Psychotherapist Adam Suchý: There is no way how to exactly measure transgender
Although the topic of transgender can be traced back to ancient Greece, perhaps even earlier, it only began to enter public discourse in the last ten to fifteen years. It has become a social phenomenon, resonating so strongly that one might feel guilty for not having a clear opinion on it. The medical aspect of the mismatch between “what a person has between their legs, between their ears, and in their heart” seems to have receded into the background. Psychotherapist Adam Suchý, working at the Department of Medical Psychology and Ethics at the Faculty of Medicine of Masaryk University, has been working with transgender people for practically his entire professional career. He recorded his thoughts and observations in a book simply titled Transgender, which took the form of a dialogue with the mother of a transgender child. Conducting an interview about the topic on the occasion of publishing a book that says practically everything about it is a bit tricky. So rather than aiming for a clear conclusion, the following lines open up further questions for which there may not be a single answer.
What inspired you to write the book?
I have been working with trans people for about twenty years - mostly diagnostically, sometimes also psychotherapeutically - so the idea had been growing in me for a long time. And when I occasionally overheard someone speaking about the topic not entirely knowledgeably or downright nonsensically, I realized that such a book was missing. One that would present both sides of the story, not just arguments for or against. The form of a dialogue came at the suggestion of my childhood friend Alena, whom I hadn’t seen for twenty years. She didn’t even know I was working on this topic, and I had no idea that she herself was the mother of a trans child. One publisher was interested in a textbook-style treatment, but we wanted to produce a text that would hold up both for the general public and for professionals. Because there are many scholarly articles - and even books - on transgender, but they either don’t reach the public or they are not understood by it. Hence a dialogue that is reader-friendly and engaging, and at the same time allowed us as authors to explore more ideas.
Shortly before our meeting, I happened to come across the “Spotlight” podcast by Aktuálně.cz, in which Senator Jiří Čunek (KDU-ČSL) says that “we deal with transgender because people have too much time.” What would you reply to that?
(laughs) That’s a popular opinion! The trans issue has always been present, but it is true that we at least socially observe a certain increase, which we don’t fully understand. But since it is discussed worldwide - even in Africa or Asia - it definitely isn’t something we Westerners created because we have too much free time. I would divide the phenomenon into two parts: the social part, where people dress or talk about themselves in certain ways, and the medical part, where they enter the healthcare system and which is associated with diagnosis. And in that second area, the transgender topic already represents somewhat of a storm in a teacup, because it doesn’t deviate unnaturally or represent a medical anomaly.
But doesn’t that actually feed the claim that we have too much time if we’re discussing something that isn’t medically unusual?
What turns transgender into a phenomenon is probably the topic itself. These people exist and enter the healthcare system needing help - without it, their quality of life would be very poor - not that they invented it out of boredom. Because when you hear the stories, I can’t imagine anyone wo uld go through it just for the sake of it: coming out, risking losing relationships, taking hormones with side effects, undergoing surgical risks, spending years visiting health specialists, and so on…
“Some studies suggest that our biological variability is probably much broader than the pressure for social consensus allows us to express.”
Adam Suchý
In the book, you acknowledge that in psychiatric practice you have experienced a multiple increase in transgender cases. What’s behind that?
We have many hypotheses, but we have to admit that we actually don’t know. And it’s also important not to juggle numbers because in absolute terms it’s not alarming. In Czechia, from 2012 - when the committee approving surgical transitions was established - until 2023 the committee reviewed around 1,600 applications for surgical gender transition and approved 1,349 transitions, which is not alarming. And even a year-on-year six percent increase in 2023 I don’t consider dramatic. According to the latest data from 2024, 0.4 % of people in Czechia are trans, which is about 43,000.
Sixteen hundred people in twelve years is one person every three days…
(laughs) I haven’t recalculated it that way, but it doesn’t seem to me, in a country of ten million, to be an epidemic as it sometimes might sound in public discussions. I feel that the social phenomenon is more visible: there are more people talking about the topic publicly who are not even in medical care.
How has the increase in transgender cases manifested in your practice?
For example, my collaboration with sexologists has grown - they refer people to us clinical psychologists and psychotherapists. Some colleagues compare transgender to left-handedness. While it was forbidden and forcibly retrained, there were few left-handers - and then suddenly many appeared. So, of course, the increase was also influenced by people no longer being afraid to seek care.
What other factors might have contributed to more talk about transgender issues?
Some speak of a societal transformation. I find interesting studies suggesting that our biological variability is probably much broader than the pressure for social consensus allows us to express.
Transgender – Otevřený rozhovor psychologa a matky trans dítěte
Alena Vernerová, Adam Suchý
Alena Vernerová, Adam Suchý
Clinical psychologist and psychotherapist Adam Suchý has been working with transgender people undergoing medical gender transition for twenty years. His profession also connected him with his youthful friend, Alena Vernerová, whom he had not seen for a long time - Adam as a professional, Alena as the mother of a trans child. And because there are two sides to every coin, together they signed a book that looks at transgender like no other. In the form of an authentic conversation addressed to "all open-minded people who want to better understand the world today". Not easy, but readable.
To what extent can the social phenomenon influence a rise in medical diagnoses? In other words, can a young person, who may not yet be certain about their identity, be influenced by the fact that there is more public discussion about transgender issues?
That happens. And although young people make up the most vulnerable group, our clients range from thirteen-year-old children to fifty-five-year-old adults. Among the older group, it’s not that they suddenly realized something was different. They always felt different, but some repressed it, others struggled. And it’s fair to say that some degree of social imitation may occur. When a person finds a group that accepts them in their difference, it can direct them toward medical care. All the more important, then, are professional criteria and guidelines - ideally combined with psychotherapy, which provides a safe space to explore and talk about the topic without acting as an arbiter saying “You are trans, you are not.”
Yet you mention in the book that even professionals can’t agree unequivocally on transgender issues…
We agree on many things, even if not in all groups. The problem is that we cannot measure transgender exactly. There is no tool that measures how you are with your identity. Moreover, criteria, diagnostic materials, and approaches are changing, and practice is influenced by how tuned-in the professional is to the subject - whether they are conservative and cautious or liberal and feel they can shorten their clients’ suffering, and thus are willing to begin treatment earlier.
Is there a right time and age to address transgender issues in relation to determining one’s own identity?
It’s complicated, because the younger the age, the more concerns and questions there are about whether it might not be a substitute issue. But logically, around twelve years old physical changes begin to diverge from the mental image people have of themselves. The identity line suddenly becomes very clear, and for trans people it starts to become increasingly painful. It must be said, however, that at that age no surgical procedures or medication are performed.
When then are they approached?
Surgical procedures are possible only from eighteen years old, and the trend is that hormones also start to be administered from eighteen. In indicated cases, puberty blockers can be introduced around twelve and are usually considered completely reversible. This gains time and gives the person a chance to live in a body more aligned with their experienced identity, if it persists into adulthood and the trans diagnosis is confirmed. But the approach is usually “watch and wait.” That means not rushing, going to therapy, talking about it. The system is set up so that if you count the waiting times, the average time before a person even reaches the committee approving surgical procedures is two to three years. That’s a lot of time to figure out how they really feel about themselves. And again we come back to the fact that it’s a process someone would not endure just on a whim. Moreover, a third of people who are approved for surgery do not undergo it.
Is there data on how many people in this process conclude they are not trans or maybe don’t even reach the committee?
Or slow the process down - they’re not sure, not in a hurry, and say that time will tell… To put it lightly, it’s not a band of wild people racing for the scalpel. They think about themselves and have responsibility. I understand calls for not rushing, but this is a process that cannot be rushed in our circumstances. And I think in Czechia we have criteria and care set up very well.
Do you ever encounter overly liberal parents who push the self-determination question too quickly with young people and children?
I don’t come across that very often. It happens that parents say they noticed it in children from a very young age - playing with opposite-gender toys from age three, dressing in opposite-gender clothes, starting to refer to themselves with the opposite gender pronoun… But that is the smaller portion of parents…
And the larger portion?
They are horrified and trying to suppress it somehow. Either parents panic and rush the child to a sexologist wanting to resolve it immediately, or they think it’s “from the internet” and want to beat it out of the child. Neither works well. Because when young people are in puberty, today they have information, support, and tools to override their parents. Or they fall into prolonged conflict, withdraw inwardly, maybe even develop mental health issues if parents refuse to discuss and show no regard for the child.
So what would be, then, from a parent’s point of view, the best option?
Paradoxically, to do almost nothing. Neither contradict nor support quick changes. As I said: watch and wait - take time and see what will happen next.
In the book you lightly refer to the music world, which I know you enjoy yourself. Let me quote a musician and ask what you say to the statement that “some adults mistakenly confuse learning acceptance with normalizing and supporting a situation that was, for those to whom it really pertains, a struggle, turning it into a sad and dangerous trend”? It was said by Paul Stanley of KISS, and he was rightly criticized by the LGBT+ community…
It makes sense to me. I realize that transgender is sometimes talked about as a trend, but more important is that in essentially every generation we can track an increase in some diagnosis that is not fully biologically explainable. Typically, I can mention hysteria, which was dealt with a hundred years ago, and when social pressure and various rules changed, it disappeared. Later, eating disorders or chronic fatigue syndrome were issues. Occasionally something like that appears and we don’t have a satisfying explanation. Only if percentages jump significantly is it probably not conditioned purely biologically.
“Essentially in every generation we can track an increase in some diagnosis that is not fully biologically explainable.”
Adam Suchý
And doesn’t that bring us full circle to the media image having made transgender primarily a social phenomenon today?
But even if transgender is a social phenomenon, it doesn’t mean it doesn’t exist. Even if we agree on its biological basis, it’s probable that various psychological-social factors also contribute. And we now stand before disentangling these connections. And it is possible that before we succeed, transgender as a topic may recede - or science may move forward. Because today we can rework the hardware - our bodies - but we cannot reprogram the brain. But we already know there are parts of the brain related to identity, so perhaps we will learn that too, and in fifty or a hundred years we might regard current procedures as obscure. (smiles)
If I ask about the next ten years, are there any visible trends now in how the discussion on transgender is developing?
I see very positively that it is being approached interdisciplinarily, whether it involves endocrinologists, urologists, surgeons, psychiatrists, pediatricians... I think that thanks to such collaboration we can reach more precise procedures and results, know whom and where to direct, and no longer just have what I like to call “transgender entrance exams,” where people live in fear of coming somewhere and being told “you passed / you didn’t pass.” As sci-fi, perhaps it’s not completely ruled out that care could evolve so that we no longer reshape the physical body, but rather “zap” something and have it solved… (laughs)
That would surely please the guy who came to the Brno book launch to debate with you with arguments from the Bible!
It’s true that hearing myself now aloud, I realize we’re on thin ice and need to say what transgender actually is. I understand that in New Zealand it’s called “a healthy lifestyle deviation,” and perhaps some people might refuse such a procedure because they are comfortable in their non‑binarness and don’t want to fit into any “normative” boxes. That is a question! And I think its answer will go hand in hand with society’s transformation and how open we become to further change—or whether we continue insisting that a boy must wear blue jeans and a girl must wear a pink skirt.
