Does Gender Reassignment Surgery Lead to Happiness?

Slug Signorino

Credit: Slug Signorino

In a recent Straight Dope Message Board thread about transsexuality, one commenter offered the following: “People who have gender identity disorders . . . are just dudes dressing up as chicks and/or dudes who have gotten a doctor to mutilate them to have imitation female genitalia (or [the other way around for women], I guess.) . . . GID patients have a mental illness and society should be looking into ways to eradicate that mental illness through some form of treatment that isn’t the equivalent of giving a paranoid schizophrenic who thinks he’s Napoleon a bicorn hat and a saber.” Care to comment? —Startled Lurker

I’m not inviting that guy to the next meeting of my LGBT support group. However, from a certain perspective, he’s got a point.

Standard medical opinion is that transsexuals are mentally ill. The revised fourth edition of the Diagnostic and Statistical Manual of Mental Disorders offers a long description of gender identity disorder that boils down to this: You think you’re the wrong sex, and you’re not happy about it. The International Statistical Classification of Diseases and Related Health Problems calls it transsexualism and defines it this way: “A desire to live and be accepted as a member of the opposite sex, usually accompanied by a sense of discomfort with, or inappropriateness of, one’s anatomic sex, and a wish to make his or her body as congruent as possible with the preferred sex through surgery and hormone treatment.”

Fact is, most transsexuals agree there’s something wrong with them. The difference is they think it’s with their bodies, while unsympathetic outsiders say it’s with their heads.

The professional view of transsexuality is evolving. DSM-V, currently under development, proposes replacing gender identity disorder with “gender dysphoria.” From what I can see this is mostly an exercise in euphemism: You still think you’re the wrong sex, and you’re still not happy about it. But others think the whole notion of transsexuality as a disorder should be abandoned. For example, in 2009 the French health ministry declared it would no longer classify transsexualism as a psychiatric condition.

Not to get all peace-and-love about it, but the core issue really is unhappiness. DSM-III dropped the old classification of homosexuality as a disorder because of the dawning realization that whatever gays and lesbians might be unhappy about, it wasn’t about being gay or lesbian as such—the main issue was social disapproval. In contrast, even with all the social acceptance in the world, transsexuals are still going to think they’re the wrong sex.

Why they do so is unknown. Some researchers think a percentage of transsexuals have an underlying physiological condition, essentially a wrong-gendered brain. Regardless, few in the field believe transsexual impulses can be eradicated or cured. The choices are some combination of hormones and surgery, or else you just deal.

The surgery part is what makes some people recoil. They cite another condition listed in the DSM, body integrity identity disorder, characterized by the wish to have a part of your body amputated, typically the left arm or leg. You don’t see anybody claiming BIIDers are paragons of mental health and doctors should merrily saw away. But another way to look at it is that sex reassignment surgery or hormone treatment is more like a full-body tattoo. Would I do it? No, but I don’t much care if other people do.

The question is whether reassignment makes transsexuals happy. Most studies say yes, but that conclusion was questioned by the U.K. newspaper the Guardian in 2004. The paper commissioned the Aggressive Research Investigative Facility (ARIF) at the University of Birmingham to review the medical reports. ARIF’s conclusion: Most studies of SRS outcomes were fatally flawed, the major failing being that a huge percentage of SRS patients dropped out of sight.

For example, one study found that of 727 subjects who had undergone male-to-female SRS, 539 had a known address. Of the 417 who were still alive, 355 agreed to participate. Of the 232 who actually returned their forms, 86 percent rated their “happiness with result” at 8 or higher on a 10-point scale.

You can spin this any way you want. The responders are a pretty satisfied group, but what’s up with the nonresponders?

Some are surely dead. A large-scale 2011 study from the Netherlands found treated transsexuals had much higher than normal death rates due to suicide, drug abuse, AIDS, and so on. Then again, other studies have concluded that while post-ops have high suicide rates, pre-ops’ are even higher.

The subject deserves more investigation. If I were desperate enough to consider sex reassignment surgery seriously, I’d still want to be damn sure it would help.

Our Readers Say

Ok, I am a post-op mtf transsexual. Almost all the transsexual people I've met, if they could take the "blue pill" and be happy with the body they we're born with, would rip your arm out of your socket to get it. The fact is, we cannot change our minds to suit our bodies, without changing us as people, essentially that would be brainwashing. So, the next best thing is to change our body to suit our mind. I don't know why I'm transsexual, I can only assume that my body developed in one direction, and my brain / mind developed in another direction. One thing I'm not going to do, is waste any more of my life looking for the reasons why I'm transsexual, life is just too short for that, and I wouldn't have made my first Dr's appointment for this, or taken my first hormone medication if I wasn't 100% certain that this was the right thing for me.
I think it's interesting people get all caught up in this stuff. I simply get up in the morning and live my life.
"The difference is they think it’s with their bodies, while unsympathetic outsiders say it’s with their heads."

I wish it were that simple. But most insurance plans in the USA specifically exclude not only hormones and surgery, but also psychotherapy for "Gender Identity Disorder". Our health providers get into this dance of calling our services different things; my psychotherapist simply billed it as am "adjustment disorder" and we were fine.

"Standard medical opinion is that transsexuals are mentally ill." Actually, formal "mental illness" is defined by a state's mental health laws, and usually relate to incompetence or diminished capacity to take care of one's own affairs. Most disorders listed in DSM-IV TR do not meet most states' definitions of "mental illness". Nonetheless, that hasn't prevented certain groups from arguing that transgender people are all "mentally ill" and should not be employed around children. Getting GID de-listed has become as much as civil rights issue as the de-listing of "homosexuality" was (which happened in an update to DSM-II in 1972).
This commentary is extremely one-sided and does not seem to have had any fact checking.

Let’s start at the top. For some reason you could not even get the date correct. How do I see it already when it is not going to be published until tomorrow (today is the 16th but you have a date of the 17th)

The cartoon is very insulting and reinforces a false stereotype. This false stereotype reduces transsexuals to mere sexual objects. A common method of demeaning and oppressing a group. Think what the reaction would be If it was a survey of colored women. Would Slug have drawn them in such a manner? Transsexual does not mean prostitute or provocatively dressed!

The statement “Standard medical opinion is that transsexuals are mentally ill” is misleading. While it may be technically correct you have to remember that at one point the practice of “Bleeding” was thought to be the best to cure an imbalance of the “Humors”, and that malaria was caused by bad air. Recent medical research shows a very high probability that it is a “miss-gendered brain” ( > 95%) If you do a little research you will find that studies have shown that the brain of a transsexual is more like the gender they identify with than the sex of their genitals. (both in the proportion of gray matter to white matter and in the BSTc region)

At least in the case of how transsexualism has been dealt with, an argument could be made that Psychology is more of a religion a science. The “research” would be laughable if it did not affect how people are treated. In the scientific world, results are repeatable and confirmed by more than one study, also the samples studied are random, and large enough to be meaningful. The researchers should keep a “scientific detachment”. Compare that to the following examples of the “research” used in Psychology.

The tragic case of David Reimer. As a baby, the surgeon had an accident when performing a circumcision on David. “Dr.” John Money convinced the parents to have more surgery done and raise the child as a girl. He followed up on the child over the years and reportedly made David engage in “sexual play” with his twin brother to reinforce the assigned gender. Money then reported that the child was fully accepting of the “sexual reassignment” and was acting just like a normal girl. Too bad that it was the exact opposite of the truth. Dr Money LIED. However this single case was used to show for more than 30 years that gender identity is learned. (when in fact it showed that you could NOT CHANGE a person’s inborn gender identity)

In a more recent bit of “research”, the Psychologist wishing to study transsexuals, found 7 that were all prostitutes. (hardly a random sample) He even had sex with one of them. He then tried to take his findings and apply it to all transsexuals. To put this in context, replace the word “transsexuals” above with “colored women” and think what the reaction would be!

To answer your question about the non-responders to the satisfaction surveys. Think about how much discrimination transsexuals face. It is not uncommon after surgery to move to a place where nobody knows you and start life fresh. The discrimination and disrespect received from doctors would lead many to not respond. The requirement for “Psychological Therapy” is not based on scientific fact, so being forced to needlessly pay for it leads to resentment. Once I am past “needing” their cooperation, I will never want to talk to them again. (please note that some people will find Therapy useful, and should therefore get it, but that should not make it a requirement for everyone) One example, How many women need to get a letter signed from a Psychologist to get the plastic surgeon to give them breast implants? Answer: None, but for the same reversible procedure, the transsexual will have to get the letter.
Is it the purpose of this article to inspire thought provoking posts or is it just to irritate people? If you researched even a little the answers to your questions exist in many places. Do you even comprehend what transition is? Any, even small understanding that hormones and surgeries are just one piece of the puzzle? Anyone like me knows exactly why there were a lot of non responders. We all know why we did the things we did so why do you care?
Full body tattoo? You really understand a lot about endocrinology, don't you?

You had to drag out the ol' BIID ruse too. does cutting off a limb result in changes to the hypothalamic, gonadal axis? You must have a "limb" between your two lower ones. SRS is about a lot more than cutting off a limb, which is not an accurate description of feminizing surgery, at all. A vagina is created. I think you would be very unhappy with transsexual medical care because you are not transsexual. I am angry about a lot of things but I am way more happy now than I was before.

The cartoon speaks a thousand words about where you are coming from. It's very offensive.

No, transsexualism and non conformity to societally imposed gender norms has no place in the DSM. People born transsexual are not the only ones who experience distress. We do not need to be distinguished from anyone else experiencing distress.
I really feel this report is wrong on so many levels.

I am a transitioned woman, having my SRS recently, and the SRS was for me only, not to satisfy some strange desire or warped self-identity, as alleged. I have all my life felt I was wrong bodied, and I can tell you, if you are NOT suffering from gender dysphoria, you cannot understand what it is. I had the surgery so I could finally feel real and alive.

Those makes all those 'mental disorder' assumptions are the ones that need to sit back and examine their own motives. Because someone is different from you, they are not automatically suffering from a mental disorder. Perhaps that kind of thinking is the aberration, a desperate need to make yourself the center of normality, a normality of which of course does not exist.

Perhaps trying to judge without the slightest attempt toward understanding is in itself a type of mental disorder.

You might think I don't like this article and it's author. You would be right.

Lizzy
Cecil, you really should do a little research before publishing such nonsense.
The vast majority of post op transsexuals just want to melt back into society. They've answered enough questions and would just like to be left alone.
Left handedness was once thought to be a disorder too. Transsexualism is a condition we are born with. We struggle to fit in our whole lives until we figure it out.
We're criticized, laughed at, attacked verbally and physically. Most religious people and institutions say were doomed to hell.
What do we want?
We just want to be ourselves. We want to be able to love and provide for our children. We want to be able to put food on the table. We want to be able to walk down the street and not have people point and stare. We want the same kinds of things that everybody else enjoys.
Ironically, today the American Psychiatric Association announced the following position statements regarding transgender people:

ARLINGTON, Va. (August 16, 2012) -- The American Psychiatric Association advocates for removal of barriers to care for gender transition treatment and for the protection of civil rights for transgender and gender variant individuals.

APA has long expressed strong affirmation of lesbian and gay civil rights since the 1973 decision to remove homosexuality from the Diagnostic and Statistical Manual of Mental Disorders.

Now APA is issuing position statements in support of access to care and civil rights for transgender individuals.

Gender variant and transgender individuals must cope with multiple unique challenges, including significant discrimination, prejudice, and the potential for victimization from violent hate crimes.

They often experience discrimination when accessing health care and are denied numerous basic civil rights and protections.

Long-standing medical and psychiatric literature demonstrates clear benefits of medical and surgical interventions to assist gender variant individuals seeking transition.

However, transgender and gender variant people are frequently denied medical, surgical, and psychiatric care related to gender transition.

Access to medical care (both medical and surgical) positively impacts the mental health of transgender and gender variant individuals.

Being transgender or gender variant implies no impairment in judgment, stability, reliability, or general social or vocational capabilities; however, these individuals often experience discrimination due to a lack of civil rights protections for their gender identity or expression.

Transgender and gender variant persons are frequently harassed and discriminated against when seeking housing or applying to jobs or schools, are often victims of violent hate crimes, and face challenges in marriage, adoption and parenting rights,

Discrimination and lack of equal civil rights is damaging to the mental health of transgender and gender variant individuals.

For example, gender-based discrimination and victimization were found to be independently associated with attempted suicide in a population of transgender individuals, 32% of whom had histories of trying to kill themselves, and in the largest survey to date of gender variant and transgender people 41% reported attempting suicide.*

APA POSITION STATEMENTS

Access to Care for Transgender and Gender Variant Individuals

The American Psychiatric Association:

1. Recognizes that appropriately evaluated transgender and gender variant individuals can benefit greatly from medical and surgical gender transition treatments.

2. Advocates for removal of barriers to care and supports both public and private health insurance coverage for gender transition treatment.

3. Opposes categorical exclusions of coverage for such medically necessary treatment when prescribed by a physician.


Discrimination against Transgender and Gender Variant Individuals

The American Psychiatric Association:

1. Supports laws that protect the civil rights of transgender and gender variant individuals.

2. Urges the repeal of laws and policies that discriminate against transgender and gender variant people.

3. Opposes all public and private discrimination against transgender and gender variant individuals in such areas as health care, employment, housing, public accommodation, education, and licensing.

4. Declares that no burden of proof of such judgment, capacity, or reliability shall be placed upon these individuals greater than that imposed on any other persons.

See the full position statements and background information:

Access to Care for Transgender and Gender Variant Individuals Discrimination against Transgender and Gender Variant Individuals

See also a recent report from the American Psychiatric Association Task Force on Treatment of Gender Identity Disorder.

*Clements-Nolle K, Marx R, Katz M (2006): Attempted Suicide Among Transgender Persons, Journal of Homosexuality, 51:3, 53-69
http://dx.doi.org/10.1300/J082v51n03_04

Grant, Jaime M., Lisa A. Mottet, Justin Tanis, Jack Harrison, Jody L. Herman, and Mara Keisling. Injustice at Every Turn: A Report of the National Transgender Discrimination Survey. Washington: National Center for Transgender Equality and National Gay and Lesbian Task Force, 2011.
http://endtransdiscrimination.org/PDFs/NTDS_Report.pdf

Wow Cecil Adams well done ,this is the most ignorant article of 2012!

the reason why transgender people have a high suicide rate ,it's not because they arent happy with themselves ,it's because society mocks,ridicule,risk of being attacked on a daily basis and even murdered,lose their jobs,rejected by their families!
If we would live in a more accepted,tollerant ,compassionate,educated world that i wouldnt say it would be fantastic but it would be much better!

I am italian and in my country transgender people have very little rights cos our government is a joke!





Before everyone goes on a rampage about the article, I have to say it's not the worst one I've read about transgender people. At least there is some attempt at trying to understand.

As to the survey response rates etc...that's nothing to make a big deal about. Ask any researcher what response rates are like and they'll tell you it takes a LOT of invitations to get responses. People have lots of reasons for not getting back, or not WANTING to get back. Maybe they were busy living a NORMAL life and just forgot. Maybe they just didn't feel like it and watching TV seemed a far more constructive use of their time. Response rates themselves can hide bias...you're pretty much going to attract responses from people who are motivated to do so...good or bad, or in the case of nerds like me with some bizarre sense of student karma, feel obliged to respond to surveys.

It does piss me off when I see idiots making grand pronouncements about transexualism 'just being (insert simplistic description' Millions of people smoke cigarettes; inhaling toxic chemicals that slowly kill you from the inside, do we call them mentally ill? Self-destructive? Delusional? What do (some) smokers say when you ask them not to blow their smoke in your face? "It's my body, I have the right to smoke." Do we question that right? Do we mandate medical supervision as a condition of supply? ...and yet, you can buy cigarettes over the counter at the seven eleven. What about hormones?

The trans people I know decided to have surgery because they wanted to LIVE, don't they have the same right?

Trust me, I've tried to think up a million different ways of explaining it, and the shortest, most accurate way I can say it is that as some of the other posters said. "It just is". Does it really matter why? Not when you see the sun coming up and going down every day, knowing that another day passed in your life that you'll never get back, asking yourself 'what would it take to be free?' I can tell you that despite all of the heartache, the trauma, the physical and emotional pain, I have never regretted the surgery. I never 'wanted' to be trans, I didn't do this to join a sub-culture. After years of living in desperation, when I fully came to terms with myself, I knew I had to change.

"Tell me, what else should I have done?
Doesn't everything die at last, and too soon?
Tell me, what is it you plan to do
with your one wild and precious life?"
(Mary Oliver, 'The Summer Day')


Where to begin to respond to something as foolish as what has been said here in the post requires me to stop laughing at the stupidity and ignornace displayed. The writer obviously started with ridiculous statements and then tried to rely on voodoo science to re-inforce his an unsubtatiated position. I can only hope this was an intentional attempt to rile everyone and not because they really are that uninformed and niave.

Simple logic here: The AMA is recognized worldwide as an organization of medical experts. Ditto for the reputation for the APAs (Psychological and Psychiatric), the National Association of Social Workers, and truly the world's best recognized experts in this field - World Professional Association for Transgender health. They and dozens more organizations all say the the proper treatment for some transgender folks includes psychotherapy, hormone therapy, and surgeries.

Their position have been expressed in court publicly and yet they are not quoted here. These opinions have also been expressed and accepted in the court systems in the US and throughout the world.

Finally many other countries include this in their national healthcare insurance including Cuba, Canada, and Argentina. Why are we in the US behind them? Perhaps because morons can make unsubstantiated statements in media sound semi-informed and people who don't think actually believe them. And if this was only an attempt to get a response out of people, shame on the writer for taking cheap shots and promoting discrimination simply to get a rise out of people.
Interesting the writter is a 'Cecil' so admittedly I'm presuming male. But it is clear this writter has little understanding of Transsexuals and is making alot of assumption where Im only making one that he is a male.

Most sex change or post op once they have had their surgery are actually happy and just assimulate into society. They have done their hard yards, their struggle to find peace in themselves. So they ride of into the sunset or a 'normal' life. They dont want their hurt and pain bout up again and so really cant be bothered filling in surveys.

The fact that those who did are happy should be recognised and accepted. The writter shouldnt be looking negatively and arguing that because the others didnt respond means alot were unhappy.
Im a sex change and even tho broke and totally happy. Having a vagina doesnt make me a woman as I always was but it does relieve a great deal of stress and pressure society has put on me. It has stopped the anxiety and worry.
Being transsexual isnt a mental disorder but it is societies pressures and bigotry that is the cause of the suicides, depression, anxiety, OCPD, Pathological Lying etc. Those are recognised mental disorders. Transsexualism is not a mental disorder. I know many sex change who are happy, would agree with me and most have gone off to live a happy life.
The article is negative, ill informed and makes assumptions that are almost Transphobic.

The writter owes Transsexuals an appology and needs to go and try to understand instead of judging.

Racheal/Storm
New Zealand
I guess I am not surprised at the amount of confusion caused by Tran-Gender conditions! Although medicine and science has come a very long way in the last fifty years, it still has an exceedingly long way to go, esp. in regard to difficult areas like what goes on in the human brain.
The idea that "Gender Dysphoria" or whatever you want to call it is a "mental Disorder" was quite radical thinking back in the SIXTIES! Dr Harry Benjamine was mostly the first to publish this data.
It was only twelve years ago that my precious son's pregnancy caused Hyperemesis...(very extreme "morning sickness 24/7)
Even back then, nurses were still being taught that this was a "mental disorder" as was believed for over 100 years before!! One of Elizabeth Bronte's sisters died from it in the 19th C.
As they thought it was a mental condition, they simply locked her in a room to die as she could neither eat or drink !
And yet they still believed this only 12 years ago. Now it is recognized as a bone-fide physiological disease.
Now in regard to gender anomalies...did you know that ALL fetuses, male or female, start off as a kind of generic female? If left alone they automatically develop into female babies. But if a gene is present from the Father they will "BECOME" male !! This process happens in two stages. Firstly in the first two weeks the genetic signal affects the "maleness" of the body. Then, a full THREE months later, the same process affects the gender of the brain only !! If for any reason these signals get mis-read or don't work in the first stage or the second, then various Intersex conditions happen in regard to the fist stage (or body) and also gender variance in the second stage (or brain). The problem is that physical intersex conditions are often, but not always, quite noticeable, at least at some stage of life whereas brain-gender is not only much more subtle but also almost impossible to prove. These signals, one must understand, happen on a molecular level and so are impossible, at this stage to prove in the lab. But, like String Theory or Dark Matter, they must be assumed to be valid until proven.
While I can understand that people don't want to sit around reading medical papers on such matters, it might be helpful if they would not judge us or toss us all in the same basket out of ignorance.
As to whether a post op transsexual is happy after the operation is not the proper question. There should be many questions with more detail. A post op who has a job will probably be happier than an unemployed post-op who has to walk the streets to make a living. A post op who does not lose family and friends will probably be happier than one who is shunned. A post op who faces discrimination and violence will probably be more unhappy and wished it could be reversed. Surveys deal with statistics and they can be manipulated by the questions. If society totally accepted the trans community, there would be close to 100% happiness. Am I happy? Totally and wished I could have transitioned many years ago.
As a trans columnist since 2001, I've been around and interacted with thousands of transpeople, some of which are transsexuals. While there is always a small percentage of those that are affected by environment and thought they were transsexual, it is quite difficult to stay the path if you're not: one friend claimed to be, was really just an exhibitionist, and after a year or so reversed course. Of all the non-op and post-op transsexuals I've met in my travels, I have only met one that questioned her life path. The guy who is quoted above is clearly among the mass of ignorant un-knowledged that has an opinion, but no understanding.
So, is the APA going to remove and Gender Identity Disorders or Gender Dysphoria issues from the DSM-V, or not? Until they do, nothing has changed. How are transsexuals any different from the homosexuals back in 1972?
I find the negative response from the trans community incredulous. The article's premise should be applauded not attacked. How is anything going to get better for transgendered people seeking GRS and hormones if we don't establish some system to monitor the results of treatment?
Is it true that we can't change our minds so it's ok to change our body??? Think of it, what choiches would we have if we were born 200 or 400 years ago? We could only change our minds! Why this isn't an option anymore?
I have been unhappy with my condition since I was a child, I remember wishing and hoping to grow as a boy...I never operated. I think surgery doesn't suits me and I also think many think as I think. The body is not a big deal, is what you do with it that counts. Surely, since I'm a straight female, changing into a male could mean a lot of problems, since I like straight boys..!
I started reconsidering my gender some years ago and I found out that I associated to being a female a lot of negative prejudices, such as women are weak and silly or superficial, so I didn't want to be recognised as a woman.
I reconsidered what really means to be a woman and so I reconnected to my feminity. I also noticed that menstrual pains ceased more and more as long as I was trying to understand what being a woman means. Sometimes I see operated FTM and I envy a bit the freedom to change the body, but who can reassure me that a fake penis would feel just like a real one? Even if I change my body, my way of feeling sex couln't change EVER.

I think that male with female-mind or brain or viceversa a female with a male-mind is a precious resource for human kind. What's wrong with a sensible man or a pragmatic woman?
wow......frankly I don't think the creator of this article know what your taking about. i was born male. but I am female. an in till you go though the HELL that most of us as a forgotten community goes though. I don't think that you are qualified to dictate OR analyze us, in how we lives our lives or how we deal with being transsexual/transgender.
nobody seems to have got the point of this article. it's trying to explain that it is possible that the desire to "normalize" one's sex through reassignment therapy may come from trying to fit into the coveted gender binary, which is nothing more than a western societal construct.
we have to wonder wether this discomfort with one's body and gender role comes from within a person, or if it was caused by society's negative overreaction to gender nonconformity. if that is true, then it's the society that needs to change to make these people comfortable in their own skin, not "force" them to change their skin in order to be accepted within the narrow confines of traditional norms.

my opinion is not that trans people are ill, but that maybe they are trying to solve the problem by dealing with the consequence (changing their body to conform to society), instead of dealing with the cause (being unhappy about their body, due to societal pressures)

basically, if you're between genders, then stay between genders and don't let anyone tell you what to do.
Just a couple of decades ago, forms asked if we were male or female, biologically speaking. Then some PC idiot came around and declared that saying sex/male/female was impolite when discussing Homo sapiens, so the word gender started to replace the word sex on any and all forms. Had we known that such a small thing would devolve in this crass misrepresentation of science and pushing pseudoscience, we'd never have transitioned from sex to gender. Sex is binary. It is a biological fact, it is a scientific reality not questioned by anyone in the biological sciences community. There are RARE medical anomalies which cause some people to fall somewhere in between, intersexed people, hermaphrodites, various chromosomal anomalies. These are all biological facts.
As for gender, it's a concept, like religion, like gods, yes tons of people buy the koolaid, but there is no solid science behind it. So when people proclaim a gender, it's no more than a belief system, imposed by our patriarchy.
We need to reaffirm the distinction between sex and gender. Gender identity belongs in the line of questioning of politics, religion, etc. Gender does not belong in the biological assessment of humans.
Trans folks (MtT or FtT though the latter is much rarer) must be able to gather amongst themselves to talk politik, in the same that biological females must retain the right to gather amongst themselves to discuss politik, the same as board members gather amongst themselves to discuss their affairs. We all have the right to assemble as we see fit. For one group to impose itself upon another is penis privilege at work.
"I find the negative response from the trans community incredulous. The article's premise should be applauded not attacked. How is anything going to get better for transgendered people seeking GRS and hormones if we don't establish some system to monitor the results of treatment?"

I myself (mtf) was shocked the first time I saw a reaction like this to a scientifically-minded article taking our plight seriously. Trans community people always seem nitpick and attack you if you say we have a disorder or there is something wrong. Basically, they are caught up in a self-obsessed trans-rights (largely semantic) movement that insists we change what everybody in society means when they say male and female, man and woman, etc. Obviously, if you have to have irreversible surgery and a life-long drug regimen to make you happy there is something wrong, but if you say so you get called a bigot and accused of not knowing your facts, of being insensitive and part of the problem. They need to get a real life and look inward and basically stfu.
I am one who only wishes to understand. I am not stupid enough to think that this gender mix up could never happen to one of my children or grandchildren. So far I am pretty sure my kids have the proper brain wiring for their genitalia, but I dont know about grandkids, nieces, nephews, cousins. I found out my nephew was gay last month, and today my sister tells me she is Bi. Now I understand NONE of this. Can you imagine how displaced I feel? Everything I had considered normal and "just the way it is" isnt normal for someone else.

I really would appreciate if people would participate in their surveys. We NEED those if we ever hope to give society what it needs in order to get these situations addressed in insurance plans. If we had reliable studies, how much easier would it be to introduce this "condition" as what it is... I dont know what it is because we dont have enough studies.

For all we know those non responders could have been so unhappy with their choice that they are dead. Perhaps they woke up one day and missed their penis? Or their breasts, and longed to nurse a baby? Maybe they saw a sweet photo and realized they'd sealed the deal on any hope for that.

Maybe they are very happy, in relationships, working as CEOs and totally loving life. We need to know so we can seal this up and say, "Yes, yes that seemed to be the solution.

I am a but touchy now about lack of research cooperation as I am dealing with a rare connective tissue disease and because people botch up the studies we are set backwards and not forwards.

It is happening to you guys too. Encourage your people to do those studies. IF, IF, IF it turns out that most of your kind are in fact NOT happy, wouldnt you want to know about this? No, because ya dont really care of THEY are as long as you are, right I get the disconnection. But, I would want that info. I would want to carry it to my SAID relative and say, "Look you might not want to go this route so fast... 80% are NOT happy for one reason or another, maybe botched results, lack of aesthetically pleasing results OR just a remorseful grievance and wishing it didnt happen.

I worked with a guy in a glass plant. He had a wife and kids. Divorced, became a woman. His family OF COURSE didnt understand. I pray right now even, that I could find him so I can see if he is still a she and very happy with the choice and if the family ever came around. I hope he is HAPPY. It was a lot of work, I pray it wasnt just a mid life crisis that took over.

Anyway... please encourage your group to do their surveys and be willing to answer those uncomfortable questions in an effort to help future generations get the care they need. Once there is solid proof that the treatment works, things get better from there. Humans accept it. Its like, "ok, he was in fact born with the brain of the male but is missing his penis... we happen to know how to grow those, so lets get get carving" and then it becomes accepted. right? Ideally?
More grist to your mill on this website held by a transgendered man who has transitioned to woman, then back to man.

http://www.sexchangeregret.com/research

He reckons the operation is only cosmetic, since he was a man who wished to be a woman and after the operation, he still was man who wished to be a woman. The condition was unchanged, precisely the result that has emerged in the follow-up study led by Dr. Jon Meyer of Johns Hopkins decades ago. Condition unchanged.
To quote,
"Dr. John Money became highly controversial among his medical colleagues when he was one of the first in the U.S.A. to advocate for surgically changing men into women at the Johns Hopkins Gender Clinic in 1966. Ten years later, a follow-up study published by Dr. Jon Meyer, chairman of the Gender Clinic, evaluated 50 transsexuals who had been patients at the Gender Clinic. The findings were a warning sign about the treatment. The report concluded that no improvement was noted in the patients’ psychological functioning as a result of Money’s gender change treatment. The clinic at Hopkins was then closed."


And what if "gender reassignment surgery" actually leads people to suicide, as the rare studies suggest? Why isn't GID more researched, by the way?

The mere fact some are adamant about wanting to switch genders is no reason enough to castrate them. Skeletal anorexics can also be adamant about wanting to lose more weight, even though they are on the brink of starvation. We don't give them guidelines for dieting or practice liposuction on them. We feed them, even if they hate us for it, because that's what should be done.
my name is Cynthia Jean Lambert I am a transgender female I am looking for in the foundation or any type of insurance out there that will paper gender reassignment surgery I was born in the wrong body with the right the gender mind, but the wrong body and I need to have the reassignment surgery done if there is anybody that can help me get the surgery done that would willing to help me pay for it. I would sure appreciate it. The gender reassignment surgery better known as sex change is the only way I will go complete about myself as a woman I was born a woman of but born in the wrong body, but have the female mind anything y'all can do out there for me I would sure appreciate it of very much sincerely miss Cynthia Jean Lambert transgender female. PS I think God for all the transgender females and all the transgendered males I think God for all those gay and lesbian and bisexual people in the community, for we are special people put on a certain for a special reason silent everybody up in prayer and may you all have a very wonderful life perhaps one day I might go to meet all y'all. You never know anything possible in this day and time thank you again sincerely miss Cynthia Jean Lambert transgender female.

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