Recently I attended training on lobbying for transgender issues. One of the big "no-no's" was talking about medical care for transgender people. The reason is pretty simple: people have a visceral negative reaction to the idea of genital surgery. In many ways, the reaction the idea of Gender Confirmation Surgeries (GCS) resembles the reaction people have to the thought of two men having sex.
The problem is that the lack of understanding about GCS for transgender people is the biggest impediment to actually receiving care. When I read the comments section of a recent article on an individual who is resorting to crowd funding her GCS, I saw the same misconceptions popping up over and over again. As a result, I wanted to address the most common comments on the subject.
1. "It's not life or death"
Without GCS sexual functioning, self-esteem, body image, socioeconomic adjustment, family life, relationships, psychological status and general life satisfaction are all negatively affected. This is supported by the numerous studies (Murad M., 2010, DeCuypere, 2006, Kuiper M. 1988, Gorton 2011, Clements-Nolle K., 2006), which also consistently show that access to GCS reduces suicidality by a factor of three to six (between 67 percent and 84 percent). Eighty percent of transgender people contemplate suicide, and 41 percent of transgender people attempt it. Lack of access to care is in fact likely to kill many transgender people. If this was a type of cancer that was killing 41 percent of the people who developed it, and it was possible to reduce the mortality rate by similar percentages, there wouldn't be any argument happening.
It doesn't even have to be life or death to be medically necessary, though. A herniated disk won't kill you, but it will wreck your quality of life. Similarly, this is why every major medical, psychological, psychiatric, and therapist organization in the U.S. has issued statements supporting the medical necessity of GCS. The court system is increasingly acknowledging this, with five Circuit Courts having ruled that withholding transgender specific health care from prisoners is a violation of the 8th Amendment, because it is medically necessary.
2. "These people need therapy, not surgery."
I have been over this before. They tried for decades to change people's gender identities, the same way they tried to change sexual orientation. Drugs. Therapy. Electroshock therapy. Lobotomies. Institutionalization. It doesn't work. It's why California and New Jersey have banned reparative therapy that tries to change sexual orientation OR gender identity. Those bans are holding up in court, because the overwhelming scientific consensus is that you can't change a person's gender identity, and you can't just make their dysphoria go away with drugs or talk therapy. If you could, then that would be the preferred treatment, not expensive surgery.
Support for the necessity of GCS is based on scientifically-based national medical research, professional medical specialty organizations, and widely and generally accepted medical and surgical practices and standards, and is supported by prevailing peer reviewed medical literature.
The opposition to the notion of necessity this comes from religious zealots and people who aren't qualified to be making medical decisions anyway.
3. "It's cosmetic."
Again, every major medical, psychological, psychiatric, and therapist organization agrees GCS isn't cosmetic. AMA Resolution 122, states:
An established body of medical research demonstrates the effectiveness and medical necessity of mental health care, hormone therapy and sex reassignment surgery as forms of therapeutic treatment for many people diagnosed with GID .... Health experts in GID, including WPATH, have rejected the myth that such treatments are 'cosmetic' or 'experimental' and have recognized that these treatments can provide safe and effective treatment for a serious health condition.
Indeed, GCS improves functionality in socioeconomic status, family life, sexuality, and mental health.
The irony surrounding the first three myths on this list is they are generally perpetuated by people who would be outraged if bureaucrats were making medical decisions for them instead of their doctors. These same people, however, are perfectly fine with the public making health care decisions for transgender people instead of actual doctors, psychiatrists, and psychologists.
This should be a giant red flag. Consider that the last few times we crowd sourced medical ethics on the treatment of unpopular minorities. We ended up with the Tuskegee Experiment and the AIDS epidemic.
4. "Transgender people are just wimps because they can't handle the mental strain"
Existing halfway between genders is stressful. Imagine for a moment if you woke up one morning with the wrong factory equipment. Most people can't, but Chloë Sevigny, who played a transgender assassin on "Hit & Miss," found wearing a prosthetic penis unbearable. "I cried every day when they put it on," she said in an interview. This, for a prosthetic that she knows isn't real, and comes off when the the day is over.
When lesbian journalist Norah Vincent tried to live as a man as a social experiment, it took less than a year before the strain caused her to have herself voluntarily committed.
When straight, healthy people try and pull off what transgender people do on a daily basis (live in the wrong gender), the strain is enough to make them suicidal too.
5. "It's not like being born with one arm."
Actually, it's similar neurologically. There's significant evidence that transgender people are hard wired with their brains expecting one set of physical characteristics, but physically having another. (Ramachandran & McGeoh, 2008). Similarly, Ramachandran found similar phenomena in people with phantom limb sensations.
This is potentially the reason why GCS has been successful where other treatments have failed. It is far easier to align the body with the mind than the other way round when body image is so deeply hard wired.
6. "Suicidality has nothing to do with your physical body"
If something was physically wrong with your genitals, how desperate would you be to have it fixed? How would you feel if they couldn't? Think you'd be depressed because you potentially face a lifetime of solitude and celibacy? Of feeling like a freak every time you looked in a mirror, went in a bathroom, took a shower, etc..?
It is very difficult for transgender people to have romantic relationships, because most cis (non-transgender) people's sexuality isn't made to handle mismatched primary and secondary sexual characteristics. The incongruence between the brain's internal body map and the physical body is also very distressing (as noted above).
7. "Treat the depression, not the gender dysphoria."
This is similar to the idea that the best way to treat chronic back pain is with vicodin, rather than a surgery that would address the underlying problem.
8. "The Affordable Care Act (Obamacare) pays for this."
No, it does not. Most of the state exchanges have exclusions of transgender coverage.
9. "I don't want to pay for that."
Study after study shows including medical benefits for transgender people costs close to nothing, if not actually nothing. The Transgender Law Center put it in perspective when they noted that if a health care plan costs you $4,000 in a year, then adding transgender coverage would add 17 cents per year to the cost of the policy. The low dollar amount is because this is a one-time cost, and it is rare. For comparison's sake, a company including same sex partner benefits would add $40.00 per year to that $4,000 total. That's a 231 fold difference in magnitude between the cost of adding partner benefits and adding transgender health care.
If it neither breaks your leg nor picks your pocket...
10. "It's mutilation of healthy tissue."
Given Ramachandran's findings, GCS is much more accurately described as reconstructive surgery. The overwhelming body of evidence showing an improved quality of life (including sexual function) for people who have had GCS also supports reconstructive surgery as accurate.
11. "I'm actually a feline trapped in a human's body. Can I get can surgery to make me a cat?"
Also known as the "I think I'm funny, but I'm not," answer. Generally used by guys who watch South Park.
When people use this argument, they assume that transgender people are mentally ill (they're not), assume it's a delusion that can be cured (wrong), and ignores one key fact. People can naturally be mentally hard wired to identify as male or female. Sometimes the wiring and the equipment don't synch up during development. We have 40-plus years of neuroscience research basically telling us gender identity and body image are written early on in development, and sometimes they don't match.
People, however, do not naturally identify as a cat, or other non-human animal.
12. "I don't like the term Gender Confirmation Surgery (GCS)."
The other two most common medical terms used are Sex Reassignment Surgery (SRS), and Gender Reassignment Surgery (GRS). However, given the growing evidence that gender dysphoria stems from an incongruence between the brain's internal body map and the physical body, Gender Confirmation Surgery is probably the most technically accurate of the three.
Also known as the honest answer. It's been said before, but it bears repeating. If you don't like gay sex, then don't have gay sex. If you don't like gay marriage, then don't get married to someone who's the same sex. If you feel abortion is wrong, then don't have one. If you don't like the idea of GCS, then don't have GCS.
14. "They should pay for it themselves."
Perhaps nothing encapsulates privilege quite like this one. Who has $25,000 lying around, a corporate short term disability policy, a supportive supervisor, and/or the means to fight an 18 month long legal battle against an insurance company? If you're not one of the lucky few transgender people who work at a big company with very pro-LGBT policies, these are the hurdles you have to face. Simultaneously, transgender people face massive discrimination in the workplace, suffer twice the national average unemployment rate, and live in extreme poverty four times more often than the general public (despite being twice as likely to hold advanced degrees).
For most transgender people, this isn't even an option.
15. "It doesn't change your DNA"
This is irrelevant. There are lots of intersex people whose identities vary from their chromosomes. The relevant part of the discussion is whether GCS is medically necessary (it is in the opinion of everyone who matters), and if it significantly improves quality of life (it does).
16. "Gay people should distance themselves from people like this before they lose some of the progress and acceptance they have received over the last 20 years."
Just like lesbians distancing themselves from gay men in the 1980's because of the stigma of HIV/AIDS would have been expedient.
And every bit as unconscionable.
Follow Brynn Tannehill on Twitter: www.twitter.com/BrynnTannehill
August 3, 2017 (Witherspoon Institute) — In a recent discussion on Twitter, Chelsea Manning (formerly Bradley Manning), pardoned by President Obama after being convicted of espionage, argued that transgender “treatment” is necessary for the health of trans individuals, “because,” Chelsea stated, “not getting medical attention for trans people is fatal.”
Manning’s argument is anything but an isolated one. When 17-year-old Leelah Alcorn committed suicide in 2014, LGBT activists immediately jumped to blame his parents and society at large for causing the tragedy. Zack Ford of ThinkProgress wrote:
Leelah Alcorn’s death was a preventable tragedy. Here was a 17-year-old girl with full access to all of the information available in the 21st century about transgender identities, including many safe and effective ways to transition. But as she wrote in her own suicide note before jumping in front of a tractor trailer this week, there was no hope attached to those possibilities — no trust that it could, in fact, get better. She had given up on crying for help.
This, despite the young man’s parents support of his gender identity. He killed himself because his parents asked him to wait until he was 18 to begin transitioning. They wouldn’t agree to pay for it earlier.
The argument can be summarized as follows. Without medical treatment (expensive surgery and lifelong hormone therapy), social acceptance, correct pronoun use, and open bathroom access, trans people will never be comfortable in their bodies or in society. Consequently, they are at a high risk for suicide, and it’s an injustice not to make these “treatments” available; the crime of killing trans people can even be laid at the feet of those who do not take these steps.
This argument, made by Manning, Ford, and so many others, is supposed to halt any criticism — or even querying — of gender theory, but it raises more questions than it answers.
If it needs treatment, isn’t it an illness?
The various liberal resources are shockingly equivocal as to what gender identity actually is. Gender identity is an “innermost knowing,” an issue of hormone imbalance, the result of a male brain in a female body, or a ‘transsexual’ brain, maybe an inherited characteristic, and many other possibilities, depending on whom you ask. According to some, gender is an inborn and permanent state; for others, a fluid awareness that might change by the day. How is it possible that a condition so insusceptible of consistent definition could be universally declared fatal without medical treatment?
Further, if transgenderism requires medical treatment, how can it form the basis of anyone’s identity? Trans people and their allies have, of course, insisted with great indignation that their condition is not an illness, but it is hard to see how this conclusion is to be avoided, if it’s insisted that it must be treated or else will be fatal.
Illnesses that require treatment do not constitute anyone’s identity. Being HIV-positive requires medical treatment. I do not identify as HIV-positive as though it made me an entirely new kind of person. It is a condition I need to treat in order to live and be healthy. How is being trans any different?
Aiming at sex-gender alignment
The goal of most transgender individuals is to live as the opposite sex. If this were not true, there would be no concern about “access to healthcare” or medical necessity. If one could simply enjoy whatever gender identity felt the most appropriate at any given time, medical intervention would be merely cosmetic. So if we agree that people who identify as transgender desire to be the opposite sex to the best of their ability — arguing that internally they already are — then we must accept that the ideal state for all individuals is cisgender, where gender and sex align naturally.
In my experience, this assertion is viewed as hateful and intolerant. To suggest that people who identify as transgender desire to be “like everyone else,” “normal,” or — dare I say — “healthy” by aligning their gender and sex is to suggest a transgender identity is itself a state of error. But again, this seems to be what is presupposed by the argument that medical intervention is so vital that, without it, a person may commit suicide.
In order to achieve a healthy and mentally stable state, a trans person must have their gender and sex as closely aligned as possible. Why, though, does this require the physical sex to change in order to align to the perceived gender? Why shouldn’t the perceived gender be what changes?
It seems far more reasonable — and medically ethical and sound — to achieve this homeostasis by changing gender to match to the already established sex. A woman taking testosterone must continue taking testosterone, or else her desired masculine secondary sex characteristics will fade away (though if she has removed her ovaries, her body will not be able to produce estrogen and bring her female sex characteristics back). As many trans men prefer to keep their reproductive organs and become pregnant, this risk is even higher. The body’s aggressive and persistent attempt to return to a state, despite medical interventions to override that state, indicates that the state is “natural.” The body is being medically forced to adapt to conditions it is unsuited to experience.
If the ideal state is one of homeostasis, in which gender and sex are the same, then why would trans people dedicate their entire lives to forcing their bodies to adapt to conditions they cannot maintain on their own? It seems far more reasonable to recognize that the physical sex at birth is the standard by which internal perception should be aligned. Logically, wouldn’t a transgender person who suffers due to misalignment of gender and sex be equally as happy aligning his gender to his sex if the end result is that gender and sex are the same? Why is the only acceptable option to force, through dramatic physical deformity, the body to adapt to the mind instead?
We need a real cure
Some trans advocates would presumably reply that sex should change rather than gender because sex can change, whereas attempts to change one’s gender usually end badly, but this response is unnecessarily pessimistic.
I have personally experienced gender dysphoria, and I explored transition in my early 20s. I am aware of the emotional struggle, and I am sympathetic to the sense of frustration and hopelessness. But I am also aware of the empowering realization that I alone control how I perceive the world. Even if I would prefer to be female, I understand that my body is male, and therefore the most effective and healthiest plan of action is to align my sense of gender to that unchangeable state. I have largely been successful, as I feel fully integrated today and am not only comfortable in my male body but find myself enjoying the pursuit of masculine physical progress.
An uncomfortable truth is that many surveys, including a 2011 Swedish study, indicate that suicide rates remain high after sex-reassignment surgery (the Swedish study reports that people who have had sex-reassignment surgery are 19 times more likely to die by suicide than is the general population); and the National Center for Transgender Equality reported in 2015 that 40 percent of people who identify as transgender have attempted suicide. The LGBT community actively fights such studies and suppresses the voices of people who, like myself, have chosen natural alignment or who regret transitioning. The medical community is currently uninterested in recognizing the inherent dangers and long-term impact of transition therapy and is equally unwilling to pursue study that may result in finding a cure or a resolution to the underlying issue. To suggest this is a medical issue needing to be cured is to be accused of proposing genocide.
But medical issues do need to be cured. If gender dysphoria is indeed naturally fatal without treatment, the only ethical solution is to find a cure that exposes the body to the least amount of risk. Obviously, this would be to correct the biological problem and/or address the psychological distress behind the dysphoria itself.
The LGBT movement has built a civilization around the validation of being “who you are” despite all efforts of judgment or persecution. Trans individuals often tell me they are now their “true gender.” Advocates like Zack Ford and others routinely demand that extreme social bigotry prevents the trans individual from living a full and happy life. But in the center of this storm of indignation and boasting of perseverance is the steady and quiet realization that these people are extremely insecure.
We cannot forget the real tragedy in all of this. People suffering from genuine mental anguish are being promised that with enough surgery, camouflage, social acceptance, legal protection, educational campaigns, and so on, they will finally feel whole as a person. Worse, they are told that the only reason they continue to suffer is due to the intolerance and hatred of those around them. The current method of addressing this concern is only making matters worse. Treatment needs to address the core problem.
Chad Felix Greene is the author of the Reasonably Gay: Essays and Arguments series and is a social writer focusing on truth in media, conservative ideas and goals and true equality under the law. You can follow him on Twitter @chadfelixg.
Reprinted with permission from The Witherspoon Institute.
Can you donate just $10 for PRO-LIFE?
Every person you help reach becomes equipped to engage in the culture war
View CommentsClick to view or comment.