Guardian

Thursday February 3, 2000

As head of the NHS sex-change programme, the furore of healthy limb amputation seems to me a case of deja vu (Healthy limbs cut off at patients' request, February 1). In 1966, at the University of California, I studied physicians' attitudes toward sex-change surgery. The majority preferred that desperate patients commit suicide rather than undergo genital surgery. Amputating healthy sexual organs was characterised as surgical mutilation and psychiatric collusion with delusion.

Only after years of futile attempts by psychiatrists to make transsexuals accept their birth sex was surgical treatment begun. The rationale for the 1966 programme at the Johns Hopkins Hospital in the US was "if we cannot change the mind to fit the body, then we must change the body to fit the mind". When I endorsed the first sex-change operation at the University of California, in 1969, I was warned of possible criminal prosecution for mayhem. This is the common law offence of damaging the limb of one of the king's fighting men to render him a less effective soldier. Healthy limb amputation may not be comparable to sex change. Half of the world lives as men and half as women. There is no large population content to be missing a leg. There is as yet no substantial body of psychiatric treatment results from attempts to cure this disorder of body image to match the well-documented futility of curing transsexualism.

We are in an early stage of treating this newly recognised disorder. Mental health specialists and surgeons must publish their clinical experiences. Then we can determine whether that learned with transsexuals is applicable.

Prof Richard Green
Charing Cross Medical School