Column: Sometimes transitioning doesn’t end with gender reassignment surgery

With the issues facing the transgender community, surgery isn’t always the best choice for some, and that’s okay.

Abigail Ruhman is a freshman journalism and political science major at MU. She is an opinion columnist who writes about student life, politics and social issues for The Maneater.

This column is part 10 of Abigail Ruhman’s “Twelve Gays of Christmas” series. Twelve Gays of Christmas is a twelve-column series about a variety of LGBTQ topics. During the holidays, members of the LGBTQ community are more likely to experience depression. By informing readers of the issues facing the LGBTQ community, these columns are meant to support the community this holiday season.

There are a lot of myths surrounding the LGBTQ community. While some are small, there is one assumption that needs to end as soon as possible — if someone is transgender, they don’t need gender reassignment surgery to transition.

Transitioning is a long process that doesn’t always include surgery. Transitioning isn’t just about matching the physical aspects of gender. It also includes the mental, emotional or spiritual components of gender.

By limiting the concept of gender to just the physical parts, society ultimately hurts transgender individuals. When society says that surgery is necessary in order to transition, they automatically link the idea of gender to a costly, emotionally taxing medical procedure.

Even before surgery can happen, the transgender individual has to go through hormone therapy. Combined with the prejudice and personal bias that medical professionals or health care providers have, the process of hormone replacement therapy can become difficult.

Approximately 61 percent of transgender and gender nonconforming respondents told the 2011 National Transgender Discrimination Survey that they have medically transitioned. Only 33 percent said that they had gender reassignment surgery. In addition, only 14 percent of transgender women and 72 percent of transgender men said they didn’t want gender reassignment surgery.

The process starts with the individual deciding if it is in their best interest to start hormone therapy. This is a combination of feeling completely comfortable with their own gender identity, as well as being prepared to share this with a medical professional. The emotional and mental strength that it takes to deal with hormone therapy takes time to build up.

Once the individual has decided they are prepared to go through hormone replacement therapy, they have to find a hormone prescriber. There are two ways to go about this: either they can talk to their current health care provider or they can find a new one.

The issue is that 33 percent of study participants experienced at least one negative experience with a health care provider related to being transgender, according to the National Center of Transgender Equality’s 2015 U.S. transgender survey.

Discrimination against transgender individuals runs so deep that they can be denied general care. This means that even after deciding to begin hormone replacement therapy, transgender individuals can struggle to find a health care professional that is willing to work with them.

Assuming that transgender individuals can find a provider, the next step is a physical and mental health assessment. This is to determine if the individual has gender dysphoria, which means that someone feels that their gender identity doesn’t match the gender they were assigned at birth. Many places require this diagnosis in order to begin hormone replacement therapy, but it’s categorized as a mental health diagnosis.

This means they have to prove they are transgender, and are then told that they have a mental illness. The danger in this is that there is a stigma surrounding both the transgender community and the mental health community. Combining these stigmas can result in a negative connotation for the transgender community.

After all of these steps, the individual is then allowed to begin hormone therapy. That’s just the beginning for people wanting gender reassignment surgery. It shouldn’t require the possibility of discrimination and an emotionally stressful process just to be considered “transitioned.”

If someone decided to do hormone replacement therapy and the gender reassignment surgery, it wouldn’t just be emotionally taxing. It would also be financially stressful. With the format of health care right now, the medical bills surrounding gender reassignment surgery can reach as high as $100,000 out of pocket, according to CNN.

Linking gender to genitalia is ultimately transphobic, and is a shallow approach to a societal construct. Gender is fluid and isn’t always the way society wants it to be. Just because someone doesn’t fit within the lines that society has drawn doesn’t mean that they haven’t transitioned.

Transitioning is less about the physical aspects and more about how that person chooses to present themselves. Some think that coming out is transitioning, while others think that starting hormone therapy is. It’s not society's job to tell someone that they have or haven’t transitioned, but it is society’s responsibility to respect that person’s identity.

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