Gender CONfirmation Surgery

“Accredited medical professional groups agree that gender-affirming care is medically necessary, safe, and effective for trans and non-binary youth,” proclaimed Admiral Rachel Levine last October. Back in March, the U.S. Assistant Secretary for Health ramped up that claim.

President Biden supports you. I as the Assistant Secretary for Health will support you and I talk about this topic, everywhere I go, to get the word out,” said Levine, a Harvard grad and medical doctor. “I am positive and optimistic and hopeful that the wheel will turn after that and that this issue won’t be as politically and socially such a minefield.”

That endorsement invites a closer look at “gender affirming care,” which as NBC noted, “commonly includes cross-sex hormones, puberty blockers, and gender reassignment surgeries.”

Dr. Maddie Deutsch, Associate Professor of Clinical Family & Community Medicine at the University of California – San Francisco (UCSF), and Medical Director for UCSF Transgender Care, reviews the “choices, risks, and unknowns associated with feminizing hormone therapy.” Taking higher doses of hormones, “will not necessarily bring about faster changes, but it could endanger your health.” Those pondering the hormone therapy might wonder what form the endangerment could take.

“Your skin will become a bit drier and thinner,” Dr. Deutsch explains. “Your pores will become smaller and there will be less oil production. You may become more prone to bruising or cuts and in the first few weeks you’ll notice that the odors of your sweat and urine will change.”

In these conditions, “you can also expect your muscle mass and strength to decrease” and “your testicles will shrink to less than half their original size, and most experts agree that the amount of scrotal skin available for future genital surgery won’t be affected.”

According to Dr. Deutsch, “many of the effects of hormone therapy are reversible, if you stop taking them. The degree to which they can be reversed depends on how long you have been taking them. Some breast growth, and possibly reduced or absent fertility are not reversible.”

Puberty blockers, according to the Mayo Clinic, are hormone (GnRH) analogues that “can be used to delay the changes of puberty in transgender and gender-diverse youth who have started puberty.” Delaying puberty “might improve mental well-being, ease depression and anxiety, improve social interactions with others,” and so forth. On the other hand, puberty blockers alone “might not be enough to ease gender dysphoria.”

Possible side effects of GnRH analogue treatment include: “swelling at the site of shot, weight gain, hot flashes, headaches,” and “mood changes.” GnRH analogues might have long-term effects on “growth spurts, bone growth, bone density” and “fertility, depending on when the medicine is started.”

As the Mayo Clinic warns, “some of the changes triggered by gender-affirming hormone therapy cannot be reversed. Others may require surgery to reverse.” And “gender confirmation surgery” (GCS) is necessary to complete the reassignment from the original design.

For the male-to-female (MTF) patient, surgical procedures may include: mammoplasty, orchiectomy, penectomy, vaginoplasty, clitoroplasty, vulvoplasty, labiaplasty, urethroplasty, and prostatectomy. Facial reconstruction, voice surgery and liposuction may also be required.

For the female-to-male (FTM) patient, surgical procedures may include subcutaneous mastectomy, nipple grafts, chest reconstruction, salpingo-oophorectomy, metoidioplasty, phalloplasty, vaginectomy, vulvectomy, scrotoplasty, and implantation of erectile and/or testicular prostheses. Some of these surgical procedures have variations.

A total vaginectomy, for example, “involves complete removal of all the tissue of the vagina and is considered risky.” It does not remove the uterus or ovaries, which are removed by salpingo-ooporectomy and hysterectomy. A muscosal vaginectomy removes some of the lining of the vagina and then closes up the entrance. The inside of the vagina then collapses in on itself. The effects of vaginectomy “are permanent and cannot be reversed.”

A penectomy, “completely destroys the penis,” leaving no skin for a vaginoplasty. For new genitals, the patient needs labiaplasty, clitoroplasty, and vaginoplasty by other means. According to the Oregon Health and Science University, the risks to vaginoplasty include vaginal stenosis, narrowing of the vaginal canal, and “a second surgery is often required to fix it.” There is also a chance of injuring the rectum during surgery.

Fistula is a rare connection between body parts such as the vagina and rectum. “If you see fecal matter (poop) coming from the vagina,” OHSU explains, “you may have a fistula and should tell us right away.” The prospect of a fistula you may recall Dr. Ergon Spengler (Harold Ramis) warning fellow ghostbusters that “crossing the streams” is bad. A fistula requires “another major surgery,” probably on the high side in cost.

According to the Cleveland Clinic, the two reasons for having a penectomy are cancer and “gender affirmation.” In a total penectomy “the entire penis, including the root that goes into the pelvis, is removed.”   In this case, the urethra, the tube that allows urine to leave the body, is rerouted to a spot in the perineum, the area between the scrotum and anus. In a perineal urethrostromy, “you’ll need to sit when you urinate.”

According to the Cleveland Clinic a scrotoplasty for gender affirmation “typically includes creating a penis” from existing genital tissue or skin from another part of the body, as in a phalloplasty. To construct a scrotum, “the surgeon cuts and shapes the lower part of your labia majora into a scrotum-like sac.” After the scrotum heals, the patient may choose to get testicular prostheses, silicone gel or saltwater implants that “create the look and feel of testicles.”

According to GCS specialist Dr. Christopher Salgado, scrotoplasty and glansplasty require an operation of 8 to 12 hours and a two-week stay in hospital. “Some transgender men,” the doctor explains, “will have their neo-penis tattooed to give the area natural coloring and depth.”

Complications of scrotoplasty include: abnormal connection between your skin and urethra, breakthrough and exposure of the testicular implants, and rejection of tissue transplanted to create a penis. Remember, in penectomy and vaginectomy, the original equipment is destroyed and the procedures are irreversible. MTF or FTM, the patient is basically SOL.

It’s not exactly clear what “medically necessary, safe and effective” procedures Dr. Levine has endured, but the results are not particularly convincing. In uniform, the Assistant Secretary for Health bears some resemblance to Tugboat Annie in the 1933 film. Levine may also recall the transvestite Dr. Robert “Bobby” Elliot (Michael Caine), who carves up women in Dressed to Kill.

The Admiral’s side effects appear to include hardening of the attitude toward the First Amendment rights of the people. In current conditions, people can have their own views as long as they don’t differ from those of the Assistant Secretary for Health and Joe Biden. Under Biden, dissident parents become domestic terrorists and violent extremists, subject to FBI harassment should they dare to protest at a school board meeting.

Those who submit to “gender confirming” surgery seem to regard their alterations as an accomplishment. If anybody thought it was all about reality dysphoria it would be hard to blame them.

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About Lloyd Billingsley

Lloyd Billingsley is the author of Hollywood Party and other books including Bill of Writes and Barack ‘em Up: A Literary Investigation. His journalism has appeared in the Wall Street Journal, the Spectator (London) and many other publications. Billingsley serves as a policy fellow with the Independent Institute.

Photo: WASHINGTON, DC - FEBRUARY 25: Rachel Levine, nominee for Assistant Secretary in the Department of Health and Human Services testifies at her confirmation hearing before the Senate Health, Education, Labor, and Pensions Committee February 25, 2021 on Capitol Hill in Washington D.C. Levine previously served as Secretary of the Pennsylvania Department of Health. (Photo by Caroline Brehman-Pool/Getty Images)