five years ago, Professor Miroslav Djordjevic, the world-leading genital reconstructive surgeon, received a visit at his Belgrade clinic: a transgender person who had undergone surgery at different clinic to remove male genitalia - and since changed their mind.
That was the first time Prof Djordjevichad ever been contacted to perform a so-called gender reassignment “reversal” surgery. Over the next six months, another six people also approached him, similarly wanting to reverse their procedures. They came from countries all over the western world, Britain included, united by an acute sense of regret.
At present, Prof Djordjevichas a further six prospective people in discussions with his clinic about reversals and two currently undergoing the process itself; reattaching the male genitalia is a complex procedure and takes several operations over the course of a year to fully complete (at a cost of some €18,000).
Professor Miroslav DjordjevicCREDIT: NYTNS
Those wishing to reverse theirgender reassignment, Prof Djordjevicsays, have spoken to him about experiencing crippling levels of depression following their transition and in some cases even contemplated suicide. “It can be a real disaster to hear these stories,” says the 52-year-old.
And yet, in the main part, they are not being heard.
Last week, it was alleged thatBath Spa Universityhas turned down an application for research on gender reassignment reversal because it was a subject deemed “potentially politically incorrect”. James Caspian, a psychotherapist who specialises in working with transgender people, suggested the research after a conversation with Prof Djordjevicin 2014 at a London restaurant where the Serbian told him about the number of reversals he was seeing, and the lack of academic rigour on the subject.
According to Caspian, the university initially approved his proposal to research “detransitioning”. He then amassed some preliminary findings that suggested a growing number of young people – particularly young women – who were transitioning their gender and then regretting it.
rof Djordjevicfears money is at the root of the problem, and says his reversal patients have told him about making initial enquiries to surgeries and simply being asked to send a cheque in return.
“I have heard stories of people visiting surgeries who only checked if they had the money to pay,” he says. “We have to stop this. As a community, we have to make very strong rules: nobody who wants to make this type of surgery or just make money can be allowed to do so.”
To date, all of his reversals have been transgender women aged over 30 wanting to restore their male genitalia. Over the last two decades, the average age of his patients has more than halved, from 45 years old to 21. While the World Professional Association for Transgender Health guidelines currently state nobody under the age of 18 should undergo surgery, Prof Djordjevicfears this age limit could soon be reduced to include minors.
Were that to happen, he says, he would refuse to abide by the rules. “I’m afraid what will happen five to 10 years later with this person,” he says. “It is more than about surgery; it’s an issue of human rights. I could not accept them as a patient because I’d be afraid what would happen to their brain and mind.”
Referrals to adult andchild genderidentity clinics in the UK have increased dramatically over the past 10 years. In April, the Tavistock and Portman NHS Foundation Trust, the only clinic for adolescents in England, reported 2,016 referrals to its gender identity development service, a 42 per cent increase compared to the previous year, which in itself marked a 104 per cent increase on the year before that.
The clinic stresses the majority of its young referrals do not end up receiving physical treatment through the service. While NHS guidelines state young people should not be givencross-sex hormone treatmentuntil 16, concerns have been raised about the lack of regulation particularly in the private sector.
Earlier this month, it was revealed a Monmouthshire MP, Dr Helen Webberley, was being investigated by the General Medical Council (GMC), following complaints from two GPs that she had treated children as young as 12 with hormones at her private clinic, which specialises in gender issues.
Referrals to adult and child gender clinics have increased dramaticallyCREDIT: E+
Dr Webberley insists she has done nothing wrong, and there were no “decisions or judgements” made on the claims against her. “There are many children under 16 who are desperate to start what they would consider their natural puberty earlier than that,” she said earlier this month.
Prof Djordjevicfeels differently, and admits he has deep reservations about treating children with hormonal drugs before they reach puberty – not least as by blocking certain hormones before they have sufficiently developed means they may find it difficult to undergo reassignment surgery in the future.
“Ethically, we have to help any person over the world starting from three to four years of age, but in the best possible way,” he says. “If you change general health with any drug, I’m not a supporter of that theory.”
These are profoundly life-changing matters around which he – like many in his industry – feel far better debate is required to promote new understanding.
But at the moment, it seems, that debate is simply being shut down.