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.

I find it really upsetting that Griffin's friends and so-called community, a very online set of people, have nothing to say about Griffin's painful life and sad death. Quite few of the alleged evil Nazi terfs at KF have posted about how sad and angry they feel about the pain and suffering and the needless early death of a young woman, while Griffin's friends are posting encouragement to more young women to go down the same path. Griffin will be memoryholed because her story doesn't fit the lies being sold to other vulnerable people.

Like the evil Nazi kiwi farmers, I'm mad at the internet today.

Metoidioplasty on the NHS?

So we currently have an NHS which barely addresses standard female care, see unhappy-and-traumatic-birth-and-post-birth threads to the right, see cannot-get-an-endometriosis-diagnosis-for-anything-upto-11-years to the left, see I'm-losing-my-mind-due-to-low-hormones-and-can't-get-HRT-or-thyroid-hormone above, and as we're talking about body modifications, see my-huge-breasts-are-causing-me-crippling-back-pain-but-I-can't-get-them-reduced-on-the-NHS below.

But the NHS has money for surgeries that pander to purely self-determined mental frameworks of oneself that don't have any firm basis in reality?

Lol. Ok.

Yep.

From the NHS England Service Specification document: https://www.england.nhs.uk/wp-content/uploads/2019/07/NHS-England-Service-Specification-for-Specialised-Gender-Dysphoria-Services-Surgical-v4.pdf

Bonkers, innit?

TBF the NHS were forced into providing MtF genital surgery by the courts so they are probably equally obliged to provide it for FtM otherwise it would be sex discrimination.

This is the genital surgery court case (from 1999):

en.m.wikipedia.org/wiki/North_West_Lancashire_Health_Authority_v_A,_D_and_G

Yep again.

A friend of mine was waiting for a skin cancer referral while the NHS was performing double mastectomies. She ended up waiting for so long that rather than a simple excision she had to have a skin graft.

Priorities, people, priorities.

TBF the NHS were forced into providing MtF genital surgery by the courts so they are probably equally obliged to provide it for FtM otherwise it would be sex discrimination.

This is depressing. I did not know about the court case. Tomorrow is my day off and I was planning to write to Wes Streeting and my MP to ask that masculinising genital surgery be banned, or at least not funded by the NHS.

Obviously I'd also like to see other gender surgeries banned, including mastectomies on young women and mtf surgeries on young men (see Ritchie Heron) but I think there's less chance of getting them banned.

Is it even worth the effort of writing that letter? Well I suppose if it brings knowledge around the life and death of Griffin and the insane harms of this surgery at the very least it may harden his resolve to keep young people off puberty blockers and prevent them taking that first step on the medical/surgical pathway.

It just sickens me that the NHS is funding this, and obviously it's not just about money and harms to young people, it's about our health service that is so stretched, hundreds of thousands of people on waiting lists for important surgeries and meanwhile precious resources are being expended on creating a class of lifelong medical patients who are destined to have many complications in the future, and if they sue that will be an additional expense to the NHS.

@EdithStourton I recently signed this petition which may interest you (& others) re NHS follow up for melanoma.
I have two sisters who have had melanoma. My sister in Australia is very lucky to be alive as her GP had initially dismissed her mole as harmless and six months later it was a worse stage than when she first sought treatment. She then developed spread into lymph nodes in her groin. I checked research when she had the op to clear her lymph nodes and she had a 50% chance of surviving two years. Fortunately it was only two nodes affected and removal seems to have done the trick, this was 20 years ago.
My other sister in Shrewsbury (that hospital which had featured in various scandals, not just maternity) had a small melanoma removed from her back - fortunately her husband had seen it. The wide excision must have been quite deep as she was ordered to do no exercise/lifting/hoovering etc for 6 weeks and it took a while to heal.
Then there were no follow ups! She eventually wrangled an appointment with a nurse specialist 🙄 who told her the NHS wasn't doing routine follow ups any more as patients found them too stressful and anyway the body was very good at dealing with melanomas!!!🤯
My sister said she found check ups reassuring but has since given up the unequal battle and has opted for regular private skin checks.

Sorry for the digression. But if anyone is concerned about skin cancers please get a private skin check. They are relatively inexpensive - around £150

And sign the petition.

Absolutely bonkers!!

I didn't know the NHS were compelled by law to do this sort of thing. How can they legally be compelled to offer surgeries that actually compromise both mental and physical wellbeing and go contrary to do no harm?

Just read that. So it means it needs legislation to overrule the court judgement unless a health authority wants to risk going to court again.

So judges are the ones that decide how NHS funds are spent? The NHS need better lawyers.

I do wonder if a current-day judge might look at the same arguments and come to a different conclusion - the NHS supposedly prides itself on being ‘Evidence Led’ yet there is no evidence that Gender Transition interventions improves long term quality of life or ‘cures’ Gender Dysphoria.

This was the sort of case the Stephen Whittle was using as lawfare in the 1990s.

The full judgement is available here: http://www.pfc.org.uk/caselaw/High%20Court%20judgment%20in%20the%20case%20of%20A,%20D%20and%20G%20v%20North%20West%20Lancashire%20Health%20Authority.pdf

(hosted on Stephen Whittle’s PFC site)

I CBA to reread it right now but IIRC it hinges on the concept of transsexualism being an illness and the NHS not being allowed to pick and choose the illnesses it treats.

So maybe TRAs will normalise gender identity to the point it washes away the right for transsexuals to receive NHS surgeries? After all, they keep telling us that a ‘female’ can have a penis, so why are taxpayers compelled to fund penectomy for ‘female’ people?

Well the NHS certainly values pride (whatever it stands for now). The evidence led defence was surely lost when they allowed biological men in womens' spaces and started asking men if they were pregnant.

does anyone know of any studies covering the impact of large doses of testosterone (without steroids) on the female body ?

Testosterone is a steroid

Quote from TransActual statement published today re: upcoming review of adult gender services…

🤦‍♀️

transactual.org.uk/blog/2024/08/21/statement-on-the-announcement-of-the-levy-review/

'We are concerned that the focus will be on the legitimacy and efficacy of medication instead of improving healthcare '

Oh, dear.

I archived that in case they realise the stupidity of the statement and try and delete it.

archive.ph/KRDi4

Well. At least they are honest.

And it really does seem to make the point that the treatments should not be tied to gender dysphoria.

I heard that the recent trans pride parade in London featured a repetitive chant…

HRT! HRT! Over the counter! And for free!

So they clearly aren’t bothered about appropriate, carefully monitored medications to treat legitimate diagnosed condition.

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

I don’t know. I think that a referendum ( anonymous at the ballot box) would probably get a fairly hefty majority. BTL comments on any articles in the press referencing these sort of surgeries reveal a mainly hostile audience, ranging from informed rejection through incredulity to instinctive repugnance. Much of the ‘unsympathetic’ commentary is founded on the sheer disbelief that the sufferers could be allowed to consider that ‘lopping bits off or grafting bits on’ (source : my neighbour) would be of benefit in anything but the very short term. Given the complaints of many of the more ‘successful’ recipients * about their ability to ‘pass’ or be ‘treated’ as their assumed sex, the disbelief may not be misguided.

You see, I'm not entirely against that, following say, an initial consult and testing with GP/Pharmacist. There is too much gatekeeping of HRT for women it would really benefit, like my next door neighbour who has been having hot flushes since she was 26 and a serious car accident put her in premature menopause. She was refused all intervention until she reached 54 years old! Or my aunt who has suffered with hypothyroidism and has low hormones all round and is now suffering increased symptoms due to estrogen dominance, but is intimidated to ask again after being dismissed by a GP twice.

But my understanding from looking on forums is TM/TW are prone to misuse it, using inappropriately high doses in desperation to look more feminine/masculine. So having it freely available over the counter is problematic.

I personally would prefer sanitary towels be made free first.

Are TransActual absolutely sure they want the wealth of international evidence to be looked at, rather than ignored? Because the evidence of teenagers with osteopenia, 95% phalloplasty complications rates and all the rest really doesn't look that great, to people who aren't part of their belief system.

https://www.tumblr.com/edinburghath/163521055802/trans-health-manifesto

'There will be no clinics, and no authorities. We will conduct our own research, and experiment with our own bodies. We will heal and grow together. We will accumulate knowledge and share it freely and accessibly. We demand nothing less than the total abolition of the clinic, of psychiatry, and of the medical-industrial complex. We demand an end to capitalist & colonialist "medicine".
We demand hormones & blockers are made available over-the-counter and by free prescription upon request.* *We need free, universal access to safe hormones & blockers at any age, the opportunity to decide our own doses, and universally accessible information on the safety & efficacy of different regimens. We are already taking hormones in this way, so this demand is simply that the danger of doing so is effectively mitigated.
We demand that all therapies that can be are made available at drop-ins, with self-referral for any therapy or procedure for which drop-in is unsuitable.
We demand anonymous blood tests, both postal & at drop-in endocrinology clinics, where we can seek the advice of a consultant if we wish.
We demand the freedom to alter our bodies without justification. We demand an end to all surgical prerequisites - nobody should have to prove life experience,health or have to be taking hormones in order to exercise bodily autonomy. We demand that these surgeries can be highly customised to meet our individual & unique needs. We demand the right to multiple surgeries, including reversal of previous surgeries if desired, so that we do not have to fear regret. We demand the free & timely provision of genital surgeries, additive & reductive chest surgeries, hysterectomies and orchiectomies, tracheal & vocal surgeries, facial surgeries, lipoplasty, contouring & microdermabrasion, surgical hair removal & transplantation, and any other possible procedure to meet our needs as we express them.
We demand resources for hair removal anywhere on our bodies, and the option of local anesthetic during these procedures. We demand voice coaching that does not coerce us to alter our voices in ways we do not express a need for, but respects our accents and our right to express ourselves however we desire.
We demand access to counselling & and any other therapies we choose. We demand the revocation of medical licenses from all gender clinic doctors & nurses, past and present.
We demand the power to hold abusers of medical & administrative power accountable for historical & present injustices.
We demand medical training to enable us to safely carry out medical procedures & research for each other, for anyone of us who wants to learn. We will enhance our collective knowledge, so that the means to understand our bodies is universally accessible. We demand to improve the quality of medications we take and procedures we undergo, to reduce negative side-effects in the long term, and to highlight our own experience and understanding of their effects on our bodies.'

I mean, it goes on ...

We demand nothing less than the total abolition of the clinic, of psychiatry, and of the medical-industrial complex.
Where the fuck do they think the drugs are going to come from if the 'medical-industrial complex' is abolished?

I'm still reeling from the death of this poor young woman. I've been following Griffin for a year or two now via Exulansic and she's tried so hard to be brave through years of medical incompetence and one massive mistake after another by the people who should have been helping her.

Any of us who have had a UTI for even a few days knows how much it impacts on your life. I can't begin to imagine what this young woman has been through for week after week of agony and confusion.