In March this year spoke to FiLiA about my work. Here’s a short excerpt, you can read the whole interview on the FiLiA website.
“What was your initial assessment of how medicine understands or manages patients who identify as other than their biological sex?
Working in psychiatry, I encountered several transsexuals who became acutely suicidal following sex-reassignment surgery. They were homosexual males with a diagnosis of Gender Identity Disorder (GID), who had undergone a thorough assessment and counselling to ensure their suitability for these procedures and to help them manage their expectations. When their psychological distress didn’t go away following surgery, they described feeling mutilated and wanting their old bodies back, which was unfortunately not possible because these operations were irreversible. I had a great deal of empathy for these patients, but I also understood the impulse of a doctor to do something, anything, as a last resort to help alleviate a patient’s distress at being born male. I wasn’t convinced that sex-reassignment was the best way to go about achieving this, but I trusted my colleagues, who were experts in this area, to have solid science behind what they were doing.
When I started examining this issue in detail, I first wanted to familiarise myself with the scientific rationale for sex-reassignment. To my surprise, I couldn’t find any studies that showed long-term improvements. Instead, the biggest study on sex-reassigned individuals showed significant increase in mortality, morbidity and suicide over time. Despite this, a whole new population of patients, mainly girls but also some boys, were being diagnosed with “gender dysphoria” and instead of being offered counselling, they were fast-tracked to a medical pathway to “gender reassignment,” that involved hormone blockers, cross-sex hormones and eventually, irreversible surgeries such as double mastectomies, hysterectomies and surgical castration.
I looked up Gender Dysphoria (GD) and found that it had replaced GID in the diagnostic manual for psychiatrists (called DSM-V). The criteria appeared very similar in spirit, but the persistent discomfort with one’s biological sex and identification with the opposite sex, that I have seen in my patients, was now redefined as a mismatch between one’s “experienced/expressed gender,” and “assigned gender.”
The criteria never define “gender,” but judging by the description of boys and girls as “assigned genders” it is safe to assume they are referring to biological sex.
But if this was the case, why do they also talk about “desire to be of the other gender (or some alternative gender different from assigned gender)”?”