Cancellation of Sex: Desexualized Human

*Prof.Dr.Zeki Bayraktar

Sex has a binary system as male and female. Well then, what are differences between male and female? Who do we call male and female?

Male; a father-to-be individual, who has 46XY genetic structure, carries these sex chromosomes in every cell, has testicular gonads [the testes], produces testosterone as a primary sex hormone, has android pelvis, is phenotypically masculine, has external genitalia with penile-penetrative structure and internal genitalia with ductal-seminal structure, has gametes called sperm produced in his gonads and contributes his sperm for genetic transfer in sexual reproduction in order to ensure the continuity of his species.

Female; a mother-to-be individual, who has 46XX genetic structure, carries these sex chromosomes in every cell, has ovarian gonads [the ovaries], produces estrogen as a primary sex hormone, has mammary glands for lactation [produces milk and breastfeeds], has gynecoid pelvis, is phenotypically feminine, has external genitalia with vaginal-absorptive structure and internal genitalia with tubal-uterine structure, has periodical menstrual-ovulatory cycles during fertility, has the natural capability for conception and birth, has gametes called oocyte produced in her gonads and contributes her oocytes for genetic transfer in sexual reproduction in order to ensure the continuity of her species [Table 1].

Table 1. Biological differences between male and female  

In addition to fundamental biological differences listed in Table 1, there are neurobehavioral and psychological differences [as a natural consequence of biological differences] between male and female in this binary sex system. In order for a sex change, the all of the existent biological and psychological features are required to be turned into the ones of the opposite sex; for instance, [for a man who wants to transition into a woman] all feminine biological and psychological features need to be recreated in a man. However; it should be acknowledged that this is and will never be possible. Genetic structures cannot be changed [cannot be interfered with], gonadal structured cannot be changed [gonads are taken out and canceled], hormonal structure cannot be changed [hormone-producing organ is taken out but a new organ cannot be recreated, hormone medications are taken from outside], pelvic structure cannot be changed, gametes cannot be changed, as the gamete-producing organ is taken out and a new one cannot be recreated, the reproduction function is completely being cancelled, breastfeeding and pregnancy can be canceled but cannot be recreated, sexual functions cannot be recreated etc.

Well then, what is being and can be done?

Phenotypic structure [appearance] can be partially changed by hormone supplements and surgery and yet, these changes all end up with the loss of organ function. At the first stage, the individual’s biological sexual reproductive organs are taken out and thus, the reproduction function completely and the sexual function partially gets canceled. Additionally, the organs and the functions of the opposite sex cannot be reproduced. Hence, the procedure stays on the cancellation of sex level. It cannot go further on the second stage. To that end, the most apparent and effective consequence of sex reassignment surgery becomes the cancellation of sex. That being the case, this consequence is not the end of it, serious medical problems due to hormone supplements and critical urogenital complications due to surgery can happen. In a nutshell, the transsexual person who has the surgery not only cannot be able to change sex [on the contrary, cancels his/her sex] but also reduces the quality of life at a certain level as well as the life expectancy up to the 25-28 years due to the experienced medical and surgical problems(2).

What is all this for? What are the arguments claimed by those who do and defend this?

This leads us to the concept of transsexuality/transgender. What is transsexuality?

Transsexuality happens when a person’s gender identity is inconsistent with their assigned biological sex and that said person is not pleased with their biological body and assigned sexual organs (3). Transsexuality is the final stage of gender identity disorder (GID) whose newly coined term is gender dysphoria (GD). Gender identity can be defined as an individual’s perception of their own body and identity within the context of specific sex/sexuality and application this gender role while expressing their feelings, attitudes and behaviours. When this does not happen, GID/GD occurs. GD occurs when a person experiences constant anxiety and distress about his/her biological sex and the gender roles that expected from this sex. CD arises when there is a mismatch between gender identity and biologically assigned sex and is an umbrella term [defines a larger spectrum] that also includes transsexuality(4).

GID/GD is a type of gender identity disorder that includes the situations when a person sees himself/herself belong to the another gender, feels extreme distress about the organs and characteristics related to his/her biological sex, feels the need to hide these organs and characteristics and wishes to have the primary and secondary sexual features of another gender(5).

In gender dysphoria, there is an evident inconsistency between a person’s gender identity and sex and this person wants to live and be accepted as a member of another gender group. A person with this diagnosis, on the one hand, aims to get rid of the primary and/or secondary sexual characteristics of his/her own body and, on the other hand, wishes to have primary and or secondary sexual characteristics of another gender. Therefore, the person who has “gender identity disorder” or “gender dysphoria” and been diagnosed as a “transsexual” desires to have hormonal and surgical treatments in order to appropriate his/her body for his/her gender identity(6). In other words, s/he aspires to change his/her biologically assigned sex with surgery and hormones and have anatomic features of another gender. S/he initiates the treatment process. After completing the required legal procedures, s/he undergoes the surgery. Both before and after the surgery, s/he undergoes a hormonal treatment (estrogen or testosterone) in order to make his/her body more masculine or feminine.

(2) Kuhn, 2007,2009;Simonsen, 2015

(3) Bayraktar, 2024a, 2024b;Steensma, 2013; Simoeli, 2022

(4) Özsungur, 2010

(5) Bayraktar, 2022

(6) Turan, 2015

Can the Sex Be Changed with Surgery?

The expression of “gender affirming” which is used for trans people does not mean that there is an actual change of sex. This is because the sex cannot be changed with neither hormones nor the surgeries or other medical interventions. Moxon explains the impossibility of sex change [through the trans term and transsexual surgeries] as such;

Trans is a misnomer, as there is no transition towards anything. Any wish or effort is to maintain sexual identification, and any desired change to the body, ostensibly to try to match it to the sexual identification, is impossible, as no individual can ever change the type of gametes he/she produces, so no individual can be in the process of such a change. Any so-called sex change can be nothing more than very superficial. Not only does a sex-change operation not lead to gamete production, but the crude remodeling of genitalia cannot render them functional, notably in respect of orgasm. No sex-specific physiology of any kind is changed: for example, stress response mechanism, which is almost entirely sex-dichotomous. [...] As is now popularly appreciated from the controversy in sports over those dubbed male-to-female trans-sexuals, foetal sex hormones lay down gross body changes that no post-natal administering of opposite-sex sex hormones can reverse(7).

That is to say, the [transsexual] individuals who have the surgery do not in fact change their sexes and transition into another sex. This fact needs to be known. To that end, “sex reassignment surgery” is a misleading expression. However, this expression is widely used both in literature and in practice and thus we are obligated to use this expression; yet, it should be reemphasized that this is not [cannot] be an actual change of sex. For instance, a male-to-female trans’ penis and testicles can be surgically removed; thereby his sperm production function and his manhood [sex] would be irreversibly canceled. Nonetheless this is not enough for him to be a female, in order to be a female, he needs to have a functional uterus, ovaries, vagina and breasts [as well as genetic structure of 46XX which is impossible]. Can this be accomplished? Certainly not. A uterus as well as ovaries cannot be recreated; a functional –real- breasts and vagina cannot be reproduced. Indeed, breast implants can be put in and a breast appearance can be achieved; yet it would not have the functions of a real breast. In similar vein, a new vagina (neovagina) can be constructed by penile inversion and surgically creating a canal between the rectum and the bladder, but this will never be a natural vagina. This is because a natural vagina is an active organ that stretches, strains, elongates, widens, excretes, is weaved with an intense neurovascular unit, is surrounded by clitoris, has maximum erogenous sensitivity, has an innate self-cleaning immunity, has lactobacilli in its flora and they produce lactic acid that contributes vaginal acidity and keeps vaginal pH level between 3.8-4,5, these creates a natural defense system and protects the vagina against infections etc. A neovagina in a trans woman will never have these features; it cannot stretch, it cannot strain, it doesn’t have erogenous sensitivity, it doesn’t have a neurovascular unit, it is not surrounded by clitoris, it cannot excrete, it doesn’t have an innate self-cleaning immunity etc. The body perceives this canal as a wound and tries to heal it. Consequently, vaginal shrinkage occurs and thus, sexual lives of many trans women are nonexistent or problematic because of this shrinkage(8).

The same rules apply for female-to-male trans people. A woman who surgically removes her breasts, uterus, ovaries and vagina, irreversibly cancels her womanhood/sex and therefore cannot produce eggs/ovum anymore and get pregnant. Be that as it may, it doesn’t mean she became a male, she doesn’t and will never have functioning male reproductive organs such as testes that produce sperm. Indeed, silicone rubber testicular implants can be added but these testes will never produce testosterone and sperm. Similarly, a penis can be constructed with the flaps taken from arms and legs yet it is not for function but for the appearance(9).

Transsexuals who have the sex reassignment surgery take sexual hormones of the gender they want to be; for example, a male-to-female trans person partially feminize his body by taking estrogen and a female-to-male trans person partially masculinize her body by taking testosterone. However, this is the change of secondary sexual characteristics as the primary sexual characteristics will not and cannot be changed. Hormones have serious side effects; they cause lung and cardiovascular diseases, mainly cancer(10).

(7) Moxon, 2015, 2022

(8) Ferrando, 2018

(9) Esmonde, 2018

(10) Simonsen, 2016a, 2016b

Transsexuals Have the Surgery with What Expectations?

The main asserted motive of sex reassignment surgeries is not congenital or anatomic defects [and there’s no such defect] but many psychological problems of trans people. Trans people experience intense psychological problems and they believe these problems and once they get the surgery [reassign their sex with surgery!]. The main asserted and expected [even imposed] motive is always as such: to heal mental health(11). A surgical treatment to heal psychological problems! This method [surgical treatment for psychological problems] which is not suggested for no other disease and in no other branches of medicine is suggested for trans people. Why? This is because the field of psychiatry under the influence of lobby activities dictates that. Transsexuals with psychological problems impatiently request these surgeries because they are convinced that this is the solution. Once they get the surgery, all of their problems will disappear! They believe it to be so. That is why they impatiently and hastily insist on getting these surgeries. That is to say, ”consent engineering” is at play, that is why these people get the surgery by consent and request. What is the result? Naturally, not what it’s expected. Psychological problems of transsexuals continue after the surgery [for a lifetime]. There are a lot of studies that confirm this argument. The most comprehensive study on this issue is carried out in Sweden. This study follows a case of total 314 transsexuals [191 male to female, 133 female-to-male] who had sex reassignment surgery between the years of 1973 and 2003 and examines various cases such as psychiatric diseases, suicide, death and conviction because of crime. According to this study, trans people who got sex reassignment surgery had the drastically high rate of psychiatric problems and suicide risk as well as higher death rates compared to the society. Interestingly, the high death rates were caused not by suicide but by cardiovascular diseases and cancer. Moreover, the cancers in these trans people were not hormone related cancers. Therefore, it means that these cancers were developed by another physical mechanism and increases the death risk twice as much. Another interesting data suggested that the risk of conviction due to crime or violence exceptionally increased in transsexuals who had the surgery. Put it differently, trans people got involved in crime more and consequently, got convicted more(12). This indicates that psychological problems of trans people do not get better with surgery; quite contrary, they get worse after the surgery in some cases(13).

A recent study carried out in Denmark and published by JAMA confirms these data; according to this population based cohort study, the rates such as “suicide attempt”, “death by suicide”, “death by no suicide”, “death by other reasons” are observed higher in transsexuals(14).
 

Transsexuals’ Life Expectancy Reduces by 25-28 Years   

Transsexuals’ life expectancy reduces by approximately 25-28 years due to the psychological and physical problems that they experience. There is a recent study in Denmark that suggests that. Average life expectancy in Denmark is 81.9 for women and 78 for men whereas it is 53.5 in trans people [who had the surgery](15). That is to say, trans people who had the surgery die 25-28 years earlier. Why? The risk of fatal diseases critically increases due to hormone-based cancers, lung and cardiovascular diseases. Surgical complications, infections and many psychiatrist problems as well as suicide contribute to this result(16).

Transsexuals have a shorter life expectancy and they cannot be happy and lead an unhappy and restless life. All studies point out that transsexuals have many psychiatric problems both before and after the surgery [for a lifetime](17). As a matter of fact, psychological problems of certain trans people increase after the surgery(18). Additionally, they experience serious problems [urinary and fecal incontinence/inability to urinate and defecate, post-op pain, genital-sexual problems etc.] that cause the loss of amenity after the surgery. Between the half of and three out of four in trans people who had the surgery experience serious urogenital problems including urinary and voiding problems(19). The physical and psychological problems that trans people experience drastically reduce their quality of life. Kuhn et al. examined the quality of life of trans people and found that it exceptionally decreases 15 years after the surgery(20). In short, trans people live a shorter life and cannot be happy and peaceful while living it(21).

(11) Turan, 2015

(12) Dhejne, 2011

(13) Simonsen, 2015

(14) Erlangsen, 2023

(15) Simonsen, 2016a

(16) Simonsen, 2016b

(17) Dhejne, 2015;Simonsen, 2016b

(18) Simonsen, 2016b

(19) Esmonde, 2018;Ferrando, 2018;Kuhn, 2007,2009,2011;Horbach, 2015

(20) Kuhn, 2009

(21) Bayraktar, 2024a,b

WORKS CITED

1. Bayraktar Z. İnterseks-Hermafrodit ve Eşcinsel, Yüzleşme yayınları, 4. Baskı, İstanbul, 2024a

2. Bayraktar Z. Transseksüellik Cinsiyetin Değişimi mi İptali mi? Yüzleşme yayınları, İstanbul, 2024b

3. Dhejne C, Lichtenstein P,  Boman M et al. Long-Term Follow-Up of Transsexual Persons Undergoing Sex Reassignment Surgery: Cohort Study in Sweden. PLoS One. 2011; 6(2): e16885.

4. Erlangsen A, Jacobsen AL, Ranning A, et al. Transgender Identity and Suicide Attempts and Mortality in Denmark. JAMA. 2023 Jun 27;329(24):2145-53.

5. Esmonde N, Bluebond-Langner R, Berli JU. Phalloplasty Flap-Related Complication. Clin Plast Surg. 2018 Jul;45(3):415-424.

6. Ferrando CA. Vaginoplasty Complications. Clin Plast Surg. 2018 Jul;45(3):361-368.

7. Horbach SER, Bouman MB, Smit JM, et al. Outcome of vaginoplasty in male-to-female transgenders: a systematic review of surgical techniques. J Sex Med 2015;12(6):1499–512.

8. Kuhn A, Bodmer C, Stadlmayr W, Kuhn P, Mueller MD, Birkhäuser M. Quality of life 15 years after sex reassignment surgery for transsexualism. Fertility and Sterility 2009;92(5): 1685-89.

9. Kuhn A, Hiltebrand R, Birkhäuser M. Do transsexuals have micturition disorders? Eur J Obstet Gynecol Reprod Biol. 2007 Apr;131(2):226-30.

10. Kuhn A, Santi A, Birkhäuser M. Vaginal prolapse, pelvic floor function, and related symptoms 16 years after sex reassignment surgery in transsexuals. Fertil Steril. 2011 Jun;95(7):2379-82.

11. Moxon SP. Sex is not non-binary (or mutable), and neither is sexual identity or orientation. New Male Studies 2022;11;1, 21-43.

12. Özsungur B. Cinsel Kimlik Gelişimi ve Cinsel Kimlik Bozukluğunda Psikososyal Değişkenler: Gözden Geçirme. Çocuk ve Gençlik Ruh Sağlığı Dergisi, 2010;17(3):163-174.

13. Simeoli C, de Angelis C, Veneri AD, et al. Severe impact of late diagnosis of congenital adrenal hyperplasia on gender identity, sexual orientation and function: Case report and review of the literature. Front. Genet. 2022;13:902844.

14. Simonsen RK, Giraldi A, Kristensen E, Hald GM. Long-term follow-up of individuals undergoing sex reassignment surgery: Psychiatric morbidity and mortality. Nord J Psychiatry. 2016a;70(4):241-7.

15. Simonsen RK, Hald GM, Kristensen E, Giraldi A. Long-Term Follow-Up of Individuals Undergoing Sex-Reassignment Surgery: Somatic Morbidity and Cause of Death. Sex Med. 2016b;4(1):e60-8.

16. Steensma TD, McGuire JK, Kreukels BP, Beekman AJ, Cohen-Kettenis PT. Factors associated with desistence and persistence of childhood gender dysphoria: a quantitative follow-up study. J Am Acad Child Adolesc Psychiatry. 2013;52:582-90.

17. Turan Ş, Aksoy-Poyraz C, İnce E, Sakallı Kani A, Emül HM, Duran A. Cinsiyet Değiştirme Ameliyatı İçin Psikiyatri Kliniğine Başvuran Transseksüel Bireylerin Sosyodemografik ve Klinik Özellikleri. Türk Psikiyatri Dergisi 2015;26(3):153-60.

*  Ürolog, Sağlık Bilimleri Üniversitesi Sancaktepe Prof.Dr.İlhan Varank Eğitim ve Araştırma Hastanesi Üroloji Kliniği, [email protected]