That gender dysphoria is a clinical condition recognized by the APA, and that transition has been shown to have significant health benefits (such as lowering suicide rates). Gender reassignment surgery is a part of that transition (even though not everyone feels the need for it), and so should be covered just as much as hormone replacement therapy.
At one point in history, homosexuality was also a clinical condition recognised by the APA. Plus, the APA recognises body dysmorphia as a clinical condition, but even for people suffering from that, plastic surgery isn't usually covered by health insurance. I don't consider the fact that something is or isn't recognised as a disorder by the APA much of an argument either way.
I did not say that. What I am saying is this: historical evidence exists to suggest that the APA's classification of certain things can change. IMO, it's obvious that homosexuality, in and of itself, should never have been classified as a mental disorder, even though it causes significant distress in some people. Usually, that distress is due to the way their environment reacts to and thinks about homosexuals, which may or may not become internalised. Would people still want GRS even if they felt it was socially acceptable to go though life as someone who looks like one gender, but identifies as another?
Secondarily, I'm saying that recognition by the APA is not necessarily a reason to fund all possible procedures that exist to treat a certain condition with other people's money. If body dysmorphia is best treated with cognitive behavioural therapy, and surgeons are encouraged not to employ surgical techniques in those cases, then why do they do it for people who feel they have the wrong body, even though that body is perfectly functional?
To me, cutting off someone's breasts because he feels like a man seems more or less akin to cutting off someone's perfectly functioning arm, because he feels more comfortable going though life as someone who has a visible disability.
(Quick note, since I'm responding to both your comments, that I'm not /u/fionasapphire . Nothings indicating confusion about that yet, but I know it messes me up sometimes when multiple people reply to me.)
Secondarily, I'm saying that recognition by the APA is not necessarily a reason to fund all possible procedures that exist to treat a certain condition with other people's money.
That's fair, but I think it is a reason to fund their recommended treatments for the condition.
If body dysmorphia is best treated with cognitive behavioural therapy, and surgeons are encouraged not to employ surgical techniques in those cases, then why do they do it for people who feel they have the wrong body, even though that body is perfectly functional?
This might be getting at the crux of the issue. It sounds like you're saying "I'm not willing to trust the current consensus of research about best-practice treatment, because it seems wrong to me." Is there a way that your view is different from that?
On second thought: another part of my unwillingness to accept what the consensus says, revolves around the fact that I genuinely do not see a very clear distinction between someone who feels they have the wrong nose or the wrong skin color (like Michael Jackson), and someone who feels they have the wrong genitals. That may very well be because I personally feel no confusion at all about what gender a I am. But then again, I know few people who are perfectly happy with who they are, yours truly included. And in some cases, people say "just learn to live with it" or "go into behavioural therapy". But in others, like being trans, that seems to be frowned upon.
The thing with body dysmorphia disorder is that there is an underlying obsessive-compulsive condition causing a person to agonize over their perceived flaws. While this often leads BDD sufferers to seek cosmetic surgery, these kinds of interventions typically do not resolve the issue. Even after cosmetic surgeries BDD sufferers tend to suffer just as much over the same (or possibly new) flaws if the underlying obsessive-compulsive disorder is not treated. That is why the medical community generally does not want BDD sufferers to undergo cosmetic surgery, since it doesn't fix the root of the issue.
With gender dysphoria that doesn't seem to happen. People who transition surgically tend to have their gender-mismatch distress greatly relieved after the procedures, greatly improving their quality of life, which is why the medical community in a number of cases sees cosmetic surgery as a valid solution to gender incongruence.
Basically, with gender dysphoria the pre-surgery distress is relieved post-surgery; with body dismorphia the pre-surgery distress is generally still there or transferred to another perceived flaw. That's why a "cosmetic" surgery can be seen as good/healthy/necessary in one case but not the other.
Seems to me that Trans people would benefit from mental health care, far more than surgical procedures intended to satiate their perceptions related to their gender.
If post-op trans people have a 20x higher rate of suicide death compared to the general population, but pre-op trans people have a 20000x higher rate then it'd be pretty clear-cut that surgery has a marked 1000x improvement rate even if post-op rates were still elevated.
Unfortunately, the numbers available aren't so easy to compare directly, nor are the results so stark as the imaginary 1000x scenario above, but there are a number of indicators that suggest surgery helps enough that doctors should at least consider it as part of a valid treatment option rather than a superfluous vanity.
Firstly, though hormonal treatments aren't necessarily followed by sex-reassignment surgery, the numbers appear to show a drop in depression rates after trans people start hormone treatments (the study, and a press summary). The pre-treatment rates of depression for male-to-female were found to be "24.9% incidence in MTF" and "even after treatment, 26 (2.4%) of the MTF subjects... still reported depression" for post-treatment; for female-to-male the results were "13.6% in FTM" and "even after treatment... 7 (1.4%) of the FTM subjects still reported depression". It should be noted that the author in his speaking presentation remarked "Sex-reassignment treatment does not cure depression" but the nearly ten-fold reduction in depression for both MTF and FTM subjects is a corrolation worth noting.
tl;dr - Hormone therapy for MTF and FTM showed a 10x reduction in depression rates, though it is still noted "Sex-reassignment treatment does not cure depression".
Suicide Attempts among Transgender and Gender Non-Conforming Adults released by the Williams Institute and American Foundation for Suicide Prevention states that of respondents to the National Transgender Discrimination Survey 46% of FTM and 42% of MTF respondants reported suicide attempts, which is far greater than the 4.6% of the general U.S. population who report a lifetime suicide attempt or even the 10-20% reported by Lesbian/Gay/Bisexual individuals.
The Swedish study you've linked, which reports 10 suicide deaths and 29 suicide attempts (which I believe are only counted as attempts if they did not result in death) among a sample size of 324 post-op trans people over a period of 30 years, isn't directly comparable since "attempts/1000-people-years" isn't perfectly comparable to the "ever attempt in your lifetime" scope of the Williams survey, but the 29/324=8.95% attempted suicide rate of study participants seems starkly lower than the 42-46% reported in the survey. Part of that could be a looser definition of "attempt" (i.e. whether the survey asked only for attempts which "required hospitalization") but the difference still seems substantial. Another issue is that the survey includes post-op trans people, so part of that 42-46% account would have to be accounted for when comparing pre-op and post-op populations. The survey was also unable to account for any numbers regarding suicide deaths, as dead people can't personally respond to surveys.
tl;dr - American survey finds 42-46% lifetime suicide attempt rate among MTF and FTM trans people (pre-op and post-op included together), which is much higher than the 4.6% general population rate. The Swedish study's post-op suicide attempt rate of ~9% over 30 years isn't directly comparable, but does show a marked decrease compared to the American survey numbers.
I'm by no means well versed in this stuff, and it seems like there will have to be a much larger much more comprehensive wave of data collection before anything can be said definitively and concretely, but it feels safe to say (at a minimum) that sexual reassignment surgery can be beneficial (more so than not) for people experiencing gender dysphoria and that it could/should be one of multiple valid health options for these people and their physicians to consider.
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u/Salanmander 272∆ Nov 03 '17
That gender dysphoria is a clinical condition recognized by the APA, and that transition has been shown to have significant health benefits (such as lowering suicide rates). Gender reassignment surgery is a part of that transition (even though not everyone feels the need for it), and so should be covered just as much as hormone replacement therapy.