Editorial

by Katherine Cummings

(The Gender Centre advise that this article may not be current and as such certain content, including but not limited to persons, contact details and dates may not apply. Where legal authority or medical related matters are cited, responsibility lies with the reader to obtain the most current relevant legal authority and/or medical publication.)

The Monash Medical Gender Centre's Dysphoria Clinic is in trouble again. It seems to have been fighting militant, misguided clientele ever since I can remember. Some of this the Clinic brings on itself by being the gatekeepers' gatekeeper and operating on a level of bureaucracy which is thankfully absent elsewhere in Australia.

Why it is seen as playing God when gender (or sex) is involved, and not for other modifications of a healthy or diseased body ...

A small number of dissatisfied clients have asserted that they should have been treated differently, provided with psychotherapeutic treatment for their gender problems, rather than being encouraged to have gender reassignment, and rushed through the process without proper attention to their "true" needs. As a result the Clinic has been shut down, pending an investigation, and a number of its clientele are left in limbo, partway through the process of transition and deprived of the certainty they need in order to function in society.

As I have often written in the past, I have little time for gatekeepers as I really don't think any adult of sound mind should need to seek permission to exercise control over her/his body. Women have fought this fight in a different context and, by and large, have won the battle. Of course the clinker in that statement is the "of sound mind" caveat, as there are still many in society, including medical practitioners, who believe that if one wishes to affirm one's gender in a way contrary to the authorised version then there must, ipso facto, be a possibility of mental ill-health.

Nor do I think there is anything special about genitalia as compared to any other body part. If I want cosmetic surgery to reshape my body into a closer approximation of my ideal, that should be entirely up to me, my bank manager and my surgeon. I can remodel my nose, why can't I remodel my genitals?

As a side issue, there is a recurrent theme in newspaper stories about gender reassignment where journalists or sub-editors refer, censoriously, to doctors playing God. Why it is seen as playing God when gender (or sex) is involved, and not for other modifications of a healthy or diseased body, passeth all understanding.

Underlying the proposition that the decision to contract with a medical technician to remodel my body is mine is, of course, the imperative that I do my homework beforehand, read up on the variant procedures available, check on possible side-effects (medical, social and legal) and then accept responsibility for my decisions. This is called being an adult.

The Monash clients who are creating problems are those who have accepted treatment for gender dysphoria, treatment they pleaded for and delighted in until they belatedly changed their viewpoints and convinced themselves that the Clinic should in some arcane way have divined their inner ambivalence and denied them the very procedures their whole lives had become centred on, the procedures for which they were prepared to sacrifice careers, families, social acceptance ... anything.

And how could the Clinic have achieved this miracle of brain-laundering? Why, through psychotherapy, of course. The fact that these cases had already been run past psychiatrists and psychologists is not sufficient. Monash runs on a committee system and psychs, sociologists, surgeons and Uncle Tom Cobley are all allowed to help or hinder the process of transition. As Trudy Kennedy, the Head of the Clinic, said, "I have been hung out to dry. They just want to blame it all on me. I have not made one decision here, they are all team decisions ..."

The critics believe the process should have gone on until the "right" decision was reached. "Right", in this instance, means right in the retrospective judgement of those who are now in denial and want to blame everyone except themselves for decisions they took and procedures they authorised.

And how many of these latter-day converts to the One True Way are there? The article by Jill Stark in the Sun-Herald of 31 May 2009 mentions three dissatisfied clients from a total of 600. Later comments on the Internet have lifted the number to eight, but even if the number were raised to twenty this would still be a dissatisfaction rate of only 3.3 per cent. The Fairfax article on gender change, which appeared in variant forms in the Age and the Sun-Herald and maybe elsewhere, also says there have been no studies of satisfaction rates in Australia. This may be true but there have been many such studies overseas going back more than thirty years and covering several countries, and the lowest recorded satisfaction rate for post-operative transgenders is around 86%, with some studies giving it in the high nineties.

It is interesting to note that the suicide rate for pre-operative transgenders is of the order of twenty per cent whereas the suicide rate for post-operative transgenders is around half of one percent.

Gender reassignment procedures are more complex than many so that there is a greater chance that things may go wrong. The endocrinological and surgical procedures are, nevertheless, remarkably sophisticated and there are constant improvements on what is, after all, a very recent surgical specialty. The first widely publicised "sex-change" (Christine Jorgensen) was carried out only fifty-seven years ago.

The former M.T.F. from the Fairfax article, "Andrew", does not appear to be complaining about the quality of the surgery, but rather the end result, and the uncritical willingness of the Monash Centre to prescribe feminising hormones. He sees a need for more rigorous psychotherapy preceding surgery.

Let us look at the testimony of the complainants.

"Angela" was F.T.M. who has gone back to living as a female after having a double mastectomy and testosterone therapy which deepened her voice and "within months had covered her body with thick hair."

At this point, after being obsessed with becoming male for years, Angela had an epiphany wherein God told her to go back to being female. By her own account she was both drunk and stoned at the time, but hey, you take your epiphanies where you find them. She has now reversed the process of masculinisation, had breast implants, married and borne three children. And why not? Anything a human being can do, some human being will do. I merely cavil at her wanting to blame someone else for her own mistakes and trying to interfere with the lives of those who are just as passionate for transition as she used to be.

"Andrew", the former M.T.F. complainant is, however, another kettle of fish. When I first read about "Andrew" in Woman's Day (19 December 1989), he was ecstatically telling the world how happy he was to be a woman at last, having spent his earlier life wanting to be female. In 1986 he (or she) had the irreversible operation "which she says she will never regret".

She (or he) went through a form of marriage with a person who wanted permanent residency in Australia and was angry when told her marriage was illegal. "I will fight for the law to be changed," he (or she) is quoted as saying.

By 2004 "Andrew" had changed his mind and wanted to sue the Monash Medical Centre for malpractice, despite his long years of unhappiness at being male, his desperate wish to be female, his marriage, and a confession that he cheated on the assessment tests which decided he was a suitable candidate for reassignment. Assuming he had been subjected to more psychotherapy, as he now says he should have been, who is to say he would not have cheated his way through that barrier as well? Psychotherapy is an imperfect science, if it is a science at all. I think it falls more into the area of voodoo or religion, but that's just my scepticism.

In 2004 "Andrew" bought into the case of Alex and joined the Forces of Darkness who wanted to deny Alex the opportunity to defer puberty until he was of a legal age to decide whether to go forward to reassignment or not. "Andrew" by then was recalling having second thoughts on the way to the operating theatre and of being reassured by medical staff that it was normal to suffer nerves at that point.

Define "normal".

In my autobiography I wrote of my feelings before surgery as follows "Was I scared? You bet! Scared and excited and worried and exhilarated and apprehensive. Did I consider backing off, cancelling or postponing the date? Not for an instant." But mentally I reserved the right to do so, right up to the point of losing consciousness. And didn't. In the latest version of Andrew's story he says to the surgeon "I think I'm doing the wrong thing. I think we've got to stop it. Then it went black." When he woke he assumed the operation had been cancelled but was shocked, horrified, destroyed, to find that in fact he was now the possessor of a neo-vagina. He claims to have bawled his eyes out.

I assume the implication is that after he made his complaint to the surgeon he succumbed to anaesthetic. But if he was in the process of counting backwards from ninety-nine with an anaesthetic mask over his face, how could he enunciate his doubts to the surgeon? If, on the other hand he had not yet started the anaesthetic procedure, why didn't he insist on his right to stop the proceedings?

A new moment of drama has been added to the latest version ... the "primal wail" and traumatised sobbing of his younger sister as "Andrew" was trollied towards the operating theatre. She didn't rate a guernsey in the earlier versions.

And so now he feels "like a desexed dog". Well, yes, the starting process is similar, but why not "desexed human"? I imagine "Andrew" knew what was going to happen down there before he agreed to the operation? "Andrew" also complains that, "I will never be able to have sex again."

There are many ways to have sex and if "Andrew" doesn't know about them at his age he must have been sleeping with Rip Van Winkle for the past half-century.

Most post-ops have no problem achieving orgasm. See Lobato et al., cited below, who say, inter alia, that "For 83.3 percent of the patients, sex was considered to be pleasurable with the neo-vagina/penis. In addition, 67.4 percent reported that initiating and maintaining a relationship had become easier ... The number of patients with a partner increased from 52.6 percent to 73.7 percent. Family relationships improved in 26.3 percent of the cases (with 73.7 percent of the patients reporting no difference) ... In conclusion, the overall impact of sex reassignment surgery on this cohort of patients was positive."

"Andrew", I understand that your attack is on the Monash Clinic, which you believe to be negligent in its treatment of you and others, but your own lack of credibility seriously weakens your case. Either your Woman's Day panygeric was true and your later story is false, or your earlier story was false and your new story is true. I suspect you don't know, or care, what truth is, and you bend it to suit your own ends.

But you could leave other people to sort their lives out for themselves and cease imposing your own opinionated and questionable values on the intimate lives of those who know what they want from life. They really don't need you to erect barriers to their life's journey because you choose to be a spoiler.

Further Reading:

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