A Response to Robert Withers

Everyone else seemed to know they were boys or girls or men or women. That's something I've never known; not then, not today. I never got to say to the grownups, ‘Hold on there-just what is it about me that makes you think I'ma little boy?’…. I was always acting out something that everyone assumed I was. I wonder what it would have been like if someone had come along and asked in a quite friendly manner, ‘Well, young one, what do you think you are: a boy or a girl?’

I want to first thank Bob Withers for opening a conversation on the disquieting experience of working with transsexuality, in particular with transgendered patients seeking sexual reassignment surgery (SRS). There are probably several responses a clinician might experience when faced with the responsibility of signing-off on a surgery that attempts to reverse a person's sexual body. My response has been, despite many years of working with all aspects of transgender, a feeling of deep sadness that the person sitting across from me cannot be dissuaded from their conviction that they must have the physical body that corresponds to their gendered feelings. I can worry that in some cases there might be some pathology in such a desire, but I am certain that there is pathology in the cultural collective unconscious that insists that sexual anatomy defines and predicts an individual's embodied gender feelings. I wonder if we might gain more understanding of gender in general if we took the view from the outside-that of the transsexuals living on the farthest borderland of cultural gender assumptions. From this perspective it is more interesting to ask, ‘Why is the clinician so anxious about the patient's desire for SRS to enhance their gendered presentation when the patient is not anxious?’ We might further wonder why we comfortably endorse breast enlargement for women who desire to enhance their female body, and easily understand the man who takes hormones to increase his masculine appearan