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The Moral Atrocity of “Top Surgery”

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The Moral Atrocity of “Top Surgery”

Do surgeons obtain truly informed consents for life-altering procedures on minors? February 25, 2022
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Beverly* from Oregon emails me: “Urgent need help with ROGD daughter please answer ASAP.” Her daughter announced out of the blue that she’s a boy (this is called Rapid Onset Gender Dysphoria, or ROGD). I’m a child and adolescent psychiatrist, and I receive messages like this almost daily. That’s because unlike most of my colleagues, I won’t automatically affirm a child’s new identity, or refer her to a clinic where she’ll be put on experimental hormone therapy.

Beverly has reason to panic. She learned not only that her daughter, a 15-year-old, has declared herself to be a boy, but that her daughter’s best friend and main influence, Mia, just had her breasts removed as part of her own male identification process. Beverly is beside herself. “Do doctors really do that to a 16-year-old?” she asks incredulously. “They sure do,” I reply.

Increasingly, confused girls with mental-health issues are lining up to have their breasts removed, erroneously believing my colleagues who tell them the operation will alleviate their emotional pain and allow them to emerge as their authentic selves. Girls as young as 13 are having “top surgery,” a euphemism for a bilateral mastectomy—the removal of both breasts—in order to create, as gender surgeons put it, a “masculinized” chest. “Bilateral mastectomy” sounds jarring and clinical; it’s a treatment for cancer, after all—one that women agonize over. 

Mind you, these are the same people who insist that five-year-olds use anatomically accurate terms, not childish nicknames, for their genitals. They soberly instruct us to teach the words “scrotum” and “vulva” to kindergarteners. But the vague, trivial-sounding terms “top” and “bottom” surgeries—that language is fine. As if the consequences of those major operations—infertility, sexual dysfunction, infection, and chronic pelvic pain, to name a few—aren’t permanent and debilitating.

As an intern in pediatrics, when one of my patients needed a medical procedure, I was required to obtain informed consent from the parents or guardian of the minor. I was obligated to explain, accurately and comprehensively, the risks—both immediate and long-term—of the procedure. I wonder how accurate and comprehensive are the consents obtained by surgeons who perform double mastectomies on minors. Mia’s mother was almost certainly told that mastectomies for minors with gender dysphoria are evidence-based treatment, supported by well-documented standards of care. But did the surgeon mention that this deceptive reassurance is being challenged in court, with the help of an amicus brief by the Society for Evidence-Based Gender Medicine?  

SEGM’s arguments against mastectomies for girls like Mia are compelling. They point out that long-term outcomes are highly uncertain and that many girls have untreated mental-health issues. They explain why the evidence supporting mastectomies in minors is low-quality and unreliable. According to SEGM, mastectomies on minors are an “experimental procedure on vulnerable youth” whose brains and identities are still developing. Leading gender clinics and psychiatric associations worldwide are rejecting these procedures. They’re saying that girls who want their breasts removed need in-depth psychotherapy, not a surgeon’s scalpel.

I know many girls like Mia, and I’m well aware that she can’t tolerate talking about her periods, let alone pregnancy, because she’s fleeing womanhood. But her identity is still evolving; if she’s like other gender-confused girls, she wore lace push-up bras less than a year ago. In the next decade, she will go through many more changes—and one of them, I hope, will be re-acceptance of her female biology. She may follow the same path as Daisy Chadra, a young woman who lived as a man for five years and had her breasts “amputated” (her word). What she lost is irreplaceable, but Daisy’s back at peace with her female biology. There appear to be thousands like her, who regret the medical and surgical interventions they believed would solve their emotional problems. Transgender activists claim regret is rare, but this de-transitioners’ site alone has 26,000 members. If Mia someday joins their growing ranks, she may experience her flat, scarred chest as a loss.

And what if she decides to have a child? The surgeon was obligated to discuss with the mother the consequences of Mia’s breast removal—not only to her daughter but also to her grandchildren. Because in this case, organ removal may have negative consequences for two generations. 

Nursing is a cornerstone of mother-infant bonding, and when she signed on the dotted line, Mia’s mother agreed to deprive her daughter and grandchildren of the opportunity to nurse. At the moment, it may have seemed irrelevant, but for consent to be informed, the surgeon was obligated to consider long-term consequences. No bottle, pacifier, plush toy, bouncer, swing, rocker, sound machine, mobile, light show, or vibrating mat will soothe an unhappy baby like nursing. Breast milk is considered the gold standard by pediatricians and the World Health Organization. It provides lasting health benefits for both mother and child.

Mia cannot fathom the magic of mother-child bonding, or the many other wonders of her female biology. If she’s like most kids, her sex education, instead of inspiring a sense of awe for her female physiology, taught that the differences between herself and a guy are due to socialization, not biology—and that it’s normal for her to reject reality and identify as a boy. But her surgeon, and her mother, should have known better. Is it really necessary to point out that adults have more wisdom than children, and that they must resist their impulses to give in to a child’s demands just because she is distressed and feels certain?

The surgeons and “gender specialists” who support or perform these procedures on children must be held accountable. Take, for example, Johanna Olson–Kennedy from Children’s Hospital L.A., a pediatrician who believes that there should be no minimum age for a double mastectomy. What if a girl regrets it? Olson–Kennedy says: “If you want breasts at a later point in your life, you can go and get them.” 

Children are being victimized on the altar of an ideology that seeks to obliterate a fundamental truth of civilization—the reality of male and female.  

Finally, the investigations are starting. Let the truth come out: the radical social agendas that animate sexuality education; the capture of the medical, mental health, social work, and educational professions; the undermining and silencing of parents. Let’s hear expert witnesses explain the denial of biological truths, the false and dangerous promises made to vulnerable kids, and the informed consents for irreversible medical interventions that were hardly informed.

Give a public platform to the victims—those who’ve been sterilized and scarred, and their families, who’ve been traumatized and betrayed. When enough people learn the truth and stand up, when the dogma is successfully challenged, and when schools, doctors, and therapists promoting the dogma are exposed, we can start to write an end to this medical calamity.

* This and other names have been changed for this article.

Top image: Jon Wightman/iStock

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