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.

From what I can glean from the r/phallo subreddit, which is for women and girls who have this surgery - yes.

Although there was a rather alarming post by a young woman who'd had the flesh and muscle from her arm removed to make her faux penis, and, due to some quirk of the human nervous system, whenever she touched her new penis, she felt freezing cold shooting pains in what remained of her forearm.

There was a graphic novel about a teenage transman (Welcome to St Hell) which got a lot of publicity last year I think.

One of the spreads that was visible on the internet showed the main character's fantasy vs reality about getting a dildo that fit in their pants and having their partner fellate it. The fantasy of course was that it would be the Best Thing Ever. The reality was feeling nothing, because it was a bit of silicone.

This is obviously much, much worse because fantasy vs reality results in permanent body mutilation, but the fantasy element seems to be an incredibly strong motivator.

I think it depends on what you count as safe.

For one thing, castration, including removal of the penis, has been going on for thousands of years to produce eunuchs. Dangerous yes, but much less so now with antibiotics etc.

But if you think about other cosmetic surgery procedures, it's not that far out. Some of them are crazy, even some of the face lifts that get done now rearrange a lot of elements of the face, people get bones shaves or removed, implants under muscles, flesh and skin removed.

There is always some risk, and I'd guess the most likely here might be damaging the urethra, but I think shortening it is not nearly so difficult as adding.

Castration isn't hard at all, I used to do it to livestock in my barn and never had a problem once.

I reckon I would be quite handy with the Burdizzos myself Tempest.

Adding this Buck Angel youtube video here (also posted on the Transman/Griffin thread).

Another Transman has died with organ failure. I think that the effects of cross sex hormones must be playing a role.

https://archive.ph/9QBEn

JFC - when will people see just how fucking dangerous this all is and how therapy is needed to support these people. Am so angry on this transman/woman’s behalf. That two children left without a parent, avoidably.

Oh that's awful. And has young children.

Clearly has a lot of risks which sadly may become more prevalent as more women take cross sex hormones

The link isn't working for me - I get "This site can't be reached".

Hmm, I could get it.

It's hard to see what happened, there could have been some more standard reason for the kidney failure. But sadly I suspect we will see a lot of this kind of thing with young transmen in their 30s and 40s.

Kidney failure can occur as the result of chronic urinary infections. Any idea why this might be relevant to someone who has had a phalloplasty where their urinary tract has been compromised and an extended using non-urinary track tissue, creating tiny pockets where bacteria can establish themselves and be impossible to shift?

@KielderWater am mind-boggled. I can’t imagine a genito-urinary specialist will have many ideas as to how this poor individual died either. Total mystery, I’m sure 🤔

They were type 1 diabetic and had gone through 2 pregnancies with multiple complications.

Meaning it’s even more bonkers that they were given testosterone in the first place.

I wonder if the rate of deaths caused by medical transitioning is already higher than the rate of deaths caused by the transphobic "genocide" claimed by gender activists. At least for females I suspect it may well be. And what the activists will make of that. Presumably they'll put it down to "transphobic" failures of "care" rather than the inherently health-damaging nature of cross-sex hormones and affirming surgeries.

Doesn’t testosterone cause issues with the urinary system making it prone to infection?

Not to speculate, but more to say if this is the case, that just cross sex hormone treatment could cause the issue without any surgery needed. But I could be remembering incorrectly.

The intro.

'Liam Johns, the transgender man known for his LGBTQ activism in Charlotte and for sharing his pregnancy journey in a 2019 Charlotte Observer series, died on Sept. 14. He was 35.
Johns was undergoing dialysis for kidney failure and was on the national kidney and pancreas transplant list when he passed away, said Chase Hayes, a friend and former partner, in an interview with the Observer.
“He touched a lot of people, especially in Charlotte, with all he did,” Hayes said. “That was his heart and soul — other than his children … He loved his city, he loved his community.”
In 2018, Johns gave birth to his first child with his partner at the time, who now goes by Freya. In 2022, he gave birth to their second.'

The article does not state if Johns had phalloplasty or not, but from the photos testosterone was clearly taken.

I maybe should have added this to a non-phallplasty thread, but I couldn't find the alternative thread I had in mind and I wanted to add it to one that had mentioned Griffin Sivret.

If she has given birth as recently as 2022 then any phalloplasty would have to have been recent.

Ah, yes. That is not a great combination.

Would someone taking testosterone be eligible for a transplant?

Is there a better link perchance? It won't load for me, keeps timing out/can't be reached

Screenshots, which hopefully are readable.

Part 2.

Not phalloplasty but complications of testosterone related.
A trans "man" who has been on testosterone for a year had an acute stroke and is left in a more or less vegetative state age just 23 years old.

"Acute ischemic stroke may be an under recognized complication of testosterone therapy in transgender males independent of degree of erythrocytosis. Further research is needed to establish a safety profile of testosterone therapy in this understudied population."

www.neurology.org/doi/10.1212/WNL.0000000000202704

A living nightmare. That poor woman, I just cannot imagine. Every time I read about that case, I can't but help but think of the hubris of the people involved in prescribing or promoting cross-sex hormones.

That's horrendous. She was left with locked-in syndrome.
There really needs to be a proper study of 1000 transmen on similar levels of testosterone and 1000 women not on it, matched for age and so on, to see where their health is 2, 5, 10, 20, 40 years down the line.