A Different Perspective on GRS


Today Brynn Tannehill on Huffington Post published an article titled Myths About Gender Confirmation Surgery. While I agree with much of what was in her post, I want to respond to some of it from a different perspective.

I want to start with saying that I ultimately agree with Tannehill about the need for insurance companies and other health care payers to cover medical care for transgender patients, including surgery as well as hormones and mental health care. Ultimately, she and I are on the same side and our disagreements are minor.

There is a common perception in the media and even in some transgender circles that all transgender people desire to have some sort of surgical changes to our genitals. The various surgeries (there are several different surgical options) get lumped into a few different names, including “Sex Reassignment Surgery (SRS)” and “Gender Confirmation Surgery (GCS).” Tannehill uses the Gender Confirmation Surgery name, which is preferred by many people who identify as transgender.

I dislike the name strongly. It indicates that surgery is necessary to “confirm” the gender of an individual. The problem with this is that many people, myself included, do NOT feel that our genitals need to match those of the sex usually associated with our gender identity. Some people’s gender is fully confirmed without surgery or any other alteration to our bodies or our genitals. It is not surgery that confirms someone’s gender because gender is not about bodies or genitals. Gender is a social construction that comes from an individual identity and social interactions. Sex is a physical aspect associated with genitals, breasts, secondary sex characteristics, etc. Not everyone is thrilled about the GCS terminology, myself included.

I don’t, however, think that people who do desire surgery shouldn’t get it! After all, I have had surgical chest reconstruction myself! People who desire surgical changes absolutely should have access to them, and I believe strongly that insurance should pay for it. Dysphoria is a real thing, requiring real interventions. I just think it is important for terminology to be clear about what surgery does – it does not change, confirm, or clarify someone’s gender. It changes the body. Tannehill argues that “Gender Confirmation Surgery is probably the most technically accurate” name. Since surgery does not alter someone’s gender identity (only their body), and many people’s gender identities are fully confirmed without surgery or especially genital surgery, I disagree.

My bigger disagreement is with the first myth Tannehill addresses. In “It’s not life or death” she then argues that surgery is necessary for transgender people because the rate of suicidal thoughts and attempts among transgender people is so high. She and I agree that much needs to be done to address the enormous distress that many transgender people feel, and that it is crucial that we provide better medical care. However, in this section Tannehill equates GCS with all medical care, spreading the same media myth that genital surgery and medical care are the same thing for trans patients. Her numbers do not include the many transgender people who’s dysphoria is alleviated by coming out, greater self-acceptance, acceptance by family and friends, changes in social networks, access to mental healthcare, hormone therapy, and non-genital surgical procedures. Equating suicide risk with need for genital surgery perpetuates the myth of the immediate and total “sex change surgery” from television and does not illustrate the huge range of different approaches trans people use to integrate our identities with our bodies and lives.

The problems with the rest of this article all pretty much stem from this original misconception. It is possible that Tannehill feels that GCS is (or was) necessary to confirm her own gender. However, projecting that need onto all other transgender people erases the enormous differences in our community. We vary enormously in what changes we want to make to our bodies, if any at all. Erasing that diversity of experience is unfortunate and damaging to us all.

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  1. I have been thinking a lot about this article, and the original article that prompted Benny’s response. I have come away with two really strong impressions.

    First, and definitely most importantly, is that care should be taken when this things are brought up. I agree 100% that trans* people should get all of their medial care, just like any one else. (I believe is socialized medicine) Surgery, hormone treatment, mental care, and any thing else that is appropriate. But much like Benny I feel that the OP focuses to much on surgery. I worry that this kind of argument could be used against trans* people who don’t want/can’t have surgery. It could be used to level claims that people who don’t commit to surgery are not “real” men/women, are just trying to get special treatment. But you can’t treat surgery as unnecessary, when it can improve the lives of people who really need it.

    The other thing that the articles got me thinking, is if there is some type of Biological difference that determines, in part, which people will have more extreme dysphoria.

    • I don’t think it’s an issue of “more extreme dysphoria” so much as which body parts we get dysphoria about. I know people who have had very extreme gender identity related dysphoria about genitals, about body hair, and about height. My dysphoria was primarily related to my breasts, and surgery turned out to be an enormous relief to me. Some people have that same feeling about their genitals and they should absolutely have access to surgery without enormous financial burden (to be clear, my surgery wasn’t covered either, and was quite expensive).

      My issue is just with the idea that gender confirmation = genital surgery. My gender is confirmed by other things, not by the presence or absence of a penis.

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