NYTimes: A Vagina Won't Make Me Happy - But It's My Right to Get One Anyway

It was really difficult to read that article - this person is so clearly mentally ill and the treatment is just making them worse.

Cosmetic surgery is plastic surgery.
No it isn't. There are distinctly different within medicine.

For a start plastic surgery is available on the NHS. Cosmetic surgery isn't.

Ok how about this one: a child with sticky out ears who is bullied at school. Pin back or not?

Why not counsel the child to accept their body as it is and not change it to fit in with what society deems as acceptable?

Cosmetic surgery is plastic surgery.

Ok how about this one: a child with sticky out ears who is bullied at school. Pin back or not?

Bowlofbabelfish

Those are examples of plastic or reconstructive surgery, not cosmetic surgery.

Which is exactly what it says on the tin. Surgery done for no other reason than cosmetic.

How can any dr justify cosmetic surgery though?

Burns patients, patients with septum defects, scarring, acne scarring, mastectomy reconstruction, cancer survivors, injury survivors, women with breasts so large they cause damage to their backs...

... would all disagree with you.

Define cosmetic? Reconstruction of the face after a car accident? That ok?

If it can be expected to alleviate dysphoria and increase quality of life, surgery should be done, be it cosmetic or SRS.

I do actually support SRS being done on those patients who are suffering horribly with gender dysphoria. But let's be honest and say many 'trans' people are only getting breast implants because they have a fetish. They still get pleasure from having a penis. They aren't transsexuals.

And the complicated thing with any of these surgeries is that a patient could come out of them thrilled with the results (think breast removal, hysterectomy) only to have significant, life-limiting complications a decade down the line. It is very easy to say hypothetically that you don't care about such things and they're worth it - the reality is very different when you're stuck in a hospital bed and going through those complications in reality. Such complications aren't generally a risk with other cosmetic surgeries although I appreciate some women have become very unwell after getting implants. (But I don't generally think breast implants should happen anyway except in extreme cases)

Terrible and desperate mental suffering. Severe and complex mental illness.

Of course the article and the writer is conflicted and unwise, intellectually bonkers even. What else could it be from someone writing about their mental disorder whilst in the midst of severely suffering it? I would only hope for some insight. I would be unreasonable to also expect them to issue a prescription and a cure. I am angry with those who let this situation happen.

We have an utter lack of proper care and therapy. Weak underfunded doctors who cannot match the desperate and fierce strength of mentally ill feelings and beliefs. Psychiatrists who are elite and above.

Surgeons with God-complexes who will take the money and 'fix and forget' and leave others to manage the day to day repercussions.

Public and politicians who will not pay for proper expensive mental health care.

"NOT MY PROBLEM" say some. Well, yes, actually it is. If we do not campaign for and pay for proper long term mental health care then this trans extremism and MH epidemic amongst young people is what happens. We cannot only have some understanding and compassion, and the will to diagnose and treat only the 'right' types of mental illness; the OK ones where people aren't too inconvenient or too horrible to others, or too difficult to deal with, or too incurable to fix.

Mentally ill people are driven (like anyone else is) to find a way through regardless of whether that will be helpful or harmful (to themselves or others) and yet they cannot be a good judge of how to do that. What do we expect to happen when very ill and disordered people have no choice but to look after themselves? And have no guidance or restraint from others to make them safe; and worse still are blindly and ignorantly 'empowered' as if they can just 'get a grip' and make themselves better all by themselves and commission their own treatments?

Some collude in the mis-diagnosis and de-medicalising and minimising of mental illness because it saves money and hard decisions. And if we can make a consumer out of mentally ill and disordered people - even better. Money is GOD. Letting people fend for themselves is the way. Care in the Community. But the community wants nothing to do with it, and less so as every year goes on "not my problem", "not one of us", "I don't want that in my life" (well who does? Not even the ill or disordered person) And the community does not have the skills anyway.

As a society (capitalist patriarchy) we have shamefully neglected and ignored serious mental illness hoping it will just go away (and fix itself). And look where it has got us. Another entirely foreseeable outcome.

Obviously women and children bear the brunt of this latest failure most severely, and as always.

Non-maleficence is a principle of medical ethics.

SOBER TUBER! MARSHLAND OF REGRET! NONMALEFIENCE!

Unfortunately this person is also a fucking terrible writer. Queer theory seems to encourage word salad along with nasty surgical intervention.

I thought there were some interesting points in the piece:

"I feel demonstrably worse since I started on hormones"

"I was not suicidal before hormones. Now I often am.

"Like many of my trans friends, I’ve watched my dysphoria balloon since I began transition."

"There are no good outcomes in transition. There are only people, begging to be taken seriously."

To me, all of this reads as someone with serious mental health issues who needs some sort of counselling to come to terms with themselves. They say themselves that transitioning is making everything worse, and (in their words) surely an unhealthy wound to remind them always that they are not a woman, is not an answer.

I can see why transitioning might make things worse as the more you do, the more apparent it becomes that you will not and cannot become what you want to be.

This article is an excellent argument for not giving people the treatment they want, and for instead carefully considering what an individual needs.

But if the person is so distressed that they want gender reassignment surgery then they should be told to "just live with it"?

I've never said gender reassignment surgery should be banned and I believe that is also the view of most on this board. I just believe that thorough psychological and perhaps psychiatric investigation should occur prior to medical or surgical intervention, in order to reduce the risk of people undergoing permanent procedures they may regret.

You may or may not be aware that some people latch onto gender dysphoria as the cause of their problems whereas it is later identified to be something else like a coping mechanism for sexual abuse. Without dealing with the underlying problem, SRS won't be any sort of cure or alleviator.

Electron1

Are you telling me what I can and can't talk about then?

You don't have to answer me do you?

If it can be expected to alleviate dysphoria and increase quality of life, surgery should be done, be it cosmetic or SRS. (Obviously it would be great if people could just learn to accept themselves, but it may not be the easiest path in a society where everybody and their dog feels entitled to tell you that you have ridiculous ears, or an ugly nose or are appallingly fat. Sometimes the harder, more enlightened path may just not be worth it. Though I believe a therapeutical approach should always be chosen to discuss and manage expectations).

But when not even the person desiring the medical intervention believes it will make their situation better, it is high time for psychiatric intervention imo.

Weetabixandshreddies, are you just here to moan at women for thinking and talking about the "wrong things".

yet the focus is on banning gender reassignment surgery? Hhmm

Is it really? Really, is that the focus here? Or are you just exaggerating to make sure you have a reason to make people feel bad for thinking about this?
It's a rhetorical question so don't bother to answer, you are clearly here to keep telling other people they are thinking bad thoughts.

But if the person is so distressed that they want gender reassignment surgery then they should be told to "just live with it"?
I look at some of the examples of cosmetic surgery and wonder how any dr can justify doing it. The results are frankly grotesque. The message that is being sent out increasingly is that is how we should look and you are abnormal to not conform yet the focus is on banning gender reassignment surgery? Hhmm

Yes, there are some terrible examples of bad cosmetic surgery, but at least in the UK, there are limits on what a surgeon will do. And if a patient is having a procedure carried out by the NHS there has to be a benefit - eg: the straightening of a wonky nose; the alleviation of mental distress caused by unusually small breasts - so repeated, unnecessary procedures just wouldn't be permitted. There isn't the money for that.

If a person is requesting a procedure which have a permanent negative effect on the functioning of their body, and at the same time admitting that it will not improve poor mental health, then I think it would be unethical for a surgeon to go along with that.

TL/DR the Bride of Wildenstein paid unethical surgeons to have that done to her, if she'd pitched up at an NHS GP she would have been directed to a counselling service.

If your child had a particularly large bulbous nose, in combination with large sticky-outy ears that they were ridiculed for daily, I think you would be the rare parent who would say, 'Just learn to live with it'.

But if the person is so distressed that they want gender reassignment surgery then they should be told to "just live with it"?

I look at some of the examples of cosmetic surgery and wonder how any dr can justify doing it. The results are frankly grotesque. The message that is being sent out increasingly is that is how we should look and you are abnormal to not conform yet the focus is on banning gender reassignment surgery? Hhmm

I don't understand how a person who claims they want to be a woman so bad can have such little understanding of what a vagina is. Surely if you are asking for surgery, you should be clear about what you are getting.

Most cosmetic surgery doesn't actually change the way a body functions completely though. It doesn't sterilise you or create a wound that intentionally never heals.

Unless you were swapping a nose for an ear it's not comparable really.

Society views gigantic breast implants as unethical and ridiculous, when they're just larger versions of something already there - yes it may affect the ability to breastfeed but it's not as impactful as removing genitalia completely and swapping it out for a wound.

Cosmetic surgery isn't just a slightly wonky nose and big breasts. There are many physical features that are far enough from 'normal' (whilst still functioning perfectly fine) that are the source of great distress, especially due to the reaction of others. If your child had a particularly large bulbous nose, in combination with large sticky-outy ears that they were ridiculed for daily, I think you would be the rare parent who would say, 'Just learn to live with it'.

As for procedures like breast enlargements where people already have normal sized breasts, I wouldn't do that. I wouldn't want my loved ones to. Other people who are paying themselves can do whatever they want as far as I'm concerned. I think doctors have a duty to ensure that the patient is likely to feel the procedure was beneficial, and they can have a good idea from surveys of past patients of who will and who won't feel the procedure was worth it.

The problem in the case of transgender patients is that there seems currently to be a push to move onto medical and surgical treatments without fully exploring motivations. The result is people whose underlying issues are not truly gender dysphoria getting treatments which may not improve their self-esteem and happiness because they don't address the underlying issues.

I'm sure it has.

I just never see it mentioned here. All I see is criticism that the medical treatment received by transsexuals is unnecessary, harmful and they need help to accept the body that they were born with. As though this is the only area in medicine that performs potentially harmful surgery without a medical need.

Unless they are a cosmetic surgeon then? Surely nothing demonstrates unnecessary surgery better than cosmetic surgery yet where are the campaigns to stop that?

You think radical feminists haven’t seriously criticized cosmetic surgery?

You think there’s been no criticism of cosmetice surgery from medical ethicists and medical practioners? You think the medical profession hasn’t weighed these issues?

How can any dr justify cosmetic surgery though?

The patient may well want it. Who's to say that it will benefit the patient? In fact when you see how many patients go on to have mire procedures or reviews of the original procedures I think there are good arguments for abolishing it all together.

Surely the answer would be to help people learn to live with and accept the body that they have rather than trying to alter it surgically?

She writes in the first paragraph:

This is what I want, but there is no guarantee it will make me happier. In fact, I don’t expect it to

Then writes:
therefore, medical professionals have a duty to ease that suffering

How can these two statements be reconciled?

it leaves the door open for care to be refused when a doctor, or someone playing doctor, deems the risks too high.

After I unrolled my eyes at “playing doctor” (no, you need objective qualifications) I don’t see what the issue is. If a practitioner seems it not worth their risk, that’s completely understandable. They have to be able to look their medical board in the eye and say “yes, I made the best choice for this patient by performing an irreversible, sterilising procedure leaving a wound that will require lifelong medical attention”. Funnily enough, any sensible surgeon would stop and think before they proceed and be looking for evidence to back this up. But there isn’t any evidence because research into outcomes is flawed, biased and sparse.

A herniated disc is a poor analogy. There’s increasing evidence and debate that surgery for this is not associated with better outcomes. It’s not a clear cut answer.

And regards to

Jesse Singal used the statistically small number of people who have come to regret their medical transitions to argue that transitioning is “not the answer for everyone.” There was a dog whistle here: Hormones and surgery can and should be withheld from patients who want them when such treatments cannot be reasonably expected to “maximize good outcomes.”

Regardless of what the real number is and the debate around that, we know the following as fact:
-The number isn’t zero

• any patient embarking on this treatment could regret it
• any medical practitioner worth their salt should be able to counsel patients on expected outcomes based on evidence.

To use a better medical analogy: if colorectal cancer is found, we have good evidence based on histological staging to be able to give a patient 5 year survival data.

Basically what I’m trying to say is, if these people want medical practitioners to provide a medical service, that service should be bound by the same standards of evidence and ethics as any other. Doctors aren’t going to, and certainly shouldn’t throw those principles out of the window just to rush people into something they want.

I find it almost abhorrent that people like this writer don’t want the same; don’t they want to know what the best treatment for their dysphoria is? Don’t they want to prevent people from being harmed? I just don’t get why no one wants to find out what the best outcomes available actually are. Stop stifling independent research and we might find out one day.

In the 2015 Transgender Equality Inquiry Dr James Barrett also said this:

'It has been suggested by those who promote this change in practice that this is what pertains in general medicine and surgery. This is absolutely not the case, the surgeons and physicians in the Association having confirmed that in general surgical and medical practice doctors do not undertake treatment which they don’t think will confer benefit, even if it is the request of a patient with full capacity. Those members of the Association who undertake non-gender cosmetic surgery confirm that this is the case.'

That was the 2015 Transgender Equality Inquiry.