By Ryan T. Anderson
Originally published November 2018
Why should a doctor perform surgery when it won’t make the patient happy, it won’t accomplish its intended goal, it won’t improve the underlying condition, it might make the underlying condition worse, and it might increase the likelihood of suicide? Sound medicine isn’t about desire, it’s about healing.
In Sunday’s New York Times, Andrea Long Chu writes a heartfelt and heartbreaking op-ed on life with gender dysphoria. Titled “My New Vagina Won’t Make Me Happy,” the op-ed reveals painful truths about many transgender lives and inadvertently communicates almost the exact opposite of its intended argument.
Next week, Chu will undergo vaginoplasty surgery. Or, as Chu puts it: “Next Thursday, I will get a vagina. The procedure will last around six hours, and I will be in recovery for at least three months.”
Will this bring happiness? Probably not, but Chu wants it all the same: “This is what I want, but there is no guarantee it will make me happier. In fact, I don’t expect it to. That shouldn’t disqualify me from getting it.”
Chu argues that the simple desire for sex-reassignment surgery should be all that is required for a patient to receive it. No consideration for authentic health and wellbeing or concern about poor outcomes should prevent a doctor from performing the surgery if a patient wants it. Chu explains: “no amount of pain, anticipated or continuing, justifies its withholding.”
This is a rather extreme conclusion. Chu writes: “surgery’s only prerequisite should be a simple demonstration of want.” This is quite a claim. And we’ll come back to it. But as the op-ed builds to this stark conclusion, Chu reveals many frequently unacknowledged truths about transgender lives—truths that we should attend to.
Sex Isn’t “Assigned,” and Surgery Can’t Change It
First, Chu acknowledges that the surgery won’t actually “reassign” sex: “my body will regard the vagina as a wound; as a result, it will require regular, painful attention to maintain.”
Sex reassignment is quite literally impossible. Surgery can’t actually reassign sex, because sex isn’t “assigned” in the first place. As I point out in When Harry Became Sally, sex is a bodily reality—the reality of how an organism is organized with respect to sexual reproduction. That reality isn’t “assigned” at birth or any time after. Sex—maleness or femaleness—is established at a child’s conception, can be ascertained even at the earliest stages of human development by technological means, and can be observed visually well before birth with ultrasound imaging. Cosmetic surgery and cross-sex hormones don’t change biological reality.
People who undergo sex-reassignment procedures do not become the opposite sex—they merely masculinize or feminize their outward appearance.