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).

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.

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.

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.

Non-maleficence is a principle of medical ethics.

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.

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)

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?

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.

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?

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?

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

Weetabix
What if the child has - courtesy bullying - become severely dysphoric regarding the ears, to the point kid won‘t leave the house? Would you really advice the kid should undergo years of therapy (which won‘t cure this bullying society) instead of granting kid the wish to get them surgically ‚fixed‘?

I had cosmetic surgery at the age of 12. It was deemed so necessary that my American insurance company actually paid for it. The risks were practically nonexistent, the healing process was minimal, and the likely outcome would be a reduction in my distress at being bullied by peers, so it was done. I am a radical feminist and have no problem with this. I don't regret having it done and I would do it again if I were 12. Cosmetic surgery covers a very wide range of procedures.

Another reason is that I take estrogen — effectively, delayed-release sadness, a little aquamarine pill that more or less guarantees a good weep within six to eight hours.

I would like an explanation for this absurd statement. Perhaps the artificial estrogen that this person is taking is not working in a very natural fashion since estrogen is a female hormone. This absolutely stinks of misogyny. Women are not producing a crying hormone in our ovaries.

This person reads like a masochist begging to be abused. The problem with masochists is very straightforward: the moral imposition on the other person is immense. If someone begs a doctor to abuse them, and the doctor agrees, the doctor has just degraded himself as a human being and as a physician. Doctors are allowed, I think, to have self respect and to make moral choices?

Doctors are not slaves. They have their own conscience, the medical ethics board, and their reputation in their professional community to consider. You want to force someone to perform unethical surgery on you? Learn to do it yourself and leave other people alone.

This especially angers me because I am close to several doctors, including my father and my brother, and it disgusts me that people think that doctors are there simply to obey orders.

Cosmetics/plastics is the same thing. The intent may differ but the discipline is the same. Anyway, I’m playing devils advocate and I do get your point - where is the line drawn on non essential surgery?

There is a grey area - our kid should indeed be ok as they are but life and other kids can be cruel. Breast reduction can be seen as purely cosmetic but it also does bring health benefits for women who are suffering from back issues etc. I know someone who had rhinoplasty for some sort of septum issue or something which aided her breathing.

Should SRS be done on the nhs? No I don’t think it should. Neither should some cosmetic surgery. There needs to be clinical justification for it.

I am playing devils advocate.

People are very quick to say that those with gender dysphoria should be given help to come to terms with the bodies that they dislike so much they want to change.
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But then are quite quick,as in this instance, to advocate cosmetic surgery in order to change their appearance because it distresses them so much???

I cannot see the difference. If you honestly believe that someone with gender dysphoria basically needs to learn to live with their body as it is then you are a hypocrite if you support someone else changing their body for a cosmetic reason.

I think that if anything about your body is so deeply upsetting to you that you want surgery, then do it. But I'm not going to differentiate and say one surgery is ok and another isn't.

There's gender dysphoria (very rare, in fact, but does exist) which can be helped by surgery - but not always, as we know.

And then there's autogynephilia (and other such fetishes) which in some men results in a demand for breast enhancements, apparently.

I cannot see the difference. If you honestly believe that someone with gender dysphoria basically needs to learn to live with their body as it is then you are a hypocrite if you support someone else changing their body for a cosmetic reason.

Nobody is actually saying this. No one is saying that someone with dysphoria shouldn’t be allowed to have surgery in order to relieve their dysphoria.

What is being disputed is Chu’s assertion that people should have medical treatments, on demand, that will not help them in any way, even if those treatments are detrimental to the person’s health and well-being.

Providing treatments that have no benefit, and will actively harm, a person is against medical ethics.

In that article, the author is describing becoming increasingly distressed and suicidal with each step of the transition process. Chu states that having a neovagina will not bring relief of that distress or suicidal ideation. Chu states that these will get worse. And putting forth the argument that doctors shouldn’t consider patient outcomes and well-being when offering treatments, but that people should get medical treatments and surgeries if they want it.

Not if it’s necessary. Not if it’s going to relive suffering. Not if it’s going to beneficial. Not if the benefits outweigh the risks.

And that doctors have no right to deny treatments that will not benefit patients and will actively harm them.

That doctors have no right to not actively do harm to their patients.

That is neither sane nor rational.

But then are quite quick,as in this instance, to advocate cosmetic surgery in order to change their appearance because it distresses them so much???

There needs to be clinical justification. When a doctor prescribed a drug /device they remain responsible for that prescription. So ‘off label’ drugs are sometimes prescribed, but doctors generally tend to be conservative and do that only when there’s a track record of the drug being used in that way - with clear evidence of benefits outweighing harms.

What’s the benefit here? Chu themselves says it won’t help. The doctor retains the responsibility for what they do and prescribe - to force them to do something they KNOW will harm the patient is unconscionable

Right. Because all the cosmetic surgeries that we see performed fall into this category?

The ever increasing boob jobs that some celebs have or the multiple face lifts where they end up unrecognisable or with severe complications from scaring etc? All of those drs acted ethically? No.

No they didn’t. I’m not arguing that at all.

I’m saying that cosmetic surgery is a broad church, and should be on the nhs based on clinical need.

SRS surgery should be a last resort for those with diagnosed GD who have not responded to non surgical treatments

It should not be on demand.

Being born male or female isn’t a congenital deformity that needs ‘correcting’ like a cleft palate.

Nobody is pointing and laughing at a boy and saying ‘ha ha that boy looks like a boy!’

Being born male or female doesn’t make speech difficult.

Stop appropriating other peoples problems for your TRA ideology.

Have you no fucking empathy?

Surely the clue is in the term "cosmetic surgery" - ie not surgery to cure an illness (like a mastectomy) or correct an abnormality (like a cleft palate), but a surgical procedure to make something appear different but without changing its functionality. Cutting off a penis and testicles and creating an inverted space using spare skin is about as far away from cosmetic surgery as one could get

Honestly as long as the risks are explained fully I see no difference between someone having gender reassignment surgery or any other form of cosmetic surgery.

Quite why I should have any right to pass judgement on what another person does with their body I have no idea.

I'm not sure why we can support someone having a boob job or their ears pinned back because they are seriously affected by it but then say no you can't have reassignment surgery even if you are seriously affected by your natal body.

Weetabix whilst I can completely see your rationale there, I'm not sure I can follow and understand it all the way through to its conclusion.

Most cosmetic surgery alters an existing body part whilst still retaining that body part (though pinned back...the ears remain.
Either enlarged or reduced, boobs remain. Maybe de-bumped or thinned... the nose remains, alljust altered,still remaining body parts).

Gender 'reassignment' surgery (I find the wording slightly 'coy' considering what actually happens) tends to equal things gone.

Testicles...removed, gone. Breasts...removed, gone. Penis...stripped, inverted, pretty much 'gone' in the form as most of us would know a 'penis'. Vaginectomy..vagina, gone.

Quite why I should have any right to pass judgement on what another person does with their body I have no idea.

I'd be interested in your view on those who have the type of body dysphoria where they believe they need to remove limbs such as legs and arms. Should the medical community proceed regardless as noone should pass judgement on what others want to do with their body?

I'm not sure why we can support someone having a boob job or their ears pinned back
I'm not really in favour of any cosmetic surgery, save perhaps something like unusually prominent ears that are causing real misery due to bullying, which don't require very invasive surgery.
But Weetabixandshreddies do you know what neo vaginoplasty involves? It is not even vaguely comparable to boob jobs etc. I've read up comprehensively on all the different methods, and read the studies on complications etc, and honestly it's nothing less than barbaric.