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.
Urologist Miroslav Djordjevic, who specializes in gender reassignment surgery, has seen an increase in “reversal” surgeries among transgender women who want their male genitalia back. In the past five years, Djordjevic performed seven reversals in his clinic in Belgrade, Serbia. The urologist explains to The Telegraph that those who want the reversal display high levels of depression, and in some instances, suicidal thoughts. Other researchers also report hearing about such regrets.
Related: Transgender teen repeatedly stabbed in genitals; LGBT advocates battling for hate crime classification
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“It can be a real disaster to hear these stories,” Djordjevic told The Telegraph.
Charles Kane, who identified as Sam Hashimi after male-to-female reassignment surgery, opted to become a man again after experiencing “hormonal regret.” In the BBC documentary One Life: Make Me a Man Again, Kane explained he originally wanted to become a woman after a nervous breakdown.
“When I was in the psychiatric hospital, there was a man on one side of me who thought he was King George and another guy on the other side who thought he was Jesus Christ. I decided I was Sam,” Kane said.
Postsurgery, Kane believed his female identity would never be liked or accepted as a real woman. He also blamed the influence of female hormones as responsible for making him seek the surgery. “I don’t think there’s anyone born transsexual. Areas of their human brain get altered by female hormones,” Kane told Nightline.
Kane’s insight may not be applicable to all transgender patients seeking reversal surgery. Djordjevic expresses concern about the psychiatric evaluation and counseling that take place prior to the gender reassignment surgery. He recalls patients telling him that when they inquired about the procedure at other clinics, they receive minimal information before being asked for proof that they could pay for the operation.
In Djordjevic’s practice, patients undergo a minimum of one to two years of psychiatric evaluation, accompanied by hormonal evaluation and therapy. Prior to the surgery, he asks patients for two professional letters of recommendation. After the procedure, he strives to remain in contact—he talks with 80 percent of his former patients, The Telegraph reports.
Related: What’s the cultural impact of transgender characters on TV?
A 2011 study found that after sex reassignment surgery, more than 300 Swedish transsexuals faced a higher risk for mortality, suicide ideation, and psychiatric issues compared to the rest of the population. The researchers concluded, “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.”
In male-to-female reassignment surgery, doctors will reshape the male genitals in the form of a vagina. The surgery also includes removing the testicles and an inversion of the penis. In female-to-male procedures, doctors remove the breasts, uterus and ovaries and extend the urethra so a transgender man can urinate standing up. Male-to-female reassignments are more common because they are considered less expensive and more successful.
Gender reassignment surgeries are expensive. Male-to-female procedures cost between $7,000 and $24,000, and the cost of female-to-male procedures can reach $50,000. The complications and the expense warrant extra care from doctors performing these reassignments. “Ethically, we have to help any person,” says Djordjevic, “in the best possible way.”
This article first appeared on The Daily Signal.
Many Americans are unaware of the serious problems that transgender persons face.
For instance, a 2016 study comparing 20 Lebanese transgender participants to 20 control subjects reported that transgender individuals suffer from more psychiatric pathologies compared with the general population. More than 50 percent had active suicidal thoughts, and 45 percent had had a major depressive episode.
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While it may not be politically correct to link psychological disorders with the transgender population, the researchers see the evidence that a link exists. As a former transgender person, I wish the guy who approved me for gender surgery had told me about the risks.
The experience of many gender-confused individuals is that medical professionals are quick to reach a diagnosis of gender dysphoria and recommend immediate cross-gender hormone therapy and irreversible reassignment surgery without investigating and treating the coexisting issues.
Research has found that powerful psychological issues, such as anxiety disorder, post-traumatic stress disorder or alcohol or drug dependence often accompany gender dysphoria.
A study published in JAMA Pediatrics in March 2016 shows a high prevalence of psychiatric diagnoses in a sample of 298 young transgender women aged 16 through 29.
More than 40 percent had coexisting mental health or substance dependence diagnoses. One in five had two or more psychiatric diagnoses. The most commonly occurring disorders were major depressive episodes and non-alcohol psychoactive substance use dependence.
Yet transgender individuals are never required to undergo any objective test to prove their gender dysphoria—because no diagnostic objective test exists. The cause of this condition can’t be verified through lab results, a brain scan or review of the DNA makeup.
Research studies from 2013 and 2009 looking for a “transgender gene” showed not a smidgeon of abnormality in the genetic makeup that causes someone to be transgender.
No alterations in the main sex-determining genes in male-to-female transgender individuals were found, suggesting strongly that male-born transgender persons are normal males biologically.
Psychological Care Urgently Needed
The study concluded that improved access to medical and psychological care is “urgently needed to address mental health and substance dependence disorders in this population.” It did not conclude that improved access to bathrooms, hormones or surgery is urgently needed.
A 2015 study of 118 individuals diagnosed with gender dysphoria found that 29.6 percent were also found to have dissociative disorders and a high prevalence of lifetime major depressive episodes (45.8 percent), suicide attempts (21.2 percent) and childhood trauma (45.8 percent).
It also noted that differentiating between a diagnosis of dissociative disorder and gender dysphoria is difficult because the two can closely resemble each other.
Another study found a “surprisingly high prevalence of emotional maltreatment” in the 41 transgender persons studied. It called for further investigation to clarify the effects of traumatic childhood experiences and the correlation between transgenderism and dissociative identity.
That finding tracks with what I experienced in my transgender life. In my life and in the lives of those whose families contact me, traumatic childhood experiences are present 100 percent of the time.
Childhood Gender Dysphoria
One area where medical professionals should tread lightly is in the diagnosis and treatment of children who have gender identity issues.
A 2015 study aimed to gather input from pediatric endocrinologists, psychologists, psychiatrists and ethicists—both those in favor and those opposed to early treatment—to further the ethical debate.
The results showed no consensus on many basic topics of childhood gender dysphoria and insufficient research to support any recommendations for childhood treatments, including the currently published guidelines that recommend suppressing puberty with drugs until age 16, after which cross-sex hormones may be given.
An analysis of the 38 youth referrals for gender dysphoria to the Pediatric Endocrinology Clinic at the University School of Medicine in Indianapolis showed that more than half had psychiatric and/or developmental comorbidities.
Without sufficient research and consensus on treatment of children diagnosed with gender dysphoria, and knowing that over half have coexisting disorders, any invasive treatment, even if recommended by the current guidelines, is simply an experiment.
It’s time to stop using children as experiments.
Transgender Persons Are Struggling Psychologically
Transgender individuals need psychotherapy, not access to cross-sex restrooms, showers and dressing areas. Blaming society for the ills of transgender persons will not improve their diagnosis and treatment.
Reckless disregard for the mental disorders in favor of enforcing preferred pronouns is madness. It’s time to show compassion by telling the truth and stop pretending they are born that way.
True compassion is acknowledging the mental disorders and providing effective, sound treatment in an effort to slow the staggering number of suicides, before rushing to perform irreversible surgeries.
Walt Heyer is an author and public speaker. Through his website, SexChangeRegret.com, and his blog, WaltHeyer.com, he raises public awareness about those who regret gender change.