Ethics of phalloplasty on female patients.

[RainWithSunnySpells]

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.

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.

WTAF?

My thoughts too.

Hysterectomy definitely isn't low risk. Finding death rates for mastectomy is difficult as it's typically being done for breast cancer so the mortality being quoted is from cancer, not the procedure. I would imagine surgical removal of penis or testicles is pretty low risk.

It does feel like a totally alien world doesn't it!! I'd be interested to hear how many men are having an elective castration.

However, I do feel there is a different argument. On one hand people can have elective cosmetic procedures and body modifications - not necessarily in the UK - but things like snake tongues and bum implants are similar in a body autonomy way.

The main issues are the claims that, for a trans person, this type of surgery will improve their quality of life, is necessary in some way and will fix the underlying medical issue/mental distress. This is a different argument and I think, a more important one.

If we could move the gender surgeries from the medically necessary camp to the bum implant camp, there would be a lot more honesty and a lot less desperation. I feel so sorry for teens who are latching onto these operations as a way to fix their lives, who have been taught to see themselves as having a sort of birth defect. It would be much healthier if it was seen as an alternative lifestyle choice.

Completely aside from the main thrust of the thread, I realise, but the description by Griffen makes a complete mockery of the line that US healthcare is far superior to “socialist” (as many in the US would describe them) systems like the NHS.

We’re not great, but her surgical team sound like they provide equivalent levels of ‘care’ as some of the horror shows operating out of Turkey and parts of Eastern Europe… but for hundreds of times the cost.

Yes, @PaterPower I don’t think ‘paying for it’ (or rather it being paid for by medical insurers to hospitals looking to maximise their bottom line) is any indicator of assured practice or service.

And none of those ops are without risk - look at Richie Heron’s issues after castration? I’ve had a pelvic floor reconstruction after vaginal prolapse and was told it was not as bad as a hysterectomy, esp as I was ‘young’ - and it was awful. My MiL had one too and was out of action for 3m. They may be routine, in isolation and when medically necessitated… but having multiple unnecessary procedures on an otherwise healthy body, and thinking it is ‘low risk’ seems wilfully insane.

It’s criminal that all these Drs Frankenstein were ever able to do these procedures at all. At what point did their ego and surgical/professional curiosity (as to ‘can I do this’) trump the hypocratic oath?

The more vocal TRAs tend to be MTF and phalloplasty is carried out on FTM. Their voices are heard less. Easier to shout about how safe "gender affirming" care is when all you are having is a boob job.

This thread title is the closest "ethics" has ever got to "phalloplasty".

The point where the check cleared I should imagine.

Does anyone know of actual peer reviewed numbers/papers on complications after gender surgery? Any country? My understanding us that (in the uk) any complication is likely to be dealt with by a different team (acute trust rather than the specialist surgeons, or standard surgical departments down the line) unless the complication is immediate, so I don’t know how these numbers would be collected here. But maybe somewhere else is doing it better.... NL? Finland?

Without these numbers, informed consent is impossible. With these numbers, I wonder whether we could ever justify the surgery (at least on the NHS).

FFS!! Then again, I guess if you look at a phalloplasty with all the surgeries and the complications, these major surgeries probably do seem low expense and low risk.

But FFS!

I was once told by a poster who doesn't come onto this board but sticks to AIBU who declared that double mastectomies for young adults are simply just acceptable gender affirming treatment. So too was phalloplasty.

When! When will these surgeries being done on healthy bodies (and mastectomies done for cancer prevention in high risk women) be viewed as per their reality? That reality being that these are life limiting surgeries, and phalloplasty being significantly higher risk than the other, and yet mastectomies are significant enough!

The ideological dismissal of what is being done is horrific. And I find that the male extreme transgender activists are some of the worst for dismissing these issues. To me, it is a glaringly obvious example of the negative sexist discrimination of that group against female people.

FFS!! Then again, I guess if you look at a phalloplasty with all the surgeries and the complications, these major surgeries probably do seem low expense and low risk.

Yes, it's all relative. In the US, about 600,000 women a year have a hysterectomy. It's a tried-and-tested procedure so doctors know what they're doing and know how to minimise side-effects. Similarly, mastectomy is a very common procedure. I'm not saying there are no complications, but I would guess that most of the complications are well-understood and predictable, so doctors can anticipate and treat them. I know much less about penectomy, castration and so on, but even there I can see that those are probably less complex operations than phalloplasty.

Phalloplasty, on the other hand, is clearly a relatively novel procedure, highly complex and with plenty of opportunity for it to go wrong. Plus, let's face it, it's being carried out by unscrupulous surgeons who are just in it for the money: there isn't a body of respectable, well-intentioned doctors who have researched the procedure and published medical papers about it, because a well-intentioned doctor wouldn't go anywhere near it in the first place.

The ideological dismissal of what is being done is horrific.

This - it's all based on ideology.

As is fgm

No time to catch up on this thread properly but wanted to add this in case I forgot later:

Prior to Covid a UK transman was engaged in a one person, 24 hour camp out protest outside the (private) hospital where the TM’s phalloplasty had been performed.

I don’t know what happened to this person afterwards, only that Covid lockdown brought a premature end to the protest.

Photo of tent and closer crops of text:

My surgeon told me mastectomy is considered “minor” surgery. And whilst I don’t think I’d call it that it is now done as day surgery.

i would imagine the other surgeries on that list like removal of penis and hysterectomy are much more serious. Not that it really needs ranking.

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

Text from images above (I used my phone’s copy text from image function which isn’t always great with handwriting, but I think this is the gist of it for anyone using a screen reader).

"St Peter's AndroLogy Centre"
145 Harley Street
World Renowned Surgeons??!
You Have Made Numerous life Changing MistaKes

1. Hand/Arm Morbidity/Radial Nerve Cut/ Nerve Damage Pain 24/7
2. Part Of Phallus Tip Died
3. No Tactile/No Sexual Sensation/Ice Cold To Touch.
4. Urinate On A 45° Angle Must Use Urine FunneL.
5. Urine Dribble/ Must Use Incontinence Pads
6. Buttocks/Nasty Scarring/Constant Burning Pain (Done Twice)

MEET MY SURGEONS

• Professor David Ralph Medical Director Numerous Surgery
• Mr. Nim Christopher (One Surgery)
• Mr. Giulio Garaffa (2 Major Op's) "He Created Most of The Damage" The Top Two Surgeons Made MistaKes Doing Repairs

• "You Have Destroyed My Life
• "SHAME ON YOU"

Dec 2018 Surgery, Prot Ralph, Buttock/Phallis + To work on My Arm Together with Mr Christopher.
WoKe To Find That Mr Christopher Had Done Arm ALone + Phallus
all 3 Arm Grafts Died.
After Prof Ralph Spent Numerous Surgeries To Rebuild The Missing Bit Of Phallus, Against My wishes Without My Permission. He Allowed Mr Christopher To Do The Final Stage OF Revision
Does Not Look Good. Made A Complaint, Prot Ralph Denies Our Agreement.

0c15,2018,I Had An Appointment With Prof. RaLph.
These Issues Were Discussed + agreed. Ater This Meeting I Received Prof Ralphs Response letter Dictated Dec 15,
We Plan To Do Further Grafting In The Areas That You Have Marked On The Arm And I WilL Personally Do This Together With M. Christopher:

I Was Not The One Who Told Lies
Prof Ralph You Owe Me an ApoLogy.

BEWARE This Centre Is Not Monitored.
Any Mistakes your On Your Own. Get Everything In Writing

Your Team Have Greatly Reduced My Quality Of Life And Indefidence. I Asked for Disablity Equipment, To Reduce Pain And Accommodate Hand Damage.

Prot. Ralph Stated I Was A Special Case And Would Receive The Items. Request Refused By The CCG And Wheelchair Department.
"SHAME ON YOU, WORLD REKNOWNED SURGEONS.
"YOU CAUSED THE DAMAGE, YOU PAY FOR THE ITEMS." The Only Specialized Services Centre In The UK:
Your Team Messed Up Big Time, Take Responsibility, Liaise And Coordinate My Care With The NHS.
Protest Began, Sept 7, 2019.

To clarify: the above surgery was NHS funded using a commissioned private service.

Why are we doing these fever dream surgeries with attendant risks to otherwise healthy patients - to produce non functional simulacra of organs of the opposite sex? How does the brain, which develops together with the rest of the body, interacts with its environment through that body, maps sensory input from that body, somehow decide that its missing parts that it never has experienced? and how exactly does creating non functional imitations of these organs improve the problem?

Absolutely tragic. TiFs having these surgeries are blinded by ideological notions and soft wording of these surgeries - and instead of surgeons having their patients wellbeing at heart, they are taking their money (if private practice) and turning them into lucrative guinea pigs. I can't believe it's legal, let alone celebrated!

Scott Newgent, Griffen, TiF YouTube stars such as Jammidodger, Instagram personality DarlingAslan... Just a small number I can think of off the top of my head who have documented poor outcomes of these surgeries.

While we're on the topic of the consequences of 'gender affirming care', does anyone know of any studies covering the impact of large doses of testosterone (without steroids) on the female body ? I've looked, but not successfully. I'm probably using the wrong search terms, because I have a feeling that there is a study out there about bone density.

At least, I hope somebody has been doing some follow-up to check for side-effects. But given the shortage of ethics in this particular medical field, I wouldn't be surprised to find that no one is bothering.

Yes that's quite a shocking paragraph when you first read it. I would like to be able to ask how 'low risk' is defined, but that's not possible as I'm not a forum member. Is it risk of death on the operating table? Complication rate? For cancer patients, is it weighing up the risks of surgery Vs no surgery?

I imagine that non-trans patients will include cancer patients and eunuchs/castrati.

I'd like to know that too Edith.