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.