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27/10/2017 07:43 BST | Updated 27/10/2017 07:43 BST

The Reality Of Post Sex-Change Regret

surgery

A recent article in the Telegraph discussing the topic of sex change regret raises some interesting points. In the article Urologist, Miroslav Djordjevic, who specialises in Gender Reassignment Surgery (GRS), talks about his concerns around an increase in "reversal" surgeries among transgender women.

He highlights the fact that those who want the reversal, display high levels of depression and in some instances, suicidal thoughts.

The interview seems to offer yet more evidence that those suffering with gender identity disorder may eventually 'come to their senses' and as such, if they make permanent changes to their bodies, it is something they will live to regret.

The article invites the reader to draw the conclusion that GRS is a de facto procedure for members of the transgender community. In reality, though exact figures are difficult to come by, not all members of the transgender community want surgery. Instead, many manage their own transition in whatever way feels most natural to them.

Interestingly, the article steers away from the fact that the numbers of transgender people presenting for treatment are increasing exponentially, and as such one might expect to see an increase in both referrals for surgery, and therefore referrals for reversal.

In addition, Dr Djordjevic fails to mention the number of patients he treats who are happy following surgery. Those who feel complete and for whom continuing to live without the surgery would not have been an option due to feelings of depression and suicidal thoughts, similar to those of their counterparts.

A comparison between these two groups would make for a worthwhile study but whether it would be as much of a 'headline grabber' is another question altogether.

It is important to note that this sense of 'regret' is not exclusive to transgender people going through surgery, but is a theme common to people undergoing surgery in general.

There are many reasons why people might change their mind about any medical or surgical treatment to which they may have consented. However, one of the most common reasons is that the surgery does not provide the end result that they wanted. This is not only in relation to what the results look like in the mirror but also about how family, friends, loved ones, work colleagues and society react to the changes. Sometimes, the hopes and expectations a patient - trans or otherwise - has of the surgery, may simply not be met.

Perhaps some trans women feel that the genital surgery may be the thing that makes them finally feel complete, however, if they have gone through a full male puberty, genital surgery alone may not give the full resolution that they need to make their body match their mind.

Men who have a vasectomy, for very good reasons, may find that their situation changes in the future and they wish they had not had it done. This does not mean that vasectomies should not be allowed, nor that every man should be made to jump through rigid hoops and protocols in order to access one.

Rather, it means that we should carefully discuss the procedure, the alternatives and the implications, in a way that the patient can understand and once every question has been answered, a joint decision on what is best should be made.

Djordjevic expresses concern about clinics who offer surgery on the basis of the patient's ability to pay, rather than basing the decision to operate on their psychiatric wellbeing following meaningful evaluation and necessary counselling. This is a point on which we agree. Any decisions to undertake medical or surgical treatment, which is permanent, should be done on the basis of robust information gathering and sharing in a model of informed consent.

This does not mean that every trans person should be put through excessive periods of assessment, just in case one regrets their decision. It means having a frank discussion about the risks and benefits and the options for reversal, should it be desired.

Feelings of gender variance are very real, and although the desire to act on them may fluctuate, if their presence is long-standing and persistent then they are unlikely to go away. Patients should have the option of surgery, if that is the route they wish to go down, just as they should be allowed to reverse their surgery if that is their wish - it does not negate their feelings of gender incongruity nor should it preclude them from taking the steps they feel they need to take to facilitate their transition, whatever form that may take.