Is Sex-Change Surgery the Solution?

Suicide rates among the transgender community are more than 25 times the rate of the general population. Statistics from a 2010 survey of more than 7,000 transgender individuals conducted by the National Center for Transgender Equality and the National Gay and Lesbian Task Force reveal that “A staggering 41% of respondents reported attempting suicide compared to 1.6% of the general population.” (emphasis removed).^[1] Also revealed in the study is that “over a quarter of the respondents misused drugs or alcohol specifically to cope with the discrimination they faced due to their gender identity or expression,” and, “respondents reported over four times the national average of HIV infection, 2.64% in our sample compared to .6% in the general population, with rates for transgender women at 3.76%, and with those who are unemployed (4.67%) or who have engaged in sex work (15.32%) even higher; (emphasis removed).”^[2]

The popular consensus is that these statistics are driven by increased mental stress resulting from the social and economic burdens of being visually non-conforming. As such, it is generally believed that the best solution for transgender individuals who have chosen to whole-heartedly embrace their gender identity is to undergo hormonal therapy and, often, sex-reassignment surgery. However popular this consensus may be, it is not firmly established in reliable scientific data. The Guardian reports:

There is no conclusive evidence that sex change operations improve the lives of transsexuals, with many people remaining severely distressed and even suicidal after the operation, according to a medical review conducted exclusively for Guardian Weekend tomorrow.

The review of more than 100 international medical studies of post-operative transsexuals by the University of Birmingham’s aggressive research intelligence facility (Arif) found no robust scientific evidence that gender reassignment surgery is clinically effective.^[3]

Follow-up studies indicate that while sex-reassignment patients are overwhelmingly satisfied with the cosmetic effects of the surgery, the surgery results in little change to their mental health and living conditions. In a Wall Street Journal article titled “Transgender Surgery Isn’t the Solution,” Dr. Paul McHugh, a psychiatrist at Johns Hopkins Hospital recalls:

We at Johns Hopkins University—which in the 1960s was the first American medical center to venture into “sex-reassignment surgery”—launched a study in the 1970s comparing the outcomes of transgendered people who had the surgery with the outcomes of those who did not. Most of the surgically treated patients described themselves as “satisfied” by the results, but their subsequent psycho-social adjustments were no better than those who didn’t have the surgery. And so at Hopkins we stopped doing sex-reassignment surgery, since producing a “satisfied” but still troubled patient seemed an inadequate reason for surgically amputating normal organs.^[4]

In a First Things article titled “Surgical Sex,” Dr. McHugh expounds:

They had much the same problems with relationships, work, and emotions as before. The hope that they would emerge now from their emotional difficulties to flourish psychologically had not been fulfilled.

We saw the results as demonstrating that just as these men enjoyed cross-dressing as women before the operation so they enjoyed cross-living after it. But they were no better in their psychological integration or any easier to live with. With these facts in hand I concluded that Hopkins was fundamentally cooperating with a mental illness. We psychiatrists, I thought, would do better to concentrate on trying to fix their minds and not their genitalia.^[5]

Dr. McHugh’s findings are further corroborated by a Swedish long-term study of 324 sex-reassignment patients which concludes:

Persons with transsexualism, after sex reassignment, have considerably higher risks for mortality, suicidal behaviour, and psychiatric morbidity than the general population. Our findings suggest that sex reassignment, although alleviating gender dysphoria, may not suffice as treatment for transsexualism, and should inspire improved psychiatric and somatic care after sex reassignment for this patient group.^[6]

The Guardian reports:

Arif [Aggressive Research Intelligence Facility], which advises the NHS in the West Midlands about the evidence base of healthcare treatments, found that most of the medical research on gender reassignment was poorly designed, which skewed the results to suggest that sex change operations are beneficial. … For example, in a five-year study of 727 post-operative transsexuals published last year, 495 people dropped out for unknown reasons. Dr Hyde said the high drop out rate could reflect high levels of dissatisfaction or even suicide among post-operative transsexuals.^[7]

Given the available data, the director of the University of Birmingham’s Aggressive Research Intelligence Facility Dr. Chris Hyde, has concluded:

There is a huge uncertainty over whether changing someone’s sex is a good or a bad thing. While no doubt great care is taken to ensure that appropriate patients undergo gender reassignment, there’s still a large number of people who have the surgery but remain traumatised [sic] – often to the point of committing suicide. … The bottom line is that although it’s clear that some people do well with gender reassignment surgery, the available research does little to reassure about how many patients do badly and, if so, how badly.^[8]

Perhaps greater heed should have been paid to Dr. Ihlenfeld’s caution in 1979 that 80% of patients who want to change their sex shouldn’t do it.^[9] Warning that the transgender patient is “the only patient who diagnoses himself and prescribes his own treatment”, Dr. Ihlenfeld comments, “There is too much unhappiness among people who have had the surgery. Too many of them end as suicides.”^[10] Furthermore, research from the U.S. and Holland reveals that as many as 20% of patients may regret changing their sex.^[11]

Some experience regret before enduring surgery, such as Brad/Ria Cooper who made headlines as Britain’s youngest sex change patient. After suffering “huge mental anguish” as a trans woman and massive hormone-induced mood swings, Ria Cooper decided to de-transition, choosing to return to her male identity as Brad Cooper.^[12] Others, such as Walt Heyer, suffer sex change regret after experiencing reconstructive surgery. Walt Heyer was 42 years old, married, and a father of 2 when he chose to undergo sex-reassignment surgery and become Laura Jensen. Eight years later, he realized that his desire to change sexes was based upon deep-rooted childhood trauma rather than a genetic disorder. With no safe reversal procedures at the time, Walt Heyer chose to once again live as a man, despite having some permanent feminine physical features.^[13] Today, Walt Heyer manages the website Sex Change Regret and is the author of several books, including Paper Genders.

In a Federalist article titled “Transgender Characters May Win Emmys, but Transgender People Hurt Themselves,” Walt Heyer testifies that the process of disconnecting from one’s former identity while building a new identity is a “marvelous distraction for a while, but it isn’t a permanent solution when the underlying issues remain unaddressed.”^[14] Eventually, reality catches up, and the individual is often left with broken relationships, a mutilated body, and the same mental stress as they suffered before changing their sex. Walt Heyer writes, “Gender change is at its heart a self-destructive act. Transgenders not only annihilate their birth identity, they destroy everyone and everything in their wake: family, wife, children, brothers or sisters, and career.”^[15]

Unfortunately, there often remains no hope at this point. No longer can the individual convince themselves that being true to their “real” self or that changing their wardrobe, voice, or body will allow their problems to go away. Having sacrificed and done “everything,” the sorrow and self-hatred ultimately remains.

Someone who has reached this place is often at their breaking point, desperate for a solution. Unfortunately, far too many transgender individuals find that solution in suicide. However, their story need not end in tragedy if we as Christians would extend to them the hope of the gospel. Rather than affirm their lifestyle choices in an effort to prevent them from feeling sorrow, anger, and regret, we as Christians should continually hold out the gospel in love. Until someone is disillusioned about their choices, they are unable to make a change. This requires that we share the truth, even when it hurts.

Be sure to Read Timothy Zebell’s book Transitioning: A Biblical Understanding of Transgenderism.