Following the French Revolution, the British philosopher Edmund Burke signaled a note of caution, warning that the desire for progress, uninhibited by convention, can lead to disaster. Revolutions in the name of lofty ideals—liberty, equality, science—can yield their opposites. A revolution in our time merits similar consideration: the transformation of human sexuality and, in particular, the rise of so-called transgender medicine.
The gender surgery program at Oregon Health & Science University, a public teaching hospital in downtown Portland, provides a productive tableau for analysis. The program is led by Blair Peters, a self-described “queer surgeon” who sports neon-pink hair, uses “he/they” pronouns, and specializes in vaginoplasty (the creation of an artificial vagina), phalloplasty (the creation of an artificial penis), and “non-binary” surgeries, which nullify the genitals altogether. Peters and his colleagues have pioneered the use of a vaginoplasty robot, which helps efficiently castrate male patients and turn their flesh into a “neo-vagina.”
Business is booming. According to Peters, OHSU’s gender surgery clinic has “the highest volume on the West Coast,” and his robot-assisted vaginoplasty program can accommodate two patients per day. His colleague Jens Berli, who specializes in phalloplasty, boasts a 12- to-18-month waiting list for a consultation and an additional three- to six-month waiting list for a surgical appointment.
This openness marks a revolution in manners and morals. In the past, transgender theorists acknowledged that their surgical transformations were disturbing and anti-normative. “I find a deep affinity between myself as a transsexual woman and the monster in Mary Shelley’s Frankenstein,” wrote the male-to-female transgender theorist Susan Stryker in 1994. “I will say this as bluntly as I know how: I am a transsexual, and therefore I am a monster.”
Such views no longer prevail. Today’s transgender medical providers conceal the barbarity of their practices in euphemisms. They are not postmodern Dr. Frankensteins but providers of “life-saving, gender-affirming care.” The model patient is no longer the middle-aged autogynephile but the troubled teenager, sold a new identity, mediated through technology, that promises to resolve deep-seated sexual anxieties—and advance the political cause of transgender activists.
The dismal metaphysics that lies beneath OHSU’s castration machines is academic queer theory, which holds that human beings are mere vehicles of “performativity” and that their nature can be molded and reshaped at will. In other words, the queer theorists argue, there is no “human nature” that cannot be transcended or obliterated through the application of culture and science.
OHSU’s castration machines must be seen in this light. The university’s doctors and surgeons believe that they can harness the advances of modern medical science to sublate the basic categories of human sexuality and replace them with a variety of synthetic forms: the artificial phallus; the artificial vagina; the dual phallus-vagina; nullification of both.
The technique for the robot-assisted vaginoplasty is gruesome. According to a handbook published by OHSU, surgeons first cut off the head of the penis and remove the testicles. Then they turn the penile-scrotal skin inside out and, together with abdomen cavity tissue, fashion it into a crude, artificial vagina. “The robotic arms are put through small incisions around your belly button and the side of your belly,” the handbook reads. “They are used to create the space for your vaginal canal between your bladder and your rectum.” The illustrated surgical literature is a catalog of horrors—peruse at your own risk.
This procedure is plagued with complications. OHSU warns of wound separation, tissue necrosis, graft failure, urine spraying, hematoma, blood clots, vaginal stenosis, rectal injury, fistula, and fecal accidents. Patients must stay in the hospital for a minimum of five days following the procedure, receiving treatment for surgical wounds and having fluid drained through plastic tubes. Once they are home, patients must continue on transgender hormone treatments and manually dilate their surgically created “neo-vagina” in perpetuity; otherwise, the tissue will heal, and the cavity will close.
One question provokes particular dread: Are the surgeons at OHSU using these machines on children? The answer appears to be yes. In an interview, Peters acknowledged that, in recent years, he has seen “a lot of adolescents presenting for surgical intervention” and that he has performed genital surgeries, including the robot-assisted vaginoplasty, on “a handful of puberty-suppressed adolescents.” Peters further stated that OHSU is “just putting [its] first series together” related to adolescent vaginoplasty and that “no one has published on it yet.” (When reached for comment, OHSU declined to respond.)
All this grisly detail is obscured through manipulative language. To the general public, Peters and his colleagues present their case in therapeutic terms—gender, affirmation, trauma, care, health, joy—and wrap themselves in the movement’s light blue, pink, and white flag. By comparison, the old transgender theorists were more honest. They saw themselves in Frankenstein and, in their struggle to overcome natural limits, brushed against them.
We can return to Burke for a final word. Besides his analysis of revolution, Burke’s other major contribution to the history of ideas was his theory of the sublime. The sublime, he argued, did not stimulate love, but terror. The vast darkness, the brewing storm, the dangerous tyrant—all elicited a complex reaction of astonishment and fear, especially that of human finitude.
Transgender surgery provokes a similar sentiment: awe of the mechanical mastery, horror at the raw human barbarism. But when the haze of emotions passes, the true nature of these interventions is revealed—they are a work of pure hubris, part of a scientific revolution that has sought to transcend all moral bounds. The revolution’s works, like Dr. Frankenstein’s, will inevitably leave behind a profound human tragedy.