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May 23, 2019

Transgender Treatment

Reuel S. Amdur

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In Canada, one of 200 people is a redhead. The same proportion applies for people who are of physically indeterminate gender and, according to Dr. Leah Layman-Pleet, of people who are transgender. The Diagnostic and Statistical Manual of Mental Disorders (DSM) gives an incidence far lower, less than .2% for persons born as male and less than .1% for females. It has been the common practice for physicians who deliver a baby of indeterminate sex, with mixed genital expression, to operate to transform the baby into a male or female, according to what appears to be the predominate characteristics. Now, many physicians avoid performing such surgery and allow the person to grow up with these anomalies intact.

According to layman-Pleet, “Society owns the pathology, not the individual.”  Besides, pathologizing gender identity opens the door for conversion therapy, which has been shown to be very destructive.

Be that as it may, people in the LGBT+ (lesbian, gay, bisexual, transgender, and other sexual non-conforming orientations) have levels of mental health problems and suicidality far greater than the general population.  The extent of such dysfunction is drastically reduced if the family is supportive of the person’s choice. 

Treatment that is affirmative of the person’s choice involves use of hormones and surgery.  Ontario has changed who may provide care.  It used to be that all assessments and treatment would need to go through the Centre for Addiction and Mental Health.  Now any physician or nurse practitioner can begin treatment up to surgery and can refer for surgery.  Hormone therapy needs to precede surgery.  As Layman-Pleet explained, hormone blockers give the person time to change.  The alternative, doing nothing during the progress of puberty, needs to be seen as a treatment choice, a wrong one.

I asked how we could justify sex change surgery while denouncing female circumcision.  The psychiatrist replied in two ways.  In the first place, people who have had a sex change in general have improved psychological and social functioning.  Only around 2% regret the change.  Secondly, in the instance of female circumcision, the female generally has no choice.  The extent of regret is far higher.

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