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

[Vegilante]

New opinion piece by "essayist & critic" Andrea Long Chu that says drastic medical interventions such as hormones & genital surgeries should be given on demand to trans people - even when they're so deeply unhappy they feel suicidal, & they're convinced the treatments they're demanding will only make them more miserable.

Why? 1) Because the "true purpose" of medicine's "first do no harm" maxim "is not to shield patients from injury but to install the medical professional as a little king of someone else’s body." And 2) because "the negative passions — grief, self-loathing, shame, regret — are as much a human right as universal health care, or food."

www.nytimes.com/2018/11/24/opinion/sunday/vaginoplasty-transgender-medicine.html

Since many people won't be able to access the article, I'll copy & paste it, with apologies to copyright holder(s).

The author is not getting a vagina.

Indeed it must be deeply painful to obsessively desire something that is completely unattainable. I think the author described this very poignantly even though I disagree with their perspective on body modification surgery and find their appropriation of the word vagina extremely offensive.

This is more word salad? What does the word “want care” mean if not “to have this procedure will improve my life”?

If I am deeply convinced that I ought to be 3 inches taller, though I know that it will be horribly painful and expensive and will not make me happy because I will be a mere facsimile of a tall person and by body will work less well... should I be getting surgery?

Maybe I could convince a plastic surgeon who was just looking for a paycheck to do it but I think most would consider this deeply unethical.

No I’m afraid that a degree of gatekeeping is absolutely essential unless we want to force docs to do things they consider unethical.

Perhaps this person would be less miserable if they stopped taking estrogen and got on with their life as they themselves admit transition is not helping their mental health at all. They sound like my husband just before he desisted TBH.

That ain't no vagina bruv.

No. This person has absolutely no clue about medical ethics and the medical profession.

No, doctors do not just give out whatever treatments a patient wants on demand. Absolutely not. Especially if those treatments pose more harm than benefit to the patient.

This person is demanding that one of the founding principles of medical practice be overthrown.

I read another piece by this author in which she describes being the (then-male) manager of a girls’ volleyball team and how then-he was given a peek into intimate women’s spaces by virtue of the role then-he had. She found it arousing and romantic to be part of the girls club but sad to be on the edge of it by virtue of her then-male sex.

Sounds like a classic case of AGP to me, a desire for women’s bodies that extends fo wanting to become female too. Of course this is physically impossible so of course even reassignment surgery will leave her dissatisfied and still craving a different body.

That to me is a mental illness in need of therapy and medication, not surgery on demand and the upending of any concept of female-only space to baby the whims and regrets of people like Chu. Her pain is real but it’s not caused by ‘terfs’ or mean doctors or transphobia. It’s all in her own mind.

The author's first (upcoming,) book apparently is on "femaleness as political suicide".

Because what the world needs is another bio male telling us what "female" really is. Also, suicide is something you DO. Being female is something you ARE. So how the fuck is it political suicide?? Jfc.

I immediately thought of this comment from Dr James Barrett who was president of the British Association of Gender Identity Specialists when he wrote this in his evidence to the parliamentary Transgender Equality Inquiry.

The same phrase — “informed consent” — seems to the Association to have been borrowed by those suggesting very radical and negative shift in medical practice. It is suggested that provided patients are of sound mind (this amounts to the exclusion of serious mental illness) and understand the nature and consequences of what they request it should, essentially, be the role of the practitioner to fulfil that request. Crucially, there seems to be no recognition or acknowledgement of the view of the practitioner concerned about the merit of the suggested procedure. If actually implemented, this arrangement would leave medical practitioners in the position of having to make diagnoses they do not believe in, prescribe drugs they personally believe will not benefit the patient and undertake surgical procedures that they themselves believe will confer no benefit or cause harm. This is incompatible with medical practice, the first tenet of which is that one should “first, do no harm”.

Is this 'give me what I want' attitude common amongst transgender patients?

No, doctors do not just give out whatever treatments a patient wants on demand.

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

I think banning cosmetic surgery would do way more for women than trying to ban transsexuals.

That was the 2015 Transgender Equality Inquiry.

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.'

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.

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?

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?

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.

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.

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.

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.

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

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.

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.

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.

Electron1

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

You don't have to answer me do you?