Althouse: “It’s a slam dunk for someone like you, taking away all your female parts. We thought you’d eat that up. A transgender gift.”

October 17, 2016

“It’s a slam dunk for someone like you, taking away all your female parts. We thought you’d eat that up. A transgender gift.”

Said the doctor to the breast-cancer patient who, in fact, did not want the surgery.

35 comments:

MayBee said...: No one in the medical field should tell him (or anyone) he is disgusting.

But this is something someone who is trans has to come to terms with:

"“Imagine, if you’re a masculine-looking trans man, and you’re going to the gynecologist,” Dr. Radix said. “You go to the front desk, and you have to out yourself. Everyone can hear what’s going on. You just want to run out the door.”

In addition, some trans people are conflicted about their bodies, “and may not want to think they have the anatomy they have,” Dr. Radix said. He added that pelvic exams could be physically uncomfortable for a transgender man because testosterone can dry out vaginal tissue. It can also change the cervix in ways that make a Pap test hard to read, necessitating a second round. "
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I also want to point out that I am female, was born female, and really hate going to the gynecologists. My friends do, too. We hate the stirrups and being weighed and the gowns and everything. So you know. you either have to decide to go because you care about your health, or you don't go. But when you are a human being, those are just the kind of choices you make.; 10/17/16, 8:16 AM
rhhardin said...: The point of the story is that everything people agree on is wrong.; 10/17/16, 8:17 AM
rhhardin said...: Obviously it has to be renamed vaginoligist, so as not to imply woman.

And why has nobody taken up my restroom identification with genitals and not gender. It solves everything.

At least everything they've thought up to rile people, so far.; 10/17/16, 8:19 AM
MayBee said...: I also want to point out the quote in this article refers to having her ovaries removed to rebalance hormones and prevent a recurrence of cancer. It wasn't about having breasts removed.

ps. Males can have breast cancer, too.; 10/17/16, 8:20 AM
MayBee said...: Or perhaps I should say refers to having his ovaries removed.; 10/17/16, 8:27 AM
Ann Althouse said...: I think there's a big difference between outwardly presenting whatever impression you want (either because you feel it's the real you or because it's an image you choose to embody) and getting your physical body changed with medical interventions (like drugs and surgery).

You can have a preference about one without the other, and it would be terrible if the belief got out there that if you feel that you really belong to the opposite sex from your body you're supposed to get treated with a particular medical intrusion.; 10/17/16, 8:30 AM
Eric the Fruit Bat said...: That's the oddest use of the expression "slam dunk" I've ever heard.; 10/17/16, 8:32 AM
Laslo Spatula said...: "Doctor, did the surgery go well?"

"Ah yes. Your vagina has been successfully transformed into a penis, and I believe you will be quite pleased with the results."

"What?! I didn't want a penis! I was here to have a knee replacement."

"Oh, you're still disoriented from the anesthetic. Don't worry: it will all be fine."

"But I don't want a penis."

"The time for doubt is gone, I'm afraid."

"But I REALLY don't want a penis. I am happy to be a woman."

"ALL women want a penis, on some level. Freud, you know."

"Turn it back! Please!"

"I'm afraid we can't do that. Once you mash the potatoes you can't un-mash the potatoes. Your potatoes are mashed."

"But I'm a happily married woman. Married to a man."

"I'm sure your husband will still love you just the same. Mostly."

"This is horrible..."

"You should have thought about that before the surgery."

"But it was supposed to just be a knee replacement!"

"All kinds of unexpected things can occur during surgery. I'm still missing a pen from three years ago: I don't know which patient THAT fell into."

"My life is over."

"Actually, that was my previous patient. Died right on the table. Sad: she never got to wake up and enjoy the experience of having a penis. She would've considered you lucky, I imagine."

"I.m serious: I think I want to die."

"Don't be so melodramatic. You women: you can add a penis to you, but you still get all woman-like about things."

"What does THAT mean?"

"Woman-like: irrational. Melodramatic. Prone to hysteria. It's not your fault, of course: it's genetic."

"What am I going to tell my husband?"

"I'm a surgeon, not a psychiatrist. Can't help you there."

"I think I just want to be alone."

"Sure, I understand. Just don't start playing with the penis yet: we don't want it coming off in your hands..."

I am Laslo.; 10/17/16, 8:33 AM
MadisonMan said...: Someone should tell the person who wrote that article that men -- born male, living as men -- do get breast cancer also.

I realize that it would mean she'd (of course) have to refocus the article.; 10/17/16, 8:39 AM
Meade said...: oddest use of the expression "slam dunk"

He probably meant say "no brainer".; 10/17/16, 8:40 AM
damikesc said...: I can't think of any issues in the world where gender confusion will make them better.; 10/17/16, 8:44 AM
MayBee said...: You can have a preference about one without the other, and it would be terrible if the belief got out there that if you feel that you really belong to the opposite sex from your body you're supposed to get treated with a particular medical intrusion.

But I don't read that as what happened. The doctor recommended a course of treatment she would offer anyone in the same circumstance: remove the ovaries because the hormonal imbalance may cause a recurrence of the breast cancer. When the patient declined, that's when the doctor said she thought it would be what she'd want. It was just an honest discussion.; 10/17/16, 8:50 AM
MayBee said...: You can have a preference about one without the other, and it would be terrible if the belief got out there that if you feel that you really belong to the opposite sex from your body you're supposed to get treated with a particular medical intrusion.

Also, much of the article is about this, though. If you feel that you really belong to the opposite sex from your body, you still need to get the medical treatments your body dictates. The article talks about trans-men not wanting to face up to the face they have gynological needs because they don't want to face the fact they have those body parts. But they do, and they do!

Even if you present as a man, if you keep your female body parts, you need to get the medical care of a female.; 10/17/16, 8:55 AM
Laslo Spatula said...: "Even if you present as a man, if you keep your female body parts, you need to get the medical care of a female."

You mean if I put a Mercedes-Benz medallion on my Ford I still need to take it to the Ford dealership for an oil change?

I am Laslo.; 10/17/16, 9:09 AM
Sydney said...: When I read the quote, I assumed the surgeon was a man and that the exchange had been one that demeaned the patient. The surgeon is a woman, and she and the patient hugged after the conversation.
I was a little puzzled about the part where the patient says he chose not to have breast reduction surgery as part of his transition to becoming a man because by that time he felt more comfortable with his body. He began the transition at age 19. Now he's an adult. Would he have become more comfortable with every aspect of his body as he matured? If he hadn't started down that hormone highway, would he have accepted who he is? I always wonder about that when young people are involved. There was a case in the media a few weeks ago about a transgender man who went through pregnancy and delivered a baby. It was reported that he always wanted to have that experience, even though he identified as a man. Seems to me that isn't really identifying as male if one of your deep desires is to give birth.; 10/17/16, 9:10 AM
traditionalguy said...: Hint: Good surgeons are sadists with zero empathy. That is what makes them good at cutting up and rearranging bodies. They cannot see the persons inside the fleshy body. If they could, they would quit or go insane.; 10/17/16, 9:13 AM
Mike (MJB Wolf) said...: "His mother and her mother had both had breast cancer..."

This seems like a fact he should not have overlooked. If your DNA is double X then you better think about yourself in that context, physically. Obviously he never forgot he was a woman, and had woman parts. He kept 'em on purpose.

I don't want to sound unsympathetic to Mr. Oberman, but ALL of us deal with changes to our looks -- some drastic some not -- after age 30 or so. When you "chose" to be a man you entered the world of thinning hair and other things men deal with every day. And I was not convinced by the "afraid of the OB-GYN" montage the author developed. All this "be brave" and "be who you are" crap we hear and the Trans guy is afraid to check in for a Pap smear? He wants to live OUT THERE as the opposite sex from his DNA but he can't take a little discomfort in the waiting room?

Don't these writers and "thinkers" realize we ALL go through some of that? It's not a special trans experience. New doctors. New offices. Outside our comfort zones. Like so much in the Times I can't help leaving this story feeling like the writer missed the real human interest angle. Probably because she just couldn't wait to use the pull quote Althouse used to start this discussion. And yet, the doctor's statement about thinking he's "eat it up" just felt pasted on and out of context.

Why did the doctor feel that way? THAT would have been some good reporting!; 10/17/16, 9:17 AM
Achilles said...: The only real issue I have with this article is We are probably paying for that surgery.; 10/17/16, 9:19 AM
AlbertAnonymous said...: This shows we've gone full Orwell.

"Transgender man" doesn't mean one who changed genders. Just one who says/acts as if it is so.

What do you call women who want to be/think they are men?

What do you call women who undergo surgery to become men?

This is why all the articles about "men" having babies...

Honestly, I have no idea why anyone reads the New York Times.; 10/17/16, 9:28 AM
Sydney said...: Why did the doctor feel that way? THAT would have been some good reporting!

I guess the doctor assumed, as most of us do, that if someone is truly transgender, they want to be the other gender completely. Evidently, this is not true. And if it is not true, then transgenderism is nothing more than a style choice. And it should not be enabled by hormonal therapy.; 10/17/16, 9:35 AM
AlbertAnonymous said...: ... And if the woman who "became" a man at 19 is considered a "transgendered man", what do you call that person if he/she changes his/her mind and "becomes" a woman again? "Un-transgendered man" ? "Re-transgendered woman"? Maybe just "Loretta"? Or would it be "Stan" again?; 10/17/16, 9:37 AM
AlbertAnonymous said...: When "Caitlyn" Jenner's run in reality TV flames out (no pun intended Laslo), will anyone be shocked that he quickly "becomes" Bruce again?; 10/17/16, 9:40 AM
Tommy Duncan said...: I'm 65 years old. I smile thinking about the conversation this incident would have generated in a 1950's or 1960's bowling alley. I miss the America of my youth.; 10/17/16, 9:52 AM
Bay Area Guy said...: I'm very sympathetic about the cancer diagnosis.

I'm not as sympathetic about the choice to pretend you're a man, when you're not.

I haven't drank that Kool-aid yet, sorry.; 10/17/16, 11:17 AM
Hammond X. Gritzkofe said...: Life's a bitch, aint it.; 10/17/16, 11:17 AM
Theranter said...: Maybee: "But I don't read that as what happened. The doctor recommended a course of treatment she would offer anyone in the same circumstance: remove the ovaries because the hormonal imbalance may cause a recurrence of the breast cancer. When the patient declined, that's when the doctor said she thought it would be what she'd want. It was just an honest discussion."

Exactly. If it was hormone-fueled BC, removing the ovaries is an important consideration. (Never mind the cancer can spread quickly to the ovaries and on from there.)

I can't read the NYT, so I'm just surmising from the comments that this female doc told a bio female that feels like it's a male that removing the ovaries was a win-win. O/T, but it does "trigger" my anger at this whole transgender surgery being covered by insurance and a couple of incidents during my (non-hormone fueled cancer) breast cancer treatments.

F to M transgenders get an automatic approval for removal of the breasts. I had an agressive cancer in the left breast, and in the left armpit (not in the lymph nodes--it was actually breast "tail" tissue and a tumor had also formed there) and wanted a double mastectomy. I did not want to take any chance of it happening in the other Breast, as with my type of breasts the cancer was incredibly hard to detect--it never appeared on any mammograms--only on ultrasound, which was only approved after the tumor was visibly protruding. Every year I'd ask about it, as well as the armpit lump, always same answer "mammogram is clear."

Anyhow the insurance company fight to approve removal of the other breast was epic and incredibly stressful, but ultimately I prevailed. So hearing about people getting auto approval for elective surgery to remove parts is maddening! (In retrospect, I should have asked how much more it would be for the surgeon to remove the non cancerous one and if it was financially feasible at the time, I should have gone that route.)

On topic: Possibly the worst event (emotionally) throughout the two years of chemo and surgeries was a mandatory pre-mastectomy visit to a plastic surgeon. I did not want to go--I knew 100% that I did not want implants, it's not like you get feeling back!-- but surgeon and Onc said I had to have the consult. Plastic surgeon was a (very large) man. I told him I did not want implants, was only there at behest of my other Dr.'s. He started in on what type of reconstruction he'd do based on my body and still-intact (incredibly nice) breasts. I reiterated I did not want recon, and therefore did not want any "skin sparing" during the actual mastectomies, and that I'd take a nose job or facelift in lieu of recon, at which point he bellowed "YOU DON'T UNDERSTAND, THIS IS ABOUT FEELING WHOLE AGAIN." I totally lost it, yelling at him that how the F would he know what makes me feel "whole" and that only asshole of a man like him would think of me as less than "whole" without (even fake) breasts. I left and was very proud that I didn't dissolve into tears until I got in my car.

Well that was cathartic to write! My whole point was the transgendered's doctor may have made similar assumptions as my a-hole plastic surgeon, but in this case, it was in her patients best interest, as it could be literally life saving, and have an added bonus, which is where she may have triggered something in the transgender's psyche.

And unless the TG had received previous hormone "therapy" (in which case it may have caused the breast cancer) why would being transgendered in mind only/never wanting to have any physical alterations even come up in a cancer consult? Why can't s/he just be her/himself and not go around proclaiming their TGness? Why is that even relevant?

(Spewed from an IPad, apologies for errors and length, not going to edit.); 10/17/16, 11:38 AM
MaxedOutMama said...: It doesn't seem to me that the central thesis of the article: "... the medical world has blind spots in its understanding of how to take care of trans men and women," is at all borne out by the information in the article.

What you have here is a patient who is avoiding reality and just got a reporter to endorse his self-destructive ideas, because the advice given (either stay on tamoxifen or get the ovaries out) is very solidly substantiated by medical evidence.

Of course one feels very sorry for the patient - sex-linked cancers are very problematic for any patient, and this one is very young. But the impression the article made on me was that the patient needs a psych referral rather than the doctors needing to get their shit together.

Also the article is flat-out wrong about the effect of testosterone on breast cancer risk. From the Komen Foundation:
http://ww5.komen.org/BreastCancer/Table7Bloodandrogenlevelsandbreastcancerrisk.html

From the advice given (lower levels of estrogen) we know that the cancer was hormone receptor-positive. Yes, on surgery or biopsy this typing is automatically done. This means that the ovaries being present do increase risk, and so does the testosterone.

But worse yet, the patient is now at a higher risk for ovarian cancer even without hormone therapy, and the testosterone increases that risk. So you have a very young patient diagnosed with very severe cancer with a family history of cancer following a life-long course of treatment that in itself carries higher cancer risks determined to pursue the riskiest possible medical strategy. And we are going to blame that on the medical profession?
http://www.cancer-network.org/cancer_information/transgender_gender-nonconforming_people_and_cancer/transgender_men_and_ovarian_cancer.php

This article is a mound of bullshit conveying fearfully bad medical advice, and the NYT should be ashamed of itself for not at least running it past some doctors, or even bothering to look up standard recommendations.

Note that if the breast cancer had not been hormone receptor-positive, testosterone probably wouldn't be the risk that it is. But it is, and the doctor trying to get the patient to deal with this risk is somehow made out to be an insensitive jerk?????

Maybe people who become deeply involved in the cognitive delusion that they are not what they are, are in fact people who refuse to accept reality and therefore create gaps in medical care themselves? That's what this troubling story says to me. I can only hope that someone in the medical field and in Oberman's field of acquaintance tries to intervene, because based on name and the limited information we are given, I am guessing that Oberman is real danger of losing his life by not dealing with this.; 10/17/16, 11:57 AM
Ann Althouse said...: Thanks for telling your story, Theranter.; 10/17/16, 12:00 PM
Hammond X. Gritzkofe said...: Althouse: ...and it would be terrible if the belief got out there that if you feel that you really belong to the opposite sex from your body you're supposed to get treated with a particular medical intrusion.

Print and broadcast media thrive on controversy. Clarity would be served, and much controversy stilled, if the language could be standardized:

SEX is a noun, the biological parts you carry; Oberman is a female.

GENDER is an adjective, a descriptor; Oberman is masculine, and prefers to present as such.

We, as readers and listeners, should be skeptical of any article which does not adhere to that simple standard.; 10/17/16, 12:43 PM
AlbertAnonymous said...: Professor Ann "Humpty Dumpty" Althouse:

That simple standard? Sex and gender are both nouns. You want to make gender only an adjective, assign it some meaning that you like it to have, and remove any other meanings or usages.

Feel free to be Humpty Dumpty, but I'll stick with Alice.; 10/17/16, 1:16 PM
AlbertAnonymous said...: Sorry Professor,

Maybe that should have been directed to "Hammond "Humpty Dumpty" Gritzkofe...; 10/17/16, 1:17 PM
Unknown said...: Theranter, second the thanks. I can't imagine how much this stupidity must irritate.; 10/17/16, 1:22 PM
gerry said...: But the impression the article made on me was that the patient needs a psych referral rather than the doctors needing to get their shit together.

It's called gender dysphoria and should be treated as a psychiatric disorder and not as a fashionable choice.

From a 30-year study done in Sweden:
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.; 10/17/16, 2:13 PM
Rosalyn C. said...: I watched the music video where Mr. Oberman was truly appearing free and totally self expressive playing the violin. I thought he really has such a feminine soul, and now he looks like a woman trapped in a man's body! What's the point of looking like a man but not having male anatomy? Just because she didn't want to fulfill people's expectations of how she was supposed to look and behave as a female she decided she had to look like man instead, at age 19? And if he can't feel normal and himself without the extra testosterone isn't that a clue that his identity is more of a fantasy than a reality? Isn't Mr. Oberman a lesbian after all?

Self acceptance is key no matter who you are, and I believe it is especially important to give that message to young transgenders. All this emphasis on surgeries and hating their bodies is making them more suicidal IMO. Take away lesson: if your "self esteem" is dependent on whether other people accept you, then you don't really have "self esteem."; 10/17/16, 2:50 PM
MayBee said...: Sorry to hear what you are going through, Theranter.; 10/17/16, 2:55 PM