Ob/Gyn in the US questions gender affirming surgeries

[ArabellaScott]

https://substack.com/inbox/post/164586786

This is a very sad, very scary read.

An Ob/gyn who enthusiastically carried out hysterectomies on young women, and has over time started to question her work.

'I performed my first hysterectomy for gender confirmation in 2019. I was so delighted to help out my own LGBT community. I took immense pride in being my local LGBT clinic’s official gynecologist. What greater joy is there in medicine than providing great care to a vulnerable, underserved community, all with the support of your administration? It was how the world should be.

Six years later, I wonder.'

I suspect this will become the sad and horrified template of more and more professionals' reaction in years to come 😨

"Sure, there were uncomfortable questions [...] The accepted answers seemed counterintuitive – however, I assumed that the experts had carefully weighed the evidence, had done plenty of research, and had reached a scientifically-based consensus before making their recommendations regarding gender medicine."

This speaks to me so much. It's exactly how I felt too. I assumed that someone somewhere had scientifically determined what treatment trans people needed, and that anyone who argued against said treatment was being unscientific. Discovering that it was entirely the other way around was a major step in my realising that GC women were not just mean transphobes and that I should listen more closely to what they were saying.

"Academic gynecologists from leading institutions agreed that regardless of one’s gender identity, if it did not include a uterus, then hysterectomy was indicated. Quite straightforward."

Huh. I'm now wondering what would happen to me if I were to transition now instead of more than a decade ago. Would I be pushed into having a hysterectomy, because my gender identity is male? That's a scary possibility! I don't want such a major surgery. The idea that very young, very vulnerable women are pushed into it, as though it's a given that they must want it, is horrifying 😢

Treatment for 'gender' issues is based on WPATH guidance. Previously, it was based on the Endocrine Society guidance.

WPATH are a very dubious organisation, put it that way.

https://reduxx.info/exclusive-founding-wpath-academic-defended-nambla-leader-child-porn-and-worked-with-pro-pedophile-academic-journal/

I've not read the blog but the person responsible for deciding if surgery is safe and appropriate is the surgeon. Blaming other clinicians for referring people inappropriately really doesn't get you off the hook.

True, but the problem is that she wasn't given the right guidelines to use in determining whether the surgeries were appropriate. The criteria were (still are) that hysterectomy is appropriate in the treatment of gender dysphoria, and therefore that any patient with gender dysphoria asking for one should be given one. According to those guidelines, every hysterectomy she ever performed was safe and appropriate and it's now that she's hurting trans people by saying otherwise.

It is truly shocking that trans-affirming medicine has taken hold among doctors without any real evidence of the benefits, and against an unevidenced threat of suicide. I tend to agree with TopographicalTime that each individual surgeon should know why they are carrying out a surgery, and be sufficiently up to date with research in that area to be confident that, in each case, it is the right thing to do (based on current knowledge). This data doesn’t exist for most trans affirming medicine, so I don’t really understand how surgeons can make a reasonable case-by-case assessment. If the procedure is being offered ‘off-label’ then they need to have that discussion with their patient.

At least, that’s how I think it should work. I am not a doctor. We’ll have a clearer view of what ‘should’ happen once the legal cases gather pace.

She’s brave to write it though. It must be really hard to publicly raise an opinion so contrary to that of your colleagues

She raises a very good point that we don’t talk about enough: if dysphoria has always been around (she argues it has), where are all the deaths by suicide? Body counts are tragically easy to count, but we have no data to suggest suicides were higher prior to the 1990s when “gender affirming care” was in its infancy.

Precisely @Delphinium20

I don't really think that's fair.

The surgeon should know what the surgery can do, and how risky it is, what a good outcome looks like.

But in a case where the "disease" being treated is part of another speciality, the surgeon is going to depend on that speciality to make the assessment in terms of their expertise.

So if someone has a problem with their hormones, for example, or epileptic seizures, it is not the surgeon who is going to be looking into those problems. It will be another specialist who says, we need to remove this gland because we can't manage it another way, or we need to make this very serious intervention to address these seizures. Even if they are not the ones performing the surgery.

It's not as crazy as it sometimes seems that surgeons weren't considered doctors at one time.

An edited version has been published in UnHerd:

https://unherd.com/2025/06/the-troubling-trends-in-gender-surgery/

I'm not inclined to be sympathetic to her. Sure, other doctors were making the decision to refer. But that doesn't absolve her from employing some critical thinking, such as: why am I performing hysterectomies on healthy young women, when hysterectomy is a last resort when the woman has a physical illness? why are hysterectomies needed for a mental health condition? what happens if this woman decides she wants children at a later date?

I found this particular sentence quite chilling: "Gender affirming hysterectomies were a delight to perform. “These teeny tiny uteri [atrophied by testosterone] are so much fun to take out,” I would tell my assistant."

That has echoes of the “yeeting” surgeon. She is a ghoul.

To me the problem lies with those saying this was life saving care. That's been the rhetoric.

I would have questioned it - I did all along. But I can't really get away from the fact that so many pretty normal people have accepted it.

I don't expect a higher than usual amount of emotional insight from surgeons, a lot of them are poor at that sort of thing.

If neurosurgery for epilepsy is being contemplated the surgeon absolutely will be involved in the very detailed work up for patient suitability and site suitability.

A gynaecologist can diagnose and treat medical and surgical gynae problems - they absolutely are responsible for making sure a hysterectomy is appropriate before they do it - that's just basic due diligence.

Legal responsibility will vary across jurisdictions but typically the person doing the procedure should take consent, which should outline the benefits and risks of surgery. If the surgeon doesn't understand the indication they can't get informed consent because how would they explain the risks and benefits?

The legal landscape will obviously be very different in the US, but morally claiming that you did a procedure because another doctor told you to really doesn't wash at consultant level.

I'm not letting psychiatrists and endocrinologists off the hook at all - psychiatrists have a lot to answer for here - but the surgeons are responsible for their surgeries.

https://www.rcseng.ac.uk/standards-and-research/standards-and-guidance/good-practice-guides/consent/

I agree. She’s a ghoul who sees the current writing on the wall. I never needed to peak, the first time I heard of women getting their breasts removed was a photo posted in praise of it in George Tatakis’s FB page. I followed him cause he’s funny. But that made me physically sick to see this woman “crying euphoria tears” at her breast removal. I stopped following him. I’m not special, but it was quite obvious there was something rotten in Denmark.

I don’t blame young people who believed in gender woo woo, but she was a grown woman, smart enough to get into med school, who failed to live up to the oath she took. She’s clever enough to write this in an attempt to save her ass. She has no moral compass, just survival smarts.

My fellow gynecologists, we are people of science. We know right from wrong. We care about our patients. We can find the courage to do this.

This bit annoyed me. Still thinking she’s got the higher moral ground to normies, or god-forbid, non-science people. No. You’re just people. You were wrong. Badly wrong.

The thing is John Hopkins had a pioneering sex change (as it was then called) clinic in the 60s and 70s that ended up stopping because they discovered the operations were ineffective in terms of making patients happier with their bodies or their lives.

This was common knowledge in the US and surely any surgeon considering performing gender affirming surgery would have known? So simply accepting that it was now deemed best for gender dysphoric people should have raised the question - what’s changed. That it didn’t suggests a lack of intellectual curiosity and professional rigour. The writer had just lost her job when she took on the role that lead to these surgeries. I would such that, in keeping with much of the US medical profession, financial expediency was a bigger factor in allowing this tragedy than anything else.

I still clearly remember the crashing stomach drop moment when I’d had my hair cut in a fringe and I realised I HATED it.

I was stuck with stupid hair for a couple of months and have learnt my lesson - the girls this woman operated on have lost their wombs (and health) forever! Words cannot express my sorrow for these girls when they realise what they have lost.

This is an interesting point which I've wondered about, because as you say, the evidence that sex change surgeries are really effective doesn't seem to exist, but so many doctors involved in this don't seem to know anything about it.

Now, as I understand it, the fact that there isn't great outcomes in adults seems to be a large part of the reasoning for trying it with kids, the idea being that transition would be more effective.

It all seems like a massive hubris.

Yes, but the surgeon is not the one assessing the risk of the seizures themselves, they depend on others for that.

In these cases, they are being told that these kids are in real danger of death if they don't get "gender affirming care."

I can't really think of a comparison, but it would be as if a whole spcialty, like dermatology say, suddenly became convinced ob some bizarre idea, like people should bathe in bat shit to prevent the development of lizard skin. Would doctors in other specialities just reject the recommendations of all the dermatologists? It just seems so unlikely they would all start to believe some bizarre unsupported thing.

Yes this seemed misguided considering she’d just said that back when she was doing all those gender-hysterectomies she effectively crossed her fingers and hoped for the best. So she’s only a science person belatedly when she eventually decided to do a little digging because she realised (duh) that it’s actually pretty hard for most women to access a hysterectomy for actual medical reasons.

There are all kinds of valid criticisms of this surgeon and her position. However, I think this is a strategically useful article. Many people lack curiosity and just haven't spent much time thinking about gender surgeries and the evidence base for them. Among the many reasons gender medicine managed to get its feet so securely under the table is because otherwise intelligent and sensible people (including doctors and surgeons) just assumed that someone else knew best and there was an evidence base for these surgeries.

This passage in particular is very telling:

I had just assumed somebody, somewhere was in charge of making sure that there was an evidence base that these extraordinary treatments that were being performed on young people – puberty blockers, cross-sex hormones, and double mastectomy – were support by extraordinary scientific evidence that showed an incontrovertible long-term benefit.

However, since there was no unbiased scientific organization of experts on transgender issues, the AAP, the Pediatric Endocrine Society, the APA, the AMA, and ACOG relied on WPATH to guide them. Why wouldn’t they? As upstanding evidence-based scientific organizations, they generously assumed their counterparts were the same. However, as the holes in the evidence behind WPATH’s official Standards of Care become more obvious, it is clear these organizations can rely only on themselves to evaluate the evidence. (Interestingly enough, the American Society of Plastic Surgeons conducted its own review of the evidence, and, contrary to the interests of its own members, concluded that gender affirming mastectomy for minors is not ready for prime time.)

I think this article is helpful precisely because she doesn't come across as angry and raging against the gender medicine machine, and because she can say she thought she was doing the right thing and assumed good faith in other doctors and in WPATH, rather than being someone who has been against gender medicine all along, or even just a sceptic.

For people who are absolutely entrenched in the gender identity belief system this surgeon will just be written off as an evil bigoted apostate. But for other doctors and people who just assume somebody, somewhere knows what they're doing and of course it's evidence based medicine, for those folks this article is helpful nudge.

We need more people to be willing to take a look under the bonnet of the genderwagon instead of just ignoring that discomforting engine noise. This article helps with that. It doesn't scare off lefty progressives with too much scepticism about gender from the get go. We can say "Look, this surgeon assumed it was all okay in gender land but now she's worried it's not". And, as many of us know from experience, this is a topic that once you open up the bonnet and go down the rabbit hole you realise what an absolute horrorshow gender medicine is.