How many trans women have genital surgery? Do trans women generally have surgery?
I thought I’d look at this because of an article suggesting that no matter how cultivated their ‘feminine’ outward appearance, ‘trans women’ (as opposed to transsexuals) have penises. I don’t know what the writer was thinking. She holds herself out as an expert on trans issues, and speaks about us, and then writes this stunningly ignorant thing. Few people call ourselves “transsexuals” nowadays, just as few people identify as “homosexuals” rather than as lesbians or gay men. The word sounds scientific, a classification from outside. We are all trans women now.
This is the final end of the “genuine trans women” argument. When the current campaign was getting going in Summer 2017, there was the pretense that the trans-excluders were not against “genuine” trans women, but wanted to exclude men who would use a liberalised gender recognition law to access women’s spaces. The definition of “genuine trans women”, whom the excluders swear they do not hate and do not want to harm, gets stricter and stricter until it disappears entirely and they call us all “men”. They want to feel good about themselves. They’re not hostile to trans women, just the bad ones. But it gets more and more difficult to find a “good” one, in practice rather than in theory, who does not experience hostility from them.
Those seeking to inspire fear and hatred of trans women, or to justify their own, suggest we don’t have surgery, and that having a penis in some way makes us dangerous. Well, in a loo you don’t expose your crotch until you are safely in a cubicle, where no-one can see, so it hardly matters there. It only matters to us and to our sexual partners. But I’d thought I’d check. How likely is it that a trans woman has had surgery?
There are huge waiting lists. A friend said that she had been waiting twenty years for surgery. I don’t know when she dated that from- ceasing to present male, or seeing a doctor about it, perhaps. Waiting lists are growing. In January The Sun claimed that the waiting time was nine months for adults and about half that for children, but as the NHS does not provide gender surgery for children that is confused. It published the report under its heading “Fabulous”, which covers fashion, beauty and celebrity “news”, pinned onto something about Caitlyn Jenner, deadnaming her.
You have to have a referral before you count as being on a waiting list. Women often talk of trying to get treatment, and the refusal of the psychiatrist. “It won’t grow back,” a psychiatrist patronised one I know. Of course. We know that. We know what we want.
Gender Identity Clinics are a “tertiary” service, that is you need a referral from a psychiatrist, rather than from your GP. There is delay at all stages: the GP might delay before referring to a local psychiatrist; then there are three waiting lists, for the local psychiatrist, the GIC, and the surgeon. The GIC waiting list is around three years, and then it requires a second gender psychiatrist to give an opinion, a wait which can last a year; and each expert can decide to see you again (and again) before making the next referral. You don’t count as being on the waiting list before you get the referral. You wait years for surgery. That begins to explain my friend’s twenty year wait, though I hope twenty years remains exceptional. Another person I knew waited about fifteen. There are 7,500 people waiting for a first GIC appointment.
The Guardian is more trustworthy than The Sun. 60% of trans women referred to Charing Cross GIC sought genital surgery. So yes, that trans woman you see in the loos might have a penis, but that does not mean she is not genuinely trans. There is clearly no moral difference between a trans woman who has had surgery and a trans woman who wants it and is waiting for it, as far as access to women’s space should go. Having an operation does not make you any more of a woman. And the trans woman with a penis is no more of a threat than a cis woman.
I am against surgery. I don’t think it does us any good, and I think we seek it to be seen as real trans, rather than for what it enables us to do. Gender dysphoria need not be body dysmorphia. Yet delay is not the answer. You sit in limbo, unable to get on with your life because you consider this thing you are waiting for to be the most important thing on Earth. It is a paradox that as the transphobes talk of “genuine trans women” they put pressure on us to have surgery, even though they decry it.
I wanted to produce some statistic about how many surgeries there are. From 2000 to 2009 there were 853 NHS surgeries though many, like me, went to Thailand or had private surgery. In the government LGBT survey, 16% of trans respondents had gone abroad for “medical treatment”: what else but surgery? To get a percentage of trans women who have had surgery, you would need to know how many are expressing ourselves female, and how many have had surgery (and are still alive) and these figures are not available. I don’t accept that you need to have or desire surgery to be a “genuine” trans woman, but anyone who suggests you must should not spread falsehoods about how many do.
Here is a trans woman expressing regret about surgery.