Status update from the Czech Republic

A guest post by Jan Kriso

This is a guest post from Jan Kriso.

The Czech Republic, the western half of the former Czechoslovakia, is a pretty average country. When it comes to population size or GDP, we rank somewhere in the middle of the EU pack. The same goes for social attitudes. The Czech Republic isn't the most liberal EU country, but we’re not the most conservative either. You know, somewhere in the middle.

Czech sexology has a long tradition. Given its geographical, historical, and cultural proximity to German-speaking countries, it's hardly surprising that the founding fathers of the field were disciples of Magnus Hirschfeld. The country's first foray into issues of gender identity came in 1936 with the case of Zdena Koubková. Zdena Koubková, then a world-famous athlete and record holder, was probably a biological male with 5-alpha reductase deficiency, which we would today classify as a disorder of sexual development. Koubková underwent surgical intervention, changed her legal sex, and also changed her name to the male version, Zdeněk Koubek.

After the war, Czechoslovakia was ruled by a rigid Stalinist regime, much like other Central European countries such as Poland and Hungary. During this period, many medical experts with the wrong political profile were expelled to the fringes of the discipline. This caused an unexpected surge of excellence in fields like mental healthcare that were frowned upon by the communist establishment. These experts, mostly trained during happier prewar times, could match their Western counterparts and formed a solid basis for the field. A prime example is Kurt Freund, a pivotal figure in the decriminalization of homosexuality in Czechoslovakia, who later emigrated to Canada and became world famous for—among other things—his work on transvestism and his invention of the penile plethysmograph. 

The number of people seeking medical transition during communism was relatively low, usually just a few dozen per year. Most were natal females, a fact shared by other countries in the region, which was markedly different from the dominance of male-to-female transitions in Western countries.

After the fall of communism, the new liberal regime sought to imitate the West in every aspect of life, as the West was uncritically thought of as an antidote to the incompetence and backwardness of communism. This sentiment is still strongly felt by people in their 40s and 50s, who now control media and academia. The legal aspects of gender transition were modeled after Canada, and with the advent of free media, transsexualism was portrayed sympathetically.

Sexologists like Petr Weiss and Hana Fifková made many media appearances and also co-authored the first specialized monograph. One of the chapters was written by Peggy Cohen-Kettenis, and this Dutch connection led to the early adoption of the Dutch protocol in the late 1990s—before the protocol was even codified. One case study they describe is of a natal female named Nikola, who was prescribed puberty blockers at age 12 and then went on cross-sex hormones and had a double mastectomy at 16. At age 18, Nikola underwent an oophorectomy, had a masculine presentation, and a heterosexual girlfriend. Nothing is mentioned about diagnostic tools measuring psychological outcomes, but Nikola was reportedly living happily in the new gender role.

There is a lot to criticize about both Weiss and Fifková. (Fifková allegedly cleared our most prominent detransitioner, Daniel Black, for sex-reassignment surgery after just 30 minutes of examination, completely overlooking his underlying conditions). The clinical guidelines they wrote are brief, unsatisfactory, and modeled too much after World Professional Association for Transgender Health’s Standards of Care 7, which is simply not a sane document. But if anything, they are kind of old school. They don’t deny the existence of Blanchard’s typology. They acknowledge the phenomenon of rapid-onset gender dysphoria. They are aware of the medical costs that come with transition and are willing to talk about it. I actually hold Weiss in rather high regard because he uses his prominence to warn about the possibility of iatrogenic harm, particularly among adolescent females with rapid-onset gender dysphoria etiology. To put things into the perspective of a North American reader, Weiss is the Ken Zucker of the Czech Republic, while his younger colleagues resemble Jack Turban.

Weiss also received a lot of flak from transgender activists. They publicly called him transphobic and accused him of being disrespectful. Judging from reports, his grave sin was trying to secure a proper diagnosis before signing off on hormones and surgeries.

Built in the 1990s, the Czech system of transgender healthcare now looks anachronistic. In order to change your sex, you need to undergo cross-sex hormones, live in your new gender role for a year (the so-called real-life test), and then undergo sex-reassignment surgery. You also have to be cleared by a commission of experts to undergo sex-reassignment surgery. Anyone even barely familiar with European Court of Human Rights rulings knows that this violates pretty much everything judges in Strasbourg have ruled in the last two decades.

It is therefore not surprising that trans activism has been focused on changing the law for quite a long time and has garnered significant sympathy among liberal media and politicians.

One of the most influential local trans activists is Lenka Králová. A biological male who fathered two children and is currently living as a „lesbian,“ Lenka Králová is the person of choice anytime the media need someone trans to talk to. And if you think you already know how this person looks and talks, you are probably correct.

Unfortunately, Lenka Králová has gathered a significant following for YouTube channel called "V tranzu" and frequently visits schools, giving speeches on the perils of being trans. Lenka Králová is also frequently celebrated by feminists. The local magazine Heroine even went so far as  to call Králová one of its heroines of 2023.

When Albatros, the local publisher with ties to the LGBT community, announced its intent to publish the Czech translation of Abigail Shrier’s Irreversible Damage, it was Lenka Králová who led the crusade to stop the publication of this book, because "if you read that book as somebody existentially impacted by it, it's horrible reading." How a book about teenage girls impacts a middle-aged man with autogynephilia wasn't explained, but the effort partially succeeded. Albatros bowed to the pressure and in March 2024 decided not to publish Irreversible Damage. Luckily, the semi-conservative publisher Bourdon took over, and the Czech audience can buy Shrier's book and decide for themselves.

Even the launch party in May 2024 didn't go smoothly. A few trans activists tried to disrupt the event with a performance of emotional instability. When asked to discuss the merits of the book, they resorted to chanting, "Our bodies are not damaged," and were taken care of by security.

Abhorrent behavior of a few activists is not newsworthy. Important judicial decisions are. On May 7, 2024, the Czech Constitutional Court issued landmark judgment pl. ÚS 52/23, in which it ruled that demanding sex-reassignment surgery for legal sex change is unconstitutional and amended part of the Civic Code. This development is hardly surprising, but—combined with other legal initiatives spearheaded by progressive politicians—it may lead to unforeseen consequences. Effective starting in May 2025, the Czech Republic will probably not have a spousal veto. When this issue was pointed out to a few members of parliaments, they seemed to be totally oblivious to the issue of trans widows.

One looks with despair at the Czech political representation. MPs who are likely to shape the political discussion about transgender issues in the years to come, like Marie Jílková or Klára Kocmanová, are well-meaning liberals who deserve praise for their dedication to the struggle against domestic violence and for gay rights. However, their lack of understanding of the complexities surrounding transgender issues could lead to unintended consequences.

When asked, Jílková said she was against youth transition en masse but was willing to talk to expert organizations. And this brings me back to the medical part of the debate. Petr Weiss, the local preeminent expert, is 70 years old and likely to retire soon. Who will replace him as the leading voice in public and expert debate?

Very likely, his replacements will be experts associated with the National Institute of Mental Health—or as we call it NÚDZ—like Petra Vrzáčková and Pavla Doležalová. NÚDZ is part of the Ministry of Healthcare. It is an official state organization and the formal leading authority in everything regarding mental health. NÚDZ recently launched a new project, Trans e-Health, and commissioned an official translation of the World Professional Association for Transgender Health’s Standards of Care 8 (with permission from WPATH). The translation was provided by Viktor Heumann, chair of an organization called Trans*parent, which is a typical trans lobby group strongly advocating for the medicalization of children.

On May 30, 2024, Vrzáčková and Doležalová held a seminar for experts and professionals discussing WPATH SoC 8 and its impact on local transgender healthcare. I attended online and, boy, what an experience it was! 

The show kicked off with Pavla Doležalová describing SoC 8 as "evidence-based and supported by systematic reviews of evidence." She then praised the document for its affirmative and holistic approach in all of its chapters. According to Doležalová, it’s vital to accept, affirm, and validate every identity. And by every, she very obviously meant every. So eunuchs and non-binaries as well.

Doležalová also spoke about the short practical guidelines they made for medical personnel who don’t have time to read SoC 8 in its entirety, a sort of digest of the whole document. Even I have to admit that the short handbook looks fancy and far better than the current guidelines issued by the Sexological Society. She also mentioned the necessity to formulate new national standards of care that should be based on WPATH SoC 8.

Then came Petra Vrzáčková, a sexologist and psychiatrist and the darling of trans activists. It’s easy to see why she’s beloved by them. She opened up about how she felt vindicated when SoC 8 came out because it aligned exactly with how she wanted to practice medicine. 

Then she went on to compare the local guidelines with WPATH SoC 8 and mused about how superior the WPATH approach is. "Look, you don’t need to take hormones for a year to be considered the opposite sex, there is no need for a real-life test, and what is truly, truly magnificent, you just need one person to diagnose you, unlike the two to three under the current practice." And then she mentioned the lack of an age limit in WPATH SoC 8. According to Vrzáčková, it was awesome that the Czech Republic allowed double mastectomies for 16-year-olds—though, most unfortunately, that possibility was withdrawn two years ago. There was something weird about the excitement with which she described helping young girls cut off their breasts. "Nobody ever regretted it!"

She also talked about other identities in need of affirmation, like, you know, the eunuchs and non-binaries I mentioned before. Vrzáčková scoffed at her older colleagues who are skeptical of the existence of non-binaries, because—as she says—a lot of research supports their existence.

To her credit, she also briefly mentioned negative outcomes, like the sterilizing effects of hormonal interventions and the possibility of detransition. Detransition, according to her, is a very rare phenomenon and definitely not a failure of diagnostics. Medical professionals, according to Vrzáčková, shouldn’t be patronizing to their clients and blame them. You know, don’t blame detransitioners for detransition! Medical professionals should be supportive instead and tell these kids that detransition is not the end of their journey. If a detransitioned transman comes to her, she tells this patient to continue on hormones to prevent osteoporosis and possibly get breast enhancement surgery.

Vrzáčková also strongly opposes what she calls conversion therapy for gender-dysphoric kids. According to her, trying to make children ‘cis’ doesn’t work. Speaking of therapy, she usually doesn’t do it because her clients have known their true selves for years—so, what’s the point?

She doesn’t see herself as a rebel, though, because she’s just like WPATH. I second that sentiment.

Viktor Heumann also mentioned what he called the robust scientific base of WPATH SoC 8 and spoke mostly about the technicalities of the translation. Then came the final words and Q&A session.

When asked how to best support adolescents in their conversations with parents, Vrzáčková stressed the importance of interest groups such as Trans*parent. She mentioned the importance of keeping parents calm. According to her advice, kids should use these organizations as their resource and then educate their parents.

I also asked two questions. First, I wanted to know how to deal with the ethical ramifications of the fact that WPATH commissioned several systematic reviews of evidence and then decided not to publish them. My question was answered by Pavla Doležalová. She said that the premise of my question wasn’t true. (This was a blatant lie on her part, as anyone can check in the PROSPERO database). She tried to cover this up by saying that the methodology was very robust. She also muddled up her response with nonsensical comments about WPATH paying Johns Hopkins University to conduct systematic reviews and promising to publish them, but not really publishing them. However, the data were accessible for anyone interested, but they were quite technical and therefore couldn’t be released to just anyone. But hey, they are the foundation of SoC 8! I was a small kid when communism fell, but this mumbo jumbo statement brought back memories of apparatchiks from my childhood.

There were also reassuring statements for anyone potentially questioning the soundness of WPATH SoC 8. According to Doležalová, neither she nor her colleagues have ever seen such a brilliant and scientifically bulletproof document! 

My other question was about the local reflections of wider international developments in Scandinavia, Great Britain, and other countries. This time, Viktor Heumann took the microphone and answered. A true believer, Heumann suggested that these countries are, in fact, well within the spectrum of recommendations in SoC 8. Doležalová chimed in and said that the anti-trans movement is global and that transgender issues have been used by politicians in countries like Great Britain.

Many people in the world were convinced that the Cass Review spelled the end of the gender-affirming model of care. But they were wrong. Nobody mentioned Hillary Cass (or Riittakerttu Kaltiala or Michael Biggs or the Society for Evidence-Based Gender Medicine or Genspect) during this meeting. They didn’t have to. Local media are mostly ignorant and barely mentioned the Cass Review. The general public is unaware of the scale of the problem. The Czech Republic went from 56 new children and adolescent referrals in 2011 to 132 in 2020 and to a whopping 484 in 2022. The increase is driven by adolescent females. Remember, we’re talking about a country of just 10 million people. These numbers are equal to the Tavistock numbers in 2020 when Hillary Cass started her review.

Some people instinctively oppose gender-affirming care for minors. Conservative MP Romana Bělohlávková organized a small conference named "Loss of Identity?!", which took place in the Czech parliament on June 4, 2024. Not a single sexologist appeared, allegedly citing adverse reactions from activists. Strangely, the conference mentioned the number of referrals abroad in the UK and US but failed to use local data. But, despite their concerns, particularly about overgrown activism, speakers repeatedly expressed their trust in experts, not realizing that experts are part of the problem.

Bělohlávková, a pediatrician by training, has no significant social media presence and is mostly unknown among the general public. Given her small-town origin and traditional values, she’s unlikely to appeal to the country's capital liberal elite dominating the media. She could be easily vilified as an ultraconservative bigot because of her links to Christian advocacy groups. And yet, she still may be the best shot vulnerable kids have.

The other side holds their conference on the 12th of June under the auspices of the Government Commissioner for Human Rights, Klára Šimáčková Laurenčíková. Lenka Králová, now an official government advisor, plans to make an appearance. So does Viktor Heumann from Trans*parent and Pavla Doležalová from NÚDZ. One can expect much greater media interest.

The Czech Republic is currently at a crossroads, and the prospects are dire. The country is on the verge of making significant changes to its laws and healthcare policies. The medical professionals who are going to formulate those policies are unreservedly pro-affirming in the most dramatic fashion. There is not a single high-stature politician raising awareness, not a single media outlet, or even a single journalist of significant profile covering the issue. Almost no one—including critics—is aware of developments in the Scandinavian countries and the United Kingdom, which have made radical changes in their policies and limited hormonal and surgical interventions to clinical research settings. 

And the wave of Czech kids who identify as trans is just about to peak.