Ethics of gender reassignment surgery

[mids2019]

I was thinking about the ethical implications of any form of gender reassignment surgery and I wonder if ultimately some surgeons bypass the ultimate stance of 'do no harm' that governs the medical profeesion.

we absolutely rightly stand against FGM (illegal) because it frantically reduces the ability to experience sexual pleasure (as well as introducing other health issues) but we legitimately consider doing surgery with similar implications with the only difference it is done on a voluntary basis? A surgeon who is about to dramatically and irreversibly damage someone's genitalia would want immense assurance that it is in the patient's best interest including evidence of psychological assessment but don't TRAs argue the assessment itself would be considered 'conversion therapy' and therefore not a part of the process?

There was a weird case in Europe where a gay man cut off another man's penis in an extreme and commercial fetish act but the person committing the act was still liable to prosecution. Is there such a massive moral divide between this situation and that of gender reassignment surgery?

We also have to consider that GR surgery unlike other surgeries impacts on the rights of others. By making a man superficially anatomically similar to a woman you are facilitating the invasion of safe spaces for women and making it notionally harder to prevent make access to women's sports. There is also the dilemma of sexual relationships and whether in reality any sexual partner is truly consenting to a GR partner when they assume they are of a biological sex.

As for puberty blocking drugs where are the large scale clinical trials and longitudinal studies to bring this practice into safe evidence based pracrice. Anyone involved in clinical trials know these things take years nd to my knowledge such normal development process has not been undertaken in the extremely interventional practice of altering body hormone concentrations?

I guess the upshot is whether medics in this field and their employers feel really sure footed legally and why would medics necessarily engage with this activity?

Consensual not commercial

I've felt this about surgeons and endocrinologists for some time. They have a duty to do no harm. Is there a parallel with cosmetic surgery? We've all seen the programs/celebs with chronic body dysmorphia hooked on life long plastic surgery addiction. Who ethically works on these individuals? Perhaps ethics don't exist anymore.

@BlooDeBloop

It is strange. I would very much hope medics act in the patient's best interest? It is insteresting the mention of cosmetic surgery because ultimately isn't gender reassignment. surgery just that, cosmetic; it does not allow you to change sex.

my concern would be with removing genetalia you severely compromise the ability to gain sexual pleasure again and I wonder how many patients really do understand that ramification? If a medic tells a patient 'I can remove your penis but you will never again derive sexual pleasure front that area' is that actually comprehended or does the gender dysphoric patient blank the information out of feel the advice is simply a barrier to their dream of becoming a woman? I wonder if some actually believe that a false vagina is an erogenous zone (similarly with nipples). I think there are some real psychological and ethical issues to address here.

Also what are the long term.endocrinological impact.of having testes removed?

Remember also castration is as old as the hills and is an ancient punishment for many cultures......Is voluntary self harm still harm?

I strongly recommend Time to Think by Hannah Barnes for more information on what’s been done to kids.

It is why these procedures have to be framed as ‘life saving’. And why so much focus is placed on the potential for suicide.

The reality is that both studies looking at whether there is improvement after these treatments and clinician feedback is that the mental health improvement may only be for a short time, if at all.

I think this is the biggest issue for me. I'm not entirely convinced especially where puberty blockers and or other hormones are used that parents/caregivers or even the teen concerned understands the magnitude of what they're ostensibly opting in for. The irreversible damage is like no other. There's a good article about this in which it was said that aside from the physical changes or lack thereof these puberty blockers also affect the cognitive changes thus leaving the kids who take them in a sort of limbo state of not quite developed but still 'under-developed' in comparison to their peers.

Heartbreaking stuff all round. Apart from anything else aren't these surgeons also concerned about the inevitable legal cases later down the line when people start connecting the dots and realising their bodies are now in some essence completely dysfunctional.

Surgeons and endocrinologists that enable young people to self harm really ought to be struck off. I wonder if that day will ever come?

puberty blockers also affect the cognitive changes thus leaving the kids who take them in a sort of limbo state of not quite developed but still 'under-developed' in comparison to their peers

Is that part of the reason why we're seeing that some people on the gender ideology side are apparently unable to form coherent arguments in support of their views, beyond "you're nasty if you don't agree with me"? It's got to stay at primary-school reasoning levels because otherwise too many people involved genuinely couldn't understand it.

You are anything but a non person. You are perfect the way you are, TransMillennial. I wish you well and truly hope you find happiness on the path you have chosen.

I still think allowing surgeons and endocrinologists near under 18s for cosmetic reasons should be outlawed

I think where adults have gender dysphoria (diagnosed by a psychiatrist who doesn’t follow the affirmation model) and it is persistent I would be ok with the surgery. I think for some people it may be a way to ease their psychological issues and I’m fine with that. I think part of the problem is a) that trans does not mean transexual anymore b) the expectation that this shouldn’t be a very specialised and niche area of medicine.

Still think biological sex is the most important thing and transwomen should expect to be excluded from female spaces as the norm not the exception. I am very GC and think any kind of transition should be absolutely the last resort after years of therapy but I can see that for some small number of people it may be the only way to get relief.

Can doctors really reassign a new gender with surgery? I doubt it is medically possible.

@TransMillennial im sorry things have been so hard for you and therapy hasn’t worked.

im trying to understand why a uterus causes dysphoria. I can’t see mine and I can’t grasp what my trans friend means about needing the uterus out. Don’t answer if this isn’t a reasonable question, I have tried to work out the reasoning for this but just can’t

Lots of medical treatments have risks and side effects, chemotherapy for example can cause pain, sickness, hair loss etc and lead to long term issues such as infertility, hearing loss, heart issues, osteoporosis etc. Any medication or surgery etc for any medical reason involves some level of risk from side effects, and at the more extreme and rare end most of these side effects can be severe and include death. Often when deciding on a medical treatment doctors have to weigh up the risk vs benefits of going down that route, often a treatment will be carried out knowing that there is a risk of unpleasant side effects or ‘harm’ but that’s because the potential benefit is seen as greater than the potential harm.

I’m not saying I disagree with your view on gender reassignment personally, but I suppose the side effects can be justified if the doctor believes that the risk of not carrying out the surgery (presumably mental distress, risk of self harm and suicide etc) is greater than the resulting negative side effects. The fact a treatment has harmful side effects won’t in itself be a reason not to carry out the treatment under the ‘do no harm’ rule because almost every medical treatment has a risk of harmful side effects, it’s more a case of trying to ensure that the outcome of the treatment is most likely to have a positive outcome that outweighs the potential risks or negative side effects.

@TransMillennial

I am sorry to read your post and hope everything works out. Neurodivergence and mental health are hideously challenging and I would assume that a variety of approaches to need to be taken to make an individual's life as happy and fulfilled as possible.

If your image of your body traumatised you to an extent that surgery was the only means to ameliorate the symptoms was to have surgery I hope this does work. I guess that whoever operated on you needs to be happy in their own minds that what they are doing in is in your best interest hence exploration of the underlying mental health issues to absolutely ensure this is the right course of action.

The concept of affirmation may work between you and a psychotherapist may work between you and them but when entering general society it has to be accepted that there are many who believe sex is immutable and will not engage with the affirmation. This is not to be cruel but a statement of their well grounded conviction that transgenderism does have major implications for women's rights.

I am sure no one wants you to be suicidal and I am sure those overseeing your care absolutely want the best for you.

Worth remembering that much of this experimental, unevidenced, medical "treatment " is carried out on children and young people who are handing over their fertility, health and future lives while under the influence of a social contagion pushed by some of these vultures.
Personally I hope the whole lot of them are dragged in front of the courts for illegal medical experimentation on children and adults.

@MolkosTeenageAngst

It is a really challenging problem doing risk benefit analysis of any procedure especially when it comes to mental health.

If we routinely give out anti depressants for example but they turn out to be a carcinogen do we continue to prescribe and is that really in the patient' interest? These are challenging ethical questions that need debating.

Incidentally as person may feel suicidal in the event of a relationship break up but obviously we can't force the other person to reform the relationship no matter how difficult life is for the person that has been left. A similar principle I believe acts with gender reassignment surgery; we cannot always offer solutions to people's health problems if it impacts on the rights of others. In this case the general societal consequence of GA realignment surgery may facilitate the removal of women's rights.

And male children who go on hormone blockers and subsequently take cross sex hormones will be able to experience orgasm in their lives. Even if they don’t have the surgery - I believe it is just the blocking of testosterone.

Marcie Bowers, a leading gender surgeon in them USA, recently said this. It was 100% unable to experience orgasm. I wonder if the parents of young kids really understand that this is what the future holds for them if they go down that path. And what kind of consent can an 8 or 10 year old give for this?

Will NEVER be able to experience orgasm

Agree ethics are interesting things - we wouldn’t agree that hopping the legs off a body dysmorphic person was the right thing …

@user4567890754

The removal of a rson's ability to enjoy sex and reproduce is a massive decision that cannot be in any way taken lightly in a humane society

Therefore any counselling should be intensive and explore alternative solutions without this process being referred to as conversion therapy.

I worry increasingly about the side effects of cross sex hormones. Have you seen all the dire warnings women get about the (slightly) elevated risk of breast and ovarian cancer when they start HRT? And thats just putting existing hormone level back to what they were in that body for the past 40 odd years.

The amount of estrogen you need to give a man to completely quash his testosterone production is much higher. Surely this puts them at significantly increased risk of stroke, blood clots, cancers, particularly prostate cancer if it's not removed and heart disease?

And girls on long term testosterone, after Lupron? Surely that also has elevated risk of stroke and hear disease?

Are these things discussed with the patients before they are put on puberty blockers and cross sex hormones, never mind when they have their tested and ovaries removed - organs that are extremely important in hormone regulation. Certainly didn't seem like it atvteh Tavistock.