Reid Vanderburgh - Cosmetic Surgery

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Moving toward an expanded life

But Isn't It Just Cosmetic Surgery?

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In early 2002, the question arose on an academic e-mail list I subscribe to, “How can I respond when a colleague questions my decision to have surgery, her argument being that trans surgeries are no different than liposuction, breast augmentation or any other form of body image-based cosmetic surgery? Her point is that women don’t value their bodies enough and are constantly changing them to fit men’s images of what is satisfactory, and that this is no different because I’m just taking it one step further in becoming a man.”

I have done many presentations about trans issues, often within academia, and have encountered this question myself. It tends to fall within the genre of the social constructionist view of gender identity and, to a certain extent, sexual orientation. I responded to this e-mail query, suggesting the following points the inquirer could use as counterarguments.

First of all, the woman who seeks breast augmentation or reduction, abdominal liposuction, or any other form of cosmetic surgery is doing so in order to enhance her image of herself as a woman. Sometimes her goal might be to appear more attractive to a specific person, sometimes her goal is to feel more attractive in general and thus enhance her self-esteem. For better or worse, her feelings about herself as a woman are tied into her physical appearance.

Contrast this motivation with that of the female-to-male transperson. He does not seek a breast reduction in order to feel better about the appearance of his breasts. He is not seeking to enhance his image of himself as a woman. He is seeking chest reconstruction so that his external gender appearance matches his internal sense of gender identity. For the FTM, it is not the shape, size or appearance of his breasts that is problematic - it is the presence of breasts at all that troubles him. Thus, the transperson’s motivation for body-modifying surgery is based in gender identity, not in body image as a basis of self-esteem. It is a means of alleviating gender dissonance.

Second, other types of body modification, such as liposuction, are not appropriate analogies in this instance, as they are unrelated to issues of gender identity. An FTM, for instance, may very well seek liposuction at some point in his life, but it would not be because of gender issues.

When the question then arises, as it often does, how do you know you really feel male instead of female, I ask, “How do you know what your sexual orientation is?” When it comes to issues of core identity, people just know. There is no litmus test, nor is it anyone else’s business to even try to determine anyone else’s identity. It’s up to every individual to do their own soul-searching, to figure out who they are. This is part of my approach to therapy with gender-questioning clients, in fact – helping them get to know who they are on a deep level, not to determine for them who they are.

Finally, when the debate becomes theoretical, hypothetical or academic (as it all too often does within the halls of academia, hence the “ivory tower out-of-touch with reality” reputation of many academics), I point out that no one else has the right to interpret or judge another’s sense of core identity. It is not up to Euroamericans to interpret how African-Americans define their identities, as an analogy. It is not up to a heterosexual woman to interpret what it means or how it should feel to be a lesbian. It is no different for a non-trans person to judge trans identities.

I have often found that those who question trans surgeries as no different from procedures such as liposuction are also social constructionists, believing that gender identity is entirely a matter of socialization. This view harkens back to John Money’s theories of sexuality and gender identity. I believe there is a biological component to both sexuality and gender, and that socialization determines how we manifest gender roles and how comfortable we are if we feel we don’t fit the gender role assigned to us. Socialization plays out in our sense of self-esteem and self-efficacy.

However, if socialization were the only mechanism behind gender identity, trans people would not exist at all – I have yet to meet a trans person who was raised by parents who were completely thrilled when their child turned out to be gender variant, let alone someone who was raised with the intention that they turn out to be trans.

In conclusion, when I am asked questions about body modification, I reply with the preceding points. And I point out, as tactfully as possible, that it’s nobody else’s business in the first place to question another’s interpretation of their gender identity.

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