Let’s deconstruct the arguments being trotted out one by one.
A Swedish study shows post-operative people are more much more likely to commit suicide.
This statement grossly misrepresents the findings of the study and suggests that the study argues against transition-related care. Quite the opposite. The study outright states that medical transition is supported by the other research, and the study is not intended as an argument against the availability of such treatment:
For the purpose of evaluating whether sex reassignment is an effective treatment for gender dysphoria, it is reasonable to compare reported gender dysphoria pre and post treatment. Such studies have been conducted either prospectively or retrospectively, and suggest that sex reassignment of transsexual persons improves quality of life and gender dysphoria.
Indeed, another Swedish study in 2009 found that 95 percent of individuals who transitioned report positive life outcomes as a result.
Additionally, the higher mortality rates are in comparison with the general populace (and not other transgender people who have not received treatment) and only apply to people who transitioned before 1989:
In accordance, the overall mortality rate was only significantly increased for the group operated on before 1989. However, the latter might also be explained by improved health care for transsexual persons during 1990s, along with altered societal attitudes towards persons with different gender expressions.
It should come as no shock that as society accepts transgender people, they suffer fewer side effects of minority stress. This conclusion is supported by other recent studies (Murad 2010 and Ainsworth 2011) that found that individuals who receive treatment not only are better-off than those who didn’t but are not significantly different in daily functioning than the general population:
Male-to-female and FM individuals had the same psychological functioning level as measured by the Symptom Checklist inventory (SCL-90), which was also similar to the psychological functioning level of the normal population and better than that of untreated individuals with GID…
The mental health quality of life of trans women without surgical intervention was significantly lower compared to the general population, while those transwomen who received FFS, GRS, or both had mental health quality of life scores not significantly different from the general female population.
I would suggest that adopting a hard and fast position based on decades-old studies is not a good position to adopt.
It’s undeniable that he is a conservative Catholic and this significantly influences his thinking and public pronouncements on the issue.
He has on multiple occasions referred to biblical values as beneficial to society. He has referred to homosexuality as “erroneous desire”.
A quote from that book reads as follows: “Where did they* get the idea that our sexual identity (“gender” was the term they preferred) as men or women was in the category of things that could be changed?”
*referring to psychiatrists that advocate/d gender reassignment surgery
McHugh actually admits on the following page in the same book that patients who received the surgery at Johns Hopkins (before he stopped it), were generally happy with the results. His objections appear to be based entirely on his own personal distaste for how they dressed or behaved after their surgery.
None of these encounters were persuasive, however. The post-surgical subjects struck me as caricatures of women. They wore high heels, copious makeup, and flamboyant clothing; they spoke about how they found themselves able to give vent to their natural inclinations for peace, domesticity, and gentleness — but their large hands, prominent Adam’s apples, and thick facial features were incongruous (and would become more so as they aged). Women psychiatrists whom I sent to talk with them would intuitively see through the disguise and the exaggerated postures. “Gals know gals,” one said to me, “and that’s a guy.”
No evidence there, just an expression of personal distaste and disgust.
McHugh also draws erroneous conclusions from research:
Dr. Dan Karasic of the World Professional Association of Transgender Health (WPATH) took exception to Dr. McHugh’s take on the Karolinska study. “McHugh does cite one study from 2011,” Karasic wrote on WPATH’s Web site, “by Cecilia Dhejne, MD and colleagues at Karolinska Institute in Stockholm. However, he misunderstands Dr. Dhejne’s work. In the paper, Dr. Dhejne states that the study was not designed to draw conclusions on the efficacy of transgender surgeries, yet McHugh does exactly that. A closer reading of the paper shows that the increased mortality is in those who had surgery before 1989, and that mortality in trans people after 1989 is not statistically different from the general population. A recently published paper by Dr. Dhejne and colleagues shows that the regret rate for those having surgery from 2001-2010 is only 0.3%. Dr. Dhejne’s work shows that outcomes for transgender surgery have improved tremendously in the past 30 years, which supports the HHS decision to remove trans exclusions.”
The words of the author specifically warn against drawing the conclusions that McHugh draws:
For the purpose of evaluating the safety of sex reassignment in terms of morbidity and mortality, however, it is reasonable to compare sex reassigned persons with matched population controls. The caveat with this design is that transsexual persons before sex reassignment might differ from healthy controls (although this bias can be statistically corrected for by adjusting for baseline differences). It is therefore important to note that the current study is only informative with respect to transsexuals persons health after sex reassignment; no inferences can be drawn as to the effectiveness of sex reassignment as a treatment for transsexualism.
Surgical regret is actually very uncommon. Virtually every modern study puts it below 4 percent, and most estimate it to be between 1 and 2 percent (Cohen-Kettenis & Pfafflin 2003, Kuiper & Cohen-Kettenis 1998, Pfafflin & Junge 1998, Smith 2005, Dhejne 2014). In some other recent longitudinal studies, none of the subjects expressed regret over medically transitioning (Krege et al. 2001, De Cuypere et al. 2006).
These findings make sense given the consistent findings that access to medical care improves quality of life along many axes, including sexual functioning, self-esteem, body image, socioeconomic adjustment, family life, relationships, psychological status and general life satisfaction. This is supported by the numerous studies (Murad 2010, De Cuypere 2006, Kuiper 1988, Gorton 2011, Clements-Nolle 2006) that also consistently show that access to GCS reduces suicidality by a factor of three to six (between 67 percent and 84 percent).
I think the more pertinent factor to examine is: what evidence is there to support McHugh’s theories?
It automatically assumes the mind is not functioning as it should, that the line of thinking should be corrected. Branding gender dysphoria as a mental illness is a direct assumption that the person is not thinking as they should. Any treatment that assumes such is therefore inadequate by definition as it rules out gender reassignment surgery as an option, and thus makes the likelihood of mental illness as a by-product greater.
It’s not about trying to stigmatise people with mental health issues, it’s about recognising that gender dysphoria is an actual medical condition.
That assumes that there is no hormonal cause at the pre-natal stage and that transgenderism is a mental illness.
Neuroplasticity proponents commonly cite things like learning musical instruments as an example of how the brain can be changed. Treatment of disorders like OCD involve treating behaviour.
It’s a hell of a leap to believe it can be used to treat involuntary feelings or a person’s whole biological identity.
Conversion therapy for homosexuality has been largely discredited.
I would suggest that forms of conversion therapy for transgenderism are not the way to go - it’s more of the same line of thinking that treats it as a mental illness and not a medical condition and contributes to a general non-supportive environment.
Gender reassignment surgery is not a decision transgender people take lightly and the criteria for having it would appear to be fairly stringent. Any decision to go forward and have surgery is a decision that should be respected.
RESULTS: After gender reassignment, in young adulthood, the GD was alleviated and psychological functioning had steadily improved. Well-being was similar to or better than same-age young adults from the general population. Improvements in psychological functioning were positively correlated with postsurgical subjective well-being.
CONCLUSIONS: A clinical protocol of a multidisciplinary team with mental health professionals, physicians, and surgeons, including puberty suppression, followed by cross-sex hormones and gender reassignment surgery, provides gender dysphoric youth who seek gender reassignment from early puberty on, the opportunity to develop into well-functioning young adults.
@sidney is now a world renowned expert on gender reassignment. It is truly astonishing the lengths you will go to win an argument on the internet. I’m not being sarcastic.
In this post you said McHugh’s views were “just controversial”, which implies controversial to everyone. That simply isn’t true, you are making the mistake of assuming something controversial to a few internet posters means everyone finds it controversial.
This is a report on a metastudy of 100 studies done on post operative transgenders. The conclusions were that there was no scientific evidence that gender reassignment surgery is clinically effective. The study also found that many of the individual studies were poorly designed and skewed to suggest that sex change operations were beneficial. As Psychiatrists are guided by science I think you would find that many would agree with McHugh that sex change operations are not beneficial in treating gender dysphobia. The study was conducted after interviews with people who were unhappy with their sex chnge operations prompted a proper research study of the available evidence.
SO, its not a simple matter, which is what the opening post in this subsection of the discussion stated. The medical community is likely divided in this question, just as they are divided on many questions. On the one hand you have a very powerful lobby demanding gender reassignment surgery for their members, while the science appears to suggest it is not beneficial or at best inconclusive. It’s quite the position for a medical professional to be in, sawing off body parts when they are informed by science that it doesn’t cure anything.
How many gender re-assigned persons are suicidal or what not after treatment in accepting countries like Thailand where children are allowed be as feminine or masculine as they want growing up regardless of their bio-logical sex?
