Incongruence
Transgender people feel like they don’t fit in, in the fabric of society, in their family unit, in a social group, or even in their own skin. They believe that the solution is to change their exterior to be able to fit in. This paper will illustrate that even after changing their internal and external physical body, they will still feel like they do not fit in. That they are still discriminated against in society and even though the surgery does occasionally bring about changes physically that allow them to ‘pass’ as cis-gender, inside themselves they still feel marginalized.
Because they feel that they cannot find happiness inside their natal body, they seek to change that in an attempt to find happiness and congruence. Most children at some point play ‘dress up’ and dress in clothing of the opposite gender. Do these children get ‘stuck’ in this stage? Or were they really the subject of a biological mistake and born into the gender of the wrong body for their psychological makeup? Perhaps a better definition would be powerfully identifying with one gender while being repulsed by the body of another.
Who Will Benefit From Gender Confirmation Surgery?
There is no known cause of gender dysphoria (Brown, 2012). There is no way to tell who will benefit from the surgery prior to undergoing it (Withers, 2015). Robert Stoller was regarded as an expert on gender disorders and claimed “patients only seek to change their outer world-their anatomy, the people they know, society”. If a patient is unwilling to be truthful during the psychiatric phase of qualification, extreme care should be given. The patient will say what they feel they need to in order to get the approval from the therapist they are working with. Which in the long run may prove to be a disservice to that individual. If psychosis is at the core, as long as the patient remains in this psychosis they are likely to believe that surgical intervention is the only path to being congruent.
Typical Surgeries Transgender Individuals May Opt For
Some transgender people undergo surgical procedures to be more congruent. For a male to female transition they may have breast implants (breast augmentation), removal of their penis (penectomy) and testicles (orchiectomy) , construction of a vagina (vaginoplasty), a nose job (rhinoplasty), a tracheal shave (Chondrolaryngoplasty), a brow shave and a host of other procedures that the individual may want to have. Facial feminization and hair removal are very common.
For the female to male transition there would likely be a removal of the uterus (hysterectomy), removal of the ovaries (oophorectomy), construction of a penis (phalloplasty), removal of the breasts (mastectomy), construction of a male chest. In both cases hormone therapy is taken to keep the characteristics consistent with that of the gender that they present, not their natal gender. Not all of these surgeries take place for all who are transgender. It is a personal choice for each individual.
Suicide Pre and Post Gender Confirmation Surgery
Statistically according to both HRC.org and TheTrevorProject.org the suicide rate for transgender youth is 40% for transgender females and 50% for transgender males. These statistics do not include those who may have been transgender and had not come out and were successful at suicide. The rate for adult transgender suicide is also 40% post confirmation surgery (Withers, 2015).
This would indicate that the surgical option did not alleviate the feelings of not being able to fit into the fabric of society that the individual thought would be resolved with surgical intervention. Meaning that the feeling inside the individual, still existed even after their “self diagnosis of cure” had been employed. If gender dysphoria is a psychosis, surgical intervention may exacerbate the issue, not cure it. The transsexual who claims the surgery has resolved their issues may believe it is true because in their psychosis, that is what they believe to be true.
Qualifying for Gender Confirmation Surgery
In order to quality as a candidate for transgender surgery the standards are similar all over the world where this type of surgery is permitted, the primary practices are typical. The transgender person must undergo a minimum of 2 years of therapy, in that course be deemed a transsexual. Take hormones for the desired sex for at least one year, preferably two, and dress and live full time in the desired sex for at least one year consistently. This process is quite fast considering that historically many of the patients wanting to undergo these procedures had already lived decades in their current body and gender.
Is two years of seeking a therapist for the purpose of obtaining permission for sexual reassignment surgery really enough for anyone to make a well thought out case to approve this, let alone obtaining two objective therapists to sign off on the desired procedure(s). Under the United Kingdoms Gender Recognition Act (GRA), the applicants have to agree to live in that desired gender until their death, once the application to change gender is granted. This is indicative that gender is fixed and stable.
Rapid Onset Gender Dysphoria
This is relatively new and most of the studies on this are small and inconsequential, though pervasive new theme in youth gender dysphoria. Exacerbated by social media and teens thinking they need to be aboard this new craze. Is the fact that females are generally more fluid sexually, and therefore more gender fluid as well (McQueen, 2015), behind this phenomenon since nearly 90% of all new cases of transgender youth are females? Gender fluid has no boundaries or rules about one’s gender.
Or is it because females are more likely to seek out mental health professionals for help that is at the helm. Fully 75% of these cases had a comorbidity that had nothing to do with being trans and 26% were on the spectrum of autism. Much talk has been given to the notion that vaccination may be at the root of this, though not enough time has passed since the newest round of vaccinations approved by the government for the studies to show anything conclusive. It has been a long held belief by many practitioners that the root cause of autism is vaccinations. Whether this is true or not is irrelevant. What is true is that the rate of transgender across all ages has spiked in recent years. Without definitive cause or reasoning.
Comorbidity
Is it possible that gender is not something we are born with and as our awareness of who we are changes over time? This does not seem likely or every animal on the planet would experience this on some level. Every transgender person you will encounter will tell you that they knew they were transgender when they were 4 or 5 years old. Doesn’t every child have that thought as a young child? We are always curious about something that is different. In every case I read, every person I know, and every person I interviewed each transgender individual had comorbidity of one (or more), mental or emotional issues that could conceivably be the explanation for the dissociative behavior between natal gender and gender dysphoria.
In the paper I read by Malcolm T. Firth (2014), he claims “the childhood abuse in the early lives of gender variant people is under-reported, although higher psychiatric morbidity, particularly depression and suicidality than in the general population.” This seems congruent with the research previously mentioned with the extremely high rate of suicide of both pre and post operative transsexual individuals. The rate of childhood abuse in transgender individuals is as high at 60% in some case studies (Firth, 2014), this is thought to be a source of the dissociative reaction for the transgender population. Not only are these children frequently abused physical or verbally by their family members, they are also bullied at school by the students and teachers.
To Operate or Not to Operate
Just because we can, does it mean we should? Aside from some very obvious considerations prior to beginning hormone treatment and potential life changing surgical interventions each patient should look at their potential long-term goals in life and make some very serious decisions. Will I ever want my own biological children? Freezing eggs or sperm may be in order for that to occur at a later date. It cannot be presumed that all transgender individuals will have surgery, though many do the top surgery and virtually all who do have surgery, take the opposite sex hormones. It cannot be understated that a percentage of those who undergo genital (SRS), eventually regret their decision and go back to living their natal gender. While that percentage is a small one (McQueen, 2014), it is a decision that is now irreversible. As their natal genitals have been mutilated to fashion the new ones. Is it against the Hippocratic Oath to remove healthy tissue and healthy organs simply because one feels incongruence with them? The margin of error in making the decision to surgically alter ones physical appearance in such a drastic manner cannot be known until it happens. Regret is not something that will likely ever be eliminated due to that fact.
