Blair Peters's field has strayed from the core tenets of medical care
In the world of gender, evidence disappears from the public realm all the time. Social media giants ban upstart accounts and censor uncomfortable conversations. Videos proudly shared on the website of a children’s hospital one day vanish the next, replaced by carefully crafted denials. This week, a revealing interview with a prominent American gender surgeon named Blair Peters (he/they) suddenly went private.
I can understand why. In the video, Peters demonstrates just how far his field has strayed from the most basic tenets of medical care (the distinctly old-fashioned oath to “first, do no harm”) into the wild frontier of helping patients realise their “embodiment goals” through life-altering, function-destroying surgical procedures.
“As a surgeon, my whole goal is helping you self-actualise how you see yourself internally,” Peters says at one point. “I really love that,” the interviewer gushes. “The collaborative vision-making, as opposed to, like, ‘this is what we’re doing and that’s all you have to choose from.’” Peters chides his fellow surgeons for clinging to a “binary” mindset when it comes to gender surgery, turning away from the wider world of “non-binary” surgeries, which encompasses procedures like phallus-preserving vaginoplasty (this is exactly what it sounds like) or gender nullification surgery (“removing all external genitalia to create a smooth transition from the abdomen to the groin”).
Under the pretence of “following the patient’s lead”, gender clinicians like Peters dabble ever more boldly in body horror. All along the way, training targeting clinicians reminds doctors not to judge their patients’ desires. Under the framework of “gender-affirming” care, doctors become facilitators or customer service specialists, freed from the responsibilities that ought to accompany the power they wield.
When I attended the World Professional Association for Transgender Health (WPATH) conference in Montreal last year, I was struck by how persuasive the idea of making progress was. New gender identities are always being declared. Fresh surgical techniques and new patient requests keep emerging. And everything can always be made more “inclusive”: there’s always some new marginalised group to bring in out of the cold, like self-identified asexuals who nonetheless enjoy sex. Or eunuchs, who crave the legitimacy inclusion in WPATH’s Standards of Care provides.
The pace of progress in this arena can be breathtaking, and everyone must run to keep up with the latest developments. Gender clinicians make unnerving statements like “we’re building the plane while we’re flying it,” as one WPATH presenter said. The “plane” they’re “building” refers to children’s bodies — the only bodies their patients will ever have.
During a session on non-binary surgeries, presenters lamented the difficulty of reconciling personal identity with the limits of medical technology and the human body: “What [these patients] want may not be physically possible” — yet. Even within the constrained realm of the possible, clinicians acknowledge that “we’re doing the procedures here and we don’t have outcome data […] these surgeries are on the edge of the field of medicine and you need a structure around you.”
By “outcome data”, the speaker meant that we don’t know whether these surgeries will ultimately help patients or harm them. By “structure”, she meant protection from medical malpractice. The uncomfortable topic of protecting patients from medical harm didn’t come up. Clinicians like Peters have become fond of saying things like “it will be fascinating to see how these young people fare”.
As Hannah Barnes put it in her damning expose of the UK’s Gender Identity Development Services for children, there’s simply no time — and little professional incentive — to think.