The debate about transgender medicine is shifting. Legislators in 20 states have recently passed bills to restrict transgender medical interventions, such as puberty blockers, cross-sex hormones, and genital surgeries, for minors. And the tide of public opinion appears to be moving against “gender-affirming care,” a euphemism for child sex-change procedures not supported by the evidence and that often cause devastating consequences. Preventing such procedures for patients under age 18 has to be the baseline.

But opponents of gender medicine should not celebrate prematurely—the battle is far from won. And while restrictions on such procedures for minors are essential, more scrutiny should be focused on a lesser-known practice: “non-binary” surgeries for adults.

Curtis Crane is one of the doctors leading this movement. Crane is a University of Iowa and Dartmouth College-trained urologist and plastic surgeon who specializes in transgender medical interventions, including experimental non-binary surgeries. 

In 2015, Crane received a flurry of publicity as an innovator in vaginoplasty, which involves castrating and creating an artificial vagina for “male-to-female” patients, and phalloplasty, which involves creating and installing an artificial penis for “female-to-male” patients. He boasted of a one- to two-year waitlist and claimed to have one of the highest volumes of transgender surgeries in the United States.

Since then, business has boomed. Crane operates clinics in San Francisco, California, and Austin, Texas, employs a team of five doctors, and conducts procedures on more than 1,000 patients per year. As part of this caseload, his practice has veered into the disturbing new territory of non-binary surgery, which includes castration, eunuch, and nullification procedures, which Crane describes as the process of “removing all external genitalia to create a smooth transition from the abdomen to the groin.” Crane has also designed and performed hundreds of non-binary surgeries in which he fashions together both male and female genitalia for a single individual. That is, he creates an artificial penis for a woman, while retaining her vagina; or creates an artificial vagina for a man, while retaining his penis.

Crane recounted the story of performing his first non-binary genital surgery in a question-and-answer session for potential patients. “In the beginning of my practice, within the first year, I’d say, I had a trans man come to me, and he wanted a phalloplasty, but he wanted to keep his vagina,” Crane recalled. After a process of “soul searching,” he concluded that, if gender was not binary, his surgeries did not need to conform to a typical male-female pattern. “[The patient] wanted to keep his vagina because he got sexual gratification out of having a vagina. And I thought it’s kind of assault to make a patient remove an organ that they’re enjoying. Let’s keep it.”

How are these physically unnecessary surgeries justified? Through the politics of “equality” and “recognition.” Last year, in a keynote speech for the Equality Alliance, Crane laid out his philosophy of transgender medicine. “Our history has been riddled with inequalities,” he said, and the West, in particular, has propped up a false gender binary—that of man and woman—that denies the basic right to recognition of individuals self-identifying as transgender, non-binary, gender-nonconforming, genderqueer, and gender fluid.

Crane proposed two solutions. First, the social-utopian solution: to reeducate all of society to accept that biological sex is not binary—“XX is not always female and XY is not always male”—and “humanize this predicament,” with the end goal of “acceptance” of anti-normative sexual identity. Second, the technical-constructivist solution: to remove, alter, fabricate, and reorganize human genitalia so that transgender patients can “become the people they were always meant to be.”

The doctor’s surgical practice represents the strange metaphysics of transgender medicine, which would like simultaneously to sever the link between sex and biology, erase the primordial distinctions between man and woman, and transcend the limitations of nature through the application of medical technology—all in pursuit of therapeutic, left-liberal notions of authenticity, identity, equality, and acceptance.

There is, however, a dark side to this philosophy. If biology, human nature, and traditional ethics are seen as impediments, rather than as guides, then rational restraints no longer remain on what can be done; the only real limitation is the imagination. And the human mind, untethered from moral limits, can conjure up nightmares. The surgeon, armed with a scalpel and a genital-nullification robot, becomes the new arbiter of human nature.

Crane styles himself as a champion of science and equality, but he more closely resembles Dr. Frankenstein. A reckoning might be coming. In 2018, the feminist writers at 4thWaveNow discovered that a large number of transgender patients had sued Crane for medical malpractice. An anonymous “detransitioner” came forward with accusations that Crane had needlessly removed her breasts while she was a minor. All of the former patients described barbaric surgeries and gruesome complications. The cases were dismissed in court, potentially as the result of settlements.

To stop the radical experiments performed by surgeons such as Crane, society will need to impose limits. Medical associations, which have been captured by gender ideologues, do not seem capable of resisting the temptation of “trans-affirming medicine.” Outside pressure will be needed, including intervention by legislators, to ensure reform within the medical system and to prohibit medically perverse practices, such as the male-female hybrid genitalia procedure.

Human beings, especially those who suffer from serious emotional disturbances, should not be subjected to experiments of this kind. Crane appeals to “equality” to justify deeply inhuman medical practices; he appeals to “acceptance” to justify the rejection of human nature itself. Both appeals are based on a lie. Our society does not have to recognize as equal those ideologies that violate natural law and does not have to accept medical practices that fail to meet the discipline’s most basic test: “First, do no harm.”

Photo: PonyWang/iStock


City Journal is a publication of the Manhattan Institute for Policy Research (MI), a leading free-market think tank. Are you interested in supporting the magazine? As a 501(c)(3) nonprofit, donations in support of MI and City Journal are fully tax-deductible as provided by law (EIN #13-2912529).

Further Reading

Up Next