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Feminism: Sex and gender discussions

Ethics of phalloplasty on female patients.

181 replies

RainWithSunnySpells · 20/08/2024 13:02

I first would like to credit batteredpancakes from the fruit farms who shared the following post (pg 1405 SRS thread) from Griffen Sivret who died last month. This was originally posted on Reddit by Griffin two years ago and it discusses the complications post surgery:

'It took me a long time to come to terms with everything that happened to me in recovery, acknowledging my medical trauma. I was and still am hesitant to completely blacklist a surgeon that got me and others closer to comfort with our bodies. But no one should ever have to go through things like this again. This is my experience and can only speak for myself, but know there are several others of us who have been hurt and traumatized by this team.

I had stage one of RFF phallo with Dr Ganor and the gender surgery team at BCH in Boston, MA in April 2021. I had additional surgeries related to stage one complications on 6-7, 6-22, 6-30, and 11-18. For most of 2021 after receiving care here and throughout my consult process, I:

-Was told that urological complications happen in 40-50% of patients. I’m not aware of any patient of theirs that DIDN’T experience urological issues or didn’t take multiple surgeries to fix.

-Staging/method of my surgery changed 4 times throughout the process to “minimize complications”, including once right before my surgery with little to no warning. The staging did nothing to prevent/minimize complications.

-You are given direct emails to staff/PA’s in plastics, but nothing for urology. You have to call the general urology line, wait for hours while writhing in pain, and sometimes not even receive a call back. If it’s the weekend or before 8/after 5, you’re out of luck. Even if your catheter bag is filling with blood or you can’t pass urine, your only advice will be “flush the tube” after waiting hours.

-Had limb swelling and chest pain ignored and misdiagnosed as being “normal” or constipation for weeks until I had DVT in both legs, blood clots in my pelvis, and bilateral pulmonary embolism. I still have joint pain and swelling issues in my legs from DVT damage.

-Urology staff ignored my breathing concerns and listed my lung functions as normal in my ER report the night before my ICU admission for clots despite struggling to breathe and my chest audibly gurgling. They discharged me without any medications after saying “I wasted my time driving down there”. There was a chance the clots could’ve killed me soon after if I didn’t get a second opinion.

-BCH didn’t read any notes or reports written by staff at the hospital I was receiving clot treatment at. BCH supposedly discovered a urethral diverticulum for the first time on 6/22, but this was already diagnosed by the previous hospital on 5/11.

-Urology did nothing to treat my diverticulum for nearly 6 months, despite discovering it. It made me completely incontinent and in diapers 24/7 for that entire time frame. They said my “leakage was normal”.

-Urology would not diagnose or examine me for bladder stones despite getting new UTI’s every single week and constant lower left back pain. I had stones for at least 4 months straight with no treatment.

-Urology would not examine me for a stricture despite it getting to the point where I couldn’t push anything through my urethra except a couple drops. I told them multiple times, they said it was “probably constipation” and an exam was not necessary. I had stricture symptoms for over 4 months with zero treatment.

I believed that this team had my best interests for far too long and falsely thought “I was just that one unfortunate case”. There was hurt people before me, there was hurt people after me. The team has new doctors and staff that have greatly improved complications and experiences, don’t get me wrong. But the experience didn’t change whatsoever when several of us gained permanent complications, weren’t given treatment for months, literally almost died because of their frequent inactions. Honestly fuck this hospital and how it’s treated patients of the past as well as everyone now.

Dr Ganor is a great surgeon with an iffy bedside manner and not very warm, especially after you experience unplanned complications that stray your surgical path. But several other doctors and staff on the team, especially in the urology department, have given out reprehensible care or a lack thereof that has left patients in recovery limbo, traumatized people, or threatened some peoples’ lives. Their team changes, but the trauma and memories stay. I’m barely complete with stage one and don’t know when or if I’ll be having any more surgeries. I really can’t recommend anyone go to this team if they want optimal urology care, a short surgical timeline, or efficient treatment.'

Secondly I would like to credit cuddle striker, also of the farms, who posted the following (pg 1404 SRS thread):

'I'll repeat information I posted long ago in this thread.

hysterectomy, castration, penectomy, mastectomy, and no-depth cosmetic vulva construction are all low risk surgeries that are well-studied due to their common use for non-trans people. adults who wish to change their body to suit them can get these surgeries for low expense, low risk.

anything done by the surgeons mentioned in this thread that promise more? that's experimental, untested work. it's surgery that is being used to promote a surgeon, work that's being done purely for cash flow.

the culture of silence in the community that gets this work done, contributes to death and disfigurement. desperation to get better work done, fear of reprisal from the surgeons, and hush culture are all dangerous things. bad results are bad results, and the high expectations are unrealistic and often dangerous.

until these surgeries are properly studied, and surgeons are sharing data and notes, these are not safe surgeries for anyone to get.

personally I do not care what adults decide to do with their bodies, dangerous or otherwise. however as a medical worker I think these kind of surgeries need to be studied properly, developed correctly, and overseen. publication of results and techniques should be a requirement.

the issue here stems originally from loose standards regarding plastic surgeons, since most of their work is privately paid there's a lower standard of care in that field.

a proper team for this kind of surgery would be a urologist, a plastic surgeon, a neurologist, anesthesiology, psychiatry, orthopedics, and physical therapists as well as a dedicated wound care and follow-up team. what we see now is a few nurses, anesthetics and a surgeon in the room, from start to finish. it's unsafe.'

I though that cuddle's post was thought provoking. Phalloplasty on a female is clearly experimental and unsafe. Reading Griffin's post from 2022, is especially heart breaking as we know that her future was one of renal failure, a brain bleed and death. I strongly believe that this surgery has major ethical concerns and that these should be brought into the open and discussed fully and without influence from ideology. Evidence based medicine is the gold standard and that is not what we are seeing currently by any stretch of the imagination. Why does this cohort of people (MTF/trans identifying females/however you wish to word it) not deserve the best - which is evidence based medicine?

This is not 'life saving care' and it is time that that myth was fully rejected.

OP posts:
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MrsWhattery · 20/08/2024 22:05

This is so awful. I’ve been horrified by these surgeries for years and had heard about Griffin’s death, and I’m familiar with a lot of the complications from Scott Newgent’s work - but until reading this thread I still hadn’t really taken on board how much horrendous, ongoing pain and misery it’s causing. And to be repeatedly shut down and told it’s normal or not a big deal when you’re in pain is even worse. Poor Griffin was only 24 and had been going through transition since high school. All that time going down that path with your health getting worse and worse and it not being taken seriously. Just so Sad

And being on testosterone which gives females an elevated risk of heart and vascular problems, probably makes it less safe to have surgery, any surgery, and makes complications more likely.

It’s such a mess and yet another aspect of genderism that’s worse for females.

ChaChaChooey · 20/08/2024 21:05

Re: transplants - you really can’t fuck around with anti rejection drugs due to the elevated risks they cause to general health, particularly cancer.
I read this a while back and it really stuck with me - first person account from a woman who has survived two heart transplants and is, at the time of writing the article, on end of life care for the cancer caused by the immunosuppressant drugs. She died a month after it was published.

It’s a proper wet-eye read, I warn you!

www.nytimes.com/2023/04/18/opinion/heart-transplant-donor.html

https://archive.ph/OfOrK

It would be a sick joke to inflict the side effects of a life time of anti rejection drugs on a young person with a physically healthy body. The risk/reward ratio can only be justified if the recipient is facing certain death without the transplant.

WarriorN · 20/08/2024 20:51

A number of years ago there was some data shared here on phallopasties and rates of major complications as well as death.

There would have been many many more done since then. I have no idea if this data is collated now but it would be extremely important to do so.

nothingcomestonothing · 20/08/2024 20:29

I find the farms' SRS and GRS thread extremely informative, and extremely horrifying.

For instance, it taught me that the male urethra is longer than the female urethra (obviously when you think about it), so in phalloplasty they have to add more tube, eg a vein. There is basically no way that a tube of arm/leg flesh with a vein down the middle can act as a functional penis, a vein can't cope with the chemical composition of urine, it breaks down. It cannot work.

And that's just for peeing, let alone getting any sexual function from a tube of arm flesh which has been amputated then sewn on somewhere different, with nerves cut both sides and stitched together in the hope that they will join together and function - they don't, at best they can signal temperature or pain. It doesn't work. It's a lie.

And it's being done on mostly young, mostly mentally unwell or neuro-diverse women, and giving them life long continence issues, pain and disability. And when you read their words they always say how they were unlucky, to have issues and need multiple surgical revisions, but that's a lie too - they're not the unlucky few, they're the vast majority of women who have phalloplasty.

The utter barbarity and cruelty of these surgeries will go down in history as a far bigger scandal than ECT, when the world regains it's collective mind.

lonelywater · 20/08/2024 20:01

ditalini · 20/08/2024 16:55

The numbers having these extreme body modifications (and yes, I would say phalloplasty is extreme) are very low and seem to be worryingly spread out rather than a few surgeons acting as centres of expertise. From self-reports, follow up and treatment of complications appears to be shockingly poor, again without centres of excellence to deal with the fallout.

In the interests of trans healthcare, I would like to see a mandatory registry for phalloplasty surgery to record techniques used, outcomes, complications etc as is found in other rare conditions to improve treatment and patient care, with surgery only funded where the surgeons are working within this framework.

Personally, I'd like to see a ban but I realise that's not feasible.

I honestly don't think people appreciate the importance of continence until they lose it, and messing with your urinary tract is a terrible risk. Psychologically there's a lot of emphasis on "I feel terrible because of this so treatment is a good" and not "but there is a high chance that later I'll feel even worse because of the treatment and am I in a headspace where I can accurately risk assess?".

Personally, I'd like to see a ban but I realise that's not feasible.
Why not? Of all the things in gender bizzaro world, ranging from the somewhat questionable to flat out "FFS! that's completely barking!" this has to be amongst the worst. Cutting bits off healthy bodies in order to make fake knobs which behave and work nothing at all like the real thing for cosmetic purposes is Mengele-level batshit. If any of our lurkers wants to try and offer any reason whatsoever (good, bad or indifferent) I'm all ears.

ditalini · 20/08/2024 19:46

www.ncbi.nlm.nih.gov/pmc/articles/PMC10501463/

I found this article quite interesting in both the contrast to:

a similar article on womb transplantation for transwomen that seemed to come to the conclusion no biggie,

And the concerns about informed consent, use of scarce resources, psychological and physical harms which all apply to current phalloplasty surgeries.

(Spoiler: men aren't really up for giving up their penises, even after they're dead.)

ditalini · 20/08/2024 19:23

FoxtrotOscarKindaDay · 20/08/2024 19:12

At this point would it really be ethically worse for female people to receive phallus organ donation? There would at least remain a better chance of a functioning urethra if there was more to work with in the first place.

MtF surgeries, including zero depth, are more successful purely because it is easier to remove something from a human body and have it continue to function than to add something. How can anyone think it would be sttaightforward to make something that didn't exist and force it to pretend to be another body part?

Growing the clitoris and having a small phallus has to be better than this butchery. It is still females that suffer most.

I don't think so. Even with the horrors of the current procedure, it's probably better than a lifetime of anti-rejection drugs which are really quite brutal.

Even with immunosuppression, these sort of implants are high risk for rejection both physical and psychological. They are seldom used in men who have had amputation either.

Plus presumably there's underlying infrastructure that female bodies don't have, either in the right place or the right size.

FoxtrotOscarKindaDay · 20/08/2024 19:12

At this point would it really be ethically worse for female people to receive phallus organ donation? There would at least remain a better chance of a functioning urethra if there was more to work with in the first place.

MtF surgeries, including zero depth, are more successful purely because it is easier to remove something from a human body and have it continue to function than to add something. How can anyone think it would be sttaightforward to make something that didn't exist and force it to pretend to be another body part?

Growing the clitoris and having a small phallus has to be better than this butchery. It is still females that suffer most.

Helleofabore · 20/08/2024 19:00

FreedomDogs · 20/08/2024 16:19

In that case you'll be relieved to hear that a) multiple studies exist and b) they don't reveal any associated issues with reduced bone mass density and indeed taking cross sex hormones appears to improve BMD in at least some cases, particularly for trans women

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6709704/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6469959/

Here we go, Leo’s story

And

www.svtplay.se/video/33358590/uppdrag-granskning/mission-investigate-trans-children-avsnitt-1?id=jp9dBRA

After 4 years on blockers 'Leo' hasn't grown, has osteopenia, spinal fractures and is in constant pain. 12 children in Stockholm have 'healthcare-acquired injuries' from blockers.

Again, Leo is a female child at the age that this documentary was made.

Obviously, nothing to see here. Female children, female young adults just so easy to ignore to allow a group of male people to have their message unmarred by negative outcomes.

- YouTube

Enjoy the videos and music that you love, upload original content and share it all with friends, family and the world on YouTube.

https://youtu.be/sJGAoNbHYzk?feature=shared

ChaChaChooey · 20/08/2024 18:42

Same story from the BMJ: www.bmj.com/content/368/bmj.m852

ChaChaChooey · 20/08/2024 18:38

There are two ‘teams’ currently offering FTM ‘Bottom Surgery’ one operates out of Chelsea and Westminster and currently only does Metoidioplasty (making fake balls and elongating the urethra, using the testosterone induced clitorial growth as a small phallus) the other does both phallo and meto and is based at the New Victoria Hospital (the surgeons are the ones named in the protest images above).

Before Covid there was just the one team who lost their private operating theatre access due to emergency NHS acquisition. During that time the phalloplasty surgical team’s NHS contract ran out and couldn’t be easily renewed because they had no theatre access.
This meant FTM ops were completely suspended for around 2 years, at which point the NHS headhunted a specialist from Serbia*, around whom the Chelsea & Westminster team has been built. I hear his meto technique is different to Prof Ralph’s so some transmen are opting to wait longer for their preferred team.

This is the most original phalloplasty team in it’s latest form:

www.newvictoria.co.uk/treatments/specialities-treatments/gender-dysphoria/phalloplasty

This is the Serbian surgeon:

https://en.m.wikipedia.org/wiki/Miroslav_Djordjevic

Not many NHS surgeons seem interested in taking up gender work, so it looks like some of the gender top surgeons and one of the MTF bottom surgeons are learning FTM surgeries?

*this has caused quite some chuntering online as travelling to Serbia was the cheapest option for self funded phalloplasty and obvs that’s much harder to schedule when the surgeon is working in London for the NHS part time.

Interestingly the Serbian chap has performed phalloplasty as reconstructive surgery on detransed former transwomen - there is a video diary online somewhere of an American fella who traveled to Serbia for the operation. Personally I can’t think of much that’s more horrifying than undergoing both sets of ‘gender reassignment surgery’ (especially as it’s not actually undoing the first surgery, nothing will get your healthy gonads and reproductive function back).

The OG phalloplasty team (then known as ‘St Peters Andrology’) have had members professionally suspended before. News stories should be online.

Rymeswithpunt · 20/08/2024 18:36

Metoidioplasty isn't that where they cut away at the vulva to try to make the clitoris look like a tiny penis?

Rymeswithpunt · 20/08/2024 18:34

HappyMaltesers · 20/08/2024 17:16

In the US anyway, surgeons all use their own (experimental!) methods... and they often won't take on patients from other surgeons. There aren't a set of standards for the surgeries so they're not all working in the same way and they really don't want to try and fix others mistakes!
The people (male and female) having these 'gender affirming' surgeries have to keep saying that their Dr is great because they can't risk pissing them off! They need someone to keep trying to fix the botched surgeries and they don't have many other options.

God, it just keeps gettng worse

Helleofabore · 20/08/2024 18:33

FreedomDogs · 20/08/2024 16:19

In that case you'll be relieved to hear that a) multiple studies exist and b) they don't reveal any associated issues with reduced bone mass density and indeed taking cross sex hormones appears to improve BMD in at least some cases, particularly for trans women

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6709704/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6469959/

This might be interesting for readers also:

https://segm.org/the_effect_of_puberty_blockers_on_the_accrual_of_bone_mass

1st May 2021

Dr Michael Biggs (an advisor to SEGM) has been calling for the release of data from the Tavistock’s experiment since 2019. A subset of the data were finally released following the judicial review into puberty suppression at the Tavistock clinic. Biggs’ reanalysis has just been published in the Journal of Paediatric Endocrinology and Metabolism. It finds that after two years on GnRHa, the Z-scores for a significant minority of the children had declined to a level that should trigger clinical concern.

The Effect of Puberty Blockers on the Accrual of Bone Mass

Suppressing puberty in children suffering from gender dysphoria — by administering Gonadotropin-Releasing Hormone agonist (GnRHa) — entails several known risks. One is that patients could “end with a decreased bone density, which is associated with a h...

https://segm.org/the_effect_of_puberty_blockers_on_the_accrual_of_bone_mass

Helleofabore · 20/08/2024 18:32

FreedomDogs · 20/08/2024 16:19

In that case you'll be relieved to hear that a) multiple studies exist and b) they don't reveal any associated issues with reduced bone mass density and indeed taking cross sex hormones appears to improve BMD in at least some cases, particularly for trans women

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6709704/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6469959/

In the first study, did you notice this at all:

However, Z-scores in the trans boys also showed an expected drop during GnRHa treatment. Similarly, they did not fully make up their bone loss as Z-scores at age 22 were still lower than baseline

Meaning, the authors acknowledge little is known about the lasting effects of puberty blockers. In this study, they propose some positive effect from cross sex hormones for females but these results show that it doesn’t really make up the loss from puberty blockers.

So, again... it is female people who are having significant issues and having these dismissed and hand waved away to maintain the focus on the positive stories of transition. The positive stories that benefit, you guessed it, MALE people while completely ignoring the needs of female people.

mb2512cat · 20/08/2024 17:47

I was going to ask if Phalloplasties had already been carried out in the U.K. This is a screenshot from the NHS Chelsea Gender Clinic, showing they already offer something called a Metoidioplasty - you can look that up - but fear not, phalloplasties coming soon!

Ethics of phalloplasty on female patients.
HappyMaltesers · 20/08/2024 17:16

newtlover · 20/08/2024 14:37

this really does deserve much wider attention, especially the case in the UK for all of us hoping it couldn't be that bad here
also-
interesting that, despite everything, Griffin calls the Dr 'a great surgeon'
when will medical insurers stop covering this? the risk of complication seems so high

In the US anyway, surgeons all use their own (experimental!) methods... and they often won't take on patients from other surgeons. There aren't a set of standards for the surgeries so they're not all working in the same way and they really don't want to try and fix others mistakes!
The people (male and female) having these 'gender affirming' surgeries have to keep saying that their Dr is great because they can't risk pissing them off! They need someone to keep trying to fix the botched surgeries and they don't have many other options.

RainWithSunnySpells · 20/08/2024 17:13

ditalini said 'I honestly don't think people appreciate the importance of continence until they lose it, and messing with your urinary tract is a terrible risk.'

I agree. I would take it further and say that poeple don't appreciate having a fully functional, pain free body until they lose it. I also wonder how much sunk cost fallacy plays a role here compared to someone who has physical issues, for example, due to a car accident (that wasn't their fault)? Knowing that you chose to damage your body through extreme body modification must be a complete mind fuck, especially as this is sold as the answer to all problems.

OP posts:
ChaChaChooey · 20/08/2024 17:08

Pelvic floor dysfunction in transmen:

https://pubmed.ncbi.nlm.nih.gov/38662108/

Ethics of phalloplasty on female patients.
ChaChaChooey · 20/08/2024 17:00

More on the above: onlinelibrary.wiley.com/doi/full/10.1111/andr.13695

ChaChaChooey · 20/08/2024 16:59

Polycythemia is a known risk of testosterone as ‘gender affirming care’

journal.binayfoundation.org/article/117441-management-of-secondary-polycythemia-related-to-masculinizing-therapy-for-transgender-individuals-a-mini-review

ditalini · 20/08/2024 16:55

The numbers having these extreme body modifications (and yes, I would say phalloplasty is extreme) are very low and seem to be worryingly spread out rather than a few surgeons acting as centres of expertise. From self-reports, follow up and treatment of complications appears to be shockingly poor, again without centres of excellence to deal with the fallout.

In the interests of trans healthcare, I would like to see a mandatory registry for phalloplasty surgery to record techniques used, outcomes, complications etc as is found in other rare conditions to improve treatment and patient care, with surgery only funded where the surgeons are working within this framework.

Personally, I'd like to see a ban but I realise that's not feasible.

I honestly don't think people appreciate the importance of continence until they lose it, and messing with your urinary tract is a terrible risk. Psychologically there's a lot of emphasis on "I feel terrible because of this so treatment is a good" and not "but there is a high chance that later I'll feel even worse because of the treatment and am I in a headspace where I can accurately risk assess?".