Gay\transgender -- not by genetics, not by upbringing, not by choice

Let me rephrase it this way: If the majority show a negative effect, why then should an individual be consulted as to what their opinion on the matter is? It involves something far beyond their own expertice. And in fact, even the experts are a bit confussed themselves. No not all. I think there isn't enough evidence to support such a drastic operation. I feel, even in the small cases, since there is also skepticism there too, a lot more study needs to be done. So for now, I say put down the knife and get to work. Hold off on any surgery until this phenomenon is actually understood.- OniPS. I'm still waiting on ALL the evidence that was going to show it had a positive post-op effect. Not from you Straggler but from those who made that claim.

Only the individual in question knows how desperate they are. You can't seriously be suggesting that the decision as to whether to surgically remove someones genitals or not be taken independently of the person in question. Did you mean "No not at all"...? If all other currently available alternatives have been considered, the patient is fully aware of the risks, fully aware of the failure rate and yet still wants to go ahead because they feel that they just cannot go on in life as things are - I don't see any reason to deny them the opportunity to try something that might work. As your link writes:

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While sex reassignment surgery has definite medical-surgical and psychological limitations, there is insufficient evidence to warrant its termination. In deed, there is evidence suggesting that some gender dysphoric patients benefit primarily from sex reassignment surgery (reference 12 and an unpublished study by S. Satterfield).

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If the patient is reaching life threatening desperation levels then holding off on surgery may not be the best course of action. Whilst I agree with you about the need for more evidence I don't think there is sufficient evidence to warrant its termination. Some evidence that this surgery does actually have a positive outcome has been noticeably absent from this thread. I'll grant you that. The closest we have are some of the quotes you provided.

I'm just saying, the final verdict should come down to trained medical professionals. And the individual, obviously, once they've decided they want to do it.Straggler: I would like to be a woman, please.Dr. Oni: Are you sure?Straggler: Trust me, I've been living that life already. In my heart, I'm a woman.Dr. Oni: Ok. We will run the neccessary tests, consult with the brain doctor and see whats up. Now I should warn you, a majority of the patients who have this done are actually far worse after. So more than likely you won't be a fit candidate.Straggler: But I reallllyyy want to be a woman. You see there's this party and this dress I bought...Dr. Oni: I undertstand your desire to do this. But I couldn't possibly in good faith perform a surgery I didn't think would benefit you. So while you may have a strong desire I have to caution you that I am a medical doctor and my job is to heal people, not make them worse. We will let you know when we have concluded our tests.Straggler: Thank you Dr. Oni... is there, anyway, you know, that I can sway your verdict?Dr. Oni: Well, no not... excuse me can you take your hand of my leg?Straggpler: Oh c'mon, Doctor...there has to be something?Dr. Oni: Well, there is one thing...Next scene, Straggler is seen walking around the streets of London with a Barcellona jersey on screaming: Spain is the best! Spain is the best!/the end Ye Cool. I think that's just a minor disagreement between us in the grand scheme. I've been doing all the leg work in this site for quite some time. It's nothing, really. - Oni

I provided you with 3 links, 2 of which said it is NOT benefiticial. 1 said MAYBE for a very small group of people. And I didn't post anymore links. The only reason I even posted the one that said maybe in a very small few is that I wanted to find some kind of support. But mostly what I found was negative.So 1 particular report said maybe for a very small group, whilst the rest said not beneficial at all in fact the person is worse, and you feel it is valid to hang one the 1 link that was vague about their position?- Oni

Where were you looking? I tried looking on Pubmed, searching for "Sex reassignment" "Quality of life". The first relevant result you get is this one:

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RESULTS:

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Compared with a Dutch reference population of community-dwelling men, transsexual men scored well on self-perceived physical and mental health. The majority reported having been sexually active before hormone treatment, with more than a quarter having been vaginally penetrated frequently before starting hormone therapy. There was a tendency toward less vaginal involvement during hormone therapy and before SRS. Most participants reported an increase in frequency of masturbation, sexual arousal, and ability to achieve orgasm after testosterone treatment and SRS. Almost all participants were able to achieve orgasm during masturbation and sexual intercourse, and the majority reported a change in orgasmic feelings toward a more powerful and shorter orgasm. Surgical satisfaction was high, despite a relatively high complication rate.
CONCLUSION:

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Results of the current study indicate transsexual men generally have a good quality of life and experience satisfactory sexual function after SRS.

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Followed by this

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RESULTS:

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Mental health-related quality of life was statistically diminished (P < 0.05) in transgendered women without surgical intervention compared to the general female population and transwomen who had gender reassignment surgery (GRS), facial feminization surgery (FFS), or both. There was no statistically significant difference in the mental health-related quality of life among transgendered women who had GRS, FFS, or both. Participants who had FFS scored statistically higher (P < 0.01) than those who did not in the FFS outcomes evaluation.
CONCLUSIONS:

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Transwomen have diminished mental health-related quality of life compared with the general female population. However, surgical treatments (e.g. FFS, GRS, or both) are associated with improved mental health-related quality of life.

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Next, :

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This follow-up study evaluated the outcome of sex reassignment as viewed by both clinicians and patients, with an additional focus on the outcome based on sex and subgroups. Of a total of 60 patients approved for sex reassignment, 42 (25 male-to-female [MF] and 17 female-to-male [FM]) transsexuals completed a follow-up assessment after 5 or more years in the process or 2 or more years after completed sex reassignment surgery. Twenty-six (62%) patients had an early onset and 16 (38%) patients had a late onset; 29 (69%) patients had a homosexual sexual orientation and 13 (31%) patients had a non-homosexual sexual orientation (relative to biological sex). At index and follow-up, a semi-structured interview was conducted. At follow-up, 32 patients had completed sex reassignment surgery, five were still in process, and five-following their own decision-had abstained from genital surgery. No one regretted their reassignment. The clinicians rated the global outcome as favorable in 62% of the cases, compared to 95% according to the patients themselves, with no differences between the subgroups. Based on the follow-up interview, more than 90% were stable or improved as regards work situation, partner relations, and sex life, but 5-15% were dissatisfied with the hormonal treatment, results of surgery, total sex reassignment procedure, or their present general health. Most outcome measures were rated positive and substantially equal for MF and FM. Late-onset transsexuals differed from those with early onset in some respects: these were mainly MF (88 vs. 42%), older when applying for sex reassignment (42 vs. 28 years), and non-homosexually oriented (56 vs. 15%). In conclusion, almost all patients were satisfied with the sex reassignment; 86% were assessed by clinicians at follow-up as stable or improved in global functioning.

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Next, a metanalysis:

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RESULTS:

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We identified 28 eligible studies. These studies enrolled 1833 participants with GID (1093 male-to-female, 801 female-to-male) who underwent sex reassignment that included hormonal therapies. All the studies were observational and most lacked controls. Pooling across studies shows that after sex reassignment, 80% of individuals with GID reported significant improvement in gender dysphoria (95% CI = 68-89%; 8 studies; I(2) = 82%); 78% reported significant improvement in psychological symptoms (95% CI = 56-94%; 7 studies; I(2) = 86%); 80% reported significant improvement in quality of life (95% CI = 72-88%; 16 studies; I(2) = 78%); and 72% reported significant improvement in sexual function (95% CI = 60-81%; 15 studies; I(2) = 78%).
CONCLUSIONS:

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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.

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Now, on the fifth article, I finally find a less positive result:

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RESULT(S):

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Fifty-five transsexuals participated in this study. Fifty-two were male-to-female and 3 female-to-male. Quality of life as determined by the King's Health Questionnaire was significantly lower in general health, personal, physical and role limitations. Patients' satisfaction was significantly lower compared with controls. Emotions, sleep, and incontinence impact as well as symptom severity is similar to controls. Overall satisfaction was statistically significant lower in TS compared with controls.
CONCLUSION(S):

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Fifteen years after sex reassignment operation quality of life is lower in the domains general health, role limitation, physical limitation, and personal limitation.

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I can't figure out from the abstract what these people are being compared to though. Is it pre-operative transgender individuals, or non-transgender individuals? If the latter, this probably isn't the appropriate comparison for figuring out if the operation was worthwhile.These certainly aren't meant to be a slam dunk response or anything, but the fact that I have to go to the fifth study I found before getting a result that didn't indicate positive outcomes for sex reassignment, suggests that you're looking in the wrong place if you're finding it so hard to find any kind of support.

I think it is valid to point out that if things can't actually get any worse for someone (e.g. they are going to commit suicide because they cannot live in the body they have) then doing something that might work doesn't seem unreasonable.In such a case isn't it worth a shot?

So if somebody can't live without being Emperor of the World, should we comply?

Yes. I'm one of those that suffers from CLWOBEOTW syndrome.But seriously, on the issue of gender reassignment surgeries, I've always had mixed feelings about it. On the one hand, who am I to tell people what people can/can't do with their body? But on the other, it seems counter-productive and counter-intuitive to have a lasseiz fair attitude about this.Can people be "treated?" Remember that homosexuality was labeled by psychologists as a mental disorder not too long ago. In fact, Britain, through its infinite civilized wisdom, castrated one of their greatest war heroes because he was gay and drove him to suicide. Yeah, I'm talking about the father of modern computers and the breaker of enigma. So, who are we to say that people who feel the need to go through surgery for gender reassignment are diseased?My mind is actually hurting from thinking about this issue. I'm out.

There's no need to stigmatize mental illness. We all have psychological anomalies of one kind or another. When they interfere with our ability to function in society, they're called "mental illness".If homosexuality was a mental illness, so what? Our response should be to give homsexuals all of the treatment, encouragement, etc. that they need.And with any problem, whether we call it a "disorder" or not, the sensible approach is to try the least intrusive solutions first and save the major surgery as a last resort.Edited by ringo, : Amputated "n" from "an".

Ok, I'll let the cat out of the bag.Out of the 6 transgendered people I know personally, only 1 is of sound minded enough for me to trust him/her with my life. Everyone else is mentally unstable/questionable.The one transgendered person who is sound minded enough, let's call her M. M is a very smart individual. I knew M when she was a he. Very intelligent, athletic, etc. Also a very handsome guy. For a while, the ladies were flocking to him. Then when people (including myself, thought he was gay after he kept turning away the ladies. So, the gay boys started hitting on him. Well, it eventually became clear that he had his eyes on me. Go figure...Anyway, he started wearing womens clothing. Then he started letting his hair grow out. He did expressed to me several times that he... I mean she never wanted to have surgery. It kills your sex drive.All this time as I was watching M change right before my eyes in slow motion, I can vouch that he/she has always been sound minded. Not a hint of mental instability.The reason I spent several paragraphs on M is because M was the person who convinced me that transgenderism doesn't always come with cuckoo in the head. Before M, I knew half a dozen other transgendered people, and they were all not quite right up there.So, again, I honestly don't know what to think about this issue. And my head is hurting from thinking about it too much.

I note that you say M "never wanted to have surgery". I don't necessarily equate that with "sound mind" but M is certainly a best-case scenario of what transgenderism should/can be.Edited by ringo, : Spellig.

I've directly interacted with three (at least that I know of...), in varying states of transition. One even made a journal of her transition (it's posted in a private online forum, so I won't be re-posting it here unless I gain her specific approval).Of those I've interacted with, only one has ever been flagged as possibly a little "off"...but quite seriously it makes absolute sense to me that every last one of her hangups and insecurities and "odd" attitudes were due in large part to how she was received by family and "friends" and the rest of the world. Out of the three, she's also the only one from the States, and was the only one to have a strikingly negative reception, almost universally, among her previous support groups. Disowned by the family, met with hostility from friends, etc. Some pessimism, depression, and paranoia are not entirely unexpected given the general public attitude toward transsexuals in the US.And even in her case, those issues have largely seemed to subside, as she's recently been married and has made a new group of friends who don't reject her.The striking part for me is that, as they have transitioned, all of them have become more well-adjusted, happy, productive people than they were before. As their outward sex is transitioned to match their inner gender-identity, they've all experienced a true improvement in their life situations.I really don't find any reason whatsoever to question the right of a person to seek treatment, including hormone therapy and surgery, to correct their physical sex, beyond the perfectly reasonable therapy, psychiatric profiling, and multi-phased transition they already have to go through.As opposed to a person who simply wants to cut off their leg, gender reassignment does no actual harm (in fact, you'd be surprised at the quality of the reassignment surgeries these days), and it actually provides a significant improvement in quality of life for those who actually have a gender identity problem.What right should anyone have to say "that's fucked up," when the actual patients feel better afterwards, and nobody's body is affected but their own?It seems to me that most of the people who get all obsessive over whether someone's lady parts were originally included are just paranoid that they might accidentally insert their penis into a surgically created vagina, and that this would somehow be "gross" or make them gay. Popular culture still reinforces the view that transsexuals are "icky," and that even after a full surgical transition they're still really their birth gender.I recall a recent Family Guy episode where Brian has sex with Quagmire's father who recently transitioned to a woman. At first he was excited to have found a person he considered beautiful and interesting...and the moment he found out that the person he slept with had recently been a man, it turned into a puke gag.Even gays still receive some of the same treatment - straights who are for some reason afraid that some gay guy is going to hit on them, and that somehow this will make them gay, too.People bring up nonsense like "he's not really a woman, surgery only changes the way he looks," as if only genetics or the presence of ovaries or the ability to bear children can make one a "true" woman. I can't see genetics, nor does the specific presence or absence of a second "X" chromosome directly have an effect on whether I find a person attractive. I can;t see ovaries, and plenty of "real" women have either needed to have them removed or otherwise can't have kids.Personally, if a person looks indistinguishable from a woman, and wants to be identified as a woman, I'm going to call her a woman, regardless of whether she was born looking otherwise. And if I were to find out that my fiance had actually been born male...well, I don't want kids anyway, and I'd want to shake the hand of that surgeon.Why all the hangup? Why is even considering disapproval necessary?

Actually, I have the opposite reaction. I'd rather be hit on, whether I'm interested or not. I can't see molecular structure either but there's still a difference between a real drug and a placebo. You can't just change the definition of words like "real" to suit yourself. Nor do you have to stigmatize a homemade woman as opposed to a real one. Because the OP seems to be concerned with the causes of the condition.

Oh, you misunderstand me. I didn't say her sound mindedness was from not wanting to have surgery. Even if she decides on having surgery tomorrow, I would still trust her enough with my life.M really is an amazing individual. Empathetic, reasonable, logical, intelligent, humorous, pleasant, thick-skinned, etc. Of course she spent 6 years in Afghanistan as a male soldier.The point is I have not observed at all any hint that M could be anything other than completely stable and completely trust-worthy individual.But again, M is in the minority of the transgender people I know well and not so well. some appear drunk all the time. Some get ridiculously emotional for no apparent reason. Some are too sensitive at how others see them. Some have very questionable beliefs. Some just go over the top with the feminine thing.M and I talk all the time. We share a lot of the same interests. We've both been through hell, so we understand each other pretty well without having to explain things too much. What I like most about M is that she doesn't feel the need to overcompensate with the feminine thing. She dresses like any regular woman out there. Regular tasteful makeup. She's feminine, but not too much. Think natural.Here's the part that convinces me she's completely sound minded. She's not shy being naked around me. Most transgendered people I know are very shy about that. M's got a male body, and she knows it. It doesn't prevent her from living as a woman. It doesn't really make her sad or anything having male anatomy.The point is it is possible to be transgendered and be completely comfortable with whatever body you are born with. And it's also possible to be transgendered and sane.But like I said, most transgendered people I know I would never trust with my life. They always seem off up there.Edit.Here's another observation.I don't know too many women who don't take care of themselves. By that, I mean daily bath/shower, clean shaven, clean clothing, well maintained hair, etc. Men, not so much.I'm a particularly picky guy. Shower and clean shave every morning. Clean clothes. Body odor suppressor, etc.Out of all the transgender people I know well and just know, M is the only one that acts like a normal woman. Shower/bath everyday. Clean shaven all the time. Takes care of hair, clothes, etc.I don't mean to sound judgeamental, but all the other transgendered people don't take care of themselves. Half of them walk around with half a beard. Their hair's a mess. A few I can smell from a few feet away. All they've done is have breast implant and then they think they're women. They don't shower and shave everyday. Their clothes are old and dirty. They appear drunk all the time (not that they're really drunk, just act like they're drunk).If you're going to start living as a woman, at least take care of yourself. I'm 100% married man and even I take care of myself way better than those "women".Edited by Taz, : No reason given.

Just as a quick note - many of the doctors sought be transgendered folks are themselves uncomfortable with transgenderism. One of the transwomen I know was refused a pass to progress with her treatment multiple times by multiple doctors because she didn't go sufficiently overboard on the "feminine thing." According to those doctors, you had to dress like a sideshow transvestite, with a dress and clown-level makeup, to qualify as "living as a woman." They wanted her to portray a caricature of a woman, because that's what they expected a transwoman to actually be. The patient preferred to not wear dresses, and still prefers to not wear dresses even after completing her full surgical transition...just as my fiance and many other women don;t always like to wear dresses or wear excessive makeup all the time.What I'm getting at is mainly that a lot of the "odd" behavior observed in transsexuals is simply the result of their treatment in society, even amongst those who are supposed to help them. If your only chance to continue your transition is that you act "over the top" with your femininity...you very well may play the role required of you.