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PS if you like him, try to communicate, as much as it is possible with a boomer, how utterly frivolous he is being with his career in speaking as openly as he has with you unless you are quite certain he is knowingly lowering his guard with extreme discretion specifically for you. Doctors aged 40+ don't seem to be aware that their workplace is a minefield rigged to the detection of the subtlest offence, and he would do well to be reminded that quite aside from breaching the important principle that his life should be a total enigma to you (younger ones disagree for the obvious bullshit culture war adjacent reasons) ... let's be honest, one doesn't arrive on the couch by way of a history of probity and good decision-making. I have had two incidents in the last year where I have needed to put myself at some risk to protect two psychs from the consequences of their own obliviousness to running their mouths.
I don't know much about surgery but just from what I have heard of the sheer novelty of methods of neovaginoplasty etc. versus the very well and time-attested, dutifully and comprehensively achieved methods of best practice sequentially arrived at over the decades that one sees in a textbook for, say, removing an appendix ... Well, I guess I respect the creative urge, it's not a spark that exactly sets aflame the soul of the commonest among us, but by goodness isn't there something that can be done whose effect is not so utterly ghoulish? Some of the latest examples of sculpture I have seen around my city are rather striking and as an artistic and aesthetic endeavour I think as an art form has a lot to recommend it, and I'll even admit to buying a few of those oddities made with trash embedded in plaster like a bottle forming a nose or whatever and so on and I'll even be so generous as to accept such efforts as something of a statement on environmentalism and consumerism - I feel like I am showing some serious broadness of mind here! -- and certainly painting is just a lovely pastime even if the skills required put it out of the reach of most even at a hobbyist level. But I must with all respect draw the line at the recreational destruction of genitals, even if the state of surgery was as staggeringly advanced as some suppose it to be, and each practitioner wasn't in fact more or less an inventor and kit-basher than stolid technician. (Seriously, even if I were in 100 percent agreement that every penis be flayed, every tit suppressed, there is a staggering legal liability that exists due to the total lack of professional consensus on standards of care, procedure, etc. It is too enormous a risk to survive more than a few more legal challenges regardless of how much goodwill or pity that community has somehow cultivated, or the seeming total commitment of practitioners to often knowingly break the law and/or support utterly unrestricted bodily autonomy (though after a thorough maiming the pharmacotherapy will consist of paracetamol and maybe if lucky 5 mg oxycodone here and there under nursing observation of unusual agony only -- arguments about bodily autonomy are so trite now that the genitals are safely binned and a butchers bill rendered and posted, indeed so well formatted too with such seemingly concern for aftercare and side effects that one might almost think one was the recipient of something akin to a medical procedure, which I might boldly describe as a type of procedure, for a medical benefit). Traditionally also trans patients are both simultaneously suicidally depressed and in a euphoria of trembling adoration of their gorgeous even if literally anatomically indescribable results, and the hug box closes like a crab pot upon personal criticisms ("I know that we're all built different ... But I'm investigating before and after photos and adjusting to the possibility that my new clitoris is the remainder of my glans. Not that it matters as it has departed on its own accord as it was increasingly necrotic from lack of blood supply in any case. Totally normal, right girls?") Autism often comes with severe deficits in the ability to recognise faces, features, etc. It is not associated as far as I know with great experience of personal intimacy. Add in a dash of a few personality disorders, and apparently a vagina and a vulture-gored sheep carcass are basically physically approximate. You are also well forewarned that you will lose your community if you happen to notice differently, or complain about even the most egregious butchery as to do so risks lowering the numbers of willing quacks and thus is equated to attempted murder (the suicide threat is the lifeblood of the transperson) upon those whose genitals remain of the tedious non-puzzle variety. So it is a field where incompetence is routine and unpunished, the victims are literally perceptually and otherwise impaired to the extent of being unable to notice the horrors committed upon them, and no standards of widely recognised surgical competency exist in any event.
I would have expected the racket to survive at least as long as the lobotomy, and I think it would have but for the politicisation of topics too extreme for most people to contemplate without abhorrence, e.g. children, sports etc. After all, wanting one's penis removed would at the very least seem to be prima facie evidence of a very serious issue. And it is, but it's not got anything to do with boys brains and girls brains being mixed up in some cosmic oopsie, but for the most part reflects the well known aspect of male sexuality to develop fetishes for content occurring in the context of an orgasm, and the heightening extremities one seeks on embarking upon the hedonic treadmill. I don't quite get the logic of being intensely aroused and so much so that one wants to heighten that by losing the source of the ability to be and exercise arousal, but that's the vast majority of the men in a nutshell, vociferously denied because it is tawdry and unspecial, not even a soul was swapped. I think the legal problems for practitioners will be based on complaints from girls, because their behaviour, while bearing superficial similarities, is more of the adolescent identity crisis/"one answer to every problem" type so much more transitory.
This is based on my observations and experiences but I have no training in any of the above. But I have not heard alternate ideas that explain reality nearly as closely.
He's well aware. I've been seeing him for a long, long time, and he trusts me somewhat at this point.
When he's going to talk about something that he knows could get him in trouble, he says it in a way that I know he's saying it against his better judgement. But he isn't telling this to most patients, he's told me that he knows he can't say this stuff with most of his patients.
But he has a history with heterodox stuff, and I think he likes it.
In the beginning he didn't tell me this kind of stuff, and he didn't share much about himself. But I think he ditched the typical psych stance because he thought he could better reach me by being more honest. And I think that was the right call, it's a large part of why I feel I can trust him
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