Talk:Sex reassignment therapy/Archive 2

Reorg done, please help clear fallout
The reorg has been done! All the tidy neat sections are here!

Also here are a few new references, and i probably botched them, as CS1 is very complicated. And because of time limitations I just had to stop adding/changing things, concentrating on making the reorg itself work. AS a result, the "ethical/cultural/political" part is rather sparse at present - but at least it's here to add things from Hijra to details of insurance coverage, without cluttering up the medical parts.Ramendik (talk) 02:31, 5 February 2014 (UTC)


 * Thanks. I am removing some superfluous opinions scattered throughout the article and placing them here.  Here are the things I've removed from the article to clean it up (click edit to see the text):

(opinionated text) <!-- ::Some individuals who desire sex reassignment therapy do not have gender identity disorder, as the term is usually defined, and desire to transition for other reasons. Individuals who choose to pursue sex reassignment therapy may include homosexual people who are unable to accept their homosexuality, or who are encouraged by caretakers to change their gender role (this was the case in the USA up to the 1970, and survives at present at least in Iran ); some cross-dressers who feel more comfortable dressed as members of the opposite gender, although it is important to realize that many transsexual women go through a period where they self-identify as cross-dressers; and people with certain psychiatric disorders, such as schizophrenia, borderline personality disorder, dissociative identity disorder, and Munchausen syndrome. (Brown 106–107)


 * Some transsexual people have pressured the American Psychiatric Association to remove Gender Identity Disorder from the DSM. Many of these people feel that at least some mental health professionals are being insensitive by labeling transsexualism as "a disease" rather than as an inborn trait. Furthermore, many people have expressed concerns that in viewing transsexualism as "a disease" some psychologists and psychiatrists have sought to develop specific models of transsexualism such as Ray Blanchard's model, which may exclude many transsexual people.


 * Other people, under the position that transsexuality is a physical condition and not a psychological issue, assert that sex reassignment therapy should be given if requested, and may even align with those who feel that all body modification should be offered on demand. (Brown 103)


 * Some activists express concern that the rules or requirements for diagnosis of transexuality and sex reassignment therapy are almost always determined by non-transsexual medical personnel who have the power to allow or deny a transsexual person's will to transition, based on their own perceptions of how a transsexual person should act and/or appear. These perceptions are sometimes prejudiced or based largely on cultural stereotypes; for example, medical personnel may reject a transsexual man as a candidate based on the length of his hair, judging it to be "too long" even though many non-transsexual men like to wear long hair.


 * A recent study done on trans women has shown that a real-life test of less than one year, or no real-life test at all, does not increase the likelihood that a patient will regret genital reassignment surgery. Many transsexual people opt for a real-life experience longer than is officially required, to remove any doubts they may have of whether they should undergo surgery or for financial reasons.


 * Many transgender and transsexual activists, as well as many caregivers, state that health and health-related problems are not usually related to the gender identity issues themselves, but to problems that arise from dealing with a gender identity that does not match an assigned gender role and the related social conflicts. Many feel that the health-related problems from the gender identity conflict are much more likely to be diagnosed in transsexual people than in the general population. Transsexual people are usually required to visit a mental health professional to obtain approval for hormones and sex reassignment surgery, thus exposing the transsexual community to a higher level of evaluation for mental health issues than the general populace.


 * Therapists' records reveal that many transsexual people do not believe they need psychological treatment as mandated by the Harry Benjamin Standards of Care, but rather they will acquiesce to legal and medical expectations in order to gain rights which are granted through the medical/psychological hierarchy. (Brown 103) Legal needs such as a change of sex on legal documents, and medical needs, such as sex reassignment surgery, are usually impossible to obtain without a doctor and/or therapist's approval. Due to this, many transsexual people feel coerced into affirming pre-ordained symptoms of self-loathing, impotence, and sexual-preference, in order to overcome simple legal and medical hurdles. (Brown 107) Transsexual people who do not submit to this medical hierarchy typically face the option of remaining invisible, with limited legal options and, possibly, with identification documents incongruent with gender presentation.


 * Another recently coined term in the medical community is Genital Correction Surgery (GCS), which emphasizes that the sex reassignment surgery is merely correcting the genitals to match the inner sense of an individual's gender.


 * Prior to surgery, transsexual men and women are often referred to as pre-operative (pre-op); those who have already had the surgery may be referred to as post-operative (post-op) or simply identified as members of the sex to which they have transitioned. Not all transsexual people undergo sexual reassignment surgery (either because of the high cost of such surgery, medical reasons, or other reasons), although they live constantly in their preferred gender role; these people are often called non-operative (non-op).


 * A more modern idea suggests that the focus on surgery status is misplaced, and therefore, an increasing number of people are refusing to define themselves in terms of operative status, often defining themselves based on their social presentation instead. Many transsexual people believe that SRS is only a small part of a complete transition. -->


 * Also, I wonder if we can maintain this about intersex people. Perhaps a link to "sex assignment" (which deals more with intersex issues) at the bottom of the article would help (click edit to see text):

(text on intersex)


 * This should allow us to start fresher with the article. I will also archive the older comments here. --Beneficii (talk) 04:49, 5 February 2014 (UTC)
 * I think the part where people w/o transsexualism/GD avail of GRT should not be removed, as it is referenced (though some of it in the old "Brown 105" format) and factual. The part where ppl with other diseases seek it might not belong in Eligibility. The Iran part does because "eligibility" does not equal "eligibility in the West" (WP:WORLDVIEW). Won't put it back before getting your opinion though - I'd like to avoid WP:EW. Ramendik (talk) 13:03, 5 February 2014 (UTC)
 * Thanks. I am in agreement.  I'm not sure how to fit it into the article, though, so I leave that up to your judgment.  Let's see what you do with it. :) --Beneficii (talk) 07:42, 6 February 2014 (UTC)
 * Here's another. We may want to redo the way the citations are done as well for that Brown source:
 * While some feel that formal diagnosis helps to destigmatize transsexualism, others feel that it only adds stigma, essentially feeling that such a diagnosis is equivalent to saying something really is wrong with them. (Brown 105)
 * --Beneficii (talk) 05:24, 5 February 2014 (UTC)


 * In my opinion, you have removed too much from the article. A lot of this material, for example, would have fit well in a History section, which is an aspect of WP:MEDMOS and is permitted by WP:MEDRS. WP:MEDRS does not suggest that we can't use any single studies or primary studies at all. And the repeated bolding of "sex reassignment therapy" is out of hand; that should only be bolded once, per WP:MOSBOLD and MOS:BOLDTITLE. Flyer22 (talk) 06:00, 5 February 2014 (UTC)


 * Information about Paul McHugh came back in the reorg, it's now in the ethical/cultural section as its primary notability is not medical. (It is a documented case of ethics-derived bias, and is usually cited by political opponents of treatment). As for a History section, it was raised before, the problem is that it might overlap with https://en.wikipedia.org/wiki/Sexual_reassignment_surgery#History, as before the development of synthetic hormones, surgery was the only way available. So the question is what to put in the History section apart from some older single studies. I actually feel such a section would be a good idea - just not sure how to populate it. Ramendik (talk) 12:46, 5 February 2014 (UTC)


 * A lot of the issues were with opinionated statements that were interspersed with factual statements in parts of the article that should have just been about the facts, like the issues of diagnosis and eligibility, and the various treatments. Opinions should be moved to their own area, but I wasn't sure where to immediately move them, so I hid them in this thread.  What do you think should be done with them?  Ramendik seems to have the right idea by looking at these issues in the social/ethical/political considerations section, so perhaps we should work on moving them there?


 * I could perhaps add back the 2010 Sweden study. Also, there was a couple of really old primary sources that didn't seem to be referenced in any of the reliable, recent medical secondary sources, so I thought that maintaining them in the article would violate WP:UNDUE and WP:MEDDATE and so removed them.


 * Glad to have you aboard. We can now work faster to improve this article on then have it reassessed on WikiProject Medicine, to move it beyond start class. --Beneficii (talk) 15:00, 5 February 2014 (UTC)


 * Also, if you want to create a history section, then let's see what you come up with. Remember WP:BE_BOLD. --Beneficii (talk) 15:01, 5 February 2014 (UTC)


 * The WP:OVERLINKING is also a problem; Wikilinks should generally only appear once in an article, though WP:OVERLINKING makes a few exceptions. Flyer22 (talk) 06:04, 5 February 2014 (UTC)

considering removing broken/outdated and not verify tags
In light of the expansion, I am considering removing the broken/outdated and not verify tags. Please post here any specific objections to that (i.e. any citations you find that are broken or outdated or do not verify the text). --Beneficii (talk) 17:05, 3 March 2014 (UTC)

Terrible article
This whole article is simply terrible and is clearly written from an advocacy position. Pretty much everything is bad here. Staring with the title. These procedures do not alter the "sex" of the people, instead they would call it "gender" not "sex." A sex change is not a real thing (at least in this point in medical science). This error is repeated again in the "Sex reassignment surgery" section. There's much more wrong with the article, but that's a start. — Preceding unsigned comment added by 24.207.136.200 (talk) 15:21, 25 October 2014 (UTC)

Historical?
This kind of procedure (castration) has been performed on gender non conforming men for centuries typically against the will of the person. Shouldn't there be some mention of this? — Preceding unsigned comment added by 24.207.136.200 (talk • contribs)
 * First off, castration already has an article. Secondly, castration (removal of the testes) is not sex assignment. Men do not stop becoming men if they undergo orchiectomy for cancer treatment, for example. Apples and oranges - A l is o n  ❤ 19:36, 21 November 2014 (UTC)
 * Why would it not be mentioned that similar procedures on gender nonconforming (gay) people have been performed for centuries? It's obviously relevant.  — Preceding unsigned comment added by 24.207.136.200 (talk) 19:02, 12 January 2015 (UTC)

broad clinical consensus
This is false and needs to be changed. "The review of more than 100 international medical studies of post-operative transsexuals by the University of Birmingham's aggressive research intelligence facility (Arif) found no robust scientific evidence that gender reassignment surgery is clinically effective. " http://www.theguardian.com/society/2004/jul/30/health.mentalhealth  — Preceding unsigned comment added by 24.207.136.200 (talk) 18:59, 12 January 2015 (UTC)


 * I would advise against that, because the statement of the existence of a broad clinical consensus comes from a reliable secondary source, the American Psychiatric Association; Birmingham's study does not make mention of whether there is a consensus. Also, the same secondary source does mention that there are few robust scientific studies showing the effectiveness of sex reassignment, which is actually in agreement with the Birmingham study that you posted, but it also adds some context to the statement: Robust scientific studies on this issue would largely be impractical or unethical to carry out, so experts in the field must lean more on clinical experience. --Beneficii (talk) 01:15, 21 January 2015 (UTC)

Paul R. McHugh and WP:LABEL?
I noticed this edit by which was made to remove the note of Paul R. McHugh's religion, citing WP:LABEL. Reading that page I don't see how it's relevant, the full title is "contentious labels". Is saying that he's "a psychiatrist affiliated with the Roman Catholic Church" contentious? It seems very relevant here; the previous paragraph describes how the Catholic Church is morally opposed to sex reassignment. Describing him instead as "a well-known opponent of sex reassignment therapy" seems much more subjective and vague, which is exactly what WP:LABEL warns against. — Flower f5a9b8 03:26, 17 November 2015 (UTC)
 * The article in the New York Times which was cited in the article in no way links McHugh's opinions about sex reassignment surgery to his religious beliefs. McHugh was director of the Department of Psychiatry and Behavioral Science at the Johns Hopkins University for 26 years.  His reasons for opposing this surgery seem founded in empirical research.  Unless you can find a reliable source stating that McHugh's opposition was based on his being a Catholic...then don't add just to demonize this person and make a sloppy point.  Editors must maintain a neutral point of view.  Magnolia677 (talk) 04:22, 17 November 2015 (UTC)

Expanding on the psychological treatment section
The section on psychological treatment currently reads:


 * According to the WPATH SOC v7, "Psychotherapy (individual, couple, family, or group) for purposes such as exploring gender identity, role, and expression; addressing the negative impact of gender dysphoria and stigma on mental health; alleviating internalized transphobia; enhancing social and peer support; improving body image; or promoting resilience" is a treatment option.

I added this, from the same version of the SoC (here's the context so you don't have to download the pdf):


 * It also states "Treatment aimed at trying to change a person’s gender identity and expression to become more congruent with sex assigned at birth has been attempted in the past without success (Gelder & Marks, 1969; Greenson, 1964), particularly in the long term (Cohen-Kettenis & Kuiper, 1984; Pauly, 1965). Such treatment is no longer considered ethical."

I was trying to expand on the section and the statement in the opening that "Treatment of gender dysphoria does not involve attempting to correct the patient's gender identity".

This was removed here. I took it to the user's talk page, but that was a mistake. Here's the conversation, which I was advised to copy across:


 * Hi, I just saw your revert of my edit here claiming that it's a 50 year old quote. That is not the case: it's from the SoC Version 7, the same version as the quote directly above it that I was expanding on. This version was published in 2012. The studies it cites are old, but clearly the organisation still considers them definitive.


 * I actually just typed out a comment questioning another of your edits, here. I'll keep this separate as these are two separate issues. — Flower f5a9b8 03:33, 17 November 2015 (UTC)


 * No matter how recent the source was, the quote you added is 50 years old. My grandpappy was buying his new Oldsmobile when your quote was written, and you want to add it to a current article about sex reassignment surgery?  Get real. Magnolia677 (talk) 03:41, 17 November 2015 (UTC)


 * Thanks for responding, I'm sure we can come to an understanding without this being adversarial. You can download WPATH's Standards of Care Version 7 if you want to verify the source of the quote for yourself. It - like the passage directly above it - comes from that version of the SoC, which had not been published prior to 2012. I don't understand what you mean when you say that the source is recent, but the quote isn't. I am quoting directly from the SoC, it is not a passage that the SoC has quoted (although I'm unsure how that would undermine it anyway). It is quite common for scientists to refer to older studies when writing about a topic, in cases where those studies were important and no studies since then have called their findings into question.


 * All I'm interested in is improving the article, and the article states very early on that "Treatment of gender dysphoria does not involve attempting to correct the patient's gender identity, but to help the patient adapt." I think many people will wonder why that is, why the section on psychological treatment does not discuss this. The quote I added explains why this is not viewed as a treatment option. If you think that this is not relevant information for the article that people would not be interested to know, then please let me know why. I can certainly see that I could be wrong along those lines and would be open to being convinced of it. However I do not think that the quote can be dismissed on the basis of its source, any more than the one directly above it which I was adding to. — Flower f5a9b8 18:21, 17 November 2015 (UTC)
 * I have no expertise on this subject, and no opinion about the scientific merit of the information you added. I'm concerned about the encyclopedic value of adding a review of 50 year-old literature.  Magnolia677 (talk) 02:43, 18 November 2015 (UTC)
 * Just a thought, but perhaps you should both read WP:MEDRS. John from Idegon (talk) 04:02, 18 November 2015 (UTC)


 * "medical guidelines and position statements from... international expert bodies" is an exact description of the SoC. Later on it calls medical guidelines or institutional position papers "ideal sources". On the topic of older research it notes "an older primary source that is seminal, replicated, and often-cited may be mentioned in the main text in a context established by reviews", which seems to back up what I've been saying (Reimer certainly fits that description). Not really surprising - if the 50 year-old literature is good enough for WPATH to base their position on, why on earth would it not be good enough for us? Even if it wasn't, surely we could just remove the citations and quote their conclusions on the basis that they are an international expert body? — Flower f5a9b8 20:21, 18 November 2015 (UTC)


 * And you both need to take this to the article talk page. Wide review of editing is the most important tool in the proper interpretation of medical sources. I have no idea which of you is right and very little interest in finding out.  Just trying to make sure we present the best information possible.  Let some people who do know what they are talking about in on the discussion.  Feel free to copy this discussion over to the article talk page. John from Idegon (talk) 20:57, 18 November 2015 (UTC)


 * Thanks for the help, I'm fairly new to wiki editing (or at least I still feel constantly out of my depth) and I really appreciate getting pointers. I started this conversation here rather than on the talk page because I was already discussing an edit this user made there (I linked to it above) and I expected this issue to be a simple clarification. I really don't see how the source could be an issue when it's already used throughout the article on the exact same topic, but I'm very happy to leave the discussion to other people. I don't come to wikipedia to get my head bitten off. — Flower f5a9b8 00:24, 19 November 2015 (UTC)


 * I support adding the quote into the section. If current secondary sources quote it, and if indeed current secondary sources depend on it, then it belongs in the article. This is the correct interpretation of WP:MEDRS. Naturally, we should cite the secondary source, perhaps having the primary sources accompany it. --Beneficii (talk) 16:58, 29 November 2015 (UTC)


 * I think I see your error here:
 * It also states "Treatment aimed at trying to change a person’s gender identity and expression to become more congruent with sex assigned at birth has been attempted in the past without success (Gelder & Marks, 1969; Greenson, 1964), particularly in the long term (Cohen-Kettenis & Kuiper, 1984; Pauly, 1965). Such treatment is no longer considered ethical."[11]
 * If I were you, I'd take those citations in parentheses out and just quote directly from the WPATH standards. --Beneficii (talk) 00:23, 1 December 2015 (UTC)


 * Thanks for helping with this. I guessed that WPATH's citations wouldn't be wanted in the article, but I wasn't sure how to format it. I tried to copy the existing formatting of the section I was adding to, but the part of the source used for the previous quote doesn't have citations so it's not directly comparable. I thought that leaving it unedited would be the best way to avoid accidentally breaking policy or causing misunderstandings, and that someone would reword it if it wasn't right.


 * I've been looking through policy some more though, and I think after going through WP:INTEXT and WP:QUOTE I could give it a go. From my understanding of them one large direct quote is really not ideal, so the current paragraph in that section could probably be reworked a bit too. If discussion ends up indicating that there isn't any problem with the source of my addition, I'll maybe see if I can rephrase the section when I edit it again. For the part I added, perhaps something like this would be better?


 * Using psychotherapy to change a person's gender identity and gender expression has been attempted in the past without success, particularly in the long term. WPATH states that "such treatment is no longer considered ethical."


 * — Flower f5a9b8 02:10, 4 December 2015 (UTC)


 * OK. There don't seem to be any objections. Go ahead and add it. --Beneficii (talk) 03:39, 10 December 2015 (UTC)

Statement of opinion
This statement from the "Ethical, Political and Cultural" section strikes me as entirely opinion, especially as it is single sourced and goes against the grain of many other references in the article: "though few post-operative transsexuals believe that sexual reassignment surgery was a mistake for them". Memarshall (talk) 05:32, 29 January 2016 (UTC)

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Common name for the "medical aspect of gender transitioning" is "Sex reassignment surgery"
See extreme variant in usage on google trends:

In books:
 * "Sex reassignment surgery" gets "... 38,900 results" while
 * "Sex reassignment therapy" gets "... 2,560 results" with no inclusion of this term in the book titles.
 * 
 * 

I'd suggest that the article would better be titled: "Sex reassignment surgery" and that any relevant mention of "Sex reassignment therapy" might be made within the article text.

GregKaye 18:58, 10 July 2018 (UTC)
 * We already have a Sex reassignment surgery article. Flyer22 Reborn (talk) 07:01, 11 July 2018 (UTC)

A Commons file used on this page has been nominated for speedy deletion
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