Few, if any, of the ideas in this essay are new. Rather, this is to the best of my ability a snythesis based on the excellent work by others that I have encountered to this date.
Sex Reassignment Surgery:
My Body, My Genitals, My Choice
Nancy Reynolds Nangeroni
If a woman’s body is her own, and she gets to decide whether or not to abort her fetus, then why don’t I have the right to decide for myself whether or not to invert my own penis?
A woman’s right to decide has been established for some time in this country. Yet if I wish to obtain SRS, I must undergo a process of extensive psychological evaluation and obtain letters of permission, as defined by the Harry Benjamin Standards of Care. Though this requirement is not set in law, the Standards of Care have the effect of law by providing the surgeon with a standard for defensibility against potential lawsuits. Even I would not be so foolish as to engage the services of a surgeon who ignores prevailing standards. The Benjamin Standards of Care rule the day, and they need to be changed. It is my body, and I’m the only one who must live with the consequences of the decision either way. Therefore it must be my decision.
Why Is There a Demand?
If we are to relax restrictions on SRS, we must first consider why access to the procedure is restricted. We also need to consider why there is a demand for SRS.
Historically, our culture has erected enormous barriers between male and female through male domination of women and intensely polarized stylizing of gender. To allow flexibility of gender and sexual identity would be to breach this long-standing divide. Most of us were raised in an environment where male meant masculine, female meant feminine, and we have been effectively excluded from one or the other since birth.
Throughout history there have been individuals who transgressed gender norms, yet for the most part they did so in secret. The communications revolution is changing this. Today’s media takes advantage of our fascination with the subject. Mobility of gender and sexuality, in concept if not in practice, is perhaps for the first time in our culture widely accessible.
Meanwhile, our notions of what is proper with respect to gender and sex have been evolving, thanks in large measure to the feminist and gay liberation movements. Public acceptance of alternative perspectives is growing. Men and women are seeking better balance between the sexes. Barriers separating the two are melting away, slowly but surely. Personal freedom with regard to gender-determined roles is on the rise. Transgender liberation is, in the words of Leslie Feinberg, “a movement whose time has come”. It’s seed has always been here, but the environment is newly fertile.
Sex Reassignment Surgery is a relatively recent product of technology. It allows an individual to more closely approximate in intimate physical detail the characteristics of an idealized opposite sex. The identity of transsexual justifies SRS, and helps provide escape from a burdensome role, and/or entry to role which seems preferable. In some minds transsexualism displaces transgenderism altogether as the only legitimate cross-gender lifestyle choice. Elements of the medical profession have embraced this soemwhat self-serving viewpoint.
There are a variety of objections to the practice of SRS.
Some people feel that SRS is a violation of the body which should be avoided unless absolutely necessary. I cannot hope to justify desire for SRS any more than I can justify the desire for body piercing, tattoos, cosmetic surgery, liposuction, or extreme muscle development. All of these violate some sense of propriety, yet all fall within the bounds of individual discretion and acquisition of preferred body and role.
SRS has less potential impact on my life than would the birth or abortion of a child on the life of someone else. The surgery does not change my gender; I have already done that without it’s help. The change that the surgery makes is so easily hidden, so personal, that very few people will be able to say for sure whether or not I have had it. Only those very close to me will really know. It is really not such big deal.
Some people would object to my SRS on the grounds of ‘morality’ or concern for my well-being. Their objections, though, are essentially the same as those leveled against abortion, and just as poorly founded. I don’t care how good your intentions may be, they do not justify denying my right to decide for myself. This is my body, they’re my genitals, and it’s my choice.
Some folks argue that post-surgical transsexuals are no better off then before the surgery. It has been observed that for many patients, the levels of post-op depression and paranoia were essentially undiminished, compared to pre-op levels. Some professionals reasoned that, since the surgery doesn’t always seem to fix things, we should be more restrictive of who gets it. Some even go so far as to discourage SRS entirely. Their reasoning is flawed, though, because most transsexuals were routinely encouraged to violate their own integrity by lying about their past. Passing themselves as women forced them to hide their uniqueness and construct fake pasts. Their lifestyle required deception as a prominent feature of day-to-day life. Their paranoia arose out of fear of being found out. Their depression grew from the continued isolation of their intimate self. Their post-op blues were due to breach of integrity, not failure of the surgery.
As most transsexuals learn sooner or later, the surgery is a cosmetic change which can be helpful in some ways, but which cannot by itself change some aspects of one’s mental state, including paranoia and depression..
If we make the decision to have SRS the right and responsibility of the individual, certain things are bound to occur.
Expect More Mistakes
Probably the most obvious, and most feared, is that some people will undergo SRS and later decide that they made a mistake. I would propose two approaches to dealing with this issue, education and assignment of responsibility.
When a person requests SRS, they should be exposed to a divulgence of information about the procedure designed to highlight potential pitfalls, and expose weakness in the requester’s resolve or reason. Such information might take the form of questions requiring a response or interview process. However, it should be made clear that the informing of the requester is not a test, rather a suggested part of their process of making their own decision. The requester would assume all responsibility for determining suitability of the procedure to themselves by signing comprehensive waivers and release forms.
In support of an effective divulgence, surgeons should be required to do follow-up on all patients and make resulting statistics known to all patients beforehand. Standards for such follow-up should be developed by independent organizations such as the Harry Benjamin Association.
Despite careful education, there will still be those that regret their choice. Such is the case with all elective surgery. It is an accepted fact that regrets sometimes occur, and transient regret is not uncommon. The holding of SRS as a special case reflects, in my opinion, our discomfort with our own sexuality. Making a mistake with our organs of sexuality carries a special fear, because these parts themselves arouse fear for many of us. There are good reasons for that: we discourage learning about this part of our bodies, and far too many of us experience genital abuse by others. Our fear is understandable, but can be conquered by exposing it to the light of day and the treatment of reason. The fear that I might make a mistake with my genitals is not reason for denying my right to own my body, any more than a fear that a woman might abuse her right to abortion allows you to deny her right to choose.
The best teacher is experience, and her primary tool is the mistake. Success teaches little; failure teaches realms. I regret every mistake I’ve ever made, and yet, I would take back not a single one, including the terrible motorcycle accident that crippled me. Were it not for that accident, I’d probably still be cowering in a closet somewhere. Protecting me from that accident would have robbed me of what I sought and needed most, and relegated me to a state of even greater ignorance than the one which I currently occupy.
End of Insurance
A significant consequence of allowing individual choice will be the reclassification of SRS as an elective procedure. This will probably lead to the end of insurance coverage. Such eventuality will cause some serious problems for individuals who do not have the means to pay for the surgery, and who are currently expecting their insurance to pick up the tab. These people tend to be adamant opponents of de-pathologizing transsexuality, since doing so could prevent them from ever having the surgery.
I would propose two ways to help these people. First, we should recognize that some pre-op transsexuals need special help in developing the skills they need to earn good money. By focusing on a path to SRS via becoming productive first, we would empower them both to pay for the surgery and to be more successful afterwards.
Second, I would propose the establishment of a fund for providing financial assistance to transsexuals. Clearly, such a fund could not satisfy all of the need, but it could shrink the obstacle for some, and provide a means for the rest of us to help these folks. By structuring assistance as loans, the fund could regenerate itself in time. Like student loans, this fund would provide a way for those for whom lack of surgery is particularly troublesome to defer payment until after their productivity is facilitated.
If we are to vest authority in the individual to make their own decision, we need to accompany this with a revision to our philosophy. We presume that it is wrong to want to change sex or gender, so we bully and badger and pathologize anyone who so desires. Then, lo and behold, we find that lots of transgender folk are traumatized, so we’re justified in pathologizing them. We’re like the mechanic who convinces you that your car needs a tune-up, then leaves it running worse than before.
The simple truth is that it’s our society that’s sick. We mistreat each other, particularly our children who cannot stand up for themselves against the overwhelming power of adults. We use our greater power to train them like pets, to behave in ways that we find satisfying. We give them toys instead of attention, lies instead of love. And we squeeze them into one of two molds, depending on whether they’ve got a penis or not. When they don’t fit exactly, we figure we screwed up somehow. Instead of questioning the mold, we figure either we or our kids just aren’t working hard enough to fit in.
This is the pathology of a sick society. The sickness rests not in the individuals who sense discord between themselves and the mold, but rather the system that produces the molds. Let us recognize the mechanism that shapes our desires. Let us manage for ourselves the shaping of our desires. Let us end the unconscious manipulation that traps us in a system of fear and prejudice. Let us teach our people to appreciate our children, all of them, in their variety of self-expression. Let us teach our parents that good parenting is measured not in performance, appearance, and manner, but in autonomy, creativity, and smiles. Let us teach our children to appreciate each other, and to lose the fear of non-conformity that we’ve burned into their brains. Let us show tough love for all forms of bullying, whether by parent against child or child against child. Let us tolerate no violation of autonomy, period.
Promote acceptance of TG roles
Medically sanctioned transsexualism based on SRS, with no similarly sanctioned transgender or non-SRS transsexual option, skews the emerging desire of transgender people. The young person who feels such desire is blocked from exploring it by the fact of their body type. They come to see their body as the agent of imprisonment, and SRS as the only visible cure. In other words, sanctioning of a non-op transsexual or transgender alternative will likely reduce demand for SRS in a healthy way. Today, many transsexuals are choosing to change some elements of their physical sexuality without undergoing SRS. It’s time our helping professionals took an active role in promoting transsexualism and transgenderism without SRS.
If we accept that it is my right to decide if I want SRS, it follows that, if I do so, there must be some good reason. There must be some aspect of SRS which is healthy for me, or I wouldn’t desire it. Likewise, there must be some positive force behind all transgenderism and transsexuality. We were not created by some cosmic mistake. We are a variation of the human condition which is normal and natural, part of the continuing health of humanity as a whole. We have a unique contribution to make to the world. Our uniqueness is something to be respected, for it contributes to the fullness of human expression, and enriches all whose lives feel it’s touch.
If transsexualism and transgenderism are to be respected, they cannot be promoted as something which must be hidden. Rather, we must develop a respectable social role for those who change either gender or sex over the course of a lifetime. The notion of changing one’s past is inherently dishonest, and robs us of integrity, community, and a healthy role in society as people gifted with a powerful perspective. I and my ‘out’ brothers and sisters are living proof that it is healthier not to hide. It is time for the helping professionals to recognize this simple truth, and help us eliminate institutionalized paranoia by publicly declaring the health benefits of being ‘out’. Enough causality, already. Let’s compare efficacy of solutions.
Advantages & Drawbacks:
The changes that I’ve described would convey a variety of benefits to both individuals and society.
The most significant benefit would be the fostering of individual integrity and responsibility. The knowledge that our desires will be respected, and that nobody else will try to make our decisions for us, cannot help but buttress our self-esteem and confidence. The absence of a gatekeeper role will simplify our self-exploration by encouraging greater honesty with both helping professionals and ourselves. Removing the fear that we will not be allowed to follow our hearts will eliminate one more obstacle to clarity of desire. The vesting of authority in the individual will promote diversity while supporting the growth of personal dignity.
The recognition of the natural participation of transgenderism in society will facilitate social gender reform. More people will come to view gender as a binodal rather than binary or bipolar. The extreme polarization of our society along sex and gender lines will soften as gender display becomes more a matter of discretion than expectation. Sex and gender role oppression will diminish as mobility among the roles is facilitated. Our culture will see, for the first time, the rise of a spirit which transcends sex and gender polarity.
We are already seeing a new flowering of transgender and transsexual spirituality. The loosening up of constraints on personal search for sexual and gender fulfillment will further encourage such activity.
Perhaps most challenging to our sensibilities, bodies that do not exactly fit the expected types will become more commonly visibly. Already, many people elect to develop breasts without ridding themselves of their penis, and some people obtain mastectomies with no intention of hysterectomy or phalloplasty. Also, many people are gifted with sexually variant body types at birth. When we lose our fear of body variation, and instead see a cornucopia of opportunity and diversity, it’s easy to see a future unfolding of richly variant human sexuality.
A difficult aspect of this change might be greater conflict with traditional sensibilities. Such conflict, if ignored or taken lightly, could lead to hatred and acts of violence. Although it is clear that our European-derived culture is founded on a tradition of violence and bigotry, our tradition is not without it’s positive aspects. Moreover, there will always be those who seek solace in an imagined past and wishful beliefs. Conflict with such persons can be minimized by intercommunication with an approach of mutual respect and accommodation. As the old saying goes, you catch more flies with honey than with vinegar. As a community, we will have to be proactive in such pursuit, or risk playing the role of respondent to someone else’s agenda.
Conclusion: Implementing Solutions
We challenge our health services professionals to be astute observers of social change, and to design our medical, psychological, and sociological support systems to best fit the evolving needs of our people. The Harry Benjamin Standards of Care have served well as guidelines to caring for those needs. Yet, as with all processes, nature demands that life evolve to meet changing need.
So I challenge our helping professionals to act out of courage, trust, and compassion, for it is the spirit of our actions that guides our future. Have the courage to expand the vision of your practice, to recognize and nurture within us this nascent self-esteem. Trust that individual responsibility for self is the starting point for effective healing technique. Have the compassion to allow others to make the mistakes that they need to make in order to move ahead with their lives.
The day will come that we no longer sort our children by sex, when sexual polarity is no longer a boundary for restriction. However, this is not currently the case. To be born male or female today imposes on most people an entire set of expectations and restrictions based entirely on presumption and which may be entirely inappropriate in virtually any aspect. Under such a repressive system, with well-developed avenues for transgender and transsexual mobility, there’s no good reason why any individual should not be allowed to have SRS if that’s what they want.
For any person other than myself to exert final authority over decisions of what to do with this physical body is a violation of my personal autonomy. This is my body, and it is the one thing that I own from the day I’m born until the day I die. To paraphrase a famous American, I may not agree with what you choose to do with it, but I will defend to the death your right to make your own choice.
STANDARDS OF CARE The hormonal and surgical sex reassignment of gender dysphoric persons, Revised draft (1/90), Harry Benjamin International Gender Dysphoria Association, Inc.