What makes a “real” woman?

I have pondered a bit on this one. Does it belong in my political blog – cause it has wider implications? Or my personal one, cause it also impacts on ME?

In the end, i plumped for here. Cause the public policy question is interesting…but limited. On the other hand, the personal issue goes much deeper.

Last week, the Telegraph reported the case of a trans woman taking legal action because the NHS refused to pay for a breast enlargement operation, claiming the decision breaches her human rights.

Ah. This raises so many questions. The NHS view seems to be that they will pay for women who “need” such surgery following breast cancer. They won’t pay when its “for cosmetic purposes”.

Huh? That sounds reasonable, until you start to unpick it. At base, these are ALL cosmetic cases. The difference is that the NHS – and the politicians that sit within it – think it is possible to divide the world into the “deserving” (tragic victims of breast cancer) and the undeserving (frivolous bimbettes who lust after bigger boobs).

And that is a caricature.

One female friend is very matter-of-fact about the issue. She’d rather not suffer from cancer: but if it happened, it happens; and she reckons she will just get on with things (able, for the first time, since puberty, to sleep on her front). For another female friend, the consequences of such an outcome has been psychologically devastating.

Ditto someone who recently fell foul of a surgeon’s smug self-assurance that HE knew what he was doing in terms of re-arranging her intimate anatomy – and has left her feeling upset, mutilated, and far less herself than before.

There is no set of rules that dictate what is cosmetic, what not: nor is something “merely” cosmetic always JUST that. As i know full well, some issues connected to how i look now have been cause of serious, tearful upset. Not quite so bad as to impact on my ability to work or socialise – but it is not hard to imagine such.

So…as we enter a period of increased austerity, with the tabloids likely to be questioning any public expenditure seen as remotely “frivolous”, what is the future for trans surgery? Probably we will be left defending what we have already – which is basically a removal of the male bits and the creation of a vagina (plus clit, if you’re lucky).

Absolutely nothing on anything any the less serious. Which prompts two questions.

First is what SHOULD be available on the NHS for the transgendered – and especially trans women, for whom i suspect the cost of intervention is that much higher.

Hormones? A few pounds a month. THE big operation? £10k-£15k…but not much point in supporting trans without that.

But what about the rest? Hair is one of the biggest bugbears of trans women: some spend thousands (or more) removing it. Breasts? Hips?

Bizarrely, ironically, the whole thrust of the NHS when deciding whether or not to treat someone with gender dysphoria is to test them to see how well they are learning to “pass” – but then NOT to give them the tools which will make that job easier.

I want my operation (the big one): i know that now…maybe before i was a little unsure…and if the NHS won’t give it to me, then i’ll darn well earn the money to have it.

But what about the rest? Today’s little wobble (and cause of a few private tears) was wondering what happens if this is all there is: if the hormones have done a little bit, left me with barely formed boobs, a bit of hip, some waist…and that’s that.

OK. Such a stupid, irrational fear. Everyone tells me this takes two years. But…but…but….just thinking about it brings me close to tears again. I know that it isn’t the shape, the bits, the add-ons that make this “real”…but still, there is something about not having those things that is profoundly disturbing, very upsetting.

Roll on 2012!



3 Responses so far »

  1. 1

    David Gerard said,

    That’s a particularly odd excuse … because a (born female) friend of mine got breast implants on the NHS for “psychological reasons.”

    I boggle at the idea that transsexuality wouldn’t be covered by that.

    (That said, wait till the hormones kick in and a fabulous rack just sprouts. I have a pile of friends this has happened to too ;-p )

  2. 2

    Lucy Melford said,

    NHS resources will always be limited. I take the view that if you CAN pay, you ought to, so that cash is freed up for the less well off to have their surgery for nothing. So that’s what I’m doing, whatever the depletion in my capital. It’s got to be worth it. I value permanent feminisation far higher than a string of nice holidays.

    There’s some consolation, if going ‘private’, from getting a degree of choice. Although even that is divided into first class and second class, depending on whether you can afford Ousterhous and Suporn, or only someone else.

    In the next few months I have to set up the referrals for facial and genital surgery. So there’s some hard thinking to do – first or second class? What do i want that will really make me feel ‘as good as’ a natal woman? Is a very high price really worth it? You only get one shot at this. I tend to think that supreme financial sacrifice might in the long run be best.


  3. 3

    Phoebe said,

    I think the finances (ftm costs vs mtf) are actually the reverse, although the numbers of trans men who get into the NHS system seem to be lower. They’ve implied a lower number of trans men in general but I think there’s a degree of selection bias in the amount of information getting out to trans guys about accessing the service, etc.

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