A Brief History of Transsexual Treatment
Before we get into what the latest science shows about transsexuals, it’s probably a good idea to cover some of the history of transsexual treatment. It’s not as if transsexuals just popped into existence around the time someone figured out how to perform a “sex change operation” (as genital reassignment surgery is still sometimes crudely referenced). We’ve been around for a long time, throughout history and across all cultures. Sure, we’ve been mostly hiding in our closets, but not all of us and not always.
The first approach scientists and therapists tried with transsexuals was to cure them by making their minds stop insisting they didn’t match their bodies. This was the dawn of the “change the mind to match the body” approach. Zoe Brain provides a pretty good summary of the situation, which I’m going to reference with some commentary here.
In the dim, distant past, little distinction was made between homosexuality and transsexuality. It was thought that gay men were really wannabe-women, and that transsexual women were really gay men who were taking things to the logical extreme. Various crypto-religious psychiatric theories were proposed about some form of “feminine essence” or “female soul” that all gays had to some degree, and transsexual women had to an extreme amount. Some of the very first surgeries were performed on this basis – and in 1940’s Germany, in the extermination camps, not on willing volunteers.
Later on, the persistent demands by transsexual women and men, and the catastrophically high suicide rate, persuaded some medics to try all sorts of therapies. Amongst them – lobotomy, leucotomy, “aversion therapy” involving administration of nauseating drugs and electric shocks to genitalia and eyeballs, all sorts of “gestalt” therapy, “neuro-linguistic programming”, “cognitive therapy”, psychoanalysis, electro-convulsive therapy with dosages far higher than would be permitted today, and often without anaesthetic, psychotropic drugs, masculinising hormones…quite literally every tool in the arsenal of psychiatry was tried. Even “spirit release therapy” and exorcism, using bell, book and candle.
This speaks directly to those who persist in believing that transsexuals ought to seek therapeutic cures to fix their confused minds, rather than seeking hormones and surgeries to alter their bodies. We have about a century of that approach being attempted upon thousands of different transsexual identifying people. Before telling people they should go down that road, it makes some sense to see where that has lead in the past. And you don’t have to look very far before a very distinct pattern emerges – total failure.
Long-term follow-ups showed temporary remission of symptoms in many cases, especially those involving the more extreme forms of aversion therapy that left 2nd degree burns, but no improvement over the long-term. Not without some unfortunate side-effects, such as the patient’s IQ being lowered to the level of a cabbage due to over-enthusiastic brain surgery. And patients continued to die.
The emphasis above is mine. For roughly a century therapists from all fields have attempted to cure the minds of transsexuals with every tool in their respective arsenals and it didn’t work. Not ever. Somehow it has become a common belief that transsexuals could be cured by some therapeutic means, even though it has been tried over and over without success. Even the ones who insist they succeeded are proven wrong by long-term followup studies. We long ago abandoned trying to “cure” homosexuals this way for this kind of reason (except for some crank therapists with more Jesus than sense). But somehow people continue to believe transsexuals have some kind of viable option here.
I myself have heard both direct and implied questions about this in my own case. Wouldn’t it be easier to learn how to live with yourself through therapy and some happy pills rather than by something as radical as transitioning into life as a woman? I get these questions even after I explain that I have done a LOT of therapy, and I took my happy pills, and I found myself spiraling downward all the same. I was right at the edge of suicide before I ever even nudged in the direction of transition. And this is not some kooky transition variation of my own, but a common description among older transitioners. We’ve tried our whole lives to find a cure, or cure ourselves, or find a lifestyle to appease us, or just hold it in and ignore the feelings, and eventually it just became too hard. We couldn’t continue like that.
And again… this is not a new story. It was observing exactly this result that lead some folks to try another approach about 60 years ago.
In the spirit of “what the heck, nothing else works”, from the early 50’s, some surgeons in Europe tried the first “production-line” (as opposed to “experimental”) genital reconstruction surgeries, in conjunction with feminising hormones…. and they started getting some dramatic improvements. By the 1960’s, French surgeons in Casablanca, Morocco were doing several surgeries per week, at a cost in today’s terms of about a quarter of a million dollars each.
Zoe’s got more, but you get the idea. This was a big change. This was the first time people tried to cure transsexuals by changing their bodies to match their minds, rather than changing their minds to match their bodies. We’re not talking about something motivated by hard scientific evidence either. We’re talking about a bunch of therapists out of ideas for what else they might try, and a few surgeons volunteering to perform the slicing and dicing.
And you know what the results of that approach were? Really quite good. I mean amazingly good if you consider that the previous approaches had a success rate that you didn’t even need fingers to count (i.e. zero). Suddenly you had a body of transsexuals coming out of treatment and living healthy, happy lives which were actually supported by long-term followup studies. And as the costs for the surgeries came down, the number of people who could try this shot up (thank you supply and demand).
I don’t want to overstate the case. Until very recently the vast majority of people identifying as transsexual were not allowed the hormone / surgery option for reasons a lot more arbitrary than you might believe (Most places, if you weren’t young, pretty, and sexually attracted exclusively to guys, you could pretty much forget it. Professionals guided by time honored principles like “no fat chicks” literally ran the show until around the 1990’s). Throughout this period the “fix the mind not the body” paradigm still ruled when it came to treating transsexuals. The point is the numbers did slowly grow. And the evidence slowly poured in, convincing ever more psychiatrists, psychologists and other therapists that it might be a good idea to stop trying to change the mind to match the body, but rather to try it the other way around.
And here we’re getting about as close as social sciences can come to establishing a scientific fact: hormone / genital reconstruction options seems to work for transsexuals. Changing the body to match the mind is as close to a “cure” as psychiatric professionals have been able to devise for transsexualism, and it is definitely NOT because they haven’t tried all other options first.
It’s not a perfect cure. It doesn’t remove all the pain from living a life within the transsexual condition. It doesn’t change stupid and destructive choices made by transsexuals in their past. But it’s demonstrably, repeatably, and reliably better than any other approach that has been attempted. Not just a little better, but a lot better.
Zoe wraps our little “fix the mind not the body” therapeutic history lesson this way:
The point is, that even if you regard this as “mutilation” rather than “reconstruction”, and say “they should try alternative treatments”, the problem is that there *is* no “alternative treatment” to try. Not that works. Religiously and Ideologically motivated mental health professionals are still attempting to turn lead into gold, leaving an unbroken line of corpses and psychic cripples to mark their 0.000000000 batting average, but they still keep trying. But while there’s literally hundreds of studies showing the effectiveness of the “triadic therapy” involving hormones and surgery, and even some studies showing the effectiveness of hormones alone on less severe cases, there’s none where someone who meets all (not just some) of the diagnostic criteria that have ever shown improvement in long-term follow-up.
The widely-held belief that “they don’t need surgery, they need psychiatric help instead” is not borne out by any actual evidence. Not a skerric, jot or tittle.
It was this complete lack of success that led to the speculation in the late 60’s about a biological cause, rather than a psychiatric one.
That was my emphasis again. It’s the note I want to close this post on, so let me hit it again. We are not lacking evidence about the treatment of transsexuals. But for some reason most of society is pig-headedly acting as if the evidence shows the opposite of what it actually does.
The “fix the mind not the body” approach has been tried. It doesn’t work. No evidence suggests that it can. Some of those closest to this evidence started realizing this before I Love Lucy aired for the first time. We’ve got evidence going back to that time period attempting the “fix the body, not the mind” approach instead. That one does seem to work in most cases.
The basics of this question are already known. We’re past the point where this stuff is seriously argued about by anyone with any respect in the field. A person now has only to be diagnosed as transsexual and triadic therapy (a real life experience in the intended gender role, hormone therapy, and genital reassignment surgery) is becoming almost routine. Indeed, those closest to the evidence are now to the point they’re arguing that this stuff needs to be covered by insurance companies as medically necessary (skeptics, please check out the citations at the end of that link, particularly the sixth footnote).
The idea of “curing” the mind is coming to be seen as not only unsuccessful, but probably unethical based on the evidence. That most people don’t know this is a point of frustration, but it doesn’t make it any less true.
So that’s the history of the clinically unsuccessful and (hopefully by now you’ll agree) factually untrue belief that transsexual minds can be changed to match their bodies. But that’s all just the “soft science” side of the equation. What we need to get to next is what researchers are finding once they start looking for the underlying biology to explain why this is so. That research has been finding out some really interesting things. I’ll start to get into them in the next post.