Does “Sex Change” Surgery Actually Work?

November 13, 2012

Decapitation Wire Killer Robert/Michelle Kosilek

From today’s NPR article “Inmate Sex Change: Should We Pay And Does The Surgery Actually Work?” by award-winning journalist and syndicated health columnist Judy Foreman:


“As the controversy continues to swirl over sex change surgery for convicted murderer Michelle Lynn (formerly Robert) Kosilek (there’s a hearing this month on whether taxpayers should pay for her electrolysis), I got to wondering about some of the questions this case raises.

Certainly, prisoners are entitled to basic health care. But do we really owe her a sex change operation?

Especially if — as some of the evidence I uncovered suggests — it wouldn’t leave her in substantially better mental health than she is in today?

I confess: I’m not sure I would even ask this question if I were sympathetic to her in the slightest. But I’m not. She is a convicted murderer. She is in prison for a reason, and a very good one.

But, that aside, back to my quest for facts: How well does sex reassignment surgery (SRS) work in the first place?

The surgery eases deep unhappiness with one’s biological sex. But it doesn’t seem to help much with other mental health issues, including suicidality.

Here’s some data: There was a major study in 2011 by the Karolinksa Institute.

Using data from Swedish registers, they studied 324 people — 191 male-to-females and 133 female-to-males — who had SRS between 1973 and 2003. For each SRS patient, the researchers randomly selected 10 people from the general population who had not had SRS. From this group, two control subjects were matched to each SRS patient — one with the same sex and age as the patient at birth and the other, with the same age and sex as the patient after SRS.

All-cause mortality was three times higher for people who had SRS and deaths by suicide were also higher. People who had the SRS were also at higher risk for hospitalizations for non-gender related psychiatric problems. It’s not totally clear why people who get the surgery get worse. But the authors conclude,

“Persons with transsexualism, after sex reassignment, have considerably higher risks for mortality, suicidal behavior and psychiatric morbidity than the general population. Our findings suggest that sex reassignment, although alleviating gender dysphoria, may not suffice as treatment for transsexualism…”

So, in other words, the surgery does get rid of “gender dysphoria,” meaning deep unhappiness with one’s biological sex. But it doesn’t seem to help much with other mental health issues, including suicidality.

If that’s true for Kosilek, I wondered, why should taxpayers foot the bill?

The Karolinksa researchers did caution that for SRS patients their findings didn’t necessarily mean the surgery didn’t help at all: “Things might have been even worse without sex reassignment.”

I wouldn’t be so swayed by this pessimistic study except that it’s methodologically much better than previous research, including an oft-cited 2010 Mayo Clinic study.

Researchers performed a systematic review and meta-analysis of 28 studies of hormone therapy and sex reassignment involving 1093 male-to-females and 801 female-to-males.

The studies were observational and most lacked controls. Overall, in the Mayo review, 80 percent of people who had the sex reassignment reported significant improvement in gender dysphoria, as well as significant improvement in psychological symptoms and quality of life.

But, as the Mayo researchers themselves note, all of these conclusions were based on “very low quality evidence due to the serious methodological limitations of included studies.”

In data-speak: garbage in, garbage out.

Ben Klein, senior attorney for Gay and Lesbian Advocates and Defenders, doesn’t see it that way. “All studies have limitations,” he told me, “but if you look at the overwhelming trend of a significant number of studies, all point to the same conclusion – that sex reassignment surgery is the only effective treatment for gender identity disorder.”

But I’m not buying that — pooling a bunch of bad studies doesn’t yield good data.

It makes more sense to wonder why the surgery doesn’t have better long-term results. One reason, suggests Renee Sorrentino, a Harvard Medical School psychiatrist who runs the Institute for Sexual Wellness in Quincy, is that by the time a person seeks sex change surgery, gender dysphoria has usually been a problem for a long time and is often accompanied by significant traumatic experiences, including bullying. Those deep psychological wounds may not be so easily healed.

That said, I know a transsexual woman, Sara Herwig, who has been helped by the surgery and now feels like a “congruent person.” So I called her.

“The thing to remember about SRS or general reconstructive surgery is that it is not a silver bullet,” she said. “You still have to deal with everything in life that everybody has to deal with. It’s not going to have a big impact on clinical depression or other kinds of mental illnesses.”

Fair enough, but did she believe taxpayers should be on the hook for Kosilek’s surgery?

Herwig has mixed feelings, “My initial reaction is that nobody paid for mine. Health insurance doesn’t cover it. I understand her desire to have the surgery, but … vast numbers of other people I know have had to pay for their own. I do think there need to be reforms in health insurance so such surgeries are covered. But I don’t think the taxpayers should pay for someone to have that kind of surgery.”

In the end, I concluded, neither do I.

And as for this month’s hearing regarding hair removal?

Give me a break. I have a couple of eyebrows I’d like taxpayers to have waxed for me.”


Read more here:

30 Responses to “Does “Sex Change” Surgery Actually Work?”

  1. alamia Says:

    “So, in other words, the surgery does get rid of “gender dysphoria,” meaning deep unhappiness with one’s biological sex.”

    I’m not so sure the surgery really does get rid of gender dysphoria. Perhaps the reason why they are suicidal after surgery is because they realize that nothing, not even surgery, can change them into women.

    • I agree Alamia, although what the journalist means here by “biological sex” is unclear, since if the trans-identifying person’s unhappiness about their sex were fixed, they would no long identify as their non-birth sex, and would in fact regret having had the surgery. (Which many do.)

      But most post-op MAABs seem to continue feeling extreme aversion to being identified as male, sometimes exhibiting strong anger and feelings of being unfairly treated even to those who had not realised that they identified as women.

      If the surgery had solved their ‘gender dysphoria’, then surely they would not care how others perceived them and would only care about their body now appearing right to *themselves*.

  2. Marie-France Lesage Says:

    “Perhaps the reason why they are suicidal after surgery is because they realize that nothing, not even surgery, can change them into women.”

    EXACTLY. If he looked like a 6’4″ version of Charles Bronson before surgery, he’s going to look like a 6’4″ version of Charles Bronson in really obvious/ridiculous drag after surgery.

    Not to mention the revolting nature of the new, very expensive “neovag” — which will seal up and/or form scar tissue in many (most?) cases and requires all kinds of unpleasant upkeep.

    If he’s trying for a “heterosexual” partner, he’ll be risking being beaten to death if he attempts to “fool” straight men into dating him. Heterosexual men are not gay. They don’t want to sleep with men.

    If he’s trying for a “lesbian” partner, he’ll probably end up alone or with someone who has their own serious mental health issues. Lesbians don’t want to sleep with men, either. Hello?

    Heterosexual and bisexual woman want a penis attached to their man — not a creepy, scary “neovag”.

    So there he is: all cut up and no one will have him. Surprise? Why would that surprise anyone? Because they’re not rational, that’s why.

  3. luckynkl Says:

    I Googled it and couldn’t find much of anything about the woman this son of a dick murdered. His wife Cheryl. Where does the state get off allowing this man to benefit off of murdering his wife? The only thing this dude is entitled to is lethal injection.

  4. GallusMag Says:

    One thing reporter Judy Foreman does not seem to understand: Kosilek has ALREADY received taxpayer funded cosmetic hair removal for his facial hair/beard. Taxpayers have ALREADY paid for that, and he has already received that, years ago. The current hearing for electrolysis involves his penis and testicular sac. When the testicular sac is surgically internalized to create a flesh-lined fistula between the prostate and the rectum the pubic hairs continue to grow internally. The recent electrolysis hearing is to determine whether Kosilek has the right to have his pubic hair removed prior to surgical creation of an internal flesh fistula (in leu of a vagina). The body does not LIKE to have artificially created fistulas jutting into body cavities. The body will attempt to reject them. There are high rates of complication to such procedures. For one thing, instead of ligaments, the only support for the “neovagina” is scar tissue, resulting in frequent prolapse. When part of the colon is resected and grafted into the fistula (for the purpose of approximating vaginal lubrication via gastrointestional bowel secretions) frequent infections of external (now internal) skin tissue caused by exposure to bowel secretions occur. Introducing follicles and growing pubic hair into this surgical fistula aggravates and compounds the usual (expected) complications of granulation, prolapse and infection caused by these procedures.

    In other words, the recent hearings re: hair removal are to decide whether Kosilek has the right to genital hair removal in anticipation of surgical “sex change” even as his right to that procedure is under appeal.

    • GallusMag Says:

      Kosilek is seeking a ruling compelling the state to fund treatments “prepping” him for a procedure which the state is currently appealing as unnecessary. Hope I’m being clear.

    • Em Says:

      ” … part of the colon is resected and grafted into the fistula (for the purpose of approximating vaginal lubrication via gastrointestional bowel secretions …”


    • GallusMag Says:

      BOSTON (AP) — A federal judge in Massachusetts on Tuesday rejected a request for additional hair-removal treatments for a transgender inmate who won a court order for taxpayer-funded sex-change surgery.

      Judge Mark Wolf also ruled that the gender-reassignment surgery he ordered for Michelle Kosilek in September will be on hold while the Department of Correction appeals his ruling.

      Kosilek, convicted in the 1990 murder of wife Cheryl Kosilek, was born male but has received hormone treatments and now lives as a woman in an all-male prison.

      Wolf said that additional electrolysis for Michelle Kosilek would have to be part of a new case.

      The state Department of Correction has said it discontinued electrolysis treatments in 2008 after finding Kosilek had already received significant hair removal and her remaining hair could be removed by shaving or hair removal cream.”

  5. KittyBarber Says:

    I think the suicide rates post-surgery etc. are so high because these men expect to come out of it looking like Zsa Zsa Gabor; when they come out of it looking just like they did before–like men in drag–well, I guess that’s a little bit disappointing.

    • Em Says:

      The compulsion to “transition” indicates further deterioration of already dicey mental health. That’s one important reason why “transitioning” people , on the whole, are such complete and utter dicks. After “transition,” because nothing has been done to address the underlying mental health issues–or “transition” has made them worse–the individual’s mental health deteriorates further, resulting in everything from continued complete and utter dickishness (narcissistic rage, anyone?) to suicide.

    • Em Says:

      The compulsion to “transition” indicates the individual’s already-dicey mental health is deteriorating. (Sorry, guys–your gender dysphoria is a symptom.) This is why “transitioning” individuals are such utter dicks–their mental health is going to hell. “Transition” does nothing to treat the underlying mental disorder, and may in fact worsen it. So, post-“transition,” you have an individual with deteriorating mental health,which leads to even more utter dickishness (narcissistic rage, anyone?) and, sometimes, suicide.

    • cherryblossomlife Says:

      Right! I think some of them really do go into the operating theatre believing that when they’re wheeled out they will be a member of the opposite sex.
      But they wake up to find they’re exactly the same sex as they were before, except now they’re castrated or whatever.
      The facial feminization surgery probable works for a short time, but I really wonder how that shit is going to look as they age. And they’re painfully aware of the fact they’re still men, when they realise that no magic “woman” mojo entered their bodies on the operating table.

      • Adrian Says:

        In addition, probably some of the “wearing off” effect won’t even need any aging to happen, but just the critical mind of the recipient.

        You can find plenty of “I woke up and was thrilled to finally have the right body” type posts, but part of the satisfaction seems to “wear off” in some people as they get more used to their new configurations and realize the imperfections of it (even on the surface looks, never mind the lack of functionality). Ditto for the facial stuff, presumably.

        At first glance they’re thinking, “wow, I pass” (and for plenty of people probably they continue to pass, in normal street crowds or wherever) but no one is as critical of a body as its owner who sees it 24/7, and that probably is even more so for people with dysphoria. So the little tell-tale “giveaways” start jumping out at them, not to mention other similarly dysphoric people in their social circles who have similarly been trying to do this “passing” business – they all know EXACTLY what to look for, after all.

        If you read stories of non-trans* just regular ol’ plastic surgery addicted people, you find the same thing going on. The new nose is great, until a while out they start obsessing over some flaw in it again, it’s not QUITE there yet, etc.

        And of course as you say, deep down they know their own histories.

    • Rose White Says:

      Hi Kitty,
      lots of you dykes end up looking like blokes in drag so don’t criticise the average post-op who does look nice.

  6. liberalsareinsane Says:

    Ms. Foreman should stop being a politically correct enabler and realize that referring to Robert as a “she” is an oxymoron. HE will never ever be a “she”. No matter how much HE stomps HIS big MAN feet.

  7. Branjor Says:

    Who cares how well sex reassignment surgery works? Even if it worked like magic you’d still have male rapists and murderers of women housed in women’s prisons, males in ladies rooms and locker rooms, males in lesbian communities dictating to lesbians what we can and cannot say, can and cannot do. That’s what’s important, not whether or not SRS “works” (for them, for men.).
    Or, thinking further, maybe they do have the right to do to their bodies what they want, but the wrong and immoral part is when they then claim to be women.

    • Branjor Says:

      To clarify the above: Maybe they do have the right to do with their bodies what they want, but not at the taxpayers’ expense.

      • 'tever Says:

        Your indifference as to whether or not the surgery works doesn’t sit right with me. The 8th amendment isn’t something to just chuck aside. Denying medical treatment to prisoners is unconstitutional and, more importantly, barbaric.

        That said, prisoners don’t have the right to demand treatments of their own choosing. That’s why the efficacy of SRS is crucial in this matter. If SRS doesn’t actually treat a disease — if demanding the surgery is, in fact, a symptom of the disorder — then it is an elective surgery that the state has no obligation to provide.

    • Marie-France Lesage Says:

      Exactly!!! When a person goes in for a name change, you have to swear that you are not requesting a name-change for fraudulent purposes.

      Obviously these CONVICTED PREDATORS should NOT be allowed to put one baby toe on the conveyor belt towards “sex change” as they are ALL doing so for nefarious purposes.

      If anyone actually cared about protecting women from monsters (!!!) they would take away Kosilek’s make-up, buzz his head weekly, take away any “female” jewelry, take away his female hormones, take away any female lingerie he’s managed to collect (you KNOW he’s collected some, right?), give him ONLY the prison-issue garb worn by all other inmates and limit any counseling towards helping him recognize, acknowledge and take FULL responsibility for the evil act of murder he perpetrated on the INNOCENT woman he nearly decapitated with a wire.

      There is no way that this woman-killer should be allowed to manipulate the system in order to feed his unwholesome sexual desires, much less to seek admission into a women’s prison!!!

      What in the world are people thinking?!? Are they thinking at all?!!!?

  8. Anonymous Says:

    I tend to agree with a great deal of what is being said here. SRS does not a woman “make”. However what should be obvious to any woman here is that it is impossible for you to survive as a coherent, congruent or ‘real’ woman, had you been born with a penis.

    IMHO the main reason that there exists an arguably high rate of suicide among those who have undergone SRS is that SRS is not medically apropriate for MEN who *think* or ‘wanna-be’ women.

    Sadly the TeeGee have managed to conflate the terms ‘gender’ with physical sex and trans-sexual with trans-gender…apples and oranges.

    Women who have survived the process of trans-sexual correction no longer suffer from gender dysphoria and are overwhelmingly delighted, to have their bodies including thir primary and secondary sexual characteristics actually conform with who they are.

    Disparaging our experience by comparing us to the TeeGee or the ‘men who would be queens’ is not only unkind and beneath you but displays a bigotry and hatred of your own kind. Frankly it demeans you and your own sisters.

    Freaks and muderers like Kosilek and that “Francis” freak in WA. are just examples of TeeGee pPCpolitics gone wild. As women we are similarly disgusted and stand similarly oppossed to such outrageous assaults on our rights and female specific protections.

    • BadDyke Says:

      Which all assumes that SOME women can be born with penises……..

      Sorry, trying to create a false distinction between ‘real’ transsexuals versus ‘false’ transgenders’ doesn’t work when the entire basis of both/either is flawed — there ISN’T some magical state of inner womanhood that you can have or claim, that can still magically come with a penis or biological maleness. (or state of inner manhood for that matter). We all start from a state of basic HUMANHOOD, with whatever bits and boobs we happen to have, and develop from that.

      “to have their bodies including thir primary and secondary sexual characteristics actually conform with who they are.”
      You’re not female, and all you will ever have is the surgically-constructed superfical appearance of a female, NOT the actual charactersitics of one. A second arsehole isn’t a vagina, and bags of silcone aren’t actual breasts………….

    • BeckyGreen Says:

      “However what should be obvious to any woman here is that it is impossible for you to survive as a coherent, congruent or ‘real’ woman, had you been born with a penis.”

      Oh, brother!

    • Adrian Says:

      And again the HBS “true transsexual” brigade shows up.

      There is no gender. There is no “born in the wrong body.” That particular emperor has no clothes on.

      “Woman” is not an identity, there is no “female brain” that is anything other than the plain biological fact of being a brain attached to a body that is biologically coded female. It says nothing at all about how you think, or behave, or should behave, or what you should be permitted to wear. Furthermore the only experience you can possibly have is the experience if living with YOUR brain, which is (naturally!!) attached to YOUR body, as a perfectly valid combination. Whatever makes you you, is FINE, and a perfectly okay way to be in whatever body you have. If anything is broken, or wrong, it’s society. If you weren’t born with female genitalia then there is no way on earth you can possibly KNOW what people who were supposedly “think like” (and of course we don’t all think the same!!!!)

      But dammit if someone is going to walk around implying that I should think one way or the other because I have a “female brain” and the like – and every time someone with a penis insists “but I have a female brain” or “I’m a woman, really, inside” that’s exactly what they’re doing. TG, TS, it’s all the SAME argument and it’s trying to shove those of us born as actual, biological women into a box. The entire house of cards is based on this idea that there’s a certain way women think that was influenced in utero by hormones or whatever it is, and so those of us who are women (biological born women with ladyparts and XX chromosomes who get slagged on by outsiders on that basis, I don’t know what way to make it clear) and are more or less happy to live in the bodies we were born with must all think in this prescribed way – and it MUST be a certain prescribed way of thinking, or else there would be no way for you to supposedly think that you “have it” because there would be no “it” for you to identify. Yet if we complain, too often the answer is “well maybe you’re really a man, inside! Maybe you’re trans*!”

      That’s offensive. That’s why people get upset at the “born in the wrong body” rhetoric.

      This “I think this way, therefore surely I need to make my genitalia conform to it” thing is just bizarre. Saying “I want to be treated the way society arbitrarily treats people who were born a certain sex” (yes, SEX, not gender) is closer to honesty but perhaps we should examine (1) why it is that such sex discrimination stubbornly refuses to die in 2012 and (2) just what are the interesting dynamics of people trying to voluntarily join oppressed groups.

      But the entire idea of “congruence” (cis?) or “mismatch” (trans?) between genitalia and thought patterns is just ridiculous from where I sit. There is no need to think of categories of brains AT ALL. There IS no “proper” relationship of brain to bits that needs to be “corrected” or not. Whatever is, is. Be free.

  9. Says:

    another lawyer for that person who needs a lawyer work no is 020 7911 0166 – email is

  10. Marie-France Lesage Says:

    Well, I was born in the wrong wealth bracket. My grandparents SHOULD have been able to endow me with a trust fun of at least eight figures. I will throw tantrums and threaten to commit suicide if the State of Washington doesn’t make me whole RIGHT THIS INSTANT.

    ***Insert sound of foot stomping and upper-lip harrumphing here.***

    Don’t toy with me, people. I know that I am a multi-millionaire born into a thousand-aire body because…well, you’ll just have to take my word for it. I just KNOW. I’ve always known that my available funds were not the funds that I should have been born with.

    Pay up, Washington!

    If you don’t agree to give me tens of millions, then you’re terrible, oppressive, hateful, backwards people who want me dead and who are not up on the latest trans-millionaire research!!!

  11. Rose White Says:

    This article is typical piece of dyke-hate against transsexuals and dykes have their own unacknowledged mental issues due to them ingesting significant quantitites of same sex hormones which brings about a revulsion as acute as the transsexual feels.
    It is termed BRSS.

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