Transgender Surgery- Common Sense and Decency are Needed
Big business: the advertising, lobbying and the experimental surgeries/procedures must stop.
WARNING - This article discusses topics that are not suitable for children, and even most adults will find very disturbing and graphic. Please don’t read further if you think this is going to trigger you.
Having read what is apparently a “spoof” article entitled “Encourage women to smell their poop to be more inclusive to Trans women” (or is it a spoof - you decide, I have read both points of view). I decided to look more carefully into the scientific and medical literature concerning the procedures and adverse events associated with what has come to be known as gender “affirmation” surgery (otherwise known as gender reassignment surgery), as well as delving into all of the other medical procedures, drugs and “therapies” that physicians are using to “transition” people. And based only on the actual peer reviewed scientific literature, what I found deeply disturbed me from a medical ethics point of view as well as from a clinical health perspective. What is the medical profession doing to these people, particularly to adolescents? Are adults and adolescents (and their parents) being adequately briefed on the risks and adverse events of these surgical and medical treatments? Is full disclosure and unbiased informed consent being performed?
Frankly, it is something I want to avert my eyes from. But as a medical professional, as an educator, as a parent, as a decent human being - I hope and believe that this substack article summarizes important information for those who wish to understand exactly what these surgeries and drugs do to the body and mind. Furthermore, based on what I have read, it is also important to recognize and understand that these procedures are being marketed, advertised, to convince children to accept these surgical and medical interventions.
I take no position here on the incidence, prevalence, merit or need for treatment of gender dysphoria or other related diagnoses. In this article I am just addressing the surgical and pharmaceutical procedures, with a specific focus on safety and adverse events, as well as on current practices involving marketing and advertising of these interventions.
Based on my review of the literature, patients that may suffer from gender dysphoria or related conditions are, in my opinion, at risk for becoming victims of marketing and advertising campaigns of those who profit from these interventions. Furthermore, my review of the literature leads me to conclude that a faddish belief that one can change their gender – that the gender-related anatomy which is a consequence of one’s genetic make-up (inborn chromosomal complement) can be readily and safely reversed at will by a combination of surgical and medical intervention - appears to have been based on flawed, biased, irreproducible clinical research.
In all of the related marketing of medical procedures to a wide variety of patients which I have reviewed, I am most disturbed by advertising for gender “affirmation” surgery. Particularly “bottom” surgery. On-line marketing materials are being placed on websites that are clearly targeting children and teens; in other words, children and teens are being “nudged” and pushed to consider (and thereby normalize) these procedures. I am particularly troubled that those who are not yet adults, who by definition are not yet cognitively and psychologically mature, are having these surgeries, treatments, hormones and drugs thrust upon them as a way to “cure” their unhappiness, their angst, and frankly, their mental health issues. This is what bothers and saddens me the most in all that I have found during my brief research and reading on this topic.
In reading what the actual medical procedures consist of, and finding various “fake” articles meant to spoof those who don’t agree with these procedures (such as the one cited at the beginning of this essay), I discovered that these procedures are being marketed to children. I was stunned to find what appears to be automated Google Ad advertising of transgender surgical centers on sites designed specifically for children and teens. For instance, I encountered these advertisements (below) when reviewing the website ifunny.io, after searching the keywords “gender affirmation” on a search engine earlier. This is a website and app targeting mostly children and young adults where one can view and post funny memes/cartoons. Frankly, the memes are pretty much gross, not very funny and for the most part, I wouldn’t have let my kids on there. But, I am not everyone, and it is clear that this site is targeted to a young audience.
There are some some pretty big corporate names that advertise on ifunny.co. But when I was on this site, the following banner ad popped up in the sidebar:
So, I clicked on the OPEN link and the Crane Center for Transgender Surgery website opens up…
From clicking a button on “gender affirmation” on ifunny.co (a site catering to children and teens as discussed above), I ended up on a transgender surgical center. Wow.
Transgender surgery is big business. Let us not forget that. It is a business that is lobbying the government for more and more transgender legislation, insurance cost coverage, and it is using the corporate press and big tech to legitimize surgeries, drugs and hormones that are still experimental and dangerous.
In this context I previously wrote about the Pritzker family, who are among the top ten wealthiest families in the USA. This family is using their vast resources to remake human gender and sexuality. They are using gender ideology to attempt to remake human biology. This family is lobbying hard for more protections for transgender procedures/surgeries, transgender education down to primary school, and they have funded medical schools, universities and transgender surgical centers throughout the USA to the tune of hundreds of millions of dollars to advance these agendas.
In the UK and in Sweden, the dangers of puberty blockers and transgender surgeries are now being discussed openly, and clinics are being shut down. Headlines such as this are now the norm:
Thousands of young people were treated by Tavistock centre in north London
Many of them were prescribed powerful drugs to delay onset of adolescence
But now the NHS has ordered it to be shut down in the wake of a damning report
James Esses, co-founder of Thoughtful Therapists, said: 'I have been contacted by a number of detransitioners who are considering taking legal action.
'Already in the USA there are class lawsuits being taken by parents of children prescribed puberty blockers. It is only a matter of time until we see similar action on our shores.'
He went on: 'Gender dysphoria is a mental health condition and should be treated as such – through explorative therapy, rather than irreversible medication and surgery.
'Far too many children have been left with physical and emotional scars from decisions we should never have let them make.'
EU and UK Chat rooms and message boards are now suggesting that medical tourism to the USA may be the best option for EU and UK citizens who want these types of procedures and modifications. Because in the USA, these clinics are still full steam ahead.
Having briefly touched on the troubling topic of advertising and marketing of these medical interventions to children and adolescents, I am now going to pivot and go through some of these procedures as defined by the Crane Surgical Center website. Crane is a prominent medical and surgical clinic for those wishing such surgeries and procedures. I am doing this because I don’t know if people realize what is involved. The words describing the procedures listed below are not my definitions - but rather come straight from the Crane surgical center (I did remove the praise for their various surgeons and the center, but little else). I recommend that (if you have the stomach for it) it is helpful to visit Crane website and review the photos of the post surgery “recovered.” Be forewarned - these photos of genitalia are quite graphic, most of the photos document very abnormal anatomical structures. Frankly, based on these images, I must conclude that current “state of the art” human “augmentation” surgery produces genital anatomical features which are anything but normal.
Genital Nullification / Nullo
Genital nullification, Nullo, or Eunuch procedures involve removing all external genitalia to create a smooth transition from the abdomen to the groin. In some cases, this involves shortening the urethra. For patients born with a uterus, a hysterectomy is required prior to any genital nullification procedure.
Phalloplasty* utilizes donor sites from either the radial forearm (RFF), the outside of the thigh (anterolateral thigh – ALT), or the back (musculocutaneous latissimus dorsi – MLD). These flaps heal well with good sensation due to robust blood supply and innervation.
“free flap” Phalloplasty. Free flaps, such as the RFF, ALT and MLD require meticulous dissection of arteries, veins, and nerves. Subsequently, after transferring the flap to where the phallus resides, the microscope is used to connect the small blood vessels and sensory nerves to the transferred flap. Like Metoidioplasty, urethral lengthening, scrotoplasty and vaginectomy can be performed at the same time.
Once appropriate would healing has been achieved, a penile implant may be inserted into the phallus to allow for penetrative intercourse.
Scrotoplasty is the formation of a scrotum using native labial majora tissue. Scrotoplasty can be performed in one or two stages. The resulting scrotum is fused in the midline, anteriorly positioned, and pouch-like.
For those who would prefer a larger scrotum than their native tissue will allow, tissue expansion with delayed Scrotoplasty can be performed.
Penile Implant Surgery can be performed about 9 months after Phalloplasty, once optimal wound healing has occurred. It involves inserting a semi-rigid or inflatable penile implant into the phallus. The rigidity of the penile implant allows the patient to achieve penetrative intercourse.
Testicular Implant Surgery can be performed in conjunction with Penile Implant Surgery.
Vaginoplasty (video link) is a gender-affirming surgical procedure in which male genitalia is reconstructed into female genitalia, complete with a vaginal vault, labia and a clitoris. Recovered photos (these are graphic).
Penile Inversion Vaginoplasty is the most commonly performed type of MTF Vaginoplasty. The testicles are removed (Orchiectomy) and the scrotal skin is used to make labia majora (Labiaplasty). The nerves to the the sensitive glans penis and the corresponding skin is preserved and used to make a clitoris. The skin of the penis and, in most cases, skin grafts from the scrotum are used to make a vaginal vault. The urethra is shortened and placed in the female position. Sensitive urethral mucosa is placed in between the labia minora.
Penile Inversion Vaginoplasty is typically a one stage procedure, however, occasionally secondary procedures are preferred to maximize the aesthetic appearance of the vulva.
Robotic-Assisted Peritoneal Flap Vaginoplasty has several names: Davydov vaginoplasty and peritoneal pull through are the best-known alternative terms. The peritoneum is the inside lining of the abdomen. Through several small incisions on the abdomen, robotic-assisted laparoscopy is performed to rearrange the peritoneum in the pelvis. This will create the inside half of the vaginal canal. The remainder of the vaginoplasty is a standard penile inversion vaginoplasty.
Permanent hair removal is required on the genital area prior to surgery.
I could go on - there are many, many other surgeries that are being conducted. But these definitions - per the Crane Surgical center website, are some of the main “bottom” surgeries. There are many, many more photos and videos on the site. Personally, I find it extremely upsetting that surgeons are doing these procedures to children and teens.
It is important to note that transgender surgery is advertised on the web as having a 94-100% satisfaction rate. However, as reported this outcome measure apparently also bundles facial cosmetic surgery, mastectomy and liposuction to yield the final “satisfaction rate”. “Bottom” surgery - which is the actual surgical manipulation of genitalia, has a much lower success rate.
What are the actual clinical data on “Bottom” surgery?
In one example, an article entitled Penile Prosthesis in Transgender Men after Phalloplasty notes that
“complications include injury to the urethra, vascular injury, skin breakdown, infection, device migration, device failure, extrusion, and erosion.
Another study: Penile Prosthesis Placement by a Dedicated Transgender Surgery Unit: A Retrospective Analysis of Complications
Results: There was an overall complication requiring surgery rate of 36% and infection rate of 20% (15/67 for inflatable prostheses and 1/13 for semirigid), with 14% (11/80) experiencing infection requiring removal. Differences in infection rates appeared insignificant across categories of previous surgery or with simultaneous surgery, but we did notice a markedly lower rate for semirigid prostheses compared to inflatable. There was a significant relationship between infection and case number, with the probability of infection decreasing over time. Device loss at 9 months was 21% overall.
If the device “loss” was 20% at nine months, that appears to imply that the failure rate within five years is 100%!
These transgender surgeries appear to require a life long commitment to ever more invasive surgeries.
For a good primer on “bottom” surgery complications, go here. Please note this paper has some graphic images..
The sad fact is that the people who have undergone these surgeries often end up with more problems than when they started.
The article below details some of these problems in the “transfeminine” population.
Sexual Medicine, Sept 2, 2022
Table 1 Representative participant responses.
Genitourinary Symptoms
•“When I take [spironolactone], I know that I need to pee a lot more and my like retention is like not as good and you're getting up in the middle of the night to go to the restroom.”
•“I was saying about the…urine being stuck in the urethra and no matter how much you pee or how much you drink water, it's never going to go away. So you always have the feeling to pee and just forcing you know or drinking more water, it just makes the urge really more irritating.”
•“I will not be able to hold when I need to pee, and then after I pee, I'll sit there for a few minutes. I'll think it's completely done, but inevitably, after I stand up, there's still something that comes out, and it causes some minor problems. I haven't really spoken to anybody about it.”
Sexual Symptoms
•“My erection has been softer since I've been on hormones and since the orchiectomy I've noticed a lot of pain at the shaft, the base of the shaft…I feel like the scar tissue pain.”
•“Since transitioning I have been pretty sexually inactive. Because estrogen has killed my libido.”
•“I've had a history of dealing with hemorrhoids and if I have an anal fissure that's come and go, but since the surgery, it's been quite consistent that after sex I'll have…terrible, terrible hemorrhoids and fissures flare up afterwards.”
•“I feel really…inadequate…we used to have sex a lot…in the beginning stages of my transitioning and it just kind of has fizzled, and I think that's just been a little disappointing, for me especially because…I don't know what to do.”
•“Since I had my gender confirmation surgery, I guess it's because of the healing process that it's not over yet. I've had some pain when muscles tense and when I'm aroused. So, it has been, I have to say that it has been uncomfortable.”
Successful Relationships with Providers
•“The care provider sort of admitted that…they weren't an expert on this and that they weren't totally sure that what they were saying was true…it was nice that they admitted that, but was you know just not very like encouraging.”
•“Most people don't know the least bit how to treat us. They seem to think that because I'm trans a sinus infection is different in me than it is in somebody else. If I wind up talking to them at all about what the surgeries I've had most of them just have no clue about anything to do with any of it.”
•“It's probably been a decade since I've seen a gynecologist because I don't know any gynecologists with expertise in dealing with trans women. The last time I went to a gynecologist he went down with a speculum, took a look at me, and said everything looked normal, and took a swab to send off for a pap smear. I had to tell him that I was postop trans sexual, and that I don't have a cervix.”
•“Even at places that specialize in trans care, they simply don't know what's going to happen and they're still learning. I feel like I've been asked a lot and it's great that again, they trust me, in terms of how to handle my HRT therapy, but they don't really have answers in terms of what's going to work.”
But it gets worse:
Genitourinary Symptoms – Participants both with and without a history of hormone therapy or GGAS reported genitourinary symptoms. Common genitourinary issues reported by both groups included urge incontinence, stress incontinence, urinary retention, and recurrent urinary tract and prostate infections. Spraying of urine, dysuria, and varicoceles were also noted. Several patients were frustrated that they had to learn about urinary side effects from hormone therapy (ie, spironolactone) through their own research and experience rather than through education from a provider. Participants who had undergone gender-reaffirming surgical intervention reported urethral strictures and external scar tissue restricting urine outflow, loss of sensation, and chronic pain in the genital region as post-procedure symptoms.
Sexual Symptoms – Participants both with and without a history of hormone therapy or GGAS reported sexual symptoms. Respondents described both their penis or vagina as being important for sexual function. Most participants, regardless of whether treated with hormone therapy, reported symptoms of lowered libido, anorgasmia, and erectile dysfunction. Pain in the genital and perineal region during sexual encounters and delayed ejaculation were common issues encountered by participants who did undergo hormone therapy or GGAS. In addition, several participants reported seeking psychological care due to distress from inadequate sexual performances.
THIS IS NOT OK!
With that, lets’ now turn to reviewing some of the current research focused on “juvenile transsexuals”. Below is a summary of a recently published comprehensive paper that reviews the history of the juvenile transgender procedures.
This is an important read for any who truly want to advocate that the use of these surgeries and drugs on children and teens does not continue here in the USA.
The Dutch Protocol for Juvenile Transsexuals: Origins and Evidence
Journal of Sex and Marital Therapy, Sept 19, 2022
It has been a quarter of a century since Dutch clinicians proposed puberty suppression as an intervention for “juvenile transsexuals,” which became the international standard for treating gender dysphoria. This paper reviews the history of this intervention and scrutinizes the evidence adduced to support it. The intervention was justified by claims that it was reversible and that it was a tool for diagnosis, but these claims are increasingly implausible. The main evidence for the Dutch protocol came from a longitudinal study of 70 adolescents who had been subjected to puberty suppression followed by cross-sex hormones and surgery. Their outcomes shortly after surgery appeared positive, except for the one patient who died, but these findings rested on a small number of observations and incommensurable measures of gender dysphoria. A replication study conducted in Britain found no improvement. While some effects of puberty suppression have been carefully studied, such as on bone density, others have been ignored, like on sexual functioning.
The paper goes on to describe the off-label drugs which are being used:
In the nomenclature of transgender medicine, “puberty blockers” denote GnRHa drugs (alternatively known as Luteinizing Hormone-Releasing Hormone agonists) which stop the production of sex hormones.1 Drugs in this class include triptorelin (branded Decapeptyl or Gonapeptyl), which is used in the Netherlands and Britain, and leuprorelin (branded Lupron) in North America. GnRHa drugs are licensed to treat several medical conditions including precocious puberty in children; endometriosis and uterine fibroids in women; and advanced prostate cancer and sexual deviance in men. The drugs have never been licensed as a treatment for gender dysphoria.
Then the issue of puberty blockers and Bone Density:
The detrimental effect of GnRHa on the accrual of normal bone mass has been documented in several longitudinal studies from the Amsterdam clinic (Klink et al., 2015; Schagen et al., 2020; Stoffers et al., 2019; Vlot et al., 2017), the London clinic (Biggs, 2021; Joseph et al., 2019), and a clinic in Ottawa (Navabi et al., 2021). Less obviously, adolescents who seek GnRHa for gender dysphoria have a lower distribution of bone density compared to the population of the same sex and age (see also Lee et al., 2020). This reflects in part the high prevalence of eating disorders.
The paper also documents that puberty blockers may be affecting IQ, and cites a number of case studies indicating that these practices are creating a class of teenagers who will never experience a normal puberty.
While the use of GnRHa to suppress puberty helped to create the juvenile transsexual, it could now be creating another “new way of being a person” (Wren, 2020): a sexless adult. This follows from the premise that natal puberty can be a kind of disease, and therefore failure to prevent an “irreversible development of secondary sex characteristics … may be considered unethical” (de Vries et al., 2011, p. 2282).
To conclude, there is ample scientific evidence that this experiment in transhumanism has been an abject failure. Based on what I have read in the scientific and medical literature, I conclude these procedures are essentially experiments being conducted on adults and children, and that they must stop.
It is up to us, the grown-ups in the room, to bring real science to the table to convince law makers, medical licensing boards and the public that these procedures are unethical and dangerous. As a physician and a scientist, I conclude from what I have read about this topic that it is time to put pressure on medical boards to act to shut this down now. From puberty blockers to “bottom” surgery, it needs to end now.
The fact is that moralizing isn’t going to do it. Cold, hard facts about the dangers, risks and harms associated with “gender affirmation” surgeries - just might. One place to begin is to investigate whether at risk adolescents, their parents, adults and any who have had what are essentially experimental medical and surgical procedures have been fully informed and provided true informed consent. And to also investigate whether these human research subjects and patients have been subjected to marketing, advertising, and “nudge” technologies which may have biased their ability to provide truly objective informed consent.