'I AM a non-person, an 'it'. I have let them mutilate me. Far from solving my problems, the operation has made things worse.'
Sandra, formerly Peter, had a sex-change operation in 1987, when she was 40. At the time of the operation she was having panic attacks and was heavily dependent on tranquillisers. Now she is finally coming off them, an alarming certainty is dawning on her: the surgery should never have taken place.
'I had a very unhappy childhood. My father was violent, and by the time I was in my twenties my doctor was prescribing high doses of tranquillisers. I tried to lead a normal life. I got married and even thought about having children, but the panic attacks kept coming at me. I began to dress as a woman, and I felt myself more and more to be the female partner during sex, which my wife of course could not understand.' Sandra saw a number of psychiatrists during the 1970s and 80s, and became more and more convinced she was transsexual - even though one psychiatrist explicitly warned her against surgery, saying that Sandra was, in reality, a gay man trying to deny her homosexuality.
'But I found the requisite two psychiatrists to recommend surgery. That is all you need. I had no money, so I could not afford any counselling, and was offered none on the NHS. I thought that becoming a woman would solve all my problems.' Here Sandra breaks down and weeps quietly into a neat hanky. 'You can't possibly imagine what it's like.'
She hands over a letter written by her GP in the wake of the operation. It makes bleak reading. 'Sandra has talked to me about her unhappiness with her present sexual identity. She does not desribe herself as homosexual, but in retrospect I feel she might have been happier if she had remained a transvestite.'
Sandra has had her hair cut short and has begun to wear more masculine clothes as a way of reclaiming her lost manhood. She blames the medical profession for recommending irreversible surgery when she was in no fit state to think the issue through for herself.
According to studies in America and Holland, around one in 20 post-operative transsexuals changes his or her mind after surgery, and around one in ten never adjusts and often becomes deeply depressed. In Britain, around 250 sex-change operations take place every year - the majority for the transition from male to female (of these, about 50 are performed on the NHS, the rest in private clinics). The NHS offers little counselling for people seeking genital surgery. Those without the funds to pay for private counselling must rely on occasional visits to consultant NHS psychiatrists to make up their mind about whether surgery is what they really want and need.
International guidelines state that at least two psychiatrists must make the recommendation for surgery, and that one of them should have known the patient for a reasonable length of time. But in practice, desperate people such as Sandra have found it all to easy to 'shop around' between psychiatrists until they have the recommendations they need for their operations.
Stephanie Robinson, formerly Steve, bitterly regrets being unable to obtain NHS counselling before having her operation in 1985, when she was 32. 'I was given female hormones and electrolysis and left to get on with it really. It didn't hit me what I was about to do until I was on that train going to the clinic for the operation. I was terrified and very confused. I got the feeling that my problem was just a burden to the doctors, and the sooner I had the chop the better it would be for everyone.' Stephanie feels that she just wandered into genital surgery. 'I would probably have chosen a less radical solution if I had thought anything else was available.'
Stephanie Lloyd, herself a transsexual, runs the Albany Gender Identity Clinic in Manchester, a large private clinic. She reports that only about two in every 100 people presenting themselves at the Albany go through with surgery. 'It is far better to make surgery more difficult to obtain than easier, believe me. I am afraid there are some psychiatrists who make recommendations too quickly, and if people can't afford to see a counsellor it is very difficult for them to take a rational decision themselves. You have to remember that people who believe they are transsexual are often in a terrible state, depressed, worried. Many need a lot of help in making up their minds.'
The Albany imposes strict conditions on its patients, which it insists are vital if serious mistakes are not to be made. In addition to intensive counselling, patients are required to live full-time in their new gender roles for one to two years before having surgery. The clinic's counsellors act as gender 'policemen', who will check whether the patient is genuinely living as the opposite sex - unannounced calls can be made to their home and workplace, names on payslips may be checked. If patients are not sufficiently committed to pass these 'tests', they will be strongly advised against surgery.
Although gender identity problems range from simple unhappiness about one's sexual role to the conviction of being trapped in the wrong body, gender surgery is often offered as the answer to every complaint. Gender counsellor Fran Springfield is administrator of the Gender Dysphoria Trust, a charity based in Eastbourne. 'Surgery is held to be the end of everyone's problems, both by gender identity sufferers and by some psychiatrists,' she says. 'But there is no magical solution. Counselling can help weed out inappropriate cases. It is absolutely vital that those who cannot pay for private help should receive adequate counselling on the NHS.'
The Gender Identity Clinic at Charing Cross Hospital is the centre of NHS sex change activity. Its director, Dr Don Montgomery, points out that transsexualism is way down the NHS list of priorities - with the result that his clinic is understaffed, underfunded, and patients are not seen as often as he would like. Dr Montgomery sighs with despair. Understaffing causes traumatic delays for genuine transsexuals, he knows. He sees patients who are tired of waiting for NHS treatment go to private clinics, where he believes some are pushed unnecessarily along the path to surgery.
'But it is so important that we start getting this right' he says. 'More and more young men are coming forward for surgery. This is not an area where anyone can afford to make mistakes.' Meanwhile Sandra and many others are struggling to come to terms with the mistake they feel has already been made.
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