Are sex change operations justified?

By Innes Bowen
Producer, Hecklers, BBC Radio 4

Julie Bindel believes sex change operations are wrong

Many people who have been through sex change operations say it was the only solution to a distressing condition.

But a leading feminist campaigner claims that sex reassignment surgery is based on unscientific ideas - and could be doing more harm than good.

"I should never have had sex change surgery," Claudia MacLean, a transsexual woman told the audience at a recent debate organised by the BBC Radio 4 programme Hecklers and the Royal Society of Medicine in London.

"As a result of the surgery, I am incapable of sex and I have lived a life apart."

Claudia was speaking out in support of Julie Bindel, a radical feminist and journalist, who was trying to persuade medics and trans people that sex change surgery is unnecessary mutilation.

Threatening concept

Radical feminists have ideological reasons for opposing sex change surgery.

To them, the claim that someone can be "born into the wrong sex" is a deeply threatening concept.

Many feminists believe that the behaviours and feelings which are considered typically masculine or typically feminine are purely socially conditioned.

In my opinion what happened to me was all about money Claudia MacLean Transsexual woman

But if, as some in the transsexual lobby believes, the tendency to feel masculine or feminine is something innate then it follows that gender stereotypical behaviours could well be "natural" rather than as the result of social pressures and male oppression.

As a feminist, Julie Bindel therefore has a strong political motivation for her scepticism about sex change surgery.

But, her argument goes beyond ideology.

Having looked into the medical research on transsexualism, she claims there is a lack of science behind the diagnosis, no satisfactory research into the outcomes for patients and individual stories of post-operative regret.

Regret

Claudia says she was referred for surgery after a single 45 minute consultation.

"At no time did I say to that psychiatrist that I felt like a woman. In my opinion what happened to me was all about money."

She is one of a small number of trans people who have publicly expressed their regrets about having had sex change surgery.

Another is Charles Kane who, as Sam Hashimi, was the subject of a BBC documentary One Life: Make me a Man Again, televised in 2004.

This showed Sam, a transsexual woman, undergoing surgery to become a man again.

She told the BBC that her desire to become a woman had developed following a nervous breakdown.

For her, these feelings were caused by a longing to retreat into a fantasy character rather than having a crisis of gender identity.

The problem is that we tend to lose touch with our patients after a relatively short period of time following surgery Dr Kevan Wylie Consultant in sexual medicine

"When I was in the psychiatric hospital there was a man on one side of me who thought he was King George and another guy on the other side who thought he was Jesus Christ. I decided I was Sam."

Others, like Miranda Ponsonby, blame post-operative discontent on society's lack of willingness to accept transsexual people.

In her forthcoming autobiography, The Making of Miranda, she describes having a strong sense from a young age that she was a female trapped in a man's body.

However, like Claudia, she says that, since her surgery, she has lived a life apart.

She claims that she is no happier now than she was before the operation.

Her advice to those contemplating sex change surgery is "Don't do it."

Stories of satisfaction

Against these stories of disappointment and regret, there are many more people who will testify publicly to their overwhelming satisfaction with sex change surgery.

But are most people who have sex change surgery satisfied or dissatisfied?

It comes as something of a surprise to learn that the medical profession does not yet know the answer to this question.

According to a review carried out by the School of Health and Related Research at Sheffield University, the poor quality of research in this area means that "little robust evidence exists" on the outcomes for patients who have sex change surgery.

Dr Kevan Wylie, a consultant in sexual medicine and the head of the UK body looking into standards of care for sex change surgery patients, admits there have been difficulties.

"The problem is that we tend to lose touch with our patients after a relatively short period of time following surgery."

Some local health authorities now refuse to fund sex change operations on the basis that there is a lack of evidence about the surgical efficacy and psychological benefits of surgery.

In the absence of more research studies, gender dysphoria specialist Dr Kevan Wylie says it is important to listen to his patients.

However, those contemplating surgery - and the health authorities which fund them - ought also to be able to get advice about the risks versus the potential benefits of such a major operation and, until further research is done, doctors are unable to give them such information.

Hear Julie Bindel argue that "sex change surgery is mutilation" on Hecklers, BBC Radio 4, 2000 BST, Wednesday 1 August. Repeated at 2215 BST on Saturday 4 August.