‘I changed for all the wrong reasons,
and then it was too late...’

When, if ever, should a person have a sex-change operation, and whose decision is it to make? Julie Bindel reports on concerns that psychiatrists are too ready to recommend the knife

Abridged from The Sunday Telegraph Magazine, 15 November 2003

Claudia, 46, describes herself as looking like ‘a middle-aged housewife’. With her long hair blow-dried into luxuriant waves and her almond eyes carefully made up, she passes well. But, as she sadly tells me in her soft Glaswegian voice, ‘I’m not a real woman, I am a sex-change.’

People like Claudia – post-operative transsexuals – are becoming more common, and more socially acceptable. This autumn Robert Briggs started term as a teacher at a London primary school; he had left at the end of summer term as Rosie Briggs. The Metropolitan Police currently employs three transgendered individuals. The Army, too, has accommodated a male warrant officer’s sex change, although she is now suing the MOD for sex discrimination, claiming she was demoted after returning to work as a woman When new legislation is introduced next year, transsexuals in Britain will enjoy more rights than homosexuals and, in some respects, unmarried cohabitees. They will be allowed to marry, to be named as parents to children born of their partners, and to hold an amended birth certificate.

Ironically, now that there is so much more awareness among the public about this issue, I can’t pass as well as I used to,’ Claudia tells me. ‘People know the signs to look out for.’ To some this may seem like evidence of an increasingly compassionate society, one in which people are being given the opportunity to become the gender they feel they always should have been and to be accepted as such. But Claudia, along with a growing number of other post-operative transsexuals – and members of the medical profession – is not happy She feels that the industry which has grown up to serve transsexuals in this country is, in its eagerness to make money, often operating on vulnerable individuals without thought for the consequences. She also believes that many of the gender assumptions at the root of transsexualism are little more than outmoded stereotypes, which can prompt people to question and even change their gender without adequate justification.

‘I changed for all the wrong reasons, and then it was too late,’ says Claudia. ‘I was seen for 45 minutes by a psychiatrist in private practice, and I believe I was railroaded into thinking that an irreversible operation was the only solution. It made me feel they were just in it for my money.’ Claudia is currently unable to work due to depression, caused by the operation: ‘I feel like this sex change has just made me into some kind of freak.’

Dr Fiona Mason, a forensic psychiatrist with an expertise in gender issues, is seriously concerned about the practices of some private clinics dealing with transsexualism. ‘I can’t imagine assessing anyone suffering from a serious disorder in under three hours. It can take three years to assess patients with complex problems. The trouble with some private clinics is that the patients are just given hormones after an hour-long appointment, which can have an irreversible effect on the body.’

Some critics are even going as far as to say that psychiatrists have not, in fact, ‘discovered’ transsexuals but created them. That is, that once ‘transsexual’ and ‘gender-identity disorder’ (GID) became common currency more people began interpreting their experience in these terms. Specialists working in gender-identity clinics made similar complaints about their patients as early as the mid-1970s. Patients were learning the symptoms of gender dysphoria and repeating them to clinicians in order to become candidates for sex-reassignment surgery. Sandra, a 25-year-old bus driver, changed sex four years ago. She is 6ft tall, with a low-cut blouse exposing her ample cleavage, and bright red hair framing a masculine face. ‘I easily   learnt what I needed to say to doctors in order to get surgery, and I know other transsexuals do the same. I felt they couldn’t wait to get hold of my money. They would have diagnosed a German Shepherd as transsexual if it had enough money for the consultation.’

Today the best-known psychiatrist dealing with transsexualism is Dr Russell Reid, who runs a private practice as well as working in the NHS. In 2000 Reid was involved in controversy over the condition known as Body Dysmorphic Disorder (BDD), where sufferers can experience a desperate urge to rid themselves of a limb. Reid was one of the psychiatrists who referred two patients with BDD to a surgeon for leg amputations. ‘When I first heard of people wanting amputations it seemed bizarre in the extreme,’ he said in a television documentary at the time, ‘but then I thought, "I see transsexuals and they want healthy parts of their body removed in order to adjust to their idealised body image," and so I think that was the connection for me. I saw that people wanted to have their limbs off with equally as much degree of obsession and need.’

But to what degree should doctors be acquiescent to the ‘obsessions’ and ‘needs’ of patients; should there be a point at which they are duty-bound to say no? I asked Dr Reid how he decides on the suitability of surgery for a GID sufferer. ‘The patient makes their own diagnosis, and I confirm or refute it. If I am happy that they are serious about considering surgery in the future, I will prescribe hormones and expect them to live as a woman (or a man, if it is a female-to-male patient) for at least a year. If, after that time, they are mentally stable, living a reasonable and public life and functioning as a whole human being, and if the hormones have been effective, I would consider them worthy of surgery.

Transsexualism is not a modern phenomenon: men wishing to be rid of their genitalia existed in some ancient cultures, such as native North American tribes. But little is known of its causes. In the 1950s, when sex-change surgery on men was being pioneered, transsexuals were viewed as mentally ill deviants. Dr Harry Benjamin, a physician and endocrinologist based in America, was the first to distinguish between transsexualism and homosexuality, ascribing a specific condition to feelings of gender discomfort in his 1966 book The Transsexual Phenomenon. He argued that transsexualism is a medical condition in which patients have an innate gender identity opposite to their sex.

Gender reassignment surgery for men and women can be carried out on the NHS or privately, and costs upwards of £10,000. There are also large amounts of money to be made from counselling those in doubt about whether to have the surgery, with one-hour consultations costing up to £150. For men the surgery can include the removal of both testicles and penis, reduction of the Adam’s apple, and the surgical construction of a vagina. Other changes, such as breast-growth, beard-reduction and skin-softening are achieved through hormone treatment.

But this is only the beginning. Most people who change sex rely on adopting traditional appearance and behaviour patterns to enable them to ‘pass’ as their chosen gender. Men who change to women rarely dress in jeans or wear their hair short, instead striving towards an extreme form of femininity, presumably to contrast as much as possible with the way they looked as men. The medical transsexual industry – together with the shops and mail-order companies which sell products to transsexuals – fully subscribes to this notion of womanhood, and promotes it as the proper image to seek.

’The perceptions most transsexuals and their psychiatrists have about women are not true,’ says Claudia. ‘They want to look like Joan Collins, and that is not how the majority of women look.’ Jenny, 59, the owner of a women’s bookshop in York, is similarly critical. Dressed in jeans, and not wearing a wig, she recalls how ‘when you are seeking a sex-change operation, perceptions of gender among most of the professionals: means that you are expected to turn up for appointments in dresses and make-up. You are encouraged to behave like a woman in all the stereotypical ways, a bit like products of 1950s finishing schools.’

Sarah Maguire, an expert on gender and human rights for the United Nations, blames such gender stereotyping for the current boom in sex reassignment surgery. ‘Were it not for the fact that we have such polarised notions of what it is to be a man or a woman, we would not have transsexualism,’ she argues. ‘If women want to fix cars, and men make curtains, then so what? It does not warrant a diagnosis of gender dysphoria because a boy loves his Barbie doll. The problem is that psychiatrists, surgeons and counsellors have a vested interest in diagnosing as many transgender people as possible.’

During the pre-operative stage of transition, many psychiatrists will look out for signs that their patients are adapting to ‘womanhood’ though dressing, walking and talking in what they perceive to be a conventionally feminine way. One Internet site aimed at transsexuals offers tips for men wishing to pass as women. ‘Repeat constantly to yourself, raising your voice at least one octave, “Am I going shopping today? Could you tell me the time please? Can I try this blouse on, please?’”

Transformation is a chain of six shops catering for male transsexuals and transvestites – one in 10,000 men in this country identifies himself as the former, one in 100 cross-dresses – and it sells a staggering array of items, from wet-look maid’s uniforms to stick-on vaginas. The promise to customers is that ‘once inside you are enveloped into a magical world of femininity where we will turn your feminine fantasy into reality.’ When I visit the branch in Euston, central London, a huge Greek man in working clothes is experiencing just that. Having carefully felt the fabric on a selection of evening gowns he finally picks out a red one disappears into a changing-room, along with a pair of size ten high heels. A complete overhaul in Transformation - including hair removal, hormone creams, clothing, and nightwear, wig and shoes, false breasts and vagina, bottom shaper, HRT, and make up – would cost about £2,500.

But there are still some things money can’t buy ‘Our customers get themselves dolled up in wigs and finery,’ Sharon, the manager, tells me, ‘but let themselves down with the way they walk and sit. I’m always telling them, “For God’s sake, close your legs, or at least cross them. Don’t sit there with everything on display!’”

It is ironic that clothes and behaviour patterns often rejected by modern women are seen as a key part of successful gender reassignment (one hormone cream even claims to enable men to feel the symptoms of PMT). Claudia says this is why she finds it difficult to fit in with most other transsexual women. ‘They look like gross parodies of 1950s starlets. But the truth is, it would not be such a successful industry if the psychiatrists just advised men who want to be women to look like Martina Navratilova. It would not have the same appeal nor require so much change.’

A growing Phenomenon is that of female-to-male transsexualism, with several operations conducted every year, which can include double mastectomy, hysterectomy and phalloplasty (the construction of a penis using skin grafts from the arms or stomach). Testosterone enables beard growth, muscle development and lowering of the voice. David Ralph, one of the two surgeons in the country who carry out phalloplasty operations, claims he currently has a waiting list of a hundred. Again, it looks as if the very fact that such operations are on offer is encouraging some women unhappy with their gender to change it, rather than adapt. ‘Because the operations are now so good, more want them,’ says Ralph, who insists that by the time he performs surgery the step has been carefully considered by both the psychiatrist and the patient.

Passing as a man is no problem for Stephen Whittle. At 47 he is short and muscular, with a deep voice, beard and cropped hair. Whittle, a senior law lecturer, is the most prominent campaigner in the transsexual community in Britain. Twenty-eight years ago he was a woman. Now he lives with his partner, Sarah, and their four young children (conceived using a sperm donor). Whittle is convinced that transsexuals should be in total control of their diagnosis and treatment. ‘No amount of study of transsexualism has provided any answers. Psychiatrists cannot diagnose if someone is transsexual, they can only do very basic diagnostic processes, such as ruling out other conditions that might complicate the symptoms. The question about whether someone is transsexual is if they choose to make the transition. If they do it, then it’s the right thing to do.’

Claudia strongly disagrees, believing that it was the medical professionals’ willingness to allow her to self-diagnose which resulted in her now unwanted sex change. It is estimated that about 20 per cent of those undergoing gender reassignment are similarly unhappy with the results. Although there is no proven scientific basis for transsexualism, many believe it is rooted in genetics. Dr Lyndsey Myskow, a GP and sex therapist at the Royal Infirmary, Edinburgh, counsels equal numbers of men and women wishing to change sex and points out, ‘There was a study in 1995 where the brains of six exhumed transsexuals were examined and found to be more like those of the opposite gender.’

How early might children realise something is wrong? ‘Definitely by three years old. If girls are playing primarily with trucks and footballs, and boys with dolls and prams, then there’s very likely a problem.’ Yet such evidence is far from conclusive. ‘We are not yet firmly embedded in the camp where we can say it’s genetic,’ admits Stephen Whittle.

So are children who grow up as tomboy girls or feminine boys being encouraged to believe they have been ‘born in the wrong body’?

Admittedly I felt desperate to have a sex-change operation, but I’m not sure I knew my own mind,’ recalls Sandra. ‘The psychiatrist told me that as long as I was felt that I was the wrong gender, I could have the hormones there and then. I had a one-hour interview with a psychiatrist, who was happy to refer me to a surgeon. He kept asking me if I played with dolls and prams when I was a child, and did I want to wear dresses? For me, it was about hating my body, but I hate it more now it’s been butchered. I tried to talk about how repulsive I thought my father was who abused me and beat my mother. My sex change was me trying to run away from myself. I’d have been better having therapy than surgery.’

Particularly disturbing is the apparent impunity with which children are diagnosed with ‘gender identity disorder’. Mermaids, a support group for children and teenagers with GID, has seen a dramatic increase enquiries since it opened its doors in 1993. Children as young as 14 are receiving sex-change treatment, including being prescribed drugs to block the onset of puberty. But evidence from the Portman Clinic’s gender identity development service in London suggests that one in four teenagers who want ‘gender-reassignment’ will later change their minds. Whatever the genetic and psychological realities of transsexualism, it seems it is often too easy to embark on a journey that will fundamentally change the rest of your life. Transsexualism is the only psychiatric or medical condition where the patients can, to all intents and purposes, diagnose themselves. While many post-operative transsexuals are happy with their new identity, others such as Claudia speak of feelings of betrayal, and of being permanently trapped between two worlds.

’I want psychiatrists and surgeons to provide a more realistic explanation of what you will be left with, physically and emotionally, after the operation,’ she says. ‘If by speaking out I can prevent another confused, messed up individual going through this, it will have been worth it’.

Abridged from The Sunday Telegraph Magazine, 15 November 2003