
“Transgender Surgery Isn't the Solution” (2014) - notsony
http://www.wsj.com/articles/paul-mchugh-transgender-surgery-isnt-the-solution-1402615120
======
hownottowrite
Dr. McHugh, reached these decisions in 1975 -- as in 40 years ago -- in
collaboration with his protégé Dr. Jon Meyer. [0]

It may also be illuminating to read about Dr. McHugh's involvement with the
Roman Catholic Church and it's panels concerning the abuse of children by
priests. [1]

>In the early 1990's, Dr. McHugh was among those in psychiatry who argued that
memories of sexual abuse recovered by adults were almost always false, a
byproduct of poor practice by psychotherapists, who often elicited the
memories through hypnosis or other techniques, failed to look for evidence
corroborating the abuse and encouraged patients to press charges against the
supposed abusers.

[0]
[http://www.ncbcenter.org/document.doc?id=581](http://www.ncbcenter.org/document.doc?id=581)

[1] [http://www.nytimes.com/2002/08/05/us/psychiatrist-says-he-
wa...](http://www.nytimes.com/2002/08/05/us/psychiatrist-says-he-was-
surprised-by-furor-over-his-role-on-abuse-panel.html?pagewanted=all)

~~~
A_COMPUTER
He was right though, therapists were unwittingly teasing false allegations of
sexual abuse out of kids.

[https://en.wikipedia.org/wiki/Day-care_sex-
abuse_hysteria](https://en.wikipedia.org/wiki/Day-care_sex-abuse_hysteria)

~~~
DanBC
But was he right in the context of catholic priests? Or was he constrained by
his cognitive biases into protecting abusive priests because he couldn't see
past (the very real problem of) false memory created by "therapy"?

~~~
A_COMPUTER
I couldn't say for sure. If he wasn't actively hiding malicious intent, it
sounds like he thought the priest cases were pretty straightforward and awful,
rather than involving repressed memories and ambiguous. The article lays out
the controversy of that better than I ever could, when I finished it I figured
I wouldn't be able to tell without digging into what he actually contributed
to the panel.

There does seem to be a common thread through his work, between fighting
freudians and disputing repressed memories and multiple personality and I
guess the transgender issue, he seems to emphasize that you can't take for
granted that self-reporting is as trustworthy as people have tried to make it.
But that's just my interpretation, I may be reading into that.

------
tacon
I remember a fascinating book from 1994, "What You Can Change, and What You
Can't"[0], about human plasticity, and how malleable we are in various areas.
There is a default assumption in our self-help culture that a majority of our
characteristics are open to change if we just apply ourselves, have good
character, grit, etc. Alas, that does not appear to be the case. Some things
are almost trivial to change, such as phobias. A trained practitioner can
typically eliminate phobias in hours. On the other hand, at least from a 1994
perspective, some aspects of sexual orientation never change. Seligman
presented a layered model of our sexual orientation, and at the very lowest,
hardest to change layer is "what gender do I feel like". I can see there being
a huge range of variation on internal feeling, depending on which genes are
expressed, and how much, how certain hormones are enabled in the growing
fetus, etc. We only have to consider hermaphrodites and the huge array of ways
that physical sexual development can go awry and extend that to the invisible
variations. I remember reading that book when it came out and thinking that
must be about the scariest feeling one can have, to be in an X body but every
part of me feels like a Y.

[0] [http://www.amazon.com/What-You-Change-Cant-Self-
Improvement/...](http://www.amazon.com/What-You-Change-Cant-Self-
Improvement/dp/1400078407)

------
GFK_of_xmaspast
On the other hand, the lived experience of transgendered people.

~~~
ComputerGuru
Which was monitored and documented in the study he references, no?

------
omonra
Here is the personal account of a person who underwent the operation that
confirms Dr. McHugh's views:
[http://www.thepublicdiscourse.com/2015/04/14905/](http://www.thepublicdiscourse.com/2015/04/14905/)

Apparently this was already known 10 years ago:
[http://www.theguardian.com/society/2004/jul/30/health.mental...](http://www.theguardian.com/society/2004/jul/30/health.mentalhealth)

"The review of more than 100 international medical studies of post-operative
transsexuals by the University of Birmingham's aggressive research
intelligence facility (Arif) found no robust scientific evidence that gender
reassignment surgery is clinically effective."

------
notsony
Author is Dr. McHugh, former psychiatrist in chief at Johns Hopkins Hospital -
[http://en.wikipedia.org/wiki/Paul_R._McHugh](http://en.wikipedia.org/wiki/Paul_R._McHugh)

TLDR summary from final paragraph:

> _At the heart of the problem is confusion over the nature of the
> transgendered. "Sex change" is biologically impossible. People who undergo
> sex-reassignment surgery do not change from men to women or vice versa.
> Rather, they become feminized men or masculinized women. Claiming that this
> is civil-rights matter and encouraging surgical intervention is in reality
> to collaborate with and promote a mental disorder._

Article might be behind a subscriber wall for some people:

> The government and media alliance advancing the transgender cause has gone
> into overdrive in recent weeks. On May 30, a U.S. Department of Health and
> Human Services review board ruled that Medicare can pay for the
> "reassignment" surgery sought by the transgendered—those who say that they
> don't identify with their biological sex. Earlier last month Defense
> Secretary Chuck Hagel said that he was "open" to lifting a ban on
> transgender individuals serving in the military. Time magazine, seeing the
> trend, ran a cover story for its June 9 issue called "The Transgender
> Tipping Point: America's next civil rights frontier."

Yet policy makers and the media are doing no favors either to the public or
the transgendered by treating their confusions as a right in need of defending
rather than as a mental disorder that deserves understanding, treatment and
prevention. This intensely felt sense of being transgendered constitutes a
mental disorder in two respects. The first is that the idea of sex
misalignment is simply mistaken—it does not correspond with physical reality.
The second is that it can lead to grim psychological outcomes.

The transgendered suffer a disorder of "assumption" like those in other
disorders familiar to psychiatrists. With the transgendered, the disordered
assumption is that the individual differs from what seems given in
nature—namely one's maleness or femaleness. Other kinds of disordered
assumptions are held by those who suffer from anorexia and bulimia nervosa,
where the assumption that departs from physical reality is the belief by the
dangerously thin that they are overweight.

With body dysmorphic disorder, an often socially crippling condition, the
individual is consumed by the assumption "I'm ugly." These disorders occur in
subjects who have come to believe that some of their psycho-social conflicts
or problems will be resolved if they can change the way that they appear to
others. Such ideas work like ruling passions in their subjects' minds and tend
to be accompanied by a solipsistic argument.

For the transgendered, this argument holds that one's feeling of "gender" is a
conscious, subjective sense that, being in one's mind, cannot be questioned by
others. The individual often seeks not just society's tolerance of this
"personal truth" but affirmation of it. Here rests the support for
"transgender equality," the demands for government payment for medical and
surgical treatments, and for access to all sex-based public roles and
privileges.

With this argument, advocates for the transgendered have persuaded several
states—including California, New Jersey and Massachusetts—to pass laws barring
psychiatrists, even with parental permission, from striving to restore natural
gender feelings to a transgender minor. That government can intrude into
parents' rights to seek help in guiding their children indicates how powerful
these advocates have become.

How to respond? Psychiatrists obviously must challenge the solipsistic concept
that what is in the mind cannot be questioned. Disorders of consciousness,
after all, represent psychiatry's domain; declaring them off-limits would
eliminate the field. Many will recall how, in the 1990s, an accusation of
parental sex abuse of children was deemed unquestionable by the solipsists of
the "recovered memory" craze.

You won't hear it from those championing transgender equality, but controlled
and follow-up studies reveal fundamental problems with this movement. When
children who reported transgender feelings were tracked without medical or
surgical treatment at both Vanderbilt University and London's Portman Clinic,
70%-80% of them spontaneously lost those feelings. Some 25% did have
persisting feelings; what differentiates those individuals remains to be
discerned.

We at Johns Hopkins University—which in the 1960s was the first American
medical center to venture into "sex-reassignment surgery"—launched a study in
the 1970s comparing the outcomes of transgendered people who had the surgery
with the outcomes of those who did not. Most of the surgically treated
patients described themselves as "satisfied" by the results, but their
subsequent psycho-social adjustments were no better than those who didn't have
the surgery. And so at Hopkins we stopped doing sex-reassignment surgery,
since producing a "satisfied" but still troubled patient seemed an inadequate
reason for surgically amputating normal organs.

It now appears that our long-ago decision was a wise one. A 2011 study at the
Karolinska Institute in Sweden produced the most illuminating results yet
regarding the transgendered, evidence that should give advocates pause. The
long-term study—up to 30 years—followed 324 people who had sex-reassignment
surgery. The study revealed that beginning about 10 years after having the
surgery, the transgendered began to experience increasing mental difficulties.
Most shockingly, their suicide mortality rose almost 20-fold above the
comparable nontransgender population. This disturbing result has as yet no
explanation but probably reflects the growing sense of isolation reported by
the aging transgendered after surgery. The high suicide rate certainly
challenges the surgery prescription.

There are subgroups of the transgendered, and for none does "reassignment"
seem apt. One group includes male prisoners like Pvt. Bradley Manning, the
convicted national-security leaker who now wishes to be called Chelsea. Facing
long sentences and the rigors of a men's prison, they have an obvious motive
for wanting to change their sex and hence their prison. Given that they
committed their crimes as males, they should be punished as such; after
serving their time, they will be free to reconsider their gender.

Another subgroup consists of young men and women susceptible to suggestion
from "everything is normal" sex education, amplified by Internet chat groups.
These are the transgender subjects most like anorexia nervosa patients: They
become persuaded that seeking a drastic physical change will banish their
psycho-social problems. "Diversity" counselors in their schools, rather like
cult leaders, may encourage these young people to distance themselves from
their families and offer advice on rebutting arguments against having
transgender surgery. Treatments here must begin with removing the young person
from the suggestive environment and offering a counter-message in family
therapy.

Then there is the subgroup of very young, often prepubescent children who
notice distinct sex roles in the culture and, exploring how they fit in, begin
imitating the opposite sex. Misguided doctors at medical centers including
Boston's Children's Hospital have begun trying to treat this behavior by
administering puberty-delaying hormones to render later sex-change surgeries
less onerous—even though the drugs stunt the children's growth and risk
causing sterility. Given that close to 80% of such children would abandon
their confusion and grow naturally into adult life if untreated, these medical
interventions come close to child abuse. A better way to help these children:
with devoted parenting.

At the heart of the problem is confusion over the nature of the transgendered.
"Sex change" is biologically impossible. People who undergo sex-reassignment
surgery do not change from men to women or vice versa. Rather, they become
feminized men or masculinized women. Claiming that this is civil-rights matter
and encouraging surgical intervention is in reality to collaborate with and
promote a mental disorder.

~~~
mrrrgn
This is the sort of bigoted non-sense that people once said -- and sometimes
still do say -- about gay folks. Luckily, society is continuing to progress
socially. I imagine in another few decades (if you're still alive) your views
will be seen as a novelty; a sad reminder of a bygone era -- like Archie
Bunker's overt racism.

~~~
slowmovintarget
You are wrong.

He's talking science, measured outcomes, greatly increased risk of suicide
with reassignment surgery, and evidence.

That this doesn't fit your politics doesn't make it bigoted.

~~~
mrrrgn
The fact is, transgender people have extremely high rates of suicide before
and after any surgeries. Life on the margins of society is not easy, and
surgery does nothing to address that problem. Here is a study, using the data
from above, which explicitly mentions this:

[http://journals.plos.org/plosone/article?id=10.1371/journal....](http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0016885#pone-0016885-g001)
"It is therefore important to note that the current study is only informative
with respect to transsexuals persons health after sex reassignment; no
inferences can be drawn as to the effectiveness of sex reassignment as a
treatment for transsexualism. In other words, the results should not be
interpreted such as sex reassignment per se increases morbidity and
mortality."

Further, numerous studies exist which disagree with the claims posted above:

[http://dare.ubvu.vu.nl/bitstream/handle/1871/23255/189321.pd...](http://dare.ubvu.vu.nl/bitstream/handle/1871/23255/189321.pdf)
"The results substantiate previous conclusions that sex reassignment is
effective."

[http://www.jaacap.com/article/S0890-8567%2809%2962807-0/abst...](http://www.jaacap.com/article/S0890-8567%2809%2962807-0/abstract?cc=y)

[http://onlinelibrary.wiley.com/doi/10.1111/j.1743-6109.2008....](http://onlinelibrary.wiley.com/doi/10.1111/j.1743-6109.2008.00799.x/abstract;jsessionid=34E20C8EDA68B9C68D9D58CE8C222804.f01t02?deniedAccessCustomisedMessage=&userIsAuthenticated=false)

What is known, is that "conversion therapies" are not useful. It's not
possible to modify a person's sense of self, just like it's not possible to
modify a person's sexual orientation.

Lastly, let's remember that slapping the word "science" on something does not
make it correct. Everyone has a political agenda of some sort, and plenty of
science has been used to justify homophobia and racism.

~~~
collyw
There are a lot of transgender prostitutes outside my workplace. I am not sure
if that the only work they can find or if it pays well. It doesn't look like a
wonderful life, hanging around a car park after working hours. (Though at
least one of them has a very flash car).

~~~
goldfeld
Maybe having someone pay for their sex is the way they have found for external
validation for their sex change? Surely surgery and reassignment can still
become much better technically, but the real problem is cultural, with society
having so much prejudice that they marginilize transsexuals as like
abominations, and it's thanks to religious bigots like this man (in society at
large). Psychiatry will make good progress in certain areas, like in dealing
with drugs, when people like him move out of the scene and newer generations
take over.

~~~
polil0
>Maybe having someone pay for their sex is the way they have found for
external validation for their sex change?

So, this is incredibly insulting. Try getting a decent job while trans. It
doesn't happen. Trans people suffer from incredible rates of homelessness and
poverty. The one niche that's allowed is sex work. You can bet your ass it's
not some kind of weird sexual validation thing for most trans folk, it's just
survival: [http://www.lgbtmap.org/news/understanding-transgender-
issues...](http://www.lgbtmap.org/news/understanding-transgender-issues-
unfair-price-release)

------
actuallyalys
The literature on sexual reassignment surgery taken as a whole, doesn't
support McHugh's claims.

First, the Karolinska Institute study [0] doesn't show the effectiveness or
ineffectiveness of sexual reassignment surgery. From the discussion section:

>It is therefore important to note that the current study is only informative
with respect to transsexuals persons health after sex reassignment; no
inferences can be drawn as to the effectiveness of sex reassignment as a
treatment for transsexualism. In other words, the results should not be
interpreted such as sex reassignment per se increases morbidity and mortality.
Things might have been even worse without sex reassignment.

Additionally, the line about "The study revealed that beginning about 10 years
after having the surgery, the transgendered began to experience increasing
mental difficulties" is speculation. The study didn't break down participants'
mental health year by year--just their mortality risk.

Next, the Johns Hopkins study. As far as I can tell, the Johns Hopkins study,
while a randomized control trial, surveyed just 50 people [2]. It's not clear
that you would get the same results after 30 years of social and medical
progress, either. A metastudy further suggests that the Johns Hopkins study is
an outlier [3].

Third, the studies of children. I wasn't able to find links to these studies,
but going off of his own description gives us enough reason to reject them.
The subjects of the study were children, which tells us little about sexual
reassignment surgery or hormones, which are treatments only adults and teens
get. (And the latter group, somewhat rarely.)

His discussion of subgroups of transgender people is too ridiculous to even
answer. Suffice it to say, Chelsea Manning wrote to a gender therapist months
before contacting WikiLeaks [1] so the idea that her transition is a way to
avoid men's prison doesn't meet even basic scrutiny.

Finally, established medical organizations agree that sexual reassignment
surgery is effective, including the American Psychiatric Association [4] and
the American Medical Association [5].

McHugh's article does not represent his chosen studies well, let alone the
larger body or literature or the scientific community.

[0]:
[http://journals.plos.org/plosone/article?id=10.1371/journal....](http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0016885)

[1]: [http://nymag.com/news/features/bradley-
manning-2011-7/index4...](http://nymag.com/news/features/bradley-
manning-2011-7/index4.html)

[2]:
[http://archpsyc.jamanetwork.com/article.aspx?articleid=49217...](http://archpsyc.jamanetwork.com/article.aspx?articleid=492177)

[3]:
[http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2265.2009....](http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2265.2009.03625.x/full)

[4]:
[http://www.psychiatry.org/file%20library/advocacy%20and%20ne...](http://www.psychiatry.org/file%20library/advocacy%20and%20newsroom/position%20statements/ps2012_transgendercare.pdf)

[5]: [http://www.imatyfa.org/wp-
content/uploads/2013/06/ama_resolu...](http://www.imatyfa.org/wp-
content/uploads/2013/06/ama_resolution_122.pdf)

