|Concerns|   |Questions| 

Concerns

Lack of accountability

There are only a few medical professionals in Australia who specialize in sex reassignment and they all work together and have a sort of interchange{1}. Despite the fact that these doctors have been administering sex reassignment procedures for more than thirty years now, the long-term outcome for their patients remains unknown. There has never been any adequate review of government funded gender dysphoria services and the administration of sex change procedures has not been sufficiently monitored or controlled.

Pre-Surgical concequences of sex modification

Cross-sex hormones have a profound effect on the human body, changing its appearance to that of the opposite sex.

Hormone treatment for the male to female patient causes the development of breasts and, unless these are very small, their removal leaves significant scarring from near the armpits to the middle of the chest. Those having electrolysis to remove facial and/or body hair will never again be able to grow a beard or moustache. The effects of the hormones could also leave them infertile and thus incapable of fathering children.

Hormone treatment for the female to male patient can likewise cause infertility, unwanted facial and body hair, an irreversible deepening of the voice, toughening of the skin, thinning of hair, elongation of the clitoris and so on.

Approximately 30% of patients who are placed on sex reassignment hormones decide that a sex change is not right and stop hormone therapy of their own accord.

Post-surgical concequences of sex modification

Persons who embark on the of sex reassignment surgery will never be able to return to a point where they are able to experience sex in the way in which one naturally does with physiologically normal and healthy sexual organs.

Men who undergo vaginoplasty (removal of the penis and construction of an artificial vagina) are, of course, left infertile and incapable of ever engaging in natural sexual relations.

Women who have undergone mastectomies will never be able to breastfeed and augmentation will never restore the appearance and feeling of their original breasts. Those who undergo a hysterectomy will, of course, never be able to bare children and those who undergo phalloplasty (artificial construction of a penis) will never again be able to engage in natural sexual relations.

This is not to mention the profound social and economical barriers to reversing the sex change. Faced with the prospect of living an isolated and lonely life on the outskirts of society without any real possibility of marriage and family, too many find suicide their only remaining option.

There are no reliable figures on the number of patients who regret surgery or commit suicide subsequent to surgery. This is mostly due to the large losses to follow-up typically associated with studies into this kind of treatment. It is not uncommon to find that nearly half of the patients in these studies fail to return or cannot be located subsequent to surgery.

 |Concerns|   |Questions| 

Questions

Questions about sex modification

• What mechanisms do the government have in place for the monitoring and control of gender reassignment procedures?
• What psychotherapy, if any, has been and is being provided to patients (a) during initial assessment, (b) during hormonal treatment and the ‘real life test’ and (c) following surgery?
• Are patients being adequately warned about the irreversible effects of hormonal treatment?
• How many patients placed on sex reassignment hormones subsequently decide to cease hormone therapy?
• What percentage of patients who decide to quit hormone treatment have suffered irreversible effects as a result of that treatment?
• What psychological support is provided to assist patients in coming to terms with unwanted irreversible effects of hormone treatment?
• How many patients, after undergoing gender reassignment surgery, express regret and want to return to living in their biological gender?
• What assistance is provided to those patients who, after having undergone gender reassignment surgery, wish to reverse as much a possible the effects of the sex change procedures and what is the long-term prognosis for these patients?
• Why hasn't the government reviewed the short-term and especially the long-term outcome of patients treated with sex reassignment procedures?
• Have assessments been made as to the number of patients who were better off after having undergone surgery as compared to those who ended up no better off or worse than they were before the treatment? If so, what were the assessment criteria used?
• Has the government determined the number of patients that have committed suicide or have died prematurely from other causes subsequent to undergoing sex-reassignment procedures?
• Are patients being informed about all the various theories on the nature of their condition and the treatment options available?
• Are patients being lead to believe that their condition is biological and irreversible and that SRS is the only ‘solution’ ?
• What percentages of gender dysphoric patients are being treated with gender reassignment procedures?
• What percentages of gender dysphoric patients are being treated with psychotherapy?
• What long-term outcome studies have been conducted, if any, to determine the efficacy and long term prognosis of patients treated with psychotherapy to those treated with sex reassignment procedures?
• How much government funding is being provided directly to support gender reassignment procedures?
• What is the total level of Medicare funding being provided for gender reassignment procedures?
• How much are gender reassignment procedures costing the private health care system?