In the comments to my post “mutilating gender” last week, J. (a.k.a Mac Diva, author of two (!) notable blogs, Mac-a-ro-nies and Silver Rights) argued forcefully against sexual reassignment surgery (SRS).
J. has repeated this point on Silver Rights arguing that SRS isn’t a “proven medical treatment” and that it “may not be an actual remedy.”
Unfortunately, J. didn’t reference the specific research she’s relying on, so it’s possible that by posting this I’ll be smearing egg on my own face. But as far as I can tell, the evidence doesn’t support J.’s claims.
First, regarding John Money, J. is mistaken to think he is “the originator of the concept.” David Cauldwell, for example, was using the term “transsexual” in the late 1940s, whereas John Money’s work didn’t begin until the 1950s.
Much more importantly, J. is mistaken about outcomes of SRS. The most comprehensive study of post-SRS outcomes is “Sex Reassignment. Thirty Years of International Follow-up Studies” by Friedemann Pf’fflin and Astrid Junge (1992 in German, English translation 1998). Pf’fflin and Junge used data from over 70 studies, in total considering the outcomes of over 2000 patients from 13 countries. They found that outcomes – measured in terms of “subjective satisfaction; mental stability; socioeconomic functioning; and partnership and sexual experience” – of SRS are generally positive. Overall, 71% of male-to-female (MTF) and 90% of female-to-male (FTM) operations had positive results. When they limited their sample only to more recent patients (who benefited from improvements in techniques and procedures over the decades), the results were positive for 87% of MTFs and 97% for FTMs.
Of course, Pf’fflin and Junge’s article is now a decade old, but I’m not aware of any study of comparable scope since then which has discredited their work. And it may be that there are problems with the data which should prevent us from drawing conclusions; Dr. Anne Lawrence, summarizing more recent studies, points out that they have a distressingly low response rate.
On the other hand, as Lawrence points out, even the controlled study by Mate-Kole (in which MTFs were randomly selected to either be given SRS quickly, or to be in a control group which was waiting for the surgery) found that “patients who underwent expedited SRS demonstrated improved psychosocial outcomes, compared to the still unoperated controls. They were more active socially, and had fewer neurotic symptoms.”
On the important issue of regrets, Pf’fflin and Junge found 14 documented cases of patients who regretted having gone through SRS. Some of these patience appear to have been inadequately prepared, or to have had botched or incomplete surgeries. While it’s of course regrettable that anyone feel regrets, 14 out of 2000 doesn’t strike me as a high enough rate of regrets to discredit SRS, or to suggest (as J. did) that a typical SRS patient may seek to have their surgery reversed.
The evidence is imperfect; and, since I don’t know what J.’s sources are, it’s possible that she’ll post references that blow this post away. For now, however, it seems that the evidence indicates that SRS probably is effective; for those patients who choose to go through SRS, it provides real relief and life improvement.
If I’ve followed her arguments correctly, J.’s main concern is whether or not tax dollars should be used to pay for SRS. My feeling is that all necessary and effective medical treatments ought to be paid for out of tax dollars, preferably in a single-payer health care system akin to France’s. Since I think the evidence shows that SRS is an effective medical treatment, I think it should be covered.
(To read J.’s thoughts on transsexuality for yourself, read through this comments thread – if you don’t want to read the whole thing, you can find her posts with a text search for “Mac Diva.” On her blogs, read this post and also this post on Silver Rights, plus this post on Mac-a-ron-ies.)
Note: Due to this post being published as Alas was switching commenting software, the original comments to this post have been “stranded.” They can still be read here. However, please leave any new comments in the new comment system (link below).