I’m looking for examples for something I’m writing. Trans people are diagnosed as trans based on not much more than their say-so. There are no lab tests, MRIs, CT or X-rays to diagnose it. I don’t think there’s any other medical field in which they cut off your testicles, uterus or any other organ because of the patient’s decision alone.

You can rule out cosmetic surgeries as an example, because trans surgeries aren’t just cosmetics - a double mastectomy isn’t just a breast reduction, for example.

My understanding is that psychiatric surgeries have gone mostly out of style, and while might be performed in some countries still, they’re a very rare edge case.


I’m looking for examples for something I’m writing. Trans people are diagnosed as trans based on not much more than their say-so. There are no lab tests, MRIs, CT or X-rays to diagnose it. I don’t think there’s any other medical field in which they cut off your testicles, uterus or any other organ because of the patient’s decision alone. You can rule out cosmetic surgeries as an example, because trans surgeries aren’t just cosmetics - a double mastectomy isn’t just a breast reduction, for example. My understanding is that psychiatric surgeries have gone mostly out of style, and while might be performed in some countries still, they’re a very rare edge case. Thanks.


[–] Philogynist 🦋🌍🍃 25 points Edited

Just to clarify, you're talking about physical medical alterations being allowed to be done to "treat" a psychological diagnosis (or self-diagnosis?)?

The closest I can think of is mood disorders being treated by given mood stabilizers or other pills, and that's not even in the same ballpark. There are body integrity identity disorder (BIID) patients who seek out amputations, but I don't know if this is necessarily done as treatment.

[Edit: Lmao great: https://pubmed.ncbi.nlm.nih.gov/19132621/#:~:text=The%20term%20body%20integrity%20identity,transection%20of%20their%20spinal%20cord.

The term body integrity identity disorder (BIID) describes the extremely rare phenomenon of persons who desire the amputation of one or more healthy limbs or who desire a paralysis. Some of these persons mutilate themselves; others ask surgeons for an amputation or for the transection of their spinal cord. Psychologists and physicians explain this phenomenon in quite different ways; but a successful psychotherapeutic or pharmaceutical therapy is not known. Lobbies of persons suffering from BIID explain the desire for amputation in analogy to the desire of transsexuals for surgical sex reassignment. Medical ethicists discuss the controversy about elective amputations of healthy limbs: on the one hand the principle of autonomy is used to deduce the right for body modifications; on the other hand the autonomy of BIID patients is doubted. Neurological results suggest that BIID is a brain disorder producing a disruption of the body image, for which parallels for stroke patients are known. If BIID were a neuropsychological disturbance, which includes missing insight into the illness and a specific lack of autonomy, then amputations would be contraindicated and must be evaluated as bodily injuries of mentally disordered patients. Instead of only curing the symptom, a causal therapy should be developed to integrate the alien limb into the body image.

So why in the fresh hell are we allowing people who desire the removal or changing of healthy sexual characteristics go undoubted and to mutilate themselves? Where is the same ethical controversy? Do trans people really have autonomy? Do they really not have a neuropsychological disturbance?

Yeah that’s a good equivalence. The fact is that this sort of controversy around BIID surgeries exists, but you won’t see as much resistance to cutting off healthy breasts/uterus for young girls who say “actually I’m a boy”.

None I can think of.

The closest I can get is maybe convincing a doctor to do a biopsy based on a patient listing symptoms that can otherwise not be corroborated.

But even then I think they’d do ultrasounds and CT scans and not an actual biopsy.

Skin biopsies were the first thing I thought of. Most dermatologists will just take off a mole, better safe than sorry kind of situation. But those are barely surgeries.

And even then, the doctor can actually SEE a possible problematic mole.

So that’s not even on a patients say so.

[–] Sylvanas [OP] 5 points Edited

Yeah, you’re right. I think it’d be similar if a doctor agrees to diagnose a “mole” they cannot see, just to satisfy a neurotic customer.

I recently read about delusional parasitosis, a condition in which people believe their skin is infested with bugs that nobody can see. They’d pick their skin and cause sores, which only adds to their delusions. Doctors don’t tell them “yes, you’re right, you have termites, here’s pesticide” - they treat them with standard psychiatric methods. Trans might be the only invisible condition that gets this strange blind acceptance from the medical establishment.

Yeah, I'm a hypochondriac and I point out all my "suspicious looking" moles to my dermatologist and she goes, "nope, they're fine". Even in that minor case they don't cut something off just to soothe a person's anxiety if they don't detect a clinical problem.

Interesting example. I didn’t realise that biopsies count as surgeries tbh. Would doctors perform a biopsy on a tissue that’s not been diagnosed as abnormal by other means? As in, would a doctor give you a biopsy based on your report that you have pain in the area?

I don’t think they would do a biopsy based on say so. It was sort of me really reaching for an example. 😁

I would consider it a “procedure” but some would call it a minor surgery.

Biopsy is "an examination of tissue removed from a living body to discover the presence, cause, or extent of a disease"

Surgery is "the branch of medical practice that treats injuries, diseases, and deformities by the physical removal, repair, or readjustment of organs and tissues, often involving cutting into the body"

A biopsy is done in a lab on tissue/an organ that's been removed during a surgery to treat an already-established health problem, or on a very small amount of tissue, fluid or cells removed for the express purpose of sending it to a pathology lab for evaluation so that disease can be diagnosed or ruled out.

If a person has surgical removal of say, their appendix, uterus, ovary, gall bladder or a lymph node, mole, tumor, unusual growth, section of inflamed bowel, etc, then the removed part or a sample of tissue from it automatically gets sent to a path lab for evaluation to establish scientifically whether or not there's anything abnormal about the tissue indicative of disease.

But often, people get a tiny bit of tissue, cells or fluid removed from a part of the body just for the purpose of having the tissue biopsied - as in a "needle biopsy" of tissue, cells or fluid removed by needle from a suspicious breast lump; the liver, kidneys, thyroid, testicles, cervix etc after other kinds of exams and tests have revealed the possibility of disease in those organs. A good example is the cervix: women in a certain age range have routine Pap smear tests done to collect cells for testing; if Pap smear cell testing reveals cells abnormal enough to warrant further investigation, a cervical biopsy will be done to obtain more cells/tissue from the cervix for more detailed examination.


[–] LOriginedumonde 12 points Edited

Hell no. Outside of trans, the furthest a self diagnosed condition would take you is mundane tests, some mild medications, and the psych ward in extreme cases. Surgery that is solely based on a self diagnosed condition would be a huge liability which is why trans surgeries are exceptional absurd.

TIP are nothing more than human guinea pigs in regard to their relationship with the medial industrial complex. There is a reason why insurance companies who are notorious for denying coverage and not giving a shit are all of a sudden tripping over themselves to finance these surgeries in full.

I know that there is a treatment for extremely debilitating OCD which involves brain surgery and an electrical implant which stimulates the brain. I don't think there's anything other than the accounting of the sufferer to diagnose these patients. However, in the specifics of the one case I know about, the patient was debilitated because he felt he had to always concentrate on his breathing and was constantly anxious over whether he was going to be unable to breathe. His distress was so extreme that he was going to surgeons and asking them to give him a tracheotomy.

I believe it's still a very experimental deal and hasn't been done often. The case I saw on a TV show talked about the struggle of this man to get insurance to cover the cost of the surgery and implant and extensive follow-up.

And even then, surgical interventions are the absolute last resort. Patients with any other kind of psychological distress have to go through extensive therapy before such invasive procedures are even considered.

They can use implants like that on severe tourettes too.

[–] ProxyMusic 5 points Edited

But conditions like severe OCD and Tourettes are not self-diagnosed conditions that are purely psychological and internal like "gender dysphoria" or "transness" are. Being "gender dysphoric" and/or "trans" boils down to one, some or all of the following: 1) being obsessed with sex stereotypes, either because they cause distress or intense pleasure (or both); 2) desiring a different body type and set of physical sex characteristics to your own; 3) preferring and adopting a mode of dress, hair style, hobbies/interests/toys, affect and behaviors more associated with the opposite sex - or with neither sex - in your particular culture & era; and/or 4) issuing public pronouncements on social media and IRL about yourself and "your" pronouns to let others know that you are NLOG/W or NLOB/M and there will be hell to pay if anyone fails to see you as a part of a special breed of people who are apart and above the rest of us the way you see yourself.

By contrast, OCD and Tourette's are long-established, clearly-defined conditions, one neuropsychiatric and one neurological. Both conditions are subject to external diagnosis because they result in a set of observable, unmistakable symptoms that others (and machines) can see and measure. And the diagnosis can be verified by repeating the testing and analysis and getting additional opinions.

OP asked about conditions in which people get surgeries based solely on the patients' say-so. Nobody gets a diagnosis of OCD or Tourette's, much less invasive interventions like surgeries and devices implanted into the brain for those conditions, simply by telling a physician or therapist that they "feel like" or "identify as" having OCD or Tourette's or by claiming they have them. Sure, the symptoms of OCD and Tourette's can be mimicked and faked, but to give a diagnosis and recommend interventions, psychiatrists and neurologists will want to see evidence observed over time and will conduct a through investigation that will involve things like brain scans and testing of brain activity.

Exploratory surgery is the most extreme thing I can think of, for something like endo or nerve compression.

Maybe a tonsillectomy if you say they make your breath smell, or wisdom teeth removal if they’re bothering you (but most dentists recommend it anyway). Lasik?

Lasik is to correct eyesight, and eyesight problems are detectable and fairly accurately measurable by optometrists. I don’t think you can get prescription glasses or lasik based on your word alone. I didn’t know about the tonsils thing, thanks - will look it up.

When you do the eye exam you could lie about how well you’re seeing things

[–] Sylvanas [OP] 1 points Edited

The initial eye exam is with a machine that guesses your approximate prescription based on your eyes reaction. You’re told to look at a picture of a balloon, and when your eyes focuses on it, there’s a ballpark number. Here starts the part where they ask you to read the numbers off the board. The machine is called autorefractor:


I think you could lie on the second part of the exam, hypothetically, and end up with an inaccurate prescription that’s half a number off - but for someone with perfectly good eyesight to cheat the initial ballon test sounds less feasible. There’s definitely an objective medical test involved in the process (other than an interview).

[–] hmimperialtortie AGP = evil 4 points

Don’t you have to have repeated tonsillitis before they remove them?

I wanted them removed bc I have stones (my mom didn’t let me anyway), but the doctor had basically agreed

Sometimes they insert feeding ports for anorexia. Edit : typically not self diagnosed but is similar to trans imo.

I had to beg to have surgery in order to obtain a biopsy to prove my cramps were more than cramps, I was gaslit for 15 years that it was all in my head. Naw, it was stage 4 endometriosis by the time they took a look and biopsies were taken. Still not the same thing though.

[–] VestalVirgin 6 points Edited

But anorexia is actually treated medically, by feeding. If they treated it like trans, they'd treat it by giving the patient pills to help her lose even more weight.

Really, the only thing I can come up with that is treated with surgery on the patients' say-so is depression (I mean, sure, there's a diagnosis, but I'm not sure they can diagnose with brain-scan? Might be possible, though), and surgery is the very last resort there, AND they are operating the brain, the organ that causes the problem.

The problem with trans is that it's people having brain problems, and this is then "treated" by operating on their perfectly healthy bodies.

[–] ProxyMusic 0 points Edited

anorexia is actually treated medically, by feeding

No, malnutrition, extreme emaciation, electrolyte imbalance, etc resulting from advanced anorexia that put physical health and life at risk are treated by feeding - and this is usually done as a last resort in the most severe cases. Such interventions are always done on people who are undergoing, or have undergone, various forms treatment for their anorexia itself. Any clinician who advises that feeding is a way to treat anorexia itself is a crackpot. Anorexia is a mental health problem that can lead to physical problems. Feeding is a way of ameliorating some of the physical health problems secondary to anorexia, but it is not a way of treating the primary problem of anorexia itself.

Really, the only thing I can come up with that is treated with surgery on the patients' say-so is depression

Brain stimulation and one kind of surgery are occasionally done for treatment-resistant depression nowadays, but only as a last resort in a handful of extreme cases after a host of anti-depressant medications, medication combinations, psychotherapy and other interventions such as a series of IV ketamine and ECT have been tried and failed - and often only after a patient has spent time under observation and treatment as an in-patient in a psych hospital or ward. Surgery for depression is not a first-line option for garden-variety depression or even disabling MDD - and it's certainly not offered or given to people who've had one or or a couple of office consults, either. Plus, a diagnosis TRMDD and surgical intervention for it are never given on a "patients' say-so." Before recommending extreme measures like ECT or deep brain stimulation, psychiatrists will have patients undergo a variety of physical diagnostic tests to rule out underlying physical causes for their depression - brain injury or disease, infection, inflammation, for example. Moreover, extreme measures like ECT and brain surgery are usually only recommended for those who have spent time as in-patients in psych wards or hospitals and whose moods, affect, behaviors, sleep patterns, appetite, weight, self-descriptions and complaints have been closely observed and documented during that time.


[–] Sylvanas [OP] 2 points Edited

I’m not a doctor, but I’m guessing that feeding ports would be based on blood tests that show malnourishment. It’s likely that there would be more evidence than a girl’s subjective testimony that she hates eating.

[–] ProxyMusic 0 points Edited

A feeding port isn't a treatment for anorexia, though; a feeding port is employed as a last resort to counteract one of the dangerous results of anorexia that's advanced - malnutrition that puts a patient's physical health and very life at risk. Putting in a feeding port is an emergency measure to save a anorectic's physical health and life, but in no way does a feeding port and tube treat the underlying problem of anorexia, a problem that is psychiatric. On the contrary, this type of intervention will most likely make the mental health aspects of anorexia worse and cause affected patients to be more resistant to treatments for the underlying, core illness of anorexia.

Portraying a feeding port as a treatment for anorexia is akin to saying that stitching up and bandaging someone's slit wrists,. or pumping their stomachs, after suicide attempts are treatments for major depressive disorder with suicidal ideation/urges. Apples and oranges.

Similarly, a biopsy is an investigational intervention done for the purpose of diagnosing or ruling out disease or a health condition. A biopsy is not a treatment. Though if biopsy ultimately results in a finding of disease or a health condition, biopsies can and often do lead to treatments being recommended and employed.

I am sorry you got the sort of medical run-around that so many girls and women get for our longstanding, very real health problems. I hope you've been able to obtain treatment for your endometriosis that has led to some relief.

If you haven't already read this, check out this article: https://www.theatlantic.com/magazine/archive/2000/12/a-new-way-to-be-mad/304671/

Check the date on it and read the whole thing.

Oh wow, the resemblance is uncanny - including the threats for self harm if they don’t get why they want.

Isn't it?! This is totally what mental illness creating community looks like: social media in the year 2022.

I love that article and reread it every once in a while.

[–] Sylvanas [OP] 2 points Edited

I’m re-reading it now, still amazed by the difference in language and terminology in an article from only 22 years ago. Btw I will definitely have nightmares about the one guy who cut off his own leg.

Thing is, you don’t even have to go as far as amputees to find online communities of malingering people. There are several commonly self-diagnosed conditions that have a huge social media following, like hypermobile Ehlers-Danlos syndrome (no lab test for that), or chronic Lyme disease (the “chronic” types fails lab test for Lyme but insist they have it still). Except doctors treat these with suspicion, unlike trans. The article shows a similar hesitance and around treating autogynephilia only two decades ago, it’s so strange how the tables have turned.

[–] Misssarcasm 1 points Edited

an identity can be built around a desire. The person you have become may be a consequence of the things you desire

Many wannabes are convinced that amputation is the only possible solution to their problems, yet they have never seen a psychiatrist or a psychologist, have never tried medication, have never read a scientific paper about their problems. More than a few of them have never even spoken face to face with another human being about their desires. All they have is the Internet, and their own troubled lives, and the place where those two things intersect.

Wow. Just wow.

The only examples I know of are cosmetic surgeries for people who were disfigured in some way and suffer mentally because of it. Mainly, women who get breast implants after losing natural breast(s) to cancer and folks who are disfigured by an injury or burn. Sometimes insurance will cover that even if the distress is purely over one's appearance

I agree with you except for one thing, all transitioning procedures (surgeries, laser hair removal, and hormones) are cosmetic. That's why they do it, to look a certain way. The body parts are not being altered because they are diseased, the person simply wants to look different. The genital surgeries are particularly crazy to me because they basically don't function at all and have an extremely high complication rate causing actual serious medical problems (see Exulansic's videos for examples). There is no way currently to give a female person a functioning penis or a male person a functioning vulva and vagina, they're willing to go through all that horror just to look like they sort of have one, from a distance. It's really criminal how many of these patients seem to be uninformed about both the best case end result and the complications.

I had a therapist that said I should just get plastic surgery for my body image issues instead of doing much to help me with them. Not sure if that's common or if she was just a shit therapist. Most therapists I've ever talked to were shit though. Not sure if that counts.

ETA: It did remind me of the affirmation only nonsense they do to trans people these days though. It honestly felt like she was basically like "yes you are unattractive and not womanly enough, go get plastic surgery". Needless to say, it made my issues worse, not better.

Load more (3 comments)