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Why “Sex Change” Surgery is Medically Necessary

The panic machine is in full swing, from far-right conservatives trying to terrorize Americans out of wanting universal health care.   There are half-truths, such as the story of Ontarioan Shona Holmes who had to abandon Canada's public health system and go south for surgery because of wait times, but without mention of how the cyst was inactive, that she was born with it (which would have made it a pre-existing condition to American insurers) and how upon return she had the remainder of the issue dealt with in a timely manner at Canada's expense.  And then there are outright lies, such as citing a line that is meant to help patients in end-stage situations put together an advance directive, and making it sound like the Obama administration is intending to encourage genocide of seniors

The question isn't “How do you want to die?” The question is simply: “What kind of care do you want, and what measures do you want taken if – at the end of life – you are unable to speak for yourself?”

And in there, of course, we have the trans bogeyman resurrected, with WorldNetDaily, OneNewsNow and others raising the panic that if universal health care is implemented, Gender Reassignment Surgery might be covered.

Now, if you're a Fundamentalist, anti-gay, not-happy-about-the-black-guy-in-the-White-House, then chances are, nothing I say is going to matter.  But if you're a typical live-and-let-live American who is maybe not too keen on the idea of the public coffer paying for “sex change” surgery but hasn't really delved into it, the following is for you.  To my thinking, this is a reasonable time to bring out the facts to show how much of a straw argument this is.  Could universal health care end up funding GRS?  Actually, it could, and that would not be the travesty it's being made out to be.  It's medically necessary, and here's why.

Popular opinion has it that Gender Reassignment Surgery (GRS, often popularly nicknamed “sex change surgery”) is a cosmetic issue and motivated by a simple “want” to be female or male, by someone who was not born as such. However, extensive medical research into transsexuality dating as far back as the 1920s and continuing through modern studies have demonstrated otherwise, and consequently, medical standards of care have included GRS as a necessary procedure for decades. In order to understand this, people will honestly need to put aside preconceptions for a moment.

The experience of being transsexual involves one's entire identity. They attempt to hide who they are, living a lie that feels unnatural in order to live up to others' expectations, the hiding driven by a spiraling sense of shame and self-loathing, until it becomes an experience many liken to “suffocating,” or vents itself in an explosion of frustration. Transsexuals are unable to explain why they feel that their gender should be something different than their birth sex, and sometimes spend years attempting to mask themselves, to “pass” as the gender that society expects them to be. This restricts their ability to function socially, emotionally, psychically, spiritually, economically (it’s hard to be productive while constantly feeling out of one’s element and/or “backwards”), maybe sexually, and leaves them often suicidal as a result. If this continues into later adulthood, often a crisis point is reached in which the person suffers a complete emotional collapse.

“Gender Dysphoria” is the name for this condition, and treatment follows the standards of care established by the World Professional Association of Transgender Health (WPATH, formerly HBIGDA), which includes GRS. No less than the American Medical Association has stepped forward advocating the necessity of surgery and its coverage.  In fact, like the AMA, the American Psychiatric Association, the American Psychological Association and their Canadian counterparts support GRS as a medically necessary part of treatment. It was partly for this reason that the Ontario Human Rights Commission ruled in 2008 that that Province should restore coverage of the procedure.

Treatment of Gender Dysphoria encorporates surgical and endocrine intervention, because analytical and aversion therapies have historically proven damaging. As much as mainstream society would like to believe that electroshock therapy, anti-psychotic drugs or conversion (“ex-gay”) therapy would help transsexuals “just get over it,” modern medicine has realized that this approach simply does not work, and usually results in suppression, suicide or extreme anti-social behaviour. Aligning body to mind, however, has enabled transsexuals to become valued and successful people in society. There are, in fact, a few transsexuals who feel that they can live without having GRS, but they are the exception and not the rule.

Gender Dysphoria (sometimes called “Gender Identity Disorder,” or GID) is currently listed as a mental health issue, but ongoing study of both genetic ”brain sex” and Endocrine Disrupting Chemicals (EDCs) show the possibility of some biological causal factor. In a study released in October 2003, UCLA researchers identified 54 genes in male and female mouse brains that led to measurable differences by gender, and went on to indicate the possibility of a brain being gendered differently to one's physical sex. Studies of EDCs show another, possibly concurrent potential that exposure to chemicals that simulate hormone characteristics — particularly between the third and eighth week of pregnancy — can affect the signals sent out to determine psychological gender and biological sex, which appear to develop at different times during gestation. In all fairness, nothing is conclusively proven at this point, and there is not a lot of research money being put into further study, as most pharmaceutical companies do not yet see a payoff from doing so. But the anecdotal and observational data from EDC and brain studies of human and animal populations would tend to support an innate origin or component of transsexuality, and coincides with transsexuals' convictions that they “just knew” that they were female (in the case of male-to-female transsexuals) or male (in the case of female-to-males).

There is more. Current legislation asserts that most forms of identification and legal documentation can only be changed to reflect one's new gender after surgery has been verified. Without GRS, many pre-operative transsexuals experience severe limitations on employment, travel and treatment in medical, legal and social settings in which verifying ID is necessary. Prior to GRS surgery, transsexuals also face limitations on where they can go (i.e. the spa or gym, or anywhere that involves changing clothes) and difficulties in establishing relationships — as well as being in that “iffy” area where human rights are assumed to be protected, but have not yet been specifically established as such in policies and legislation. In hospitals, prisons and such, they are housed by physical sex rather than their gender identity, creating potentially risky situations, unless the authorities directly involved choose to keep them in isolation instead. And at the end of the day, without GRS surgery, one's gender is always subject to being challenged or stubbornly unacknowledged by those who don't realize that a transsexual's gender identity was not a matter of choice. There is also an extremely high risk of violence faced upon the accidental discovery that one's genitalia does not match their presentation.  No other supposedly “cosmetic” issue so completely affects a persons rights, citizenship and safety.  

It's a procedure that costs about $20,000 for male-to-female transsexuals, up to $80,000 for female-to-males, and most health insurance providers make specific exemptions to ensure that GRS specifically is not covered, so it's not like there are a lot of other options — we're looking at a serious roadblock in a small group of peoples' lives.  When the Alberta government delisted GRS, we calculated the total cost to Albertan taxpayers at 19 cents per year — spread across a population size of America, it would be negligible.

Transsexuality is not widely known or understood in mainstream society, and should not be confused with other aspects of the larger transgender (umbrella term) culture. Although much sensationalism can be made of something like medical coverage of Gender Reassignment Surgery, the realities paint a very different story.

Mercedes Allen

Permission is given to redistribute as people see fit, provided the text is not altered

Crossposted to The Bilerico Project

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