Transgender Surgery Isn't the Solution

[Olivia P]

A drastic physical change doesn't address underlying psycho-social troubles.

June 12, 2014 7:19 p.m. ET, By PAUL MCHUGH

The government and media alliance advancing the transgender cause has gone into overdrive in recent weeks. On May 30, a U.S. Department of Health and Human Services review board ruled that Medicare can pay for the "reassignment" surgery sought by the transgendered—those who say that they don't identify with their biological sex. Earlier last month Defense Secretary Chuck Hagel said that he was "open" to lifting a ban on transgender individuals serving in the military. Time magazine, seeing the trend, ran a cover story for its June 9 issue called "The Transgender Tipping Point: America's next civil rights frontier."

Yet policy makers and the media are doing no favors either to the public or the transgendered by treating their confusions as a right in need of defending rather than as a mental disorder that deserves understanding, treatment and prevention. This intensely felt sense of being transgendered constitutes a mental disorder in two respects. The first is that the idea of sex misalignment is simply mistaken—it does not correspond with physical reality. The second is that it can lead to grim psychological outcomes.

More: http://online.wsj.com/articles/paul-mchugh-transgender-surgery-isnt-the-solution-1402615120

Google cache, limited time only:  http://webcache.googleusercontent.com/search?q=cache:http://online.wsj.com/articles/paul-mchugh-transgender-surgery-isnt-the-solution-1402615120

[Olivia P]

This article needs significant attention from those of us that are strong enough in the comments section, such misinformation cannot be allowed to pass silently.

[Cindy]

Mmm couldn't open it to respond

[Olivia P]

Eh, they put up a pay wall literally the second I posted it here...

So not only are they misinformimg people with extremely outdated information, they are deliberately limiting access to their subscribers so all reactions are biased creating the illusion of legitimacy?

[Cindy]

Typical! So they discriminate against those they discriminate against!

[Olivia P]

I really do dislike news sites that hide behind pay walls

Google cache, limited time only:  http://webcache.googleusercontent.com/search?q=cache:http://online.wsj.com/articles/paul-mchugh-transgender-surgery-isnt-the-solution-1402615120

[Arch]

This guy is taking extreme liberties with the Swedish study. Read it here at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3043071/.

At the start of the article, the authors warn that the study "does not, however, address whether sex reassignment is an effective treatment or not." Near the end, the authors explicitly state, "It is therefore important to note that the current study is only informative with respect to transsexuals [sic] persons health after sex reassignment; no inferences can be drawn as to the effectiveness of sex reassignment as a treatment for transsexualism. In other words, the results should not be interpreted such as sex reassignment per se increases morbidity and mortality. Things might have been even worse without sex reassignment." They also do not compare the suicide rate with pre-transition suicide rates (I only skimmed the article and did not see such a comparison, and such comparisons were not the focus of their research).

They also note, "Other facets to consider are first that this study reflects the outcome of psychiatric and somatic treatment for transsexualism provided in Sweden during the 1970s and 1980s. Since then, treatment has evolved with improved sex reassignment surgery, refined hormonal treatment,[11], [41] and more attention to psychosocial care that might have improved the outcome." In other words, these people were all treated twenty-five to forty-five years ago when treatment was still in the Dark Ages. The results are also specific to one country, and the authors note that Sweden is a small country with few transsexuals. Thus, the study cohort, while larger than previous cohorts, is quite limited, and the results reflect a particular country and treatments during a particular time period when discrimination was likely high and surgical results were likely less impressive than they have been in the twenty-first century.

So McHugh is drawing conclusions that the study was explicitly not designed to address. I guess he assumes that nobody is going to look up the article and call him on it.

[Tysilio]

McHugh is famous for this pseudo-intellectual bigotry. It's astonishing that any mainstream media outlet gives him a platform in this day and age. I wish I could have read the whole thing, but this article seems to be pandering to the anti-government/anti-media bias of the right wing... in other words, it's preaching to the converted. (And the WSJ is famous for the idiocy of their editorial/opinions pages.)

Sigh. Freedom of speech, and all that...

[Olivia P]

McHugh is famous for this pseudo-intellectual bigotry. It's astonishing that any mainstream media outlet gives him a platform in this day and age. I wish I could have read the whole thing, but this article seems to be pandering to the anti-government/anti-media bias of the right wing... in other words, it's preaching to the converted. (And the WSJ is famous for the idiocy of their editorial/opinions pages.)

Sigh. Freedom of speech, and all that...

The Google cached version still has the full article if you want to read it

[suzifrommd]

There is so much wrong with this, I don't know where to begin.

I'll hit just two:

1. McHugh says nothing in his article to back up his assertion that gender identity can be changed. He knows that no one has EVER been successful changing people's gender identities or making trans people into cis people.

2. The question isn't "is everyone happy after SRS?" That's a silly question. Of course everyone isn't happy. There is NO HUMAN POPULATION in which everyone is happy.

The question isn't even "are people who had SRS as happy as people who didn't?" Comparing apples and oranges. Be like asking are people who lost limbs and live with prosthetics as happy as those who never lost limbs.

The question SHOULD BE "are people who had SRS happier than they would be if they hadn't had it." Neither of McHugh's cited studies answers this question.

[Virginia]

Full article available at:
https://genderidentitywatch.files.wordpress.com/2014/06/paul-mchugh_-transgender-surgery-isnt-the-solution-wsj.pdf

Related article: "Johns Hopkins Psychiatrist: Transgender is 'Mental Disorder;' Sex Change 'Biologically Impossible'" available at:
http://cnsnews.com/news/article/michael-w-chapman/johns-hopkins-psychiatrist-transgender-mental-disorder-sex-change

As a survivor of childhood trauma with male and female alters, I am glad to see media coverage explaining that a person's need to express themself as another gender CAN be a mental disorder.

I am not and have never have been transgender. There is nothing natural or normal about my need to express myself as my gender not assigned at birth. I have Dissociative Identity Disorder (DID; sometimes referred to as Multiple Personality Disorder/MPD). My innate ability to dissociate enabled me to survived my parent's psychological abuse, the environment I grew up in and being raped by an older boy by splitting my mind into me and separate 7-year-old child, tweenage girl, Protector and Inner Self Helper personalities. It was a highly successful coping mechanism that enabled me to do an amazing job of simulating a healthy person. I lived a happy life, had a successful career as a graduate level engineer and have been married to an amazing woman who has stood by my side through all of this for 20+ years.

In 2009 an external event triggered System decomposition. I suffered a midlife breakdown at the age of 48 and my 13 year old female alter became self aware. The bloody battle for the body that commenced between us was misdiagnosed as transsexualism. We are not "out" to anyone, live completely separate lives and come and go as separate cisgender people. She is a strong alter, fronted for the system through junior high and fronts for my System two days a week now. It took growing shoulder length hair, androgynous reshaping of my eyebrows and removing my beard (except Van Dyke) with laser/electrolysis to quell her body dsyphoria by making my body more closely fit her self image from when she had fronted for the System 35+ years ago. A full transition level estrogen HRT regimen further decreased her dysphoria by reducing my body hair. But more importantly, chemical castration met my psychological need as a trauma victim to end the cycle of abuse by making it impossible for me to reproduce.

Despite my insistence that it was not right for me, my gender therapist and then my cognitive psychologist crammed the idea that I was in denial of my transgenderism down my throat for nearly THREE YEARS. When I began to experience time/memory loss, nightmares and flashback, I was correctly rediagnosed with DID and referred for trauma recovery therapy. Catering to my female alter's needs and wants by transitioning or SRS would have done nothing to fix the underlying cause of my need to express myself as male and female. Destroying the world I had spent the best part of a life building, a short period of the grass being greener on the other side and I would have been right back where I started on the other side of the fence. The only way out was through. And I have spent the last 2 years in bi-weekly couple's counseling and twice a week psychodynamic therapy learning to face the demons my child's mind locked away nearly 50 years ago.

I understand it is cheaper and easier for society to take a cognitive approach, let the handful minority of people who see themselves as the wrong gender live that way rather than bearing the cost of the thousands of hours of therapy required to heal a potential underlying psychological condition. But I am sick and tired of the insurance companies, the psychological community and now the media jumping on the transgender bandwagon when there are many reasons a person may need to express themselves as their gender not assigned at birth that have absolutely NOTHING to do with gender.

[Myarkstir]

Didn't read the article as this kind of self righteous bullwad ignites a furry in my unequaled to this date. And the rest of my opinion would probably get me banned...v

[Myarkstir]

The question SHOULD BE "are people who had SRS happier than they would be if they hadn't had it." Neither of McHugh's cited studies answers this question.

I think having worked 38 years and a half on this that I know darn well what I want. Over the last year i did what was needed to get my gcs and got the results I wanted. This operation will be the completion of all my work, nit a solution to a problem. I found the solution when I was 8.5 years old.

   

[VeryGnawty]

This intensely felt sense of being transgendered constitutes a mental disorder

Describing dysphoria as an "intensely felt sense" is a gross misappropriation of words.  The author is intentionally ignoring the fact, on purpose I presume, that gender dysphoria is a debilitating condition which cannot be changed according to our knowledge.  What can be changed is the body and superficial factors that, in many people, reduce the dysphoria.

The first is that the idea of sex misalignment is simply mistaken—it does not correspond with physical reality.

"Physical reality" is a buzzword that people use to try to make their arguments look more legitimate without having to present any evidence for said argument.  When someone uses the term "physical reality" it usually means they are about to reveal their ignorance on exactly that.

[AngieFerg]

Do a little research on Paul McHugh and you will that he self identifies as a religious  and social conservative that believes in "family" and "traditional" values. For all his attempts to make an unbiased claim and use unbiased statistics and reasoning, he is extremely biased. He is not an unbiased source of information by any stretch IMHO.

[peky]

This guy is taking extreme liberties with the Swedish study. Read it here at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3043071/.

At the start of the article, the authors warn that the study "does not, however, address whether sex reassignment is an effective treatment or not." Near the end, the authors explicitly state, "It is therefore important to note that the current study is only informative with respect to transsexuals [sic] persons health after sex reassignment; no inferences can be drawn as to the effectiveness of sex reassignment as a treatment for transsexualism. In other words, the results should not be interpreted such as sex reassignment per se increases morbidity and mortality. Things might have been even worse without sex reassignment." They also do not compare the suicide rate with pre-transition suicide rates (I only skimmed the article and did not see such a comparison, and such comparisons were not the focus of their research).

They also note, "Other facets to consider are first that this study reflects the outcome of psychiatric and somatic treatment for transsexualism provided in Sweden during the 1970s and 1980s. Since then, treatment has evolved with improved sex reassignment surgery, refined hormonal treatment,[11], [41] and more attention to psychosocial care that might have improved the outcome." In other words, these people were all treated twenty-five to forty-five years ago when treatment was still in the Dark Ages. The results are also specific to one country, and the authors note that Sweden is a small country with few transsexuals. Thus, the study cohort, while larger than previous cohorts, is quite limited, and the results reflect a particular country and treatments during a particular time period when discrimination was likely high and surgical results were likely less impressive than they have been in the twenty-first century.

So McHugh is drawing conclusions that the study was explicitly not designed to address. I guess he assumes that nobody is going to look up the article and call him on it.

I would have not recommend this paper for publication if I was the editor of the journal or a reviewer for the journal. The most glaring and fundamental flaw of this paper and on the conclusion hat are drawn or extrapolated from it is that it las the appropiate control.

The changes in suicide rate, criminal behavior, etc. rates of post-SRS transsexuals should have been compared against those of pre-SRS transsexuals...

and then there are other issues with the methodology of this paper... stand-by 

[peky]

well, there were 300 or so experimental post SRS TS versus 3000 controls... well not a fair comparison, you can see that the standard deviation of he controls are 2 to 3 times tighter than the TS... and so do the rates... to be credible the number o controls should have match the experimental sample...

any statisticians out there ? disagree or agree ?

[Rina]

McHugh entered into psychiatric research with a goal of "ending sex reassignment", according to his own words. He's rather one of a kind in his blatant acknowledgement of his own bias. He's also rather one of a kind in his blatant misrepresentation of other researchers' studies. If it weren't for the fact that he after all is a very skilled academic, I would just conclude that his ability to interpret research is lacking. However, given his education, I can only conclude that he is intellectually dishonest, and misrepresents those studies on purpose.

Sadly, his ability to present his position as if it were founded on science (and the opposing position as if it were not), using half truths and skewed interpretation of research, affects many conservatives, and if you take a detour to certain conservative religious forums (please don't - it'll ruin your day), you'll probably see McHugh mentioned on the first page of any trans-related thread. I don't know how many times I've dissected his statements in such threads, but they just keep coming up. He has done a lot of damage, culturally as well as politically (I've heard that he has been one of the influences behind not covering transgender healthcare through insurance and welfare), and he has even managed to influence the Vatican. If anything, I wish the scientists behind the studies he abuse would be made aware of his misrepresentation, I'm sure they wouldn't like what they see.

[Stochastic]

well, there were 300 or so experimental post SRS TS versus 3000 controls... well not a fair comparison, you can see that the standard deviation of he controls are 2 to 3 times tighter than the TS... and so do the rates... to be credible the number o controls should have match the experimental sample...

any statisticians out there ? disagree or agree ?

I am not a statistician, but if I can see obvious problems with methods, then are big problems with the study. Not worth going over in detail because no one here is interested in being bored to tears with a discussion of methods . Conclusions appear to be in line with other studies. The problem is the mischaracterization of results from others which unfortunately is the baggage that comes with any research.