Ethics of gender reassignment surgery

I suspect that part of the reason is that no single speciality has oversight of the process, and that each speciality feels (rightly or wrongly) that they are devolving some of the responsibility onto their colleagues. So the surgeons and endocrinologists assume that the referral is made on the basis that the medical/surgical pathway has been assessed as the most appropriate for this patient. And then from the endocrinology and surgery point of view, unless there are clear medical contraindications, the focus is on how to carry out the treatment for which the patient has been referred, rather than on whether this course of treatment is appropriate for the patient in the wider context.

The primary care practitioners, or whoever made the initial referral, is at a safe distance from the really awful surgical complications that may ensue down the line and may never really find out, or want to know what the long-term outcome is. There's a similar process of denial built into what little research there is on surgical outcomes, with lots of patients lost to follow-up or only followed up for fairly short timeframes. So there's a massive level of cognitive dissonance built into the process, I think, both from the patient's and the medics' perspective. I assume that in the US model people can self-refer to surgeons, which creates an obvious financial conflict of interest as well.

Exulansic has a very good, if distressing, series of videos in which she deconstructs the tiktok/social media stories of people with really horrible surgical complications, and she really unpicks the conflict between the truly terrible outcomes and the desperate need of the patients to believe it was the right thing to do and everything is fine really.

And even if you could, it would be too later in adults post-puberty. 99% of adult development and differentiation is done by 16.

my concern would be with removing genetalia you severely compromise the ability to gain sexual pleasure again and I wonder how many patients really do understand that ramification?

Yes.

By changing someone's genitalia you're not changing their biological sex. Unless you're able to change a person's XX or XY chromosomes they simply cannot change their sex.

Any of this for under 18 year olds is morally wrong and shouldn’t be allowed. Puberty blockers, hormones, surgery - all of it. I can’t believe it’s allowed. It’s outrageous. In the future we will look back at this as abuse, I have no doubt.

For adults, I can’t see how - in a world where anyone can have extreme cosmetic surgery - you can stop people having this type of surgery. It is essentially cosmetic surgery. You can’t change sex. I think it’s a terrible solution to mental health issues and/or answer to harmful societal pressures, but I feel that way about breast implants too.

I came across a horrific paper the other day which deserves its own thread.

About using pbs to stop unwanted sexual behaviour in young autistic males. Chemical castration.

There are actually a lot of complications with mastectomies too. It's not a walk in the park and you can be left with life long damage.

This is why very few adult transexuals have had genital surgery. Especially males.

Yet society thinks they do.

I worry increasingly about the side effects of cross sex hormones. Have you seen all the dire warnings women get about the (slightly) elevated risk of breast and ovarian cancer when they start HRT? And thats just putting existing hormone level back to what they were in that body for the past 40 odd years.

The amount of estrogen you need to give a man to completely quash his testosterone production is much higher. Surely this puts them at significantly increased risk of stroke, blood clots, cancers, particularly prostate cancer if it's not removed and heart disease?

And girls on long term testosterone, after Lupron? Surely that also has elevated risk of stroke and hear disease?

Are these things discussed with the patients before they are put on puberty blockers and cross sex hormones, never mind when they have their tested and ovaries removed - organs that are extremely important in hormone regulation. Certainly didn't seem like it atvteh Tavistock.

Agree ethics are interesting things - we wouldn’t agree that hopping the legs off a body dysmorphic person was the right thing …

Will NEVER be able to experience orgasm

And male children who go on hormone blockers and subsequently take cross sex hormones will be able to experience orgasm in their lives. Even if they don’t have the surgery - I believe it is just the blocking of testosterone.

Marcie Bowers, a leading gender surgeon in them USA, recently said this. It was 100% unable to experience orgasm. I wonder if the parents of young kids really understand that this is what the future holds for them if they go down that path. And what kind of consent can an 8 or 10 year old give for this?

Worth remembering that much of this experimental, unevidenced, medical "treatment " is carried out on children and young people who are handing over their fertility, health and future lives while under the influence of a social contagion pushed by some of these vultures.
Personally I hope the whole lot of them are dragged in front of the courts for illegal medical experimentation on children and adults.

Lots of medical treatments have risks and side effects, chemotherapy for example can cause pain, sickness, hair loss etc and lead to long term issues such as infertility, hearing loss, heart issues, osteoporosis etc. Any medication or surgery etc for any medical reason involves some level of risk from side effects, and at the more extreme and rare end most of these side effects can be severe and include death. Often when deciding on a medical treatment doctors have to weigh up the risk vs benefits of going down that route, often a treatment will be carried out knowing that there is a risk of unpleasant side effects or ‘harm’ but that’s because the potential benefit is seen as greater than the potential harm.

I’m not saying I disagree with your view on gender reassignment personally, but I suppose the side effects can be justified if the doctor believes that the risk of not carrying out the surgery (presumably mental distress, risk of self harm and suicide etc) is greater than the resulting negative side effects. The fact a treatment has harmful side effects won’t in itself be a reason not to carry out the treatment under the ‘do no harm’ rule because almost every medical treatment has a risk of harmful side effects, it’s more a case of trying to ensure that the outcome of the treatment is most likely to have a positive outcome that outweighs the potential risks or negative side effects.

@TransMillennial im sorry things have been so hard for you and therapy hasn’t worked.

im trying to understand why a uterus causes dysphoria. I can’t see mine and I can’t grasp what my trans friend means about needing the uterus out. Don’t answer if this isn’t a reasonable question, I have tried to work out the reasoning for this but just can’t

Can doctors really reassign a new gender with surgery? I doubt it is medically possible.

I think where adults have gender dysphoria (diagnosed by a psychiatrist who doesn’t follow the affirmation model) and it is persistent I would be ok with the surgery. I think for some people it may be a way to ease their psychological issues and I’m fine with that. I think part of the problem is a) that trans does not mean transexual anymore b) the expectation that this shouldn’t be a very specialised and niche area of medicine.

Still think biological sex is the most important thing and transwomen should expect to be excluded from female spaces as the norm not the exception. I am very GC and think any kind of transition should be absolutely the last resort after years of therapy but I can see that for some small number of people it may be the only way to get relief.

You are anything but a non person. You are perfect the way you are, TransMillennial. I wish you well and truly hope you find happiness on the path you have chosen.

I still think allowing surgeons and endocrinologists near under 18s for cosmetic reasons should be outlawed

puberty blockers also affect the cognitive changes thus leaving the kids who take them in a sort of limbo state of not quite developed but still 'under-developed' in comparison to their peers

Is that part of the reason why we're seeing that some people on the gender ideology side are apparently unable to form coherent arguments in support of their views, beyond "you're nasty if you don't agree with me"? It's got to stay at primary-school reasoning levels because otherwise too many people involved genuinely couldn't understand it.