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.

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.)

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.

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.

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.

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.

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

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.

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.

Yes! I genuinely couldn’t make sense of it when I first found out about it. Just… why? It can’t possibly make any female person really feel like their “true self”, if that self is supposed to be a man. It doesn’t look or function like a penis and causes so many horrible problems. The available procedures aren’t fit for purpose, and the reality is being suppressed because it’s so hard for people going through this to admit it isn’t the best thing ever and “trans joy”.

Exactly!

I think there's a shocking lack of knowledge about the human body/biology generally among most people especially the young who don't seem to get taught any of that at school any more. David Lammy being a prime example. With regard to phalloplasty I suspect the young women who seek this have never seen a real penis, or interacted with one in real life (most are presumably lesbians and those who perhaps are heterosexual, and then claim to be gay men after they transition, still seem to know nothing about men), so I think they genuinely don't understand the first thing about the workings of a penis apart from standing to pee! They also, of course, know nothing about urology and the risks to the whole urinary system that this sort of surgery presents.

I find it hard to believe that any heterosexual woman would be sexually interested in one of these flesh rolls and of course they can't work like a penis so even for the ones whose appendages heal, it is necessary to have some sort of inflation device. The odd one might be simulating some form of sexual act with the occasional person whose sexuality is so mixed up they go for it but it's not a viable option in general. I doubt any of this is explained to them. Instead they get gaslighting and brainwashing and somehow convinced this is what they need to do to "be a man". 🤷‍♀️

Dr P is writing at length about all this:

x.com/psychgirl211/status/1825786137442484308?s=46&t=A2fpFNgDRyXF2d6ye97wEA

Believing oneself to be born in the 'wrong body' is, by definition, a sign of mental illness.

As I explain here, 'Gender Dysphoria' has entered our symptom pool and, instead of being treated appropriately (or just ignored), it is being exploited and monetised at the expense of children and other vulnerable people.

‘Why Gender Dysphoria is a lie’:
x.com/Psychgirl211/s…

In one of her Instagram posts, Griffin spoke of having "bottom dysphoria".

This makes no more sense than claiming to have foot or arm dysphoria.

No surgeon with an ounce of ethics would be willing to cut off those body parts.

So, why were Griffin's healthy uterus and breasts deemed to be no more than medical waste, to be removed and burned in an incinerator?

Why did a civilised society allow this to happen to a young girl who, when she began on ‘GAC’ already had multiple psychosocial (and probably developmental) issues?

From her posts, by the end of her life, Griffin was in the grip of a raging psychosis.

And, as Chica says here, it must be automatically assumed that anyone giving 'consent' to these unnecessary, dangerous and experimental cosmetic surgeries is experiencing a 'disturbance in the balance of their mind'.

In other words, they are displaying symptoms of psychosis/thought disorder, such as:

Difficulty thinking: (concentrating, putting thoughts together, reasoning).
Delusions: (false, fixed beliefs).
Behavioural changes; (bizarre or unusual behaviour, social withdrawal or isolation)
Mood changes; (depression, feeling empty, sad, worthless, mania).
Other changes; (sleep, appetite, weight, managing emotions).

(And, for all we know, these individuals are also experiencing the other classic symptoms of psychosis, such as hallucinations and thought blocking).

I believe a new category defining the mental dysfunction of the ‘trans-identified’ needs to be formulated. I call this ‘Trans-Type Psychosis’ (TTP).

Griffin's case is also all the more egregious because she was given PBs at age 13. This is just at the age when her brain would have begun synaptogenesis and myelination, two essential neurobiological processes. (I am writing an article on the ‘Myth of the Trans Child’, where I explain these processes in detail. Keep an eye out for it).

The PBs thus switched off, or at best, severely interfered with the development of Griffin’s higher-level cognitive skills. She was therefore mentally incapable of fully understanding the consequences and implications of the later 'gender affirming' procedures to which she nominally consented.

(Impact of PBs on executive functioning):
x.com/Psychgirl211/s…

This case should go down in medical and legal history. It represents the nadir of an ideology run amok and exposes a medical profession that is incapable of regulating itself and of curtailing the actions of individuals such as Dr Oren Ganor.

Transgender ‘healthcare’ does not produce joy, or self actualisation. It instead represents a profound contempt for the human body and leads only to the immiseration of all involved, (except of course the doctors raking in huge sums from these abominable surgeries).

Transgender ‘healthcare’ is a crime against humanity.

It should be banned, in all of its forms, and for all age groups.

Because mentally well people simply have no desire to disrupt the normal functioning of their healthy bodies.

Those who embark on surgeries to deform and mutilate their bodies do not have ‘Gender Dysphoria’.

They are experiencing Trans-Type Psychosis (TTP) and they need to be protected.

Protected from themselves. And from doctors like Oren Ganor.

It’s what a civilised society would do.

The PBs thus switched off, or at best, severely interfered with the development of Griffin’s higher-level cognitive skills. She was therefore mentally incapable of fully understanding the consequences and implications of the later 'gender affirming' procedures to which she nominally consented.

This. Performing unnecessary, highly physically damaging, surgery on young people who are mentally ill and who have had their cognitive function impaired such that they cannot properly understand, and therefore properly consent. This should never happen in a civilised society, let alone be celebrated.

I would like to see a ban, too, but I do think it is actually feasible. They eventually banned lobotomies on the grounds that they were inhumane, I see no reason why - as the horror of cases like locked in syndrome and this poor trans mans death (and the stories of the medical journeys of people like Scott Nugent) become more well-known - there shouldn’t be a move to completely prohibit them.

Ethics went out the window from day 1.

When they decided to give puberty blockers to people in the 90s, they specifically gave an age range to the ethics committee [after being denied by other ethics committees] and then ignored the range, and specifically gave an end point of 16 for collecting data as persumably, most kids would have finished puberty by then. Knowing that the effects could be discovered years down the line. Oh and now the people involved are running the institutions so if you think they are going to have a sudden change of heart, think again.

Only 1 adult clinic would give their longer range [such as it is] data to Dr Cass, presumably because they had so little of it, it wasn't worth the paper it was crayoned on.

And here's another latest Ethical consideration...in the Texas Children's Hospital [the largest children's hospital in the world] who announced they had stopped all this but just carried on...the latest whistleblower is alleging how, to get around medical insurance, they are registering kids as the incorrect sex, and then stating they have low hormone levels and thus the hormoes will be to correct a low level so bingo - it will be paid for on the medical insurance. So that's not gonna mess with data in any way, AMIRITE?

The sheer audacity to come onto Mumsnet, where many of us have or had crippling osteoporosis from early or even just normal menopause, telling us how girls not getting the correct hormones 20-30 years earlier has no effect on bone density is breathtaking.

You are right to be concerned about the bone density dismissiveness. For the bone density to recover in a female person, from my reading of the studies, it requires a female to be treated with testosterone after puberty blockers.

And yes, so much of this information is lost in historical medical data.

We know that girls treated with Lupron over a certain amount of time develop significant bone density, joint and connective tissue health conditions that are life limiting and may be life shortening. And we know that the impact on an adult female body of Lupron can also lead to major health issues from previous case histories.

The bone density study I read was clear that in female patients, it was only after testosterone was used that bone density started to recover, if it did indeed reach healthy density. I think anyone declaring bone density for female patients as a non-issue would be spreading misinformation.

And sorry, just to add.

If a person really does believe there is no issue with bone density with ‘gender affirming care’ for female people that includes puberty blockers, then does that mean that person only ever expects that female person to go on to have testosterone as a treatment?

What about those who desist / detransition before testosterone? And what about those who only take testosterone for short time before detransitioning?

It seems even more dismissive of the needs of desisters and detransitioners than usual, to dismiss their potential bone health issues.

Thanks to everyone who has posted links in answer to my question. I'll have a read of the links today - I was out last night.

@FreedomDogs if you are familiar with the literature, do you know of any studies on the general health of transmen after 5-10-20 years who first given hormones as young adults?

Or anyone else?

Lets not forget that Griffin had a 'fursona' at 12, so before the puberty blockers were started at 13.

I also read that Griffin had an addiction problem as a teen. IIRC this was pain medication (please correct this if I am wrong) and developed before the major surgeries.

I think that pain medication addiction should be a co-morbity that is considered seriously. After a big operation, you are going to need medication for the pain during your recovery after all.

Griffin was set on this path at a young age.

...in the Texas Children's Hospital [the largest children's hospital in the world] who announced they had stopped all this but just carried on...the latest whistleblower is alleging how, to get around medical insurance, they are registering kids as the incorrect sex, and then stating they have low hormone levels and thus the hormones will be to correct a low level so bingo - it will be paid for on the medical insurance.

See also Australia and getting round funding and other rules.

https://www.mumsnet.com/talk/womens_rights/5106375-women-and-girls-prescribed-t-for-testicular-disorder

The disorder in question is, of course, not possessing any testicles due to being female.

This is not healthcare. The people carrying it out might be classed as healthcare practitioners but these experimental cosmetic surgeries do not promote health.

They create damage physically and mentally and I doubt the ethics of anyone carrying them out - that goes for most cosmetic surgery these days.

Plastic surgery is a relatively new field, mostly born of attempts to improve outcomes for people with horrific trauma wounds from WWI/2.

Modern cosmetic surgery is a greedy grasping field that preys on people's insecurities and fears and does more harm than good.

There are ethics boards for research - but are there ethics boards for procedures that are being carried out experimentally?

The lies! It's just insane, but I guess this is what happens when you are untethered from reality. It's still shocking though.

Liars and butchers,every last one of them.

It shows how male-driven this movement is. Everything is about the penis, even fake, rotting ones. Mentally ill girls and young women desperately trying to escape being female (and guess what makes them so fearful and loathing of the female condition - yep, men. The predators.) And what happens to these victims of butchery? They're made stalking horses for the predators driving it all, put into contact with the worst of men, the ones who can read "vulnerable and at risk" a mile off. And when they're no longer useful, they're discarded, forgotten.

Are metoidioplastys being performed via the NHS?

I believe a new category defining the mental dysfunction of the ‘trans-identified’ needs to be formulated. I call this ‘Trans-Type Psychosis’ (TTP).

I agree there is a lot of mental illness involved, and many people who are already mentally ill are attracted to gender ideology because it promises a “deletion” of the old self and a shiny new “birth”, complete with praise and adulation and a special supportive community.

But it’s unlike other mental illness in that it’s being confirmed and asserted back at people everywhere they look - by their school, doctors, books, news outlets, TV shows, workplaces. How can a young person who’s fallen into this disentangle reality from all those messages especially if they’re already weakened by PBs? It must be so incredibly hard to realise something is very wrong as Griffin clearly did, but to not be able to get clear answers or a hold on why their life has become such a nightmare when it was supposed to be about some kind of fabulous step into “joy” and “truth”?

I feel so upset for Griffin. The Kafkaesque sense of confusion and not being heard, and spiralling into feeling worse and worse with so little help forthcoming is so awful to read. And anyone who could have said “it’s ok to be a GNC girl/woman, it’s OK to feel confused as you grow up, it will get better” is painted as evil and a bigot and ostracised from these girls’ lives.

Yes, 2 surgical teams, both based in London hospitals (Chelsea & Westminster and New Victoria).