Monday, January 7, 2013

A Truly Moronic Suggestion!

It is one of those truly stupid ideas that simply will not die.  Far too often, usually after a news story about how someone has major regrets about having undergone sex reassignment surgery, or in the most recent case, an woman who now regrets having taken male hormones, some fool will pop up and say "If you make a mistake, then live with it!"  At times, this is part of a larger demand for "surgery on demand." That is, the idea that the Standards of Care should be abandoned, and people should be allowed to have SRS on a whim.  Sadly, there are some unscrupulous surgeons who come close to that already.

The latest incarnation of this idiocy, comes, as it always does, from someone known for taking extremist positions.  In this case, not surprisingly, and not for the first time, the source is Suzan Cooke.  In a couple of articles, here, and here, Cooke has a hissy fit over the idea that doctors should actually have to be responsible for doing their jobs.

For MTF transsexuals, hormones are a major diagnostic aid.  If a man mistaken thinks he should transition it is usually sexually motivated.  A few months to a year on a proper dose of estrogen, and his sex drive is reduced, and voila, he begins to lose interest in transition...unless, of course, he is an aging transvestite, where a lowered libido is often the trigger for the sudden desire to become a woman.  In the case of an FTM, sexual issues are rarely the cause of a desire to transition, but there is also the issue of the difficultly of reversing the effects of testosterone.  For a woman, taking hormones by mistake are far worse than they are for a man.  For a man, about the worst possible outcome is permanent sterility (relatively rare, since they probably won't be on them long enough) and possibly the neat to have his breasts surgically dealt with (again, relatively rare).  

In the case in England that triggered Cooke's most recent rant, it was a woman who not only underwent testosterone treatment, but who also had a double mastectomy.  Interestingly enough, the doctor in this case is the one who replaced Dr. Russell Reid who became mired in controversy when a patient, who had clearly lied and who had suffered from some seriously delusional ideas about how life would be as a woman, had regrets after undergoing SRS.

Now, Cooke's suggestion might seem, at face value, to be reasonable.  But, in truth, it is simply wrong.  First off, doctors have a responsibility to, as the pledge in the Hippocratic Oath, to "first, do no harm."  A surgeon should require that anyone seeking SRS provide verifiable documentation from a competent therapist, as well as a second recommendation from another therapist.  The second letter is necessary because, quite frankly, there are some therapists who simply should not be allowed to practice.  I know, I saw one early in my transition, and that person contributed greatly to my transition being delayed.

I was dealing with several issues, including coming to grips with my true sexual orientation.  Instead of working with me on these issues, the therapist I was seeing simply glossed over them, and pushed me to proceed.  I clearly needed time, and she wanted me to move ahead.  This led, among other things, to a serious breakdown, and I detransitioned for seven years.  In retrospect, I wonder what might have happened if I had allowed her to pressure me into proceeding before I was ready.

I also know of a case involving a middle-aged woman who, more out of loneliness than any gender issues, started claiming to be an "FTM" so should could hang out a research study targeting "transgender" people.  She actually seemed to relate more to the MTF staff, but she was being pressured by one of the FTM staff members to "get off the fence" and start hormone therapy.  It was obvious that this was not a good idea, but he would not listen to reason.  Fortunately, she relocated to Alaska, and escaped from his efforts to get her to do something that would have caused serious problems.

Transition, hormones, and surgery are not to be taken lightly.  To suggest that someone "just live with it" is an incredibly callous view, especially coming from someone who felt the need to transition.  If you are a transsexual, imagine being told that.  Actually, you probably don't have to imagine.  I know I was, more than once.  It is not good advice.  Now, imagine having undergone surgery by mistake, and actually losing the option of dealing with one's situation. SRS is, especially for a MTF patient, irreversible.  There is no real possibility of becoming a full male again.  

Mistakes happen.  I can think of two well-known cases where the person involved has almost certainly made a mistake, but has refused to acknowledge it.  And I know of several causes where the person has made the fact that they made a mistake very well known.  In all of these cases, a competent therapist could, and should, have prevented the person from making the mistake.  Yes, the person involved lied, and for that reason, they share some of the responsibility.  But a competent therapist will do more than simply take a person's statements at face value.

If anything, the Standards of Care need to be tightened.  People who really need SRS might be a bit inconvenienced, but they will make it through the process.  Those who should not have surgery should be screened out, before a mistake is made.

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