Mick Hartley

An American "gender-affirming" surgeon, Karla Solheim, begins to have doubts. Gosh golly, have I been doing the right thing here? Paragraph after paragraph of wide-eyed innocence as she happily mutilates "gender dysphoric" young people – girls wanting to be boys – and then starts wondering if, as a doctor ("first, do no harm"), she should really be removing body parts from healthy young people.

I performed my first gender-affirming hysterectomy with pride. It was 2019, and I was delighted to be my local LGBT clinic’s official gynaecologist. There is, after all, no greater joy in medicine than providing great care to a vulnerable, under-served community in Iowa. This was, I felt, how the world should be.

Six years later, I’m not so sure.

Hmm. It's a bit late to start having second thoughts, isn't it? 

In 2019, I took a job as an Obs and Gyny doctor at a nonprofit in Iowa, after my private practice went out of business. I had a wife, twins in preschool, and a toddler. And, after working for a Catholic organisation previously, I loved the progressive policies of my new employer. They provided medical transition services for transgender patients and even sponsored an out-of-hours LGBT clinic for patients who might not have felt comfortable in a mainstream doctor’s office. I was at the clinic, enthusiastically, once a month to provide my expertise.

I was quite surprised, though, that the clinic seemed almost exclusively T, without much LGB. Call me naive, but for the past decade, I had my head down: training, getting married, having kids and starting my practice. And by the time I looked up, the LGBT world was very different from the last time I had really been around other gay people.

I also had some uncomfortable questions: hadn’t we learned in medical school that most paediatric gender dysphoria resolves by adulthood? If so, did it make sense for young adolescents to transition to the opposite sex? Was it really plausible that transgender female athletes didn’t have a biological advantage over natal females? The accepted answers seemed counterintuitive to me. Nonetheless, I was on board….

But as the years went by, I couldn’t help but notice some troubling trends. The trans patients who came to me had more and more mental health complications….

I began to feel more uneasy that hysterectomy — surgery that carries numerous surgical risks, and results in irrevocable lifelong infertility — was necessarily the right thing for this new group of trans patients. But if they didn’t have any contraindications per se, I couldn’t really say no. After all, according to the American College of Obstetricians and Gynecologists, a hysterectomy is “medically necessary for patients with gender dysphoria who desire this procedure”….

Still wondering how best to take care of my patients, I went on a private online forum for O&G doctors to ask about how others addressed nonbinary individuals who requested gender affirming hysterectomy. I was told my question was “transphobic”. I was told that the surgery was “life saving” (presumably due to the suicidality brought on by the presence of one’s natal uterus).

This didn’t sit well with me. I wondered about one of my patients, who had detransitioned just a few years after her hysterectomy. Conventional wisdom said detransition almost never happened; that the rate was just 1%. Well, I certainly hadn’t done a hundred hysterectomies for gender affirmation. So what was going on here?

And so on. It's a tough read, but I suppose it's a welcome sign of the times that someone so clearly unsuited to a rebel role – someone who has always happily followed the party line and is dedicated to her career and to her patients – is now beginning to see the light. Things have got so bad in "gender-affirming care" in the US that even someone like Karla Solheim here feels compelled to speak out.

I had just assumed the experts crafting guidelines were ensuring that there was a body of evidence supporting the incontrovertible long-term benefits for these extraordinary treatments that were being performed on young people: puberty blockers, cross-sex hormones, and double mastectomy.

But you assumed wrong.