We watched the recent 60 Minutes segment highlighting people de-transitioning—meaning reversing the decision to transition to the gender opposite the one they were assigned at birth—with some dismay. We do believe it’s important to understand the reasons why a few people change their minds. But we feel the CBS piece did the trans community more harm than good by focusing on de-transitioners. As an organization serving people who elect transgender top surgery in New York, we want to weigh in.
Broader Discussion Needed
The segment began by discussing an Arkansas law passed last month prohibiting doctors from treating transgender youth. Along with several other states, Arkansas is on track to make it a crime for doctors to, for instance, prescribe hormones to block puberty. This move to deny care is an alarming trend worth exploring.
The story, entitled “transgender healthcare,” then shifted to introduce several young people who had started to transition and changed their minds, becoming “de-transitioners.” This is a key unfortunate aspect of the program. Instead of bringing up other, more common medical challenges for the transgender community—such as access to basic healthcare without discrimination—60 Minutes chose to focus on an issue for a very small slice of the population. Many people are still not well informed about all the health challenges trans people face, and we believe it would have been more useful to present the broader topic.
Not only would a broader discussion have been helpful, bringing up the topic of de-transitioners right after talking about restrictive legislation may imply that people changing their minds is a valid reason for laws like the one unfolding in Arkansas.
Satisfied or Not?
The program mentioned in only a quick comment, “the vast majority of transgender youth and adults are satisfied with their transitions” before spending several minutes on de-transitioning. There are apparently few studies to date; but those that do exist point to de-transitioning after surgery as “exceedingly rare.”
Acknowledging that we are just one voice in the mix, those findings track with our experience with top surgery in New York. We have performed many dozens of procedures by now, and not one patient has expressed regret. Instead, we are gratified at the joy top surgery can bring transgender patients.
Trans people still struggle for acceptance in society, there’s no doubt. We feel that shining a bright light on the small percentage of those who change their minds about transitioning is just another instance of non-support for the community.
Standards of Care
It was worthwhile for 60 Minutes to note that in the de-transitioning cases presented, standards of care may not have been properly observed. At least two of the young people interviewed indicated they had not received adequate counseling.
The World Professional Association for Transgender Health (WPATH) publishes a Standards of Care manual that should be the foundation of any health organization’s protocols for trans people. The WPATH manual is a good resource for medical professionals working with transgender people of all ages. The guide presents extensive recommendations for exploring gender dysphoria, providing education on the variety of gender expressions recognized today, discussing any coexisting mental health concerns and referring patients to other providers.
Top Surgery in New York
As we meet transgender patients seeking male to female or female to male top surgery in New York, we determine that they have received good care and they are coming to us at an appropriate point in their journey. We recommend other plastic surgeons assess readiness by making sure each patient:
• Has had effective counseling
• Has been living for some time as their new gender
• Has good primary care
• Has started hormone therapy
• Has a decent support system
It’s concerning, as 60 Minutes pointed out, that unprepared providers may be tempted to jump into the transgender healthcare market, as there’s money to be made, and in the words of one professional interviewed, trans people “are interesting.” We urge medical practitioners who want to provide care to do their homework first.
The medical community betrays trans people in many ways, starting with basic denial of care. Even knowing a few people do change their minds, we agree with one physician interviewed by 60 Minutes, “Stories of de-transitioners means the transgender community as a whole needs more and better healthcare, not bans on treatment.”
We feel the show should have presented a more balanced look at transgender health. As this article available through the National Institutes of Health notes, the biggest barrier to good care for trans people is lack of knowledge on the part of providers. Other barriers include financial issues, discrimination, socioeconomic challenges and more.
We also believe that illustrating a point about subpar medical care for the trans community by highlighting the small percentage of people dissatisfied with a gender affirming decision was not a good strategy for CBS. It feels like just another betrayal.
We welcome transgender patients, like our friend Adonis, to our practice in New York for top surgery and other procedures to enhance their lives. We enjoy working with them and making decisions together.