Sex change surgery: Too much, Too young?

"Before the transition, when I was a man, I was trying to fit into this male role I didn’t understand. It’s similar to going through puberty and not fitting the social standard.” It’s hard to imagine that Jane Fae, feminist and winner of the 2010 Erotic Writer of the Year, used to be a ‘young and awkward boy’ as she describes it today. Her long blonde hair and high-heel pumps have somewhat become her trademarks that scream femininity and confidence, and she speaks with passion of her transition. “I knew something was missing when I was eight, I just didn’t know what it was then”, she says in her soft but distinguished deep voice. Her gender reassignment in 2011 was a crucial step she always wished she had done much earlier than at 52 years old.

Not even knowing what ‘transgender’ was as a young boy in the 1960s, she is certain that having surgery earlier would have made her happier. “I knew something was wrong as a little boy, and I think many people can know this at a young age.” While Jane had to wait until she was in her 50s, transgender surgery as early as possible is now becoming a trend. It’s an unarguable fact that gender reassignment operations in general have increased since the early 2000s: according to NHS England, they went up by a third from year 2000 to 2009, with the average age for transwomen being 42. But today even children can be considered for transition, along with the age for gender reassignment operations steadily lowering with time.

The Tavistock and Portman NHS Trust found that referrals for medical treatment for gender dysphoria to people aged 18 and under have increased over the last 6 years from 97 in 2009 to 1398 in 2016: a rise of over 1000 per cent. While people under 18 years cannot legally undergo sex change surgery in the UK, the clinic gives support tools such as counselling and sometimes hormone blocking for children experiencing gender dysphoria. This trend might indicate that an early sex change surgery could make people happier. But having the chance to undergo a transition sooner doesn’t mean one always should.

With no ideal age to undergo gender reassignment, Dr. James Barrett, a psychiatrist at the Charing Cross Gender Identity Clinic, believes it’s better to wait. “I would not recommend starting treatment too early”, he says. “If you wait until puberty has got a little way along, a good portion of the children will consider themselves more like straightforward lesbians and gay and will not need medical intervention after all.”

Waiting when one’s older and wiser might be the sensible choice, especially when considering the dark numbers on surgical regrets. A Swedish study from 2011 by Cecilia Dhejne et al at the Karolinska Institute looked at long term outcomes of transgender patients and found that they are liable to suffer from a range of psychological difficulties, such as suicidal behaviour and psychiatric morbidity.

---

"Before the transition, when I was a man, I was trying to fit into this role I didn’t understand"

---

Similarly a survey conducted by The Guardian in 2004 found that there was no conclusive evidence that sex change operations improve the lives of transsexuals.

But while Dr. Barrett advises at least a year for counselling and advice before an operation, a number of other studies indicate that an early treatment for young transgenders is vital for their happiness. The Tavistock Clinic issued a report to the government stating that ‘Gender variant adolescents are at grave risk: 23 per cent have engaged in self harm/suicide. There is a clear and strong case that delaying treatment for young people risks more harm than providing it.’

Waiting for surgery could also lead to a change of mind rather than body. Dr. Barrett says that while few people regret their surgery regardless of age, some find it best to avoid it altogether. “Some people don’t feel the need to undergo surgery that involved a major recovery process. The transition can take three to four years, so many don’t want to spend the time and energy on this.” He adds that long consultation is important before setting a date for the reassignment to ensure that nobody undergoes treatment they might later regret.

This method proves to be effective at his workplace: statistics from his clinic show that 2033 people in 2016 were satisfied with their treatment and that they got sufficient information prior to their treatment, compared to the 15 that disagreed, making it only 6 per cent unsatisfied patients. “It takes about a year with consultation when people come to us and thinking of changing gender” Dr. Barrett explains. “It’s important getting to know them before anything happens.”

But for Jane Fae long waits and cold attitudes made her brief encounter with a NHS gender identity clinic a bad one. ”My experience there was anything but good. It probably took me 10 months to even get the first appointment and made the transition more difficult. Nobody would call me by my new name or even acknowledge my true gender.”

While she doesn’t say the younger the better, less consultation time and better methods for young trans people are needed. “I’m not saying the transition process at the NHS clinics should be rushed, but they need better priorities so that they can help more people with gender dysphoria. If a 14 year-old thinks he or she is transgender then they should be followed-up immediately.” To her, regret numbers are not to be trusted no matter what age. ”People who don’t do something about it and don’t get to undergo surgery are more likely to commit suicide. The articles I read on regrets are usually unbalanced and deals with small numbers of people. There is a risk of regret in all kinds of surgeries.”

Since her unhappy times attending a single-sex school in Birmingham where she would rather be with the girls, Jane never doubted being female. “I don’t like the term ‘gender reassignment’. Gender affirming sounds better, because it is something we know we are from an early age. The gender you are is in your mind, the physical stuff confirms it.” Jane is not alone in thinking this. Caitlyn Jenner said in an interview with Vanity Fair that she felt liberated after her transition and has often expressed of being born with “the soul of a woman”. However, Co-ordinatior of the LGBT foundation UK, Laurence Webb, empathises that surgery isn’t the answer for everyone when they transition. “Surgery doesn’t change someone’s gender. It’s simply part of your identity – knowing your gender is in many ways no different to knowing your favourite colour.”

But for many simply knowing their gender isn’t enough. Like Jane, Juliet Jacques also chose to have surgery at a later point than she originally whished, and has never regretted it since. “I was ten years old when I first realised I had a gender identity issue, but I only decided to begin transition when I was 27. During that time, I went through many identities - gay, cross-dresser, queer, transgender - but deep down, I think I always knew I wanted reassignment, but couldn’t admit it to myself because of internalised prejudice. But I feel more confident now.”

According to NHS England, young people with gender dysphoria that are left untreated may lead to profound psychological and social disturbance. But Trans Liaison Officer for the LGBT help organisation Support U, Alyssa Black, says that while waiting times at clinics should be reduced there shouldn’t be any pressure to undergo surgery sooner. “Lower surgery for trans people is a complex procedure with varying outcomes and there’s a simple truth that every trans person’s journey is different. Each individual person has their own choice: my body, my choice is the mantra.” There are many reasons why Jane feels it would have been better to undergo surgery sooner rather than later. But one of them is also a struggle she faces on a daily basis.

“I’m not young, so it’s definitely more difficult for me to find a partner”, she says.After the divorce from her wife, her romantic life turned out to be far from easy. ”I tried dating both men and women, but being a transgender person at my age makes it hard. At this stage in my life, in my experience women are more complicated and slightly tongue in cheek, while men still regard me as a bloke.”

Although Jane wants people to be open-minded on earlier transitions, she says each person’s decision point on when to have the surgery is just as important to respect, whether they are young or old. when the gender reassignment surgery takes place. “Would I’ve liked to have the surgery sooner? Of course, but I’m happy today. I have my house and my children. The surgery just made me feel complete: to finally be a woman was like coming home.”

#Transgender #Genderreassignment #JaneFae #LGBTQ