What a great distillation of the project’s arc and essence. I will go back and read this again but I think it’s the third or fourth piece in the last 2 weeks that have helped me better channel my rage in the direction of the mad scientist. (The first was Stella’s interview of James Linehan.) Society’s tolerance of the mad scientist is its own problem— but is this what ‘sine qua non’ means? Without the evil sociopath, there’s no useful-idiot-enabling-the-sociopath problem.
Thanks! My take is that mental health is the most neglected part of healthcare, and gender identity was until recently a very small niche within mental health. Because society doesn't really care about people it can't understand, gender clinicians were able to get away with a lot, due to a general lack of oversight.
This makes a lot of sense. It's admitted by the Dutch that passing was the core reason for puberty blockers. The other reason given is that they give pre-teens a bit more time to decide whether to transition, but that only makes sense if the changes to their bodies prevent them from having time, which in itself is valuing the "blank canvas" over the changing body and again means passing is the goal.
I am intrigued and disgusted by your (likely spot on) suggestion that it's the surgeons (and perhaps the endocrinologists as well - concocting just the right formulas as alchemists), rather than the desperate patients, who really drive the Dutch protocol, so they can achieve great feats of science and art. It makes a lot of sense since the medical field has more power than the patients to control what treatments are available and more sway with lawmakers and insurers to keep things the way they want them.
Thanks for your comment. I never bought the 'time to think' justification, as puberty blockers are clearly a serious commitment to a particular treatment pathway.
This piece is provocative but ultimately fanciful. There's a real disconnect between the suggestion that puberty blockers exist to create a “blank canvas” for surgeon-artists and the actual experiences of trans youth. While many trans people do eventually seek surgery, their motivation is typically to relieve persistent gender dysphoria—not to fulfill some aesthetic ideal imposed by clinicians.
Puberty blockers are not guaranteed to be fully reversible, and that’s a valid area of medical debate—but their stated purpose in gender medicine is to delay irreversible changes, not as a prelude to artistic transformation. The idea that doctors are driven by aesthetic ego rather than patient care veers into conspiracy territory. It's fine to interrogate medical culture, but this framing misrepresents both the ethical intent of gender-affirming care and the lived realities of trans people. Let’s not mistake Baudrillardian flourish for evidence.
Thanks for the comment, Ollie. I would distinguish between the patient's motivation for seeking the surgery, and the surgeon's motivation for providing the surgery. A skilled surgeon can make a good living regardless of specialism, so what motivates some surgeons to specialise in facial feminisation? Do you consider it fanciful that someone's motivation might be other than they have lead society to believe?
The plastic surgeons I have encountered fall into two categories; those who focus on reconstructive work for people who have experienced car crashes, house fires, industrial accidents, dog attacks or street fights, and those who focus on aesthetics, usually in the private sector. Both types are skilled artists paid to help people, in different ways, but the aesthetic surgeons seem mostly involved in raising self-esteem, or maintaining careers for people who sell their image or body, rather than restoring appearance to 'normal'.
A friend of mine had breast implants because her ambition was to work in a strip club. (After the surgery, she was disappointed to discover that the club which recruited her was a front for prostitution, rather than a sex-positive performance space for free expression). For transgender males we have both aspects of aesthetic surgery available, because feminine boys do often suffer from low self-esteem, but are also commodified as sex objects for closeted men.
Thought-provoking stuff. Trans surgery is not for the benefit of the confused, distressed patient but for the 'surgeon artist'. Makes you think.
Thanks for the comment Suzanne. I have met some brilliant surgeons who only want to help people. In the aesthetics business, I'm not so sure.
What a great distillation of the project’s arc and essence. I will go back and read this again but I think it’s the third or fourth piece in the last 2 weeks that have helped me better channel my rage in the direction of the mad scientist. (The first was Stella’s interview of James Linehan.) Society’s tolerance of the mad scientist is its own problem— but is this what ‘sine qua non’ means? Without the evil sociopath, there’s no useful-idiot-enabling-the-sociopath problem.
Thanks! My take is that mental health is the most neglected part of healthcare, and gender identity was until recently a very small niche within mental health. Because society doesn't really care about people it can't understand, gender clinicians were able to get away with a lot, due to a general lack of oversight.
This makes a lot of sense. It's admitted by the Dutch that passing was the core reason for puberty blockers. The other reason given is that they give pre-teens a bit more time to decide whether to transition, but that only makes sense if the changes to their bodies prevent them from having time, which in itself is valuing the "blank canvas" over the changing body and again means passing is the goal.
I am intrigued and disgusted by your (likely spot on) suggestion that it's the surgeons (and perhaps the endocrinologists as well - concocting just the right formulas as alchemists), rather than the desperate patients, who really drive the Dutch protocol, so they can achieve great feats of science and art. It makes a lot of sense since the medical field has more power than the patients to control what treatments are available and more sway with lawmakers and insurers to keep things the way they want them.
Thanks for your comment. I never bought the 'time to think' justification, as puberty blockers are clearly a serious commitment to a particular treatment pathway.
This piece is provocative but ultimately fanciful. There's a real disconnect between the suggestion that puberty blockers exist to create a “blank canvas” for surgeon-artists and the actual experiences of trans youth. While many trans people do eventually seek surgery, their motivation is typically to relieve persistent gender dysphoria—not to fulfill some aesthetic ideal imposed by clinicians.
Puberty blockers are not guaranteed to be fully reversible, and that’s a valid area of medical debate—but their stated purpose in gender medicine is to delay irreversible changes, not as a prelude to artistic transformation. The idea that doctors are driven by aesthetic ego rather than patient care veers into conspiracy territory. It's fine to interrogate medical culture, but this framing misrepresents both the ethical intent of gender-affirming care and the lived realities of trans people. Let’s not mistake Baudrillardian flourish for evidence.
Thanks for the comment, Ollie. I would distinguish between the patient's motivation for seeking the surgery, and the surgeon's motivation for providing the surgery. A skilled surgeon can make a good living regardless of specialism, so what motivates some surgeons to specialise in facial feminisation? Do you consider it fanciful that someone's motivation might be other than they have lead society to believe?
The plastic surgeons I have encountered fall into two categories; those who focus on reconstructive work for people who have experienced car crashes, house fires, industrial accidents, dog attacks or street fights, and those who focus on aesthetics, usually in the private sector. Both types are skilled artists paid to help people, in different ways, but the aesthetic surgeons seem mostly involved in raising self-esteem, or maintaining careers for people who sell their image or body, rather than restoring appearance to 'normal'.
A friend of mine had breast implants because her ambition was to work in a strip club. (After the surgery, she was disappointed to discover that the club which recruited her was a front for prostitution, rather than a sex-positive performance space for free expression). For transgender males we have both aspects of aesthetic surgery available, because feminine boys do often suffer from low self-esteem, but are also commodified as sex objects for closeted men.