Gender reassignment surgery: An outmoded operation?

Do we really need another GRS clinic in Canada? Or is gender reassignment surgery — or gender confirmation surgery, as some refer to it these days — becoming a less popular option for those who identify as the opposite of their birth sex designation?

In the days after the only clinic in Canada that offers GRS surgery was attacked by an arsonist, many in the mainstream media and social media as well as transgender advocates said the incident highlighted the need for more GRS clinics across the country.

Yet, some of those same trans advocates have successfully lobbied for the right to change one’s gender designation on official documentation without having to undergo GRS or any type of cosmetic surgery. Most provinces in Canada allow an individual to simply change their gender designation by signing some papers.

Indeed, there seems to be a movement in Canada away from gender reassignment surgery, with some asking why they should “mutilate” their bodies to conform with their gender identity. GRS is part of an outdated way of thinking, they feel, and they see the surgery as risky, with serious potential complications.

And, sexually speaking, some feel that they should be able to enjoy “the best of both worlds,” that their mix of sexual apparatus and gender identity is a blessing, not a curse. I am sensing that fewer trans people, at least, younger trans people feel trapped in  their bodies. If anything, they feel trapped within a binary system that dictates how they should behave and present themselves.

So, what is the future of GRS now that it is not deemed to be a medical necessity to change your official gender designation in Canada? Do we still need more GRS clinics? Or will one suffice — for those who still want to have the operations?

— Jillian

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14 thoughts on “Gender reassignment surgery: An outmoded operation?”

  1. People should be able to change their gender markers regardless of surgery. There is not a shortage of people for the surgery., the waiting lists prove that. Surgery will still be something that many people want and need, regardless of identification document laws. I live in the U.S. and went to Montreal for my surgery in 2012 because Dr. Brassard has one of the best reputations around. I was very impressed with the results of the surgery, and the aftercare I received there was incredible..

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  2. To get GRS or not is a highly-personal decision, but I think we do need enough resources in Canada that people who want GRS can get it with a reasonable waiting time. And in response to Jillian’s concerns that there might not be enough people in Canada wanting GRS to support many surgeons, if Canada became a centre of excellence for this sort of thing, we could attract people from other countries to come here, just as Thailand does now.

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  3. There are two issues here, with some overlap:
    – How you see yourself and feel within your own body
    – How you want others to see and treat you.

    If you have a deep-seated, unshakable conviction that you should really have been born with a body of the opposite sex (etiology as yet unknown), then surgical procedures are necessary, just as they are with any birth defect (unless you want to live with it). The need has not changed. If living with male genitalia between your legs is abhorrent, and the body map in your brain says you really need a vagina, then the full surgical route is the right one.

    If your issue is that you wish to be perceived and treated as a person of the sex different from that of your birth, but you do not have body dysmorphia, then bottom surgery should be neither necessary nor desirable. You make as few or as many changes as works for you.

    It is unfortunate that even in the 21st century the sex you are perceived to be will set up a huge number of expectations, and people will likely treat you in certain ways. There really should be no need to “change gender.” People should be allowed to be whatever gender they wish, and there should not be so much baggage to go along with it. But unless medical science is able to find a marker for transsexualism and make a very early correction, there will continue to be a need to change biological sex.

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  4. I am having GRS, but I completely agree about this being a choice, not a prescription. Gender roles are the real issue. There is a spectrum of roles, moving from the most masculine to the most feminine. I am happiest in taking role where my body is as fully close to a biological female as possible. The more I approach that role the less dysphoric I am and I hate feeling dysphoric dissonance. I have lovers and friends whose choose a definition body image to fit there idea gender role. That is fine with me.

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  5. Some people need it, some need to not have it, and all need support in having what is right for them.

    There’s a long history of the choice to not have GRS being very much discouraged. Decades ago it was nearly impossible to transition without it as doctors and therapists strictly enforced it (and enforced a timeline to it – didn’t schedule it soon enough? Then you must not really be trans and we’re denying you HRT permanently.)

    In the past decade (located in a large urban area of the US) I had providers who enforced that path in similar ways. My first endocrinologist for HRT even insisted on interrogating me for an hour about my plans for transition and GCS as part of the first appointment and before she would prescribe at the second directly said that she had looked up my salary and decreed, “you are paid enough that you have no excuse to not have SRS.”

    I’m someone who had that surgery because my choice was to have it or keep being screwed over on HRT (monthly dose changes, increases and decreases, all with remarks that it would end when after surgery was complete.) People like me deserve to not be pressured into a surgery that they do not want just as much as people who want/need it deserve better access to it.

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    1. Hi, Danielle and everyone else who has been commenting to this post.

      I should disclose that I had GRS — in Montreal — because I felt I needed it, and I would have had it regardless of whether the new, relaxed rules about changing gender markers were in place back then (in 2009).

      But as many people call out for more GRS clinics across the country, I wonder if the relaxed rules will actually deter other plastic surgeons, besides those at the CMC, from even considering learning how to do the procedures and then doing them. I’m thinking that they may feel it is not worth their while — and the investment — because there is a finite number of people who want this surgery. The pie is only so big. The CMC has a lot of foreign clients because of its excellent reputation. The backlog of patients there is said to be about two years, if various media reports are correct, and I bet half of those patients on the waiting list are from other countries.

      But are there enough Canadian trans people who want GRS to warrant several clinics across the country? I don’t see it being a long-term sustainable business for more than one or two clinics. And once the backlog is cleared and with some, if not many, younger trans people choosing not to have GRS thanks to the aforementioned relaxed rules and the quite vocal global movement against “mutilating” the body, I am doubting we’ll see many GRS clinics popping up across the country.

      I may be wrong; that’s why I posed the title of this post with a question mark. I was asking for the input of readers.

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  6. Gender affirmation follows as many paths as there are trans and gender non-conforming individuals out there. The idea that because there is less pressure to conform with a specific pattern of transition does not remove the necessity of easily accessible, funded gender confirming surgeries. And it’s important to point out that it is not one procedure. The one mentioned above, best called genital reconstructive surgery, because that’s what it does, is necessary for many trans people for innumerable reasons. For myself, being a gender fluid female AMAB who experiences phantom sensations and cannot get any kind of satisfaction from the factory standard equipment, GRS is a necessary thing. Making room for more varied experiences does not mean restricting access to NECESSARY medical procedures. It takes a ridiculous amount of time for anybody to get any part of the process completed, surgery being one of the fracking longest, most intrusive, and most expensive portions of the process. Hell, there are people who are opting not to have GRS because of how long it takes, how much it costs, and how hard it is to get, despite being covered in most provinces. The other option is to fund travel, accommodations, and surgical costs abroad for people seeking Gender confirming surgeries. It would also be nice if all of the gender confirming surgeries were covered, not just GRS. That’s just my 15000 dollars (the cost of quality surgery outside of canada, not including travel and accommodations)

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  7. Seriously? You attribute that now gender markers can be changed without surgery so do we really need SRS clinics! As a 49 year old ftm who started transitioning a year ago, the thought of seating for at least 2.5 year’s on a waiting list just to have a consultation as to whether Ohip will pay for chest surgery to remove DD breasts. The system is broken and yes more clinics. Than the wait list for the one clinic in Canada will be another long wait, I’ll be lucky if by the time I am 55 having the body l identify. I’m male.

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  8. In Ontario surgery is no longer necessary to change the gender marker on the birth certificate yet there was supposed to be over 1200 people waiting for approval before CAMH lost the monopoly for this approval. I don’t think the desire for this operation is dropping by much.

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  9. I don’t think that the demand for GRS is dependent upon the legal ability to change gender markers on various government records.

    As an example, from 2009 to 2012, in Alberta, the government had cancelled funding for GRS entirely. However, at the same time, there were major changes made to policy at several levels of government which facilitated changing gender markers on various key documents.

    Since restoring funding in 2012, the wait times for GRS have been steadily increasing, and are now in the range of 2-3 years, which is consistent with the demand levels in place in 2009 when funding was cut. This suggests that the demand for GRS is independent of the issues related to ID.

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