Every Trans Person’s Right to Gender Confirmation Surgery

Although it’s been several years that I’ve been providing gender therapy for transgender folks, I’ve noticed a surge over the past few months of my trans clients who are bringing up their very serious intention to have Gender Confirmation Surgery (GCS). My theory is that, as it becomes more of a reality that insurance companies will be covering the costs of the surgery, the idea of GCS moves from thoughts of, “Yeah, if I ever win the lottery!” to “I better start making some plans to do this!”

Known in the past, and still currently in some circles, as Sex Reassignment Surgery (SRS), “bottom surgery,” or (I shudder to type it) “a sex change operation,” GCS is one of the most talked about, debated about, and joked about (and not in a funny way) aspects of transitioning. For those transgender persons who suffer from Gender Dysphoria to such an extent that they need medical treatment to help reduce the intensity of the symptoms, GCS is oftentimes seen as the “Holy Grail” of the process.

For those of you who aren’t transgender you might wonder why that is…

I want to pause as I recognize a hesitancy coming up in me as I write this post. I hate that I have to write about this, first of all, because I am anxious for our society to be at a point where there is no debate as to whether or not it is a medical necessity for someone who is trans to have GCS. It pains me to know that so many people don’t want to trust in the fact that many people who experience significant Gender Dysphoria need to have surgery to correct the “birth defect” of having the wrong genitalia. Wouldn’t you???

I had a dream a few months ago that I came out of a surgery and was accidentally given a penis. I know, what better dream could a gender therapist ask for? It gave me even just the slightest glimpse into the discomfort, disgust, and even terror that someone can feel when they do not have the anatomy of the gender they identify with.

You can do this visualization yourself. Look down, and imagine you have the genitalia you aren’t supposed to have. Imagine going through your day with it. Putting your underwear on with it there. Using the restroom with it. Being sexually intimate with it. Either no longer being child-bearing or suddenly being child-bearing. I haven’t even mentioned yet the hormones that come with the anatomy, and how they are flooding you with too much of the kind you aren’t supposed to have!

Something doesn’t quite feel right, huh?

Stay with me here, the exercise isn’t over yet. Can you imagine what it’d be like to be asked, often and by total strangers, whether or not you have a penis or vagina, because they assume by your appearance that you are “one of those people” and think it’s okay to get that personal with you?

And then, depending on your answer, they might decide you really aren’t the gender you say you are?

And then they take away certain rights and privileges from you, even though you are a citizen of the United States of America?

That when you turn on the news you hear very loud, angry, uninformed voices telling you that you cannot use the public restroom of your true gender because you have the “wrong parts” and are more than likely a sexual predator?

This is the reality of a person who is transgender.

I’ve sat with dozens of clients over hundreds of sessions who experience this disconnect between their gender identity and the body they were born in. This is real, people, trust me! This shouldn’t be up for public debate, subject to ridicule, or used as as grounds for discrimination. They need GCS, period, and it needs to be covered by insurance.

Let me be clear about the intention behind this blog post.

This isn’t meant for you to feel sorry for those who are trans. Most of my clients get it, that there is still a ways to go before everyone really does understand what it means to have this condition. These scenarios that I’ve asked you to think about are real and they do happen. But my clients try not to dwell on them too much, as they would much rather focus on the improvements that will come from the treatment.

My hope is that this and other similar discussions will, best case scenario, convince you to become an ally for these folks, and to help fight for their right to fair and equal health care. Middle case scenario is that you now have more understanding and compassion about this condition. Worst case scenario, you still don’t “get it,” but you trust that if enough people are having this experience that it probably is real, and that you pay no more mind to it and go about your business and let them go about theirs.

Homework Assignment

I was inspired to write this post by an article I read today called Myths About Gender Confirmation Surgery by Brynn Tannehill. It goes through, point by point, all of the “issues” that people bring up against GCS and succinctly explains why they are false. It is excellent, I strongly encourage you to read it and share it with your social networks.

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  • Julie Dominesey

    December 18, 2013 at 9:18 PM Reply

    As Someone who transitioned to an outward identity of Female, to be congruent with the prayers I said at 4 yaers old..Well its been 12 years now..Still no GRS, but I will when I can..8 weeks from work, the money etc…For a therapist to take on the challenge of trying to vocalize my every day well its nice in a way….Nice to see someone with an open heart and an open mind try..my facebook is public folks, my job is as a cashier, customer service professional,, in a way I’m a public person…in a very conservative area..so if you want in well read on Julie Dominesey is my name…Their is no shame in my game….and I blog often I’ll let you in if you read it.

    • Dara Hoffman-Fox

      December 19, 2013 at 5:20 PM Reply

      Thanks for your comments Julie, it’s great to meet you!

  • Taryn

    December 19, 2013 at 8:47 PM Reply

    Thank you caring enough to support us in our need to express our authentic self. I am pre op, GRS is my goal but not sure when. It’s all about the money. Why this country cannot accept this operation as a medical necessity if beyond my comprehension. But I guess I understand because I have experienced gender dysphoria my entire life.

    • Dara Hoffman-Fox

      December 20, 2013 at 11:36 AM Reply

      Hi Taryn, I appreciate your comments and totally agree 🙂

  • Gemma Seymour-Amper

    December 19, 2013 at 10:19 PM Reply

    I would very much prefer it if everyone stopped using misleading terms like “gender confirmation surgery”, and used correct surgical terminology such as vaginoplasty. Continuing to refer to vaginoplasty, mastectomy, phalloplasty, hysterectomy, and other related surgeries as “sex change”, “sex reassignment”, “gender confirmation”, or whatever tortured and tortuous phraseology you care to tart it up with simply reinforces the belief that our identified sex/gender is something which needs to be confirmed by others rather than confirmed by us.

    I am a woman. I did not “become” a woman because I started taking hormones, burned the hair off my body, or had any particular surgical procedure. What we call “transition” in order to help other understand it, is simply taking steps to ensure that fewer people would make the mistake of assuming an inaccurate sex/gender designation.

    So long as we continue to regard sex/gender as some external thing which can be bestowed upon us by therapists, the APA’s DSM, the ICD, surgeries, government identification, or what have you, we will continue to fail to fully achieve respect for ourselves and respect by others. There is no, and cannot ever be, any objective measurement by which we can determine whether or not a person is sufficiently “trans enough”. Being trans is and always will be a self-diagnosed condition. There are exceedingly few, if any, other conditions which can be in any way compared to being trans.

    We need to stop apologising to society for being who we are. We need to stop allowing society to ignore the very real and present suffering of hundreds of thousands of people every year in order to protect against the possibility of negative outcomes, which have already proven to be minuscule in number.

    Hopefully, with HHS now reviewing the three decades plus long Raymond Ban on public funding of transition-related healthcare, things are going to change dramatically for the better in the very near future. But, even if we don’t achieve victory there, a vagina doesn’t make a woman, any more than a dress or lipstick or nail polish or a handbag and heels. A period doesn’t make a woman.

    A woman makes a woman.


    • Dara Hoffman-Fox

      December 20, 2013 at 11:40 AM Reply

      Gemma, I do wrestle with which terms to use on a fairly regular basis, so I understand your frustration. With my clients I use whatever terms, if any, that they prefer. When I write for this blog I go back and forth with terms to see how they strike the readers. I used the Gender Confirmation Surgery term from the article that I referenced in the Homework Assignment section by Brynn Tannehill, who identifies as transgender.

      What I’m learning through all of this is that everyone is different. There are those who want surgery because they do feel it will help them feel more “whole,” and that’s a quote I’ve heard many times. There are those who transition because it does help them get closer to expressing their authentic selves, sometimes with a goal in mind of femaleness, whatever that means to them, and sometimes not. There are those who feel the same way you do about it. All of the perspectives are valid and should be honored.

      Thank you for sharing your thoughts…

  • Shakina Nayfack

    December 20, 2013 at 10:12 AM Reply

    Thank you for this article, and for linking people to my interview! I deeply appreciate the work you are doing.

    • Dara Hoffman-Fox

      December 20, 2013 at 11:41 AM Reply

      Hello Shakina! So nice to have you drop by. I will be sure to continue following your adventures. 🙂

  • leah1026

    December 21, 2013 at 9:25 AM Reply

    The blog post said: “My theory is that, as it becomes more of a reality that insurance companies will be covering the costs of the surgery, the idea of GCS moves from thoughts of, “Yeah, if I ever win the lottery!” to “I better start making some plans to do this!”

    I’ve actually said something similar for a long time. People always used to throw around that only 10% of transsexual people got GCS. But I’ve always maintained that if money weren’t an issue the numbers would be dramatically higher. People have always wanted surgery by because it was beyond their reach they compartmentalized that desire in the back of their brain as a coping mechanism. They are now realizing they no longer to have to cope; that surgery is a realistic goal.

    Someone else poo-poo’d the term Gender Confirmation Surgery and I have to disagree with them. Although it’s not correct surgical terminology it does emphasize exactly what surgery means to us. Gender Confirmation Surgery completed me, it made me whole in mind, body and spirit. It’s such a visceral feeling/experience you can’t understand unless you’ve been through it. To me the term is quite appropriate.

    • Dara Hoffman-Fox

      December 21, 2013 at 10:41 PM Reply

      I appreciate you sharing your perspective and am glad you were able to connect with some of what I was writing about. Stop by again! 🙂

  • translife8210

    February 20, 2014 at 4:35 PM Reply

    Thank you for sharing your perspective. I really enjoyed the visualization part for cisgender people. Hopefully society will understand our dilemma and we can get proper healthcare soon. I have great insurance, it just doesn’t cover anything related to transition. I’m one of the many waiting on a miracle to have my surgery.

    • darahoffmanfox

      February 24, 2014 at 8:17 AM Reply

      Hey thanks for your comment! I think coming up with ways for cis folks to really “get” what is going on can go a long way. I truly believe that day will come, and soon, for your miracle to come true…

  • Bree Catlin

    February 24, 2014 at 7:23 PM Reply

    Thank you, as a therapist who has dealt with us, you have keen insight, no matter the terms you use. I am 5 months into HRT and have not decided what further steps I need, as i await the results. I am leaning towards the SRS/GRS/GCS or whatever other alphabet soup people pour out. but all steps HRT, FFS and the above are serious medical procedures with risk and side effects, so i have to consider carefully. Thanks for the article.

    • darahoffmanfox

      February 28, 2014 at 1:55 PM Reply

      I am glad you stopped by to read the article! My best to you in the coming days as you figure out where life takes you next…

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