Unfortunately, such stories as this are not as unusual or strange as they may initially seem to be at first. More than a few people push, push and push until they achieve their fondest dream only to find out that things are not what they had once hoped they would be once they've crested the hill and saw what lay beyond.

The joke and cautionary tale, we used to share among friends years back when preparing for SRS was that after surgery you weren't any shorter, your teeth weren't any whiter and the sun didn't shine any brighter.

I know I will be pilloried for say this, but in a way, obtaining SRS has become too easy, allowing people who will not have good outcomes such as your friend to do something that is not in their best interest. Unfortunately, far too many are blinded to reality to accept such judgements. Hence, the suicide rate among post-ops TSs continues to be far too high.

I hope this missive isn't censored as some of my other ones have been, for maybe, just maybe someone will read it and ask themselves, "Am I someone she is talking about?"

Okay, I'm off my soapbox for now. Till next time, do stay safe and sane.

Nancy Cole

There have been cases of detransitioning about ever since the early SRS. They were just so rare and the numbers of SRS cases were so few that they seemed more invisible. There were a couple of the "Wrong Body" series on MSNBC rerun earlier in the year that featured people who detransitoned, and it delved into the whys. Two did not follow the Standards of Care (SOC) route and shortcut the process or lied their way through therapy, and went overseas to Thailand before they required psychological evaluation (and that has been evolving there). Religious based guilt was in part responsible for detransition in two cases after they got embroiled with a bunch of tax exempt charlatans seeking to cure homosexuality through prayer and behavior modification, and they also admitted to having sidestepped procedures.

From working with several therapists in my area, I am aware that people have tried to get SRS approval and were denied on the basis that they were seeking unrealistic goals, the end to all their other problems through sex change. Some went ahead and got surgery anyway. Careful therapy caught that they actually had problems other than gender dysphoria, mostly borderline personality disorder, and in one case a CDer with a fantasy who had deluded himself that he should be female. I know of others who lied convincingly through the therapy process. Had these folks passed through the gates they would likely have been detransitioning also. Not all therapists are as aware and able to catch lies as others.

Lack of social approval remains the largest cause of the depression seen to accompany gender dysphoria, and according to the preamble of the DSMiv ('94 text revision), should not be considered a mental illness at all since it is "...the result of social, religious or political disapproval...).

The rate of satisfaction with surgery among TS is actually quite high, well over 90%, with less than 3% of people who make it to the surgeons knife detransitioning, and others stating they were not completely satisfied. Often the reason for the latter is the lack of acceptance complicated by the difficulties in "passing" by many transtioners who are older and have long been prey to the ravages of testosterone, so they do not find the acceptance they expected/wished for. Sadly those who would prevent transitioning for whatever bigoted and biased reason leap on these few cases of detransition and regret and would make them causes for ending the procedures, though many more people have been helped than have had regrets and detransitioned.

I also cringe when I think about the debate between those who see the Standards of Care as necessary, and those that want depathologization, which are not actually two opposite sides. One group thinks taking GID and Gender Dysphoria out of future editions of the DSM equals surgery on demand just like any other plastic surgery or corrective surgery. "'Taint necessarily so Newton" nor should it be. That is actually two different issues.

Listing Gender Dysphoria (or call it Gender Incongruence) in the DSM as a special case of non disorder depression with effects would serve very well to provide justification for corrective surgery, but not saddle people so afflicted with a disorder diagnosis. The SOC should not have to follow the APA disorder language to justify approving people for a medical procedure that has been demonstrated to effect a cure for a mental problem. Neither should surgery on demand be undertaken for something with as much social ramifications as SRS, not without some assurance that the surgery meets the criterion of doing no harm and the patient has been made well aware of the irreversible nature of the surgery, physically as well as socially.

It would be nice if GID was taken out of the disorders section of the DSM (and the terms Gender Incongruence they propose to replace it with continues to have a disorder diagnosis number so is not effective in doing so), as it might make it slightly more easy to get a job for people who are marginalized by the unwashed majority. Having to admit to having or having had a diagnosed mental disease does not make for good employability. The proposed change for the DSMv are unlikely to help, but what can you expect from psychiatrists? Helping people is not what they are about, as their mental illness theory devolves from judgemental and punitive theory from bygone ages steeped in religon and belief in demons and supernatural causes.

CaroL