Transgender manager sues after botched op costs him his leg

I think it all hinges on the legitimacy of the concept of gender identity.

Psychiatrists aren’t infallible no, but don’t you think if they had an alternative evidence based cost effective treatment they’d be using it?

From bbc etc earlier in the year:

In the previous version - ICD-10 - this was considered a gender identity disorder, in the chapter entitled mental and behavioural disorders.

Dr Lale Say, a reproductive health expert at the World Health Organization, said: "It was taken out from mental health disorders because we had a better understanding that this was not actually a mental health condition, and leaving it there was causing stigma.
"So in order to reduce the stigma, while also ensuring access to necessary health interventions, this was placed in a different chapter."

Commenting on the revisions, Graeme Reid, lesbian, gay, bisexual, and transgender rights director at campaign group Human Rights Watch, said the changes would have a "liberating effect on transgender people worldwide".

That's a good point, Old Crone - not all gender dysphorias are equal. Despite what Stonewall say...

Psychiatrists don’t class gender dysphoria as a delusion though.

I suppose it depends on what variety of gender dysphoria you're talking about.

Man who honestly believes he's a woman, or a woman trapped in a man's body. This is a delusion. A man who truly believes he's Napoleon is clearly deluded. Why should a man who truly believes he's a woman not also be considered to be deluded?

Person who is unhappy with the social roles ascribed to them because of their sex. This is not a delusion and it's not a mental disorder. It's a problem with society and is best fixed by making society fit people, by allowing people to be who they are regardless of sex. It's absurd to try to make people fit society's constructed roles by changing their bodies to make them look like the people who normally fit in the roles they want to inhabit.

Man who is aroused by the thought of himself as a woman. Fetishistic crossdressing and autogynephilia are not delusions, they are paraphilias.

Internalised homophobia. Not a delusion, and not fixed by making someone 'straight' by altering their body.

I've probably missed some other varieties of gender dysphoria, but I can't see how the 'born in the wrong body' type can be considered as anything other than a delusion.

I can't think of an accurate comparison to trans surgery, as it seems unique in terms of being more deadly than cancer, while simultaneously being not a mental health issue, but a huge suicide risk. I can't think of any other medical situation where so many conflicting bits of information are all agreed as facts.

That sums up succinctly the point I was trying to make.

Gender dysphoria is clearly a psychiatric condition imo just because ICD changes it from a mental disorder to a sexual one doesn’t mean that’s the case - they admitted they did it to reduce stigma.

I thought there was a move to try to remove stigma about mental health conditions. How is this helped by removing what is clearly a mental health condition from the category of mental disorders in order to reduce stigma about that particular disorder?

Probably worth remembering that the psychiatric profession gave us not only lobotomies, but recovered memory syndrome and the ensuing 'satanic panic' which led to a number of entirely innocent people spending years in prison.

Infallible they are not.

I don't understand the psychiatrists' reasoning - the cry from the transactivists is that these people want to be the thing that their body is not - the opposite sex - so badly that they will kill themselves if they cannot be what they believe their inner self to be. So, that seems parallel to wanting to be thinner, despite the clear objective, measurable evidence that your weight is so low as to be harmful for your health.

I don't understand the psychiatrist's thinking on this stuff at all. You can't be born in the wrong body any more than you can be born in the wrong head, you can't add hormones and bolt on/remove body parts and change your DNA - and if you believe these things are true you fit the definition of someone who is deluded.

Perhaps the psychiatrists are also suffering from delusion.

Psychiatrists don’t class gender dysphoria as a delusion though. It isn’t the same as anorexia. Wanting to be male or female isn’t the same as wanting to be so thin you’re dead.

Bariatric surgery and medical transition both have risks, one more so than the other but they’re both forms of harm reduction.

Gender dysphoria is clearly a psychiatric condition imo just because ICD changes it from a mental disorder to a sexual one doesn’t mean that’s the case - they admitted they did it to reduce stigma. No other reason.

AMAM I agree totally that the surgeries are ludicrously risky. I think all medical transition should be banned personally.

'Surely there is a way to weed out predators' - well - 98% of sexual offenders are men, while of course representing a tiny %of men overall. Men should be able to care for their own dependents in family changing provision. But the simplest way to exclude predators from being around women and children is to segregate by biological sex.

Don't rapists and predators have little respect for women
Personally I think a man being able to claim to be a woman while doing very very little to demonstrate their "womanhood" is the ultimate in disrespect.

E.g Shauna Smith www.eastidahonews.com/2016/10/transgender-woman-pleads-guilty-target-dressing-room-voyeurism/

It's obviously a mental illness. People feel they are in the wrong body. I hope one day there will be medicine to treat it, like we medicate other mental disorders. Combined with therapy of course

^ this, this, this
How can it not be a mental health issue?

BUT surely there is a way to weed the predators out?

If there was a way to weed the predators out we’d have less need for single sex spaces. Besides, if a man walks into the communal women’s changing room at my gym (no cubicles) I don’t care about his bona fides. I simply don’t want him in there. I wouldn’t want my dad, brother, nephew, uncles or any of my male friends in there either.

This is why so many trans people are opting to keep their biological bits and live as the opposite sex and fighting for the rights they'd have as the opposite sex I think.

How is 'living as the opposite sex' different from living as your own sex? Men can't have women's rights because women's rights are for women. Why should women's sex based rights be sacrificed because some men want to be women?

Huh? You don't need top do anything at all legally. Most things have gone self id. All a man has to do to access female facilities, hosp wards etc is utter some magic words. In the case of eg single sex communal facilities at a pool, then he only has to say the magic words if challenged, and girls and women are advised not to challenge as it's transphobic to do so.

This is why so many trans people are opting to keep their biological bits and live as the opposite sex and fighting for the rights they'd have as the opposite sex I think.

The surgeries are very risky. I don't think just because you're a man that wants to be a woman, you should have your penis cut off in a risky surgery to gain a non useful vagina to be considered a woman.

It's very tricky as legally letting a biological male be known as a woman and letting them have the use of female toilets, changing rooms, apply for female only roles etc can be dangerous BUT surely there is a way to weed the predators out? How many men will pretend to want to be female, go through the rigmarola of changing their gender legally, seeing doctors and having counselling, changing their passport etc all to perv on some women in a changing room? Don't rapists and predators have little respect for women and it's all about control? They wouldn't want to be a female surely? They want to throw their testosterone about with control.

A more accurate comparison with bariatric surgery for morbidly obese people is someone who self harms by cutting themselves. The long term solution is therapy and changing the behaviour long term, but short term you still disinfect and sew up the wounds to treat the consequences of the self harm.
I can't think of an accurate comparison to trans surgery, as it seems unique in terms of being more deadly than cancer, while simultaneously being not a mental health issue, but a huge suicide risk. I can't think of any other medical situation where so many conflicting bits of information are all agreed as facts.

Re comparisons with Bariatric surgery.

If you have bariatric surgery you have certain health risks that accompany your weight, and a surgeon SHOULD be weighing this up against the risks of surgery.

If you are trans and it's NOT a mental health issue then you theoretically DO NOT have risks associated with not having surgery because your body and mind are otherwise healthy. However you might have physical co-morbid health issues which absolutely should be taken into consideration when considering surgery or hormones. Thus the need for gatekeeping.

The comparison here is to suggest that bariatric surgery and trans related surgery or hormones have the same starting point - that's not true. Or at least shouldn't be.

The accurate comparison if we take the view its not a mental health is is about approving bariatric surgery for someone who is a healthy weight to prevent them becoming overweight or obese in future AND not considering the risks short term and long term of surgery.

Cos that's what removing gatekeeping and ethics means.

Someone deciding to take drugs or surgery because they believe their body is 'wrong' is a totally different kettle if fish for this reason.

There are reasons why hormones and surgery are not appropriate if your body otherwise healthy because you are actively introducing unnecessary risk for lifestyle reasons.

If you are saying it's mental health related, then mental health avenues should be pursued as a first line treatment.

If this ISN'T being done in the case of bariatric surgery in ALL cases (as in anyone can just ask for it and get it without gatekeeping) , then again this is fundamentally going against medical ethics and is actively potentially dangerous.

The whole point is that there should be a series of checks in the system to ensure risk is understood and managed to minimise it and to act in the best long term interests of the patient.

That's what's absent from trans health and the lobbying on trans health.

I do think there are areas of private practice which cover cosmetic procedures and may include some bariatric surgery where following ethical practice is substandard and missing which is exposing some patients to unnecessary risk. That too is a scandal. But this side of the cosmetic industry absolutely shouldn't be being used as a justification for allowing trans medicine to have less gatekeeping.

Either bariatric surgery is done for health reasons (remember WHO is now saying trans treatment is purely for lifestyle) thus there is a risk if no surgery is carried out or its cosmetic and there are ethical reasons why its not appropriate.

The whole trans lobby message is that surgery and hormones are appropriate in ALL cases, and doctors should only affirm not ask questions or raise concerns about risk as to do so is transphobic.

The comparison between bariatric surgery and trans issues therefore represents a either a complete lack of understanding or complete deliberate disregard of risk management, safeguarding and medical ethics.

Which frankly is either very ignorant or simply frankly utterly terrifying and actively into eugenics and advocating exploitation and abuse for commercial purposes.

Seems to be a trend of ‘transing ’out the gay. As if a person who strives to alter temblor body to the extent of major surgery and a lifetime of drugs and denial is ‘better than gay’.

It's not unrelated that you see on social media moms in the Bible Belt of the US blarbing on about their trans kids.

I guess the bible condemned gay but not trans (although I’m sure they’re is a bit about men not wearing women’s clothes but you can get around that by declaring that little Fred is a girl).

Trans people and anorexics both reject a normal body and believe it to be "wrong" and in need of adjustment. People with anorexia achieve that alone, people with gender issues need the validation, prescription and surgeries from medics. Both do harm to an otherwise healthy body, and the root of the harm is in the mind - clearly and agreed in the case of anorexia, not in transgenderism.

Just to point out that if bodies like WHO are saying it's NOT a mental or physical health condition then what they ARE saying is its a cultural issue or quasi-religious belief that someone thinks they have been born in the 'wrong' body. Aka this is a lifestyle choice not a health choice.

This in theory should have major ramifications.

There certainly should not be procedures carried out on the NHS for lifestyle reasons.

There should be higher, not lower, levels of ethical oversight.

There should be much, more scrutiny over the medical effects of hormones and surgery and whether there are long term side effect - more on a par with potential substance abuse.

There should be awareness of what happens if someone is dissatisfied with their lifestyle choice.

Also if this is a lifestyle choice there should be scrutiny over whether its advocates encourage this lifestyle choice in more vulnerable groups for whatever reason.

Conversely if this is indeed a mental health condition there should be much more scrutiny of giving surgery to those with mental health issues because they are more at risk if something goes wrong, and there needs to be a higher level of gatekeeping to ensure that vulnerable people do fully understand possible side effects and long term physical risks that might come from surgery, and obviously psychological support must form a dual strategy of dealing with with that aspect of the issue.

The problem is because the likes of Stonewall have lumped people who are cross dressing (lifestyle primarily) with people who have some sort of dysphoria (definitely mental health) together into one singular group and then the likes of WHO are subsequently forming policy on the basis of this.

The net result is neither group are being served either by lobbyists or by health professionals which leaves vulnerable groups open to exploitation from unethical and unscrupulous people willing to cash in on the trans industry (and that's what it is).

Those who are trans for lifestyle reasons are mislead by claims of hormones and surgery being amazing with little research or information about long term issues. This is covered up by the mental health claim of suicide if they can't have the lifestyle they want?

If its a lifestyle choice then why are people given power for saying about suicide? That's like a drug addict saying if I don't get my meds I'll shoot myself (potentially taking out others in the process).

Which then comes back to either a problem with 'the dealers' (those misspelling the lifestyle and getting people hooked on drugs /idea of surgery) or/and the whole mental health angle.

The lack of scrutiny and ethics either way is mind blowing and utterly appalling. And that's really the scandal, not whether women off the Internet are saying sex is important and it's not the same thing as gender.

It's what either people who want the lifestyle or are vulnerable with mental health issues are being told by the medical profession and by lobby groups.

The attempts to silence are merely trying to cover up and pretend there isn't an entire industry based on exploition going on, and it's very easily spottable in the cognitive dissonance which is 'its not a mental health condition but I'll kill myself if I don't get my own way' that's going on.

There should not be an argument on this thread if you believe that medicine and surgery should be ethical and be lead by evidence not ideology.

If you are arguing to the contrary then you are advocating for a medical wild west where big pharma can advert without impunity or restrictions and doctors can experiment on whoever they like for whatever reason without the patient either being aware or having little to no recourse of malpractice.

Oh and a complete lack of thought for appropriate mental health support, because that's 'transphobic' to suggest.

It is that black and white yet this is how the area is effectively being run at the moment.

And I've not even mentioned how it's potentially homophobic and sexist in its ramifications too.

www.dailymail.co.uk/news/article-7541679/Hundreds-youths-gender-surgery-wish-hadnt-says-head-advocacy-network.html

This is the natural progression of a society which encourages surgery for every conceived flaw in the body - nose jobs, breast jobs, lip plumping, face lifts. The whole idea that we have the right to look the way we desire, through mutilating heathy, working bodies - an act that in itself is supposed to make us happy - is bizarre.

I’m almost 60 but when I was 25 I was sterilised. I got pregnant easily and had my family. I was allowed an operation on the nhs as a young person with another 20 years of potential fertility.

But nowadays it would be very unlikely to be done at that age because so many people have changed their minds when they have it so young. It is too costly to give to young women who may change their mind, and yet it is a tiny operation in comparison to ftm ‘bottom’ surgery. But 35 years ago it was much more freely done with very little counselling.

I think trans surgery could go the same way - the de-transing movement is gaining momentum and in an nhs where resources are being spread more thinly every year, operations which are not physically medically necessary will be the ones to go first.

Ftm is a massively more complex and costly operation compared to mtf. I don’t see how either can continue to be seen as affordable interventions - particularly with a higher understanding of rate of complications and rate of de-transition being clearer.

This is why there is such resistance to research into the longer term flaws of the surgeries as treatment for what we are discovering could be a very varied number of factors behind the desire to change sex. The surgeries, I believe, will be eventually be dropped from the NHS for almost everyone, regardless of the history behind the desire.

The heavy risks of previously physically healthy patients becoming chronically ill through the surgery, or changing their mind/requiring further corrective surgery or suing has to preclude it eventually. I can’t see how it can be sustainable, at least on the NHS.

Medical trends change, - they always have - as we learn more. Research is critical.

I'm in my early 30s.
I went to a school with 1000 other kids.
2000 over the time I was there.
Not a single one of them was trans that I or my siblings are aware of.
Some of us were gender non confirming. Some of them were and are gay.
Some of us had eating disorders. Some self harmed.
Where are all the anorexic girls now? They're trans instead. This just wasn't a thing 20 years ago. The fact that it is now proves social contagion.
No one is born in the wrong body. There is no such thing as a gendered soul.
I had an eating disorder, I know what it's like to hate your body, hate everything about yourself.
To not fit in. To thrash around trying to grab some control, to change yourself, to find answers, to try to be happy in this fucked up world. Growing up is hard.
I feel so sorry for girls trying to grow up in this world that seems even more fucked now than it was then.

Strangely familiar derailment style on this thread.

The difference between obesity and anorexia is delusion. Gender dysphoria has delusion as a feature.

The WHO and others may say it is not a mental health condition - but, there is a delusion that their body is "wrong". Our bodies may not be the way we would like, they may not enjoy the best of health, but, they are what they are - not being our ideal does not make them "Wrong", just not what we'd choose if we were a game of Mr Potato Head.

Bariatric patients are not unaware of their body condition - a symptom of anorexia is to be unable to see the body as it really is, they see fat where there is none.

Trans people and anorexics both reject a normal body and believe it to be "wrong" and in need of adjustment. People with anorexia achieve that alone, people with gender issues need the validation, prescription and surgeries from medics. Both do harm to an otherwise healthy body, and the root of the harm is in the mind - clearly and agreed in the case of anorexia, not in transgenderism.

Medics who give people drugs which will do them harm, or surgeries which are not medically necessary could do to reflect on some critical thinking.

I'm glad to see a growing number of medics expressing concern about the approach to managing transgender patients. Because this is just fucking mental.

Interesting thing about cosmetic surgery in the uk
www.prasis.co.uk/support_guidance/reducing_risk/cosmetic_surgery_on_under_1618s.aspx

And on cosmetic surgery in general, there is rather a lot in there about making sure full understanding must happen.

www.gmc-uk.org/-/media/documents/Guidance_for_doctors_who_offer_cosmetic_interventions_210316.pdf_65254111.pdf