Opinion: What I wish I’d known when I was 19 and had sex reassignment surgery

My perspective:

The western scientists are absolutely terrible at understanding psychological problems so everything is re-framed as a physiological problems ("it's a chemical imbalance", "you were born with wrong physiology" etc.), which they have mastered.

If someone is raised in a cult, do you change the world to fit that person in or do you help that person fix their beliefs?

The same rule should apply for kids raised in other types of abusive households.

This probably would have been the Harry Benjamin Standards of Care, 1990 edition[0], which I will link, but I can't really stomach trying to read/summarize.

The fact is the regret rate for gender affirming surgeries less than 2% [1]. Absolutely heartbreaking for those it happens to, but hip replacements have a significantly higher regret rate.

As to this article in particular, I will note:

* Most of the health risks associated with taking supplemental estrogen are specific to the oral route. Transdermal (gel or patches), injected, or subcutaneous pellet implants avoid the risks of blood clots and stroke.

* There is likely nothing stopping the author from taking supplemental testosterone in addition to, or instead of, estrogen.

For context, I'm a transgender non-binary person in my 30s. I started transitioning a few years ago, and had non-conforming gender affirming surgery this past September. If anyone is interested in details, I've written about it elsewhere[2]. To my knowledge, I am the only person publicly out about having had that particular procedure done.

Under the medical standards of care prior to WPATH v7 (2012)[3], I would have been denied care unless I did a lot of lying and performative gender things that I would have found distressing at best. There are still major issues with the standards of care, but they've definitely improved.

While I've had some post op complications that I'm not happy about (which aren't my surgeon's fault), I have every reason to believe that they're fixable, and if I had to make the choice over again, I'd have still done it.

My HRT includes a combination of estrogen, progesterone, and testosterone. I've largely been able pick which primary and secondary sexual characteristics I want for my body. My appearance these days frequently leaves people unsure of my gender, which I find affirming.

0. http://www.genderpsychology.org/transsexual/hbsoc_1990.html

1. https://journals.lww.com/prsgo/fulltext/2021/03000/regret_af...

2. https://rya.nc/private/transition.html

3. https://www.wpath.org/media/cms/Documents/SOC%20v7/SOC%20V7_...

> I once believed that I would be more successful finding love as a woman.

Holy yikes Batman.

> In high school, when I experienced crushes on my male classmates, I believed that the only way those feelings could be requited was if I altered my body.

And there you have it. This person tried to “trans the gay away” and regretted it. Zero percent shocked.

> I had to persuade two therapists, an endocrinologist and a surgeon to give me what I wanted.

This is the meat here. There are a shit ton of safeguards to make sure people aren’t making the wrong decision but you can learn to make all the right sounds for the therapists, psychologists, and doctors and lie your way through anyway. I’m so unbelievably sorry that this guy misdiagnosed his internalized homophobia as self image issues as dysphoria and has to live with that but his experience isn’t universal.

> I know now that I wasn’t old enough to make that decision

The subtext here being that no one is old enough to make that decision. Which isn’t true at all. I have trans friends who have known since elementary school. Confidence has more to do with time lived “out to yourself” and living as your post-transition gender than age.

> yet that was the person who committed me to a lifetime set apart from my peers

Not at all surprised at his feelings when that’s how he views his situation. He’s at absolute worst essentially a better passing pre/no-op trans man, who go on to live happy fulfilling lives.

> I must choose between the risks of taking exogenous estrogen, which include venous thromboembolism and stroke, or the risks of taking nothing, which includes degeneration of bone health. In either case, my risk of dementia is higher, a side effect of eschewing testosterone. >

Or he could take testosterone like a trans man and not deal with this at all. Also the scary side effects of low T and and high E is the reality of every woman. Making a mountain out of mole hills. Also must suck for everyone with hormone deficiencies, chronic migraines, adhd, seasonal allergies, or cancer, who have to take pills even day. Guess they’re all lifetime medical patients too.

> I didn’t need parents questioning me or establishing realistic expectations

Ughh this is the most post-hoc reasoning I’ve ever seen. If this guy was actually trans and it worked out well for him and he lived a happy life it would literally be the opposite story for the same events.

> I’m also alarmed by how readily authority figures facilitate transition

No he isn’t because he hasn’t gone though the process in 2022. He has an idea informed by the internet on how the process surely must go. You can’t get GRS without two separate psych evals, a doctor sign off, and you have to be living as your post transition gender for at least a year. Even HRT with “Informed Consent” which is the least restrictive doctors still refer you to a therapist to talk with you before any of the effects kick in and is only available for 18+. For anyone younger you still have to have a psych eval and parental consent. If you think psychologists aren’t challenging people who come in for dysphoria symptoms you’ve never talked to a trans person whose had to deal with the rampant gatekeeping.

I know this will come off as petty but come on dammit. Hang out in some queer spaces for like 2 seconds and you’ll know that the reality of trans folks really is.