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).

pombear

I'm not pretending that it isn't huge surgery. I can't contemplate how desperate you must feel to consider having it done but I feel the same about all cosmetic surgery. When I see programmes about tummy tucks or breast implants or face lifts where they peel your face away from your skull I cannot imagine wanting that done. But as far as I'm concerned it's between the patient and their doctor and it's really none of my business.

With regards limb amputations - I don't know. Gut reaction makes me want to say no. But I don't know enough about it. I don't know what the medical advice is. If respectable doctors (ie not a butcher with a folding table in a back alley somewhere) assesses that it is in the patient's best interest then again, that is between the patient and their dr.

What I would hope is that for all of this surgery all patients are given as much support, counselling etc as they may need so that they can be absolutely clear that it is what they want and they appreciate all risks.

This discussion just feels as though it is none of my business. It won't impact on my life so I feel that I have no right to comment and I certainly won't judge anyone that has it done.

Scrumplestiltskin

Yes I do. I was a nurse on a urology ward. I nursed a patient who had had it done. I do know.

How is it any of my business?

Weetabix Thanks for your thoughtful answer.

I'm with you about not being able to contemplate being that unhappy with your body for whatever cosmetic surgery people want.

I'm already concerned about the growing normalisation of cosmetic surgery already - but at least that's for body parts that are being changed cosmetically, but those parts are at least retained in some way.

But if we all just go "hey, whatever you need, not my business" and it slips towards not retaining body parts, actually removing body parts that provide natural bodily functions like urination, sexual function and pleasure, lactation, etc, that to me seems like a concerning step.

Both for what we expect of the medical profession, and of the message we give to upcoming generations. A tummy tuck keeps your tummy and doesn't create a continual wound. A face lift keeps your face. Creating a neo-vagina destroys a penis and creates a wound.

People who choose to self-medicate with heroin because it helps their mental health problems don't impact my life.

Essentially they're not my business. But that shouldn't mean I don't support services who help them seek support in other ways that are less destructive to their bodies and lives?

I just find it a very slippery slope. You are applying your judgements onto the procedure. For someone that hates certain parts of their body maybe losing the ability to breast feed, maybe even losing sexual pleasure is a price worth paying for them? I don't know because I've never felt it.

Maybe cosmetic surgery appears less serious to the individual but what price for society? Is the increasing popularity actually encouraging more girls and women to hate their own bodies? Are we all starting to see the norm as being surgically sculpted and enhanced? I would argue that the more mainstream cosmetic procedures are more damaging to society because they are becoming normalised and because more people are doing them.

I absolutely would support better support services because I don't think that any of these life changes should be made without considerable thought.

Shouldn't the standard just be to do the surgery where strong suffering/dysphoria (psychological assessment) has been demonstrated and an improvement in life quality can be reasonably expected (psychological assessment, studies on outcomes)?

I can't see what else should factor in. I very much doubt limb removal will make people happier. The wish is a symptom not an end to itself. For SRS there are people who are happier with it, while others are not. You get similar mixed bags for all kinds of cosmetic procedures and there the responsibility of doctors should lie, to weed out notorious self-harmers or people who aren't really dysphoric but just want to win the 'flattest tummy contest' in the fitness center.

Taking the breast example: If a woman is so dysphoric about her breasts that she insists on surgery, the function of the breast won't be super important, as she'll probably never nurse her child due to the sysphoria, anyway, no?

No other medical treatment gets given "on demand" to people. Why should hormones and surgery to try and make you more like the opposite sex be any different?

I'm a GP and am often saying no to requests for opiates, benzos, sick lines, referrals for stuff that doesn't meet referral guidelines and is normally dealt with in primary care.
I have to abide by GMC guidelines and if that seems to be me being authoritarian that is part of my gatekeeper role that is essential if the NHS doesn't go bankrupt or have 3 year waiting lists and everyone on prescription opiates and sick lines.
I do think a lot of private plastic surgery is dubious ethically. Body dysmorphia is a real condition and surgery rarely cures the problem.
I've not yet met a transsexual who can really explain exactly what they think they could "do" in their desired gender that they can't do in their current one. What does Pippa Bunce do that Phillip Bunce can't? Why can't you be your authentic self without altering your body and wanting your pronouns changed?

I'm a woman because of my female body not because of the way I think and dress. My job and hobbies are unisex. It seems an overly simplistic way of viewing the world and gender changing treatments seem to be completely the wrong answer to the problem of gender dysphoria when many sufferers seem to have an almost OCD type preoccupation with gender and gender stereotypes rather than focusing on what sort of person they are and what they want to achieve in life.

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

Since children are being put on puberty blockers to facilitate gender reassignment in their future we have as much right to pass judgement on this as any other form of abuse.

If it wasn’t for gender reassignment surgery there would be no pretext for sterilising children.

I read this article earlier and I must say it is illuminating in quite a few respects. First off, an attempt to describe gender dysphoria :

"Dysphoria feels like being unable to get warm, no matter how many layers you put on. It feels like hunger without appetite. It feels like getting on an airplane to fly home, only to realize mid-flight that this is it: You’re going to spend the rest of your life on an airplane. It feels like grieving. It feels like having nothing to grieve."
I found that helpful.

I also watched a Facebook discussion between trans people arguing about whether gender dysphoria as a diagnosis is wrong for gender ID and sort of drawing a line between the UMBRELLA how it is preventing "real" trans from getting their hormones or whatever...

My point is that I'm seeing cracks in the ideology and new ways to dredge up some arguments to gender critical voices.. (the FB thing is on Esther Betts page)

The NYT essay is deeply disturbing. The "king" thing? The dad is a pediatrician,,,hmmm therapy please.. " Take it from my father, a pediatrician, who once remarked to me that he would no sooner prescribe puberty blockers to a gender dysphoric child than he would give a distemper shot to someone who believed she was a dog."

It's astounding this was published in the Sunday NYT. Not sure what to make of it

Perfectly put 2rebecca
Thank goodness we have the gate keeping of NHS GPs.
For every patient who thinks they have a right to surgery I would say surgeons have a right to refuse to perform that surgery for whatever reason, be it ethical, professional judgement or steering clear of bonkers patients telling them how to do their job and avoidance of future court cases.

I agree it is entirely up to drs to decide on any treatment or surgery, as I said.

I do find it interesting that there are surgeons willing to perform some quite questionable cosmetic surgery (where do ethics fit in these cases?) and that we are accepting of the increase in cosmetic surgery such that it is becoming almost the norm now to have it done.

I just find it a very slippery slope. You are applying your judgements onto the procedure

No one is doing that. This is about medical ethics, something you should understand as a nurse. No ethical doctor will perform a procedure that will make the condition of the patient worse. The writer of the article under discussion has admitted that surgery will damage their mental health and lead to more suffering, yet they are still insisting they must have that surgery. I understand this person is in the US, maybe things are different there, but in the UK a doctor who agreed to provide any kind of treatment on that basis would be, rightly, disciplined and likely struck off.

This is about medical ethics, something you should understand as a nurse. No ethical doctor will perform a procedure that will make the condition of the patient worse

But this surgery does not definitely make someone's condition worse. People have it done and are happy with the results. I have no idea in this case and presume that the person concerned will be working through things with their doctor.

I am unsure why people are refusing to see the similarities with cosmetic surgery. If you see gender reassignment surgery as unethical then do you not see cosmetic surgery as unethical? To undertake a procedure on a healthy patient and expose them to all of the risks that surgery poses just to alter their physical appearance? Is that not unethical?

To participate in the growing pressure within society to make people feel bad about "normal" bodies? Isn't that unethical?

The concern about medical ethics only appears to relate to gender reassignment surgery and I can't work out why?

But I also believe that surgery’s only prerequisite should be a simple demonstration of want.

The thinking of a society where medical care is paid for. If you have the money, it's your right to get anything you want, even surgery when your real problem is psychological. If you don't have the money, well....

The thinking of a society where medical care is paid for. If you have the money, it's your right to get anything you want,

It's happening here too. Women pay privately to have a C Section don't they when they wouldn't have one on the NGS unless there was a clinical need.

But this surgery does not definitely make someone's condition worse. People have it done and are happy with the results. I have no idea in this case and presume that the person concerned will be working through things with their doctor.

In the case of this individual, they have already admitted it will exacerbate their existing mental illness and will not bring about any relief from dysphoria, therefore, it would be unethical for a doctor to carry out surgery.

Maybe in this case but not in all cases.

Maybe the author of this article won't have the surgery. I am talking generally.

No ethical doctor will perform a procedure that will make the condition of the patient worse. The writer of the article under discussion has admitted that surgery will damage their mental health and lead to more suffering, yet they are still insisting they must have that surgery.

This is what I find scary about this article. And it very much aligns with this consumerist mindset that is advocated by some professionals on the trans-train, like Ehrensaft 'a touch of testosterone, for the nonbinary identity,.... just cut 'em off, you can always get new breasts later, ...'

Maybe the author of this article won't have the surgery. I am talking generally.

But this thread isn't about surgery generally, it's about a specific case.

It feels like getting on an airplane to fly home, only to realize mid-flight that this is it: You’re going to spend the rest of your life on an airplane

So, an entirely irrational belief that has no basis in reality.

If someone said they felt like they were trapped on an airplane would you prescribe a parachute?

It's happening here too. Women pay privately to have a C Section don't they when they wouldn't have one on the NGS unless there was a clinical need.

The choice of C-section or no C-section is a very sensitive topic for me. When pregnant, and researching birth complication statistics, I realized that I could better live with the potential complications of a C-section to those of a natural birth.

I had a fallout with a doctor over saying as much on some information night (to be clear, I could not choose and did not demand I can choose. The doc just asked, whether we thought the birth experience can be planned. To which I responded, well a scheduled C-section will presumably be quite well plannable. At which point the doc called a C-section this super risky thing - and from there it escalated. I sure knew my stats and in the end the doc told me I should not scare the other women. Not sure why they should know everything about possible complications of C-sections but not about those of 4th degree tears. But Ok. It turned pretty nasty)

In the end my child (first child) was breech, so it was a 'compulsory' scheduled C-section, which was good as the baby had the cord twice tightly wrapped around his neck. There really would not have been a choice and in pre-C-section times we would both not have made it.

Ever since I have wondered, whether it is right to not allow women the choice in this (as long as it does not endanger rhe lives of baby and mother, obviously), considering they have to live with the consequences for the rest of their lives.

In the case of this individual, they have already admitted it will exacerbate their existing mental illness and will not bring about any relief from dysphoria, therefore, it would be unethical for a doctor to carry out surgery.

Quite. First, do no harm. And this is a patient who admits from the outset that the surgery is causing them harm. Ethics aside, what surgeon wants to risk the inevitable lawsuit?

I hate how huge fake plastic boobs are described as breasts.

Breasts are made of tissue, not silicone and their purpose is to feed babies.

I hate how huge fake plastic boobs are described as breasts.

In the particular context I described, it is above all highly irresponsible, as it suggests that an underage girl who gets a mastectomy (which Ehrensaft&Co advocate for), can always reverse the decision. Which is patently untrue, as you do not get back the function, a function whose loss these young girls may very well regret later.

'I hate how huge fake plastic boobs are described as breasts.'

Hell yes.