Transgender activists are demanding regulations for doctors performing genital surgery




‘I have seen horrific unethical practices by surgeons who lie about their experience and horrific results surgically as a result of that’

Rafaella Gunz


A group of transgender activists—all of whom have undergone genital surgery— have released an open letter to the World Professional Association of Transgender Health (WPATH). The purpose is to request reform in their regulations.

Under the current policies, surgeons are allowed to become members of the WPATH collective without providing any real proof of training when it comes to these sensitive surgeries (with the exception of being licensed plastic surgeons).

‘We the undersigned are writing as current and former patients who have undergone genital surgery related to our gender identity, namely, Vaginoplasty, Metoidioplasty and Phalloplasty procedures. Surgeons performing these procedures hold membership in the World Professional Association of Transgender Health (WPATH) and utilize that membership to signal value to prospective patients,’ the letter reads.

‘In light of this affiliation, we believe that oversight and intervention is necessary to maintain the reputation of the WPATH as a whole. The performance of transgender genital surgery is an exceptionally interdisciplinary endeavor, and WPATH is uniquely positioned to reduce harm being done to vulnerable patients by the current lack of oversight.’

‘It is our request that the association evolve to offer a form of accreditation for surgical membership in WPATH. Furthermore, we believe that this change would only be successful with substantial input from a Community Advisory Board of patients. Finally, we envision a collaborative research database to ultimately provide accurate information for surgical providers and patients.’

First-hand accounts

‘I can’t count how many times I’ve heard groups of trans people say, “we should start a database on surgeons” because the reality isn’t matching the claims they make about their outcomes, and it doesn’t feel like anyone besides us cares,’ Gaines Blasdel, a trans advocate and one of the letter’s co-authors, tells OUT.

‘I have seen horrific unethical practices by surgeons who lie about their experience and horrific results surgically as a result of that. We are using transgender people as guinea pigs and the medical profession allows this to happen,’ says a WPATH surgeon quoted in the letter.

Their demands

The letter requests that the doctors have complete professional training as opposed to using these surgeries as practice, offer sufficient aftercare, provide accurate medical information, and counsel patients before offering experimental surgeries.

The letter also demands more representation in WPATH’s advisory board.

‘We demand the formation of a Community Advisory Board to assist in creating this accreditation path. The current structure of one “community stakeholder” WPATH member per chapter committee is far too little, too late. This advisory board should include representation from transgender people historically excluded from access to genital surgery; people from the global South, non-heterosexual people, gender non-binary people, and people with psychiatric comorbidities. The community, including non-WPATH member post-surgical patients, should have the opportunity to submit feedback to the community advisory board.’

‘The ultimate purpose of this letter is to maintain our access to quality care. To do that, we must collaborate with surgeons and WPATH on a sustainable future. We know that there is no perfect procedure, and no perfect surgeon, and we have no desire to hold the surgical community to unrealistic standards. We are thankful that surgeons have chosen to specialize in a historically-marginalized population, and understand that they frequently do so at personal and professional risk. Many surgeons have, to our great relief, stepped in after experiences of mistreatment and dismissal in less ethical hands. We ask you to join with us in creating minimum acceptable practices.’