Recently, I received a broadcast message from my online neighborhood chat room news feed. An autistic neighbor was soliciting donations for “medically necessary and lifesaving” top surgery.1 Before researching this article, I would have had no idea what “top surgery” was. Essentially, plastic surgeons transform a biological male chest into a transgender female chest, or vice versa. (Many transgenders undergo “bottom surgery” too.)2
Two neighbors responded online. The first suggested therapy first as a young person is likely to change their mind a lot by middle age. The second asked how top surgery was “lifesaving.” In response, the trans neighbor suggested the questioner research transgender suicide rates.
My libertarian bias tells me that if an adult wishes to undergo gender transition, and they pay for it themselves, more power to them. Turns out, insurance was paying for most of my neighbor’s top surgery; even Medicare will pay for transgender surgeries. Donations would pay for some uncovered medical procedures, such as the anesthetization, and travel expenses.
My empathic bias tells me that if someone is willing to put themselves through all the hassle, including drug and hormone treatments, social stigma, incapacitation time, as well as the major surgeries — removing body parts, or fabricating new ones from skin grafts — they must feel genuinely compelled.
But I would not agree that gender transitions represent just another instance of an oppressed group fighting for equal rights, as have native Americans and African-Americans, women, and gays. For two reasons: (1) if transitions are financed by the public through insurance, the public does have standing to participate in the policy debate; and (2) if the person transitioning is legally a minor, adults remain responsible for their welfare.
Moreover, transitions aren’t the only source of transgender controversy. There is also the hot-button issue of trans youth participating in competitive sports. Here, again, others have standing in the policy debate. Some girls have complained that trans girls (that is, transgenders who were classified as male at birth) enjoy unfair physical advantages in many sports.