If an Orthodox Jewish transsexual desires to transition, which will set him on a course of taking hormones and finally having SRS [Sex Reassignment Surgery], is this permitted per halakha?
Are there any differences if this is MtF (male to female) or FtM (female to male) transitioning? What prohibitions, if any, does this course of action violate? Does pikuach nefesh [danger of life] play a role in determining the halakha? And assuming that someone goes forward with this surgery, rightly or wrongly, under halakha, is this person seen as being the sex which he was born, or the one he presents as and physically resembles? This is aside from the question of how Orthodox Jews ought to treat such a person on a whole. Is he to be included within the community, or summarily excluded?
While this is by no means an exhaustive list, these and other questions have been addressed by several extremely prominent scholars within the field of Jewish Medical Ethics. In his work "Contemporary Halakhic Problems," Volume 1, pages 100-105, Yeshiva University's own Rabbi Dr. J. David Bleich, RIETS Rosh Yeshiva and Rosh Kollel and Professor of Law at Cardozo, lays out the facts.
There, Bleich unequivocally states that "Sex-change operations involving the surgical removal of sexual organs are clearly forbidden on the basis of the explicit biblical prohibition, "And that which is mauled or crushed or torn or cut you shall not offer unto the Lord; nor should you do this in your land" (Lev. 22:24.) Sterilization of women is also prohibited, as recorded in Even ha-Ezer 5:11."
Bleich notes that these prohibitions may be expanded upon due to the commandment, "A woman shall not wear that which pertains to a man, nor shall a man put on a woman's garment" (Deut 22:5), which "is not limited to the wearing of apparel associated with the opposite sex but encompasses any action uniquely identified with the opposite sex, proscribing, for example, shaving of armpits or dyeing of hair by a male." In this vein, "a procedure designed to transform sexual characteristics violates the very essence of this prohibition."
Another renowned posek [halakhic decisor] and specialist in Jewish Medical Ethics, Rabbi Prof. Avraham Steinberg, former director of The Schlesinger Institute of Shaare Zedek Medical Center, currently works as a physician at Shaare Zedek's Pediatric Neurology, and is the Director of The Center for Medical Ethics, Hebrew University-Haddasa Medical School, Jerusalem. In Steinberg's "Encyclopedia of Jewish Medical Ethics" vol. III, pages 1036-1037, he addresses the question of transsexual surgery as well. Steinberg notes that the biblical prohibitions of castration, crushing or wounding the genitalia, and "wearing women's clothes" which "includes conducting oneself like a person of the opposite sex," are violated in converting a man to a woman.
Are there any times during which such a surgery might be permitted? Several Orthodox Jewish transsexuals whom The Observer interviewed noted that they had been told by their physicians that by the time they underwent SRS, they were already sterile. When asked whether that affected the aforementioned prohibitions, Rabbi Bleich explained that, "Castration of a male who is physiologically sterile is equally forbidden." When asked how a situation of pikuach nefesh would affect the decision of a transsexual to transition, Rabbi Bleich stated, "You're telling me facts I do not believe are medically substantiated," claiming that he would need to see proof to that effect. When then asked how a situation of pikuach nefesh in which a transsexual threatened to kill himself would affect his ability to have the Sex Reassignment Surgery, Rabbi Bleich answered that he was skeptical of that claim.
"I have never found a psychiatrist who was willing to tell me that these people develop genuine suicide complexes. Clearly, when you have a person who is suicidal, there are all kinds of things that can be done." When offered some anecdotal evidence of transsexuals who had attempted to kill themselves and had been hospitalized because of it, Bleich remained unimpressed. "In other cases, psychiatrists will tell you that attempted suicide is not a real danger. Attempted suicide is an attempt to attempt suicide." However, he agrees that one does not "ignore the attempts at suicide- it's a call for attention, even if it's not real, and deserves treatment."
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