Post by Ayla on Mar 6, 2016 8:47:47 GMT 8
A disappointing article that lionises Walt Heyer followed by some interesting "discussion" on a Catholic forum
"Doctors need to show that surgery can resolve psychological distress
I have just been reading a disturbing book: Paper Genders by Walt Heyer. First published in 2011, it is an important document because, as the author writes in his subtitle, it is about “Pulling the Mask off the Transgender Phenomenon”. This phenomenon, as readers will have noticed, is being increasingly thrust into the public forum as more and more people are given space to write of their (or their children’s) problems identifying with their gender.
I find something slightly sinister about this publicity – but not, I hasten to add, with its victims. I am reminded of the huge and implacable advance of the movement to change the ancient, biological and religious definition of marriage and the success it has had in the western world (though not in Africa, China, in East European countries or in Russia.) Are we now to see a similar assault on the ancient, biological and religious difference of gender as either male or female? Or can you change your gender simply because you feel you are living in the wrong body? Transgender people believe you can.
This is not the same as having a rare intersex condition, where babies are born with both male and female organs and where there is genuine confusion at birth as to their sex. Corrective surgery at a later stage is often advised in cases like this. People who become transgender have been identified as to their sex at birth in the straightforward way; but at some stage they reject this birth gender for the opposite one. Needless to say, this causes much heartbreak and pain for all concerned, not least the sufferer.
The question raised by Heyer’s book is: what should the medical, surgical and psychological fraternity do when faced by such cases? Is it ethical to offer hormonal and chemical treatment and finally gender reassignment surgery to patients or should they be offered psychotherapy and other help instead, in order to help them come to terms with their biology and their DNA?
Heyer is clear that patients are suffering from a mental disorder for which they require the right kind of treatment – not radical surgery which, as his title indicates, cannot actually deliver the emotional and mental peace that people are desperately seeking. In other words, you cannot change your sex, even if on paper – ie your birth certificate, your passport and other official documents – it states that you have done so.
To those who might challenge the assumptions of Paper Genders and say Heyer doesn’t know what he is talking about, he would respond, “Yes I do.” For Heyer himself, born a boy, and who later married, who had a family and who was a successful businessman, was deeply unhappy in his male identity for many years...."
Hilary Howes, CMG • 9 hours ago
To not find the answer to the question Does hormone therapy and GRS resolve gender dysphoria you have to overlook a large number of well documented scientific studies, the finding of medical and psychological professional organizations, many countries health care systems and the many biographies of transgender people themselves and only look at the long discredited theories of Paul McHugh and the books of Walt Heyer. I think your readers deserve better.
grennachio • a day ago
I think I would be concerned if an attempt to understand the human condition of sexuality in its strange, rich variety were to be reduced to the matter of considering some such varieties as ‘mental problems’ It is more a cultural/sociological one and should be understood as such.
Those days when such and such a condition could be deemed sinful (and in general accepted as such by the wider society) have passed because such notions may not today gather all that much of a purchase on the sensibilities of a generally secular populace. One way (and a spurious one, I think) around this is to look to ‘mental problems’ and ‘psychiatric’ explanations in order to cope with such phenomena. Some religions and some churches do indeed do precisely this. Not all, though!
I think it is more a sociological and cultural matter than a mental one that seeks remedies. Anyway, who defines ‘mental‘ and/or the relevance of an application of the word ‘psychiatric‘ to all this. ‘Mental’ is often a boo-word uttered and shoved into the politics of culture where one experience of the human condition is pitted against and confronts something different, a long established orthodoxy which grapples to understand what happens when in Brecht’s words - “the continuity of the ego is a myth.” Fixed and established ideological representations are shattered and are now up for grabs Certainly, for instance, the history of ‘homosexuality’ in the Catholic Church’s understanding of it has wandered off, once the notion of sinfulness has enjoyed less of a grip in the age of modernity, into the realms of psychiatry and mental problems, where it may not belong. If it’s a sin, it’s a sin and not a mental problem.
Concerning the topic in question various cultures and religions handle it differently. The so-called theocratic perspective offered by Islam in the religious Republic of Iran, (whilst no doubt the envy of perhaps many a sub-Saharan country with a colonial Christian legacy) utterly condemns homosexuality and calls for and implements death penalties against it but looks compassionately on the human psyche in its explorations and longings for a particular sexual identity, those areas where the person feels that they are trapped in the wrong sexual body. Iran has carried out many, many operations to turn ‘men into women’ and ‘women into men’. Has it been successful? The above article looks to the problems occasioned by those who having experienced a change come to regret it. Remember, not all regret such a life-changing operation; many carry on happily in their new status. Nonetheless I recall seeing on TV a young ‘lady’ who had transitioned from being a young man into a beautiful to look at and seemingly stunning instance of femininity. A young Mullah had written a book on the subject and stressed how modern and sympathetic the teachings of the faith as instanced in Iran, were in this regard However, ‘She’ (a young ‘lady’ in the programme) deeply regretted the whole transitioning process but it could not be reversed and whilst some of her fellow transitioners in that religious republic rejoiced in their new permanency she woefully and tearfully lamented her now irreversible plight.
Further afield the lady boys in Thailand instance a culturally established, well institutionalised process whereby the male can be schooled via operations and medical assistance into the new identity. Is it a way out of poverty where such new forms of sexual being are able to garner the attention of well-placed foreigners and tourists - is it cruel or unfair to say that an economic niche meets happily with a new cultural form, through a sort of process of elective affinity?
I do not find the ‘mental’ approach all that enlightening, informative or stimulating. Perhaps the secular pied piper plays his merry/sad tune and garners behind him a whole troupe of pied beauties.
Hilary Howes, CMG • 9 hours ago
To not find the answer to the question Does hormone therapy and GRS resolve gender dysphoria you have to overlook a large number of well documented scientific studies, the finding of medical and psychological professional organizations, many countries health care systems and the many biographies of transgender people themselves and only look at the long discredited theories of Paul McHugh and the books of Walt Heyer. I think your readers deserve better.
Bella Hilary Howes, CMG • 8 hours ago
Your comment in the NCR deserves a place here and I hope that is acceptable to you. If not please reply and I will remove it. ---
"I [Hilary Howes] am transgender and catholic and feel called to help christians with their acceptance of transgender people. I think that the idea that God has made a mistake is a mistake. I accept that God has some reason for making me transgender although I am sure I don't know what it is and it took me a long time to get to that acceptance. Gender variant people exist in every society and throughout history and cross-gender behavior is seen in many species so I feel I have to accept that it must be part of gods plan. Perhaps the better question is why are we as a culture so concerned about it? What possible difference would my gender make if we really treated all genders as equal? The power structure that rests on inequality and class is the real reason there is any question about transgender people in religion, politics, or anything else. Wouldn't it be more Christian to get over that stuff?
Majorana Fermion Uncle Brian • 2 days ago
A bit of a misrepresentation, I'm afraid, as many doctors and researchers in the field now see transgender people who must chemically and surgically transition as being of mixed sex development. There are over 20 sex-dimorphic sites & attributes in the brain, more in the skeletal system, and in the endocrine regulation systems. How they develop, the gene expression dances that must take place at certain crucial steps...it's all fairly well understood. And what's also well understood is that they do NOT necessarily have to develop in parallel with the one part used by the birth doctor to assign sex at birth on the paperwork. Oh, and those 20+ sex-dimorphic brain sites? They include the locations for the sense of Self (damage it and you have trouble knowing you from other) and the brain's low level, hard wired map of the body. The sex-dimorphic endocrine receptors include those that help co-regulate Serotonin. If they don't get the receptor they developed for (remember, their development path does not have to necessarily match the one used for birth paperwork) then serotonin regulation becomes difficult after puberty. This negatively affects sleep regulation, hunger, thirst, mood, immune, autoimmune and a few other functions.
So really, if you look at what has been learned in neurology, endocrinology, developmental biology and genetics since 1994, you'll understand why the various medical establishments and specialities now endorse treating trans people with hormones and surgery. And they tend to be fairly conservative organizations - they make those choices based on overwhelming proof.
buckingham88 Majorana Fermion • 18 hours ago
Does this explain why so many, proportionally, gender reassigned people end up being sectioned or on the streets?
Majorana Fermion buckingham88 • 7 hours ago
No, that's pretty much completely society's fault. In areas of the country where trans people are accepted and legally protected against discrimination, those rates are far lower. It's an economic problem, not a medical or mental one.
buckingham88 Majorana Fermion • 3 hours ago
So the brain chemistry that causes all the differing conflicts in a persons brain you tell us of, does not lead to any other dysfunction?
In your mind, if the only problem for mental health is society's attitude, all you need do is fix society and no one would have mental health issues.
Not so.
One cannot rule out organic mental disease as a driver.
I am genuinely interested in knowing the answer to my question.
I am after a field study.
You clearly have read a lot in this area.
Can you give me some reference that allows me to answer the question I put to you.
Why is it that transsexuals end up sectioned or on the streets or both?
This is a real pastoral area for the CC.
In my, albeit limited, experience the greatest discrimination against transsexual people, having talked to them, comes from the LGBT community itself, which is riven with conflict.
They don't seem a good fit, in some people's eyes.
Generally transsexuals are not considered in the same group but as outsiders.
I see this will cause great distress.
However the mental illness attached would appear to be part of the problem of alienation as well as part of the cause.
Using your analogy a Venn diagram [you talked overlapping bell curves, but you get my drift], where there is overlap in cause and effect between mental illness, social dysfunction thus caused, community acceptance and care, religious tolerance, any other factor, nutrition, housing or lack of it, could be drawn.
I note your prodigious out put of blogs on this subject, around the clock and trans continental.
I would appreciate your finding such an article for me, kind regards.
see more
Majorana Fermion buckingham88 • 3 hours ago
Actually it is not "brain chemistry". It's merely sex-dimorphic brain sites (different for men and women, on a spectrum not a binary despite the di- prefix) that correctly developed but in the direction "opposite" expectations based on birth sex assignment by a doctor.
I believe the Williams Institute may have put out a fair number of published papers on what you seek.
On huge influence is that 40% of homeless youth are LGBT. And their primary reason for being homeless is that their conservative Christian parents threw them out of the family house as young as 12 or 13 because they would not stop being LGBT. Many of them are indeed trans.
buckingham88 Majorana Fermion • an hour ago
Thanks for the reply.
Beg to strongly differ on neuroscience.
You cannot ignore brain chemistry.
Many in the community experiment with drugs to alter their brain chemistry, sometimes to self medicate for depression and suicidal thoughts.
Some are genetically prone to mental illness caused by shifts or lack of neurotransmitters.
From what your experience is, all we need to do is get rid of conservative Christians and all our problems will go away. No more youth on the streets.
This sounds like a strongly held belief statement.
I have asked you for studies, your reply is so vague.
This is a genuine enquiry.
If the science and medicine is so strong, lets see it.
Majorana Fermion buckingham88 • an hour ago
"Many in the community experiment with drugs to alter their brain
chemistry, sometimes to self medicate for depression and suicidal
thoughts.
Some are genetically prone to mental illness caused by shifts or lack of neurotransmitters."
Are those not true of non-trans people as well, and in the same percentages, or do you have some proof that trans people are more prone to physiologically (ie not environmentally) caused mental illnesses?
Uncle Brian Majorana Fermion • a day ago
Majorana, I’ve read your comment twice, but I haven’t found in it your answer to the question I raised, which is this: In your view, does “gender reassignment surgery” change the patient’s sex, or doesn’t it?
Majorana Fermion Uncle Brian • a day ago
No, surgery does not change a person's sex. That's why you don't see it called "sex change surgery" any longer & why so many trans people object to that term.
What it does is take an incongruent part of the body and reshapes it to match their sex. Which is determined not by the shape of that one body part pre-surgery, but rather by their neuroanatomy (and often, their endocrine & skeletal systems & a number of other sex-dimorphic attributes).
For the vast majority of people, their 'sex' = that one body part, the rest of their body parts, their social gender role, their sexuality...anything that we humans use to drop people into a vague, general bucket of male or female. They dont' realize those are actually separate, independent attributes because for them, they always matched. Medicine & esp. neurology now recognizes that isn't always so and that's starting to be reflected in social changes. It's not actually a threat, just change.
Uncle Brian Majorana Fermion • a day ago
No, surgery does not change a person’s sex.
On that point, at least, we’re in full agreement, though not, I suspect, on very much else.
Thank you, Majorana.
Majorana Fermion Uncle Brian • a day ago
Unfortunately the devil is in the details. Since we differ at such a basic level as how 'sex' is defined, our agreement is essentially meaningless in any practical sense. From my POV, the surgery *confirms* a trans persons's sex.
www.catholicherald.co.uk/commentandblogs/2016/03/03/gender-reassignment-surgery-the-questions-that-still-need-answers/
"Doctors need to show that surgery can resolve psychological distress
I have just been reading a disturbing book: Paper Genders by Walt Heyer. First published in 2011, it is an important document because, as the author writes in his subtitle, it is about “Pulling the Mask off the Transgender Phenomenon”. This phenomenon, as readers will have noticed, is being increasingly thrust into the public forum as more and more people are given space to write of their (or their children’s) problems identifying with their gender.
I find something slightly sinister about this publicity – but not, I hasten to add, with its victims. I am reminded of the huge and implacable advance of the movement to change the ancient, biological and religious definition of marriage and the success it has had in the western world (though not in Africa, China, in East European countries or in Russia.) Are we now to see a similar assault on the ancient, biological and religious difference of gender as either male or female? Or can you change your gender simply because you feel you are living in the wrong body? Transgender people believe you can.
This is not the same as having a rare intersex condition, where babies are born with both male and female organs and where there is genuine confusion at birth as to their sex. Corrective surgery at a later stage is often advised in cases like this. People who become transgender have been identified as to their sex at birth in the straightforward way; but at some stage they reject this birth gender for the opposite one. Needless to say, this causes much heartbreak and pain for all concerned, not least the sufferer.
The question raised by Heyer’s book is: what should the medical, surgical and psychological fraternity do when faced by such cases? Is it ethical to offer hormonal and chemical treatment and finally gender reassignment surgery to patients or should they be offered psychotherapy and other help instead, in order to help them come to terms with their biology and their DNA?
Heyer is clear that patients are suffering from a mental disorder for which they require the right kind of treatment – not radical surgery which, as his title indicates, cannot actually deliver the emotional and mental peace that people are desperately seeking. In other words, you cannot change your sex, even if on paper – ie your birth certificate, your passport and other official documents – it states that you have done so.
To those who might challenge the assumptions of Paper Genders and say Heyer doesn’t know what he is talking about, he would respond, “Yes I do.” For Heyer himself, born a boy, and who later married, who had a family and who was a successful businessman, was deeply unhappy in his male identity for many years...."
Hilary Howes, CMG • 9 hours ago
To not find the answer to the question Does hormone therapy and GRS resolve gender dysphoria you have to overlook a large number of well documented scientific studies, the finding of medical and psychological professional organizations, many countries health care systems and the many biographies of transgender people themselves and only look at the long discredited theories of Paul McHugh and the books of Walt Heyer. I think your readers deserve better.
grennachio • a day ago
I think I would be concerned if an attempt to understand the human condition of sexuality in its strange, rich variety were to be reduced to the matter of considering some such varieties as ‘mental problems’ It is more a cultural/sociological one and should be understood as such.
Those days when such and such a condition could be deemed sinful (and in general accepted as such by the wider society) have passed because such notions may not today gather all that much of a purchase on the sensibilities of a generally secular populace. One way (and a spurious one, I think) around this is to look to ‘mental problems’ and ‘psychiatric’ explanations in order to cope with such phenomena. Some religions and some churches do indeed do precisely this. Not all, though!
I think it is more a sociological and cultural matter than a mental one that seeks remedies. Anyway, who defines ‘mental‘ and/or the relevance of an application of the word ‘psychiatric‘ to all this. ‘Mental’ is often a boo-word uttered and shoved into the politics of culture where one experience of the human condition is pitted against and confronts something different, a long established orthodoxy which grapples to understand what happens when in Brecht’s words - “the continuity of the ego is a myth.” Fixed and established ideological representations are shattered and are now up for grabs Certainly, for instance, the history of ‘homosexuality’ in the Catholic Church’s understanding of it has wandered off, once the notion of sinfulness has enjoyed less of a grip in the age of modernity, into the realms of psychiatry and mental problems, where it may not belong. If it’s a sin, it’s a sin and not a mental problem.
Concerning the topic in question various cultures and religions handle it differently. The so-called theocratic perspective offered by Islam in the religious Republic of Iran, (whilst no doubt the envy of perhaps many a sub-Saharan country with a colonial Christian legacy) utterly condemns homosexuality and calls for and implements death penalties against it but looks compassionately on the human psyche in its explorations and longings for a particular sexual identity, those areas where the person feels that they are trapped in the wrong sexual body. Iran has carried out many, many operations to turn ‘men into women’ and ‘women into men’. Has it been successful? The above article looks to the problems occasioned by those who having experienced a change come to regret it. Remember, not all regret such a life-changing operation; many carry on happily in their new status. Nonetheless I recall seeing on TV a young ‘lady’ who had transitioned from being a young man into a beautiful to look at and seemingly stunning instance of femininity. A young Mullah had written a book on the subject and stressed how modern and sympathetic the teachings of the faith as instanced in Iran, were in this regard However, ‘She’ (a young ‘lady’ in the programme) deeply regretted the whole transitioning process but it could not be reversed and whilst some of her fellow transitioners in that religious republic rejoiced in their new permanency she woefully and tearfully lamented her now irreversible plight.
Further afield the lady boys in Thailand instance a culturally established, well institutionalised process whereby the male can be schooled via operations and medical assistance into the new identity. Is it a way out of poverty where such new forms of sexual being are able to garner the attention of well-placed foreigners and tourists - is it cruel or unfair to say that an economic niche meets happily with a new cultural form, through a sort of process of elective affinity?
I do not find the ‘mental’ approach all that enlightening, informative or stimulating. Perhaps the secular pied piper plays his merry/sad tune and garners behind him a whole troupe of pied beauties.
Hilary Howes, CMG • 9 hours ago
To not find the answer to the question Does hormone therapy and GRS resolve gender dysphoria you have to overlook a large number of well documented scientific studies, the finding of medical and psychological professional organizations, many countries health care systems and the many biographies of transgender people themselves and only look at the long discredited theories of Paul McHugh and the books of Walt Heyer. I think your readers deserve better.
Bella Hilary Howes, CMG • 8 hours ago
Your comment in the NCR deserves a place here and I hope that is acceptable to you. If not please reply and I will remove it. ---
"I [Hilary Howes] am transgender and catholic and feel called to help christians with their acceptance of transgender people. I think that the idea that God has made a mistake is a mistake. I accept that God has some reason for making me transgender although I am sure I don't know what it is and it took me a long time to get to that acceptance. Gender variant people exist in every society and throughout history and cross-gender behavior is seen in many species so I feel I have to accept that it must be part of gods plan. Perhaps the better question is why are we as a culture so concerned about it? What possible difference would my gender make if we really treated all genders as equal? The power structure that rests on inequality and class is the real reason there is any question about transgender people in religion, politics, or anything else. Wouldn't it be more Christian to get over that stuff?
Majorana Fermion Uncle Brian • 2 days ago
A bit of a misrepresentation, I'm afraid, as many doctors and researchers in the field now see transgender people who must chemically and surgically transition as being of mixed sex development. There are over 20 sex-dimorphic sites & attributes in the brain, more in the skeletal system, and in the endocrine regulation systems. How they develop, the gene expression dances that must take place at certain crucial steps...it's all fairly well understood. And what's also well understood is that they do NOT necessarily have to develop in parallel with the one part used by the birth doctor to assign sex at birth on the paperwork. Oh, and those 20+ sex-dimorphic brain sites? They include the locations for the sense of Self (damage it and you have trouble knowing you from other) and the brain's low level, hard wired map of the body. The sex-dimorphic endocrine receptors include those that help co-regulate Serotonin. If they don't get the receptor they developed for (remember, their development path does not have to necessarily match the one used for birth paperwork) then serotonin regulation becomes difficult after puberty. This negatively affects sleep regulation, hunger, thirst, mood, immune, autoimmune and a few other functions.
So really, if you look at what has been learned in neurology, endocrinology, developmental biology and genetics since 1994, you'll understand why the various medical establishments and specialities now endorse treating trans people with hormones and surgery. And they tend to be fairly conservative organizations - they make those choices based on overwhelming proof.
buckingham88 Majorana Fermion • 18 hours ago
Does this explain why so many, proportionally, gender reassigned people end up being sectioned or on the streets?
Majorana Fermion buckingham88 • 7 hours ago
No, that's pretty much completely society's fault. In areas of the country where trans people are accepted and legally protected against discrimination, those rates are far lower. It's an economic problem, not a medical or mental one.
buckingham88 Majorana Fermion • 3 hours ago
So the brain chemistry that causes all the differing conflicts in a persons brain you tell us of, does not lead to any other dysfunction?
In your mind, if the only problem for mental health is society's attitude, all you need do is fix society and no one would have mental health issues.
Not so.
One cannot rule out organic mental disease as a driver.
I am genuinely interested in knowing the answer to my question.
I am after a field study.
You clearly have read a lot in this area.
Can you give me some reference that allows me to answer the question I put to you.
Why is it that transsexuals end up sectioned or on the streets or both?
This is a real pastoral area for the CC.
In my, albeit limited, experience the greatest discrimination against transsexual people, having talked to them, comes from the LGBT community itself, which is riven with conflict.
They don't seem a good fit, in some people's eyes.
Generally transsexuals are not considered in the same group but as outsiders.
I see this will cause great distress.
However the mental illness attached would appear to be part of the problem of alienation as well as part of the cause.
Using your analogy a Venn diagram [you talked overlapping bell curves, but you get my drift], where there is overlap in cause and effect between mental illness, social dysfunction thus caused, community acceptance and care, religious tolerance, any other factor, nutrition, housing or lack of it, could be drawn.
I note your prodigious out put of blogs on this subject, around the clock and trans continental.
I would appreciate your finding such an article for me, kind regards.
see more
Majorana Fermion buckingham88 • 3 hours ago
Actually it is not "brain chemistry". It's merely sex-dimorphic brain sites (different for men and women, on a spectrum not a binary despite the di- prefix) that correctly developed but in the direction "opposite" expectations based on birth sex assignment by a doctor.
I believe the Williams Institute may have put out a fair number of published papers on what you seek.
On huge influence is that 40% of homeless youth are LGBT. And their primary reason for being homeless is that their conservative Christian parents threw them out of the family house as young as 12 or 13 because they would not stop being LGBT. Many of them are indeed trans.
buckingham88 Majorana Fermion • an hour ago
Thanks for the reply.
Beg to strongly differ on neuroscience.
You cannot ignore brain chemistry.
Many in the community experiment with drugs to alter their brain chemistry, sometimes to self medicate for depression and suicidal thoughts.
Some are genetically prone to mental illness caused by shifts or lack of neurotransmitters.
From what your experience is, all we need to do is get rid of conservative Christians and all our problems will go away. No more youth on the streets.
This sounds like a strongly held belief statement.
I have asked you for studies, your reply is so vague.
This is a genuine enquiry.
If the science and medicine is so strong, lets see it.
Majorana Fermion buckingham88 • an hour ago
"Many in the community experiment with drugs to alter their brain
chemistry, sometimes to self medicate for depression and suicidal
thoughts.
Some are genetically prone to mental illness caused by shifts or lack of neurotransmitters."
Are those not true of non-trans people as well, and in the same percentages, or do you have some proof that trans people are more prone to physiologically (ie not environmentally) caused mental illnesses?
Uncle Brian Majorana Fermion • a day ago
Majorana, I’ve read your comment twice, but I haven’t found in it your answer to the question I raised, which is this: In your view, does “gender reassignment surgery” change the patient’s sex, or doesn’t it?
Majorana Fermion Uncle Brian • a day ago
No, surgery does not change a person's sex. That's why you don't see it called "sex change surgery" any longer & why so many trans people object to that term.
What it does is take an incongruent part of the body and reshapes it to match their sex. Which is determined not by the shape of that one body part pre-surgery, but rather by their neuroanatomy (and often, their endocrine & skeletal systems & a number of other sex-dimorphic attributes).
For the vast majority of people, their 'sex' = that one body part, the rest of their body parts, their social gender role, their sexuality...anything that we humans use to drop people into a vague, general bucket of male or female. They dont' realize those are actually separate, independent attributes because for them, they always matched. Medicine & esp. neurology now recognizes that isn't always so and that's starting to be reflected in social changes. It's not actually a threat, just change.
Uncle Brian Majorana Fermion • a day ago
No, surgery does not change a person’s sex.
On that point, at least, we’re in full agreement, though not, I suspect, on very much else.
Thank you, Majorana.
Majorana Fermion Uncle Brian • a day ago
Unfortunately the devil is in the details. Since we differ at such a basic level as how 'sex' is defined, our agreement is essentially meaningless in any practical sense. From my POV, the surgery *confirms* a trans persons's sex.
www.catholicherald.co.uk/commentandblogs/2016/03/03/gender-reassignment-surgery-the-questions-that-still-need-answers/
