Euphemisms and deceptions : This is not 'Do no harm'!

The third part of our interview with Dr Chrysostom highlights what can only be described as a complete dereliction of duty of care and professional accountability on the part of the medical profession. In addition, this blog provides clear evidence of the failure of the medical profession to explain why vulnerable children and young adults with a range of traumas and psychological conditions, are being treated with life-changing surgeries for their psychological issues.

The interview was carried out by Carolyn Brown, ScotPAG Convenor

Q: What is your opinion about the way these surgeries are presented to the general public?

A: Euphemistic language is rife within the gender medicine industry. Phrases like “bottom surgery” and “penile inversion surgery” are particularly deceptive, as they obscure the stark reality that the majority of the penis is amputated during the procedure. These terms can easily mislead adolescents and young adults, thereby creating the false impression that the intact penis is simply turned inside out to form a vagina — and that the process is somehow reversible.

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Q: You infer in what you have written that there are serious ethical issues at play in this area of health treatment. We know that health practitioners have presided over medical scandals in the past. What are your thoughts regarding why your colleagues have not learned from past mistakes?

A: Medical practice, I believe, should be based on a clear, truthful and scientific basis. In these cases, my view is that there is significant deception involved. When there is deception, there is no ethics. Medical scandals have happened in the past and will continue to happen if fellow medical professionals fail to scrutinise the practice. When I researched into these surgeries, I was shocked and dismayed that my fellow medical professionals are capable of such malpractice.

From an ethical standpoint, it is profoundly troubling that surgeons are permitted to amputate healthy organs in response to what is fundamentally a psychological condition. Equally disturbing is the lack of scrutiny from professional regulatory bodies, Royal College of Surgeons, Health Care Inspectorate of Wales, Cabinet Health Secretaries, Health Boards, politicians, and other stakeholders. There appears to be a collective unwillingness to question or debate these practices, despite their irreversible and life-altering nature.

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Q: Do surgeons hold the referrers responsible for decision making that supports surgical procedures? What constitutes a condition for refusal to operate in other surgical procedures?

A: Normally in any surgical decision making, it is the surgeon who decides to do the operation and takes responsibility for that decision. With regards to these so-called gender surgeries this does not seem to be the case and it is less clear. If a physician refers a patient for surgery, a surgeon may appropriately defer or refuse to operate under certain circumstances, as outlined in the renowned surgical principle described in Bailey and Love’s Short Practice of Surgery. This principle states:

"From making the cure of a disease more grievous than its endurance,

Good Lord, deliver us."

This reflects the core medical ethic: "Do no harm." I contend that the so-called "gender surgeries" fall squarely within the warning set forth by this principle, as they risk causing greater harm than the condition they seek to address. The leaflet issued by Gender Identity Clinics (GICs) commissioned by NHS England states: “You will require two recommendations for surgery to be undertaken by two responsible clinicians from a specialist Gender Identity Clinic (GIC) that is commissioned by NHS England.”

This statement is highly misleading and raises serious concerns about clinical governance. It implies that clinicians within these NHS-commissioned GICs are competent to recommend surgical procedures. But the clinicians involved in making these recommendations do not hold formal qualifications or training in surgery. They have not undertaken surgical fellowships, nor are they fellows of any of the Royal Surgical Colleges. Crucially, they have not completed accredited postgraduate training in key surgical disciplines such as operative surgery, surgical anatomy, surgical physiology, principles of surgery, surgical pathology, and surgical management. These are formally assessed through exit examinations such as the FRCS (Fellowship of the Royal Colleges of Surgeons). In the absence of such qualifications and without having passed recognized surgical exit examinations, these clinicians in gender clinics lack the professional competence required to assess patients for major, irreversible surgical interventions. Their endorsement of surgery falls far outside their scope of training and expertise.

Furthermore, neither the GIC leaflets nor their publicly available materials provide any clinical justification for recommending the removal of healthy, disease-free organs such as the penis, testicles, or breasts in individuals with a recognised mental health condition. These organs have no established role in the pathogenesis of gender dysphoria, and there is no credible evidence base to support their removal as a treatment. It remains unclear what clinical rationale or evidence these “recommendations” are based on.

It is deeply concerning that NHS England continues to commission clinicians without surgical qualifications to recommend life-altering operations. This commissioning practice is inappropriate and may represent a systemic failure in safeguarding, exposing vulnerable patients to irreversible harm through decisions made by individuals who have neither the training nor the competence to understand the long-term consequences.

This matter requires urgent scrutiny. The public must be assured that surgical decisions within the NHS are only made by professionals who have undertaken formal surgical training and passed recognised surgical exit examinations, and that NHS commissioning upholds the highest standards of patient safety, accountability, and clinical responsibility. If the purpose of referral is to masculinise (i.e., convert a female into a male) or feminise (i.e., convert a male into a female) an individual, this is biologically impossible without altering the genome of at least 30 trillion cells in the human body. Therefore, these so-called gender specialists have neither the scientific basis nor the expertise to “recommend” such surgeries.

It appears that surgeons in these cases are functioning more as technicians, removing healthy reproductive organs at the request of patients and based on the recommendations of clinicians whose qualifications may be insufficient. The prevailing attitude seems to be that if a patient wants the surgery, it will be done—regardless of long-term outcomes or potential harm. This abandonment of scientific standards in favour of patient preference is professionally and ethically unacceptable.

The Hippocratic Oath

What becomes apparent is a systemic shift of responsibility: the surgeon does not justify the operation medically, but rather performs it based on a presumption of informed consent—even when that consent may be based on misconceptions or false expectations. There is no proper explanation offered for why such drastic physical intervention is considered appropriate for a psychological condition. As stated earlier, the surgeries themselves are fundamentally deceptive. They do not create a vagina, vulva, or penis. These anatomical claims are biologically false. Yet the consent process appears to rest on precisely such promises.

Taken together, this reveals that surgeons are distancing themselves from full responsibility for these procedures. When no disease exists in the organs being removed, most responsible surgeons would hesitate to proceed. By deferring instead to recommendations from the GIC, they avoid bearing direct responsibility.

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Q: You’ve said that children and young adults should not be treated with hormones and surgery for a psychological condition, which you believe gender dysphoria to be. Can you say a bit more about why you think this?

A: Surgeons traditionally removed diseased body parts, drained abscesses, made skin grafts and flaps to heal wounds, mend fractures, removed blockages, closed perforations, arrested haemorrhage to save lives. I have never heard of surgeons removing normal bodily organs just because “the patient wants it”- sadly I am hearing of it now. Whenever a patient presents to emergency department with a keen interest to kill himself/herself, a physician is not ethically, legally, and morally allowed to prescribe a toxic fatal dose of barbiturates to satisfy and respect patient’s wish. The doctor should certainly refer the person to a mental health physician to sort out his/her suicidal tendency. If someone presents after cutting themselves in their forearm, the physician will not give him a scalpel and local anaesthetic to help him complete the cut just because the person is mentally distressed and wishing to cut him/herself fully.

An orthopaedic surgeon will never amputate a foot or hand just because the patient is obsessed with thoughts of disliking the limb even if the psychiatrists are unable to cure the mental issue. Similarly, when an adolescent patient with 'gender identity disorder' presents to surgeons and request for a so called “sex change” operation, how is it that the surgeons cut off perfectly normal bodily organs and castrate them?

Such patients should be referred to psychotherapists for treatment and if they are in the rare instance found to be suicidal, to the psychiatrists. That should be the standard ceiling of care for these patients.

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The final part of this important interview will be published in our next blog

Link to Part 1 - on the deceptive surgery of 'gender reassignment'

Link to Part 2 - on the harms caused by surgery

Link to Part 4 - on the social influences on children and young adults