Opinion Editorial: On the Necessity of Gender Reassignment Surgery

By Kevin Chau | UTS Staff Writer | SQ Online (2015-16)

Last summer, I took a few classes in Thailand as part of a study abroad program offered by UC San Diego. It was a breath of fresh air to be outside of the mundane and experience a whole other culture, one that is quite a bit different from that of the United States, specifically San Diego County. One particularly striking cultural difference, however, was that the concept of transgender individuals is hardly an issue at all in Thailand. For instance, major tourist attractions were the “famous and fabulous” ladyboy cabaret shows, in which men and women dressed up as the opposite gender and sang and danced. Additionally, transgender individuals have more roles with client interaction, like as cashiers at 7-11. In contrast, the notion of transgender individuals and gender dysphoria is not a readily discussed topic among students here at UCSD, likely a reflection of American culture as a whole. Although there are plenty of resources for the LGBT community, I’d recently attended a Blabbermouth event at the Loft here at UCSD where a performer, the “Queer Rapper,” rapped about the current, disappointing, level of acceptance of the LGBT community. On top of that, there is now this absurd notion of denying transgender individuals certain rights when it comes to surgery.

In the wake of recent events, most notably Bruce Jenner’s transition to her new identity Caitlyn Jenner, the concept of gender identity has become more and more prevalent. Prior to Caitlynn Jenner’s transition, the notion of gender identity was a highly controversial topic in the world of medicine. In particular, gender reassignment surgery (GRS) has become a major point of contention, being both properly praised as a solution to gender dysphoria, and absurdly criticized as an unnecessary medical procedure. This scrutiny is the basis upon which transgender individuals are wrongfully stripped of their right to undergo surgery; transgender individuals should absolutely have the right to undergo GRS.

Johns Hopkins Hospital has been at the forefront of the anti-GRS ideals. Ironically it was the first American hospital to offer GRS to patients in the 1960s, yet it halted this practice in 1979 at the insistence of their then-Chair of Psychiatry, Dr. Paul R. McHugh, with many other hospitals following suit. Dr. McHugh argued that there is no biological basis for gender dysphoria and that it is a mental health issue comparable to body dysmorphic disorder. He states in his work Psychiatric Misadventures, “We don’t do liposuction on anorexics. Why amputate the genitals of these poor men?”


Dr. Paul R. McHugh is a doctor of psychiatry at Johns Hopkins Medical Center. He also served for a time as psychiatrist-in-chief at Johns Hopkins. He opposes GRS for transgender individuals.
Dr. Paul R. McHugh is a doctor of psychiatry at Johns Hopkins Medical Center. He also served for a time as psychiatrist-in-chief at Johns Hopkins. He opposes GRS for transgender individuals. (Source)


Dr. McHugh himself made a number of anti-transgender remarks this past June, independent from policy-pushing under Johns Hopkins. He describes transgender “feelings” as memetic (not to be confused with internet memes), as if these feelings had absolutely no biological basis. In this article, he also accuses Caitlynn Jenner of wanting to feel “sexy” and having a feeling of “autogynephilia”; Dr. McHugh completely disregards Caitlynn Jenner’s overwhelming desire to feel comfortable in her own body.

These statements by Dr. McHugh are opposed by recent studies that show that there is in fact a biological cause to what Dr. McHugh considers a “mental illness.” In a 2003 study from UCLA, over 50 candidate genes were studied for their influence on sex differentiation in mice, with seven confirmed to significantly influence sexual orientation and gender identity, indicating that there is a genetic factor in sexual orientation that is not just limited to an individual’s genitalia. The study challenges the idea that gonadal hormones are the only factor in sex differentiation. Its implications are that the presence of specific genitalia does not dictate one’s gender, thus reinforcing the case for GRS as an important right for transgender individuals.

Social safety is also a key factor in the necessity of GRS. Facial reconstruction to the opposite gender is considered GRS. Caitlyn Jenner did not undergo genital surgery; as of now, the final step in her gender reassignment was facial reconstruction. This surgery allows transgender individuals to have some semblance of public safety since transgender individuals are not welcomed by all Americans. Walking around in public as a clearly transgender individual poses a very real risk of outright public violence.

According to Jenner, the last step in her gender reassignment was facial reconstruction. (Source)


There is also the issue of arbitrary gender classification. For instance, in the 2004 study Discordant Sexual Identity in Some Genetic Males with Cloacal Exstrophy Assigned to Female Sex at Birth, the gender is arbitrarily assigned to victims of cloacal exstrophy, a complex defect of the entire pelvis associated with severe phallic inadequacy or even phallic absence. Traditionally, assignment to the female sex is advocated for afflicted males, resulting in unpredictable sexual identification. In such cases, the availability of GRS seems necessary; third-party gender assignment cannot consider the desires of the afflicted individual since these individuals are newborns.

Recent times have seen a heightened recognition of gender dysphoria, although there is still a long way to go until ladyboy cabaret shows become a mainstream American pastime. In May of 2014, the Obama administration lifted a 33-year-long ban on Medicare coverage for GRS, thus providing a way for transgender individuals to undergo GRS even if they cannot afford it. This is a step in the right direction. GRS is gaining momentum as a solution to gender dysphoria. Transsexuality has been around long before the term was even coined; thus, it is obviously not a result of societal factors, as Dr. McHugh would argue, and almost certainly has biological causes as indicated by the cited studies. Individuals should have the right to undergo GRS if they believe that it is the best solution to their gender dysphoria.
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