Non binary gender affirming surgery and the problem of treating patients who were 'pubertally suppressed'

[ArabeIIaScott]

As far as I can tell, this is basically the pick 'n' mix approach to genitals:

https://www.youtube.com/watch?app=desktop&v=FhIycMvV8vk

There's discussion, too, of the increasing number of patients who have had pubertal suppression, and how the medics apparently just don't really know how to deal with the issues this has created.

''‘…folks who maybe have had minimal engagement with their own genitals, either due to dysphoria or just due to the young age at which they're having surgery after pubertal
suppression or minimal to no sexual experiences prior and how after vaginoplasty we're asking them to do all these high maintenance things and be really involved, um, with this anatomy.

And just, yeah, the psycho social implications of that -yeah um it's something we've been talking a lot about in our team at ohsu and we're kind of writing up our early experience with peds endocrinology and pelvic floor physio and us as surgeons and kind of really collaborating to put out you know this is our early experience with this group of patients and this is what's working and what isn't.

Um, because there's just so little that's really been talked about or described, and as you know more and more vaginoplasties and gender surgeries being done and has more suppressions coming through like it's it's coming right at us so as a field like we all kind of need to be aware and start thinking about how we can optimize these outcomes and it's challenging because there's this question of how does that factor into consent when you're consenting someone for pubertal suppression, and there likely is some effect on downstage genital surgery but you don't know if an individual is going to desire genital surgery in the future or not and then it's also hard to have that conversation with someone that maybe hasn't went through puberty or ever engaged in sexual activity.

It's a really tricky thing – um - and when it comes time to actually do surgery if an individual does go through suppression and ultimately in their later teenage years and wants a vaginoplasty not only are you facing the struggle of not having a lot of tissue to work with, um, but that tissue hasn't been under the influence of testosterone which definitely affects some things and then a lot of patients just from psychosocial issues and the dysphoria that they're experiencing or just blatant transphobia in society may have not had the opportunity to have a sexual partner, um, and more often than not there's been almost no genital engagement in terms of self-stimulation or masturbation so then trying to assess things like erogenous outcomes after a surgery when someone's never had a neurogenous experience in their life is incredibly difficult because they don't really have a baseline to compare it to.’

I will do a full transcript later. Lots in here that is horrifying.

A friend, whose father is a surgeon, Always claimed that surgeons were known to be psychopaths. So I thought I’d look that up. Here is an interesting study that I came across. Makes perfect sense when you read that interview posted here. Something akin to the Stanford prison experiment but more like Dr Moreau.

Among the hospital subspecialists, surgeons and paediatricians were the highest-scoring individuals on the PPI–SF, with scores for coldheartedness of 138 and 148 respectively next highest treat was carefree nonplanfullness

These poor poor children don’t stand a chance.

https://publishing.rcseng.ac.uk/doi/full/10.1308/rcsbull.2015.331

*trait

The descriptors make even more sense but my god, who wants a surgeon that doesn’t learn from their mistakes. This could also cover the likes of the mesh scandal and Dr Pattison’s breast cancer scandal.

The way he talks about removing genitals from children is how I've heard some people talk about tattoos. 'Ooh you can just get one and if you change your mind later you can ink over it or get lazer removal'. Their first thought isn't 'if you aren't 10000% sure this is what you want forever UNTIL YOU DIE don't do it'.

Always do now regret later.

What an utterly fucked up world we’re living in.

And I for one have no doubt that these perioperative care teams he’d like to see more of in order to help children and teenagers come to terms with the challenges of dilation would all be recruited from people attracted to the role with the best of intentions. Nothing there whatsoever to attract creeps and wrong ‘uns, no sirree.

That interview is one of the most chilling I've read in a long time (and given the range of toxic perverted stuff around women and children, there's plenty of competition).
His complete failure to understand the most basic issues about child / adolescent psychology & development, let alone safeguarding is unforgivable.

I do say I think we're a little bit different geographically in Portland and on the west coast where I feel like we just have a lot more sort of non-binary queerness fluid identities versus like places like new York seem to be very binary, um, so I think part of it's geographical [...]

WTAF? Part of it's geographical? But this isn't a social contagion - yeah, right...!

Bloody hell that was nauseating and so, so sad to read.

If these children are so immature and pre sexual that they are horrified by having to dilate and manage their neo vagina, just maybe they shouldn't be performing the surgery on them then?! How on earth can they consent?

Oh and 'trans broken arm syndrome'? Try being a woman, mate. Everything from a headache to dropping dead is put down to 'your age' and you just have to get on with it 🙄

I don't want to detract from the horror of the content either, but I cannot bear it when people say 'went' when they mean 'gone'. He sounds like a bloody teenager.

It’s like I’m living in a crap sci fi film sometimes. None of this is remotely okay. I feel so desperately sorry for these children.

What the transcript misses out is all the knowing intonations and giggles. Which are quite telling. Here, he said 'binary' with a supercilious sneer.

I don't know if one could call these children/patients 'pre sexual'. I get the impression they may have had sexual function and urges destroyed or removed by puberty blockers, and/or traumatic histories.

Thank you for doing so much work transcribing that Arabella. I'm truly lost for words at these young people's healthy bodies being chopped up before they're properly adults.

I've just watched a video of a young transman in hospital who can barely speak because they've taken flesh from inside the mouth to try and reconstruct a urethra as their previous one failed.

It's monstrous.

I've just watched a video of a young transman in hospital who can barely speak because they've taken flesh from inside the mouth to try and reconstruct a urethra as their previous one failed.

WTAF?! These damaging lunatics are literally making it up as they go along.

I don't know if one could call these children/patients 'pre sexual'. I get the impression they may have had sexual function and urges destroyed or removed by puberty blockers, and/or traumatic histories.

The transcript mentions 16-18 year olds so not pre sexual - for many people that's more like more like peak sexual!

This . This a million times over.

I watched that the other day, can't remember what it was now, but it was awful. Was it the thing where she kept getting to convince herself as much as her audience that it was all worth it whilst looking increasingly like she wished she hadn't bothered with any of it?

Thank you for this transcription, ArabellaScott. Heroic work 💪

A relative of mine had this surgery recently. Early 20s, various comorbidities, been on blockers for years. His parents were told it was either fund the op or 'lose' him.

Apparently, despite supposedly having done plenty of research, he was a bit surprised by the challenging realities of recovery and then dilation. I doubt I will ever hear the full story of how things go as he ages. But I wouldn't put money on it all being just great.

Early 20s, various comorbidities, been on blockers for years.

I'm sorry to hear about your relative @CovetedAsFuck Is ASC one of his comorbidities? There's a big and IMO under-explored issue around autistic problem-solving styles. Fixing on the first solution to a problem and pursuing it it doggedly no matter what. Burning the house down to get rid of a mouse. It applies to gender issues too.

he was a bit surprised by the challenging realities of recovery and then dilation.

I've not yet met a surgeon who didn't underestimate recovery and after care. Doesn't matter what specialism! The surgeon who fitted DH's pacemaker cheerfully told him he could be back at work on Monday. The GP signed him off for a month.

Yes it is, @AmaryllisNightAndDay. There’s a lot of ASC in the family and this young person does have a diagnosis.

There’s been a tremendous amount of effort to understand and support him ever since early childhood and it’s been really well-intentioned, but here we are. Everyone immediately around him is fully on board with it all, and so invested that they just can’t allow themselves to question past decisions.

True, 'pre sexual' was probably a bad choice of words.

I'm just so horrified I can't articulate it.

That none of these so called professionals sees any issue here. Children too young/ immature/ traumatised to be at ease with their body in any sexual way at all are being asked to consent to losing their sexual function, their fertility and drastically reducing their chances of enjoying a happy sexual relationship in future, just so these monsters can perfect their techniques of dominating nature.

These surgeons want to be God, don't they?

Who will look after those poor kids?

That too is so horrific and tragic.

Again and again we see vulnerable children, teens and young adults being sold that myth that transition = perfect life and end of all unhappiness.

Absolutely positive that the likes of that YouTube influencer Jamie ? (Jammi Dodger) never discusses or acknowledges the medical horror stories and regret. They call them influencers for a reason and it is young teens that watch those videos. The sheer irresponsibility and breathtaking narcissism behind each video. Not to mention cold hard cash…

Everyone immediately around him is fully on board with it all, and so invested that they just can’t allow themselves to question past decisions.

I'm so sorry, and sorry for the rest of the family too. There's no good road map for this.

These surgeons want to be God, don't they?

When you're young you think you're invincible and that applies to the doctors as much as the patients.