Sex Reassignment Therapy - Controversy

Controversy

In 1967, John Money, a prominent sexologist at Johns Hopkins Hospital, recommended that David Reimer, a boy who had lost his penis during a botched circumcision, be sexually reassigned and raised as a girl. Despite being raised as a girl from the age of 18 months, Reimer was never happy as a girl, and when he learned of his sex reassignment, he immediately reverted to living as a male. Money never reported on the negative outcome of Reimer's case, but in 1997, Reimer went public with the story himself. His case, as well as several cases of intersexed infants with conditions such as cloacal exstrophy who have been reassigned and raised as females, suggest that gender identity is innate and immutable. Milton Diamond, the winner of the Norwegian Diversity Prize for his research efforts on behalf of transsexual and transgender people worldwide, had tracked down Reimer, discovered the failure of his sex reassignment, and exposed his case.

In 1979, when Paul McHugh became chairperson of the psychiatric department at Johns Hopkins, he ordered the department to conduct follow-up evaluations on as many of their former transsexual patients as possible. When the follow-ups were performed, they found that most of the patients stated that they were happy as members of their target sex, but that their overall level of psychological functioning had not improved. McHugh reasoned that to perform physical gender reassignment was to "cooperate with a mental illness rather than try to cure it." At that time, Johns Hopkins closed its gender clinic and has not performed any sex reassignment surgeries since then.

A similar conclusion came from James Beatrice in 1985. He used the Tennessee Self-Concept Scale and found no significant difference in self-acceptance among pre- and post-operative male-to-female transsexuals, transvestites and a control group. Based on further analysis with the Minnesota Multiphasic Personality Inventory he concluded "The results suggest that these transsexuals may be at risk for further deterioration of their psychological status if sexually reassigned."

Analyses of recent studies have stressed problems with randomization, control groups, and self-report in follow-up assessments. A 1997 and 2004 review of follow-up studies by the University of Birmingham concluded "The degree of uncertainty about any of the effects of gender reassignment is such that it is impossible to make a judgement about whether the procedure is clinically effective." A 2010 meta-analysis of follow-up studies reported "Very low quality evidence suggests that sex reassignment that includes hormonal interventions in individuals with GID likely improves gender dysphoria, psychological functioning and comorbidities, sexual function and overall quality of life. MF transsexuals may have worse outcomes than FM individuals."

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