Don’t have GRS

Personal stories of why people wanted genital surgery, and why they regret it.

The way transgender is understood in Anglo-American culture, in the theory and practice of law and medicine and in the way trans people understand ourselves (until it’s too late) puts overwhelming pressure on trans women to have genital surgery which is not in our interests. When we regret hormone treatment and surgery, there is pressure on us not to say that in public. I regret surgery, so I have an interest in this- to save others from my mistake, as I cannot rectify it- but I am not alone, evidence of regret is suppressed and evidence of satisfaction exaggerated.

The circumstances of MtF and FtM around motives for surgery are completely different.

The diagnostic criteria for gender dysphoria in the DSM and gender incongruence in the proposed ICD-11 both require a strong desire to be rid of primary and secondary sex characteristics and to have the characteristics of the opposite sex. The Equality Act protects people who want their sex reassigned, or have had their sex reassigned, though the heading is “gender reassignment”.

At the time I changed my name and went full time, I was ambivalent about surgery, but a year later I passionately wanted it. Why would you want surgery? I believe I wanted it at the time because I wanted social acceptance, or possibly to accept myself. Where a person male by genes gonads and genitals wants to dress as a woman, there were two categories they could fit- transvestite and transsexual. The transvestite is considered to be a sexual fetishist, which I found unattractive, but the transsexual had a medical condition, which I found more congenial. I felt my personality was feminine, a concept which now I consider meaningless.

If there were more acceptable categories, protected against discrimination by law, not involving surgery, perhaps I would not have wanted surgery. Medicine tends to categorise health problems which require the intervention of doctors to cure, but possibly we could reconceptualise gender dysphoria. Gender incongruence type 1 is a desire to live in the role of the opposite sex. The treatment is to live in the role of the opposite sex, using an appropriate name and clothes. Gender incongruence type 2, a distinct condition which may or may not co-exist with type 1, is a desire for hormones. Type 3 is a desire for surgery. Type 4 is a desire to subvert gender, by not fitting any particular gender role, and the treatment is to be allowed to present as you want, male, female, androgynous.

There should be the freedom to present as you want anyway, without the need for medical affirmation, but I did not feel free and medical affirmation, or a category defined by doctors, might have helped me accept myself. The health problem would be shame and distress rather than cross-gender behaviour, and the treatment to alleviate the shame and distress rather than to change the behaviour. As the medical model is about desiring cross-sex characteristics, the GICs can’t cope with non-binary people. They still demand change of name, as Charing Cross did when I first went there in 2001.

I would have said, I want surgery because I am transsexual. I am a woman and my penis distresses me (it did). In the bath I want bubble-bath to hide it (I did). I now feel I wanted surgery to be classed as transsexual and so to be socially acceptable, as demonstrated by the available legal and medical categories. If there had been different types of gender incongruence recognised by medicine and protected by law, I might not have wanted surgery or hormones.

Transsexual support groups enforced the desire for surgery because it differentiated us, the real TSs with a medical condition, from all the weirdos and perverts, just as law, medicine and the wider culture did.

Hormones can reduce fertility, possibly permanently. I wanted to reduce my sex drive because my attractions shamed me. Self-acceptance would have been a better way.

Surgery is irreversible. I mourn being mutilated, and the pain is keener because it was my choice. That choice was socially constrained, and I am moving from self-blame to rage against those constraints.

A great deal of research reports high degrees of satisfaction with treatment, and low rates of regret of surgery. I am unsure why. Possibly it involves people surveyed shortly after surgery, when I and others experienced euphoria; possibly people feel shame about our regrets. I certainly do. People are unwilling to score below Neutral in a satisfaction survey, marginal people are less likely to complain of bad treatment, and while we might open up to a qualitative researcher we might not on a survey. In my case, I have been loath to speak out because I don’t fit the accepted understanding of trans women, and might spoil it for those wanting surgery now; and I want to maintain links to trans groups. Though Johns Hopkins stopped doing GRS as they decided it did no good.

 ♥♥♥

Sylvia Morgan undertook qualitative research, trying to find difficult to reach trans people rather than using the customary routes of gender clinics and trans support groups. Post-op, most people lose touch with those sources and that might be a reason why some research reports such high satisfaction rates. Four out of thirteen post-op trans people expressed regret. That is a huge figure.

People report long waiting times to see gender clinics, and long waiting times for surgery referral once there- perhaps seven years. A friend waited longer. Another friend said the psychiatrist kept challenging her desire, saying that it won’t grow back once it’s cut off, as if she did not realise that. Of Dr Morgan’s research subjects, Lady G who wanted penetrative sex had to wait many years because she had to work in male role, as a lorry driver, and the protocols demanded the “real life test”. She also refused to fit the stereotype of a “woman trapped in a man’s body”- “I don’t know how women feel. I just know how I feel. I’m definitely not trapped. All I want is the wee operation down there.” She passes as a woman, unlike most of the MtF research subjects, and has a strong sense of being one.

Kylie, though, felt hurried. She was not sure how she felt and questioned the conclusion of her first half-hour consultation that she had “insight” and an “excellent understanding” of the transition process.

People used The Script, saying they felt trapped in the wrong body, felt they were not of their assigned gender from very young. “People play the game to get what they want.” Dr Morgan reports that discussions in support groups are dominated by medical procedures and visits to the GIC, and I observe that on facebook, with regular delight at getting surgery or despair at the delay. It is a way of getting status in the groups, that you are seeking surgery. Four said they had never considered medical procedures before joining support groups.

Phoenix felt pushed through a process. She had said she did not particularly want surgery, but had it three years after her first referral to the GIC. She drifted through the process and does not know how she got where she is, post-op.

Vida first went to the GIC in March 2010, and had surgery in October 2012, having pushed for it. She was processed quickly because she demanded progress. There appears to be little consistency in procedures and protocols. Waiting times appeared arbitrary. One psychiatrist was described by many participants as condescending, patronising, clock-watching. Trans women felt disrespected, as I did.

We want medical recognition in order to get legal recognition, so we have surgery as that is what the medical model requires. The participants wanted a vagina in order to “feel fully female”, rather than for what one would do with it: gynephile trans women still go to surgeons who can give depth. The psychiatrists generally did not attempt to dissuade them. (We would hate it if they did, denouncing them as cruel gatekeepers.) Yet the surgery is a symbol of being a woman or truly transsexual, rather than a choice because of what the penis and testicles can do, or the neo-vagina can do.

Dr James Bellringer, who does NHS vaginoplasties, said the backlogs were “spiraling out of control”. In 2013/14 they received over three hundred referrals yet did 180 operations. “The nature of gender surgery is that the vast majority of these referred patients will go on to GRS,” he said.

Iain, a gender queer trans man, thought better of it. The effects are irreversible… there’s so much that can go wrong… it sounds like a world of pain and struggle and scarring and infection.

Oestrogen is a symbol too. Subjects perceived it as enhancing emotions and gentleness, but one reported that her powers of concentration were a lot worse, another that she was considerably weaker, making her job more difficult.

As hormones and surgery are primarily symbolic, that one is really trans, entitled to legal recognition, others as well as I feel euphoria after finally having surgery. But then Carina reported that reality hit her like a big sack of potatoes. Surgery does not mean social acceptance, necessarily, and the body has to heal its effects. The neovagina is in effect a wound, so you have to fight the healing process with dilation.

Vida felt recovery took two years, and had further depression ten years after surgery, “because there is no aftercare or support”. Dolores said she had not understood how difficult and time-consuming dilation would be: “A lot of girls just don’t bother with the dildo, they just let the vagina close up”. Lily agreed. “Nothing really prepares you for what happens afterwards.” I think when some people go for the gender reassignment there is a hope for changing your life, starting a new life, but then it’s still just you with your same problems, and after the surgery you have more to worry about… Some of them just give up, they stop dressing in female clothes and everything.

Sally hoped surgery would give her psychological relief and social acceptance, but it brought neither. She had had profound ongoing depression since transition. Trans support group organisers told me not to talk about my personal problems, not to talk about being depressed since my surgery.

People determined to get the surgery are kept in the dark and fed on bullshit. Nine out of 28 participants had attempted suicide, some more than once.

While people are taking hormones and having surgery for validation as a true trans person rather than for the actual results treatment will provide, there will be inappropriate treatment, and social pressure to have treatment. I know what the desire for the operation feels like. I felt it. Now, I feel betrayed.

 ♥♥♥

When T-Central linked to this post, Calie wrote, The last two T-Central featured posts were based on very successful transitions. One from Halle, who has transitioned, and the other from The Transgentle Wife, the spouse of one who has transitioned.

This post is from Clare Flourish who has regrets. It is important to read both sides.

I will add that I know many who have transitioned and are happy and I know some who are not. In all cases, it seems that the lack of love in the life of those with regrets, or the lack of a job, is often the case.

Clare mentioned in a comment to her post that there is pressure to physically transition. I have seen this and know several who gave in to that pressure. Some are happy. Some are not. Clare is one of my favorite bloggers. She is just lovely in her pictures and I do hope things will turn around for her.

I am grateful for the link and kind words, but I am glad I transitioned. It was how I found myself. I feel transition could mean something different, that it does not need the monolithic full-time + hormones + surgery. I feel people should be encouraged to find those parts of transition which work for them, without imagining they must come as a package.

Some of the comments below go into these issues in depth.

19 thoughts on “Don’t have GRS

  1. Clare you are brutally honest which I very much respect. Yes, surgery or hormones should never be a prerequisite for some kind of authenticity which unfortunately used to be a measuring stick that even trans people themselves used. If you were a TV you were a pervert but if you were a TS you had a medical condition except that the difference between the two is often paper thin.
    Lots of people have dysphoria and don’t transition and 150 years ago no one could but dysphoria existed anyway. You get to define who you are and if full transition is for you then fine but if not then that is fine too. No one can push you into it and today we have more varied methods to treat dysphoria. No matter what you did you are still Clare and you brains were not affected in the least :):)

    Liked by 3 people

    • Over here I think there is still pressure to transition physically. These trans women express it. The medical conceptions of trans make it worse. There is pushback, and objection to the use of the word “transsexual” because it implies physical transition is necessary; but I feel there are too many operations, and overall the surgeons do more harm than good. But transphobes, saying trans women are dangerous, put pressure on us to prove ourselves, so that the rate of operations will go up.

      Liked by 2 people

  2. Dear Clare, you have the rare skill of being both excoriating and coruscating within the space of a couple of words. Brilliant is another way of describing it, both for the quality of your commentary/analyses and the light that you bring to bear on such diverse topics.
    Every day you make me stop and think and today’s catches me right in the plexus as it taps into my own contemplation of my need for GRS and even my decision to apply patches to my legs twice a week.
    I also appreciate your ability to prompt me to think about femininity, woman, womanhood, and other loose concepts that no one is evidently able to define in a way that has universal meaning, for me.
    Thank you for doing all this on a daily basis, whilst also having a busy life.
    I just hope that there is some one there for you, some place there for you, where you can find a moment to ‘turn it off’ and be at peace.
    with thanks
    Alice

    Liked by 1 person

  3. So here is a perspective none that have commented here share. I speak from the personal perspective of an older woman who was surgically corrected at age 23.
    My thoughts at that time had nothing to do with “authenticity” or what other trans people might think or feel.
    The only “pressure” l felt to pursue SRS came from deep within me and a need to correct a fundamental physical wrongness with my body.
    I think that the biggest mistake so many make is to subscribe to some artifcially invented construct that defines cross dressers, (transvestites) as perverts, and those desperately in need of surgical correction as somehow “superior”.

    Liked by 1 person

  4. Claire makes a good point. “There is pushback, and objection to the use of the word “transsexual” because it implies physical transition is necessary.”
    This is why trying to erase the distinction between a transsexual, (or a “true/classic” transsexual), and other gender variants is a mistake. I have always advocated for different treatment protocols for the nearly infinite variety apparent on the gender spectrum.

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    • Hello, again. You know, when you came before, calling yourself “The sceptic”, I thought you were a TERF? So did my gay friend. In what way are you a heretic?

      Different treatment protocols. Treatment seems scrappy, and variable, coming after long delays. We need more engagement from the psychiatrists.

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  5. I see myself, (identify), as a heretic because l am sceptical of the idea promulgated by the trans “community” that surgery or hrt are mandatory in order to enjoy social acceptance, or possibly to provide some magical elixer for self acceptance.
    I am also highly sceptical of the idea of “people taking hormones and having surgery for validation as a true trans person rather than for the actual results treatment”.

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  6. Psychiatrists and surgeons can only do so much. The truth is within us. How we relate to others is a function of who we are.
    In my mind, that is the key: knowing who we really are.

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    • I think our positions are quite close, actually. I don’t think surgery is wrong in all cases. Though I also think it makes no sense that, say, almost everyone is cis, really of the gender/sex they were assigned at birth, but maybe one in a thousand are trans, really of the opposite sex and gender because of an opposite sexed brain. AI may pick out trans people from brain scans, but it may be picking out transness rather than sex.

      Self-acceptance has to go with knowing who we are: unless one can accept it, one cannot know who one is. Psychological treatment would go with a greater variety of types than cis and trans, and an understanding of people in terms of our gifts, qualities and predilections rather than our sex. It would not be conversion therapy.

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  7. Thanks so much Clare for your writing, for including Callie’s comments, and for the exchanges in the above comments. I’m scheduled for GCS next January, have been taking HRT for a year. None of what I have done or will do is because I wish for social acceptance. I’ve considered and opted out of FFS for example. I don’t want to return to a life of stealth, where by passing I’m returning to a jail cell of worry and fear that I’ll be found out for what I am.

    That said, I’m lucky to live in an area that is supportive which allows me a perspective to consider what I need without the overhang of prejudice or hate. I’m also quite fortunate to have close friends here, and even the loving support of my ex-wife who’s planning to come and help with my recovery.

    I do consider that the surgery, recovery, and lifelong maintenance will be quite a load. I’m well aware that once that bridge is crossed there’s no turning back. In my soul it feels like the right thing to do, for me. Again, I do appreciate your wisdom and thoughts, which give me more to consider over the next few months.

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    • You are welcome.

      I am sure you have thought long and deep about this, before scheduling. I know you can make the decision for yourself. But, given that the maintenance is such a load, you might consider orchiectomy, penectomy and labiaplasty without vaginoplasty. Unless you want to be penetrated, I would recommend against vaginoplasty, which makes the operation much more complex and lengthy. Even if you want to be penetrated, you might consider labiaplasty only: the neovagina is not as stretchy as the natural one, and a friend told me her male friend had complained of soreness in his penis after sex.

      What does surgery achieve? You do not need testosterone suppressants any more, and can wear tight clothes. You may have a lesser sexual response (that might be a good or a bad thing). If you have health problems in the future, if you do not have the operation you might be able to return to making your own hormones rather than taking synthetic hormones. Someone in Chonburi at the same time as I had a stroke a few months later.

      (Rhetorical question) Who will see your groin, apart from you?

      Dr Suporn’s colleagues said, if you feel at all uncertain, please tell us and we will try to talk you out of the operation. I felt no uncertainty.

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      • I admit that deciding for/against the neovagina is something I’m grappling with. I was fortunate to participate in the Gender Odyssey conference a couple of weeks ago in Seattle as a Session Host for all four days, which included presentations by several GRS surgeons, including my own which provided me with a fantastic opportunity for me to compare and confirm my selection. I learned that some percentage of patients opt out of the neovagina for the same reasons you describe.

        I’m leaning toward the neovagina even though I don’t envision penetrative sex. As far as I know so far I’m a lesbian so the vagina isn’t needed, right? But still it seems like having one is a good idea if only to avoid another possible regret of not having one. The surgeons also said that if one stops dilating that it naturally closes down (heals) anyway.

        Clare, you’ve provided me with great food for thought, thank you. I’m now going to consider this decision carefully, trying to weigh the pros and cons.

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        • Mine has not fully healed, more than ten years after I ceased dilation. However the scar tissue of the healed orifice is causing other problems.

          I see what you mean about regret. A vagina can be constructed with bowel tissue later, but that carries its own problems.

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          • Hi Clare, time for a quick update.

            I talked to my therapist yesterday (who is AFAB and is non-binary) about my considering not having vaginoplasty. After some conversation they suggested that since I can’t know now what I’ll want/wish-I-had that I go ahead with it. And last night I had dinner with a lesbian friend who is cis and with whom I’ve shared so many things. She also suggested that as we all know we can’t predict the future and recommended that I go for it. A big factor for me is also considering future partners I’d hate to have to carry around the baggage of “yes, I’ve had GCS but…”, worrying about when to tell, how it will be accepted, etc. I have enough to worry about and have lived too long with so much baggage.

            I also complained to my therapist that dilation will be such a drag, like overhead, to contend with. The maintenance seems daunting. They suggested that I try to reframe dilation as being something I’m doing for myself, for my body, almost like physical therapy that’s needed after trauma. Sure, no one likes PT but most would say that they’re thankful for having it.

            I do appreciate your giving me this food for thought and I’ll continue to think about it but for now I think it’s settled that I’ll have that procedure.

            Emma

            Liked by 1 person

  8. Thank you, Clare, for a post that really makes you think out the process of physical transition.

    I have love in my life, and children. I also have a very successful career in a very visible profession. These are the only reasons I have not transitioned. TERF’s will say I am a liar and that a real transsexual cannot survive without physical transition. They will really never know because they never tried to build up the will power to do so. I have my ways of dealing with it and I have blogged about this many times.

    I have also said that, for me, there is a deep need for the full physical transition for the reasons you have stated. I very much agree, however, that the full surgery is not necessary for many. I have some friends who have simply given up on the daily dilating, which makes you ask why they had the surgery in the first place (and I think you have answered that question in your post).

    Thanks for another fine and brutally honest post, Clare.

    Like

    • Thank you so much for sharing it. It has had most of its views from T-Central. I want to support the needs of trans folk, and making these points is part of that.

      I don’t think TERFs believe there is such a thing as a “real transsexual”. Trans women might say that the need becomes overwhelming for “real” trans folk, but I know people who transitioned on retirement, or who have not transitioned because of their partner. It is not just will-power, it is the reasons you have not to transition. Trans people should respect your reasons.

      Like

  9. I tend to agree with the comments above.
    “Unless you want to be penetrated, I would recommend against vaginoplasty, which makes the operation much more complex and lengthy. Even if you want to be penetrated, you might consider labiaplasty only: the neovagina is not as stretchy as the natural one, and a friend told me her male friend had complained of soreness in his penis after sex.”
    This is an important consideration, especially if one is still married to one’s spouse. I “upgraded” roughly 10 years after my original srs for precisely that reason. I was and continue to be very happy the results.
    Everyone is different in many different ways. I think what is important is what works for you the individual irrespective of the opinions of others who necessarily have different needs.

    “What does surgery achieve? You do not need testosterone suppressants any more, and can wear tight clothes. You may have a lesser sexual response (that might be a good or a bad thing). If you have health problems in the future, if you do not have the operation you might be able to return to making your own hormones rather than taking synthetic hormones. Someone in Chonburi at the same time as I had a stroke a few months later.

    (Rhetorical question) Who will see your groin, apart from you?”

    Like

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