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?

This is why very few adult transexuals have had genital surgery. Especially males.

Yet society thinks they do.

There are actually a lot of complications with mastectomies too. It's not a walk in the park and you can be left with life long damage.

I came across a horrific paper the other day which deserves its own thread.

About using pbs to stop unwanted sexual behaviour in young autistic males. Chemical castration.

Any of this for under 18 year olds is morally wrong and shouldn’t be allowed. Puberty blockers, hormones, surgery - all of it. I can’t believe it’s allowed. It’s outrageous. In the future we will look back at this as abuse, I have no doubt.

For adults, I can’t see how - in a world where anyone can have extreme cosmetic surgery - you can stop people having this type of surgery. It is essentially cosmetic surgery. You can’t change sex. I think it’s a terrible solution to mental health issues and/or answer to harmful societal pressures, but I feel that way about breast implants too.

By changing someone's genitalia you're not changing their biological sex. Unless you're able to change a person's XX or XY chromosomes they simply cannot change their 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?

Yes.

And even if you could, it would be too later in adults post-puberty. 99% of adult development and differentiation is done by 16.

I suspect that part of the reason is that no single speciality has oversight of the process, and that each speciality feels (rightly or wrongly) that they are devolving some of the responsibility onto their colleagues. So the surgeons and endocrinologists assume that the referral is made on the basis that the medical/surgical pathway has been assessed as the most appropriate for this patient. And then from the endocrinology and surgery point of view, unless there are clear medical contraindications, the focus is on how to carry out the treatment for which the patient has been referred, rather than on whether this course of treatment is appropriate for the patient in the wider context.

The primary care practitioners, or whoever made the initial referral, is at a safe distance from the really awful surgical complications that may ensue down the line and may never really find out, or want to know what the long-term outcome is. There's a similar process of denial built into what little research there is on surgical outcomes, with lots of patients lost to follow-up or only followed up for fairly short timeframes. So there's a massive level of cognitive dissonance built into the process, I think, both from the patient's and the medics' perspective. I assume that in the US model people can self-refer to surgeons, which creates an obvious financial conflict of interest as well.

Exulansic has a very good, if distressing, series of videos in which she deconstructs the tiktok/social media stories of people with really horrible surgical complications, and she really unpicks the conflict between the truly terrible outcomes and the desperate need of the patients to believe it was the right thing to do and everything is fine really.

I think you could argue that an individual undergoing gender reassignment doesn’t pose a direct risk to women’s rights, the risk to women’s rights come from the politicians or organisations who make the laws and/ or policies which decide whether gender reassignment affords individuals the right to single sex spaces in line with their gender reassignment. The rights of individuals don’t change because they have had gender reassignment unless the country/ state/ organisation etc within which they’re in recognises that, it’s not like you can have gender reassignment and then go to any place in the world and automatically be seen as that sex, there are many places globally where gender reassignment would not afford you entry into a single sex space of that gender. I suppose there are maybe a small number of individuals who after gender reassignment manage to ‘pass’ as the other sex and may therefore be able to gain access to single sex spaces even if it’s unlawful or against individual policy to do so but in most cases even after gender reassignment the true sex of most trans individuals is obvious and so they can only enter single sex spaces if laws or policies allow them to do so, regardless of which surgeries they have or haven’t undergone.

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.

It's an interesting theory, but most of the people who are guilty of arguing like toddlers in this debate do not have the excuse of having been on blockers.

@MolkosTeenageAngst

you have a point but ultimately I assume the GR person wants to enter single sex spaces etc.as a result of the surgery. It would be strange if the person didn't in reality.

the problem then becomes that a medical team have performed radical surgery but the public won't necessarily validate that decision in terms of sport, access to shared space etc. and won't this add to the patient's mental health problems?

the person would therefore act as an example.to.pressure policy makers to redefine rules on access etc. From a policy perspective there may be no difference between a man with a penis and one without.

I think the argument should be re framed from trans rights to biological women's rights generrally.

@BlackForestCake

I think a reason for some responses from trans women in these arguments is that many put on a faux passive demeanour as it is their interpretation of feminitity. Male.aggression ultimately surfaced though because they are , yes, a man and the rage is expressed through an incoherent rant.

I wonder how many GR people.say the 'right thing' upon assessment to force the surgery to go ahead. If it is well known that saying your suicidal allows the surgery to go ahead then people will use this.

the problem then becomes that a medical team have performed radical surgery but the public won't necessarily validate that decision in terms of sport, access to shared space etc. and won't this add to the patient's mental health problems?

No radical surgery can ever change a person's biological makeup. So I wonder whether the cost and risk is even worth it?

the problem then becomes that a medical team have performed radical surgery but the public won't necessarily validate that decision in terms of sport, access to shared space etc. and won't this add to the patient's mental health problems?

Yes quite possibly, and trans-activists will probably blame society and say that society needs to change, and that it's the attitudes that are causing harm.

Rather than, it's just a reality that you can't change sex, society is within its rights to accept this correct viewpoint, and the trans person is unfortunately suffering because of unrealistic expectations that everyone should go along with their own belief about themselves.

Interestingly when a Scottish surgeon started to write articles extolling (and I believe actually performed) removal of limbs for body dysmorphia it was hastily quashed as a recognised treatment due to ethics.

Weird how it's very accepted when it's to do with sexuality and sexual organs and also children.

Cosmetic surgery is hugely questionable in terms of medical ethics, though.

If you take it from the pov of what medicine is supposed to be, and what doctors are supposed to do, it's very difficult to see how 99.9% of cosmetic procedures can be justified. Significant risks for no medical purpose.

Personally I don't think people who do this kind of work should be considered doctors, whatever their training is. What they are doing is something totally different from medicine, and medical professional and ethical organizations can't regulate that while maintaining their core responsibilities. The metrics are opposed.

The other issue not discussed is that plastic surgery has been found ti be ineffective for other types of body dysmorphia. After an initial high, more surgeries are sought and none of it dispels the mh issues related. Only intense therapy.

I think ther are two things going on here - TP who want surgery (I saw a trans person saying you should only ever have surgery if you genuinely hate your body, not because it’s part of the journey, or you feel it’s expected). Maybe young people are more likely to think surgery is the answer because of the rubbish they are exposed to. There was an horrific thread on here with surgical outcomes a while ago - one being that kids who have been on PBS don’t have genitalia that’s developed enough to use in the surgery that adults who have been through puberty have.

The other group have no intention of every cutting off their dicks, are part of the trans umbrella and just want to push our boundaries, scare us and erase us

https://www.mumsnet.com/talk/womens_rights/4721731-complications-from-trans-surgery

this was the thread

@Justnot

Not having GR surgery to retain male sexual function belies the whole idea of transitioning. Its as if the person wants to retain their sexuality which is fundamental to sexual identity while being accepted as a 'woman' in others ; doesn't make any sense.

The safeguarding issues related to male desire in areas where women are vulnerable are obvious

GR surgery in effect means the person becomes nearer asexual rather than the opposite sex. Do people realise the crudity of such operations which are similar to amputation?

Should it even be called gender 'reassignment' surgery?

Especially as it is not medically possible to change a person's chromosomes or biological makeup. By removing a penis you're not creating a woman.

They ARE amputations, 'similar to' almost fudges the issue and I think it's important that we are very clear here, no euphemisms or minimising. SRS in men requires amputation and in women, well, god knows; "easier to make a hole than a pole" as someone said to me once.