Entrando no horrível mundo das cirurgias trans.

WPATH, or the World Professional Association for Transgender Health, is respected as the peak body for transgender medicine. Its “standards of care” (SOC) were once regarded as a benchmark for ethical and effective treatment for minors and adults. The eighth edition (SOC8) , which was released in 2022, has been translated into ten languages.

Its prestige, however, has been tarnished by the leak of hundreds of posts from an internal messaging forum. These are evidence of doctors basing their surgery, even on young people, on trial and error, not on medical research. The internet went wild over the leak. The Times of London called WPATH quack medicine, and Diplomate of the American Board of Psychiatry and Neurology Lauren Schwartz, MD stated: “WPATH has evolved into one of the most egregious disfigurements of medical practice our profession has ever encountered.”

However, the real scandal emerges not just in leaks of confidential discussions but in what is publicly known about WPATH’s authorized procedures. The word “kinky” comes to mind over and over again. I wonder if President Joe Biden had these in mind in his message to the trans community on Easter Sunday: “You are loved.  You are heard.  You are understood.  You belong.  You are America, and my entire Administration and I have your back.”

The President of the United States has endorsed what is effectively a nationwide program of sexual lobotomies. This is completely nuts.

Here are some of the fetish-appeasing surgeries that WPATH is pushing.

Non-binary

Chapter 8 in SOC8 is devoted to treatment of non-binary people, who desire to appear neither male nor female. WPATH surgeons are ready to comply with their demands. One problem is that there is no agreed definition of what “non-binary” means – and therefore of what treatment may be needed. In fact SOC8 acknowledges that “At times, nonbinary people find themselves educating the provider from whom they are seeking services despite the inappropriateness of providers relying primarily on their patients for education.”

Is this medicine or is it making it up as you go along?

Prior to the latest WPATH guidance, “bottom surgeries” were limited to binary surgical options such as vaginoplasty (creating an open wound to be used as a vaginal canal) or phalloplasty (constructing a non-functional penis). However, WPATH shifted to accommodate the emerging trend of individuals who prefer a “queer” identity that does not conform to either male or female biological sex classifications. These surgeries cannot remotely be construed as medically necessary. Gender-queer “identities” can include eunuchs, gendervoids, demi boys, pangender etc, etc. There are customized surgeries for them all.

Eunuchs

Chapter 9 in SOC8 is devoted to eunuchs. Eunuchs? You might have thought that the last eunuch died when the last Turkish sultan closed his harem. But no, some fetishists want to be castrated. WPATH doesn’t regard this as a psychological problem.

SOC8 welcomes eunuchs under its “gender diverse umbrella”. This kind of surgery is deemed legitimate because otherwise clients will engage in sado-masochistic “actions that may cause them great harm,” ie, self-castration. There are apparently two types of eunuch surgery: one removes the testicles (bilateral orchiectomy) and the other eliminates the penis (penectomy). 

Speculating on the inclusion of the infamous eunuch chapter, Canadian psychologist Jordan Peterson, in conversation with journalist Michael Schellenberger, who released the files, suggests sadism very likely provided the impetus.

Nullifications

An even more radical variety of non-binary surgery is nullification, which results in an absence of external primary sexual organs.” This “Barbi smoothie” surgery entails “amputating genitals for a smooth, sexless appearance.”  The idea is to achieve a “flat front” or genital-free torso preserving only urethral and anal openings. 

After a double mastectomy, females identifying as nonbinary typically request the skin nipple grafts be destroyed, modified, or moved out of normal alignment. Additionally, they may request some portion of breast mound tissue be retained to allow for day-to-day “fluid” shifts in gender moods. Nullification surgery for a female sacrifices her vagina together with the clitoris and labia.

Now for something completely different

The idea of a “sex change” is essentially binary and therefore old-fashioned. There are only two sexes, so there are only two possible sex changes – male to female and female to male. A gender fluid world opens up a whole spectrum of possibilities. Let me quote this paragraph from SOC8:

“Additional surgical requests for nonbinary people [assigned male at birth] include penile-preserving vaginoplasty, vaginoplasty with preservation of the testicle(s), and procedures resulting in an absence of external primary sexual characteristics (i.e., penectomy, scrotectomy, orchiectomy, etc.).”

WPATH Surgeon Dr. Thomas Satterwhite brags in the leaked files of his willingness to undertake these kinky surgeries:

“I’ve performed mastectomies without nipples, or have created chests with varying degrees of remaining breast tissue, or created incision patterns specific to my patient’s wishes. For bottom surgery, I’ve performed minimal-depth vaginoplasties (vulvoplasties), phallus-preserving vaginoplasties, and nullification procedures. I’m quite comfortable tailoring my operations to serve the needs of each patient.” 

In other words, you can have bespoke genitalia. A particularly repugnant example is bigenital surgery (penile-preserving vaginoplasty). Yes, this is a Thing. Some folks want both male and female sex organs.

In fact, a 33-year-old Ontario man is currently in litigation to obtain taxpayer-covered bigenital surgery with Dr Curtis Crane, a specialist transgender surgeon in Austin, Texas. The litigant has refused the binary option, which would remove his penis to construct a vagina; he claims that this would be akin to gay conversion therapy.

Dr Crane, a WPATH member, explains his ethics in a promotional video on his website. “I can’t think of a time that a patient has come up with a surgical request that I haven’t been able to fulfill,” he says. “I had a trans man come to me and he wanted a phalloplasty but he wanted to keep his vagina and I said, well you know no problem. I’ve never been asked to do this and I’ve never there’s certainly not anything published on it and I’ve never seen it but I’m happy to think about this.”

So he did some “soul-searching”. This was his reasoning: “being a trans man or trans woman or non-binary has nothing to do with your anatomy, has nothing to do with what’s between your legs.” Furthermore, he reasoned, “if gender exists on a continuum why then would my surgical treatments be binary? It doesn’t make any sense to recognize that gender exists on a continuum but I’m only going to offer all male options or all female options.”

Unsurprisingly, Crane has been the subject of multiple lawsuits. One of his former patients, Scott Newgent, warns that these innovative genital surgeries can result in a lifetime of complications not easily resolved even when “repair” surgeons are willing to tackle the botched results from the original surgeon’s mistakes. Newgent strives to make the public aware that surgeons like Crane are conducting “sheer experimentalism.” 

Believe it or not, this is only the beginning. Non-binary psychotherapist Laura A. Jacobs served on the committee drafting SOC8. She complains that all modifications are modelled on “cis bodies”. Why not be more creative, she asks. “Do we have to stick to penis and vagina norms? Can we have genitalia that looks like flowers or abstract sculpture? Can we have multiple? Can they be interchangeable?”

Child and adolescent psychotherapist Dr. Elliot Kaminetzky poses the obvious question: “At what point do we stop pretending this is healthcare?” President Biden, are you listening?

The good news: WPATH is on the way out

In the 1930s, 40s and 50s, surgeons gave thousands of people a kind of brain surgery called a lobotomy. The originator of the procedure received the Nobel Prize in Medicine in 1949. It was billed as a wonder cure for mental illness – and even for homosexuality. Too late, doctors decided that lobotomies were almost completely bogus. Nowadays it is a byword for medical malpractice.

“The horrifying story of lobotomy should have served as a cautionary tale for the medical world, illustrating the dire consequences that can occur when doctors swiftly embrace novel, innovative procedures without first subjecting them to thorough scientific scrutiny to establish their value, safety, and effectiveness,” says Mia Hughes, the author of the WPATH files report.

Fortunately, doctors seem to be less enthusiastic about transgender surgeries in recent months. Over the last year, membership of WPATH appears to have fallen by 60 percent, perhaps as a result of scandals and the repudiation of its methods by British and European medical authorities. Something is in the air.

WPATH is beginning to look increasingly like the defunct American Pain Society (APS). This organization established a subjective rating scale used to prescribe pain medications. It quickly took hold throughout the healthcare system – and it helped fuel the opioid epidemic. By 2019 the APS had closed, facing allegations that it colluded with opioid producers.

WPATH may meet a similar fate. It can’t come too soon. Dr David Bell, a psychoanalyst and former staff governor of the main gender  clinic in the UK, the Tavistock and Portman National Health Service foundation trust, declared: “I do not know how any responsible medical authority can do anything after the release of these files but break off all ties with WPATH, and indeed condemn its continued existence.”