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even an androginos [who has both male and female organs]
is commanded not to make himself look like a woman.

3. A person may not injure himself needlessly, as the gemara
says in maseches Bava Kama (91b): “A person who injures
himself, even though he has no right to do so, is exempt
[from punishment].” Chazal learn this prohibition from
the passuk, “But the blood of your own lives I shall de-
mand,” (Bereishis 9:5) and also from the injunction, “Do
not destroy its trees,” (Devarim 20: 19) – and all the more
so, it is forbidden to treat one’s body in a destructive man-
ner. See the response of the Igros Moshe (Choshen Mishpat
1:103), where the author discusses how donating blood for
a non-Jew can be permitted when it involves injuring one-
self whereas the mitzvah of piku’ach nefesh is only said in
regard to Jews.

Study the [writings of ] those authorities who permit
cosmetic surgery1 only for a woman or a child but not for
a man, except for when there is concern that without the
surgery the patient may fall into a depression, which is con-
sidered tantamount to piku’ach nefesh. It is inconceivable
to permit injuring oneself, and undergoing surgery and
anesthesia which entail a degree of risk to life, for the whim
of imbeciles and fools. Take a look at that which is set forth
in Tosfos (Yevamos 70a s.v. he’arel), namely that a tumtum
[an individual of unknown gender, whose organs of gender
lie within his body] does not have to have himself cut open
so that he can be circumcised [if he is a male] and so that
he can make the pilgrimage to the Beis Hamikdash on the
festivals and offer the mandatory sacrifice upon doing so.
The simple explanation for this is that a person ought not

1. The topic of undergoing surgery for cosmetic purposes [when there is no med-
ical benefit] is discussed earlier in siman 132, ‘Response to Question Three,’ in
regard to operating in order improve the appearance of a hydrocephalic infant so
that it will be easier for the parents to take care of him. See also simanim 187-88.

Gender Change to Prevent Suicide 2 417