Response to Zoe Jane Playdon

Dr M.T. Haslam


Issue 19
Autumn 2002

I was interested to read Dr Zoe Jane Playdon's talk given at the Royal Society of Medicine premises on the 16th of April, having heard it in the flesh at the time. It was an excellent overview of the situation, but it was a pity that she had to indulge, albeit briefly, in the present popular game of psychiatrist/doctor knocking. I guess her doctorate is not in medicine since the usual misunderstanding came out. I make reference to the following:

Page 13, para 4: "these objections include the inference that transsexualism is a mental illness."

I am not sure how mental illness here is defined. My definition of psychiatry is a medical speciality which specialises in conditions which cause disturbances of thinking, emotion or behaviour (i.e. mental attribute of the brain). The etiology (cause) of such disturbances can be many and varied; that is what specialism is for. For instance, mixoedema is due to a deficiency of thyroid hormone, but it can cause psychiatric illness and may well require the attention of a specialist in psychiatry, as well as a specialist in endocrinology (there aren't that many of the latter!).

Then on to page 16 para 4. "Most doctors who take a special interest in gender problems are psychiatrists." That is reality. It is also quite reasonable since their expertise is often needed. One has, for example, to ensure that the individual who has gender problems does not have a psychotic illness which is causing pathological beliefs. It happens.

Now as to physical examination. Any doctor who has a client with gender problems, and may want "sex change" surgery, and who does not do an examination of the genital area as part of his assessment is, in my view, a fool. In this day of litigation it would be negligent not to have confirmed normality in this area, or to pick up the occasional intersex state (they happen) or anything that might make surgery later difficult or questionable, e.g. prostate disease, hypospadias, or a host of genital abnormalities, undescended testes, gynecological difficulties - you name it. These guys have all qualified, done their medical training, done their house jobs in general medicine and surgery, often done a higher degree to obtain a membership or a doctorate (M.D.) For heaven's sake - you don't need an endocrinologist to prescribe hormone therapy as a general rule (item 6) - any doctor specialising in gender problems knows these issues backwards. What makes Zoe think a GP is better at physical examinations than a specialist with higher qualifications? That is not to knock not GPs but most of them will have little expertise in the issues that are important in gender clients. And frankly (item 4) the risk of cervical cancer is no more a gender issue than a pimple on the nose and is not really relevant.

So let's have a bit of balance in this argument. Doctors, and doctors who specialise in psychiatry, are quite busy enough. If someone doesn't want to see them, that's fine. Don't!

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