THE EFFECTS OF SEX REASSIGNMENT SURGERY ON MALES
Although the psychological pain that boys feel from gender dysphoria is undoubtedly real, studies demonstrate no psychological relief from cross-sex hormone treatment or surgery.
Deceptions of Vulvoplasty
Dr. Joseph Chrysostom, a surgeon in Wales, UK, has written to the NHS about how vulvoplasty surgeries (faux vaginas) fail to provide patients with anatomically and functionally authentic vulvas. An excerpt of his letter, along with a table specifying the differences between a biological vulva and a synthetic one, is posted below.
Long-Term Effects of Orchiectomy (Orchidectomy)
"The practice of performing orchidectomy . . . exposes patients to lifelong metabolic and cardiovascular risks. These risks, including strokes, heart attacks, and heart failure, are likely to manifest within a few decades, resulting in preventable harm and substantial healthcare burdens."
- from a letter Dr. Joseph Chrysostom, a surgeon in Wales, UK, wrote to the Healthcare Inspectorate Wales (HIW) regarding the harmful effects of orchidectomy. Read the letter in full below.
Elevated Mortality Rates
Surgery increases mortality rates even more than cross-sex hormones do.
Obtaining their mortality information from the Swedish national registers, a long-term study (from 1973–2003) revealed that transgender-identified males (TIMs) who underwent sex reassignment surgery (SRS) experienced higher risks for mortality, suicidal behavior, and psychiatric morbidity than the general population (Dhejne et al., 2011). These mortality data were then compared to population controls matched for age and gender. Comparing the mortality risk for this cohort after SRS to those who underwent surgeries for other reasons, the analysis revealed a significant mortality risk increase: ten years after SRS, the TIM has the same risk of dying as a non-SRS person after 30 years on cross-sex hormone treatment (CSHT).
Dhejne, C., Lichtenstein, P., Boman, M., V. Johansson, A. L., Långström, N., & Landén, M. (2011). Long-term follow-up of transsexual persons undergoing sex reassignment surgery: Cohort study in Sweden. PLOS ONE, 6(2), e16885. https://doi.org/10.1371/journal.pone.0016885
Postoperative Complications
Sex reassignment surgery has a high frequency of serious postoperative complications.
In 2004, the Guardian (US edition) asked Birmingham University's Aggressive Research Intelligence Facility (ARIF) to assess the findings of more than 100 follow-up studies of postoperative transgender-identified males (TIMs). It concluded that none of the studies provided conclusive evidence that gender reassignment is beneficial for patients. It found that most research was poorly designed, and the findings of the few studies that have tracked significant numbers of patients over several years were flawed because the researchers lost track of at least half of the participants, and the complications were not investigated. The experiences of the actual patients make for harrowing reading.
The past twenty years have not improved the situation. In 2023, researchers published data from Canada’s first vaginoplasty postoperative care clinic (Potter et al., 2023), indicating that nearly a quarter of the TIMs who were operated on accessed care for surgical complications or pain within the first three years after surgery, and more than half of them sought care within the first year. More than three-fifths (61.3%) were seen for more than one visit and presented with more than two symptoms or concerns.
Common patient-reported symptoms during clinical visits included pain (53.8%), dilation concerns (the body identifies the neovagina as a gaping wound, and so it has to be dilated for life, including multiple times daily during the first year; see here for the eight-page aftercare regimen) (46.3%), and surgical site/vaginal bleeding (42.5%). Sexual function concerns were also common (33.8%), with anorgasmia (inability to orgasm) (11.3%) and dyspareunia (painful intercourse) (11.3%) being the most frequent complications. The most common adverse outcomes identified by healthcare providers included hypergranulation (an excess of granulation tissue that rises above the surface of the wound bed) (38.8%), urinary dysfunction (18.8%), and wound healing issues (12.5%). An older review of the literature on complications of the neovagina in postoperative TIMs shows an overall complication rate of 32.5% (i.e., about one in three cases) and a reoperation rate of 21.7% (more than one in five cases) for “non-aesthetic reasons” (Dreher et al., 2017).
Another paper discusses various neovaginal complications in TIMs (Mundluru & Larson, 2018): fifteen percent suffered from a neo-urethra stricture (an abnormal narrowing of the urethra), leading to urinary tract infections and pain. Ten percent of the cases developed scar tissues in the neovagina, causing it to become narrower and shorter. One in 10 patients experienced stenosis of the neovagina, which negatively impacts sexual functioning. Another significant concern was “intravaginal hairballs.” Other complications include vaginal prolapse (when the top of the vagina weakens and collapses into the vaginal canal) and recto-vaginal fistulas (a tunnel between the vagina and rectum, leading to rectal discharge through the vagina, including during sexual intercourse).
Potter, E., Sivagurunathan, M., Armstrong, K., Barker, L. C., Mont, J. D., Lorello, G. R., Millman, A., Urbach, D. R., & Krakowsky, Y. (2023). Patient reported symptoms and adverse outcomes seen in Canada's first vaginoplasty postoperative care clinic. Neurourology and Urodynamics, 42(2), 523-529. https://doi.org/10.1002/nau.25132
Dreher, P. C., Edwards, D., Hager, S., Dennis, M., Belkoff, A., Mora, J., Tarry, S., & Rumer, K. L. (2018). Complications of the neovagina in male-to-female transgender surgery: A systematic review and meta-analysis with discussion of management. Clinical Anatomy, 31(2), 191-199. https://doi.org/10.1002/ca.23001
Mundluru, S., & Larson, A. (2018). Medical dermatologic conditions in transgender women. International Journal of Women's Dermatology, 4(4), 212-215. https://doi.org/10.1016/j.ijwd.2018.08.008
Urogenital Complications
In a quarter of postoperative cases, a new form of body dysmorphia develops; and in three-quarters, additional serious complications arise, resulting in half requiring reoperations.
These findings are summarized in the abstract of a 2024 study (Bayraktar, 2024):
Gender reassignment surgeries are performed not to treat a congenital or anatomical anomaly, but to treat the psychological problems of transsexuals. In fact, there is no definitive evidence showing that psychological problems in transsexuals are cured by hormonal and/or surgical treatments for gender reassignment. On the contrary, there is evidence that these psychological problems persist after medical and surgical interventions, and even increase in some transsexuals, and a new form of body dysphoria occurs in a quarter of cases. Psychological problems in transgender people are not cured by surgery, and additional surgery-related complications develop in three-quarters of the cases. The vast majority of these are urogenital complications, and more than half require reoperations. However, in a significant proportion of cases, the outcome is unsuccessful and these urogenital complications significantly reduce the quality of life of transsexuals. Data also show that the life expectancy of transsexuals who undergo surgery is shortened by an average of 25–28 years due to psychological problems, suicides, surgical complications, reoperations, and diseases related to hormone use. These results have led to an increase in the number of detransitioners who regret their medical and surgical transition and want to return in recent years, and have increased ethical debates on this issue.
The complete journal article in PDF form can be found here.
In a letter to the editor published on February 19, 2025, the same author describes (with photographs) the case of a trans-identified male (TIM) who underwent surgery: "An MtF case presenting with complaints of difficulty urinating and pain. The patient, who had undergone surgery at another center, exhibited swelling, pain, and tenderness below the urethral meatus. The patient frequently experienced infections, pain, and swelling, was unable to engage in sexual intercourse, and had persistent urination problems (in MtF cases, the urethra is severed at the level of the bulbar urethra; therefore, the visible meatus in this case is actually a severed bulbar urethra. This urethra remains in continuous contact with neighboring tissues and the atmosphere, much like an open wound, leading to frequent infections)."
He concludes his letter with a question and a plea to the surgical community: "Transgender individuals who undergo GAS [gender-affirming surgery] lose their reproductive function irreversibly and almost entirely lose their sexual function, while their urinary function is also significantly impaired. . . . So what do they gain for all these losses? Nothing (it is claimed that their mental health improves, but there is no definitive evidence in the literature to support this claim, and in fact, there is evidence to the contrary). So, what is the reason for this insistence on GAS? As a surgeon/urologist licensed to perform GAS, I find these surgical procedures unethical and follow current medical practice with concern. I am making these reminders to fulfill my professional and moral responsibility and to recommend that GAS procedures that harm transsexuals be reviewed. We must act according to the principle of 'First, do no harm' and our priority should be to avoid harming our patients."
Bayraktar, Z. (2024). Urogenital complications that decrease quality of life in transgender surgery. The New Journal of Neurology, 19(1), 52–60. https://doi.org/10.33719/nju1374837
Bayraktar, Z. (2025). Urogenital and extra genital mutilation in gender-affirming surgery: Are we violating primum non nocere? Archivio Italiano Di Urologia E Andrologia. https://doi.org/10.4081/aiua.2025.13324
Psychological Outlook
Psychological outlook is not improved by surgeries.
We already knew from a large study out of Sweden spanning decades' worth of data that those who underwent surgery for gender-affirming purposes committed suicide at a rate that is over 19 times the rate in the general population (Dhejne, et al., 2011).
A 2019 study initially claimed there was a psychological improvement after sex reassignment surgery (SRS) (Bränström & Pachankis, 2020a); however, the authors issued a retraction after their statistical methodology was questioned (Bränström & Pachankis, 2020b). In this retraction, they acknowledged that “the results demonstrated no advantage of surgery in relation to subsequent mood or anxiety disorder-related health care visits or prescriptions or hospitalizations following suicide attempts in that comparison.” Not only did those who refrained from surgery fare no worse, but they also had half as many serious suicidal attempts; however, this difference did not reach the threshold of statistical significance.
Dhejne, C., Lichtenstein, P., Boman, M., V. Johansson, A. L., Långström, N., & Landén, M. (2011). Long-term follow-up of transsexual persons undergoing sex reassignment surgery: Cohort study in Sweden. PLOS ONE, 6(2), e16885. https://doi.org/10.1371/journal.pone.0016885
Bränström, R., & Pachankis, J. E. (2020a). Reduction in mental health treatment utilization among transgender individuals after gender-affirming surgeries: A total population study. American Journal of Psychiatry, 177(8), 727–734. https://doi.org/10.1176/appi.ajp.2019.19010080
Bränström, R., & Pachankis, J. E. (2020b). Correction to Bränström and Pachankis. American Journal of Psychiatry, 177(8), 734–734. https://doi.org/10.1176/appi.ajp.2020.1778correction
Deceptions of Vulvoplasty
Dr. Joseph Chrysostom, a surgeon in Wales, UK, has written to the NHS about how vulvoplasty surgeries (faux vaginas) fail to provide patients with anatomically and functionally authentic vulvas. An excerpt of his letter, along with a table specifying the differences between a biological vulva and a synthetic one, is posted below.
"I previously wrote to the Prime Minister of the United Kingdom to express my concerns about certain surgical procedures being performed under the guise of 'gender-affirming care' by the NHS and private surgeons in the UK. These procedures include vaginoplasty, phalloplasty, vulvoplasty, and bilateral mastectomies with no surgical indication. My primary concern is that these surgeries fail to provide patients with anatomically and functionally authentic vaginas, penises, or vulvas, nor do they alter a person's sex.
"The Prime Minister’s office forwarded my letter to the Department of Health and Social Care (DHSC), which, while not disputing my claims, directed me to raise these issues with NHS England. Following this guidance, I am addressing this letter to you, focusing specifically on Vulvoplasty. Attached, you will find a detailed table highlighting why I believe this procedure is inherently deceptive and should be banned in the UK."
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According to Cunningham's Manual of Practical Anatomy that is followed world-wide as well as the textbook Gray’s Anatomy, vulva consists of the following structures:
1. Mons pubis
2. Labia majora
3. Labia minora
4. The clitoris
5. Vestibule of the vagina
6. The bulbs of the vestibule
7. The vaginal orifice
8. The urethral orifice
9. The greater vestibular glands (Bartholin’s glands)
The following table shows the differences between the biological female vulva and the neovulva created in males:
Vulva | Neovulva (created from vulvoplasty) |
Mons pubis is a natural protrusion of hairy skin by subcutaneous fat anterior to the pubic bones. | Needs multiple further surgeries (Z-plasties) to create such an elevation. |
The hairs cease abruptly at a horizontal line where the mons meets the anterior abdominal wall. | The corresponding pubic hairs extend upwards towards the umbilicus. |
Labia Majora | Vulvoplasty/Labiaplasty Product |
The labia majora are a pair of rounded folds covered with skin which extend posteroinferiorly and meet across the midline anterior to the anus. They surround the pudendal cleft. | These are man-made folds of skin from the skin of scrotum with no well-defined shape. There is no pudendal cleft in this vulvoplasty/labiaplasty product due to the absence of vaginal introitus. |
Each labium majora has two surfaces: the external is pigmented and covered with crisp hairs and the internal is smooth but studded with sebaceous follicles. Between the two surfaces there is a considerable quantity of areolar and adipose tissue. | The bulges are created from the rugose skin of scrotum with no typical crispy hairs or adipose tissue. This cannot match the intricate anatomy described in the adjacent column. |
The round ligament of the uterus ends in the adipose tissue and skin of the front part of the labium. | No similar structure present, as surgeons are unable to create a round ligament insertion. |
Labia Minora | Synthetic Labia Minora |
These are two small cutaneous folds devoid of fat situated between the labia majora extending from the clitoris obliquely downwards, laterally, and backwards for about 4 cm on each side of vagina. In the virgin, the posterior ends of labia minora are usually joined across the median plane by a fold of skin, named the frenulum of the labia minora. Labia minora covers the urethral and vaginal openings. They have sebaceous and sweat glands. Labia minora secrete sebum which reduces friction due to its oily secretions and protects vulva against maceration from excessive moisture as they cover the vaginal and urethral openings. | There are no sebaceous glands that can secrete sebum in this man-made structure. The synthetic is created from penile skin which has no skin appendages (hair and glands). |
Vestibule is the cleft between the labia minora; in it, the vaginal and external urethral orifices are situated, and between them numerous small mucous lesser vestibular glands open on the surface of the vestibule. The part of the vestibule between the vaginal orifice and the frenulum of labia minora consists of a shallow depression named the vestibular fossa. | In this man-made bulge there is no vestibule, no lesser vestibular glands, no vaginal introitus, and no vestibular fossa. |
Clitoris | Synthetic Clitoris |
The clitoris is an erectile structure, homologous with the penis. The body of the clitoris consists of two corpora cavernosa. Each corpus cavernosum is connected to the pubic and ischial rami by a crus. The free extremity, or glans clitoridis, has the shape of a mini glans penis normally seen in a biological male. Corona glandis clitoridis is seen in all females once the natural clitoro-preputial adhesions are separated. Clitoris is a singular structure with no scar tissue in it. | A sliver of tissue is shaved off from the glans penis and is planted on top of the amputated corpora cavernosa. As this heals, scar tissue forms between the amputated corpus cavernosum and the sliver of glans. These structures have no resemblance to the glans clitoris or to the body of clitoris. There is no corona glandis clitoridis and no clitoro-preputial adhesions. |
Clitoral pearls can be seen in up to 1/3 of females. | There are no clitoral pearls in the synthetic clitoris. |
Vaginal introitus and hymen vaginae are present in a normal female vulva. | No vaginal introitus or hymen vaginae in vulvoplasty/labiaplasty bulges. |
There are bulbs of the vestibule which are oval masses of erectile tissue which lie one on each side of vaginal orifice. | Vulvoplasty product has no bulbs of the vestibule. |
Each is covered by a fibrous sheath and a bulbospongiosus muscle and is attached to the perineal membrane and overlaps the corresponding greater vestibular gland posteriorly. | The man-made vulvoplasty is unable to replicate a synthetic version of these bulbs. |
The bulbs narrow anteriorly and are united by a plexus of veins (the commissure of the bulbs) between the urethra and the clitoris. This commissure is attached to the glans of the clitoris by a thin strip of erectile tissue. | There is no commissure of bulbs and no attachments of bulbs to clitoris. |
Greater vestibular glands are present (Bartholin’s glands). | Greater vestibular glands are absent in this synthetic structure, as it is impossible to replicate. |
There is a fully functional bulbospongiosus muscle, which acts as a sphincter of the vagina and is assisted by the underlying erectile tissue of bulbs of vestibule. | There is no bulbospongiosus muscle and no erectile tissues of bulbs of vestibule. |
There is a suspensory ligament of clitoris suspending the clitoris from the anterior abdominal wall. | The equivalent structure is destroyed during the disassembly, amputation of corpora cavernosum, and destruction of corpus spongiosum. Hence, there is no suspensory ligament of this “clitoris.” |
The NHS vaginoplasty leaflet lists the following as common complications associated with the vulvoplasty procedure.
Common general surgical complications:
· Pain
· Blood clots
· Infection
· Sutures rupturing
· Urinary tract infections (UTIs)
· Urinary retention (unable to pass urine)
· Poor scarring
Common vulvoplasty surgery-related complications as listed in NHS leaflet:
· Loss of sensation
· Loss of sexual function
· Dissatisfaction with visual appearance of the vagina, clitoris and/or labia
· Inability to orgasm
· Urinary incontinence (unable to control the need to urinate)
· Necrosis to skin or clitoris (tissue dying resulting in blackening of the skin or clitoris)
· Urethral stenosis (narrowing of the urethra, making it difficult to urinate)
These are common complications, and it is unacceptable for surgeons to subject physically healthy young adults to this type of harmful operation.
References:
Brunicardi, F. Charles, Dana K. Andersen, Timothy R. Billiar, David L. Dunn, John G. Hunter, and Raphael E. Pollock, eds. 2019. Schwartz’s Principles of Surgery. 11th ed. New York: McGraw-Hill Education.
Cuschieri, Alfred, and George B. Hanna, eds. 2015. Essential Surgical Practice for Higher Surgical Training. 5th ed. Boca Raton, FL: CRC Press.
Ellis, Harold, Sir Roy Calne, and Christopher Watson. 2013. Lecture Notes: General Surgery. 13th ed. Chichester, UK: Wiley-Blackwell.
Ferguson, James, and Michael St. John, eds. 2017. Oxford Handbook of Clinical Surgery. 4th ed. Oxford: Oxford University Press.
Standring, Susan, ed. 2020. Gray’s Anatomy: The Anatomical Basis of Clinical Practice. 42nd ed. New York: Elsevier.
Townsend, Courtney M., R. Daniel Beauchamp, B. Mark Evers, and Kenneth L. Mattox, eds. 2021. Sabiston Textbook of Surgery: The Biological Basis of Modern Surgical Practice. 21st ed. Philadelphia: Elsevier.
Williams, Norman S., P. Ronan O’Connell, and Andrew McCaskie, eds. 2018. Bailey & Love’s Short Practice of Surgery. 27th ed. Boca Raton, FL: CRC Press.
Zdilla, M. J. 2024. "Anatomy of the Clitoris: The Corona of the Glans Clitoris, Clitoral Coronal Papillae, and the Coronopreputial Frenulum." Anatomy & Cell Biology 57 (2): 183. https://doi.org/10.5115/acb.24.027
Deceptions of Vaginoplasty
Dr. Joseph Chrysostom, a surgeon in Wales, UK, has written to the NHS about the effects of sex-reassignment surgeries. An excerpt of his letter, along with a table specifying the differences between a biological vagina and a synthetic one, is posted below.
"I am deeply concerned about the operation called vaginoplasty, performed by certain plastic surgeons and urologists within both the NHS and the private sector. I believe this procedure is misleadingly marketed to young, vulnerable individuals, often adolescents, by promising the creation of a new 'vagina.' To perpetuate this misrepresentation, the operation is named vaginoplasty, which implies the formation of a true vagina.
"From my research as a medical professional, it is evident that this operation merely creates a 'deep surgical wound lined with a flap of skin.' The body recognizes this structure as a wound and attempts to heal it through granulation and scarring, which causes the opening to contract over time. To prevent closure, patients must endure lifelong, often painful dilation to keep this unnatural cavity open.
"To illustrate the disparity between a natural vagina and the result of this procedure, I have included a comparative table in the following pages. This will underscore the extent to which this operation deviates from the claims made by its proponents."
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Biological Female Vagina | Synthetic Male "Vagina" |
Biological female vagina is a highly distensible fibromuscular elastic tube. | This is a non-distensible and deep surgical wound in the perineum (bottom) that tends to contract as healing takes place. |
Inner lining is non-keratinised stratified squamous epithelium. | It is made of keratinised stratified squamous epithelium (a.k.a. "skin"). |
Inner lining is designed for a moist surface. | Inner lining is designed for a dry surface (prone to macerate when exposed to prolonged moisture). |
Has a laminal propria layer below the surface epithelium, which is highly vascular and filled with elastic fibers. This elasticity provides the vagina with the capacity to distend enormously during intercourse as well during childbirth. | There is no lamina propria and therefore, no elasticity. Instead, this surgical wound lined by penile skin tends to contract. |
Lamina propria is rich with blood capillaries leading to water exiting these capillaries and keeping the vaginal lining naturally moist. | There is no lamina propria layer to provide moisture. |
Inner lining has no glands and no keratin. | Inner lining has sweat glands, apocrine glands, sebaceous glands, hair follicles, and a surface lining of keratinisation. These secretions tend to accumulate, leading to maceration and infection (as there is no natural mechanism to clean the cavity). |
Not prone to maceration, as the lining is designed to be moist from natural human secretions in vagina and cervix. | Prone to maceration, as surface sweat glands, apocrine glands, and sebaceous glands pour out their secretions along with the transudates that arise from the wound. These collections can lead to local abscess formations and sepsis along with bad odour on the person. |
Lining cells are loaded with glycogen, which provide the much-needed glycogen inside vaginal lumen. | This faux-vagina contains no glycogen (since there is no lining that can provide glycogen). |
Lactobacillus, which is a commensal bacterium found in vaginas, ferments glycogen to lactic acid and maintains acidic pH around 3.5. This pH prevents growth of pathogenic bacteria and fungus. | Harmful bacteria and fungus tend to grow deep inside the cavity, as there is no preventative mechanism. This can lead to sepsis and premature death. |
A cervix protrudes from the vaginal vault, which pours out copious secretions from cervical glands and mucosal cells to cleanse the vagina and to provide sufficient lubrication for penis during penetration. | There is no cervix to provide cervical mucus secretions for lubrication and maintenance of physiology. |
A circular and longitudinal muscular layer provides contractility as a normal physiological function. This allows for sensations during intercourse and childbirth. | There is no muscular layer to provide contractility and sensation. |
There is an adventitial layer around the vaginal muscle layer. This layer has dense connective tissue with extensive vascular supply and elastic tissue. | There is no adventitial layer and no surrounding layers to provide vascular supply or elasticity. |
Each side of the vaginal orifice has bulbs of vestibule, which are oval masses of erectile tissue. | Such bulbs of vestibule are nonexistent. |
Two Bartholin’s glands (greater vestibular glands) are present at the vaginal introitus, which release copious secretions that help in entry of penis at the start of intercourse. | There are no Bartholin’s glands to release helpful secretions. |
Bulbospongiosus muscle surrounds the vaginal opening that helps keep it closed as well as assists in erection of clitoris during sexual activity. | There is no bulbospongiosus muscle to aid in closure of the cavity or erection of a clitoris. |
There is a rich supply of nerves from the vaginal nerve plexus, which are rich in autonomic nerves that supply vaginal walls and contribute to the tumescence of the vaginal vestibule and clitoris during sexual excitation. (These vaginal plexuses are supplied by both sympathetics and parasympathetics.) | No vaginal plexus of nerves exist in this surgical wound; therefore, there are no arousal sensations during intercourse. |
"The table clearly indicates that young adolescents and adults are being misled into believing that surgeons are providing them with a new vagina through these procedures. In reality this deep surgical wound, which is lined with a full-thickness skin graft, does not resemble nor function as the natural anatomy of a female vagina."
Complications of so called “Bottom Surgery/Vaginoplasty”:
Post-op infections and sepsis
Necrotising fasciitis
Pulmonary embolism
Inadvertent bowel and bladder injury
Incontinence of faeces (due to inevitable damage to external anal sphincters during the operation)
Rectal prolapse (due to inevitable damage to the central perineal tendon and damage to levator ani muscles)
Urinary strictures
Neovaginal stricture requiring often painful lifelong dilatations
Numbness in perineum and perianal region (damage to perineal branch of ventral ramus of S4 nerve)
Fungal and pyogenic infections in neovagina (due to lack of acidic pH)
Failure of reproduction/sterility
Unpredictable effects of operation on leftover prostatic tissue from hormones and surgery
Urethral and recto-neovaginal fistulae (this complication can leave the individual with uncontrolled leakage of faeces and/or urine between the legs all the time, which can lead to untimely death due to gram negative endotoxic shock)
"If the patient needs treatment from resulting sepsis, surgery will include a colostomy to divert faeces to the abdominal wall prior to another major plastic surgery in the form of gracilis muscle interposition. This procedure will need liaison with the colorectal team and intensivists. Such a rescue operation by a colorectal surgeon is technically very demanding to do in a perineum with abnormal, inflamed, scarred skin of a 'neovagina,' apart from generalised scarring and blurred planes of dissection. This rescue operation is fraught with further complications and unacceptably high perioperative mortality. Instead, a surgeon may opt for the safer option of Hartmann type of permanent (lifelong) colostomy."
Long-Term Effects of Orchiectomy (Orchidectomy)
"The practice of performing orchidectomy . . . exposes patients to lifelong metabolic and cardiovascular risks. These risks, including strokes, heart attacks, and heart failure, are likely to manifest within a few decades, resulting in preventable harm and substantial healthcare burdens."
- from a letter Dr. Joseph Chrysostom, a surgeon in Wales, UK, wrote to the Healthcare Inspectorate Wales (HIW) regarding the harmful effects of orchidectomy. Read the letter in full below.
From,
Dr. Joseph Chrysostom MS(Gen Surg), FRCSEd
Barry XXXXX
To,
HIW Wales, Quality Nursing
Subject: Long-Term Harmful Metabolic Effects of Bilateral Orchidectomy (Castration) Without Surgical Indication on Young Adults in England and Wales
Dear Sir/Madam,
I have come across reports of young male patients undergoing bilateral orchidectomy without surgical indication through the NHS and private surgeons subcontracted via commissioning mechanisms, including by the JCC in Wales. This concerning practice demands urgent scrutiny.
Bilateral orchidectomy destroys Leydig cells, which account for approximately 20% of adult testicular mass and are critical for synthesizing testosterone from cholesterol. Testosterone, a key male sex hormone, regulates various physiological functions by binding to androgen receptors and promoting protein synthesis in tissues like the prostate, muscles, bones and testes. Its absence profoundly disrupts lipid and glucose metabolism, increasing the risk of metabolic syndrome, cardiovascular complications, and early-onset ischemic heart disease.
Research indicates that testosterone deficiency elevates PCSK9 activity, reducing LDL receptor function in hepatocytes and causing higher LDL cholesterol levels. This mechanism contributes to atherosclerosis, compounded by testosterone deprivation, which accelerates cholesterol pool expansion and metabolic dysregulation. The NHS is effectively adding castrated individuals to the list of conditions associated with hypercholesterolemia, such as diabetes, hypothyroidism, and nephrotic syndrome.
Evidence links testosterone deficiency to significant cardiac dysfunction, including impaired stress response, altered substrate uptake, and an increased risk of heart failure—even in patients without pre-existing cardiovascular disease. Studies have also highlighted the benefits of testosterone treatment in mitigating heart failure symptoms, underscoring its role in maintaining cardiac health.
The practice of performing orchidectomy on young adults with gender dysphoria—a psychological condition outlined in the DSM-5 but not recognized as an indication for surgery in standard medical textbooks—exposes patients to lifelong metabolic and cardiovascular risks. These risks, including strokes, heart attacks, and heart failure, are likely to manifest within a few decades, resulting in preventable harm and substantial healthcare burdens.
Gender dysphoria requires mental health intervention, not irreversible surgical procedures. I strongly urge the Welsh and UK governments to cease the practice of castrating young adults for a mental health diagnosis. Additionally, the prescription of anti-androgens and oestrogens to biologically male patients should be reconsidered, as their cells are inherently adapted to respond to testosterone.
The long-term consequences of these procedures will lead many affected individuals to hold governments accountable for enabling such harmful practices.
References:
Cai et al. (2015). Effect of testosterone deficiency on cholesterol metabolism in pigs fed a high-fat and high-cholesterol diet. Lipids in Health and Disease, 14:18. DOI: 10.1186/s12944-015-0014-5. https://lipidworld.biomedcentral.com/articles/10.1186/s12944-015-0014-5
Vlachopoulos et al. (2014). Testosterone deficiency: A determinant of aortic stiffness in men. Atherosclerosis, 233(1): 278–283. https://www.atherosclerosis-journal.com/article/S0021-9150(13)00763-6/fulltext
Simon et al. (1997). Association between plasma total testosterone and cardiovascular risk factors in healthy adult men: the Telecom Study. J Clin Endocrinol Metab, 82(2): 682–685. https://academic.oup.com/jcem/article-abstract/82/2/682/2823553
Goodale et al. (2017). Testosterone and the Heart. Methodist Debakey Cardiovasc J, 13(2): 68–72. DOI: 10.14797/mdcj-13-2-68. https://journal.houstonmethodist.org/articles/10.14797/mdcj-13-2-68
Kelly & Jones (2013). Testosterone: a metabolic hormone in health and disease. Journal of Endocrinology, 217(3): R25–R45. https://joe.bioscientifica.com/view/journals/joe/217/3/R25.xml
Svedlund Eriksson et al. (2022). Castration of Male Mice Induces Metabolic Remodeling of the Heart. Journal of the Endocrine Society, 6(11): bvac132. DOI: 10.1210/jendso/bvac132. https://academic.oup.com/jes/article/6/11/bvac132/6679722
Personal Story
Read a firsthand account of living with surgical complications.
"Aside from keeping myself hygienic, I dilate about 4 times a year for 20 mins each and it never closes and most of the time never bother outside managing the trickle of urine from my constricted urethra after going to the toilet, the occasional shooting pain and the despair of my own stupidity.
"My pelvis is behaving as if it’s been impaled, constantly trying to heal, constantly confused with what to do with the nerves. My urethra goes through cycles of constriction, meaning every 2 years I need surgery to open it again.
"Dismiss me if you like, and put it down to ‘poor surgical outcomes’, but it’s not - I got lucky if you can believe it, I can climax, but there is nothing but numbness in the outer groin, I have tried prodding with clean knives and needles to see if I feel anything, but it’s just not there, there are isolated patches of nerve connectivity too where i [sic] can, but its mostly numb. This is not rare.
"Most of my friends who had SRS have no sensation. Nothing."