In the film One Flew over the Cuckoo’s Nest a criminal (Jack Nicholson) gets himself admitted to an insane asylum in order to avoid the dangers of prison life. He ends up having his frontal lobes disconnected from the rest of his brain using an ice pick hammered through his skull just above the eyelid (the standard operation in those days). In an instant he is changed from a troubling, funny, exciting psychopath to the personality equivalent of an empty coke can.
Prefrontal leucotomy, mind surgery, using the knife to alleviate mental suffering, turned out to be a disaster, a zombie maker. Thousands underwent it, even women with post-natal depression had the ice pick, and on one occasion a nine year old boy. Opponents of the operation were sidelined, and its inventors Walter Rudolf Hess (no, not that Hess) and Antonio Egaz Moniz were awarded the Nobel Prize for medicine in 1949.
Is gender re-assignment, the sex change operation, an operation to cure severe psychological distress, today’s psychosurgical equivalent of prefrontal leucotomy? Initially treated with extreme reserve by the medical profession, gender reassignment is now extraordinarily fashionable with a veneer of respectability hanging over it. There are some 5000 trans-sexuals who have had the operation in the UK. The term gender re-assignment (Americans call it gender confirmation) has a nice tidy ring, a bit like re-indexing your library. You were on the shelf labelled men, now you are on the shelf labelled women. If you want to be returned to your previous shelf, go ahead. If it sounds simple, it isn’t. Like prefrontal leucotomy, the phrase gender reassignment hides a profound biological misconception.
You cannot reassign sex, no more than you can move the earth’s axis. What you can do is to surgically alter somebody’s outward appearance and refashion their genitalia, and add a wash of hormones to keep the sexual show on the road. While your sex may be male, your gender is now female, gender being the term now used to describe your feeling of sexual identity. I have used the word ‘appearance’ because that is all it is. Unfortunates who have had this operation have not changed their sex, only how they look. And they don’t look good to others. Many lead isolated lives, let alone being sexually fulfilled.
While transgender surgeons are remarkably optimistic about the results of their work, some claiming a 97 per cent satisfaction among their patients, a rate as a far as I know never equalled for any other operation in the medical textbooks, statistical follow ups of patients are few and far between. In a Danish study of 102 patients, between 1998 and 2010 ten patients died with an average age of 53 years as against 79 years for the normal population, mainly due to an unexplained increase in unrelated physical illnesses. There was a slight reduction in psychiatric illness following surgery, but it was not statistically significant.
An earlier Swedish study in 2011 of 324 sex-reassigned individuals between1973 and 2003, ‘…. found substantially higher rates of overall mortality, death from cardiovascular disease and suicide, suicide attempts, and psychiatric hospitalisations in sex-reassigned transsexual individuals compared to a healthy control population….’.
Those who find their transition does not work can ask for the operation to be reversed. Regret rates are highest in male to female transitions. However there are no figures for ‘de-transition’ operations in the UK, one was recently planned but shut down by Bath University ‘as it might offend people’. Transgender is a heavily politicised subject bringing censorship with it.
Is there a scientific basis to transgender surgery? No there is not. We are born with either the XX chromosome, female, or the XY chromosome, male. A very small number of patients even though they are genetically male – they have the XY chromosome – grow into poorly developed females. This is because they lack a vital gene switch on the Y chromosome which tells them to grow up as males
If a female mouse has this gene forcibly switched on all her offspring develop as males even though some of them are genetic, XX, females. ‘including growing a penis and testicles, mounting females, and performing every behaviour characteristic of male mice. By flicking a single genetic switch, (Goodfellow) the researcher had switched an organism’s sex.’
There can be no doubt of the force of nurture over nature in matters of behaviour, especially sexual, but it is highly probable that all forms of sexuality are at root genetically determined – everybody thinks this is the case for homosexuals – which would explain why homosexuals react badly if anybody tries to persuade them to try to be heterosexual. Will this be so when children who have been pressured into thinking they are the wrong sex, on maturity discover this not to be the case.
Why then do some people want to change sex? The desire may be a self-image disorder, some subtle physical rewiring of the brain similar to anorexia or those suffering from a desire to have a limb cut off, a condition called apotemnophilia, who sometimes will go to any lengths, including self-amputation, to achieve their wish. Some of the latter have subtle changes in their brain anatomy associated with this desire, although so far nothing conclusive has been found in the brain scans of people who want to change sex. What ever the cause of being born feeling you are in the wrong sex, like wanting to rid yourself of one limb, it is both extremely painful and tragic. What is sad is that the disorder has been caught up in radical politics.
Trans-genderism has proved a sitting target for a politically powerful, well-financed and vociferous lobby who believe in the Maoist refashioning of society. One of its major targets is the patriarchal society with its emphasis on family and kin. No longer will white males have the right to force their genes on that most oppressed of individuals, the straight female. In a new world people can be any gender they like to be, and change at any time. The very roots of sexual identity are to be torn up, no men, no women, no marriage, no children, no society.
Dismissing genetic arguments, indeed all science, as ‘a white man’s construct’ the first step for the lobbyists was to pressure politicians to write into the law that an individual’s choice of gender is his or hers, and requires no medical certification confirming it. If a patient comes to her doctor and declares herself to be male, then she is male. If she further would like to be made into a physical male, no type of psychological investigation should follow as feeling you are in the wrong sex is not a disease, just as homosexuality is not a disease. To back this up in some jurisdictions, for example Canada, if you refuse if asked to use gender-neutral pronouns when referring to transgender people, you risk being convicted of a criminal offence.
Following the dictum of the founder of the Jesuits, St Ignatius Loyola, ‘give me a child until he is seven and I have him for life’, transgender theory has been imported into schools, with teachers mandated to look out for children who express doubts about their gender, to encourage them to consider they might be in the wrong body and to advise their parents to start the first steps toward arresting puberty with a view to a gender operation at maturity. To reinforce this the age at which a child is recognised to be able to decide on his or her sexuality has been lowered to 17. Totally false press releases have stoked the movement with claims being made that 1 per cent of the population is transgender, it is more likely 0.3 per cent.
GPs who ten years ago may never have seen a transgender patient in their lives, now report seeing at least one a year, sometimes more. Alarm bells have begun to ring, far too late, with some GPs refusing to prescribe hormone treatments for children. Psychiatrists, surgeons and medical researchers have all begun to express serious doubts about the value of this type of surgery, pointing out the lack of evidence for its value, and the possible serious long term effects, both psychological and physical, of changing one’s sex.
Sadly as with all political lobbies, the extremely hard work of a few activists means the transgender horse has already bolted, with the UK government offering a Sir Humphrey ‘consultation’ on the suitability of this treatment written in such impenetrable language that few members of the public will read it let alone fill it in. One can guess its conclusions.
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Is life in general good for transgender patients after surgery? Some say their life is transformed by the operation, and there must be cases where suicide is avoided by the operation. I do not for one instant doubt the good faith of surgeons faced with the obvious suffering of patients wishing to transgender, but surgery is a funny thing with a massive placebo effect. What may appear to be a cure may be no such thing. If I were an abdominal surgeon with no idea whatsoever, except a clinical impression, of the long-term success or failure of say, gall stone surgery, I would not refuse to operate but I would be cautious about taking the next stone out.
Even more so with surgery of the mind.
Dr Renee Richards, a former professional tennis player wrote:
I wish that there could have been an alternative way, but there wasn’t in 1975. If there was a drug that I could have taken that would have reduced the pressure, I would have been better off staying the way I was – a totally intact person. I know deep down that I’m a second-class woman. I get a lot of inquiries from would-be transsexuals, but I don’t want anyone to hold me out as an example to follow. Today there are better choices, including medication, for dealing with the compulsion to cross-dress and the depression that comes from gender confusion. As far as being fulfilled as a woman, I’m not as fulfilled as I dreamed of being. I get a lot of letters from people who are considering having this operation and I discourage them all. ©
This article first appeared in the winter edition of The Salisbury Review