Many have heard in the past few weeks that Vanderbilt University Medical Center (VUMC) is pausing pediatric sex reassignment surgeries for an indefinite period of time. But why? And what are the implications for the broader trend of juvenile gender transition surgeries?
The Story of VUMC
After disquieting videos came to light, including a 2018 video of VUMC assistant professor Dr. Shayne Taylor talking about the profitability of “top surgeries” and hormones for the hospital in Nashville, Tennessee Gov. Bill Lee and senior Sen. Marsha Blackburn (R-Tenn.) called for an investigation of the Pediatric Transgender Clinic at Monroe Carell Jr. Children’s Hospital, which is part of VUMC.
According to its web page, the clinic “offers evidence-based, personalized gender-affirming care for transgender and gender-diverse children and adolescents.”
Taylor is a physician with VUMC’s Program for LGBTQ Health and the Clinic for Transgender Health for patients aged 18 and older.
The VUMC pediatric clinic “raises serious moral, ethical, and legal concerns,” the governor said, after becoming aware of the videos. “We should not allow permanent, life-altering decisions that hurt children or policies that suppress religious liberties, all for the purpose of financial gain. We have to protect Tennessee children, and this warrants a thorough investigation.”
After the videos became known, Blackburn wrote on Twitter on Sept. 20: “There is nothing healthy about mutilating the bodies of minor children. We need an investigation into VUMC putting profits ahead of children immediately.”
Two weeks after the call for an investigation, VUMC suspended “gender-affirming” surgery for minors, it announced in a letter to Tennessee state Rep. Jason Zachary, which was then posted on Twitter.
According to Dr. C. Wright Pinson, VUMC’s chief health system officer, the hiatus was to review “new recommendations” going forward. The transgender clinic, established in 2018, has performed sex reassignment surgery on an average of five minor children a year, the letter states. The pause in pediatric surgery may last several months.
Growing and Lucrative Business
The worldwide gender surgery “market” is projected to hit $1.5 billion in four years. In the United States, the number of gender clinics is exploding with many clinicians favoring “swifter assessments and the provision of puberty blockers, hormones, and gender-affirming surgeries for young people at or near the moment they present with gender dysphoria,” reported Undark, a digital magazine affiliated with the Knight Science Journalism Fellowship Program at the Massachusetts Institute of Technology.
Yet, serious questions remain, Undark reported, such as: “What is the long-term impact of blocking puberty on a young person’s health? Can practitioners correctly determine which youngsters will still identify as trans when they are adults? Do the psychological assessments contribute to children’s suffering by delaying access to puberty blockers and hormones? Why has the number of teens coming forward to receive transgender medical care, particularly those assigned female at birth, risen so dramatically in recent years?”
Earlier this year, Sweden’s National Board of Health and Welfare stated that the risks of the commonly used puberty blockers, called gonadotropin-releasing hormone analogs, and hormonal treatment outweigh their possible benefits. Treatment should be limited to research settings and exceptional cases, the Swedish agency stated.
Puberty-blocking drugs can lead to bone-thinning, the Cleveland Clinic and Mayo Clinic report. Moreover, the drugs have little to no effect on gender dysphoria, quality of life, depression, anger, or anxiety, and neither do sex reassignment hormones, according to the United Kingdom’s National Institute for Health and Care Excellence.
Yet, puberty-blocking drugs are surprisingly lucrative, costing up to $39,000 per month without insurance, according to Undark. AbbVie’s puberty blocker Lupron brought in $752 million in revenue in 2020, and the puberty-blocking implant Supprelin LA has a list price of $37,300.
Does Gender Reassignment Work?
The woke pro-transgender agenda has cast a chill on research that questions the effectiveness and appropriateness of sex reassignment medicine and surgery, and especially patient outcomes.
Nonetheless, a definitive Swedish study published in the journal PLOS One in 2011 found that “persons with transsexualism, after sex reassignment, have considerably higher risks for mortality, suicidal behavior, and psychiatric morbidity than the general population.”
“Our findings suggest that sex reassignment, although alleviating gender dysphoria, may not suffice as treatment for transsexualism, and should inspire improved psychiatric and somatic care after sex reassignment for this patient group,” the study reads.
The researchers also found that “sex-reassigned persons had a higher risk of inpatient care for a psychiatric disorder other than gender identity disorder than controls matched on birth year and birth sex.”
“This held after adjustment for prior psychiatric morbidity, and was true regardless of whether sex reassignment occurred before or after 1989. In line with the increased mortality from suicide, sex-reassigned individuals were also at a higher risk for suicide attempts, though this was not statistically significant for the time period 1989–2003,” the researchers wrote.
While woke voices warn that gender-confused people will kill themselves if not given a medical gender switch, the opposite seems to be true, according to some research.
More recently, a research letter in the Journal of the American Medical Association (JAMA), found disappointing results from “gender-affirming” surgery (GAS).
“In a study of more than 4,000 patients, those with an established diagnosis of a mental health condition had a higher chance of experiencing postoperative complications within 90 days of GAS versus those without a mental health condition,” MedPage Today reported on the letter’s findings.
Patients who underwent mastectomy, breast augmentation, hysterectomy, orchiectomy (removal of the testicles), phalloplasty, or vaginoplasty were more likely to experience the postoperative complications of “acute kidney injury, surgical site infection, deep venous thrombosis, pulmonary embolism, wound disruption, urinary tract infection, pneumonia, blood transfusion, hematoma, urethral stricture, urethral stenosis, and rectovaginal fistula,” in the 90 days following surgery, MedPage Today reported.
The Epoch Times reported in May on complications of sex reassignment surgery in the article “When Gender Surgery Goes Wrong.”
The research letter is surprising, since JAMA has usually been pro-transgenderism, even invoking the colloquial—and political—term “transphobia” in an otherwise medical article it published in February.
More Surgical Complications
“Gender-affirming” surgery often includes voice alterations in which patients wish their voice to be higher or lower pitched and, for men, their Adam’s apple to be removed (chondrolaryngoplasty).
Yet, those surgical operations are also beset by complications, according to research presented this year at the annual meeting of the American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS) association.
“Over time, vocal care for transgender patients has evolved from behavioral therapy to hormone-replacement therapy, to voice therapy, and now, to laryngeal surgery,” Medscape reported. However, “few studies have reported on complications and suboptimal outcomes.”
It turns out that complications from Wendler glottoplasty (in which sutures on the vocal folds raise voice pitch) and chondrolaryngoplasty are often seen, Dr. Matthew Naunheim of Massachusetts Eye and Ear and Harvard Medical School in Boston said at the AAO-HNS meeting.
With glottoplasty, “granulation tissue issues” were seen as short-term complications, and glottic insufficiency was seen as a long-term complication, Naunheim said, and were “more than [they would] expect.”
“Glottic insufficiency is characterized by incomplete closure of the vocal folds with phonation, which causes an increased risk of aspiration,” according to an entry in the National Library of Medicine.
Long-term complications seen with chondrolaryngoplasty included skin tethering or dimpling, and infections or fistula, the AAO-HNS presenters said.
Sex reassignment surgery has become a surgical cash cow. Researchers have been perfecting chondrolaryngoplasty on cadavers, according to a study published in the journal OTO Open in 2020.
“We carried out our cadaveric feasibility study in an anatomy laboratory at an academic center,” the researchers wrote. “We used a lower oral vestibular incision, along with retractors and an endoscope to dissect and gain access to the laryngeal prominence of the thyroid cartilage. … We were able to remove the laryngeal prominence successfully in all of our cadaveric specimens with this transoral approach.”
Not Happily Ever After
Increasingly, the voices of young people who regret their sex reassignment surgeries are being heard. Sometimes called “detransitioners,” these young patients express regret at their irrevocably modified bodies and likely inability to have children. They cite the intense internet support they received for their “trans” decisions at a time when they needed validation as one reason for pursuing sex reassignment surgery.
Some detransitioners also say that they were pushed through the sex reassignment system without being fully vetted or fully understanding the severity of their moves. Some say their short-term emotional confusion was enabled into a new, and unwelcome, permanent identity.
As the Vanderbilt University Medical Center pauses its pediatric sex reassignment surgeries, some are welcoming the decision and hoping it will slow the medical trend of ushering children into new gender identities they might later regret.