Wednesday, April 10, 2019

Trans Regret & Body Autonomy

Regret is a very difficult thing to deal with, and there is great concern out there about what will happen if a transgender person may regret their decision to transition.  I first encountered this worry when I informed my friends and family that I had switched my hormones. I was actually quite surprised at how many people said to me - wow, okay, are you sure that is what you want to do? And very often that was followed up with - so, what will happen to your ability to produce testosterone if you are on estrogen for too long? Will you loose the ability to produce testosterone in the future if you change your mind?

It is almost as if they don't know me at all. And that is the rub, isn't it? Well for me it is, as it indicates that I hid myself very well. So well in fact that most people really have no idea of the life I have lived and for how long this "transgender thing" has been around. Weirdly, I didn't really understand that either.

Keeping those things in mind, I should have been better prepared for people being concerned about my upcoming surgery. If they were concerned about hormones, then they would be kind of freaked out about a surgery, right? Yeah well, I didn't really think that one through all the way. Maybe before we go any further, I should inform you what surgery I am discussing. People generally think about the surgery when trans people talk about surgery. No, it is not the surgery, however, it is right next door! Hahahaha..... I am scheduled to have an orchiectomy at the beginning of June. Don't know what that is? It is the removal of my testicles.

Why? Well, yeah, that is the question huh? Basically because since I switched my hormones it has become more and more clear that estrogen is a very important thing to me and my well being. Testicles produce testosterone. There, isn't that enough? It really should be. However, there is a bit more. I take spironolactone to prevent my body from using the testosterone that it constantly produces. That particular drug does other things to me besides the T thing. Number one would be that it makes me pee all the time. It sucks. Especially considering that I am a teacher. We don't have the ability to leave our classroom whenever we want. Number two is that it makes me dizzy and lightheaded when I stand too quickly. Besides those glorious side effects, I have unfortunately come close to not being to get my prescription. I had a pharmacy tell me they ran out and there was nothing they could do about it. Yeah, good times!

Basically I have decided to have my testicles removed so that I can have more control over my own body. Such a large, permanent change should be taken seriously, right? And I have. I kind of think that about 30+ years of pondering my gender is probably a long enough time to make a serious decision like this. The tortured days, and nights..... the endless discussions with my therapist.... the annoyingly long (all on my part) discussions with my wife....


Anywho….. I have been fielding questions from highly concerned people about what will happen if I regret my decision to remove my testicles.  It has been strange listening to these people describe their concerns about me and my body. Largely I have been pondering why so many people have been worried about my balls!  It is quite interesting that people are worried about what I will do to my own body.

Do you know what is weird? Nobody has ever said to me, congratulations. Don’t you think that is the appropriate thing to say?  What if you knew somebody who was born with a deformity that limited them in life and they have had to deal with it their entire life?  What would you say to them if they announced to you that they finally received a surgery date?  Would you ask them if they are sure that it is the right thing for them to do? Would you be worried that at some point they may regret their decision to change their body?  Would you tell them that you are excited and happy for them? I know for me, that is what I would do.


Okay, but whatever, you do know that I am NOT a man right? Oh, that's right.... I hid myself too well. So well that throughout most of this blog I have referenced myself as a man. Yeah, I am aware of that. Go ahead, take a look back through my documented history, you can see for yourself, I have referenced myself as a male for most of my history. So, maybe, possibly, I can sympathize with my friends and family who are concerned that maybe I may change my mind at some point.

What I have a harder time with are WPATH suggestions. What is WPATH? World Professional Association for Transgender Health. Yeah, I agree, exciting! Wait, there is a world-wide organization that is supporting transgender health? Well, yes and no. In many ways WPATH is accused of being a gate-keeping organization. What is gate-keeping? It is the practice of not allowing people to have autonomy over their own bodies. Meaning? Well basically it means is that unless you meet certain guidelines you will not be allowed access to that thing.

Vague? Possibly. So let's see if I can clarify a little. WPATH publishes a little something called the SOC - Standards Of Care. On it's surface this sounds as though it may be a glorious set of recommendations that the medical community needs to do for their transgender patients. That way ill informed doctors could reference it and then deliver appropriate care for their patients. And maybe some doctors use the SOC in that way, which would be fabu. However, in my limited amounts of experience, what I have seen is doctors and insurance providers using the SOC to limit access to medical care for the transgender community.

How so? The SOC include checklists that are to be used as guidelines for most things that transgender people want to do. Some of the checklists are:

Criteria for puberty-suppressing hormones (for children)
Criteria for hormone therapy
Criteria for masectomy
Criteria for breast augmentation
Criteria for hysterectomy/orchiectomy
Criteria for phalloplasty/vaginoplasty

Notice how they say "criteria?" Yeah most people do. What most people gloss over is the section of the SOC that say:

As in all previous versions of the SOC, the criteria put forth in this document for hormone therapy and surgical treatments for gender dysphoria are clinical guidelines; individual health professionals and programs may modify them.

Now, if doctors, insurers, therapists, and psychologists, actually understand the English language and can read, they would understand that these are not requirements, but guidelines. As well, people can feel free to modify them. Especially in states that have informed consent laws. Informed consent is when a health care provider does not have to follow these guidelines at all and can perform any procedure they are qualified to, as long as the patient is clearly informed about the risks, consequences, and outcomes.

However, the problem with this situation is that some health care providers make these guidelines become requirements. In my search for a doctor to perform my orchiectomy I struggled with doctors having more strict requirements instead of less strict ones. Here is what the SOC currently states for an orchiectomy.

Hysterectomy and Salpingo-Oophorectomy in FtM Patients and Orchiectomy in MtF Patients:
  • Persistent, well documented gender dysphoria;
  • Capacity to make a fully informed decision and to give consent for treatment;
  • Age of majority in a given country;
  • If significant medical or mental health concerns are present, they must be well controlled;
  • 12 continuous months of hormone therapy as appropriate to the patient’s gender goals (unless hormones are not clinically indicated for the individual.
As well:

Two referrals—from qualified mental health professionals who have independently assessed the patient—are needed for genital surgery. .... Each referral letter, however, is expected to cover the same topics in the areas outlined below.

The recommended content of the referral letters for surgery is as follows:
  • The client’s general identifying characteristics;
  • Results of the client’s psychosocial assessment, including any diagnoses;
  • The duration of the mental health professional’s relationship with the client, including the type of evaluation and therapy or counseling to date;
  • An explanation that the criteria for surgery have been met, and a brief description of the clinical rationale for supporting the patient's request for surgery;
  • A statement about the fact that informed consent has been obtained from the patient;
  • A statement that the mental health professional is available for coordination of care and welcomes a phone call to establish this.
Yeah, so, those are the checklists of recommended items for someone requesting any genital surgery. It says that there are two referrals required, however, doctors and insurers are actually requesting three. Two from mental health professionals and one from the doctor prescribing your hormone therapy.

Now then, let's go back to the "guidelines" for surgery that the SOC says are not mandatory. I contacted about ten different doctors for my surgery. Pretty much every single one required that I meet every checklist item, plus their added items, prior to even scheduling me for an appointment. When I informed them that the SOC are guidelines and not requirements, they informed me that it does not matter, and that for them, they are requirements. When pressed about what appears to be an instance of denying care to trans people, they informed me that it was the insurance providers policy. I told them that insurance is not paying for my surgery, that I am. They said they did not care, that it was their insurance providers insistence.

There are many people I have discussed this situation with, and surprisingly almost everyone has told me that they have no problem with those checklist items being requirements. When asked why, they said, because we need to make sure that the people that have these procedures will not regret their decision.

Wow. Seriously? Is that the bullshit that you're going to hide behind? Apparently yes, they will try. Surprisingly, to me at least, most transgender people also support these guidelines. When asked why, their answer is the same, we need to make sure that transgender people will not regret their decision.

Hmmm..... I am calling BULLSHIT!!! Totally, fully, completely, bullshit!

I do not think at all that people are worried about other humans regretting their decisions for how they may prefer to modify their bodies. But I do think I know what it actually is.... it's just plain old fashioned transphobia. How so? Well, thanks for asking, let's explore the answer to that question. In this discussion we will focus on breast augmentation. Why? It is the number one most performed plastic surgery procedure. In 2017, there were about 300,000 of these procedures done in the United States alone.

Okay, what types of requirements are there for a cis-gender human to get breast augmentation? This is a difficult question to answer as it is different for every doctor and basically there is no universally accepted pre-requisite, and many have no pre-requisites at all. One plastic surgery center I found via Google states:


You may be a candidate for breast augmentation if:
  • You are physically healthy and you aren't pregnant or breastfeeding
  • You have realistic expectations
  • Your breasts are fully developed
  • You are bothered by the feeling that your breasts are too small
  • You are dissatisfied with your breasts losing shape and volume after pregnancy, weight loss or with aging
  • You are unhappy with the upper part of your breast appearing "empty"
  • Your breasts are asymmetrical
  • One or both breasts failed to develop normally or have an elongated shape
If you're considering surgery, spend some time reviewing breast augmentation photos and learning about what to expect during recovery. Preparation ahead of time helps patients have reasonable expectations and a smoother recovery.
Hmmm..... notice anything missing? I do. How about referral letters from your health providers? What about referral letters from your mental health professionals? What about a checklist of items that the surgeon demands that you provide evidence for completion? Those things do not exist for cis-gendered humans for breast augmentation. So, how about for the trans population that would like breast augmentation?

Criteria for breast augmentation (implants/lipofilling) in MtF patients:
  • Persistent, well-documented gender dysphoria;
  • Capacity to make a fully informed decision and to consent for treatment;
  • Age of majority in a given country (if younger, follow the SOC for children and adolescents);
  • If significant medical or mental health concerns are present, they must be reasonably well controlled.
Although not an explicit criterion, it is recommended that MtF patients undergo feminizing hormone therapy (minimum 12 months) prior to breast augmentation surgery. The purpose is to maximize breast growth in order to obtain better surgical (aesthetic) results.

As well, the patient is required to submit one referral letter from a mental health professional describing the same checkpoints listed earlier for genital surgery. They are also kind of lying when they say one referral letter, they actually mean two. One from your mental health professional and one from your medical doctor prescribing your hormone therapy.

Okay, so obviously there are quite a few differences in the "requirements" to fulfill to be able to get a boob job. Some may still say, yeah well, that is important to protect people from regretting a life changing procedure. In 2017 there were quite a few articles running around stating how lots of trans people are regretting their surgeries and are requesting a procedure to medically transition back to the gender they began as. Newsweek published an article:

Gender-confirmation surgeries—the name given to procedures that change the physical appearance and function of sexual characteristics—increased by 20 percent from 2015 to 2016 in the U.S., with more than 3,000 such operations performed last year. Rates are also increasing worldwide. Now, at least one surgeon is reporting a trend of regret.

Wow, so this trans regret thing is pretty serious. I mean, there is even a trend of regret, right? I used to actually think that publications like Newsweek could be trusted. Did you notice that they give a large number, of 3,000 such operations, but never actually give numbers to the supposed "trend" of surgery regret? These days, I don't know if anything can be trusted. It seems as though everyone is just being inflammatory to sell their product. Drama sells. And people are so intrigued by possible regret that trans people may have. So then, what about the trend that Newsweek reported on?

I found some info about this, but not from such an "esteemed news organization" as Newsweek. The info I found is the following:

36 surgical reversals out of 18,000-27,000 trans patients who’ve received surgery is a reversal rate of 0.13-0.2%. This is consistent with existing studies finding that rates of regret following genital surgery of about 2%, and indicates that only a small fraction of those who do experience regret will go on to seek reversal surgery

Okay, so maybe there is not exactly "a trend" of surgical reversals of Gender Confirmation Surgery. That is the whole kit and caboodle by the way, not just a boob job. So the rate of regret, with an actual study, was between 0.13-0.2%, and they report it is consistent with a rate of 2%. Which is ten times what the study showed, but whatever, make it bigger to account for some statistical errors. That is fine. But still, even with increasing it, the rate of regret, leading to a reversal, for a full GCS, is being reported at 2%.

Shall we take just a small moment and compare that rate of regret and reversal to the rate of regret and reversal for cis-gender breast augmentation. This is again difficult stats to find. But I found the following:


The most common surgeries among the survey group were breast augmentations (31 percent) and nose jobs (27 percent). Liposuction came a close third at 24 percent, while 16 percent had eyelid surgery.
Asked how they felt following surgery, two thirds (65 percent) said they "regret having cosmetic surgery" although 28 percent said they "couldn't be happier with the results".


Another source reports on breast augmentation specifically:

The FDA lists 26 potential complications, from rupture and deflation to infection and necrosis, and warns that up to 20 percent of women will have their implants removed within 10 years.

While the first stat is not super official it falls in line with what I have heard, most people who have plastic surgery regret their decision. Looking at the first quote, it says that 65% of Britains regret their surgery. Ummm..... trend anyone?

The second stat, coming from the FDA is pretty darn reliable, 20% of women will have their implants removed. That is a pretty big number of women who clearly regret their decision to have breast implants.

Yeah, let's make sure that we remember the trans stat, 2% regret reported, with the study putting it 0.2%. Okay, so a bit of math says, with 2%, that is one tenth of what cis-women report, and with 0.2%, that is one one hundredth. But hey, we need to make sure that trans people don't regret their decision.

What I am hearing is that people care SO much about the transgender humans that we just want to make sure that as few people as possible regret their decision to transition. And that is with hormones alone, and we especially want to make sure they do not regret any surgical decisions they make. However, with cis-gender humans, we don't really give a shit.

Did you happen to take a look at the requirements for getting breast implants and compare the cis-gender and transgender requirements? The cis-gender requirements are all ones that a single human all by themselves can make. They are making a choice about how they are going to treat their own bodies. For trans people? Yeah, no apparently we are not competent enough to make decisions about our own bodies. To even have surgeons consider you for a breast augmentation, you need to have two letters, a doctor, and a therapist. Did you see what the therapist has to write? I did. My therapist's letter is about 3 pages long. Yup 3 pages.

Yeah, for the orchiectomy, the requirements are even more severe than for breast implants. I actually got into a bit of an argument with a psychologist about the requirements. One of the old requirements for an orchiectomy is that you have 12 continuous months of living as the gender you identify as. So I suppose that one line will put the surgery out of contention for anyone who identifies as non-binary huh? Yeah, sorry, you don't identify enough with either gender to qualify as living full time as either male or female huh? Yeah, sorry, you're fucked.

Okay, but anywho, back to the direct comparison of breast augmentation for trans and cis humans. Now, not for one second do I believe that our society cares so much about trans people that we want to make sure they do not regret their surgical choices as much as the cis population does. What it is people, is straight up transphobia. There is nothing else that you can suggest to me that will make it so that I do not see the discrimination before me. Hell, they even put it in writing! That is what the Standards Of Care show. The SOC show that it is discriminatory in nature to expect different requirements from different groups of humans.

How can it be proven that our society as a whole is not discriminatory? Okay, maybe I am overgeneralizing too much, so let's just focus on the medical community and insurance providers for a moment. How can it be demonstrated that surgeons are not massive transphobes? Ummm..... it is really quite simple. Have the exact same requirements for anyone to get the procedure. As long as there exists a difference between trans-human's requirements and cis-human's requirements, then it is nothing but blatant discrimination.

The thing that really kicks me in the balls about this, (HAHAHAHAHA) is that most transgender people that I have spoken to are in support of these requirements! When asked why, they say that we need to protect our image, and anyone regretting any medical choice they have made is just bad publicity for our group of people. That is quite sad actually. It seriously reminds me of the practice of circumcision. Which, as reported by many men, is frequently performed so that their baby boy's penis looks just his daddie's. Wow, how sick! In other words, many trans people who have survived the inquisition that is this absurd checklist of surgery requirements thinks that if they had to go through it, then everybody else should have to as well.

Fuck! Even WPATH states, that their criteria are recommendations and not requirements! Nobody should be forced to conform to the expectations of a society that cannot clearly see it's way to actually allowing human beings to have autonomy over their own fucking bodies! Ummmm.... yeah, sorry, I am pretty heated about this bullshit.

Sometimes it makes me really wonder if they actually know about the transgender population. Like for instance, are they aware that there is an extremely high suicide rate? Basically it is somewhere between 40-50% of all transgender people will attempt to commit suicide at some point in their lives. I've actually read of some people who will say that statistic is proof of how mentally unstable the transgender population is. That is really sad. Mostly because it is that sort of rhetoric that is causing the problem. Transgender people are more likely to kill themselves because of rejection from society. Yup, pretty simple. People who face harassment, discrimination, and rejection from family and friends for some weird reason want to kill themselves more. So, to help these humans part of the solution is apparently making them jump through hoops, the SOC, to get the procedures that would actually help them to be better accepted by an already over critical society. But we are worried that some of them may regret their decision. Seriously?

I have actually had some contact with a few people who did come to regret their decision to transition, so maybe societie's, and WPATH's concerns are well warranted huh? Because, see if just one transgender person comes to regret their decision, we need to stand up and protect the poor misguided transgender human. Hmmm...... that is still pretty fucked up. As it turns out, the people I know stopped or de-transitioned because of a lack of societal support. Which is what I have also heard from my therapist and my doctor. These people didn't decide they were not transgender, they decided they could not put up with the vast amounts of negativity that they received from their community. Wow. Seriously, wow.

Let's see if I can wrap this up without using the f-word. Uhhhhh........ people should be allowed to do with their bodies as they please. Simple. Easy. You have no right to tell another human being what they can and cannot do to their own bodies. They are our own bodies! How about a simple deal, I wont tell you what to do with your body, and you wont tell me to do with mine. Yes, even if we disagree with what the other one is doing. Yes, even if you think it is wrong to do to oneself. Yes, even if........!!!!

Simple.

Body autonomy.

Love you!

Love your body!

Even if you have to change it to love it, you love that fucker up!

Oops...


Picture Credits:
https://www.deviantart.com/thelonemackerel/art/Regret-384681825
https://pxhere.com/en/photo/548566
https://www.maxpixel.net/Worried-Girl-Waiting-Worry-Thinking-Woman-Sitting-413690
https://pxhere.com/en/photo/869403
https://pixabay.com/images/search/stress/










4 comments:

  1. Hi Kelly,

    I hope that you are (reasonably) well ;-). An excellent and informative article. Over the years, I have read/watched quite a few stories/videos about trans people who have committed suicide and along with my own experience I have always felt that the major contributors to suicide are the inability or colossal difficulty of being able to match your body with your mind (via "gatekeepers") and the general non-acceptance of trans folk by society (slowly improving...)

    I truly believe that the immense difficulties involved generate such despair that the easier choice is suicide. You have a moment of weakness combined with despair and you become just another statistic. It makes me sad in simply writing this... Anyway, I am happy for you and truly appreciate the fact that you choose to share your journey with us! Hugs, Tanit

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  2. There is an awful lot to unpack in this post. I agree that the choice is yours and as you proceed let me offer my congratulations to you. It is clear that you have thought through things and done the proper due diligence.
    I think that the medical world has become too scared and focused on the legal world. People sue over everything and the doctors and their insurers are way more than gun shy. They spend more time and energy on CYA than they do on medicine.
    I wish you well in all things.

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    Replies
    1. Hiya Pat! There is an immense amount in this post. I think it is probably the longest one I have ever posted.

      Thanks for your thoughts!

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