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?

There are no ethics in saying that surgery provides relief when it still doesn't change your sex and is just fueling a fantasy, it risks life changing complications and there is no proper follow up study to demonstrate any of the claims.

It's quackery exploiting vulnerable people who are unhappy with their bodies.

Surgeons dont amputate limbs because the patient doesnt feel it belongs to them. anorexics are not encouraged by doctors to starve themselves. There is no good evidence that surgery helps those with gender dysphoria and those that do it are not practising science based medicine. In this country that normally gets you struck off.

Mids yes it makes no sense - but no one ever comes onto defend/explain the no surgery decision - this is all my supposition from reading the other thread and similar. There will be genuine reason for some, the availability, the awareness of shite outcomes so we might hear those sorts of reasons but the out and out I’ve got a penis and I’m a woman aren’t in the business of explaining themselves or answering a direct question cos it’s all a load of illogical bollox

From some personal connections who’ve had the euphemistically named ‘top surgery’ it was most definitely an expression of self hatred in an autistic young woman with very black/white thinking. Heart breaking.

I'd like consent forms that lay out suicide stats and immediate and longer term risks from surgery or hormones.

The young person I know is prepared to risk side effects of experimental treatments because the life expectancy for trans people is 30, die to suicide.

When they've been taught that, it's hard to argue.

SRS in women involves removing skin from one arm & using that to simulate a penis.

There are pictures of these flayed arms online. They are as awful as you’d expect them to be.

I think for adults who have had a full psychiatric assessment and have tried less invasive interventions such as therapy, surgery can be an ethical offer for clinical disphoria.
But if not meeting above criteria it’s unethical, same as offering a medication before therapy for other mental health issues.

The ethics of talking about suicide in a deliberate way to create social contagion go against the Samaritans guidance on suicide for a reason.

Yet no where do I see this social contagion on suicide being challenged when it comes to trans.

It isn't hard to argue when put into this context.

You do something about the unethical social contagion....

Does the NHS ie WE pay for such surgeries?

Or are they privately funded like other cosmetic surgery?

Yes the NHS fund them.

I don't think you can use suicide threat as a form of emotional black mail to achieve something necessarily. Surely suicidal feelings should be treated through therapy/medication prior to any attempt at surgery.

Some of the surgery descriptions are hideous.

Giving hormones and performing this kind of surgery on children is abuse. There will be court cases in the future.

Where are all the trans children from earlier generations before this was a fashion?With the exception of a very tiny minority, most were just going through a phase.

I just saw this from MrMenno and it made me think of this thread:

Gender affirming surgery and hormones, ie transitioning is an ethical minefield and already the subject of thousands of pages of ethics debate.

The key difference between cosmetic surgery (which gender affirming surgery is), and genital mutilation (male or female) is willing and enthusiastic consent.

It’s the same difference between good sex and rape. So I would not minimise the importance of consent.

The ethical minefield is more about informed consent. Anything medical- cosmetic surgery, taking hormones the requirement isn’t just for consent but for informed consent and that is one area where I think the medical professionals currently fall short.

Slight derail, but I would be interested in reading that paper @WarriorN

The provision for severely autistic young people in my area is mixed sex.
If my DD got pregnant that would be catastrophical, apart from everything else that would be catastrophical about such a scenario.

on topic: it is odd that the medical treatment and healthcare that are so necessary are in fact hugely damaging, but this do not seem to be communicated clearly at all.

I was blissfully unaware until a friends adult child wanted to transition and they talked about the difficult procedure.
Then another friend explsined how «neovaginas» are actually made and how they must be maintained and it was such an eyeopener.
When it comes to the skingrafting to fashion the skinroll they attach to transmen, it is horrible. It in no way approximates a penis.

It seems someone is very keen on selling a lie

www.tandfonline.com/doi/full/10.1080/24750573.2018.1462038

It's a very sensitive and difficult area. It's noted that it's damages the bones and other factors.

I can’t help but think that if these surgeries and hormones etc. weren’t available that there would be a lot less people with ‘gender dysphoria’. They’d probably have some other kind of dysphoria or their unhappiness would find another way of manifesting, but it is mainly because they see other people doing this and they know it can be done (to some extent) that they that it becomes such an all encompassing desire.

If it’s not possible, then you won’t give it much thought. If it appears possible, if only you had more money or the world would just bend to your will, then it becomes a goal just out of your reach, and so becomes an obsession.

The human spirit is quite an amazing thing. You give it hope and it will strive. The diet and beauty industry use it against us all the time.

It is a difficult thing to discuss. However, injected contraception or other contraception in girls are not without side-effects either. They can be quite severe.

Young people with severe autism can be very interested in sexual activity, and like the boy in this article, may have no sense of boundaries either for themselves or for the other bodies in their vicinity.

The alternative is to place them in self-contained units with 24/7 care, which is also a high risk situation.

I can’t help but think that if these surgeries and hormones etc. weren’t available that there would be a lot less people with ‘gender dysphoria’.

What did people do 100 years ago?

When Mermaids started up, their assumption was that most kids with gender issues would grow out of them, turn out to be LGB etc. And in those days, far more of them did.

There were surgeries attempted 100yrs ago. Even some Roman emperor wanted to be changed into a woman. He changed his name to a woman’s name. He dressed as one. Had a lover who he made address as his “wife.” (Some charioteer who were the sports celebrities of the day, think a Beckham boyfriend). He offered a big reward to any surgeon or magician who could turn him into a woman. There wasn’t much time for any attempts as I believe this Roman emperor was stabbed to death by assassins at a very young age…I want to say early twenties?

There was an interesting article on woman's hour today, talking about anorexia. Hadley Freeman talked about girls wanting to be seen as ill. They needed the attention and care that would come from being seen as being as desperate as they felt.
I wonder whether some of the medical steps have the same effect, demonstrating outwardly the distress and confusion that's felt.

Gender stereotypes existed 100 years ago. I'm sure people felt constrained by them in some way.

Dressing in a different way, probably did happen.

But crucially surgery just wasn't even on people's radar for anything, even if necessary to health. Before antibiotics removing part of your body was extremely risky. It only started to be widely available during WWII for surgery which I find quite remarkable. And anesthetics were really primative and also dangerous until the 20th Century.

A hundred years ago, you could die from a simple cut on your finger.

We do take for granted that we can perform surgery and expect to live. Scarily, that might cease to be the case during the course of the next century too.

So asking what people would do about surgery 100 years ago, is a bit like asking them whether they'd consider flying to the USA next week.

I have wondered about the commonality between eating disorders and self-harm. Over/under eating and bulimia do harm you, can even be life threatening. As can other forms of self harm from physically hurting yourself, to recklessly endangering yourself to neglecting yourself to over-exercising.

Self-harm is often interpreted as a cry for help. An outward demonstration of psychological agony/pain using whatever means is within that persons control.

There are other psychological reasons why people have disordered eating or self-harm, but I think the cry for help, the wanting to be seen as unwell and in need of help may be a commonality in some cases.

This is true, but castration and FGM existed millennia before antibiotics so those minor surgeries were occurring, and in some cultures were not unusual.