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The doctors profiting from trans surgery Selling a new body is a highly lucrative business

Spanish doctors have found a succulent market niche. Camilo Erasso/Long Visual Press/Universal Images Group/Getty Images

Spanish doctors have found a succulent market niche. Camilo Erasso/Long Visual Press/Universal Images Group/Getty Images


June 1, 2022   5 mins

I have the strangest feeling that my body has been stolen from me. When I started my transition, I was not aware of any options besides medical treatment to modify my body. Years later, I still ask myself why no one told me that I could have left my body the way it was; why no one ever explained that sexuality in that body was possible. There was no violence involved, no threats were made.

But I feel that I was robbed of the possibility to experience my body any other way. I don’t believe this is a universal truth for all trans people. It’s simply something that I feel, something that pains me.

I am not oblivious to what many of you must be thinking: how could it be a robbery when trans people themselves choose to undergo operations? To compare the medical treatment of transgenderism to theft is certainly risky because it makes it seem as if trans people have been forced to accept these treatments when in reality we see the exact opposite: people fighting for the right to receive hormones and have surgery. It certainly doesn’t appear like anyone is forcing us to do anything.

This is true, but from my point of view it is also true that the conditions under which we make these decisions have been and continue to be very complex. Without refuting trans people’s agency and autonomy, I think it’s worth mentioning the role these medical professionals have played in this story. Starting in the late Eighties, the health professionals who worked with trans people touted the famous threefold treatment method (psychological or psychiatric evaluation, hormonal treatment, and surgery). They doled out diagnoses explaining to people that they had “an incurable illness, with chronic treatment options”, which consisted of hormonal therapy and surgery. And these treatments were not publicly funded until almost 25 years later. The results: trans people became a succulent market niche. (They tell us that we have the wrong body and then we pay them: it has to be admitted that this is a brilliant business model.)

Among the surgeons in Spain leading the field in so-called “gender reassignment surgery”, a few figures stand out in terms of how they’ve built their practice on the myth of the wrong body. These are professionals with dubious reputations: surgeons who have been working for decades and have treated thousands of trans people, and whose businesses are booming, despite their appalling reputations among the trans community. In my experience as an activist, I’ve heard terrible stories of extremely questionable results sold as infallible cures, claims from patients who wanted to report malpractice but had signed multiple documents that impeded them from later filing complaints, and tales of trans people being called by their original gender pronouns on the operating table.

And, as the icing on the cake, some of these doctors have become the public face of trans advocacy: there’s not a panel discussion, debate, TV news report, or documentary on being transgender that they’re not a part of. There they are in their offices, sitting in front of their computers with screensavers showing pictures of our bodies before and after we lie down on their table, saying that the problem with people who have gender identity disorder is that they were born in the wrong body.

How did these professionals manage to become such “experts”? Well, in some cases they formed part of the medical teams of Gender Identity Units — consultation teams which tell people that in order to be cured they have to have an operation but, unfortunately, the treatment wouldn’t be covered by the public health system. And then they tell them that there’s a place they might be able to go.

Guess which place? To these surgeons’ private clinics: they refer patients to themselves. And that’s how it went for many years.

Some of these medical professionals have taken other, even more slippery paths. They’ve learned how to monetise trans people’s need for sexual reassignment, mainly women, by creating an extensive catalogue of bodily modifications that go far beyond what could be considered any form of treatment.

To prove this, a colleague of mine went to one of these clinics explaining that she was a trans woman who wanted to have a vaginoplasty. She walked out with a €70,000 estimate for the procedure, after the doctor had added on multiple retouches for “feminisation” of her face and body. If you want to be a woman you will need a pinch of this, a splash of that, and a large dollop of that over there. It is easy to become trapped by the myth of the wrong body because it doesn’t specify when treatment will end. The reality is that treatment never ends: neither trans people nor anyone else can ever have a perfectly male or perfectly female body because that body does not exist.

The websites for these clinics show that the catalogue of treatments for trans women is significantly more extensive than for trans men. Does this have anything to do with the fact that we live in a sexist society that is constantly imposing impossible demands on women’s bodies? Of course. In this sense trans women are a much more interesting business prospect than cis women (women who are not trans) because to the former we’ve said that corporal modification is the chronic treatment for our incurable illness and to the latter we’ve said they are frivolous.

It is truly shocking that I was taught to hate some parts of my body while there are people who literally make a living from that hate, who get rich modifying our bodies and bathing in an aura of progressivism. And although, of course, there are some well-meaning professionals, the end result is the same.

This notion that trans people’s disconnect with their bodies is created by social pressures is a very unpopular argument within the trans community. In my opinion, trans people born on a desert island wouldn’t be trans: our gender expression would not be associated with any fixed gender identity and less still to a concrete social corporality. If we’d been born on desert islands we’d never dream of operating on ourselves.

Right now, it often seems that the end goal of trans movements in some parts of the world is the right to access hormonal treatments and surgical interventions in order to alter our bodies. But holding the right to bodily modification as the only solution to our suffering is problematic. Of course, trans people can, should, and must have this right, but centring all trans political aims on it distracts from a question which, from my point of view, is more relevant: what actually causes the suffering that trans people feel and how can that be addressed?

Our bodies are fine — the problem is how certain parts of us are interpreted in our society, the meanings and connotations assigned to them. And due to this, unfortunately, many people might feel the need to alter themselves.

It’s like we’re being assaulted by all these ideas and yet we exonerate the thieves, shouting: “No one has stolen my body, I abandoned it of my own free will because it was never mine!” But yes, it was yours. It was and is the only body you have.

Extracted from The Myth of the Wrong Body by Miquel Missé, published by Polity.


Miquel Missé is a Barcelona-born trans man and activist. He is the author of The Myth of the Wrong Body published by Polity.


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Tom Lewis
Tom Lewis
2 years ago

Not to be unkind, but, why do I seem to detect a large dollop of narcissism about some trans-sexual’s, particularly those who might describe themselves as ‘activists’ ?
Why does this author think that trans people being exploited, by plastic surgeons, are any different to a non-trans person, being exploited by an industry, that predates on ‘victims’ unhappy with the way they ‘present’ ? Cosmetic plastic surgery is an industry, who’s whole reason d’eter (sorry, foreign languages are not my forte, in fact, come to think of it, expressing myself in the writing isn’t my forte either) it seems to me, is built to capitalise on peoples dissatisfaction with their bodies, the original intent, of the likes of Archie McIndoe, being ‘lost’ in the mists of time.
Maybe it’s just me, but being called by the wrong pronouns is hardly the worst thing that might happen to someone (that narcissism thing again), a person might after all be ‘mis-labelled’ ‘American’ when ‘obviously’ they are from Canada, or even, the horror, called Australian when, in fact, they come from New Zealand (or vice versa). You (the trans activist community) really should just learn to roll with it, think to yourself/themselves (bloomin eck, a plural, that actually makes sense, who would have thunk it) ‘idiot’ and move on. Worse things, as they say, happen in Ukraine.
I appreciate that this might come across as unsympathetic, I am not unsympathetic to the plight of trans people, I expect many aspects of their lives might be fraught, or difficult, but I do sometimes think “good grief, get a life and move on”. I was on ‘friendly’ first name terms with the first person to ‘transition’ in the UK (she had to go to Denmark for surgery, if you’re interested), she wasn’t everybody’s cup of tea, she ‘was’ what one might call, a bit eccentric, but, and I’m sure some people could be unkind, the local community and she rubbed along just fine, without dwelling on how imperfect ‘life’ might be.

Last edited 2 years ago by Tom Lewis
JP Martin
JP Martin
2 years ago

Greedy doctors make money selling these surgical interventions and the drug companies get a customer for life. But transgender activists and their enablers insist that any clinician who encourages a patient to accept their body as it is rather than opt for surgery is guilty of conversion therapy. Absurd and evil.

Martin Bollis
Martin Bollis
2 years ago

An article that epitomises the sickness of our age. Whatever ails me it’s somebody else’s fault. It’s somebody else’s job to fix it, everybody else should lay down their own concerns to attend to mine, and, if anybody does attempt to help and gets it wrong, they’re bad people.

Last edited 2 years ago by Martin Bollis
Caroline Watson
Caroline Watson
2 years ago

There is a huge disconnect in the whole concept of ‘Transgenderism’. The underlying ideology says that ‘gender’ is a feeling and sex is irrelevant and on a spectrum. ‘Trans’ activists emphasise the difference between sex and ‘gender’. However the word ‘transition’ means moving from one side of a binary to the other. When people announce that they are ‘trans’, they pretend to be the other sex and often have mutilating surgery that gives them some physical characteristics of the other sex. They also expect other people to also pretend that they are the other sex and tolerate them in the lavatories, changing rooms and other facilities provided for the other sex.
If people want to dress in clothes and adopt behaviours that are socially attributed to the other sex, they can. We have never lived in a time where that has been more possible. In the case of women ‘dressing as men’, most people wouldn’t notice or comment; men dressed ‘as women’ usually adopt far more stereotypically ‘feminine’ clothing than actual women do. The issue that people have with them is that we are expected to pretend that they are the other sex. If they were just seen as slightly eccentric members of their own sex, and used their own lavatories, no one would care.
So, if they believe that sex is an irrelevance and a spectrum, why are they so keen to pretend to cross the binary? It can only be because people who are making money out of it have persuaded them to.

N Forster
N Forster
2 years ago

Don’t ignore the considerable peer pressure to conform to these new standards of gender non conformity. There is an element of social contagion which leads young women to go from chest binding to double mastectomy often without ever talking to a mental health expert. Especially under the currently fashionable idea of “gender affirming treatment.” . It isn’t just about pressure from cosmetic surgeons, it can also be about the demonisation of mental health care and the cheerleading of social media “communities” who urge those who consider themselves trans to go further than they might otherwise.

Cheryl Poniatowski
Cheryl Poniatowski
2 years ago

Transpeople don’t pretend to have visibly ambiguous sexual differentiation of the BSTc, nor do they pretend to have cross-gender response to stimuli in functional MRI. You are laboring under profound misunderstanding of the basis for transsexuality and ignorant of the ever-increasing body of evidence that transgender dysphoria is caused by an intersex condition of the brain.

Jennifer Tate
Jennifer Tate
1 year ago

This is not really true. The imaging studies have found differences but that gender is more of a spectrum. I am a cis woman who has always not felt completely at home in her body because society tells me how far away it is from perfect since I was a little kid. I think the problem with thinking there are only two genders is thinking you are the only one who feels uncomfortable when almost everyone I know does, and capitalism also benefits from this. I have been a teacher and a mom to a son and a daughter I never treated any of them differently because of their genders but because of their personalities are learning differences.

Christine Hankinson
Christine Hankinson
2 years ago

Well I thought it was very interesting and I’m glad that a trans activist is addressing us, the largely non trans community.
It is very complex and whereas I am unsure of the writer’s original cis or transitioned sex, it shows the profound confusion on issues of sex and gender. (Sex: male/female is biological.Gender: masculine/feminine is societal).
What gender critical feminists have always tried to do is improve and change notions of gender, to remove the harmful stereotypes of masculine and femininity that afflict so many.
Unfortunately many trans women (male to female) fetishised the uber feminine and then that became the ideal to transition.
There was also that suggestion that men could be better women than women – seemingly the whole point of success in Drag.
As an adult human female I have, since childhood, resented the limitations that society placed on my sex, as well as enjoying other bits. Life isn’t simple. I was never happy that my breasts became large it drew completely the wrong kind of attention. You adapt. You find ways.
So I feel very sad and angry, on their behalf, for people who have been misled to the point of assaulting their own bodies and injured their sexuality. That gender expectations have caused this is an alarm call.
And I thank you OP for your article. It really is time both sides of the sex/gender, trans/gender critical, debate talked to each other with compassion and respect.

Cheryl Poniatowski
Cheryl Poniatowski
2 years ago

You are confusing a fetish (mental disorder) with transsexuality (sexual disorder).

“Transsexualism no longer is classified as a mental disorder in the International Statistical Classification of Diseases and Related Health Problems (ICD). The World Professional Association for Transgender Health (WPATH) and many transsexual people had recommended this removal,[57] arguing that at least some mental health professionals are being insensitive by labelling transsexualism as a “disease” rather than as an inborn trait, as many transsexuals believe it to be.[58] Now, instead, it is classified as a sexual health condition; this classification continues to enable healthcare systems to provide healthcare needs related to gender.[59] The eleventh edition was released in June 2018. The previous version, ICD-10, had incorporated transsexualism, dual role transvestism, and gender identity disorder of childhood into its gender identity disorder category. It defined transsexualism as “[a] desire to live and be accepted as a member of the opposite sex, usually accompanied by a sense of discomfort with, or inappropriateness of, one’s anatomic sex, and a wish to have surgery and hormonal treatment to make one’s body as congruent as possible with one’s preferred sex.”
Historically, transsexualism has also been included in the American Psychiatric Association‘s Diagnostic and Statistical Manual of Mental Disorders (DSM). With the DSM-5, transsexualism was removed as a diagnosis, and a diagnosis of gender dysphoria was created in its place.[60] This change was made to reflect the consensus view by members of the APA that transsexuality is not in and of itself a disorder and that transsexual people should not be stigmatized unnecessarily.[61] By including a diagnosis for gender dysphoria, transsexual people are still able to access medical care through the process of transition.[citation needed]
The current diagnosis for transsexual people who present themselves for medical treatment is gender dysphoria (leaving out those who have sexual identity disorders without gender concerns).[60] According to the Standards of care formulated by WPATH, formerly the Harry Benjamin International Gender Dysphoria Association, this diagnostic label is often necessary to obtain sex reassignment therapy with health insurance coverage, and the designation of gender identity disorders as mental disorders is not a license for stigmatization or for the deprivation of gender patients’ civil rights.[62][63]” — Wikipedia

N Forster
N Forster
2 years ago

Where is the editor?
There is so much confusion in this piece, so many incoherent views it is difficult to make sense. I’d like to be sympathetic to the author, but this seems to be one confusing assertion after another. 
The overall impression I take is that the author is blaming others for performing surgery that people ask and pay for, and accusing the same surgeons of “hate”?
If anyone can summarise this piece in the comments, please do, I’m at a loss. 
But it does seem to be a collection of assertions, self absorption, an abdication of responsibility, histrionics and complaints around the theme of other people are not doing what the author wishes. Yes?
Whilst it is easy to have aversion from such behaviour from an adult, I suppose compassion is the best response.
It is odd however that despite having “transitioned” their body from female to male, the author seems to harbour many stereotypical toxic female qualities in their writing. It’s an awful piece of writing.

Last edited 2 years ago by N Forster
William Shaw
William Shaw
2 years ago
Reply to  N Forster

I think you’ve described it rather succinctly.
As an Unherd column it’s bad, as an excerpt from a book it’s truly awful.

Last edited 2 years ago by William Shaw
N Forster
N Forster
2 years ago
Reply to  William Shaw

I’ve just reread it. Dear me, it is something. A real mix of sophistry and histrionics. It must be a nightmare first to have this self perception that puts us at odd with biological reality, but then to find solace in such a contorted ideology paints the sufferer into a corner which prevents the sufferer ever learning techniques to cope with life beyond seeking others to blame and blaming the world as it is.
It’s all suffering.

Last edited 2 years ago by N Forster
Tom Watson
Tom Watson
2 years ago
Reply to  N Forster

I suppose a summary might be “many of those who are transgender may want to think twice before forking out to have their bits lopped off; that so many want to is of course the fault of capitalism. We should all be more accepting of our own bodies [but not in a way that undermines the idea of trans-ness].” At least with Unherd you get a window into what people you’d never normally read are thinking, if only to remind yourself that they really are all over the shop.

Marcia McGrail
Marcia McGrail
2 years ago
Reply to  N Forster

Yes, this piece – and I must add, others of its ilk – have made my head hurt and my eyes water to the point of farce. But please don’t label us of a stereotypical XX bent as having toxic qualities. That is most of the human race, not just half of it.

Lord Rochester
Lord Rochester
2 years ago
Reply to  N Forster

Indeed, if the trans activist movement were now something of a house fire, this article would be the moment the burning roof collapses inwards.

Cheryl Poniatowski
Cheryl Poniatowski
2 years ago
Reply to  N Forster

Every lie is best sold if it contains a grain of truth. While it is true that there are sociopathic right wing surgeons out there who cut transseuxals for fun and profit, and do a horrific job of it too, it is not true at all that the entire industry is corrupt and disingenuous.

Since it is a lie, we have to ask ourselves why is the author painting a disingenuous picture? There’s a commonly known phenomenon called the ‘sell-out’. It’s a person who makes a living from betraying their own. This is one of them IMO and that’s why you are confused. As a person of integrity who would never do such a thing, witnessing it is an alien experience for you.

ralph bell
ralph bell
2 years ago

Doctors who financially gain from operations should be bound by conditions just as insurance or other financial products are with a duty of care to providing full explanation of what they are agreeing and a cooling off period before the event.
I agree with the writer that other options should always be discussed and considered before physical changes.

N Forster
N Forster
2 years ago
Reply to  ralph bell

For sure, though it seems trans activists have been rather keen to classify talking therapies for trans people as “conversion therapy” and thus illegal. They’ve succeeded in Canada, and failed in the UK.

Julian Farrows
Julian Farrows
2 years ago
Reply to  N Forster

Transgender ideology is itself a conversion therapy – one that seeks to detach children from leading fulfilling sexual lives through confusion and toxic kindness (enabling). Unable to really have children of their own they need to indoctrinate new converts – who better than the psychologically susceptible young?

Cheryl Poniatowski
Cheryl Poniatowski
2 years ago
Reply to  Julian Farrows

Where did you learn that? I suppose you think that for the first 45 years of my life I ran around recruiting children into my harem instead of desperately repressing everything about myself so I wouldn’t end up murdered. Oh by the way, my ex eventually threatened to kill me.

John Scott
John Scott
1 year ago

You clearly have had abuse and mental issues that your transition has not cured. I am sorry for your abuse, and your sad situation is a case in point of how confused, abused people have been manipulated.

Brian Villanueva
Brian Villanueva
2 years ago
Reply to  ralph bell

In many US states (and I think in UK), it’s actually illegal for a doctor or other medical professional to suggest that someone who says they are “trans” might not want to get puberty blockers and cross-sex-hormones and should instead focus on underlying mental health issues. It will, at a minimum cause you to lose your medical license, and can result in criminal charges.

How can we hold doctors responsible for not counseling patients well when we’ve made counseling patients legally impossible?

Cheryl Poniatowski
Cheryl Poniatowski
2 years ago

The WPATH standard of care requires doctors to thoroughly evaluate patients for confounding factors and comorbidity. You are repeating a right-wing myth. In my case, I was blackmailed into taking an antidepressant that caused brain damage and hearing loss in order to pursue medically necessary treatment…all because my family harassed me into a nervous breakdown over my gender transition.

It would have made more sense to lock them up than to lock me up, but that’s not the way society is wired. Transgender people are powerless and routinely absorb all the abuse rather than inflicting it. No doctor ever lost their medical license or was brought up on charges for refusing care to a transgender person. I was evicted from the hospital with a necrotic graft and infection while bleeding to death because my surgeon was one of those right-wing grifters who cut transsexuals for fun and profit, and no charges were filed for him abandoning me to die. The police wouldn’t even take my complaint and no attorney would take my case either because ‘people like you don’t win lawsuits’. Yes, after calling every single medical malpractice attorney in the state, I finally found one who would tell me the truth rather than lead me on or hang up on me.

The degree of confusion in these comments is mind-boggling. Almost nobody on here has any idea what they are talking about.

Do I regret my decision to transition? No, I had no choice in the matter because I was dying anyway. What I regret is that my options were so drastically limited that I had to flip a coin and pick one of the three ‘reputable’ surgeons in the US at the time, because after being evicted from my home at knife point and incurring rent as well as a house payment, I couldn’t afford to travel to the UK or Thailand to investigate other options. Plus at the time there was no such thing as insurance for any of my care, and I was also working 120 hours per week to make myself essential so that my employer couldn’t possibly afford to fire me and hire three more people as replacements. There was no law against summary dismissal upon ‘coming out’ and still isn’t in many US states because we don’t have universal application of the Bill of Rights under the right-wing court system and legislature that refuses to formally codify equal protection. So I made my choice of surgeon in an exhausted brain fog while rapidly decompensating as my dysphoria became all-consuming for want of any outlet whatsovever to release the stress. Eventually I just went with the recommendation of a trusted friend who now vows to never make any recommendation ever again after what I went through.

I shouldn’t be surprised, but somehow I’m always amazed when people publicly post nonsense and seem to also believe it. If you heard it on Fox, it must be true because Tucker and Rupert never lie, except they got off twice from libel lawsuits by arguing that no one in their right mind believes a thing that Tucker says.

Cheryl Poniatowski
Cheryl Poniatowski
2 years ago
Reply to  ralph bell

I can’t speak for every transgender person, but I can say that everyone I know who has been through sexual reassignment was encouraged ad nauseum to seek alternatives because the process is so damn risky…including me. I think you are laboring under the misconception of surgery on demand. It’s not like that, not in reputable circles anyway. Maybe in Mexico where they do fetish amputations of limbs too…

Chaconia 0
Chaconia 0
2 years ago

“I’ve heard terrible stories… of trans people being called by their original gender pronouns on the operating table.” Is this person serious or is this a satirical piece? Is this the worst thing to be said about doctors performing trans surgery? As the patient is in the active process of physically trying to change gender, surely you can forgive the poor doctors who at this point are literally dealing with two genders. And, btw, misgendering is probably the least of the black humour expressed by these doctors while performing their grim task. Perhaps merciful that the patients are unconscious and not able to hear the worst of it. Maybe Miquel needs to lighten up a bit – have a listen to Ricky Gervais’s “Supernature”  and stop taking himself so seriously. 

S Ash
S Ash
2 years ago

This is such a confusing article. If this person didn’t think he was in the wrong body and should have been a woman, what made him ‘ trans? Sounds like a ” gender-non-conforming” (itself a deeply gendered idea) man. So could he just live as he likes and stop trying to change his sex? And if not why not?

Linda Hutchinson
Linda Hutchinson
2 years ago
Reply to  S Ash

I thought that the author was a trans-man, which I took to mean a natal woman who transition to a man. But I get confused with all this, so I could be wrong.

Cheryl Poniatowski
Cheryl Poniatowski
2 years ago
Reply to  S Ash

A competent therapist would have explained that in many cases social transition and hormonal reassignment is sufficient to clear up gender dysphoria well enough to restore a semblance of normal mental function, whereas in other cases that’s not sufficient to relieve the dysphoria enough for normal function, and sometimes the person would also simply like to have the capacity for authentic and natural-feeling sex with an appropriate romantic interest. At that point, a competent therapist would also have cautioned that even if the surgery was as successful as could be hoped and sexual function was a possibility, there is always some loss of sexual sensation and the range of partners who are accepting of such a modification is extremely narrow.

The fact that this person is implying and/or outright stating that such conversations never happened leads me to conclude that either this person rushed transition and consulted with charlatans who were not following the Standard of Care, or that this person is simply lying about events in order to sell books in the heat of authoritarian fascism in a perverse trading on lived experience that amounts to shooting one’s own troops in the back.

cynthia callahan
cynthia callahan
2 years ago

Thank you for this article sharing an ‘unheard’ perspective. The take away here is that people are not being helped by denying them options that do Not alter their physical bodies. And now In some countries it’s a crime punishable by law to offer any other options. How is this good for anybody?! (Pun intended) Of course this is exploited for money as every human weakness is. Conversation is being silenced on this topic. Thank you for opening it up. Hopefully people will soon realize that ‘cosmetic’ surgery never solves the problem before more people suffer irreparable harm. What is fathomable is pushing children into this during development when the hormone treatment is going to create a lifetime of medical and psychological need that is and will be exploited.

rae ellis
rae ellis
2 years ago

Unscrupulous surgeons prey on people’s discomfort with their bodies. This is not exclusive to people who want to pretend they’re the opposite sex. These surgeons don’t hate anyone — they just love money.

Last edited 2 years ago by rae ellis
Judy Englander
Judy Englander
2 years ago

This is an intriguing article but I would like to know more about the author’s personal experience. He says no one explained that sexuality in his original body was possible. What, exactly, does that mean? Is he saying that he now understands his original self as gay? I see the article has been extracted from another. Are there important sections in the original missing from this piece?

Linda Hutchinson
Linda Hutchinson
2 years ago
Reply to  Judy Englander

I agree, I was intrigued by that snippet about no-one explaining that sexuality in his original body was possible, and I kept reading to see what was said, but it was not expanded upon. A pity, because this should have been the crux of the article; plastic surgeons making money from people’s psychological problems is hardly big news.

Last edited 2 years ago by Linda Hutchinson
Judy Englander
Judy Englander
2 years ago

What it could mean – who knows? – is that the author was simply a lesbian but was persuaded that she was ‘really’ a man in the wrong body. If so, it’s a very important point.

Cheryl Poniatowski
Cheryl Poniatowski
2 years ago
Reply to  Judy Englander

I think this is a fabrication. Nobody is going to tell a transgender person that their original equipment is broken. What therapists and doctors tell transgender people is that they have options to align their bodies to their brains to improve the feeling of internal congruency, but that there is always risk in the process and if it’s possible to use what one was born with that’s a superior alternative.

It’s sad that a book like this is put forward as a serious treatise. The language isn’t just disingenuous and biased. There’s outright falsehoods even in the snippets that were excerpted here.

Sandi Dunn
Sandi Dunn
2 years ago

I love Ricky Gervaise’s brave take on trans ‘activist’ hype. The trans fascists can’t cancel him as they have done to others!

Cheryl Poniatowski
Cheryl Poniatowski
2 years ago
Reply to  Sandi Dunn

What part of punching down on a despised minority is remotely brave?

John Scott
John Scott
1 year ago

Despised minority? Please give us a break. No one cares what mutilation you want to do to your body (as long as I don’t have to pay for it). But we do care about women’s rights being taken away by the trans community, and the silliness (now criminal) of the pronoun fiasco. Come on Cheryl, get a grip and leave the rest of us alone.

R Wright
R Wright
2 years ago

The essay failed to properly explore the reality behind the trans movement explored by others such as Sue Donym in their essay ‘Inauthentic Selves’. It isn’t about a few doctors making money: it is about gigantic pharmaceutical companies, political lobbying by astroturf organisations and the surgical alteration of thousands of vulnerable people.

Cheryl Poniatowski
Cheryl Poniatowski
2 years ago
Reply to  R Wright

Yes, because the hormonal and surgical alteration of a couple thousand people is so intensely profitable that it justifies the expense of launching an astroturf operation. lol

I’m having trouble chewing my food without spitting it out in a fit of laughter. You actually believe that transpeople have that kind of pull? We are universally despised and deprived of housing and jobs for the crime of existing. Those of us who survive to take advantage of medical care while maintaining the resources required to pay for all the expenses associated with it such as uninsured procedures, custom made clothing, prostheses, job loss, divorce, rejection by parents, and disinheritance, are such a small number that when I transitioned in the US in 2005 there were only three surgeons with a national reputation to choose from. There wasn’t enough demand to sustain the practices of any more surgeons than that.

It’s amazing that such myths exist at all. Whatever happened to critical thinking skills? A couple of Internet searches are adequate to disprove your own misconception. Did you bother?

Christopher Barclay
Christopher Barclay
2 years ago

The discussion of issues concerning surgery and hormones would be helped by trans people accepting the right of others to speak freely about transition. The abuses by surgeons are permitted by the silencing of people such as Keira Bell.

Last edited 2 years ago by Christopher Barclay
Cheryl Poniatowski
Cheryl Poniatowski
2 years ago

Her story is problematic for a number of reasons.

“But the further my transition went, the more I realized that I wasn’t a man, and never would be. We are told these days that when someone presents with gender dysphoria, this reflects a person’s “real” or “true” self, that the desire to change genders is set. But this was not the case for me. As I matured, I recognized that gender dysphoria was a symptom of my overall misery, not its cause.”

https://www.persuasion.community/p/keira-bell-my-story

None of my medical providers told me that my gender dysphoria reflected my “real” or “true” self, or that my desire to change genders was set. What they told me was:

1) Gender dysphoria has its roots in many factors, but the primary factor is a physical difference in the sexual differentiation of the brain

2) Transition is an expensive, painful, dangerous, arduous, and socially alienating process that is fraught with physical, financial, and emotional risk

3) A ‘go-slow’ approach is the best approach because it reduces risk while improving the chance that a partial and less risky accommodation will prove sufficient

4) The availability of sex partners is dramatically reduced by surgical reassignment, owing to the loss of sensation, the suboptimal function, and the lack of acceptance on the part of a large segment of the straight population

5) Any involvement of comorbid conditions such as depression and maladjustment must be dealt with prior to approval being given for any physical intervention such as hormones and surgery, and no reputable endocrinologists or plastic surgeons will provide care without a therapist’s letter attesting to the patient having completed the requirements of the Standard of Care

“My relationship with my parents continued to be difficult. I was no longer speaking to my mother. My father had kicked me out of his apartment shortly after I turned 17, and I went to live in a youth hostel. He and I were still in touch, though he was adamantly opposed to my transition. Reluctantly, he took me for the surgery.”

So after all this bellyaching about how she was deceived by unscrupulous physicians into mutilating her own body in what amounts to medical experimentation on kids, it finally comes out that she was rejected by her own parents and found herself struggling to survive without them.

This is affirmation? No. Her father proved to be emotionally and financially abusive. If she’s having regret now, could it have anything to do with her father having abandoned her, and her inability as a young adult to compensate for the crushing effect of this abandonment? How do we know that if she hadn’t been dealing with sexist abuse in the home, she still wouldn’t have reached a less drastic accommodation with her gender dysphoria that preserved her fertility instead of pursuing full transition in the hope that fixed things for her? We can’t know that, because her own father cut her off from that possibility by rejecting her and leaving her to her own devices. The fact of the matter is that no medical institution that provides affirming care operates in a vacuum. If her father had been mature and emotionally stable, he would have stuck it out with his daughter and helped her to navigate these decisions intelligently. He would have gone to therapy appointments with her. He would have done independent research and conveyed what he learned in the context of the risk versus benefits. He would have encouraged her to think for herself and keep in mind that reproductive instinct could be an important factor.

Instead, what he did was abandon her. Research has conclusively proven that transition is more risky when the parents inflict sexist abuse on their kids instead of actively supporting them as they attempt to navigate an intense medical process in a climate of raging bigotry. If anyone is to blame here, it’s the father, not the physicians. He abdicated his parental responsibility and tossed it into the laps of strangers who tried in good faith to bring about an acceptable outcome despite his obstructionism. In kicking her out instead of trying to understand her, he gave up the chance to advise her to take it slow and maybe not embark on full reassignment as soon as she was legally able to. Rather than showing her concerned love and support, he emotionally kicked her in the face. No wonder she jumped at the chance to subsume her emotions in testosterone. She was possibly also having fantasies of kicking his ass someday.

I’m gravely concerned that the right wing is able to latch onto a couple of regret stories and twist them into a narrative against science. It’s as bad as what they are doing with global warming.

For anybody who isn’t paying attention, I’m facing the possibility that my California home will have no running water if the record-breaking drought continues much longer. People in Arizona are enduring weather so hot they can’t work during the day and they can’t sleep at night without air conditioning. We’re facing the possibility of air strip runways melting again and shutting down air traffic from affected airports. For the first time, we’ve received warnings that wet bulb temperatures in many places around the globe will exceed survivable levels soon, meaning people without air conditioning or underground shelter will die because their bodies will be unable to cool in the hot muggy atmosphere laden with evaporated moisture that otherwise belongs in the soil.

Science denial always runs into the brick wall of reality eventually. However, since transsexuals are a tiny minority of everyone, eugenics solutions will seem entirely acceptable to the majority once we devolve to cannibalism. We’ve even got religious leaders publicly calling for the execution of queer people.

https://youtu.be/LR6sMGHIvdY

That’s the catch when dealing with a powerless segment of the population. They always lose unless the majority decides that’s not an acceptable outcome.

Last edited 2 years ago by Cheryl Poniatowski
Jo Jones
Jo Jones
2 years ago

“Our bodies are fine” – but that is what trans people (and I work with many teenagers who believe they are trans) say they don’t believe. They say “We are trapped in the wrong body”.
What do you really want from those of us who are not trans because it’s very VERY hard to guess?! And if it means that you keep your p***s yet enter women’s spaces, how do I know if I can feel safe with you unless you clearly dress as a woman? Those of us who have had unwanted male attention physically forced forced on us should not be told to lighten up or that we are bigoted. Those like Alex Drummond are welcome in my space as she would be pilloried and abused in a male space but not all trans women are like Alex.

Cheryl Poniatowski
Cheryl Poniatowski
2 years ago
Reply to  Jo Jones

So you speak for all transgender people?

Regarding safety in the bathroom, that’s a fabrication. Can you point to any statistics that transgender people abuse bathrooms as sexual predators? No, because the evidence says exactly the opposite. Transgender people are far more likely to be attacked in the bathroom than to attack someone. I know of two transpeople who have undergone abuse and attacks in public restrooms. One is me and one is my transgender divorce attorney.

I personally know of zero transpeople who have used crossdressing as a pretext to launch sexual attack in a bathroom. It’s preposterous to even suggest that anyone who wants to get away with rape is going to become a social pariah in exchange for the privilege. How is the enhanced scrutiny that transpeople face everywhere going to help a rapist get away with a crime? It’s ludicrous.

cara williams
cara williams
1 year ago

there is no such thing as transition.

Dominic A
Dominic A
2 years ago

Who was it that said, ‘all causes start as a movement, become a business then degrade into a racket’…? Give ‘ em a prize.

Dominic A
Dominic A
2 years ago

Maybe those who were confused, hated the article, and those in support could be united with an analogy:

A young person has struggled with bodily deformity and obesity, their entire adolescent & adult life, with concurrent depression, suicidal ideation etc. In desperation they reach out to support groups, GPS, who heartily commiserate, and tell the person some great news – there are treatments, near cures, great success rates! The person, or rather patient-to-be, has already heard talk of these cures from multiple media sources, in glowing terms. Politicians and health professionals have all but mandated their use! They are referred on to a surgeon who also recommends and then carries out these treatments – weight reduction (eg gastric bands, wiring jaw, lipo) and plastic surgery for correction of deformity.

Now imagine that person has anorexia nervosa – there is no obesity, nor deformity to be seen – but no matter, all agree that the measure of such things are feelings, it’s a state of mind, which no-one has the right to contest – slice away!

I think, maybe, that is what Miquel has been through.

Phil Mac
Phil Mac
2 years ago

I never get why if so many people are prepared to accept or even enthusiastically embrace the idea that there could such be a massive physical defect as to be in the wrong body they are utterly resistant to the equivalent proposal that it might be a mental disorder.
Both are substantial disorders and I don’t know of any evidence that shows which it is, so why aren’t both explanations given consideration?
The advantage of the mental diagnosis is that it shouldn’t involve irrevocable mutilation. I guess the authors point is that the disadvantage is that it doesn’t enrich the medical vampires.

Cheryl Poniatowski
Cheryl Poniatowski
2 years ago
Reply to  Phil Mac

Your ignorance of the science does not constitute evidence of absence. A simple Wikipedia search easily gives up the evidence. Why would you post here without doing your due diligence first?

Many studies have demonstrated a physical difference in the sexually dimorphic structure of transsexual brains. It’s not like this is a mystery. It has been known since 1995 imaging studies proved it, and speculated about as early as a hundred years ago. While we are still finding out more all the time, what we do know is that trans brains are physically different. This is indisputable. Research funding is also depressingly scarce. This is also indisputable.

Some studies have incorporated bigotry on the part of the researchers (i.e. Blanchard) that warped the conclusions about the influence of sexual differentiation in the brain on behavior, even though he was observing and speculating accurately on the physical genesis of the conditions he was cataloging, as proven in imaging that became available with technologically developed equipment that was not available in his era. His premise that late-onset transsexuality was primarily fethish is not the lived experience of people like me and is condemned as pseudoscience by the World Physicians Association for Transgender Health. Entrenched bigotry is nothing new to medicine, but it is unfortunately rampant among those studying transsexuality who sometimes seem to get into the field for fetishistic reasons of their own and project them onto every research subject they study.

https://en.wikipedia.org/wiki/Causes_of_gender_incongruence

Jake Dee
Jake Dee
2 years ago

If you had been born on a desert island you wouldn’t have been born. A paradox I know but I think you get the point.
We are all born from humans and into human communities. That’s not oppression or slavery it’s our human reality.

jonathan carter-meggs
jonathan carter-meggs
2 years ago

Dissatisfaction arises from the conflict between expectations and reality. Expectations are not innate but develop over time based on character, personal requirements and societal norms. I would suggest that a valid reaction to dissatisfaction is to alter ones expectations (not fixed and/or innate) as much as it is to seek to change reality (fixed and/or innate).

Valerie Taplin
Valerie Taplin
1 year ago

Trans is big business. A lot of money is made around all things “trans” related. The column inches sold. The “informational” courses sold. The surgical and pharmaceutical interventions. The therapists fees. Someone always pays, sadly often the taxpayer, as state departments oblige staff to attend nonsense courses that are totally unnecessary and unrelated to their job functions. This is another example of the pernicious effects of the left – I for one strongly disapprove.

William Shaw
William Shaw
1 year ago

Bodily modification ranges from tattoos to nose jobs to lip plumping to piercings to reassignment surgery.
Let people do as they please.

William Shaw
William Shaw
1 year ago

Bodily modification ranges from tattoos to nose jobs to lip plumping to piercings to reassignment surgery.
Let people do as they please.

William Shaw
William Shaw
1 year ago

I returned to re-read this article.
Sorry, it’s still rubbish.

Last edited 1 year ago by William Shaw
Cheryl Poniatowski
Cheryl Poniatowski
2 years ago

Where to begin?

Gender dysphoria has its roots in a physical ambiguity of the hypothalamus that arises during a flood of prenatal hormones. The fact that androgen-insensitive males not only develop as females but also identify exclusively as females lends credence to this assertion. The fact that this physical ambiguity has been observed in frozen section in repeatable studies also lends credence to this assertion. The fact that this physical ambiguity has been introduced artificially in repeatable studies of mice (cross-gender prenatal hormones) and flies (prenatal radiation) that exhibited cross-gender behavior as well as this physical ambiguity also lends credence to this assertion. The fact that functional MRI can detect complicated ambiguous brain function in transgender people under the influence of specific stimuli also lends credence to this assertion. Finally, the fact that similar ambiguities have been reported in gay and bisexual people cements the hypothesis that gender is NOT a social construct but rather a form of neurological organization.

The degree of ambiguity in the sexual differentiation of the human brain is highly variable. Some people may express strong transgender identification with severe dysphoria, and others may be less impacted. There’s no one-size-fits-all solution.

The World Physicians Association of Transgender Health enforces a strict standard of care…on PATIENTS rather than doctors. That standard includes the completion of a course of psychotherapy to evaluate the potential for comorbid or confounding factors that may confuse the diagnosis. That diagnosis no longer includes a mental disorder but is now a sexual disorder…in both the ICD and the DSM…amounting to a diagnosis of an intersex condition of the brain.

The claim in the comments that people are running around getting body parts lopped off without psychological evaluation is bogus. Either they never thought of investigating the requirements of the Standard of Care, or they don’t care to. Every transgender person who undergoes full sexual reassignment is painfully aware of the rigor of the process. Anything beyond electrolysis and facial feminization for MTF involves a course of psychotherapy, and even then most reputable plastic surgeons may still require a letter from a psychotherapist if they have any doubts at all as to whether or not they risk being sued for medical malpractice.

“In addition, before you can have certain feminizing surgeries, you’ll be required to meet specific criteria. To start, your health will be evaluated to rule out or address any medical conditions that might affect treatment. You’ll also need a letter from a mental health provider stating that you meet World Professional Association of Transgender Health (WPATH) standards of care criteria for facial feminization surgery.

Since facial feminization surgery might cause irreversible physical changes, you must give informed consent after thoroughly discussing:

  • Risks
  • Benefits
  • Cost
  • Alternatives to surgery
  • Social and legal implications
  • Potential complications
  • Changes from the procedure that can’t be undone”

https://www.mayoclinic.org/tests-procedures/facial-feminization-surgery/about/pac-20467962

Regarding the dubuious outcomes that transgender patients endure, that’s not unique to transgender patients. Even people getting back surgery endure risks that may seem unacceptable. In fact, I’ve been offered three spinal fusions that I’m putting off for as long as possible to avoid ending up paralyzed or dead before I’m already at the end of my rope. If transgender patients run an extreme gauntlet in pursuit of gender coherence, it’s got nothing to do with unscrupulous doctors taking advantage of transgender patients and everything to do with politicians, religious leaders, and authoritarian bigots interfering maximally with access to care so that such dubious outcomes are guaranteed in a self-fulfilling prophecy of failure.

When I transitioned, in order to qualify for my right to a gender-appropriate birth certificate, a gender-appropriate marker for my Social Security, and a gender-appropriate marker on my driver’s license, I was legally required to undergo sexual reassignment at least as far as the removal of reproductive organs containing gametes: in my case, the testicles. It wasn’t doctors enforcing this requirement on me: it was politicians.

I was also enduring such horrific gender dysphoria at the sight of my own p***s that I couldn’t stand to look at myself in the mirror. This had absolutely nothing to do with societal expectations or the influence of physicians. I began having these deep-rooted feelings as a teenager before I even knew what a transseuxal was, and didn’t even learn the term until decades later. I deliberately avoided any discussion or exposure to anything ‘gay’ in a desperate attempt to repress this side of myself because of the risk of rejection and imminent harm (I later endured both during my transition). Pretending that surgeons talked me into my transition is preposterous.

Despite this strongly cross-gendered situation, I now function and present ambiguously, both because I have a strongly split sense of self, and also because it’s too damn hard to present entirely female all the time while struggling with a deep voice and male pattern baldness during global warming, especially after disability has savaged my finances and I can’t afford even decent clothes any more.

The fact is that this alleged medical binary gender paradigm enforcing strict gender conformity on patients is a complete myth. There are surgeons who do anything or everything according to what the patient requires, including creating genitalia that can function in either a male or female role or even both in one for compatibility with romantic partners of both sexes if that’s what is best for the patient, or nothing at all if that would be better. Psychotherapists encourage a go-slow attitude to reach accommodation without incurring too much risk. However, for those who present strongly transsexual from a very young age who will never be comfortable until they are 100% coherent, early intervention and comprehensive reassignment is essential to prevent permanent harm.

In my case, not only did that option not exist back then, but I also felt it essential that I father children. I don’t know why, but I was driven to. That doesn’t change the fact that I am strongly transgender. All it does is complicate the treatment.

But the icing on the cake here is the universal erasure of the intersexual person who is clinically neither male nor female in physical presentation or function. Most tellingly, the horrific abuse of such people with involuntary sexual reassignment at birth into one of two binary genders that existed for a hundred years or more and continues to this day in some places is not mentioned even once in this disingenuous soliloquy of transgender regret marketed as pearls of wisdom. Right wing bigots not only deny the intersexual condition of the transgender brain, they also studiously ignore the intersexual condition of the non-binary body, because it stands as a blatant refutation of ‘God’s Plan’ of two genders. The fact that this author can’t, or won’t, include physically intersexual people who are now subject to the same exact standard of care that transgender people are subject to, or even mention the nightmarish abuse of infant bodies including the covert administration of hormones as ‘vitamins’ with complicity of the parents, and the deliberate concealment of medical records until a lawsuit is filed demanding them, proves conclusively that either this person doesn’t know or doesn’t care what he is talking about. The swipe at MTF by an FTM also smacks of trans-exclusive radical feminism (TERF).

I’m calling BS. Everyone undergoes a different transition with different goals for different reasons, and the medical framework is both cautious and restrictive. I don’t think this book is written to inform. I think this book is written to put money in the author’s pockets…from right wing bigots who are looking for any excuse to hate on people like me.

Last edited 2 years ago by Cheryl Poniatowski
Ormond Otvos
Ormond Otvos
2 years ago

People in the 25 comments so far seem often unable to read for content. It seems they just read for some words and phrases in order to apply their pro and con biases.
I found the article/excerpt to be well reasoned, and accurate in its reading of the greed and narcissism involved in exploiting troubled teens. It seems we’re living in times of misinformation-addled zombies.
Trumpism is another form trans activism. Think on that.
Just another rabbit hole.

Alex Shipley
Alex Shipley
2 years ago
Reply to  Ormond Otvos

Thank you, sir, for congratulating yourself as the only enlightened person amongst all who have commented here. We needed you to show us the error of our ways. Oh, and yes, I did read the article all the way through, as did everyone else here, I believe. If we don’t agree with you, however, we must surely be deficient, right?