A letter to my surgeon

Looking back, looking forward

I drafted the following letter over the holidays. I’m still not sure whether I want to send it. What’s done is done. Writing it, however, helped me clarify my thinking on what I experienced, and why I feel the way I do.

Dear Dr ______,

In 2010, you performed a total hysterectomy/oophorectomy on me after I was diagnosed with gender identity disorder by a gender specialist. You advised me that it was in my best interest to have a hysterectomy because a person injecting testosterone had a higher risk of cancer in the reproductive organs. You also told me that removing my uterus would mean I wouldn’t have to go for regular gynaecological exams, which you said would lessen my dysphoria. At the time, I did not truly understand what I was giving up (i.e. my ability to give birth), even though back then I didn’t think I’d ever want a child. I believed you because I wanted to. I hated everything about my female body and I didn’t think that would ever change. It did.

I am writing to you now, in 2024, as a former patient, to update you on how my life has unfolded since then. I know that as a medical specialist you may not often collect feedback from patients about their longterm outcomes. Perhaps hearing about those longterm outcomes is worth your time. Maybe it can even inform your practice moving forward.

When I was diagnosed with gender identity disorder, I was offered only one path for my dysphoria — medicalization and transition. I now wish that I had been offered a more thorough assessment and psychotherapy first. It took a single 90 minute psychological appointment with a gender specialist to alter the entire trajectory of my life.

More recently I learned that I have autistic traits that I think greatly contributed to why I thought I was trans. I was also sexually assaulted a few years prior to my starting on hormones. So many of my symptoms had to do with social difficulties, gender nonconformity, a confused understanding of sexual orientation, a discomfort with sex, and sensory issues. Once I received a diagnosis of gender identity disorder, though, these issues remained unaddressed. I was told medical transition was the way to resolve my mental health issues.

While initially my medical transition did make me feel better, I continued to struggle with depression and anxiety. By 2013, I was again experiencing suicidal thoughts. My relationship with my family of origin, which had always been difficult, worsened significantly following my gender transition, as they did not accept it. So toxic had our interactions become that I had to make the difficult decision not to attend my father’s funeral in order to not further upset my family. I still grieve over this.

I was told that medically transitioning would improve my mental health, yet a decade after I was diagnosed, I was still struggling with the same issues. I slowly came to ask myself: What had been the point? After undergoing a double mastectomy with male contouring for my chest, and a total hysterectomy/oophorectomy, I chose to stop short of having a phalloplasty. I realized that surgery was no cure for my difficulties. I chose to pursue psychotherapy instead.

Since then, I have managed to break out of my depression. I no longer think of myself as male and believe that I was misdiagnosed. I also no longer take medications, including testosterone. The changes to my body, however, are irreversible. I am now at a place in my life where I would have liked to have had children of my own as part of my family, but that door has permanently closed.

I have chosen to continue to live legally and socially as a man as I do not wish to disrupt my life or my family’s life further. I cannot go back in time and undo what was done to me, but I hope that by sharing with you how my perspective has evolved, that you will keep this in mind as you continue to work with patients who report gender-related distress.

I have encountered too many people who, like me, have experienced harm due to the unnecessary medicalization of psychological distress. It needs to stop.