TRANSGENDER IN PERSPECTIVE

LAW OF HEALTH

Arranged in order to fulfill the task of the Field Work Lecture

Arranged by :
drg. ENDANG SRI LESTARI
NPM : 171003741010614
Nur Hafni Kurniawati, S.ST.
NPM. 171003741010617

LEGAL SCIENCE MAGISTER PROGRAM

FACULTY OF LAW
UNIVERSITAS 17 AGUSTUS 1945
SEMARANG
A. Introduction
1. Background Problems
The transgender phenomenon is not new. In society, the phenomenon of transgender
becomes the hottest topic of discussion because of the pros and cons of what is called trans-
gender.
Society views transgender in general as someone who is given a male sex when he is
born, but he acts not like the sex he has. It can be said that transgender is a person's inequality
with gender. Usually they feel that they are trapped in the wrong self, so they apply or dress
that is not in accordance with their physical and gender. Transgender refers to people whose
gender identity is different from the gender set at birth. Trans-gender is divided into 2 (two),
namely:
a. Transmen, trans men are people defined as women at birth but identify themselves as men;
b. Transwomen, trans women are people who are determined as men at birth but identify
themselves as women.
In the transgender phenomenon, for some it is considered to have a bad influence on
the environment and surrounding communities. Some say that transgender is a form of
deviation, some people feel they don't like it or don't want to live side by side with them just
because they are afraid that their family or relatives will follow in their footsteps so their
families or relatives are not allowed to get along with the transgender .
Transgenders and the like are those who are deemed to deviate from the prevailing
norms. Identity search makes not a few people also feel that they are not a certain sex so they
change their sex with surgery and are ready to face negative assumptions from the public
about the actions they do.
Transgender is not uncommon to get a bad stigma or get a negative view of the
community. Especially, for the people of Indonesia, who are largely unable to accept their
presence, and tend to denounce and discriminate against trans-gender.
Article 1 paragraph (3) of Law Number 39 Year 1999 concerning Human Rights,
states that:
Discrimination is any restriction, or exclusion that is directly or indirectly based on
human differences on the basis of religion, ethnicity, race, ethnicity, group, class,
social status, economic status, gender, language, political beliefs, resulting in
reduction, deviation, or the elimination of the recognition, implementation or
recognition of human rights and fundamental freedoms in the life of both individuals
and collectives in the political, economic, legal, social, cultural and other aspects of
life.

In positive law, these transgender people get a legal umbrella "human rights" as
stipulated in Article 1 paragraph (3) of Law Number 39 Year 1999. Based on this, they ask
the community and the state to acknowledge the existence of this community.
Judging from the Indonesian constitution, namely Article 28 J of the 1945
Constitution of the Republic of Indonesia, which states that
(1) Everyone must respect the human rights of others in the orderly life of the
community, nation and state;
(2) In exercising their rights and freedoms, each person is obliged to submit to the
limitations stipulated by law with the sole purpose of ensuring recognition and respect
for the rights and freedoms of others and to fulfill fair demands in accordance with the
balance. moral, religious values, security and public order in a democratic society.
 However, based on Law Number 39 of 1999, human rights also have limitations, where
the limit is not contrary to moral, religious values, security, and public order. It is stated in
Article 70 of Law Number 39 Year 1999 that:
In exercising their rights and freedoms, every person is obliged to submit to the
limitations established by law with a view to guaranteeing recognition and respect for
the rights and freedoms of others and to fulfill fair demands in accordance with moral,
security and orderly considerations, general in a democratic society.

It is also stated in Article 73 of Law Number 39 Year 1999 that: "The rights and freedoms
set forth in this law can only be limited by and based on the law, solely to guarantee the
recognition and respect for human rights and basic freedoms others, decency, public order,
and national certainty
Gender differences are not the basis for gender inequality. Tolerance of rapid cultural
change will occur in a society that is very tolerant of actions, both positive and negative,
provided that it is not a legal offense. People who have tolerance tend to be more receptive to
new things. New things that are produced and will encourage social and cultural changes in
society. Example: In the past women who dressed as men were considered to be behaving
deviant. However, in a tolerant society, this is accepted so that changes in clothing occur.
For example, transgender groups who often get discrimination, even verbal abuse or
harassment, moreover they are understood as a minority group. As fellow human beings, such
treatment should only increase them to become more diluted, and consider themselves dirty
and have no place in society.
Transgender groups in the social environment are a minority group that is demanded to
behave like a majority (hetero-sexual) community. Sexual orientation, sexual identity and
gender and gender expression "must" be in a straight line according to the sex they have, then
there will be stigma such as abnormal, sinner, sick, turn.
This transgender group will at the highest level do a change of sex to determine their true
identity, so that they are recognized as normal human beings. Sex change or transgender is
known since the development of the Diagnostic and Statistical Manual of Mental Disorder
(DSM) method. However, not everyone can do sex-change operations immediately
According to Dr. Dadi Garnadi, a person to be able to perform sex change operations
according to the IDI standard (Indonesian Doctors Association) must be preceded by
observations by a team of doctors which includes psycho-logical tests, hormonal tests,
personality tests, health tests conducted by experts such as psychiatrists, psychologists ,
surgery, natural diseases, genetic, obstetry and gynecology. A person can perform a sex
change operation, so it can be ascertained that the person has gone through the process and is
said to be eligible for a sex change.
In medicine, the DSM method can track a number of symptoms, namely feeling
uncomfortable and dissatisfied with one of the anatomy of sex, hoping to change sex and live
with another sex, experiencing continuous shaking for at least two years, the appearance
physical intersex or genetic that is not normal, and can be found mental disorders such as
schizophrenia, which according to JP Chaplin in the Dictionary of Psychology is a kind of
psychotic reaction, which is characterized by symptoms such as self-confinement, disruption
in emotional and affective life and negativism behavior.
The sex change operation itself is included in the plastic surgery operation which is
regulated in Law Number 36 Year 2009 regarding Health. Thus, it is very important to know
about transgender in terms of health law, considering that transgender will also have an
impact on changing one's identity.
2. Problem Formulation
From the background description of the problem, then in this paper the authors
formulated the problem regarding: How is transgender viewed from the perspective of
health law?

B. Discussion
The American Psychological Association mentions that trans-gender is a general term for
people whose gender identity, gender expression, or behavior that is incompatible usually
associated with the sex they are assigned at birth.
Transgender is a term used to describe people who do, feel, think or look different from
the sex they were assigned at birth. Transgender does not show any specific form of sexual
orientation of the person. Trans-gender people can identify themselves as heterosexual,
homosexual, bisexual, pansexual, polysexual or asexual. Exact definitions for transgender
still flow, but include
1. Concerning, relating to, or establishing a person whose identity is not in accordance
with the conventional understanding of male or female gender, but rather combines or moves
between the two;
2. People who are assigned gender, usually at the time of their birth and are based on their
genitals, but who feel that this description is wrong or imperfect for themselves;
3. Non-identification with, or non-representation as gender given to himself at the time of
his birth.

The causes of transgender can be caused by 2 (two) factors, namely:

1. Congenital factors (hormones and genes);
Genetic and physiological factors are factors that exist in individuals because there are
problems, including in the composition of chromosomes, hormonal imbalances, brain
structure, abnormalities in the brain's nervous system.
2. Environmental factors.
Environmental factors include erroneous education in childhood by allowing boys to
develop in women's behavior or vice versa, during puberty with disaffected and traumatized
homosexuals, trauma of sexual promiscuity with a boyfriend, husband or wife.
In essence, the problem of gender confusion or what is commonly referred to as a
symptom of transsexualism or transgender is a symptom of a person's dissatisfaction because
they feel that there is no compatibility between physical and genital forms with the psyche or
any dissatisfaction with their genitals.
Transgender is generally not categorized as a mental disorder. However, sometimes
transgender people are more at risk of suffering from mental disorders due to conflicts within
themselves about their gender identity, and also because of discrimination and social
pressure.
Transgender people can experience gender identity disorder / gender identity disorder
(GID), if being transgender makes them feel pressured, depressed, or become unable to
undergo daily activities, such as working and building relationships with others. To help
improve mental health and evaluate their condition further, transgender people can consult
with a psychiatrist or psychologist. In some cases, a gender transition is one solution.
The decision to make a gender transition is not a simple matter. A transgender is strongly
advised to get counseling from doctors and psychologists before making that decision.
Although most transgender people don't actually feel the need to change their physicality or
make a gender transition with certain procedures, there are also some who consider it a
solution
 As stated, gender change or gender transition is carried out preceded by a series of
physical and psychological examinations to reduce the risks that may arise. Here are choices
of ways that can be taken:
1. Hormone replacement therapy;
For male transgender, hormone replacement therapy plays a role in stimulating the growth
of mustaches and other masculine physical characteristics, ranging from skin, hair, voice, to
fat distribution. While for female transgender, hormone replacement therapy plays a role in
bringing up the breasts and allocating body fat distribution.
2. Operation.
For transgender women, surgery is performed to change the voice, face, skin, Adam's
apple, hips, breasts, buttocks, and genital organs. While surgery for male transgender, to
change the appearance of the chest, genital organs, uterine lifting (hysterectomy), fallopian
tubes, and ovaries.

Like all medical procedures, gender transitions also have risks to health. Here are some
risks to look out for:
1. Side effects of hormone therapy to make the body look more feminine or masculine,
such as blood clots, weight gain, hair loss, gallstones, and sleep apnea. Hormone therapy in
trans-gender people can also cause infertility;
2. Hormone therapy combined with a bad lifestyle, such as too much alcohol and smoking,
greatly increases the risk of liver, lung, and other bodily disorders;
3. If performing a transition operation, this effect will be permanent, and sometimes the
results of the operation are not as expected. Side effects of surgery are also not small,
including infection, bleeding, to the loss of genitals and body parts that are dissected.

Some other methods carry even more dangerous risks. For example injecting silicone to
form certain parts of the body, which can cause health problems in the future, as well as
undesirable changes in the shape of the face and body. Silicon that is injected with a syringe
that is used interchangeably is also at risk of causing diseases, such as hepatitis to HIV.
In Article 69 of Law Number 36 Year 2009 concerning Health, sex change operations or
gender transitions are equated with plastic surgery. Article 69 of Law Number 36 Year 2009,
states that:
(1) Plastic surgery and reconstruction can only be carried out by health workers who have
the expertise and authority to do so;
(2) Plastic and reconstructive surgery should not conflict with the norms prevailing in
society and are not intended to change identity;
(3) Provisions regarding the requirements and procedures for plastic and reconstruction
surgery as referred to in paragraph (1) and paragraph (2) shall be stipulated by a Government
Regulation.

Article 69 paragraph (2) of Law Number 36 Year 2009 has clearly stated that plastic
surgery and reconstruction should not be in conflict with the norms prevailing in society and
are not intended to change identity. The purpose of identity associated with plastic surgery is
an easily recognizable identity, namely the shape of the face and not a natural identity such as
a change in gender.
In Indonesia the rules regarding sex change procedures are not specifically regulated in a
regulation. To provide recognition, protection, determination of personal status and legal
status of every population event and important events experienced by Indonesian citizens and
Indonesian citizens outside the territory of the Unitary Republic of Indonesia, Law Number
24 of 2013 concerning Amendments to the Law Law Number 23 of 2006 concerning
Population Administration.
In Article 1 paragraph (17) of Law Number 24 Year 2013, what is meant by an important
event is an event experienced by someone including birth, death, stillbirth, marriage, divorce,
child recognition, child endorsement, adoption of children, change of name and change in
citizenship status. From this understanding, sex change is not included in important events,
however, this sex change is known in the law as another important event.
Article 56 paragraph (1) of Law Number 24 Year 2013 stipulates that the recording of
other important events is carried out by the Civil Registration Officer at the request of the
concerned population after the determination of the district court, which has obtained
permanent legal force, while the other important event explained in the Elucidation of Article
56 paragraph (1) as follows: "What is meant by other important events are events determined
by the district court to be recorded at the implementing agency, including changes in sex".
So, in the case of a change in sex by a person, it needs to be preceded by a determination
from the district court to then be recorded in the implementing agency, namely the regency /
city government which is responsible and authorized to carry out services in population
administration matters [Article 1 paragraph (7) Law Number 24 of 2013], and reporting of
sex change is an obligation regulated in Article 3 of Law Number 24 of 2013 that: "Every
resident is obliged to report population and significant events that he experienced to the
Implementing Agency by fulfilling the requirements required in Resident Registration and
Civil Registration
Own sex change operations, in Law Number 36 Year 2009 itself there are no rules that
provide clarity. Regulations governing the requirements and procedures for plastic and
reconstructive surgery, as mandated by Article 69 paragraph (3) of Law Number 36 Year
2009, which states that: "Provisions regarding the terms and procedures for plastic and
reconstructive surgery will be stipulated by Government Regulation" not yet formed.
Related to gender change, in terms of health it is also necessary to know the risk of
transgender. One of the risks most often associated with transgender is HIV disease. The
following are possible factors that are less supportive for maintaining the health of
transgender people:
1. Lack of access to health services, because most transgender people do not have access
to health facilities, partly because of stigma and social discrimination from the community;
2. Limited information and health services, because there are not many mental health
service centers that have adequate knowledge and competence to deal with transgender
people;
3. Contrary to rules and beliefs, as are the rules or norms that limit the use of condoms as a
prevention of HIV infection.
Hormone therapy in transgender people also carries a long-term impact on health. Some
health problems that can occur, namely bone loss, high blood pressure, thyroid disorders, and
changes in the body's metabolism. Therefore, transgender people who have undergone
hormone therapy need to get regular health checks.
The controversy about transgender causes not a few transgender people who live in
discrimination and social rejection. This can lead to the risk of physical and mental health
disorders, such as depression, anxiety disorders, and suicide. For this reason, transgender
people need to conduct routine health checks on doctors who understand this condition, at
appropriate health centers.
Regarding mental health, transgender people also get the right to health services, as stated
in Article 144 of Law Number 36 Year 2009, which states that:
(1) Mental health efforts are aimed at ensuring that everyone can enjoy a healthy mental
life, free from fear, pressure, and other disorders that can interfere with mental health;
 (2) Mental health efforts as referred to in paragraph (1) consist of preventive, promotive,
curative, rehabilitative mental disorders and psychosocial problems;
(3) Mental health efforts as referred to in paragraph (1) shall be the joint responsibility of
the Government, regional government and the community;
(4) The government, regional government and the community are responsible for creating
the highest mental health conditions and ensuring the availability, accessibility, quality and
equitable distribution of mental health efforts as referred to in paragraph (2);
(5) The Government and regional governments are obliged to develop community-based
mental health efforts as part of overall mental health efforts, including facilitating community
access to mental health services.
It is also stated in Article 146 and Article 147 of Law Number 36 Year 2009 that:
1. Article 146 of Law Number 36 Year 2009
(1) The community has the right to obtain correct information and education about mental
health;
(2) The rights referred to in paragraph (1) are intended to avoid violating the human rights
of a person who is considered to have mental health disorders;
(3) The Government and regional governments are obliged to provide information and
education services about mental health.

2. Article 147 of Law Number 36 Year 2009

(1) Efforts to cure mental health sufferers are the responsibility of the Government,
regional government and the community;
(2) The healing efforts as referred to in paragraph (1) shall be carried out by authorized
health personnel and in appropriate places while respecting the human rights of sufferers;
(3) To treat mental health sufferers, special health service facilities are used that meet the
requirements and are in accordance with statutory provisions.

Thus, for transgender people who experience inner turmoil related to their gender identity,
which causes conflicts in their souls, it is very necessary to be provided with mental health
services, so there is no inner conflict that causes disruption of the psychological and physical
health of the transgender.

C. Conclusions
In Article 69 of Law Number 36 Year 2009, sex change operations or gender transitions
are equivalent to plastic bed operations. The provisions of the Article also state that plastic
surgery and reconstruction must not conflict with the norms prevailing in society and are not
intended to change identity. The purpose of identity associated with plastic surgery is an
easily recognizable identity, namely the shape of the face and not a natural identity such as a
change in gender. Contrary to the provisions in the Elucidation of Article 56 paragraph (1) of
Law Number 24 Year 2013 which states other important events are events determined by the
district court to be recorded at the implementing agency, including changes in sex. This
gender change can be made after getting a decision from the district court. Own sex change
operations, in Law Number 36 Year 2009 itself there are no rules that provide clarity.
Regulations governing the requirements and procedures for plastic and reconstructive
surgery, as mandated by Article 69 paragraph (3) of Law Number 36 Year 2009 also has not
yet been formed