Madeleine Kearns

The grim reality of gender reassignment

Lisa Littman, a doctor and researcher, recently surveyed ‘detransitioners’ — people who thought they were transgender then changed their minds. The majority, 55 per cent, ‘felt that they did not receive an adequate evaluation from a doctor or mental health professional before starting transition.’ Sadly, it seems, their identity issues were more complicated than simply being trans. Many of these individuals are now living with the consequences of medical treatments that failed to help their gender issues and may have caused permanent physical and psychological damage.

There is no objective diagnosis for transgenderism, and the evidence supporting hormonal and surgical ‘reassignment’ as an effective remedy for gender dysphoria (the feeling of being at odds with one’s sex) can be sketchy. Meanwhile, there is plenty — not least the risk of infertility and loss of sexual function — to suggest that so-called gender reassignment is very often a bad idea.

In the mid 20th century, sexologists and surgeons began to experiment with ‘sex change’ interventions for a tiny number of (mostly male) patients who, for complicated psychological reasons, wanted to live as the opposite sex. Of course, no one can literally change their sex. For humans, sex is determined at conception; it is evident even in fossilised bones discovered thousands of years after a person’s death. Still, with the help of medical technology, a patient could undergo experimental hormone treatments and surgical procedures, enabling him to more closely resemble a woman. Back then, the debate wasn’t whether ‘trans women are women’ but whether these medical interventions really helped alleviate gender-related confusion and distress.

Some reckoned they did. In 1965, Johns Hopkins University carried out sex change surgery, the first American academic institution to do so. The experiment was discontinued in 1979, under psychiatrist-in-chief Paul McHugh, who had major concerns about the treatment’s efficacy. 

‘In those days we weren’t thinking that we should do something because somebody would like us to do it,’ McHugh tells me.

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