Recently, a press release written by Dr. Sherman Leis of Philadelphia attributed the high level of suicides among trans people to the shortage of doctors performing gender-affirming surgery. This took me by surprise, as I had never pondered that particular ponder when it came to the subject of transgender suicides. I had often attributed it to despair related to physical and emotional abuse, feelings of helplessness, loss of prestige, disappointment with results, on and on. Seriously, I could write a 1,000-word article that does nothing but list the reasons that trans people commit suicide, but “shortage of doctors” was never one to enter my mind. So of course being the type of obsessive lunatic who can’t stop gathering more information, I dug deeper into Dr. Leis’s argument.
With trans people not being a huge part of the population overall — the most commonly cited statistic being that we number about 700,000 people in the U.S. — of course the number of medical practitioners who specialize in transgender-related issues would be relatively low. One website I went to put the number of doctors performing gender-related procedures at 294. With my terrible math skills, I was still able to put this at one doctor for about every 2,400 trans people. It gets wonky when this number includes plastic surgeons, who only do top surgery for FTMs or facial feminization, as well as those who do the most sought-after yet unicorn-like procedure, gender reassignment. When you contrast this with 46 general pracitioners (65 specialists) per 100,000 people, it shows that there is indeed a shortage of trans-focused doctors.
However, that doesn’t reflect on something else I learned. Now, to let you know a bit more about me personally, I’ve never been one of those trans women whose dysphoria is so strong that I’ve obsessed about “the surgery.” I’ve thought about it, but honestly, I could live without it, so I’ve never done much research beyond how much it costs and how it’s done. Out of curiosity because of the article, I emailed three of the best-known gender-affirmation surgeons in America to find out how long their wait times were. Two of the doctors’ clinics emailed me within just a few days, with one giving a six-month waiting period between first consultation and surgery, and the other giving a waiting period of two years for its premier surgeon and six months for its lesser-known surgeon. The last clinic said that it would take two weeks to reply to my email. To be fair, the two-year wait is for probably one of the most recognized, experienced, and highly regarded surgeons in the world, Dr. Toby Meltzer of Arizona.
Imagine if you had to wait two years for a gallbladder surgery or for an angioplasty? A two-year wait for a cancer-related mastectomy would be a death sentence; hell, even a six-month wait would be. This puts it into perspective. Throw into the equation that we are talking about a surgery that is not only life-affirming but potentially lifesaving, and it gets complicated. Nowadays, we live in an era where gender-affirming surgery has come leaps and bounds from where it was just 20 or 30 years ago. While we have lost many of our trans elders to AIDS and deep stealth, we have also lost many to suicide. The trans community is rife with horror stories of bad surgeries that vary from toxic infections to bad “plumbing jobs” (do not ask if you have a weak stomach) to the most horrific one, “the dead hole.” These tales come largely from this era of inexperienced surgeons and “Mexican doctors,” but they remain a constant bogeyman in the depths of trans-focused forums and discussion groups. Many early trans women took their lives because the surgeries they thought would make their lives better made them far, far worse.
This is why so many trans people wait two years to go to the most experienced doctors, who word of mouth has affirmed as greatly skilled in their jobs. It’s no surprise it’s this way either. You wouldn’t let the guy whose car is always breaking down and has had the same dented quarter panel that’s been painted primer gray for two years fix your car, would you? You wouldn’t let a person who builds mediocre bird houses redo your cabinets. And anyone who says “I just graduated law school” would terrify a defendant. So why would you trust a similar doctor with the most important surgery of your life?
Dr. Leis’s statement certainly gives one food for thought. When you add a shortage of high-quality doctors to the long list of other obstacles like high costs, lack of insurance coverage, endemic poverty among trans people (especially people of color), you start to see that being told to wait two years — or to opt for a less experienced doctor — certainly appears like one more hurdle we shouldn’t have to face.
AMANDA KERRI is a writer and comedian living in Oklahoma City. Follow her on Twitter @EternalKerri.