Six years too late
A gynecologist has misgivings.
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.
The hysterectomies went well. They were uncomplicated. Even the one patient who came back to see me for well woman care after detransitioning didn’t tell me she regretted her surgery. I hope that all those patients are still happy not to have their uteri. But in terms of the clinic overall, staffed by earnest, well-meaning clinicians as it was – were we doing the right thing?
In some cases, I don’t think we were.
…
I was on board and ready to support my community. Sure, there were uncomfortable questions – hadn’t we learned in medical school that most pediatric gender dysphoria resolves by adulthood? If so, did it make sense for young adolescents to transition to the opposite sex? Was it really plausible that transgender female athletes didn’t have a biological advantage over cis girls and women? 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.
What experts though? Trans ideology isn’t based on a whole lot of expertise. It’s mostly based on threats and abuse.
For a few years, I essentially became the go-to gynecologist in my community for gender-affirming hysterectomy referrals. I enjoyed taking care of my transmasculine patients. Some of them drove hundreds of miles from their homes in rural Iowa to receive their care in our LGBT clinic. I felt good about providing such a much-needed service. As I would joke to my assistant, a gender affirming hysterectomy referral was “my easiest consult of the day.” They came in knowing what they wanted: a hysterectomy. Unless they had a major contraindication to surgery, like uncontrolled diabetes, it was an easy decision to book it. Unlike hysterectomies for abnormal bleeding or pelvic pain, there was no need to document prior attempts at treatment, failures, and impact on the patient’s life for the insurance companies to authorize these hysterectomies. “Gender dysphoria” always got approved (with the requisite two letters, one from a mental health professional and one from a PCP).
That comes as a shock to me, I have to say. The medical kind of hysterectomy had to withstand a lot of questions, while the sad mood kind was waved right on through.
As the years went by, I couldn’t help but notice some troubling trends. The transmasculine patients who came to me had more and more poorly controlled mental health comorbidities. I also started seeing a fair percentage of them who were really quite feminine – not much different in their gender presentation than my cis patients.
I started to be a little more uneasy that hysterectomy was the right thing for this new group of transmasculine patients, but if they didn’t have any contraindications per se, I couldn’t really say no. After all, according to ACOG Committee Opinion #823, Health Care for Transgender and Gender Diverse Individuals, “Hysterectomy with or without bilateral salpingo-oophorectomy is medically necessary for patients with gender dysphoria who desire this procedure.”
Medically necessary, even though “gender dysphoria” is not medical. I cannot make sense of that.
As a medical system, for better or worse, we make our traditional gynecologic patients with miserable periods jump through quite a few hoops before they are approved for hysterectomy. Generally, they have to have a full workup for any reversible medical reason for their miserable periods and try some sort of medical management of their heavy periods, because it is such a grave decision to take a patient for a major surgery like hysterectomy with all the accompanying risk (death, bowel injury requiring lifelong colostomy, urologic injury requiring lifelong urostomy, chronic debilitating surgical pain, vaginal cuff dehiscence with evisceration, massive blood loss, stroke, etc.)
By contrast, according to medical guidelines currently in play, a uterus-having person need only walk into a gynecologist’s office, declare themselves to have a nonbinary or male gender identity, and endorse dysphoria from the presence of their uterus to qualify for hysterectomy.
I can make even less sense of that. It’s insane.
Still wondering how best to take care of my patients, I went to a private forum for Ob/Gyns to ask about how others addressed nonbinary individuals who requested gender affirming hysterectomy. I was told my question was “transphobic.”
What is the scientific medical term for transphobia?
To sum up: medicine is shockingly captive.
It’s absolutely appalling. The whole thing is going to be so unbelievable to future generations. The stark difference between the treatment of ordinary women and those who express allegiance to the new religion is mind-blowing.
Almost thirty years ago, in my thirties, I had a total hysterectomy. I had endometriosis, PCOS, adhesions everywhere damaging my GI tract and sticking my internal organs together, a uterus which was misaligned, frighteningly heavy and painful periods, a history of miscarriage and increasingly dangerous pregnancies – but it was the ultrasound discovery of precancerous tumours on both ovaries which finally prompted the doctors to relent and remove everything. From my teens onwards, far too many doctors had told me that my periods would ‘settle down’ after pregnancy (they got worse) or perhaps they were waiting for menopause to ‘fix’ everything, as happens to other women. Mustn’t reduce any woman’s breeding potential!
The enthusiasm for effectively spaying girls and young women who are disproportionately lesbian and/or autistic smacks of eugenics.
Of course, this makes me wonder how many young women have learned about this glitch in the system, and thus take the relatively easy route of getting declared ‘gender dysphoric’ in order to not have to argue with a doctor about getting permanent relief from painful periods.
I fail to see why anyone born female and wishing to be accepted socially as male, would seek a total or partial hysterectomy as a necessary step to be taken towards that end. That may make her less reproductive, but it is not going to make her any more male than she already is.
Likewise, a male wishing to transition to female as best he can might find a surgeon willing to castrate him, and add a penectomy, prongectomy, dongerectomy or whatever it is clinically called. but that will not give him the female parts that really matter.
Perhaps it can be considered as all God’s fault, like his decision to plonk that damned talking snake into the Garden of Eden. (I suppose in his omnipotence and omniscience God might try to fudge his way out of it by saying that it seemed like a good idea at the time.)
Forced teaming strikes again. There is no such “community” she was helping. There’s only one letter on that list that would demand (not need) a hysterectomy for “gender confirmation.”
In some cases? Think some more.
How about the contraindication that humans can’t change sex?
“On board” what, exactly? Perhaps a bandwagon? You weren’t there to “support your community”, you were there to treat individual patients. These are not the same thing; their needs and interests might conflict with each other (That is if any given “community” can have needs and interests, and if that “community” actually exists; see “forced teaming” above. Assuming they do have “needs” and “interests” can tend to blot out the individuals making up that supposed “community”, along with their particular interests.)
Obviously not uncomfortable enough. You were able to brush them aside, despite your cognitive dissonance. Look at almost any disaster of human technology, like the destruction of the space shuttle Challenger, or the Chernobyl meltdown, and there will be someone (sometimes several someones), brushing away “uncomfortable questions”, accepting convenient, expedient answers, rather than correct ones. You should have paid attention to that discomfort. Because the questions were not hard questions. Observe.
What does that tell you about this condition? What does this say about “transness” and “gender identity”? Clearly you weretaught about desistance (yes, there is a term for this phenomenon), but you didn’t seem to have learned it.
No. Next question?
Let me rephrase this question so it makes sense. Was it really plausible that male athletes didn’t have a biological advantage over girls and women?
No. It’s not plausible. At all.
See how clear language makes things easier to judge? Delusional language leads to poor answers, because it hides the facts of the matter, understanding of which would permit a better answer than the one to which the loaded language is trying to steer you. Because humans can’t change sex, trans identified males are never female. But when you’re trying to fool yourself, you need all the rationalization you can get. But forgetting that “transgender female athletes” are men? That’s like claiming to not see an elephant “hidden” under a hanky.
DINGDINGDING! Those are alarm bells ringing. How and why were these answers counterintuitive? What did answering “Yes” to those troubling questions say about those answering in the affirmative?
And here’s where you launch Challenger, and continue with the risky testing of the Chernobyl reactor. This is where you surrender your responsibility and judgement to others, rather than facing your discomfort and doubt head on. Your desire to be a “good ally” and remain “the go-to gynecologist in my community for gender-affirming hysterectomy referrals” over-rode your caution and sense. Maybe this was your tacit admission that the decisions taken by others were not medical ones but ideological ones. There’s a big difference between removing a woman’s unhealthy uterus as part of the treatment of a disease, and removing a perfectly healthy one because the uterus itself is viewed a disease needing to be removed.
Had you looked, you would have discovered the dearth of follow up studies, the lack of investigation into the efficacy of the “procedure”. Whether you would have realized that this failure to monitor was a deliberate measure is another question, but the lack of data would have been something else to question. Instead, you bowed to the wisdom of experts without expertise, who conveniently removed from you the burden of all of those uncomfortable questions. Qualms dispelled, a gender affirming hysterectomy referral was your “easiest consult of the day.” What happens when it turns out there is no Jesus taking on your sins?
You mean the young women who’d bought into the lie that they could become men, thereby escaping an overtly sexualized, patriarchal “femininity”?
“Gender presentation” is bullshit. “Cis” is bullshit. You’re cutting flesh to solve psychological problems that can’t be solved by cutting flesh.
But everyone is essentially “nonbinary”. Either everyone is, or nobody is, making the term meaningless. It does not mean that someone is neither male or female, and scooping out their innards won’t change that. The best anyone can hope for is to dress androgynously and keep people guessing, rather than mutilate and sterilize yourself and declare that you have successfully “transcended” or “smashed” the binary. The only thing you have smashed is your body.
Don’t worry yourself too much over your query; any questioning at all would have bene considered “transphobic.” Remember, you’re supposed to shut up and follow the “experts.”
Delusional politics and ideology all the way down.