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Did It Have To Happen?

Every time I hear of a post-operative transsexual who commits suicide, I wonder, "Did it have to happen?" What went wrong? Was the surgery a failure? Did she change her mind too late? Did he confuse sexual orientation issues with gender identity concerns? Was she mistakenly diagnosed as TS, or was he not diagnosed at all?

I'd like to explore this subject from the perspective of a therapist who has been involved in a number of individuals' transitions. Many transsexuals choose to adhere to the Harry Benjamin International Gender Dysphoria Association's (HBIGDA's) Standards of Care. In choosing an endocrinologist and/or surgeon who is a member of HBIGDA, patients must engage in a period of psychotherapy prior to receiving the medical treatment they seek. While some participate in therapy only to satisfy the guidelines, others appreciate the opportunity to explore their gender identity issues with a knowledgeable, objective professional.

Some people, however, resist this process vigorously. The reasons they give are many. Some do not believe in the process of therapy, saying they know all there is to know about themselves and no outsider can enlighten them further. Some resent the intrusion of a person who has the power to permit or deny the medical treatment they want. Others fear they will not meet the criteria for medical treatment because of past or present mental or emotional problems. A fair number resent the cost of a service they do not consider necessary in addition to the charges for more highly valued medical and cosmetic services.

As a therapist, I see psychological evaluation and counseling of pre-operative TSs as essential. Although there are many who do not need it, there are a number of people who seek sex reassignment services inappropriately or prematurely. How is the medical practitioner to distinguish one type of patient from another? Endocrinologists and surgeons are no more competent to assess true transsexuality than I am to prescribe hormones or perform surgery. They depend on the skills of the therapist to evaluate as well as prepare the prospective patient for the experience ahead. In this way, inappropriate applicants such as the unrealistic, depressed or mentally ill can be redirected to appropriate treatment while those not yet ready for the stresses of transition or surgery can be prepared through education and support.

When I hear of the tragedy of a transsexual suicide, I wonder which of a number of circumstances may have occurred. Perhaps important issues in her life remained unresolved despite having achieved her dream of SRS. Did she suffer from depression, health problems, difficulties in the workplace, conflict with friends or family? Did he relocate "to start fresh" and find himself lonely and isolated? Did she have unrealistic expectations of the way it would be after SRS? Did his therapist mess up? Did she even have a therapist?

When individuals seek medical treatment from physicians who adhere to HBIGDA's guidelines, they are required to complete one full year of crossliving and six months of psychotherapy prior to SRS. This is a powerful combination for helping issues surface that need attention before irreversible medical procedures are performed. While there is no guarantee that these people will never suicide after SRS, had they proceeded within the guidelines of the Standards of Care, the safeguards would have been in place to identify them as being at risk and appropriate treatment could have been offered.

Dr. Anderson is a therapist in the San Francisco Bay Area. She can be reached at 415-776-0139.


© 1997 by Barbara Anderson & 3-D Communications, Inc.



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