Dr Linda Miller helpfully puts transsexuality on the GP debating table.
However, I feel that her article (GP, 2 June) was somewhat two-dimensional.
I was on the BMA ethics committee in 2004 when the change in the law regarding gender recognition was being debated. I researched the subject and was surprised at what I discovered.
Historically, transsexuality has been considered a psychiatric condition.
The arguments are complex. Essentially it is a condition whereby one rejects one's biologically and genetically determined sex, preferring to dress and live as a member of the opposite sex. However, the availability of gender reassignment surgery (GRS), by implication, re-labels a psychiatric condition as a medical one.
It was the generally accepted wisdom that GRS should be the last resort for transsexual people if, at the end of extensive psychological counselling, it was deemed to be appropriate and necessary, on a case-by-case basis.
It is believed that some 50 per cent of transsexuals undergo this almost irreversible surgery.
In both male-to-female and female-to-male GRS extensive plastic surgery is carried out. Treatment does not end with surgery and there is a need for ongoing support and therapy afterwards.
There has been absolutely no research into the effect of GRS. An obvious need exists for evidence to be collected comparing the psychological outcomes for those who do and those who do not undergo GRS.
If this issue is a matter for society, then research into the impact of GRS on society should also be done. This surely must be carried out before rubber-stamping such treatment as acceptable.
Experts in their field at the Portman Clinic in London believe that offering GRS to transsexuals is preying on their delusional fantasies and is, in itself, absurd. The expectation of GRS is that it will afford the transsexual acceptance; there is no evidence to show this could be enforced by legislation or otherwise. The changes in UK law are aimed in part to respond to a decision in the European Court of Human Rights. They also hope to minimise the rejection of transsexuals in society. That is a laudable aim but laws are not always the best way of reducing social stigma. They also stop a very long way short of an holistic approach to the bigger issues raised by transsexuality.
An Australian transsexual is suing the state of Victoria for giving him poor advice which led to him agreeing to GRS. He claims that it has actually harmed him further psychologically. There are other post-operative transsexuals preparing to follow suit.
We have a responsibility to ensure the treatment being offered is both sound in its evidence base and ethical.
Dr John Wenham, Walkden, Manchester.