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?

IMO medics commiting these atrocities are not doing so in the patient best interest but do so because of power and money. If they did it for the patients best interest they would be evidence led.

There is no extra power or money doing breast implants on a woman who has had a mastectomy for breast cancer vs a transwoman wanting fake breasts. At least not anywhere that has universal healthcare, which is most countries.

There is a real difference between breast implants post masectomy (cancer) and breast implants to make a man feel like woman. One is an attempt to restore something at least in shape of something lost through disease, the other is an attempt to fulfill a psychological need for something the patient never had or has conception of.

I wonder if tw choose their breast implant size and whether any choose small cup sizes? If always large doesn't that tell you something about the perception of the other sex by trans people?

Yes there is a difference, but the surgeon who does them born doesn’t get more money or power for one over the other. So I don’t think that money and power is really a motivation for surgeons who do any gender affirming surgeries in countries with universal health care.

does them both! Not born.

I wonder about surgeon motivation as I actually believe medics are reasonable people and professionally wouldn't do anything they didn't believe in

The surgeon must therefore be guided by institution policy. I wonder how much interaction the surgery team have with the psychological assessment team. If the psychological assessment is limited (or removed) due to it being deemed 'conversion therapy' then I would suggest many surgeons would have grave misgivings about surgery performance

There must be surely questions about just doing breast surgery and not genetalia? Do trans people really want a hybrid anatomy?

It’s different surgeons for breasts versus genitalia. You’d never go under the knife for both at once anyway because it’s too long to be under.

I think you have a point about stove piping, different psych doctors, different surgeons there is no joined up approach for each transgender person and every medic is assuming that all checks and assessments have been done.