50 years of sex changes, mental disorders, and too many suicides
The New York
Daily News gossip column reported a girl was making the rounds
in Manhattan clubs who admitted to being a man in 1965. She had undergone a
sex-change operation in Baltimore at the Johns Hopkins gender clinic.
By
1979, thirteen years later, enough gender surgeries had been performed to evaluate
the results. It was time for a report card based on actual patients.
1970s:
How effective was the change surgery? What were the outcomes for transgender
people?
The
first report comes from Dr. Harry Benjamin, a strong advocate for cross-gender
hormone therapy and gender-reassignment surgery, who operated a private clinic
for transsexuals. According to an article in the Journal of Gay & Lesbian Mental Health,
“By 1972, Benjamin had diagnosed, treated, and befriended at least a thousand
of the ten thousand Americans known to be transsexual.”
Dr.
Benjamin’s trusted colleague, endocrinologist Charles Ihlenfeld administered
hormone therapy to some 500 transgender people over a period of six years at
Benjamin’s clinic—until he became concerned about the outcomes. “There is too
much unhappiness among people who have the surgery,” he said. “Too many of them
end as suicides. 80% who want to change their sex shouldn’t do it.” But even
for the 20% he thought might be good candidates for it, sex change is by no
means a solution to life’s problems. He thinks of it more as a kind of
reprieve. “It buys maybe 10 or 15 years of a happier life,” he said, “and it's
worth it for that.”
But
then, Ihlenfeld himself never had a sex change. I did,
and I disagree with him on that last point: The reprieve is not worth it. After
I had a reprieve of seven or eight years, then what? I was worse off
than before. I looked like a woman—my legal documents identified me as a
woman—yet I found that at the end of the “reprieve” I wanted to be a man every
bit as passionately as I had once yearned to be a woman. Recovery was difficult.
Nevertheless,
based on his experience treating 500 transgenders, Dr. Ihlenfeld concluded that
the desire to change genders most likely stemmed from powerful psychological
factors. He said in Transgender Subjectivities: A Clinician's Guide,
“Whatever surgery did, it did not fulfill a basic yearning for something that
is difficult to define. This goes along with the idea that we are trying to
treat superficially something that is much deeper.” Dr. Ihlenfeld left
endocrinology in 1975 to begin a psychiatry residency.
About
three years ago, while writing my book Paper Genders, I was curious and
called Dr. Ihlenfeld to ask if anything had changed his mind about the remarks
he made in 1979. Ihlenfeld was polite to me on the phone and quickly said that
no, nothing had changed his mind. It is interesting in today’s atmosphere of
political correctness that Dr. Ihlenfeld, a homosexual, holds the view that gender-reassignment
surgery isn’t the answer to alleviate the psychological factors that drive the
compulsion to change genders. I appreciate his honest, clinical evaluation of
the evidence and refusal to bend the medical results to fit a particular
political viewpoint.
Next
let’s take a look at the Johns Hopkins University Gender Clinic where the
transgender girl gossiped about in the New York Daily News had
her surgery. Dr. Paul McHugh became director of psychiatry and behavioral
science in the mid-1970s and asked Dr. Jon Meyer, director of the clinic at the
time, to conduct a thorough study of the outcomes of people treated at the
clinic. McHugh says,
[Those who underwent surgery] were little changed in
their psychological condition. 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.
In
2015 I sat across from Dr. McHugh in his office at Johns Hopkins University and
asked him the same question I had asked Dr. Ihlenfeld: Had anything changed his
mind regarding surgically made genders? McHugh told me that he has yet to see a
medical justification for the surgical alteration of genitalia and that it is
the obligation of medical practitioners to follow the science where it leads,
rather than ignoring the science to advance political correctness.
These
two powerful and influential doctors were early pioneers in the treatment of
transsexualism. Dr. Ihlenfeld is a homosexual psychiatrist; Dr. Paul McHugh is
a heterosexual psychiatrist. Both came to the same conclusion, then and now:
Having surgery did not resolve the patients’ psychological issues.
2000s:
Were the psychological factors from the Hopkins and Benjamin clinics
supported by later studies?
Studies
show that the majority of transgender people have other co-occurring, or
comorbid, psychological disorders.
A 2014 study found 62.7% of patients diagnosed with gender
dysphoria had at least one co-occurring disorder, and 33% were found to have
major depressive disorders, which are linked to suicide ideation. Another 2014
study of four European countries found
that almost 70% of participants showed one or more Axis I disorders, mainly
affective (mood) disorders and anxiety.
In
2007, the Department of Psychiatry at Case Western Reserve University in
Cleveland, Ohio, committed to a clinical review of the comorbid disorders of the last 10
patients interviewed at their Gender Identity Clinic. They found that “90% of
these diverse patients had at least one other significant form of
psychopathology . . . [including] problems of mood and anxiety regulation and
adapting in the world. Two of the 10 have had persistent significant regrets
about their previous transitions.”
Yet
in the name of “civil rights,” laws are being passed at all levels of
government to prevent transgender patients from receiving therapies to diagnose
and treat co-occurring mental disorders.
The
authors of the Case Western Reserve University study seemed to see this legal
wave coming when they said:
This finding seems to be in marked contrast to the
public, forensic, and professional rhetoric of many who care for transgendered
adults . . . Emphasis on civil rights is not a substitute for the recognition
and treatment of associated psychopathology. Gender identity specialists,
unlike the media, need to be concerned about the majority of patients, not just
the ones who are apparently functioning well in transition.
As one
who went through the surgery, I
wholeheartedly agree. Politics doesn’t mix well with science. When politics
forces itself on medicine, patients are the ones who suffer.
What
about the suicides?
Let’s
connect the dots. Transgender people report attempting suicide at a staggering
rate—above 40%. According to Suicide.org, 90% of all suicides are the result of
untreated mental disorders. Over 60% (and possibly up to 90% as shown at Case
Western) of transgender people have comorbid psychiatric disorders, which often
go wholly untreated.
Could
treating the underlying psychiatric disorders prevent transgender suicides? I
think the answer is a resounding “yes.”
The
evidence is staring us in the face. Tragically high numbers of transgender
people attempt suicide. Suicide is the result of untreated mental disorders. A
majority of transgender people suffer from untreated comorbid disorders—yet
against all reason, laws are being enacted to prevent their treatment.
I
write out of deep concern for the transgender men and women who
attempt suicide, who are unhappy, and who want
to go back to their birth gender. The other ones—those who appear to be
functioning well in transition, at least for now during their “reprieve”—are
celebrated in the media. But I hear from others—the ones who prefer to stay
hidden, who are contemplating suicide, whose lives are torn apart, who have had
the surgery but still have debilitating physical or psychological issues—the
ones whose reprieve is over.
In
the 1970s and now, gender-reassignment surgery is routinely performed when
requested. Transgender people are the one population allowed to diagnose
themselves with gender dysphoria solely on the basis of their desire for
sex-reassignment surgery, and not because the medical community has found
objective proof that such surgery is medically required.
After
fifty years of surgical intervention in the United States, a scientific basis
for surgical treatment of transgender people is still lacking. A task force
commissioned by the American Psychiatric Association did a review of the
literature on the treatment of gender
identity disorder and in 2012 stated, “The quality of evidence pertaining to
most aspects of treatment in all subgroups was determined to be low.” In 2004,
the review of more than 100 international medical studies
of post-operative transsexuals found “no robust scientific evidence that gender
reassignment surgery is clinically effective.”
We
hear the echoes from the pioneers at the Hopkins and Benjamin clinics and see
their early conclusions confirmed in today’s studies, showing again and again
that psychiatric and psychological disorders exist in the psyches of
gender-changers—but who is paying attention?
Scorn
and vilification await anyone who dares to suggest that psychotherapy is needed
to effectively treat gender dysphoria. Dr. McHugh, Dr. Ihlenfeld, and others
like them display great integrity when they publicly raise concerns about
psychological issues existing in the gender-changers, and when they push back
against the “steamroller approach” of treatment that provides hormones and
reassignment surgery without first pursuing less-invasive and life-altering
treatment.
Advocates
and trans-clients fear that if a psychologist or a psychiatrist looks too
deeply into the patient’s psyche they could discover the presence of a disorder
that, if properly treated, would take away the dream of sex change, a fantasy
they nurtured most of their lives. Living in denial is often a means of escape,
a way to avoid looking back at early childhood events and doing the hard work
of dealing with a painful past. The causes of these disorders lie buried so
deep, and stirring them up leads to such high levels of anxiety, that changing
one’s identity and appearance—while extreme—seems preferable.
Thirty-three
years ago I underwent gender-reassignment surgery only to
discover it was a temporary reprieve,
not a solution to the underlying comorbid disorders. I have written books,
published articles, and spoken publicly around the world to enlighten people on
the prevalence of suicide among transgender people and on the risks and regrets
of changing genders.
Television
networks such as ABC that glamorize transgenders like Bruce Jenner, in his
psychological turmoil, do a great disservice to transgender people and to those
who treat them by denying them a safe environment in which to tackle the deeper
issues of comorbid disorders and suicide. Continuing to ignore history and the
warnings in studies and reports—however inconvenient or politically incorrect
they may seem—is no solution to the treatment of psychological disorders.
Ignoring suicides will not help to prevent them. Outlawing certain medical
interventions when we know that 90% of suicides are due to untreated mental
disorders and that a majority of transgender people have coexisting
psychological disorders doesn’t advance effective treatment protocols; it shuts
down the freedom to follow where science leads.
Allowing
a political agenda to override and silence the scientific process will not
prevent suicides or lead to better treatments for this population. It’s not
compassion; it’s reckless disregard for people’s lives.
Walt
Heyer is an author and public speaker with a passion to help others who regret
gender change. Through his website, SexChangeRegret.com,
and his blog,WaltHeyer.com, Heyer
raises public awareness about the incidence of regret and the tragic
consequences suffered as a result. Heyer’s story can be read in novel form in Kid
Dakota and The Secret at Grandma’s House and in his
autobiography, A Transgender’s Faith. Heyer’s other books include Paper Genders and Gender, Lies
and Suicide. Reprinted
with permission from The Witherspoon Institute.
