Norman P. Spack, a pediatric endocrinologist, is the founder of the transgender program at Boston's Children's Hospital.

I think most specialists agree that transgenderism is primarily a neurological, not a psychological disorder, even if we don’t understand its cause. So we shouldn’t blame what’s commonly called sex reassignment surgery for patients’ psychological problems.

Severe psychological trouble can follow such operations, but research and experience show that early treatment benefits patients.

One widely cited Swedish study found that those who have had such surgery are far more likely to commit suicide than people in the general population. Research by the Dutch endocrinologist Dr. Louis Gooren -- one of the first to treat transgender youths -- and others, also found that suicide was particularly high among male-to-female transsexuals. But he has said that more recent experience with patients who complete their treatment before the age of 20 shows they do remarkably better

So while this shows that surgery alone cannot make people pass easily into society, I believe it also demonstrates the devastating consequences of not treating this condition early.

A Dutch study of the first 55 young men and women who were given hormones to block puberty at its onset, cross-sex steroids at age 15 to 16, and had surgery at 18, found that none of them harmed themselves or considered suicide. At age 20 to 22 the treated group’s psychosocial functioning was as good or better than a control group of same-age nontransgender Dutch young people.

Patients have also become far more satisfied with their surgeries as operating microscopes have helped surgeons save nerves. Consequently, all 12 of my patients who have had a feminizing genitoplasty at ages 18 to 24 were pleased with their sexual function and sensation within four months. The patients I’ve treated who were over 45 were not always so fortunate.

Genetic boys could have surgery at 17, especially if they are going to college, since the months of necessary post-operative care are best done at home. If genetic girls who identify as male have very large breasts, mastectomies could even be done at 14.

Criticism of us for operating on children ignores the growing benefits of such surgery for transgender adolescents and young adults at over 40 programs throughout North America.



Join Opinion on Facebook and follow updates on twitter.com/roomfordebate.

