Surgeon's account of gender affirming care

[BettyBooper]

A surgeon has been writing to various bodies for the last two years to raise serious concerns about surgeries and hormones. Noone is willing to take responsibility.

Horrific that this can continue.

His account and the responses he has received here

https://www.scotpag.com/post/gender-reassignment-surgery-a-medical-deception

Oh indeed. I've also witnessed linking between victim of rape gangs then going on to be pushed into genderwoo by camhs and social workers.

There will be a reckoning. Its fucking awful.

@BettyBooper Horrifying, a terrible abuse of trust and power to do such a thing to vulnerable individuals, mostly young women and girls I assume? I will have no sympathy for these so called professionals when their time comes.

Oh yes. And in the most horrendous way. And those at the absolute top were actively aware. I can't say more without being outing. But it will come out.

The Children's Commissioner needs to take a good hard look at this. Maybe in the mirror.

I am certain that not wishing to be honest and end up ostracised is massive, but my suspicion would be that lying to oneself is an even bigger thing.

I imagine that for most (younger) women there would be nothing worse than admitting to yourself that you are infertile as a result of a choice you made; likewise for most men there would be nothing worse than admitting to yourself that you do not have a functional penis and an ability to orgasm as a result of a choice you made. I imagine that we are evolutionarily wired to avoid considering the possible negative implications of appalling decisions we have made, or lying to ourselves that we did not make a decision (and instead we were compelled to take the path we did) because the alternative is too much for the human mind to cope with.

Typing the above made me think about the young racing driver (I googled - Bily Monger) who lost both of his legs aged 17 in a crash. He went back to racing but seems to have given up after a couple of years. I have never read any interviews with him, and I don't know how he thinks and feels... but I suspect that he thinks he was born to race, driven to it, and that he has no regrets, because the accident is just one of those things that can happen when you race, and he is a racer. A more rational perspective might be "I loved racing, but with hindsight I wish I had never done it and was able bodied to this day"... but human's aren't strong enough to think like that.

Re: the last sentence... I am tempted to agree... subject to some caveats -

I can see how someone with an extremely saggy face as they age might regard the relatively unintrusive (compared to leg amputation) facelift procedure to be necessary, and the doctors say that the small risks are worth it for potentially large MH benefits. And the negative feelings about looks as one ages are rational, not a sign of mental illness, albeit if the negative feelings start to dominate then it is mental illness.

In contrast a leg amputation guarantees physical disability - no amount of claimed MH benefit can be enough.

With an elective mastectomy I would argue it is more similar but not as clear cut as leg amputation, but elective breast reduction for those with massive breasts that cause real world issues is more like a facelift for someone who is aging really badly.

But overall I would feel much more comfortable with making all cosmetic procedures illegal, than I would legalizing amputations for people with BIID. And medical transition seems much more like legalizing amputations for people with BIID than it does cosmetic surgery (because of how big the consequences are), although ironically medical transition is a type of cosmetic surgery given that it is always 0% successful in terms of changing someone's sex.

I think we need to remember that there are some doctors who are more than willing to harm their patients. There was a case of a male doctor who carried out multiple unnecessary mastectomies in the news not that long ago. That's the reason why we have (or are supposed to have) so much safeguarding around medicine, because there is such enormous potential for harm, and some of it will be deliberate. They are just human, after all, which means that some of them are dangerous people, albeit with a medical degree. Look at the doctors behind the infected blood scandal who knowingly gave tainted blood to little boys just to see what would happen. And that's before we even start on the ones who are just plain incompetent. Half of doctors are below average when it comes to knowledge and skill set. Some of them will have been bottom of their class and the worst in their group at uni.

Gender medicine will attract a certain type of doctor because it's experimental, and because it involves operating on genitals and breasts.

It's entirely cosmetic, isn't it?

I thought that was the definition of surgery to change appearance in an otherwise physically healthy person.

The difference is, is that gender medicine is based on a lie that you can change your sex. It’s basically mutilation of healthy body parts dressed up as medical improvement.

If I was to have a face lift, I certainly wouldn’t be under the impression that it would make me look like Angelina Jolie.

Its all based on medical experiments, mutilation and lies.

NHS website (my bold additions!):

Gender surgery for trans men includes:

• construction of a penis (phalloplasty or metoidioplasty) LIE
• construction of a scrotum (scrotoplasty) and testicular implants LIE
• a penile implant

Surgery for trans women
Gender surgery for trans women includes:

• removal of the testes (orchidectomy)
• removal of the penis (penectomy)
• construction of a vagina (vaginoplasty) LIE
• construction of a vulva (vulvoplasty) LIE
• construction of a clitoris (clitoroplasty) LIE

https://www.nhs.uk/conditions/gender-dysphoria/treatment/

This is it. I think you can have all these various surgeries at your own expense but be aware they don’t make you change sex.
I don’t mind if you have all your genitals chopped around, just like I don’t mind if people have boob jobs, or nose jobs. As long as we all agree it’s cosmetic surgery of a body that is working absolutely fine, you just aren’t happy with it.
I don’t think the NHS should cover it.

Sorry for this very naive question, I am trying to learn.
Does the NHS routinely pay for and carry out these surgeries? Do we know how many per year?

Yes it does. This might be of interest:
www.england.nhs.uk/wp-content/uploads/2019/07/NHS-England-Service-Specification-for-Specialised-Gender-Dysphoria-Services-Surgical-v4.pdf

I don't think that NHS publishes numbers. Google throws up a few newspaper articles on numbers that you might decide to look at.

I think it's complex.

It is cosmetic in that is does not involve anyone changing sex, but it does have real world affects in terms of hormone levels let alone the side effects.

And, additionally, I think "cosmetic" implies "relatively trivial" and that SRS is not at all trivial.

It is the worst of both worlds - it is cosmetic in terms of doing nothing according to it's own aims (sex change), but it is serious invasive surgery, not cosmetic, in other ways.

I would add to this that, as with all private surgery, if everything goes pear-shaped during the surgery it is the NHS hospitals that step in to treat the emergency. I imagine that the long-term health conditions caused by SRS will frequently end up being treated by the NHS too.

'I'll be honest, I increasingly don't think psychiatry is real medicine.'

I would like to respectfully disagree with you on this.

Rather, I think psychiatry is an imprecise area of medicine. A lot of that is to do with the fact that for most of history, we have been going in completely the wrong direction in terms of treating psychiatric illnesses. Any understanding of how the brain works has been a fairly recent development.

For a lot of history, all you could do when someone has a really serious psychiatric illness, when people weren't doing something horrible like torturing them or burning them as a witch or whatever, all you could realistically do was try and limit harm from the symptoms.

E.g, margary kemp was a woman in the medieval era, who suffered from postpartum psychosis. She actively was trying to harm herself and end her life, even by biting herself when she could not access an implement. To prevent this her husband restrained her, and tried to maintain basic needs (e.g food/water).

In the modern era, this treatment would seem barbaric. You could give antipsychotics, therapy, maybe sedatives rather than literally tying her up. But at the time, with the technology and resources avaliable, that would be the best anyone could possibly do.

Then for a lot of the 20th century, people were doing actively harmful stuff like lobotomies.

We've generally been moving in the right direction in terms of psychiatry since some point perhaps in the 80's? So that's a pretty small knowledge base foundation to be working off, only a couple of decades, vs other areas of medicine. E.g, we've been doing trauma surgeries for thousands of years.

Its also very difficult to find out how some well interventions work.

You need a control group with no intervention to see how effective an intervention is.

e.g If we do a randomised controlled study on how effective anti-depressants are at treating suicidal people, and give some people placebo pills, if the anti-depressants are helping, some people will probably have to die to get this information.

Yes, I suppose some gender operations alter hormone levels. I guess orchidectomies and oophrectomies. Not top surgery. Do people often have oophrectomies with their hysterectomies? I don’t know enough about it.
Then you would have a lifetime of hormonal
support on the NHS, to resolve a physical problem, that wasn’t a problem to begin with and was working fine.
I wonder how people in the US square this with their insurers.
But I do think if you stringently assessed most people having cosmetic surgery, to see if they had mental health issues, private plastics surgeons would go out of business.

Listening to Lord Winston, who was very pro trans in the original Lords debate on the GRA, I think one of the things that's made him more sceptical is trans people having completely unrealistic expectations of what surgery can do for them. Young people especially, because typically they don't have much knowledge of surgery.

I don't particularly like the cosmetic surgery industry, because there are too many cowboy practitioners willing to do anything for money, and too many people with unrealistic expectations who think surgery will sort out some mental distress they have with their body.

But there are ethical surgeons in the field. Surgeons who, if a young woman turns up looking for a breast enlargement or similar, will say "here's exactly what the procedure involves, here is a comprehensive breakdown of the risks, here's what you can realistically expect, here's my portfolio if you want to see my work," and then most importantly say "go away and think about whether this is what you really want".

Is that happening regularly in gender surgery? I kind of doubt it. Or, if the doctors are outlining the risks, the kids are just tuning them out.

Sometimes I see trans-identified youngsters online talking about their hopes for surgery, and I think of the old movie Myra Breckinridge, which you can tell is a male fantasy because the transwoman is played by Raquel Welch, and basically no actual women look like Raquel Welch. That's the level of realism the youngsters are working on.

100% - and I genuinely believe that - in an ideal world - cosmetic surgeries should be reserved for extreme circumstances, for example very large noses or sticky-out ears that severely increase bullying and make people very self-conscious and less mentally well, and can be put right with relative low risk.

Cosmetic surgery should - IMHO, in an ideal world - be about minimising the harmful effects of specific characteristics that depart from human norms, not to make someone a bit more attractive. Not least because the more people have cosmetic surgery the more inflated beauty standards become, leading to more people wanting it or feeling they need it.

A penis on a man is not a "specific characteristic that departs from human norms"

@SionnachRuadh Or, if the doctors are outlining the risks, the kids are just tuning them out.

That's why the NHS webpage I linked to in earlier post is so ethically wrong. Young people will read that and think they can get a real penis/vagina because the Sainted NHS says so.

The NHS Service Specification I also linked to says:
The surgeon will offer the patient a pre-operative consultation, and will provide them with information, and agree with them the surgical intervention to be provided, which will be consistent with the patient’s gender expression goals, within the limits of what can reasonably be achieved with best surgical practice.

This consultation will take place after months or years of waiting (NHS), of cross-sex hormones and of 'living as the other sex'. Who, at that point, is able to really hear and digest "'well actually it's not really a penis/vagina after all".

@JamieCannister cosmetic sugery! I could go on for hours. I think it’s unwise and vain and a risk you don’t need to take, and then your children inherit the problem anyway (nose jobs particularly) and life is too short to be so self obsessed when the beautiful universe is there to experience. Your body is just a vessel you sail through this experience of life in etc etc etc.

If someone wants to chop their body about, we need to think about personal responsibility. Why are we classing gender surgery or all failed cosmetic surgery as anything other than self harm? A mental health decision to ruin a functioning body because of depression or dysphoria or age related sadness etc. You can do it, but why does the tax payer pick up the pieces? Why is it not classed as self harm like cutting is? Why is it promoted as empowering and the tax payer should enthusiastically pay for it and clap while they do?

So I can't help wondering, are these young people shown photos of actual 'neo-penises' or 'neo-vaginas' that they hope to be getting? And in some cases, the ancillary damage done to other parts of the body?

@SionnachRuadh

"But there are ethical surgeons in the field. Surgeons who, if a young woman turns up looking for a breast enlargement or similar, will say "here's exactly what the procedure involves, here is a comprehensive breakdown of the risks, here's what you can realistically expect, here's my portfolio if you want to see my work," and then most importantly say "go away and think about whether this is what you really want".

Is that happening regularly in gender surgery? I kind of doubt it. Or, if the doctors are outlining the risks, the kids are just tuning them out."

There are ethical surgeons in the field of gender surgery too. The surgeon who did my double mastectomy didn't ask if I wanted to see his portfolio: he planted me in front of it and told me to look. He wanted me to be very aware of what I could and could not expect. He was also upfront that with my weight, there would be some inesthetical results in places.

That said, I already knew about all that, because I'd already looked up pictures and stories on the topic. I fear that might potentially be a big difference between old-timers like me, and the new generation: the level of personal investigation before committing to surgery. Do they even have time to properly research the matter? And enough mental space to make their own proper decision? And are they given a choice of surgeon, and an idea of what to ask for, to accept and to expect? It's such a massive decision, and it makes me sick that so many young people are pushed into it as a matter of fact.

This is what the service specification says:

The operating surgeon will obtain consent for the proposed intervention at a specific pre-operative appointment, so as to allow an informed process and give the patient adequate time to consider any relevant options and alternatives. Each patient should receive detailed verbal, written and pictorial information on the:
• Different surgical techniques available (with referral to colleagues who provide alternative options)
• Advantages and disadvantages of each technique
• Limitations of a procedure to achieve “ideal” results
• Inherent risks and possible complications of the various techniques
• Appropriate aftercare

They should be. A reputable and ethical cosmetic surgeon has a portfolio to show what the end result looks like, and will argue for the least drastic treatment.

Or, in this case, they should show how the end product doesn't much resemble the thing it's supposed to resemble.

But if one cohort of transitioners is teenage girls, and another cohort is middle aged men in the grip of a fetish, you have to ask how persuadable they are.

If we read the OP's linked article again we see a surgeon concerned that these procedures on 'naive adolescents' are 'disturbing and without appropriate indication' and 'deceptive' in nature. Even the Royal Colleges appear unwilling to endorse or take full responsibility for them.