What is Medicalization?

Medicalization is a concept in which a normal condition or behaviour is identified as a disorder in need of medical attention. The beginnings of this concept were originated with Michael Focault and Ivan Illich. There are many implications when it comes to Medicalization, especially when referring to the medicalization of Transgender people.

The Transgender Community

The idea of being transgender dates way back to Greek myths, where a male would be turned into a female as a punishment. While this is just a myth, it is evident that the idea of sex change has been around for a long time. A transgender person is someone in which feels as if they have a different gender expression or identity than that in which they have been assigned. The world has come a long way in expanding the means of gender. A persons gender isn't just classified as male or female anymore; it is their internal sense of self, and their relationship with it can change over time. The standard classifications used to be male or female, but in todays day and age, people are using more specific terms to describe their gender. When someone feels strongly enough about wanting to change their appearance to match their true identity, they experience something called gender dysphoria, and can go through with a process called Gender Reassignment Surgery, in which the anatomy of the body is altered.

File:Sexual orientation map.pdf

Types of Procedures

Female to Male (FtM)

Metoidioplasty is a masculinizing, lower body surgery for those experiencing female to male gender dysphoria (GD). It is the process of urethral lengthening, and is proven to be very complicated and poses many challenges. This procedure includes

Lengthening and straightening of the clitoris
Urethral reconstruction
Scrotoplasty with implantation of testicular prostheses

Male to Female (MtF)

When someone experiences male to female GD and wants to go through with GRS, there are many processes and techniques used to alter their genitals. The 5 major steps in all of the techniques are

Orchiectomy
Penile Disassembly
Creation of a Neovaginal Cavity
Repositioning of Urethral Meatus
Clitorolabioplasty

Cons

With any type of surgery, there will always be side effects or health risks that the patient will have to deal with. Some of the complications that are possible to occur are urethral stenosis, bleeding, partial wound dehiscence, just to name a few.

Accessibility

When a person decides to go through with GRS, it is often hard to access, especially in Canada, due to the limited amount of people specialized in the field.The wait times can be up to a few years, especially since there are very few clinics in Canada. It is a very tedious procedure, and can take multiple years to complete. When someone decides they want to have gender reassignment surgery, they can not just simply go to the clinic to get it done. The surgery can be done only after at least one year of hormone treatment, and at least two years after getting a psychological consultation. Most procedures are irreversible, so it is not accessible to everybody. Potential patients have to go through a screening process and fulfill several requirements before being able to get it done, something called the “gatekeeper” model. This, on top of the expensive nature, are what makes it unaccessible to everyone. Also, it raises the question about whether or not psychologists and doctors should be able to interfere and have the final say on this procedure.

Cost

Anywhere from $5000- $50000, depending on the surgeries desired.

Questions concerning the Medicalization of Transgender surgeries

The question of fairness according to the GRS is a popular one. Who should decide when a trans person can medically transition? Is it too expensive of a process for those who are marginalized and can’t afford it? Should the government make it more accessible to everyone? It is hard to decide how much intervention should be involved in this process, because both sides of the debate have good arguments. To some, the argument of “it’s my body I can do whatever I want with it” is the clear answer. Why let someone else decide whether or not someone can transition and live their life how they desire? Although throughout the years the problem has gotten better, it is still something that people who are trans have to face.

References

https://www.unfe.org/system/unfe-74-SEXUAL_ORIENTATION_AND_GENDER_IDENTITY_ARE_NOTHING_NEW_PDF.pdf

Kich et al., (2009). Encyclopedia of Contemporary LGBTQ Literature of the United States http://go.galegroup.com.ezproxy.library.ubc.ca/ps/i.do?ty=as&v=2.1&u=ubcolumbia&it=DIourl&s=RELEVANCE&p=GVRL&qt=IB~9780313348594~~TI~%22Transgenderism%22&lm=&sw=w&authCount=1

Sigurjonsson, H. et al, (2015) Male to Female Gender Reassignment Surgery: Surgical Outcomes of Consecutive Patients During 14 Years http://www.sciencedirect.com/science/article/pii/S2352587815000492

http://transhealth.phsa.ca/trans-101/glossary

Raigosa, M., et al (2015), Male-to-Female Genital Reassignment Surgery: A Retrospective Review of Surgical Technique and Complications in 60 Patients http://onlinelibrary.wiley.com.ezproxy.library.ubc.ca/doi/10.1111/jsm.12936/abstract

Djordjevic ML et al (2013) Comparison of two different methods for urethral lengthening in female to male (metoidioplasty) surgery. J Sex http://www.sciencedirect.com.ezproxy.library.ubc.ca/science/article/pii/S1743609515303751?_rdoc=1&_fmt=high&_origin=gateway&_docanchor=&md5=b8429449ccfc9c30159a5f9aeaa92ffb