Shirah Vollmer MD

The Musings of Dr. Vollmer

Should Psychiatrists Give A Patient Permission To Change Gender?

Posted by Dr. Vollmer on May 19, 2016

Jane wants to become John. She wants “top surgery” meaning she wants a double mastectomy. The surgeon requires a letter from a psychiatrist stating the patient can give informed consent. Yet, the surgeon does other procedures in which he obtains informed consent without the assistance of a mental health professional. In the surgeon’s mind, I suspect, is a fear of regret, resulting in a malpractice lawsuit, in which the letter from the psychiatrist serves as some protection. Further, for the patient to get insurance reimbursement, she/he needs a diagnosis of gender dysphoria, but who is to say that gender dysphoria is a mental illness? Yes, it causes suffering, but so does having body parts that cause distress. All of us need to decide what we accept and what we change, and perhaps, just perhaps, gender is no different. Perhaps Jane is not mentally ill, but only sees a way in which he can live in the world and be happier with himself. Perhaps Jane is navigating his world in a way that makes sense to him, and perhaps that is all that matters, given that Jane is an adult. The “Janes” of this world are a growing population; a population that gives some of us pause as to what the rules of the road really are. Jane reminds us that we are not restricted to our biological body parts and that change can happen, sometimes with happy outcomes and sometimes with sad outcomes, but this is what comes with decisions of adult life. If Jane wants help from a professional, that is an avenue that is open to him. To mandate that is simply absurd.

2 Responses to “Should Psychiatrists Give A Patient Permission To Change Gender?”

  1. Shelly said

    How can a psychiatrist assist in this assessment? Are there specialists in this arena? Do you train specifically in this field? Or does anyone who comes to you and says “I want to become a man (or woman), please help me,” automatically have “gender dysphoria”? What about those people who want a leg cut off? Is that similar or entirely different?

    • A psychiatrist can take a good history, but I am not sure that certain historical reports can either vote in favor or against gender reassignment. There is no board certification in gender issues, although there are self-proclaimed “gender specialists”. You bring up the very important issue of the difference between mutilation and enhancement. This is the debate brought up with piercings and tatoos. Cutting a leg off is clearly mutilation, but as you suggest, it is all a matter of opinion as to where to draw that line. There are no answers, only questions. Thanks and have a nice weekend.

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