Twenty years ago, Olivia Jensen
had the perfect life: married, two kids, a prestigious
position at a top university. There was only one problem:
she was a man.
"I remember standing on my dock
by the lake and just screaming at the heavens at the
horror of the life I had been given," she recalls. "Though
from the outside I was doing it to virtual perfection."
After five years of careful consideration,
the McGill University geophysics professor chose to
change her sex. That was in 1989 and to this day she
has no regrets. "It all happens after surgery," she
says. "That's when you begin to discover who you are."
Testimonials like Dr Jensen's are
pretty convincing about the merits of gender reassignment
surgery (GRS). But a recent systematic review by the
University of Birmingham's Aggressive Research Intelligence
Facility (ARIF) calls the procedure's evidence base
into question. "The degree of uncertainty about any
of the effects of gender reassignment is such that it
is impossible to make a judgement about whether the
procedure is clinically effective," the review concludes.
SKEWED FINDINGS
ARIF, a research body which
advises health authorities in Western England about
the evidence base of healthcare treatments, says the
problem with current research is that most of it was
poorly designed and produced skewed results. The study
was commissioned by The Guardian after journalists
came across a number of sex change patients who said
their surgery hadn't worked out for them. The review
looked at more than 100 international medical studies
of post-operative transsexuals and found that research
suggests up to a fifth of GRS patients regret their
surgery; a British study from 1998 indicated they have
an attempted suicide rate as high as 18%. "The bottom
line is that although it's clear that some people do
well with gender reassignment surgery," Dr Chris Hyde,
ARIF's director told The Guardian, "the available
research does little to reassure about how many patients
do badly and, if so, how badly."
CAREFUL SCREENING
Dr Ray Blanchard, head of
Clinical Sexology Services at the Centre for Addiction
and Mental Health (CAMH) where Dr Jensen had her surgery,
disagrees with ARIF's conclusions. "In reality, there's
little prospect of anyone obtaining data of significantly
higher quality than the data we already have," he says.
"The studies we have are far from perfect. But to claim
that they show nothing at all is simply evasive."
Dr Blanchard's experience doesn't
bear out the testimonies from The Guardian's
sources. "The available studies show that the majority
of carefully screened patients who undergo sex reassignment
say they're glad that they did so," he says. "There's
no obvious reason to distrust their self-report."
The phrase 'carefully screened'
is key here. Before they can undergo GRS, patients at
CAMH with gender dysphoria ? the sense that a person's
gender doesn't match up with his or her sex ? are first
screened for major mental illness. The clinic then requires
patients to perform a 'life test,' working, attending
school, or completing charity work in the social role
of their chosen gender for two years before they qualify
for surgery.
In spite of the lengthy process,
patients like Dr Jensen say it's all worth it. Gender
dysphoria can send sufferers into a downward spiral
of depression sometimes ending in suicide. "We are people
who have desperately tried to construct a manhood over
a long period in our lives, and it isn't working," explains
Dr Jensen. "And it's such a frustrating burden. We begin
to hate ourselves for doing it. We hate the world for
having put us in this place."
RADICAL DECISION
The jury's still out on what
causes this condition, but theories range from schizophrenic
delusions to neurological differences caused by in-utero
hormone imbalances. In the absence of an established
etiology, treatment is whatever seems to work, from
psychotherapy to hormone therapy. GRS is an option for
those who feel they can no longer inhabit the wrong
body. According to the Diagnostic and Statistical Manual
of Mental Disorders (DSM-IV) entry on gender identity
disorder, an estimated one in 30,000 adult born males
ends up seeking sex reassignment surgery.
Although male to female surgery
is cheaper and more common than female to male, it's
far from routine surgery. The testicles and penis are
removed, although one procedure involves turning the
penis inside out and implanting it in the body to form
a vagina. A clitoris is formed with tissue from the
glans, and breast augmentation, rhinoplasty and even
adam's apple reduction are all possible extras.
The question of gender is so complex,
it's hardly surprising that surgery intended to change
it is controversial. "Transsexuality isn't the issue,"
says Dr Jensen. "It's the fact of being a gender-conflicted
person in a world that only offers two gender options.
Transsexuality is just one of a million solutions to
the problem. It isn't that it takes us to the right
place; it takes us to the other place when the
first one didn't work. And this gender role is a better
place for me."
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