There’s a patient attribute so fundamental to successful cosmetic surgery that every plastic surgeon worth his or her salt looks for it carefully in each consultation. It’s not that a patient has a concrete idea of the procedure(s) they want, or that they understand exactly what surgery entails, or that they have a large budget at their disposal.
No, the most important characteristic a plastic surgery candidate must demonstrate is a healthy attitude. This means they are emotionally well grounded, have reasonable expectations for their results and are psychologically ready to go under the knife.
When Emotional Health is an Issue
Because this is unfortunately not the case with every patient, board certified plastic surgeons are trained to evaluate cosmetic surgery candidates. They are well aware that some people desire a procedure with unrealistic hopes for the ultimate results—such as landing a job or winning a partner back. They also know that many people with Body Dysmorphic Disorder (BDD), an estimated 1% of the general adult population, seek plastic surgery one or more times during their lives. These patients need to go to counseling rather than to the surgical suite.
It’s reasonable to suppose that transgender individuals may be more likely to have emotional health challenges than the average plastic surgery candidate. As they come to grips with gender dysphoria, they face a world in which life is not easy. They may be shunned by their friends, schoolmates and even their own family. They may suffer discrimination in employment, housing, healthcare and more, not to mention abuse and violence. Transgender individuals have a shockingly high rate of suicide, according to an article in the Los Angeles Times last year, at 41%, or nine times the national average.
The Role of Transgender Surgery
All that said, we reject the notion that “gender change is self-destructive” put forth by some ultra conservatives and even some transgender people themselves. We found a piece in the Federalist last month to be unfortunately typical of what some people believe:
Gender change is at its heart a self-destructive act. Transgenders not only annihilate their birth identity, they destroy everyone and everything in their wake: family, wife, children, brothers or sisters, and career. Certainly this demonstrates the behavior of someone hell-bent on total self-destruction and self-harm.
The author of the article, a transgender person who ultimately underwent surgery to reverse his change from male to female, went on to assert that:
Taken to the extreme, self-destruction leads to suicide.
In other words, this gentleman feels that transgender surgery is a significant contributor to the high rates of suicide among those with gender dysphoria.
Alternate Views on Transgender Suicide
It’s undeniable that those who do not feel comfortable with their “assigned” gender have a higher rate of suicide than the general population, and we know that some take their lives following plastic surgery. But rather than see surgery as a cause, we believe the contributing factors outlined in the LA Times article make more sense. Referring to a study by researchers at the UCLA School of Law, the article pointed to discrimination, violence, HIV status and homelessness as directly related to suicide attempts.
Interestingly, the UCLA team also found that being “out” raised the risk of suicide, and concluded that in today’s world, being seen as transgender makes people a more likely target for discrimination. They also noted that those with strong family ties were less likely to take their lives.
Transgender Surgery in our NYC Practice
It’s clear that in spite of recent media coverage and growing understanding of the range of possibilities related to gender and sexual orientation, it is premature to think that transgender individuals can easily flourish in today’s society. There are many hurdles to overcome. Many transgender people suffer a great deal along the way, and some give up the fight.
For all these reasons, when we meet a candidate for transgender surgery in our New York City consulting room, we take extra time to get to know them. We encourage them to talk about their experiences, good and bad, as they explored their gender identity. We pay particular attention to the strength of their support system, including what kind of counseling they have had and their network of family and friends.
When we meet a patient requesting woman to man or man to woman surgery, we will not move ahead unless we feel as certain as the candidate does that the procedure will improve his or her quality of life. If there is any doubt, we will suggest counseling instead.
But this is because we may suspect that plastic surgery will not help, not because we believe transgender surgery causes suicide.
Photo by BK available through a Creative Commons attribution license