Both supporters and opponents quote research work to justify their view.

By P.K.Balachandran

There is a raging controversy over sex change or gender re-assignment in the United States with both supporters and opponents quoting research studies to justify their view.

Gender re-assignment is catching up in the Western world. Socio-cultural change and the availability of medical expertise and facilities lie the root of the growing popularity of gender-re-assignment.    

Switzerland has the highest proportion of people identifying themselves as transgender (6%). Thailand is next with 5%. The world average, however, is 3%, as per the website

Quoting a new study published in the journal JAMA Network Open, CNN said that the number of gender-changing surgeries done in the United States nearly tripled between 2016 and 2019. They rose from 4,552 in 2016 to 13,011 in 2019, declining only slightly to 12,818 during the first year of the Covid-19 pandemic.

The number of medical appointments related to gender identity disorder rose from 13,855 in 2016 to 38,740 in 2020.

Gender changing surgeries included breast or chest procedures, often called “top surgery,” which made up more than 56% of the surgeries. Facial and other cosmetic procedures were also included in the sample. People who had genital reconstructive procedures, often called “bottom surgeries,” made up more than 35% of the procedures.

However, not every person who identifies as transgender or non-binary, will choose surgery. It’s usually done as one of the later steps in gender-change care.

Gender-change care is multi-disciplinary to help a person transit from his or her assigned gender – the one the person was designated at birth – to his or her desired gender – the gender by which one wants to be known. The majority of the patients were 19 to 30 years old, making up more than 52% of the surgeries. Breast and chest procedures were twice as common as genital procedures among that age group. Genital surgeries were more common among those older than 40. In America, surgery is not typically recommended until adulthood. And in some American states, surgeries on teens are illegal.

Positive Outcomes

Research has supported the positive effects of gender-change. Surgeries offer significant physical and mental health benefits, including better mental health, a reduction in suicidal thoughts, a better quality of life and a higher rate of general life satisfaction.

Surgeries even have indirect health benefits such as reducing the number of people who smoke, the study shows.

Major medical associations – including the American Medical Association, the American Psychiatric Association, the American Academy of Paediatrics and the American Academy of Child & Adolescent Psychiatry – agree that gender-affirming care that can include surgery for adults is clinically appropriate and sometimes even life-saving, CNN reports.

Studies consistently show that people who have surgeries to help their “sex” (assigned at birth) match their “gender” (actual orientation) are extremely satisfied and generally do not change their minds later, as some critics have suggested.

Very few who had transitioned from one sex or gender to the other regret their decision to do so. According to Statistica,a study in the UK involving 3398 transgender persons found that only 0.45% regretted changing their gender. It was 1.9% in the Netherlands, 2% in Sweden and 8% in the US. On the average, in the world at large, 97% were happy with the transition they had made.

Those who regretted the transition, attributed it mainly to societal pressure. Only 2% said that they encountered medical problems after transition.

Sixty-six countries in the world allow sex/gender identity change but among these, 34 insist on surgery.  

Cornell Varsity Review

Cornell University’s Public Policy Portal reported on a study that examined scholarly research on the effect of gender transition on transgender well-being.  A systematic review of all scientific papers published in English between 1991 and June 2017 found 93% saying that gender transition improved the overall well-being of transgender people.

Among the positive outcomes of gender transition were: improved quality of life, greater relationship satisfaction, higher self-esteem and confidence, and reductions in anxiety, depression, suicidality, and substance use.

The  regret rate ranged from 3% to 3.8%. Regrets are most likely to result from a lack of social support after transition or poor surgical outcomes using older techniques.

Factors that ensure success in the treatment of “gender dysphoria” (a state of unease, dissatisfaction with one’s gender) include adequate preparation and mental health support prior to treatment, proper follow-up care from knowledgeable providers, consistent family and social support, and high-quality surgical outcomes (when surgery is involved).

Transgender individuals, particularly those who cannot access treatment for gender dysphoria or who encounter unsupportive social environments, are more likely than the general population to experience health challenges such as depression, anxiety, suicidality and minority stress.

Major medical associations – including the American Medical Association, the American Psychiatric Association, the American Academy of Pediatrics and the American Academy of Child & Adolescent Psychiatry – agree that gender-affirming care that can include surgery for adults is clinically appropriate and sometimes even life-saving, CNN reports.

The Downside

However, not all agree to these conclusions. There is a downside to gender reassignment surgeries, says the US National Centre for Biotechnology (NCBI) website.

The site notes that trans-sexual issues and Sexual Reassignment Surgery (SRS) are receiving a great deal of attention and support in the media, schools, and government. Given the early age at which youth seek treatment for Trans-Sexual Attractions (TSA) and gender dysphoria and given the serious risks associated with such treatment, it is essential that family and youth be advised about the risks and alternative treatment options.

Psychological conflicts have been identified in those wanting sex change and also in their parents. Therefore, treatment of conflicts associated Trans Sexual Attractions and the regrets of those who have been through Sexual Reassignment Surgery have to be studied.

There are serious risks associated with sex change, NCBI points out.  They include the risk of depressive illness and suicide. Physicians and mental-health professionals should know these risks and the regrets of those who have been through sex-change operations. These patients and their families also should be informed of other treatment options.

Consequence of Propaganda

Dr. Paul McHugh, former chairperson of the Department of Psychiatry at Johns Hopkins Hospital, wrote as follows: “The idea that one’s sex is fluid and a matter open to choice runs unquestioned through our culture and is reflected everywhere in the media, the theatre, the classroom, and in many medical clinics. It has taken on cult-like features: its own special lingo, Internet chat rooms providing slick answers to new recruits, and clubs for easy access to dresses and styles supporting the sex change. It is doing much damage to families, adolescents, and children and should be confronted as an opinion without biological foundation wherever it emerges.”

School Kids Motivated

Transsexual issues are creating a new controversy in US elementary and high schools today as a result of youth and their parents asserting a right to identify the sex of their child without regard to the biological and genetic realities.

The parents and child may insist that the child’s name be changed to one of the opposite sex and that the child be allowed to wear clothing of the opposite sex and use opposite-sex bathrooms.

These families are often preparing their children for Sexual Reassignment Surgery (SRS) without being given the knowledge of the serious, documented risks associated with such surgery or other treatment options for gender dysphoria, referred to in the past as Gender Identity Disorder (GID).

Endocrinologists who are giving hormones to these youth, mental-health professionals who are affirming SRS surgery, and surgeons have a professional responsibility to understand these grave risks; and these patients also should be apprised of these risks, Dr.McHugh says 

Psychological Consequences

The largest study to date of the long-term psychological state of post-SRS persons was an analysis of over three hundred people who had undergone SRS in Sweden over the past thirty years. This 2011 study demonstrated that persons after sex reassignment, have considerably higher risks for mortality, suicidal behaviour, and psychiatric morbidity than the general population.

In 2014, Dr. Paul McHugh wrote in The Wall Street Journal about this research, “Most shockingly, their suicide mortality rose almost 20-fold above the comparable non-transgender population. This disturbing result has as yet no explanation but probably reflects the growing sense of isolation reported by the aging transgendered after surgery. The high suicide rate certainly challenges the surgery prescription”.

Important medical and psychological issues need to be considered before the educational, medical, political, and judicial systems rush headlong into a process of affirming in youth and in their parents a fixed, false belief that a person can be a sex that is not consistent with their biological and genetic identity and that such individuals have the right to transsexual surgery, Dr.McHugh recommends.

An understanding of what motivates youth to identify with the opposite sex is essential as well as the reasons why parents would encourage or support transsexual attraction.

Dale O’Leary, the author of the important book The Gender Agenda, has co-authored an important 2015 research paper, “Understanding and Responding to the Transgender Movement” among youth and adults with TSA, lists the reasons for a girl or boy wanting to changing the gender. It could be an emotionally distant, angry, selfish, depressed, or critical mother who fails to bond closely with her daughter for any number of reasons, including unresolved anger with the maternal grandmother that was misdirected at the daughter.

It could be a failure to affirm the daughter’s goodness and female gifts; a failure to support and encourage same sex friendships; a failure to critique and protect her daughter from gender theory errors; failure to communicate that fulfilment and happiness can be found in being a psychologically healthy female.

In the case of the male child, it could be a failure to grant that a male could also love beauty that is often associated more with femininity than masculinity and a desire to be what one loves. It could be severe childhood rejection by same-sex peers, creating a sense of not fitting in with them, which results in intense fears of rejection and an unconscious belief that one would feel safer if he were of the opposite sex. 

Or it could be a sense of pleasure in rejecting the values and moral code of the parents. In many cases it could be pressure from a significant other to cross dress, take hormones, and move toward SRS.

There are also cases of severe narcissism and acceptance of a gender theory one can create himself or herself as he or she wants. If freedom is the greatest good in the world, then why should anyone be constrained by biology? One’s sex as male and female is seen not as a gift but as a constraint that must be overcome. So if technology can alter one’s body, then so be it.

Vatican’s View

On April 19, 2024, AP reported from the Vatican about its view on sex change.  The Vatican repeated its rejection of “gender theory,” or the idea that one’s biological sex can change. It said that God created man and woman as biologically different, separate beings, and said people must not tinker with that or try to “make oneself God.”



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