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Summary
- The term "sex affirmation" (formerly
called "sex reassignment") and procedures
have significant difference for men (identified
female at birth) than for women
(identified male at birth).
- Genital reconstructive surgery (GRS) for
women (who were identified male at birth)
is often a single procedure with a successful
outcome, performed competently by a number of
surgeons in Australia. Genital reconstructive
surgery for men (identified female at
birth) are multiple surgeries, high risk to
health and high risk of failure, expensive,
performed by few surgeons in Australia.
- The Health Insurance Commission of Australia
recognises the hazards associated with
female-to-male genital reconstructive surgery
and does not insist that a
man have imitative surgeries
such as phalloplasty or
metoidioplasty surgeries completed as
prerequisite to amending Medicare records.
- Australian Federal Case Re Kevin :
Validity of Marriage of Transsexual (2001) FamCA
1074 and (2001) FLC 93-087), established
imitative genital
reconstructive surgery is not required for
men identified female at birth,
to be legally accorded all
the rights and responsibilities of men
identified male at birth.
Sex Affirmation Treatment process for men
1. The single most effective sex
affirmation treatment for men is an intramuscular
injection of 200-250mL of testosterone once every
14-21 days (Gooren, Louis J. G., 1999; Asscheman
and Gooren, 1992; Meyer et al., 1986).
2. Testosterone hormone treatment, within
a relatively short period of time (12 months or
less) ushers in a number of visible, irreversible
male secondary sexual characteristics. For these
men, this is a lifelong maintenance treatment
(Asscheman and Gooren, 1992).
3. The most effective sex affirmation
surgical procedure for men is chest
reconstructive surgery (HBIGDA, SOC 6, 2001).
While somewhat similar to mastectomy, it is
fundamentally different in a number of ways from
the routine mastectomy procedure.
4. The technique for a contoured,
masculine-shaped chest requires a skilled surgeon,
time off work and active physical exertion and
financial resources to facilitate an acceptable
outcome. The vast majority of men plan for and
undergo this aspect of sex affirmation
treatment.
Sex Affirmation Lower Surgeries for men
Remaining surgical procedures are located in the
lower half of the abdomen - hence the term lower
surgeries.
5. Hysterectomy or
oopherectomy is the only lower surgical sex
affirmation procedure currently required by law for
men in Australia (to correct their birth
certifcate). Given the widespread practice and
surgical skill available in Australia and desire by
many men have these female reproductive organs
removed, it appears to be a reasonable demand.
Concurrently, men in Australia often receive advice
from their healthcare professionals to retain these
native organs, because so little is known about the
long-term effects of removal.
6. Genital reconstructive
surgeries for men are a series of distinct
multiple surgical procedures, with several separate
stages of surgery requiring multiple admissions to
hospital; considerable health resources and
financial resources (between $US30,000 and
$US150,000); are fraught with frequent technical
difficulties such as fissures, strictures and stone
formation (Ralph, 1999), which often require
additional operations.
7. Professor Stephen Whittle, Coordinator
of the FTM UK Network for over 20 years, advises
that while "many FTMs can achieve quite masculine
features through hormone therapy and a bilateral
mastectomy, current best medical practice
recommends that they do not undergo genital
surgery." (Whittle, 1998).
8. Rachlin's 1999 study, Factors which
influence Individuals' Decisions when Considering
Female-to-Male Genital Reconstructive Surgery,
found "none of the individuals in the transsexual
group rejected surgical options because they were
satisfied with their own body. They wanted male
genitals, if only they were attainable".
9. The Australian Commonwealth Government
Health Insurance Commission has already advised
that the "…HIC does recognise the hazards
associated with female to male gender reassignment
and would not insist that a person have this type
of surgery completed as a prerequisite to amending
Medicare records." (Correspondence from the Health
Insurance Commission to the Men's Australian
Network, 1 May 2000).
10. The Harry Benjamin Standards of Care
advise practitioners and surgeons that phalloplasty
procedures require "several separate stages of
surgery and frequent technical difficulties which
may require additional operations…The plethora
of techniques for penis construction indicates that
further technical development is
necessary."(HBIGDA, Version 6, February 2001).
Risks of Genital reconstructive surgery for
men
Genital Reconstructive surgeries:
- are extremely expensive;
- vary in number often requiring upward of six
to eight hospital inpatient stays (for
phalloplasty), and in some cases upward of 15 or
16 hospital stays of anywhere up to three to
four weeks each and ultimately may take upwards
of two to three years to complete if
successful;
- can result in incontinence and considerable,
ongoing pain;
- can be debilitating and result in
catastrophic failure;
- often leave multiple scaring;
- can result in result in tremendous social
cost (such as losing employment) and social
isolation (from families and social support
networks);
- should the surgical procedures fail, men
suffer severe depressive illnesses as a result
of undertaking the process (Whittle, 1998);
- when they fail are not limited to sexual
inability but also broader health problems. As
Professor Stephen Whittle states "Of those few
network members who have pursued such surgery,
nearly all are now disabled for life and will
never work again." (1998);
- are "not recommended by any of the leading
physicians in the field." (Whittle, 1998).
Despite all these issues, successful genital
reconstructive surgery for men is strongly
rehabilitative: enabling them the ability to stand
to void, negating fear of discovery, and offering a
secure sense of completion (Huntersmith, 2001).
As Dr Huntersmith (2001) says "There
appears to be no doubt that surgery for
female-to-male transsexuals can be extremely
beneficial. I often see an amazing change in
behaviour and mood after successful surgery. Not
only are our patients reassured to find that there
are people willing to help them, they also show
dramatic improvement both physically and
psychologically from the effects of surgery."
Such enormous risks coupled
alongside coextensive benefits, genital
reconstructive surgeries must remain a personal,
private decision made individually without
legislative duress.
In Conclusion
In cases where surgery fails or where
health diminishes due repeated anaesthetic and
surgical procedures, men become vulnerable to
discrimination and abuse, and are compelled to
suffer under burdens of secrecy, shame and
considerable pain.
Implications are far-reaching when
legislators compel these men to risk their lives
and support of their families to undergo the
highly problematic and health-threatening
procedures associated with imitative sex
affirmation treatment.
Given the extraordinary complexities and
expenses, including the high risks of
complications and failure of these surgeries,
legislators are urged to consider carefully the
implications of discrimination and abuse of
reasonable human rights for these men when
imposing imitative sex affirmation surgeries as
requirement for correction of the birth
certificate.
References
- Asscheman H, and Gooren, LJG. (1992) Hormone
treatment in transsexuals. Journal of
Psychology & Human Sexuality, 5,
39-54.
- Re Kevin (Validity of Marriage of
Transsexual) [2001] FamCA 1074 (12
October 2001). [online]. Sydney,
Australia. Available from: http://www.austlii.edu.au/au/cases/cth/family_ct/2001/1074.html
[Accessed 24 March 2003].
- Gooren, Louis J. G. (1999) Hormonal Sex
Reassignment. International Journal of
Transgenderism, 3, 3.
- Harry Benjamin International Gender
Dysphoria Association. (n.d./2001). The
standards of care: The hormonal and surgical sex
reassignment of gender dysphoric persons.
[online]. Minneapolis, USA. Available
from: http://www.hbigda.org/
[Accessed 1 March 2003].
- Health Insurance Commission in
correspondence to the Men's Australian Network,
1 May 2000
- Huntersmith, D. (2001). Reassignment Surgery
for our men. Torque, 1(2), November 2001.
http://www.mtra.org.au/library/01/huntersmith.html
[Accessed 24 June 2006].
- Rachlin, K. (1999) Factors Which Influence
Individual’s Decisions When Considering
Female-To-Male Genital Reconstructive Surgery
[online]. International Journal of
Transgenderism, 3,3. Available from:
http://www.symposion.com/ijt/ijt990302.htm
[Accessed 1 March 2003].
- Ralph, D. J. (1999) Urethral Complications
in Phalloplasty. Boys' Own, 30,
16-18.
- Whittle, Stephen (1997) Supporting
Statement for Mr Dale Altrows to the Canadian
Jurisdiction of Montreal, Quebec,
Canada.
- Whittle, Stephen (1998) Response to DfEE
Consultation Paper on Legislation Regarding
Discrimination On Grounds Of Transsexualism In
Employment, United Kingdom.
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Considerations for Legislators regarding Genital
Affirmation Surgery
