Five years ago, Professor Miroslav Djordjevic, the world-leading genital reconstructive surgeon, received a patient at his Belgrade clinic. It was a transgender patient who had surgery at a different clinic to remove male genitalia – and had since changed their mind.
That was the first time Djordjevic had ever been contacted to perform a so-called “reversal” surgery. Over the next six months, another six people also approached him, similarly wanting to reverse their procedures. They came from countries all over the Western world, Britain included, united by an acute sense of regret. At present, Djordjevic has a further six prospective people in discussions with his clinic about reversals and two currently undergoing the process itself; reattaching the male genitalia is a complex procedure and takes several operations over the course of a year to fully complete, at a cost of some euros 18,000 (pounds 16,000).
Those wishing the reversal, Djordjevic says, have spoken to him about crippling levels of depression following their transition and in some cases even contemplated suicide. “It can be a real disaster to hear these stories,” says the 52-year-old. And yet, in the main part, they are not being heard.
Last week, it was alleged that Bath Spa University has turned down an application for research on gender reassignment reversal because it was a subject deemed “potentially politically incorrect”.
James Caspian, a psychotherapist who specializes in working with transgender people, suggested the research after a conversation with Djordjevic in 2014 at a London restaurant where the Serbian told him about the number of reversals he was seeing, and the lack of academic rigour on the subject.
According to Caspian, the university initially approved his proposal to research “detransitioning”. He then amassed some preliminary findings that suggested a growing number of young people – particularly young women – were transitioning their gender and then regretting it.
But after submitting the more detailed proposal to Bath Spa, he discovered he had been referred to the university ethics committee, which rejected it over fears of criticism that might be directed towards the university. Not least on social media from the powerful transgender lobby.
Speaking this week, Caspian described himself as “astonished” at the decision, while Bath Spa University has launched an internal inquiry into why the research was turned down and is at present refusing to comment further.
Until the investigation is complete, Djordjevic, who performs around 100 surgeries a year both at his Belgrade clinic and New York’s Mount Sinai Hospital, is unwilling to give his exact opinion on the apparent rejection, but admits he is baffled as there is a desperate need for greater understanding in reversals.
“Definitely reversal surgery and regret in transgender persons is one of the very hot topics,” he says. “Generally, we have to support all research in this field.”
Djordjevic, who has 22 years’ experience of genital reconstructive surgery, operates under strict guidelines. Before any surgery, patients must undergo psychiatric evaluation for a minimum of between one and two years, followed by a hormonal evaluation and therapy. He also requests two professional letters of recommendation for each person and attempts to remain in contact for as long as possible following the surgery. Currently, he still speaks with 80 per cent of his former patients.
Following conversations with those upon whom he has helped perform reversals, Djordjevic says he has real concerns about the level of psychiatric evaluation and counselling that people receive elsewhere before gender reassignment first takes place.