This is a debate that has been bullrushed by the sudden political success of Trans activists, but there are genuine medical and ethical issues that need to be taken into account:
I’m a transsexual woman in my thirties who transitioned in my early twenties, and I wish I could have done so earlier. Even so, I am wary of today’s Brave New World of transgender activism in which important safeguards of transition are under attack and any counter opinion, even if made by a trans woman such as myself, are labelled as an attack on trans rights. At first it was easier for me to not ruffle the trans activists’ feathers, but my conscience got the better of me, and now I am continuing to speak up in order to help those who deserve better in their own journey of transition.
Through talking to other trans people in my life, it has become apparent to me that transition surgeries are an answer but not the answer to the long-term health and well-being of gender dysphoria patients. Unfortunately, many trans people get so fixated on surgery for so long, that they may forget that there is more to life and transitioning than just surgery and other medical intervention. The fixation is often driven by the fantasy that surgery, and transition in general, will transform them into a new person, and that all the problems in life will go away.
I haven’t known a lot of trans people over the years, but of the few that I know, there did seem to be a powerful belief that if they could fix just this one thing — their gender — then their lives would be perfect forever. In at least two cases, having transitioned, they then discovered that they were just as miserable as they had been before despite having changed to their preferred gender. All the surgery in the world won’t fix mental problems, and the disappointment and anger seemed to be that much greater when the situation finally came home. I’m not claiming this is in any way universal, but of the small number of trans people I’ve known, it was true for half of them.
During my gender transition, I didn’t fixate on surgery even though I was highly dysphoric back then. I’ve had my ups and downs, but I’ve always done okay. To be honest, thinking about sex and gender a lot is unhealthy, particularly during high-conflict public debates on what it means to be transgender and what rights we have to get the help we need. As the debate grows more divisive, the media valorization and glamorization of trans people, especially trans children, is not helping but rather, it is pulling us away from the honest conversations we need to have.
Forty-one percent of transgender people [PDF] have experienced suicidal ideation or self-harm, though this statistic does not indicate to what extent the attempts were before or after transition, or at what stage of transition. Nevertheless, studies have shown high rates of suicide among (alleged) trans people post-medical transition. Why is this the case and can the quality of transition be a factor?
As I understand it, the overall success rate of transgender surgery is higher the earlier it is conducted … within reason. This is where the ethical issues are the most pressing:
The move away from the medical gatekeeping model for treating gender dysphoria is not only unfortunate, it is irresponsible. Over the past few decades, the strictness of the standards of healthcare used to determine suitability for hormone replacement therapy (HRT) and related surgeries have been relaxed significantly. In 2008, the Endocrine Society endorsed puberty blockers as a treatment for trans teenagers. Then in 2011, the World Professional Association for Transgender Health (WPATH) issued new Standards of Care internationally for treating such patients via puberty suppression, while formalizing the ‘informed consent’ model. But it didn’t end there.
Last month here in Australia, new guidelines published in the Medical Journal of Australia gave the green light for potentially more trans children to go on HRT as young as 13, defying international guidelines. Specifically, “decisions about affirming a young person’s gender identity should be driven primarily by the child or adolescent, in conjunction with their family and health care providers.” While this experiment was hailed as world-leading, the minimum legal age for smoking, drinking and voting in Australia remains at 18, and it’s still 16 for consensual sex. So in Australia, a 15-year-old teen cannot consent to sexual activity but they can consent to life-altering medical treatments that they almost certainly cannot fully grasp at that age.
