Gender Reassignment Surgery - A medical deception

Part 1 of an extensive ScotPAG interview with surgeon Joseph Chrysostom, April 2025

Dr Chrysostom is an NHS whistleblower who has 25 years of experience working in the NHS in Accident & Emergency medicine. He is a Fellow of the Royal College of Surgeons of Edinburgh, and an accredited ATLS instructor with the RCS London. He has spent the last two years writing letters about 'gender affirming care' to many professional bodies, including his Health Board, the General Medical Council, NHS England, the Welsh government, the Health Care Inspectorate of Wales, the Royal College of Surgeons in London, the Royal College of Surgeons of Edinburgh, the Royal College of Physicians, the Royal College of Anaesthetists, the Ombudsman, and the Prime Minister.

Please note: The interview includes links to more detailed material

It was conducted by Carolyn Brown, ScotPAG Convenor

Q: When did you start to become concerned about ‘gender affirming care’ and what alerted you to this issue?

A: For more than a year, I came across parents of patients who were in the process of being referred to gender clinics for so called “’gender affirming care.” These are mostly patients who are in the adolescent age group who have not completed their adolescence. (Adolescence is defined as between 10 and 24 by Oxford Handbook of Pediatrics, 3rd Ed.)

These are patients with normal human anatomy who are biologically male and female. They also have a normal genito-urinary physiology with no congenital anomalies nor endocrine dysfunction according to their parents. They are supposedly suffering from a mental health condition called “gender dysphoria”, also called “gender incongruence”. Many of them have underlying mental illnesses such as: depression, anxiety, autism, obsessive compulsive disorders etc. Many of these youth, in my opinion, are encouraged to believe through social media indoctrination, that they are born in the wrong body. There is no scientific basis for such an ideology.

Because of my concerns, I researched the operations that are being carried out on these naive adolescents. I find these operations disturbing and without appropriate indication. The mental health condition called gender dysphoria that is described in the DSM-5 psychiatry manual is in the mind of the person and the treatment should be directed towards mental health issues and not with cross sex hormones and/or surgery.

Q: Approximately how many letters outlining your concerns have you written?

A: I have written more than 30 letters, often sending multiple letters to many of the medical bodies and governmental agencies.

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Q: One of your letters is to the Royal College of Surgeons of Edinburgh (RCSEd). In it you outline some of the potential harms for adolescent females if they take cross sex hormones. How did the RCSEd respond to your letter?

A: The Royal College of Surgeons of Edinburgh responded to my correspondence by stating that my concerns regarding these surgeries fall “beyond the purview of the College.”

Q: How have other organisations responded to your letters?

A: I have written to many professional bodies and governmental agencies, in an effort to determine who holds responsibility for authorising surgical procedures on physically healthy men and women that involve the removal of normal organs such as the testicles, penis, and both breasts. To my dismay, I have been unable to identify any professional body that explicitly endorses these surgeries or is prepared to assume full responsibility for them. Yet, these procedures continue to be performed with apparent impunity. Below, I present the available evidence in support of this concern.

The Royal College of Surgeons of England (RCS) acknowledged receipt of my letter but chose not to respond further. Neither of the surgical Royal Colleges confirmed whether they support or endorse these procedures. In response to my concerns regarding the use of hormonal treatments and the associated surgeries, the Royal College of Physicians (RCP) in London stated that they, “...do not hold or currently intend to issue a stated position on the topic.” This response makes it clear that the RCP does not wish to endorse or take responsibility for the hormonal treatments, or the surgical procedures currently being carried out in the UK. I wrote my concerns to the Royal College of Anaesthetists (RCoA), the reply was as follows:

“While there are no guidelines specifically for anaesthetists with regards to non-clinical issues in gender reassignment surgery, the GMC issues guidance on personal beliefs (please see attached document). The GMC’s position with regards to a conscientious objection to a treatment can be summarised as, "...you must make sure that the way you manage this doesn’t act as a barrier to a patient’s access to appropriate care to meet their needs." They also noted that the law doesn’t require doctors to provide treatments or procedures that they consider are not clinically appropriate or not of overall benefit to the patient.

In the case of gender reassignment surgery, given that a surgical colleague considers the treatment clinically appropriate, and such surgery is not illegal, the GMC’s guidance on conscientious objection is relevant. From this, it appears the RCoA’s position is that if a surgeon deems the removal of the testes, penis, or both breasts to be clinically appropriate, anaesthesia will be provided without further independent scrutiny. The RCoA does not seem to carry out its own clinical assessment regarding whether such surgeries may cause harm to the patient. Instead, it seems to defer the responsibility entirely to the surgeon’s judgment.

Letters to my Health Board in South Wales

I raised my concerns with the health board where I work regarding gender surgeries.

In response, the Medical Director wrote the following:

“Gender dysphoria is a complex area that should only be managed by specialist services, for all the reasons you have outlined. There are no paediatric services in Wales, and the only adult service is based in Cardiff. Our health board does not have a service in place.

The Cass report very much reflects the uncertainty you articulate about the correct approach to use of relatively untested treatments outlined in your correspondence. My feeling is that these are complex areas that should be left within the scope of practice of specialists in the area. Both to give patients access to MDT care but also to provide access to the properly conducted research studies which will hopefully in the future provide the evidence needed. I believe we both agree on the fundamental medical principle of ‘first, do no harm.’ As you point out in your letters, harm can result from offering treatments that lack a solid evidence base. But we must also consider the potential harm of inaction when patients are experiencing significant psychological distress.”

The Health Board acknowledges and agrees that the treatments in question are, “relatively untested,” and, as highlighted by the Cass Report, there is still the need for an evidence base for these treatments (including chemical and surgical castration).The Health Board also reaffirmed the principle of “first, do no harm.” But what greater harm can be done than the irreversible destruction of healthy, functioning organs essential for sexual reproduction and lactation? The harm cited in cases of inaction is psychological distress—manifesting as anxiety and depression—which is best addressed by General Practitioners and in-house psychiatrists and therapists, not by surgeons removing vital organs. It is evident from this exchange that the health board does not wish to assume responsibility for the decision to refer these patients for surgery. Instead, they opt to pass the responsibility to the so-called “gender specialists” at the Cardiff gender clinic.

Prime Minister’s Office

I wrote to the Prime Minister to express my concerns regarding the nature of these operations. In response, the Prime Minister’s Office directed me to the Department of Health and Social Care (DHSC) The DHSC responded to me by stating that I should direct my queries to NHS England. The DHSC did not refute my concerns about the potentially deceptive nature of these surgeries.

I subsequently contacted NHS England with my concerns about the misleading nature of these gender surgeries. NHS England did not attempt to defend the procedures. Instead, they redirected me back to DHSC. I wrote to he DHSC once more. I am yet to receive any response. I also raised my concerns with the GMC. Their response was that the actions of the surgeons in question fell within the boundaries of current legislation, and therefore, they are unable to intervene. They did, however, recommend that I take the matter to the Parliamentary and Health Service Ombudsman (PHSO).

Parliamentary and Health Service Ombudsman

I have written to the PHSO three times. I am awaiting a reply.

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Dr Joseph Chrysostom was interviewed by Carolyn Brown (Convenor scotPAG.com)