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Members of Israel's transgender community are protesting what they see as discriminatory treatment by the Israeli medical system, including doctors' demands for a psychological evaluation before providing hormonal treatments for people who want to undergo sex changes.

A project promoting the right to high-quality health care for gays, lesbians, bisexuals and the transgendered will be kicked off at today's gay pride parade in Jerusalem.

"The ties between a doctor and the transgender patient are complex, because many doctors still have stereotypes, and there are doctors who treat without being sensitive," said Nora Grinberg, an activist for transgender rights and a member of the Health Ministry's committee to update regulations on sex-change operations.

She said there are doctors who refuse to treat transgender patients, meaning that they don't identify with their birth sex and may want to undergo a sex change.

"The knowledge on the subject of transgender identity has undergone a revolution in the last 15 years," Grinberg said. "But the demand that patients be referred to a psychiatrist or psychologist before being given hormones indicates discriminatory treatment, a situation known as the 'gatekeeper,' in which the person doing the treating has the power to allow or bar medical treatment for a transgender person and den the patients' right to autonomy."

There has been a major increase in demand for sex-change treatment in recent years, but representatives of the transgender community have said the situation for those seeking sex-change surgery is far from satisfactory.

A Health Ministry committee was convened two years ago to review sex-change procedures established in 1986, but the committee has yet to issue any recommendations.

Sheba Medical Center, Tel Hashomer, is the only place in the country performing sex-change surgery, and there are many complaints about how the matter is handled there.

The Health Ministry said the committee looking at amending sex-change surgery procedures has developed wide-ranging draft recommendations. The ministry said they are being re-examined, however, due to opposition by Grinberg and Physicians for Human Rights. The ministry said any complaints about discriminatory treatment in the health care system can be filed with the ministry's ombudsman.

Grinberg said candidates for surgery are currently required to apply to a hospital committee and remain under follow-up care for two years before receiving approval for the operation. She said the wait is contrary to accepted practice around the world.

Grinberg also objected to the requirement that patients undergo psychiatric evaluation before surgery, a practice she said violates medical ethics. Sex-change surgery is covered by national health care, but there are some associated costs that are not covered.