Taxpayers should pay £40 million for trans men to have penises fitted abroad to bypass NHS waiting lists

[inkjet]

apple.news/AOPrr5ERrTlOl2lwYl1lM3g

It’s an LBC article I saw on Apple News.

“Some 7.1 million people were on the waiting list in October, with 400,000 waiting for more than a year. Mr Brown said he understood that his group’s demands could seem outrageous in this context.”

Back in 2018 we were discussing the "surprising" nature of people our leaders decide should be consulted - then it was a convicted killer and rapist being invited to talk to the House of Lords about how life can be made easier and better for transgender prisoners.
I'm sure this came after the meetings about making life in prison better for pregnant women, those with sight & hearing impairments, prisoners with disabilities and with mental health problems (sarcasm alert).

www.mumsnet.com/talk/womens_rights/3180050-Invited-to-talk-at-the-House-of-Lords

"fitted"!? Like a new carburettor!

Yes, people want to operate on each other, rapists, killers, porn advocates and flashers.

That's who's been advising the government.

BellaAmorata I couldn’t agree with you more about only over25s being the minimum age for any such devastating and risky surgery. Though even at that age of think I would doubt anyone’s genuine mental capacity to decide (I know that’s different from what is legally required to give consent though). For example at 25 I still thought I would never ever want kids. At 25 I was sick to the back teeth of the sexual harassment at work and in the street and in public/private places like pubs and clubs which I otherwise loved being in.

Had I naively considered at 25 or younger that a way out of all of that was possible plus access to an encouraging affirming (online) community.. Maybe I would have been interested in exploring some of that (although I have to say personally my inner response was to resent men for their behaviour, rather than want to be a man). But I definitely did know women at that age who fantasised about being men for what they imagined would be the freedom of that.

It’s frightening today what kids from very young ages will be being told is possible and aspirational online. So actually with all that background of grooming and gaslighting maybe 25 starts to look a bit too young.

And talking of grooming and gaslighting here is the NHS gender dysphoria information: www.nhs.uk/conditions/gender-dysphoria/treatment/

At the same time as it’s outrageously NOT even mentioning the terrible risks of pain and failure rates after these surgeries; ‘Your surgeon should discuss risks and limitations’ but then afterwards: ‘your health needs are the same as anyone else’s’ - it’s also misrepresenting what the surgeries create.

The NHS actually use the description words penis and scrotum, vulva, vagina, clitoris. Whatever simulation is made surgically, it will be in no way creating these actual genitalia which have complex functions and sensations naturally present for sexual pleasure, reproductive and urination purposes and ensuring these functions are kept physically healthy.

Nobody should be allowed to pretend that a constructed simulation is the same thing as a naturally present organ. The NHS don’t qualify these words which already have a widely understood meaning in any way, which is completely wrong.

You can’t blame anyone reading that for thinking it’s absolutely just a simple question of clip on Lego body parts. This is the NHS talking… I don’t understand how they can be allowed to use this language. Or who thought it was a good idea.

‘Gender surgery for trans men includes:
construction of a penis (phalloplasty or metoidioplasty)
construction of a scrotum (scrotoplasty) and testicular implants
a penile implant
Removal of the womb (hysterectomy) and the ovaries and fallopian tubes (salpingo-oophorectomy) may also be considered.

Surgery for trans women
Gender surgery for trans women includes:
removal of the testes (orchidectomy)
removal of the penis (penectomy)
construction of a vagina (vaginoplasty)
construction of a vulva (vulvoplasty)
construction of a clitoris (clitoroplasty)
Breast implants for trans women (trans-feminine people) are not routinely available on the NHS.
Facial feminisation surgery and hair transplants are not routinely available on the NHS.
As with all surgical procedures there can be complications. Your surgeon should discuss the risks and limitations of surgery with you before you consent to the procedure.

Life after transition

Whether you've had hormone therapy alone or combined with surgery, the aim is that you no longer have gender dysphoria and feel at ease with your identity.
Your health needs are the same as anyone else's with a few exceptions:
you'll need lifelong monitoring of your hormone levels by your GP
you'll still need contraception if you are sexually active and have not yet had any gender surgery
you'll need to let your optician and dentist know if you're on hormone therapy as this may affect your treatment
you may not be called for screening tests as you've changed your name on medical records – ask your GP to notify you for cervical and breast screening if you're a trans man with a cervix or breast tissue
trans-feminine people with breast tissue (and registered with a GP as female) are routinely invited for breast screening from the ages of 50 up to 71.’

the NHS England Specialised Commissioning
consulation is now closed- but this language would surely mislead kids reading it. Maybe they’ll still take comments?

www.engage.england.nhs.uk/specialised-commissioning/gender-dysphoria-services/

No need to go abroad. NHS England is funding a new service to provide this surgery at Chelsea and Westminster hospital. It involves a huge surgical team and the proposal includes a full time Tissue Viability Nurse. TVNs specialise in wound healing, specifically wounds that aren't healing. It's almost as if they anticipate problems with these operations.

https://www.whatdotheyknow.com/request/nhsserviceeforprovisionnof_mas#incoming-2108473

It should be in the Daily Mail soon if KJKs conversation with the first caller to TERF Talk Tuesday is anything to go by 😉

TERFtalktuesday #letwomenspeak

Thanks for the link. It’s absolutely chilling what’s being proposed by the NHS. Built in medical failure ramping up on a mass scale. Where is the CQC on this? the GMC? NMC?

Phalloplasty has a >50% complication rate, especially urinary / kidney issues because the female urethra is so much shorter than the male's and it's hard to stretch it. Plus it's unheard of to do the whole procedure in one go, normally it's done in stages over 2 years. Especially if you're having RFFF where they deglove your arm of skin and muscle to the bone to harvest tissue for the phallus. Then you need a graft for the arm, plus later on there's the need for hysterectomy, oopherectomy...

My point being that I can't really see a scenario where these procedures could all be done overseas. The NHS would have to get involved at multiple points, either doing the surgeries at some stages or emergency treatment for the infections that are a very common complication of these procedures.

In fact with such a high complication / failure rate, these procedures should not really be offered at all.

If this were a easy low risk operation you’d have private providers competing to offer it on price and location and cherrypicking it. Like they do with other straightforward treatments. The fact it has to be majority provided in a major hospital setting with a massive team tells you it must be known to very high risk in the profession and with expensive major hospital A&E emergency specialists needing to be on standby.

This.

Let's offer all these procedures abroad. Great! Fab!

But we must warn you if you have an emergency complication, we can't guarantee we have got the resources to deal with that. Which might have massive implications for you, or another patient who needs emergency surgery when we don't have enough emergency operating hours.

What do you mean 'go abroad for the treatment for complications too'? You won't be well enough to travel and you won't be insured to travel. You certainly cannot fly...

Idiots.

Yep they need to make a BIG point about complication rate because no, surgery shouldn't be happening if the complication rate is that high. The surgery is clearly not ethical nor fit for purpose.

"First, do no harm*".

*except when there are multiple lucrative follow-up surgeries

I don't think the NHS can reasonably say this because, if a patient is haemorrhaging or has another life threatening complication like a fistula, the NHS can't refuse to treat them. For example, the risk of haemorrhage after a hysto is quite high.

So I think it's an all or nothing choice, either the NHS offers the entire suite of surgeries and treatments in the UK at the NHS' cost, or they offer no transmasculine srgeries other than radical mastectomy which is at least somewhat more known.

I think that NO transgender surgeries should be offered on the NHS, and never to under 25s, whether NHS or private. But, if you're the type of person who wants to offer them, then it has to be all or nothing.

The problem remains:

You have one theatre and one emergency team. Yet if you have a whole cohort of people who have surgery abroad who then have complications, you still only have one theatre and one team to deal with both the work load you've accounted for from domestic ops and this new work load you've got.

And this emergency team don't necessarily have specialist skills for this type of surgery repair.

So you run the risk of two patients needing the service provision that is inadequate for demand. That endangers lives and increases risk of further complications, not only of those going abroad for gender surgery but also regular surgery.

In order to facilitate extra surgeries abroad, you HAVE to expand emergency provision available domestically too. You can not just outsource all extra surgery abroad because it doesn't work like that.

If you can not increase emergency provision in line with the total number of ops regardless of the country they are carried out in (based on estimates of complications), you can not increase the number of ops without compromising patient safety.

You cannot just outsource provision because emergency provision can only be done in-house and that matters.

The complication rate being so high, means this is a non starter, because upping emergency provision simply isn't possible. It's the constraining factor not how many ops you can pay for abroad. It's how many emergency staff and facilities you have here.

And these staff need to be appropriately trained to deal with this type of complication. You can't magically increase this number over night.

Provision across the board has to be increased gradually. There are no short cuts.

And yes, if the failure rate and complication rate is that high, is it meeting the thresholds for effectiveness / cost for the NHS. Is the benefit significantly high enough to merit it - and crucially, where is the research to back this up.

If it does not exist, we absolutely should not outsourcing ops abroad in some kind of research project. (assuming here of course that they decide they need to do this research. If there's no research and no intent to do research then it's ethically a toilet of horrors).

Idiots are incapable of joining the dots on this though. They have no idea what good patient care is.

I've just come across a worrying argument from November between a 14 year old trans-identifying child (who identifies as it) and some possible adult men/older teens on twitter. I am going to redact names, because there is no purpose in directing more traffic to harass a confused child. I share the conversation here, because the level of confusion over what surgery can and cannot achieve is very relevant to this thread, and this individual child's misapprehensions gives us further insights into what level of misinformation is flying around transgender support forums.

Trans-Identifying Teenager: no one cuts their dick off... it's meant to be 100% possible and facilitated to be able to detransition later in life if necessary.

Poster 2: Lmao.They are absolutely cutting d*cks and boobs off. Their is no coming back from cutting your dxck off. Once they mutilate their body it's never going to be the same again.

Trans-Identifying Teenager: the surgery turns your penis inside out, basically. remolds it into the shape of a vagina. 100% reversible. if you took the time to back your insolent arguments with evidence, you'd know that :)

Poster 3: You don’t even believe that. It’s not reversible.

After some more tedious back and forth, the teenager supplied this screenshot from an abstract, which the teen thought was proof penises could be restored.

I'll do a text version of that image in a moment.

Agree with all this.

Another reason why phalloplasties should not be offered is that it's really hard to know what specialism they flal into. In the US they seem mostly to be done by plastic surgeons, which is why in my view US patients end up with so many horrible complications.

For ACTUAL mean (e.g. injured soldiers) penile reconstruction is usually done by urologists and this would seem to be the more obvious specialism. But no decent urologist is going to want to sully their reputation with the losing game that is trans phalloplasty, which is why I think the spivvier plastics guys have gone into it instead.

Text of Abstract
Introduction: Sex reassignment surgery (SRS) has proved an effective intervention for patients with gender identity disorder. However, misdiagnosed patients sometimes regret their decision and request reversal surgery. This review is based on our experience with seven patients who regretted their decision to undergo male-to-female SRS.

Aims: To analyze retrospectively seven patients who underwent reversal surgery after regretting their decision to undergo male-to-female SRS elsewhere.

Methods: From November 2010 through November 2014, seven men 33 to 53 years old with previous male-to-female SRS underwent reversal phalloplasty. Preoperatively, they were examined by three independent psychiatrists. Surgery included three steps: removal of female genitalia with scrotoplasty and urethral lengthening, total phalloplasty with microvascular transfer of a musculocutaneous latissimus dorsi flap, and neophallus urethroplasty with penile prosthesis implantation.

Main outcome measures: Self-reported esthetic and psychosexual status after reversion surgery and International Index of Erectile Function scores for sexual health after phalloplasty and penile prosthesis implantation.

Results: Follow-up was 13 to 61 months (mean = 31 months). Good postoperative results were achieved in all patients. In four patients, all surgical steps were completed; two patients are currently waiting for penile implants; and one patient decided against the penile prosthesis. Complications were related to urethral lengthening: two fistulas and one stricture were observed. All complications were repaired by minor revision. According to patients' self-reports, all patients were pleased with the esthetic appearance of their genitalia and with their significantly improved psychological status.

Conclusion: Reversal surgery in regretful male-to-female transsexuals after SRS represents a complex, multistage procedure with satisfactory outcomes. Further insight into the characteristics of persons who regret their decision postoperatively would facilitate better future selection of applicants eligible for SRS.

Keywords: Male-to-Female Transsexuals; Outcomes; Phalloplasty; Regret; Sex Reassignment Surgery.

Link to Abstract

As I'm sure you will appreciate, this is not restoration of a penis. It is a description of a similar procedure to a phalloplasty procedure that is used on trans-identifying females who wish to live as men, but using flesh from the back instead of the arm or thigh. It even links to an abstract on exactly that: Total Phalloplasty With Latissimus Dorsi Musculocutaneous Flap in Female-to-male Transgender Surgery

Lol it's deiniftely not reverisble because they flay the penis, remove the inside and use it to construct the labia, whilst stitching the penile skin to the inside of the incision they make to create the vagina. And they re-route the urethra and also remove the tip of the penis to create a faux clitoris, plus they remove the scrotal sac and testicles, so....

Could you theoretically unscramble it all to create a surgically created penis? Only in the sense that you can recreate a whole egg out of some smashed bits of shell. These kids seem to think human beings are like sims or lego men.

If I cut up a ruffled dress, it wouldn't be reversible. There is a saying "measure twice, cut once" for fabric, which alludes to the impossibility of putting your fabric swatch back together after you've cut too much off.

The kids think human bodyparts are easier to fix and replace than a roll of gingham cotton!

These kids seem to think human beings are like sims or lego men.

and

The kids think human bodyparts are easier to fix and replace than a roll of gingham cotton!

That does seem to be how they think, and it's scary that anyone could pretend this level of lack of understanding could ever amount to "informed consent."

So true!!!

Again, I honestly do think this way of regarding the human body is heavily influenced by the fact that kids these days are increasingly disembodied as they live through their phones rather than in the real world.

That does seem to be how they think, and it's scary that anyone could pretend this level of lack of understanding could ever amount to "informed consent."

Truly scary - that poor misguided teenager that Purgatory quoted is in for a shock if/when reality bites.

Phalloplasty has a >50% complication rate, especially urinary / kidney issues because the female urethra is so much shorter than the male's and it's hard to stretch it.

Also I bet there's no evidence in relation to long term complications of these procedures. Once these women have been without oestrogen for 30+ years, their risk of urinary tract complications must go through the roof.