New surgery provides trans patients with BOTH male and female genitals

The latest ethically dubious growing trend in the consumerist world of gender medicine is nonbinary-affirming surgeries that serve the wishes of patients requesting no genitals or both sets of genitals.

Mia Ashton Montreal QC

The latest ethically dubious growing trend in the consumerist world of gender medicine is nonbinary-affirming surgeries that serve the wishes of patients requesting no genitals or both sets of genitals.

These surgeries either create a smooth sexless appearance for those non-binary individuals who identify as neither male nor female, or involved preserving the existing genitalia while constructing that of the opposite sex, for those who identify as both male and female.

A recent article in Vice told the stories of four non-binary people and “their experiences with individually customizable genital surgeries that affirmed their gender identities.” It documents their struggles to find surgeons willing to perform these procedures and how some found themselves alienated from the transgender community for the medical route they chose to take.

One was Hyde Goltz, a female non-binary mortuary student in Minnesota who had already succeeded in finding a surgeon to carry-out a “vagina-preserving phalloplasty,” meaning that this individual now has both a vagina and a surgically constructed appendage made from skin and flesh taken from either the patient’s forearm or thigh. This is a procedure that comes with an extremely high complication rate.

There is a growing community online of people seeking “bigenital anatomy,” in other words, both a penis and a vagina, and they call themselves Salmacians, a term taken from sci-fi and derived from the Greek myth Salmacis and Hermaphroditus, in which Salmacis prays to the gods that she and Hermaphroditus be together forever and the gods grant her wish by merging the two into one body.

On the Salmacian website, it states “most Salmacian people are queer, but anyone, of any gender or orientation can be Salmacian” for reasons and desires that “vary wildly. For some, a mixed genital set can be a source of gender affirmation or nonconformity. Others may want new genitalia while avoiding the hassle and risk of removing their natal genitalia,” while others may “simply want a broader array of options during sexual activity.” According to Vice, this online community has grown into the thousands.

The backlash towards this group comes largely from within the transgender community. Goltz, who writes a blog about the transition process, told Vice most of the online harassment comes from other trans people who feel Goltz is “making a mockery” of the trans community by “only going halfway.” Others believe a diagnosis of gender dysphoria is necessary in order to be considered trans.

“That was the hardest hate mail to take,” Goltz told Vice. “Other trans people saying, ‘No, you’re doing it wrong’.”

Nonbinary-affirming surgeries are still rare. For now. Although according to surgeon Richard Santucci, of The Crane Center for Transgender Surgery in Austin, TX, "vagina-preserving phalloplasties” are somewhat common, making up around 20 percent of the phalloplasties he perform each year. Of note, The Crane Center is owned by Dr. Curtis Crane, the surgeon responsible for the botched phalloplasty that ruined Scott Newgent’s life. Newgent’s story is featured in Matt Walsh’s documentary "What is a Woman?"

Santucci emphasized to Vice that bigenital surgery is “safe, sound, and proven science,” despite acknowledging that his research group has written a significant chunk of the literature on the subject. Naturally, the Vice article appeals to the authority of the World Professional Association for Transgender Health (WPATH) which included a chapter on non-binary affirmation in its recently released Standards of Care 8.

Vice also noted that for the first time in its history, WPATH included a "eunuch" chapter in its Standards of Care. This chapter refers to eunuch as a gender identity and defines those who identify as eunuch, which they explicitly state can include children, as "those assigned male at birth (AMAB) and wish to eliminate masculine physical features, masculine genitals, or genital functioning … As with other gender diverse individuals, eunuchs may also seek castration to better align their bodies with their gender identity. As such, eunuch individuals are gender nonconforming individuals who have needs requiring medically necessary gender-affirming care."

WPATH, the professional association that sets the international guidelines for gender-affirming care including for children and adolescents, then included a hyperlink to the Eunuch Archives, which it describes as "the greatest wealth of information about contemporary eunuch-identified people." This is a website that contains written child-castration pornography. 

Vice also told the story of Mels, an agender and asexual office 34-year-old office manager in Delaware, whose surgical goals were “a full gender nullification procedure - a wholly smooth exterior.” This was achieved by an orchietomy (removal of the testes) and a penectomy (removal of the penis). Mels had to pay for these body modification procedures privately as no insurance companies would cover them.

“The underpinnings of SOC8 is the individualized nature of care,” Loren Schechter, a plastic surgeon and treasurer of WPATH told Vice. “We have to address the person who’s sitting before us.”

“There are quite a few surgeons that don’t do [bigential surgery],” Dr Curtis Crane, the surgeon responsible for ruining Scott Newgent’s life, told Vice. “They believe there’s an inherent harm, that you’re leaving someone halfway, in-between, and therefore incomplete.”

“The main thing I learned from the trans community is that we don’t live in a binary world. So why should my treatments be binary,” said Crane.

Another patient who had received a vagina-preserving phalloplasty in 2021 told Vice about being afraid to leave New York for fear that complications would arise and other surgeons wouldn’t know how to handle it.

“I’m chained to my surgery team for the rest of my life,” said the 26-year-old. “Until more doctors know how to deal with this kind of surgery I can only go to them with it.”


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