Transgender Surgery Isn't the Solution

6/3/15. Psychiatrist Paul McHugh says a drastic physical change doesn't address underlying psycho-social problems.



http://www.wsj.com/articles/paul-mchugh-transgender-surgery-isnt-the-solution-1402615120




The following response is from Dr. Aaron Ceresnie (full disclosure:  my nephew)

This article seems to be drawing conclusions from a lack of perspective of a person who identifies as transgender and from the perspective that being a transgender person is itself a medical/psychiatric problem. I would suggest that "transgendered" also isn't the correct language, and identifying as a different gender than given at birth is not in and of itself is not a mental disorder, unless it causes significant functional impairment and distress. The much larger incidence of suicidal thoughts/attempts in that population should also take into account (which this article does not) the proportional amount of harassment and violence transgender people are subjected to on a regular basis from as early as they begin identifying that way publicly, or even if trying to pass discreetly. There are no anti-discrimination protections for transgender people, and they are often victims of hate crimes. I didn't see any discussion regarding the influence of constant bullying, a lack of social acceptance, or recognition of their identity as legitimate. Also, people who are transgender in one form or another have always existed and have been documented in indigenous cultures. The 10 year follow-up study that found an increased risk of suicide was comparing transgender individuals to a non-transgender population. I'm wondering how that data compared to other transgender individuals who wanted but could not get the surgery. The author's statements also reflect an assumption that the transgender population is homogenous, which isn't the case. A lot of people who are identify as the opposing sex never want surgical interventions. There's just more nuance and heterogeneity than suggested in the article.

Moreover, Bradley/Chelsea Manning isn't a good example and it seems presumptuous to say he wanted to identify as female for a lesser punishment. Military documents show he started questioning his gender and asking about reassignment surgery in 2009 and he didn't provide WikiLeaks with any information until 2010. I don't see a good connection there.

I'm also not aware of any research showing success of psychiatrists or therapists "restoring natural gender feelings to a transgender minor", which sounds a lot like conversion therapy for people who are gay (which has also not been successful and denounced by the American Psychological Association due to its coercive nature).

Sexual reassignment surgery of minors is a legitimate concern, and I would argue a consenting adult who has really thought about it should be entitled to the surgery. This article seems to be more concerned with how Medicaid allocates money than the legitimacy of the surgery itself or the socio-cultural environment in which transgender individuals exist. The article is making the case that surgical intervention is never a good idea, and I'm not sure there's evidence to support that claim either. More research is always a good idea. One could make a similar argument about elective plastic surgery. 

Here's some additional information about transgender people and gender identity from the APA
http://www.apa.org/topics/lgbt/transgender.aspx

 

Aaron Ceresnie, Psy.D.