July 25, 2023

There is much talk about gender-affirming surgery (“GAS”). A lot of it surrounds the initiatives taken by some hospitals and medical centers to make these surgeries available to teenagers and, reportedly, younger children. What we seldom talk about is what exactly is going on with these surgeries. It’s worth working our way down through the products being sold to the reality behind the sales pitches.

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The American Society of Plastic Surgeons has a list of “Gender Affirmation Surgeries,” which they explain have as their goal “to give transgender individuals the physical appearance and functional abilities of the gender they know themselves to be.” The surgeries that a “multispecialty team that typically includes board-certified plastic surgeons” perform are intended to make men look more like women, women look more like men, and both to look more like neither. To this end, they re-sculpt facial bones, give men boob jobs, castrate men and create fake “vaginas,” give women mastectomies, and cut skin off of women’s bodies to create fake penises. All of it, of course, is dressed up in euphemisms:

The goal of transmasculine top surgery, or masculinizing chest surgery, is to remove the breast tissue from both breasts and create a masculine or nonbinary appearance to the chest.

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The goal of transmasculine bottom surgery, or masculinizing genital surgery, is to reconstruct the female genitalia into male genitalia.

Plastic surgery has developed over time to have two aspects: Reconstructive surgery for body parts damaged by injury or disease and cosmetic surgery to augment people’s looks according to their preferences.

Image: Gender affirming care? (A woman’s arm after surgeons give her a fake “penis.”) Twitter screen grab.

Under those definitions, it’s apparent that so-called “gender affirming surgery” is cosmetic surgery (with an occasional bit of the internal if organs are also taken (e.g., hysterectomy, ovariectomy)). It is voluntary, elective, and performed on normal parts of the body. Cosmetic surgery’s only purpose is to improve appearance or remove signs of aging. A collateral benefit may be that the person feels more comfortable in his or her own skin, or what’s left of it, because the person now looks as he or she wishes to appear.

More specifically, what is the point of gender-affirming surgery, i.e., what does it affirm exactly?

Affirm is etymologically from “Middle English affermen, affirmen, “to decide upon” (c. 1300); “to state positively” (late 14c.)…”

Decide “late 14c., “to settle a dispute, determine a controversy,” from Old French decider, from Latin decidere “to decide, determine,”