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Transgender Prisoners and Surgery

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Previously we noted, here and here, the First Circuit case of Kosilek v. Spencer, No. 12-2194.  Robert Kosilek is in a Massachusetts prison for murdering his wife, and he wants the taxpayers of that state to pay for "gender reassignment" surgery as "treatment."

Yesterday, Dr. Paul McHugh, former chief psychiatrist for Johns Hopkins Hospital, had this op-ed in the WSJ (subscription required) questioning whether this "treatment" is appropriate for any patient:
We at Johns Hopkins University--which in the 1960s was the first American medical center to venture into "sex-reassignment surgery"--launched a study in the 1970s comparing the outcomes of transgendered people who had the surgery with the outcomes of those who did not. Most of the surgically treated patients described themselves as "satisfied" by the results, but their subsequent psycho-social adjustments were no better than those who didn't have the surgery. And so at Hopkins we stopped doing sex-reassignment surgery, since producing a "satisfied" but still troubled patient seemed an inadequate reason for surgically amputating normal organs.

It now appears that our long-ago decision was a wise one. A 2011 study at the Karolinska Institute in Sweden produced the most illuminating results yet regarding the transgendered, evidence that should give advocates pause. The long-term study--up to 30 years--followed 324 people who had sex-reassignment surgery. The study revealed that beginning about 10 years after having the surgery, the transgendered began to experience increasing mental difficulties. Most shockingly, their suicide mortality rose almost 20-fold above the comparable nontransgender population. This disturbing result has as yet no explanation but probably reflects the growing sense of isolation reported by the aging transgendered after surgery. The high suicide rate certainly challenges the surgery prescription.

There are subgroups of the transgendered, and for none does "reassignment" seem apt. One group includes male prisoners like Pvt. Bradley Manning, the convicted national-security leaker who now wishes to be called Chelsea. Facing long sentences and the rigors of a men's prison, they have an obvious motive for wanting to change their sex and hence their prison. Given that they committed their crimes as males, they should be punished as such; after serving their time, they will be free to reconsider their gender.
Of course, for a murderer there may not be any "after."

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Crazy is as crazy does.

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