Christin Milloy:

Rise up and seize equality

Transgender Uterus Transplant: My Body, My Choice (Part 2)


Continued from Part 1

Where Swedish doctors had ignited in my mind the somewhat-realistic prospect of some day being able to carry a pregnancy, a trio of Canadian doctors appeared and made quick effort to snuff that prospect out.

Black-and-white closeup, pregnant belly and two hands.

A possibility neither outlandish nor far-fetched… Unless bullies get their way.
(FreeImages.com/Bas Silderhuis)

In 2012, the three doctors (all men) from the Faculty of Medicine at McGill University in Montreal, Quebec, published a paper entitled The Montreal Criteria for the Ethical Feasibility of Uterine Transplantation: A set of proposed criteria required for a woman to be ethically considered a candidate for a uterine transplant. Wherein, they propose a series of restrictions for the application of UTx technology when it ultimately becomes available as treatment in a clinical setting.

Some of the requirements were quite reasonable… Like, that age should be considered for health reasons, and that steps must be taken to ensure the recipient isn’t being coerced by a partner or family. In fact, each requirement proposed by the doctors was unpacked, explained and justified in granular detail… All save for one: “(Recipient) must be a genetic female.” No explanation given.

That one ugly statement, that trans women should not be “ethically” allowed to receive UTx, plainly made and left boldly undefended: As if it should be self-evident; As if it should go without saying (…except, let’s just say it anyway to make sure, guys, since we’re making the rules here).

Some of their peers must have been as upset and confused as I was, since a year later in 2013 they published an update to their paper: “Uterine transplant offers the same promise of a solution for males or trans individuals wishing to gestate a child as it does for genetic females with UFI. Nevertheless, the Montreal Criteria require that the recipient be a genetic female. This warrants both justification and discussion.” Why yes, it does. So then, what were their reasons for proposing to ban trans women from UTx?

They suggest the hypothetical possibility of complications in vascularization (properly connecting the blood vessels, so the uterus receives enough oxygen and doesn’t die). However, the primary element of success in the new Swedish procedure was a novel method of achieving vascularization, which may not depend on sexual dimorphism and so this could be a non-issue.

They were also concerned about narrow hips, and the “placement of uterus in a non-gynecoid pelvis.” Well you’ve got me there, I do have narrower-than-average hips: Just like every other woman with narrower-than-average hips who has ever not been banned from getting pregnant. Side note, births from UTx in experimental trials are achieved by caesarian. So delivery through my “non-gynecoid pelvis” wouldn’t be a concern.

The Montreal doctors also pointed out that trans women’s hormone treatments would be “more complicated.” Ha! What else is new. Still, why should more challenging mean banned?

The ultimate trump card in the Montreal Criteria for the exclusion of trans women from UTx is just that there is a lack of experimental data to go on, which renders any attempt at UTx treatment for trans women in a clinical setting technically unethical.

As I see it, that leaves only one option: Experiment. Experiment with trans women on an equal basis as they first experimented with the cis women who took part in their first human clinical trials… Many of whom have now successfully given birth.

Experiment.

I volunteer.

Parts 1 and 2 of this article first appeared together (slightly edited) in This Magazine, print edition (2015).

3 Comments

  1. Alex
    Thursday, 2017.01.26 at 22:51

    More brief commentary. 1. Agree again. 2. UGH, transphobia. 3. Good luck. I hope you get the chance to participate in this research, and maybe carry your own child.

  2. Joanne S,
    Monday, 2017.01.30 at 19:40

    Dear Christin,
    I much enjoy reading your blog. However, I am disappointed at your interpretation of the Montreal Criteria. The paper clearly stipulates the following: “Uterine transplant offers the same promise of a solution for males or trans individuals wishing to gestate a child as it does for genetic females with UFI. Nevertheless, the Montreal Criteria require that the recipient be a genetic female. This warrants both justification and discussion. To date, only female recipients have been used in animal and human trials of uterine transplant. There are many interesting yet daunting theoretical medical issues concerning uterine transplant with a nongenetic female recipient, including the creation of adequate uterine vascularization de novo, the necessity for appropriate hormone replacement to sustain implantation and pregnancy, and the placement of the uterus in a nongynecoid pelvis. These unique considerations merit investigation; however, in the absence of sufficient research demonstrating safety and efficacy, uterine transplant in men and trans individuals fails to meet the first stipulation of Moore’s Criteria for Surgical Innovation, which requires that novel surgical procedures have an adequate research background. It is on this basis that the Montreal Criteria exclude nongenetic female recipients.

    However, it certainly bears mentioning that there does not seem to be a prima facie ethical reason to reject the idea of performing uterine transplant on a male or trans patient. A male or trans patient wishing to gestate a child does not have a lesser claim to that desire than their female counterparts. The principle of autonomy is not sex-specific. This right is not absolute, but it is not the business of medicine to decide what is unreasonable to request for a person of sound mind, except as it relates to medical and surgical risk, as well as to distribution of resources. A male who identifies as a woman, for example, arguably has UFI, no functionally different than a woman who is born female with UFI. Irrespective of the surgical challenges involved, such a person’s right to self-governance of her reproductive potential ought to be equal to her genetically female peers and should be respected.”

    In other words, the Montreal Crtieria is actually there to protect surgeons from experimenting in trans individuals like ourselves. I appreciate that we are at least acknowledged and that our personhood is acknowledged. I agree wholeheartedly with the paper, and with you when you say: experiment. I am convinced that in the future we will have access to the procedure and we will benefit from it. We’ll look back and we’ll be glad we weren’t experimented upon without solid research.

    • Christin Scarlett Milloy
      Wednesday, 2017.02.22 at 14:30

      You have to do human clinical trials at some point.

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Christin Milloy