Michelle L. Kosilek, pictured in this Jan. 15, 1993 file photo, is a transgender inmate serving life in prison for murder. U.S. District Judge Mark Wolf ruled in Sept. 2012 that sex-reassignment surgery is the only adequate treatment for Kosilek's gender-identity disorder, which he found was a "serious medical need." Kosilek was named Robert when married to Cheryl Kosilek. He was convicted of killing her in 1990. (Lisa Bul/AP, file)

As the controversy continues to swirl over sex change surgery for convicted murderer Michelle Lynn (formerly Robert) Kosilek (there’s a hearing this month on whether taxpayers should pay for her electrolysis), I got to wondering about some of the questions this case raises.

Certainly, prisoners are entitled to basic health care. But do we really owe her a sex change operation?

Especially if — as some of the evidence I uncovered suggests — it wouldn’t leave her in substantially better mental health than she is in today?

I confess: I’m not sure I would even ask this question if I were sympathetic to her in the slightest. But I’m not. She is a convicted murderer. She is in prison for a reason, and a very good one.

But, that aside, back to my quest for facts: How well does sex reassignment surgery (SRS) work in the first place?

The surgery eases deep unhappiness with one’s biological sex. But it doesn’t seem to help much with other mental health issues, including suicidality.

Here’s some data: There was a major study in 2011 by the Karolinksa Institute.

Using data from Swedish registers, they studied 324 people — 191 male-to-females and 133 female-to-males — who had SRS between 1973 and 2003. For each SRS patient, the researchers randomly selected 10 people from the general population who had not had SRS. From this group, two control subjects were matched to each SRS patient — one with the same sex and age as the patient at birth and the other, with the same age and sex as the patient after SRS.

All-cause mortality was three times higher for people who had SRS and deaths by suicide were also higher. People who had the SRS were also at higher risk for hospitalizations for non-gender related psychiatric problems. It’s not totally clear why people who get the surgery get worse. But the authors conclude,

“Persons with transsexualism, after sex reassignment, have considerably higher risks for mortality, suicidal behavior and psychiatric morbidity than the general population. Our findings suggest that sex reassignment, although alleviating gender dysphoria, may not suffice as treatment for transsexualism…”

So, in other words, the surgery does get rid of “gender dysphoria,” meaning deep unhappiness with one’s biological sex. But it doesn’t seem to help much with other mental health issues, including suicidality.

If that’s true for Kosilek, I wondered, why should taxpayers foot the bill?

The Karolinksa researchers did caution that for SRS patients their findings didn’t necessarily mean the surgery didn’t help at all: “Things might have been even worse without sex reassignment.”

I wouldn’t be so swayed by this pessimistic study except that it’s methodologically much better than previous research, including an oft-cited 2010 Mayo Clinic study.

Researchers performed a systematic review and meta-analysis of 28 studies of hormone therapy and sex reassignment involving 1093 male-to-females and 801 female-to-males.

The studies were observational and most lacked controls. Overall, in the Mayo review, 80 percent of people who had the sex reassignment reported significant improvement in gender dysphoria, as well as significant improvement in psychological symptoms and quality of life.

But, as the Mayo researchers themselves note, all of these conclusions were based on “very low quality evidence due to the serious methodological limitations of included studies.”

In data-speak: garbage in, garbage out.

Ben Klein, senior attorney for Gay and Lesbian Advocates and Defenders, doesn’t see it that way. “All studies have limitations,” he told me, “but if you look at the overwhelming trend of a significant number of studies, all point to the same conclusion – that sex reassignment surgery is the only effective treatment for gender identity disorder.”

But I’m not buying that — pooling a bunch of bad studies doesn’t yield good data.

It makes more sense to wonder why the surgery doesn’t have better long-term results. One reason, suggests Renee Sorrentino, a Harvard Medical School psychiatrist who runs the Institute for Sexual Wellness in Quincy, is that by the time a person seeks sex change surgery, gender dysphoria has usually been a problem for a long time and is often accompanied by significant traumatic experiences, including bullying. Those deep psychological wounds may not be so easily healed.

That said, I know a transsexual woman, Sara Herwig, who has been helped by the surgery and now feels like a “congruent person.” So I called her.

“The thing to remember about SRS or general reconstructive surgery is that it is not a silver bullet,” she said. “You still have to deal with everything in life that everybody has to deal with. It’s not going to have a big impact on clinical depression or other kinds of mental illnesses.”

Fair enough, but did she believe taxpayers should be on the hook for Kosilek’s surgery?

Herwig has mixed feelings, “My initial reaction is that nobody paid for mine. Health insurance doesn’t cover it. I understand her desire to have the surgery, but … vast numbers of other people I know have had to pay for their own. I do think there need to be reforms in health insurance so such surgeries are covered. But I don’t think the taxpayers should pay for someone to have that kind of surgery.”

In the end, I concluded, neither do I.

And as for this month’s hearing regarding hair removal?

Give me a break. I have a couple of eyebrows I’d like taxpayers to have waxed for me.

Tags: Gender, Law

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  • Ralph850

    NO, pure and simple. These people have a problem, thats for sure. But being sympathetic to some twisted idea that buy changing your appearence you change your sex only causes more problems. Look people, sex is not determined by what body parts you hack off or sew on. Chromosomes, thats it. Refering to this murderer as “Her’ or “She” only perpetuates the fallacy of sex re-assignment.
    One thing will take care of this problem in our society. Murderers should be executed, post haste.

    • ReaganS

      Ok I can see your frustration on this issue, but get one thing straight Transgender or Transexual people have a medical condition and it is real. As for your comments about chromosomes… Don’t think that Chromosomes determine gender. Chromosomes lie all the time. Back to the question at hand, Yes in most cases Genetal Reassingment Surgery is in fact a very effective treatment for transsexuals. Again I know this is a very touchy subject with this person being a convicted killer. I myself feel no remorse for her suffering, but to have a vile attitude towards all people that are transgender is a very sick way to look at things.

      • Ralph850

        Reagan S

        TransGender people have a psychological condition. Psychology can be lumped into Medical, just as Dentistry can. Trans sexual is a misnomer, there is nothing you, I, or anyone else on this planet can do about changing ones sex. I never said Chromosomes determine gender, I said they determine sex. These people have a psychological problem, they feel they should be of the opposite sex and act as if they are of the opposite GENDER. In order to appease their improperly operating self image they wish to rearrange their bodies to fit some incorrect self-image. A self image they have created, that does not fit the reality of their body. Unfortunately our society has grown to believe that it is better to appease these people, rather than root out the cause of their problem. I believe we are born pretty much a blank slate. We are a product of our environment, our experience. Sure a screwed up brain, one that works strangely may help to skew ones experiences, but that does not mean we as a society should simply say, oh sure you have a problem poor thing. Lets just hack up your body till you think it’s right. No it is our responsibility to find the cause of this persons misperception of themselves. In order that we stop this disease. Participating in this disease by referring to a male as HER, or SHE does them and our society a dis-service. You encourage their disease,, and mask real world issues.

        I do not have a “Vile attitude” towards people with any disease, I simply know reality and fantasy.

        • ReaganS

          I’m sorry I meant sex. Chromosomes lie all the time about a person’s correct sex. There are many variations of Chromosomes like xx, xy, xxy, yyx, xxx, and so on. The fact that a person could have all of the sex characteristics of a female and still be xy or a boy xx. These are all variations in the makeup of chromosomes. They lie all the time.

          Also the gender Identity and orientation of a person is believed and pretty much supported to be developed by hormones. Hormone wash or lack thereof over a developing fetus can cause it the brain to develop in or out of sync with the physical sex. Because all fetus are all female in the beginning the entire blueprint for development is there. This is why some people associate feeling like a woman in a mans body. Because quite literally that’s what it is. There have been post-mortem brain dissections done of trans people and that of cis people and the trans peoples brains developed similar to that of the cis gender that they identify as. There was a study done by measuring the white matter of the brains using MRI came up with similar results.

          Also according the the American Medical Association and the American Psychiatric Association and pretty much every other member of the medical and scientific community disagrees with you as far as this being a psychological problem. You can check the information yourself it readily available on their websites. Everything that you think about trans people is wrong and has been proven wrong by people who have actually done the research . You should really take a look and stop acting like you are right. You’re not! If you still feel you are correct about your statement then please cite your source.

          There is actually some pretty interesting data out there that explains a lot about this medical condition. I have found it quite fascinating doing my research on it. It really opened my eyes.

        • dsws

          Chromosomes do not determine sex. One locus on the Y chromosome sets off a cascade of events that together determine biological sex. There’s nothing special about the X chromosome that leads to female phenotype when two copies are present: people with Klinefelter syndrome (XXY trisomy) are physiologically male and can be definitively diagnosed only by karyotype.

          That’s in mammals. Not all species even have sex chromosomes, and not all species with sex chromosomes use the XY system where one locus starts the process that results in male phenotype. Among insects, for example, WZ sex determination is the norm.

          • Leslea

            True, but trannies by definition have a normal XY chromosomes. Don’t conflate them with those with legitimate biological conditions.

          • ReaganS

            Oh please I can tell your lack of understanding by the derogatory terms that you use. Nor do you wish to educate yourself. You are pathetic! Please cite your source smart guy!

        • Zoe Ellen Brain

          The Reality:

          Sexual Hormones and the Brain: An Essential Alliance for Sexual Identity and Sexual Orientation Garcia-Falgueras A, Swaab DF Endocr Dev. 2010;17:22-35

          “The fetal brain develops during the intrauterine period in the male direction through a direct action of testosterone on the developing nerve cells, or in the female direction through the absence of this hormone surge. In this way, our gender identity (the conviction of belonging to the male or female gender) and sexual orientation are programmed or organized into our brain structures when we are still in the womb. However, since sexual differentiation of the genitals takes place in the first two months of pregnancy and sexual differentiation of the brain starts in the second half of pregnancy, these two procescan be influenced independently, which may result in extreme cases in
          trans-sexuality. This also means that in the event of ambiguous sex at birth, the degree of masculinization of the genitals may not reflect the degree of masculinization of the brain. There is no indication that social environment after birth has an effect on gender identity or sexual orientation.”

    • Zoe Ellen Brain

      ” A 46,XY mother who developed as a normal woman underwent spontaneous
      puberty, reached menarche, menstruated regularly, experienced
      two unassisted pregnancies, and gave birth to a
      46,XY daughter with complete gonadal dysgenesis” — The Journal of Clinical Endocrinology & Metabolism
      January 1, 2008

      vol. 93

      no. 1


      You were saying about how sex is determined by chromosomes?

      1 in 300 men don’t have the 46,XY chromosomes most men do. So that’s over half a million in the USA. Not exactly a “tiny, insignificant minority”.

  • bells201

    I will not argue the issue of SRS – that is a mute subject here – however what is important is – who should be financially responsible for the cost of the surgery ?
    Outside the prison walls if you want to have SRS you have to pay for it yourself – no insurance policy that I have ever seen covers this, So I guess why should the state pay for something that is not normally covered by insurance ?
    It is not that I am unsympathetic or have an issue with TG people this is just real world stuff. Can this person live with out the surgery – yes – If the argument is that this person would be likely to kill themselves in prison , well then isn’t the answer to let every one that is in prison out that is likely to kill themselves – Maybe the best thing is to let this person out of prison – then there is no cost , Mass health will not pay for this , Medicare will not pay for this – I think the attorney for the Commonwealth just didn’t use the right arguments

    • ReaganS

      I pretty much agree with you. I don’t feel that this person should get a free pass. There are thousands of trans people that save their entire lives for this and the fact that some criminal murder gets it on the tax payer dime. It’s hard to believe. There are some insurance companies that will pay for this but not many. I suspect that with the release of the new DSM then a lot more will fall in line. Still for someone that has killed someone…NO! give hormone treatment and that’s it. I really don’t care about suffering.

      • Leslea

        Only if Mitt Romney was still the governor of Massachusetts!

      • Zoe Ellen Brain

        You may not care about suffering – and you’d be in a majority. Which is why the 8th amendment forbidding cruel and unusual punishment is part of the constitution.

        If your views were those of a fringe minority, the 8th amendment wouldn’t be necessary. If almost no-one was racist, the 14th amendment wouldn’t be needed either.

        • ReaganS

          What about the person she murdered! I could careless about her wanting SRS. There are plenty of trans-women out there well more deserving of it than this trash. That’s why I say hell no not on the tax payer dime. Unless all trans women get it too and then just then maybe .Do you know that the suffering of law abiding trans-women is just as bad as this murder trash. It is not cruel and unusual punishment if everyday trans-people suffer the same fate.Why the hell should she get it over someone who is well more deserving? By that I mean a loving kind productive member of society. One who isn’t a murder! Don’t you dare call me a bigot! You have no frigging Idea who I am and what I support. Well if you read some of my post you could figure it out. If she wanted to have the surgery then maybe she shouldn’t have murdered her wife! Don’t do the crime, if you can’t do the time!

        • ReaganS

          Because if it was my daughter she murdered then I would want that bitch to suffer everyday of the rest of her life!

    • Leslea

      Why not let him kill himself in prison? That will save the state lots of money.

    • Zoe Ellen Brain

      A growing number of insurance policies cover it now – possibly because every professional medical authority has called them out on this very special exclusion, just as it would call them out if they excluded treatment for blacks or jews.

    • Emily Striker

      I agree, let’s let her out of prison – parole her so she can pay for her own surgery! Letting her out of prison would save the state far more money than the surgery costs anyway. Maybe give her one of those fancy ankle trackers or something.
      Anyway as is coming up again and again in this case is simply the fact that SRS is actually necessary and should be covered, but people are annoyed because it might be covered in the prison system before it’s covered for the public. So really, yes the state should pay for her surgery if she has no way to pay for it herself; but also it should be covered for everyone else.
      I’m from Canada and we are slowly getting there, in about 1/3rd of the provinces SRS is now covered by our healthcare system. Also there are a couple insurance companies that do already cover SRS due to previous legal cases where it has been found necessary, sadly not many though.

  • Amber Thompson

    The surgery has a 98% satisfaction rate.

  • Prash

    I agree with bells201. Why should “only” inmates’ surgery be paid by the taxpayers? If this is so important, why should even non-imates’ surgeries be paid?

    What next? Someone says that they want a breast enlargement surgery and everyone else shoult pitch-in (for the severely depressed)?

    Based on the little bit of understanding I have about transgender issues, these surgeries are still non-essential and selective. Having everyone pay for this is not such a good idea. And, again, why the differentiation between prison inmates and those transgender people who have been good citizens?

    PS: I am very pro-LGBT rights and I have donated time and (some) effort to help LGBT causes.

    • Leslea

      The punishment for his crime is lifetime forfeiture of his human rights. He is nothing but a piece of meat with number, put in a cage. Why should we be concerned whether he was depressed or not?

      • Zoe Ellen Brain

        The 8th amendment says otherwise. It bans cruel and unusual punishment, such as withholding adequate food, shelter, and medical care.

        That still happens – the case in Arizona where a diabetic charged with drug possession died a few days after arrest, before her first hearing, because prison guards confiscated her insulin for example. But it’s not supposed to.

  • jefe68

    No. Why should the tax payers foot the bill for this man?
    He killed his wife and is now in prison for the crime. End of story.

    • Zoe Ellen Brain

      I agree it’s absurd. The solution though to this absurdity is not to repeal the 8th amendment forbidding torture, but to treat transsexuals who have done no wrong no worse than convicted murderers.

      • ReaganS

        It’s not cruel and unusual punishment to forbid the surgery! Many trans-women can’t afford or are unable to have the surgery for whatever reason and have to deal with it. Therefore it isn’t considered cruel. Why should someone that is incarcerated for a violent crime be given a privilege over someone who hasn’t? She should be lucky she wasn’t put to death for killing someone!

        • Zoe Ellen Brain

          ” Many trans-women can’t afford or are unable to have the surgery for
          whatever reason and have to deal with it. Therefore it isn’t considered

          Except at least 40% of those attempt suicide, do they not? And many complete it too.

          Of course it’s cruel! The AMA thinks so. The APA thinks so. Every professional medical group thinks so. But just because it’s common practice to mistreat trans people this way doesn’t make it right, or prevent it from being cruel.

          • ReaganS

            I’m well aware of statistics of trans people. What you are failing to understand is that I don’t really care that much about a murderer piece of trash. This is my opinion and I’m free to have it. I don’t feel this murderer should receive any preferential treatment that a law abiding trans-woman wouldn’t receive. IF she kills herself oh frigging well. You know what she shouldn’t have murdered her wife. If that was my daughter she murdered I would want her to suffer for the rest of her life. By the way… what about her victim? She wasn’t given the same courtesy. So STFU! You will never change my mind so piss off! This isn’t about mistreating trans people this is about paying for a treatment that some don’t get. It’s about privilege to a person who I feel is unworthy of it because she murdered her wife. Not about abusing a trans people!

  • Adam

    These studies demonstrate that SRS effectively treats gender dysphoria. Some trans people continue to suffer post-surgery because of the prejudice and ignorance displayed in this column.

    The studies cited did not include a control group that did not have surgery (probably because deliberately denying care known to be life-saving is unethical). It’s unfair to compare trans people who’ve had surgery to non-trans people who do not have to deal with discrimination and stigma. An older case-control study showed that the group that received surgery had better outcomes.

    If you are going to cite medical evidence, please do so honestly. The American Medical Association, American Psychiatric Association, American Psychological Association, American College of Obstetricians and Gynecologists, National Association of Social Workers and the World Professional Association for Transgender Health all recognize SRS as life-saving medically necessary care that should be paid for by public and private insurance.

    • jefe68

      I’m sorry but this person committed murder. If he can raise the money, maybe you can help, then that’s great. But as a tax payer I draw a line at this. I’m all for humane treatment of prisoners, but this entire case is above and beyond the pale. By the way how about all the suffering that the victims family is going through every time this case is in the news. What about them?

      • KRobert

        What she did was horrible, yes. And as a society, we have decided that we are better than murderers. We give all prisoners access to health care. If they have cancer, we treat it. If they have heart conditions we operate and install pacemakers. If they have liver problems we give them medication.

        Why do we do this? Because we do not treat people in prison like subhuman beasts, no matter what they did. An eye for an eye leaves the whole world blind.

      • Zoe Ellen Brain

        Ms Kosilek offered to pay for her own treatment in 1993.

        Prisoners aren’t permitted to pay for medical treatment. If it’s necessary, the prison has to provide it. If not, it’s strictly forbidden.

    • Zoe Ellen Brain

      Control groups were included in the earliest studies, at least initially, but the mortality rate was so high in the untreated group that these were terminated early. That was known 50 years ago.

      “Treatment aimed at trying to change a person’s gender identity and expression to become more congruent with sex assigned at birth has been attempted in the past without success (Gelder & Marks, 1969; Greenson, 1964), particularly in the long term (Cohen-Kettenis & Kuiper, 1984; Pauly,
      1965). Such treatment is no longer considered ethical.”

  • 3rd Side of the Coin

    Since trans people are such a minority, I realize that many people just don’t realize the severity of the condition. Being trans may not be life threatening in the way a horror like cancer is, but the fact of the matter is, people do die from it. 41% of trans people attempt suicide. 41 percent! (Compare that to 1.6% for all Americans.) And this 41% only takes into account the cases that are actually reported. Additionally, this doesn’t address the more quiet ways to commit suicide. Over a quarter of trans people have misused drugs or alcohol (national averages are 7.3% for alcohol and 1.7% for prescription drugs), while over 30% smoke (almost 10% higher than the national average).

    All of these numbers are so high for a reason. They are so high because trans people are dealing with a congenital condition that causes severe and relentless mental anguish. So being trans doesn’t kill in a way that cancer or something else as insidious does; it kills by ravaging a person’s thoughts, emotions, and psyche.

    And while people with other life-threatening conditions most often get care and compassion, trans people get treated with misunderstanding and sometimes revulsion, which helps exacerbate the high numbers of trans people who do harm to themselves. As an example of this mistreatment, 19% of trans people were refused basic healthcare, 28% were harassed in medical settings, and 2% were the victims of violence in doctor’s offices.

    But I feel the biggest crime here is that the overwhelming number of insurance companies cover no part of dealing with this congenital condition. People are suffering, there are ways to alleviate that suffering, yet nothing is being done because of ignorance about the situation, because of bigotry towards something that is innate and trans people did nothing to bring upon themselves, and because of lack of concern for these people who are very much on the fringes of society… and while these attitudes still pervade, trans people continue to suffer and die.

    The fact of the matter is: Whether or not an inmate should be entitled to gender-reassignment surgery should be a moot point. ALL trans people should be entitled to gender-reassignment surgery. If this was already incorporated into the everyday health care for trans people, there would be much less of an outrage about an inmate receiving this type of care, because, agree or not, prisoners should be entitled to health care for any condition that’s causing them to unduly suffer.

    *All of the numbers in this post are taken from National Transgender Discrimination Survey Report on Health and Health Care.

    • Leslea

      So this mental illness is “cured” by chopping off a dick? Mental illness is a disease of brain. Why not lobotomize him?

      • Leslea

        BTW I do support the idea of castrating and de-dicking of all rapists and sex offenders. But it should not cost the state nothing, just have a guard with a machete do it.

        • Zoe Ellen Brain

          This makes you better than a murderer how? By employing a contractor to torture someone to death instead of doing it yourself?

    • ReaganS

      Wow very well put.

  • Pingback: Does “Sex Change” Surgery Actually Work? « GenderTrender()

  • WomanBornTS

    I think a lot of the reason why the suicide rates are so high is that we are never really given a break. Yes we can Transition and even become legally female but many in the public and academic world act like it is their personal right to act as judge jury and executioner towards us for a crime we didn’t commit. We as a group are very low on the totem pole if not at the bottom so we are easily exploited. Look at how easy the LGBT conned all of you into believing we’re all their personal property to label as they feel free. I didn’t transition to become transgender or to become a forced into member of the “Gay Community.” For me that has been the single greatest cause of suicidal ideation. That’s right the LGBT is it, my biggest bully, the cause of my greatest distress and the ones that are happily referring me back to a listed birth sex I so didn’t relate to (Transgender=weasel word) that I went through all the legal and medical hoops to change. Guess what they are the last ones to trust on the issue of being Transsexual and they should be the last ones to claim any right to speak for me since they have tried to steal my right to speak for myself and to choose my own community. As for Michelle “she” killed a woman that generally is a very ugly thing males do. I also don’t believe anyone that could rape a woman should ever be allowed to transition either. I’m with the taxpayers on this one.

    • Leslea

      Sir, you chose your life and you are dealing with the consequence of your choice. By contrast, women are forced into the life of oppression since the moment of their births. You have no right to complain about being “very low on the totem pole.” Please consider that Inmate Kosilek may be transferred to a women’s correctional facility and pose significant danger to the general population there. He is a rapist-murderer who killed his wife. Get real, sir.

      • WomanBornTS

        Leslea the comments you’ve left indicate that you are the exact type of person that I point to as believing you are somehow entitled to treat us like dirt. I’d like to thank you for proving my point and let you know I really feel sorry for you that you are stuck being the type of person you are..

    • bells201

      WomanbornTS – You quote that “Michelle “she” killed a woman that generally is a very ugly thing males do.” you need to brush up on your facts if you check the CDC statistics you will see that woman commit just as many acts of domestic violence as men and woman kill 2 out of 3 children and even a higher percentage of infants are killed by woman, Sadly we disguise this as post pardon depression in many cases, My real issue here is if “she” (Michelle) is given a free sex change operation that is not part of usual health care provided (industry wide) – I am sure it cost you a small fortune for your medical care (for right now I will not discuss the issue of right or wrong this is not where the real issue is for this discussion) the issue is who should be responsible for the cost ?

      • WomanBornTS

        I really would love for people to be able to get to the point where they understand that this is neither a choice nor something undeserving of medical coverage. The problem is that there are more than one type of persons considered as transsexual and a lot of different types that mimic it. I think the science has shown we are very real but the soft sciences sociology, social work, and psychology are still stuck twenty years or more behind. Transgender isn’t helping because it lumps us all together and creates confusion as to who is what and why and it also violates our civil rights and rights to quality unbiased healthcare. I truly believe the numbers of post-op suicideality pointed to in the article has gotten worse because screening has become a joke under Transgender to the point its almost to ondemand sex changing. I wish we could get to a point where there is a science based test to tell if someone really is cross sexed and MRI imaging I think is getting close to be able to do it. So who should pay for it sadly for now I think we should pay our own way until testing can do a better job of weeding out the bad candidates and false transssexuals.

        • WomanBornTS

          Also in Thailand for many years it was simply show up and pay. I even know one post-op that just talked to a psych over there for ten minutes then given the operation. She is a hell of a mess. Most of them shared this information through transgender groups so a lot of people who shouldn’t have gotten SRS did thanks to the LGBT and their transgender umbrella.

          • bells201

            Unlike some here – I keep an open mind with regard to trans sexuallism and transgender. I will admit that I do not know enough on the subject to discuss it on an intelligent level – but under this discussion it is on the health care benefit and expense that the state should or should not have to pay. Then there is the issue of what to do with this person after the operation. Part of me can not help but to wonder if this is some sort really messed up person who has nothing better to do – after all this didn’t come to light until after he was convicted and jailed or if it is real. However the crux of the article is should the state have to pay for this surgery

          • WomanBornTS

            From what I understand there was some documented history of it before the marriage and that the marriage was supposed to help cure Michelle of it. My take on what I read came across as victim blaming to me. Transsexuals are divided by sexual orientation and from I’ve seen in my interactions with those who id as female but are attracted to females is they can be very violent and verbally abusive. Michelle took that abusiveness to the extreme. They also have the lowest amount of evidenced differention of the brain sex.If they perform the operation then depending on where “She” is from and if they change birth certificates will determine if “She” is leglly female. If “she” is legally female then she will have to be transferred to a woman’s facility.

          • Zoe Ellen Brain

            No, I’m afraid she won’t. There’s plenty of caselaw on this. Post-op Transsexuals are most often condemned to spend their sentences in “administrative segregation” – solitary confinement, under a punishment regime, with no privileges,

            “Nevertheless, the Eighth Amendment does not require the separate
            placement of inmates based on sex. Galvan v. Carothers, 855 F.Supp. 285
            (D. Alaska 1994) (The placement of a female inmate in an all-male prison
            wing did not constitute cruel and unusual punishment.); Dimarco v.
            Wyoming Department of Corrections, 300 F.Supp.2d 1183, 1192-1194 (D.
            Wyo. 2004) (The placement of an intersexual inmate, who was of alleged
            female gender but was anatomically situated as a male due to the
            presence of a penis, in segregated confinement for a period of 438 days,
            with concomitant severely limited privileges, solely because of the
            condition and status of ambiguous gender was not a violation of the
            Eighth Amendment prohibition against cruel and unusual punishment where
            the safety of the inmate and other inmates was secured by placing the
            inmate in administrative segregation, and the inmate was provided the
            basic necessities of food, shelter, clothing and medical treatment.);
            Lucrecia v. Samples, 1995 WL 630016 (N.D. Cal. 1995) (The transfer of a
            transsexual inmate to an all-male facility and her housing in an
            all-male cell did not violate the due process clause where the inmate
            failed to demonstrate the infringement of a liberty interest.).”

  • David Ropeik

    thoughtful piece. issues laid out clearly. morality raised but left to other levels of consideration. well done

  • liberalsareinsane

    Ms. Foreman should stop being a politically correct enabler and realize that referring to Robert as a “she” is an oxymoron. HE will never ever be a “she”. No matter how much HE stomps HIS big MAN feet.

  • Edith

    This article plays dress up. Why the sensational focus on one person, this person, in particular? In the grand scheme of things how many people need SRS? How much would it cost the taxpayer as a percentage of what is already dumped on the prison industrial complex which nobody seems to think is an issue of greater importance than tabloid issues like this? You use one study to support your thesis. Who has the time to fact check this? Who has the time to find evidence that would contradict the evidence you present. I am surprised you didn’t use the Meyer study promoted by pedophile apologist, Paul McHugh, to support your conclusions.

    Yes, your article plays dress up. You cover up your puny minded prejudice in academic drag, blowing something that should be a non issue in a transparent attempt to stir up an electronic lynch mob. Disgusting!

  • Edith

    You think you really have an issue with this because of “the expense to the taxpayer”?

    This should be an indication of how shallow your concerns are:

    “A spokesperson for the Rhode Island Department of Corrections says the exact cost of the procedure is unknown. Liver transplant operations can cost more than $1 million. The bill will likely be paid for by Medicaid and you, the tax payer.”

    For that kind of money, the state could pay for at least fifty SRS surgeries, probably more.

    Your motives in writing this article are obvious.

  • Trans-friendly Psychologist

    As this author points out herself, the main study she cites is not enlightening as to the effectiveness of SRS, as it does not compare before-SRS to after-SRS, but rather after-SRS to people whose gender has always been concordant with their biological sex. She has absolutely no cause to say “people who get the surgery get worse.” She also assumes that gender dysphoria, which she allows that SRS helps, is not a serious condition worthy of treatment in and of itself.

    I appreciate that the author revealed her own biases, but I think she is not very far along in wrestling with how they distort her judgments and conclusions, and certainly not in curbing her sarcasm enough to show basic respect for other humans. That’s a personal process, and I don’t believe it’s right, or helpful, for her to play it out in a published article.

  • Frannie Carr


    The tenor of this discussion has occasionally gotten a bit off track. This is a place for debate — but it must be civil.

    In case you need a refresher, you can read WBUR’s community discussion guidelines here:


  • Bonze Anne Rose Blayk

    Ms. Foreman’s article omits half of the critical ending sentence of the “Conclusions” stated in the Karolinska Institute’s study of outcomes of sex reassignment surgery:


    “Persons with transsexualism, after sex reassignment, have considerably higher risks for mortality, suicidal behaviour, and psychiatric morbidity than the general population. Our findings suggest that sex reassignment, although alleviating gender dysphoria, may not suffice as treatment for transsexualism, —– and should inspire improved psychiatric and somatic care after sex reassignment for this patient group. —”

    That is: better postoperative care is needed, NOT additional restrictions on access to surgery.

    Your quotation is dishonest, Ms. Foreman. I expect better from a writer on health care issues when citing research findings.

    Moreover, according to the study, “Other facets to consider are first that this study reflects the outcome of psychiatric and somatic treatment for transsexualism provided in Sweden during the 1970s and 1980s.”

    The survey data in this particular study is therefore largely obsolete and irrelevant to modern cases, if only because surgical results have improved significantly – as the authors go on to state, “Since then, treatment has evolved with improved sex reassignment surgery, refined hormonal treatment, and more attention to psychosocial care that might have improved the outcome.”


    – bonze anne blayk