Paging Dr Mengele
March 26, 2012
Tracking Transgender: The Historical Truth
March 28, 2012

The Fallacy of ‘Cosmetic’ Surgery for Trans People

A woman who was arrested last year for providing dangerous “butt enhancement” shots consisting of cement, caulk, tire sealant, and other toxic and troublesome substances is facing new charges as more victims come forward. I don’t know how many of this woman’s clients were trans, but I suspect that at least a few were.

The fact that this underground business is thriving – and destroying women’s health and lives – is a testament to the problem of classifying transition surgeries and other treatments as “cosmetic” as opposed to medically necessary.

In my opinion, no trans-related surgery or procedure should be classified as “cosmetic,” whether it’s chest reconstruction/augmentation, genital correction, facial feminization/masculinization surgery, or any other procedures related to transition.

There are certain treatments that are medically necessary for those people who need to transition and live in the world as their correct sex and gender. Some of those treatments might involve corrections to the body other than the standard “top” and “bottom” surgeries.

While both women and men come in many shapes and sizes, there are particular body shapes that reflect “femaleness,” including a rounded hip-and-butt area. For some trans women, this type of shape is important in their medical transition, both psychologically and functionally (consider the cut of women’s clothing compared to that of men’s).

We have seen how important it is because many specialty shops that cater to trans women offer padded undergarments and other prosthetic devices that provide this “female” appearance. We have also seen how important it is when we see the continued demand for illegal “butt enhancement” and similar procedures.

When there is a medical condition present (and we have seen, both through the policies of medical organizations and the findings in some legal cases, that the need to transition is a medical necessity), whatever surgeries and other procedures are necessary to correct, alleviate, or ease that condition should be considered medically necessary treatments. Those procedures might include silicone or fat injections, or, in the case of female-to-male transition, liposuction to correct body shape.

These procedures should be made available in the same way that any other medical procedure is made available and paid for by insurance or other health-care programs. Of course, that will still leave some people out, but it’s a start, and it might be a way to reduce backdoor (no pun intended) injections that leave people sick, disfigured, or even dead.

Certainly, the culture needs changing. Our standards of beauty need a serious overhaul. People – both men and women, trans and non-trans – should not feel compelled to get surgeries or other “beauty” treatments to create or maintain a facade simply because it is expected or valued by society.

People shouldn’t have to get Botox treatments or facelifts to get hired for or maintain a job, as many older executives are doing today. The media, the cosmetics companies, the pharmaceutical companies, and the advertising industry need to stop telling us what is attractive and what constitutes an acceptable and correct gender presentation.

But even if all this changes, which it won’t anytime soon, the need for people to transition will still exist. And until we recognize the full range of medically necessary procedures for trans people, these underground “practitioners” will continue to pop up and endanger people’s health and lives.

Readers – thoughts?

cross-posted from Tranifesto


  1. Megan says:

    Even if we accept that trans-related surgery is “cosmetic” (and we shouldn’t), why is this the only “cosmetic” surgery that requires extensive counseling and evaluation before it can be accessed? Cis people don’t need to go to a shrink or do a “real-life test” to get their enhancement surgeries, why should trans people?

  2. I think the first place to bring about change is in the Transgender Community and getting Transsexuals out of it. When you combine people who cross dress for a habit or that just want to play games with the gender binary with people who have a legitimate need to transition you get and send dangerous mixed messages. To many times I've heard Transgender identified people call procedures for Transsexuals cosmetic and a choice in the media. I've also heard them make fun of both male and female post-op genitals with friends like that who needs enemies? How are we going to get insurance companies to cover these procedures when Transsexuals are lumped with people who make it a choice for themselves and that work awefully hard to invalidate Transsexuals?

  3. Jenny Howard says:

    You'll get no argument from me. Before it can ever happen, though — especially with greater federal involvement in health insurance — I think the trans-hating* portion of the population will have to get much smaller. As long as it's 40, 50, 60%, transition healthcare coverage will get blocked. Somewhere around 20-25% they won't have the political muscle to force their way. How do we get there? Yeah, good question.

    *I don't generally use the word "transphobia," because hatred and disgust are not the same thing as fear.

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