came in February 2012, while the latest arrived this year, shortly after the death of Goiar's mother - the only person who did not turn her back on her when she decided to start dressing like a girl as a teen, she says. Charlotte Goiar cannot stand to see herself in the nude. "I cannot imagine a worse physical defect for a woman than to have a penis," she says.

Goiar would rather not be defined as a transsexual, and instead talks about herself as suffering from Harry Benjamin Syndrome, as diagnosed by one doctor. "It affects one in every 30,000 live births, and has been recognized as a rare disease by the World Health Organization since the 1960s," she explains. "It is caused by the alteration of a gene in the early stages of gestation."

While the battle has worn her out physically and psychologically, Charlotte Goiar dreams of a rebirth in her forties. "And finding someone who will give me a job, and a man to love me," she confesses. The courts recognized that "surgery cannot be denied on the grounds that the means are not in place" because the patient suffers from "severe adaptation and behavioral problems." The Supreme Court also noted that the Galician health services already provide "surgical treatment in case of mental disorders."

A government decree dating from 1995 expressly prohibited the public health services from paying for gender-reassignment surgery, but that ban was lifted in 2007. By then, Andalusia had already been performing these operations for eight years, and this region was later joined by Madrid, Catalonia and the Basque Country. Other regional governments, such as Aragon and Extremadura, pay to have patients treated elsewhere, or else cover intermediate procedures such as mammoplasty. But other regions still play with the legal void to avoid offering gender-reassignment surgery, instead giving patients grueling and never-ending hormone treatments.

Goiar still takes three powerful pills a day, which come with significant side effects. After the surgery, she will at least be able to drop the antiandrogens.