To transition, to have hormonal treatment or to have genital alignment?

Today this is not a question because dogmatic treatment requires all individuals who wish to undergo genital surgery to publicly, visibly live "the other gender" and to have a minimum of one year of hormonal treatment (if one medically tolerates it, no matter if one actually wants this or not!). Furthermore dogma requires us to undergo psychiatric treatment (no matter if there actually is an indication in the form of "behavioural, social or emotional problems severe enough to warrant treatment" or not!) as well as to get "some other approval" (usually this means seeing a psychotherapist, once again it does not matter if one actually needs and/or wants psychotherapy or not or if this is meaningful or destructive) before a transsexual can even be considered for such surgery.
Is this reasonable? Is it appropriate? Or does it make any sense at all?


First and foremost it is important to understand that how our genitals look, how we emotionally interpret our lives, how we physically perceive ourselves, how we want to be perceived by others and how we actually are perceived by others MAY OR MAY NOT HAVE ANYTHING TO DO WITH EACH OTHER and it has even less to do with the gender our driver's licenses, birth-certificates (or other id) show

It is true that a great majority of people who are legally or medically designated female live a (predominantly) female life, (usually) think of themselves as women, (most often) express themselves in a feminine way and (typically) get taken for women, however this is by no means the case for everybody! This gets particularly obvious when it comes to sexuality: Today it is accepted that a woman can express her sexuality in a heterosexual or in a homosexual relationship and that neither of the two is a manifestation of a mental illness nor is it a crime nor anything that would warrant any medical, legal or other intervention! Why this is not the case for the other 6 parameters (and the many I have not mentioned) I don't know.

From my perspective it is clear that pretty much any and all combinations of the above parameters (and the ones I have not mentioned) would exist, somewhere, however to me it is also clear that none of these can be seen as "fixed either/or expression" - maybe with the exception of that legal or medical "male/female" designation in birth-records or driver's licenses. This is simply true because the real biological world comes in infinite variations of the theme we call 'life'. Or to put this differently: Personal identifications vary by their very nature and are individual!

True, some of the possible combinations may cause problems, sometimes even severe ones. Sometimes they may even cause problems severe enough to really warrant mental treatment! For example a person who is designated female, thinks of herself as being a woman, expresses herself to the best of her ability in a feminine way but it still perceived by others as being male would potentially see this as a problem. Potentially, but not necessarilyAnd I agree, if this person would seek the assistance of a therapist this might make sense, might help her - but of course this decision is left to her!

Now for transsexuals this is different. We are mandated into mental-treatment and psychiatry by psychiatry itself, no diagnosable problem is necessary! (see the "mental or physical" page). Because psychiatry wants to put a label onto people before treatment can be dispensed in the absence of a diagnosable problem one is simply invented, called "Gender Dysphoria" and defined as an undiagnosable (except by self-identification), invisible, untreatable and very severe condition each and every transsexual (and nobody else) is said to suffer from! Again, it does not matter if we actually are dysphoric of our biological gender or not and if so, of which aspect (i.e. social presentation, social interactions, self-perception, physical sexuality, emotional sexuality, hormonal levels - just to name a few).
Then absurd treatment regimes are forced onto us, we are deprived of our most basic civil rights (the right to freely decide over our bodies, the right to medical treatment unconditional of behaviour (i.e. that we have to follow a dress-code to merit medical treatment), the right to free self-expression - and that's just to get this list started!). It's all done through the power our society has given to medical practitioners and with the pretence that "this is in our best interest".

Fundamentally of course this means that we - all human-beings, with the exception of physicians - are declared incompetent by medical doctors, in full support of their professional organizations, to decide or even know which gender we are! AND BECAUSE WE ARE ALL INCOMPETENT TO KNOW THIS, IT MUST NOW BE A MEDICAL DOCTOR WHO MAKES THIS DETERMINATION, EITHER BY PUTTING "THE RIGHT ONE" ON A BIRTH-CERTIFICATE OR BY DECIDING WHO GETS SURGERY TO CHANGE IT AND WHO DOES NOT!

What this basically means is that we can no longer decide which gender we are, this is now decided FOR US, by a medical doctor. Obviously the question arises in what way this doctor could be better (or equally, or at all) qualified to know what gender any given person should have???
From my perspective I am the only person who knows what I feel, THEREFORE THIS DECISION MUST ALWAYS REMAIN WITH ME! Any other person, no matter how well trained in whatever field, will be less qualified than myself to make this decision! I find it is an extraordinarily arrogant statement of doctors to say THAT THEY KNOW BETTER WHICH GENDER A PERSON HAS TO BE than the person him or herself does, and I FIND IT ABSURDLY ARROGANT THAT DOCTORS THEN CONCLUDE THAT THEY HAVE THE RIGHT TO INFLICT THEIR DIAGNOSIS ONTO A PERSON WITH A SCALPEL (I.E. IN INVOLUNTARY GENDER REASSIGNMENTS OR ASSIGNMENTS AS IN INTERSEX-CASES), OR BY WILFULLY WITHHOLDING THEIR SERVICES.

In my opinion surgically assigning a gender to a person (or performing any non life-saving genital surgery) without consent of this very person IS FIRST DEGREE ASSAULT, the denial of such surgery if requested by an individual IS A FAILURE TO RENDER ASSISTANCE, or, as we are talking of medical doctors who have the duty to render such assistance, I would designate this as FIRST DEGREE PASSIVE ASSAULT. This should be treated accordingly and in any case, a person doing such things is not fit to practice medicine and should immediately be banned from practicing! If professional organizations are unwilling to do this, then the legal system should step-in - after all, a doctor doesn't practice medicine because of his education, he practices medicine because we, the people, give him a license to do so

Having said this, not everybody who 'wants' genital surgery may actually need it and this is certainly not right for just about anybody. Lynne Conway's page about unsuccessful transitions ( may give some insights here.
But of course it really doesn't matter what kind of an elective medical procedure we would be talking about, some people will regret these later.
Be it a hip-replacement that doesn't work out or some plastic surgery. Even a tattoo. (Of course this isn't limited to medical treatments at all, people regret many things in their lives. Apparently about 50% regret their marriages and get a divorce!). But no, we don't require people to see a psychiatrist before they can get that tattoo or a gastric bypass (or before they can get married of have children) or if a guy wants his penis extended or a girl her breasts enlarged! We leave this to the individual - and all the mistakes that come along with it also! We only send people to psychiatrists if a guy wants his penis shortened and a girl wants her breasts removed... We consider self-determination a basic right and we don't try to prevent people from making mistakes unless such mistakes would severely impact other persons - EXCEPT FOR TRANSSEXUALS!


In the end this is all about finding a meaningful balance between the freedom of expression and the protection of the individual.

However if, as so often in transgender-care, the protection of the individual becomes more hurtful, destructive and damaging than no protection would be and at the same time there is no impact whatsoever to other people or society at large then there is clearly something badly wrong!

After all, we hardly do any good if - in an extreme example - we drive an individual into suicide as a measure to potentially prevent her from making the mistake of a lifetime...


The current set-up dogma and the medical community forces onto us is harmful to most transsexuals, psychotherapy is often a lot more destructive for us than it is beneficial, it keeps the transsexual in the role of 'transsexual' instead of socially functioning individual, it keeps the person focussed on a destructive and painful past rather than on constructing a beautiful future! (After all, the very notion of working-up our past isn't applicable because that past was for all intents and purposes not ours!).
This damage is emotional, but it also affects our well-being, both physical as well as mental, it is social (as in 'stigmatization'), the pseudo-treatment imposed onto us makes us loose a good part of our lifetime and it is destructive in that any and all outlook on a better future is taken away from us as we can no longer decide on our own, make our own lives, but wholly depend on the decision of a third party!
At the same time, once again as Lynne Conway's page about unsuccessful transitions ( shows, the system fails to do what it is advertised for: To prevent people from getting this surgery if this is not guaranteed to be beneficial for them! - A notion which I find ludicrous anyway!!!


There is a saying: Nothing in medicine is absolute! I think it is high time for physicians to recognize that this is true even when it comes to their absolute right to treat a patient. Because sometimes the only ethical decision is to allow the patient to treat him/herself at his/her own discretion!


Of course the main problem here is not that these professionals completely misunderstand transsexuality, the main problem is that we are legally forced into the care of these people in the first place because our medications are not available to us freely!

There is nothing wrong with how psychiatrists work (or at least nothing that would be of interest here), WHAT IS WRONG IS THAT TRANSSEXUALITY LIES OUTSIDE THE SCOPE OF PSYCHIATRIC AND/OR MEDICAL PRACTICE!

The tools they use to understand the psyche are not applicable to understand transsexuality and neither is the therapy that results from any and all (mis-)understanding they draw from the application of these tools!

Psychiatrists treating transsexuals is a classic case of "the wrong tool for the wrong job!". 


In the end there needs to be the recognition that MAINTAINING NORMAL LEVELS OF SEX-STEROIDS IS A HUMAN RIGHT, that this therefore cannot be prescribed, denied, withheld, limited or mandated by a medical practitioner or anybody else!

(see also the human rights page and the ethics page)