Same, I imagine there is a huge gap between what the surgery for a male looks like vs a pooner, they must be 100% lying that this is what they do for men whose dicks fall off. I'd really like to see some kind of informed study comparing the results but I don't know how common it is for men to get their bait and tackle fully ripped off these days to the point of needing the same level of full reconstruction of the organ. Definitely would like to see comparisons between flat chested mastectomies and zippertit surgeries as well.
I'd say I'd like to see the same for stinkditches but to my knowledge nobody has ever had to perform an operation like that on a natal woman? I'm trying to think of a situation where it would be medically necessary but all I'm coming up with is either an intersex condition or maybe a horrific full body burn?
I saw a study about phalloplasy for cis men.
It was, sadly, just as shitty of a surgery and none of the men were happy with the results.
All but one required extensive therapy in order to be able to even live with the results, even though their natal anatomy meant they didn't have as many urinary issues as pooners.
One couldn't accept it even then, turns out, he was a black man given a white penis!
The one who didn't need therapy to accept his dick?
That was because, before therapy was even offered, he had it removed after many complications when his wife refused to have anything to do with it.
Then he committed suicide.
What you are describing is outcomes research on the first few penis transplants, not phalloplasties. This is a completely different surgery involving a graft of a donor organ from a cadaver versus a phalloplasty, which is novel construction using autografting (tissue from the patient's own body).
Penis transplants are very new, for men only, and can't currently be performed in women. I believe fewer than ten have currently been done. In the future when the techniques are more stabilized, transplantation may offer better outcomes for men who lose their penises than phalloplasty currently can (including natural erections), but transplantation of donor organs includes an additional wide variety of psychological and immunological components that aren't relevant to trans-identified women/phalloplasty. I'm mildly concerned about the day these people start experimenting with donor implants in women -which is surely coming sooner than the day we'll see uterine implants in men -but thank god it's not currently a thing.
On the last episode that MissionApplication97starred in, he robbed many a man, woman and child of their belief in a benevolent higher power when he filmed himself... "squirting."
'm mildly concerned about the day these people start experimenting with donor implants in women -which is surely coming sooner than the day we'll see uterine implants in men -
You'd want to make an attachment point first, yeah. Probably by using a hot glue gun to melt down a part of it and add some glue on their for stability. Once you have a landing point that is melted shut, you can just kachunk and enjoy.
What you are describing is outcomes research on the first few penis transplants, not phalloplasties. This is a completely different surgery involving a graft of a donor organ from a cadaver versus a phalloplasty, which is novel construction using autografting (tissue from the patient's own body).
Penis transplants are very new, for men only, and can't currently be performed in women. I believe fewer than ten have currently been done. In the future when the techniques are more stabilized, transplantation may offer better outcomes for men who lose their penises than phalloplasty currently can (including natural erections), but transplantation of donor organs includes an additional wide variety of psychological and immunological components that aren't relevant to trans-identified women/phalloplasty. I'm mildly concerned about the day these people start experimenting with donor implants in women -which is surely coming sooner than the day we'll see uterine implants in men -but thank god it's not currently a thing.
Update on Cid the stinkditch sub and his dom Volo (Steelepups)
Cid is still very content with his decision to have a vaginoplasty. This is the most recent result pic after having a revision done last September.
He's happy to answer questions about his ditch and show it in use.
Cid now prefers ditch sex over anal and it appears his other gay male sex partners are also loving the 'pussy'.
Other men who want to have a vaginoplasty now see Cid as a source of inspiration. Reminder that it's the guidelines of those fetishists at WPATH that make health care providers OK even crazy 'gender affirming' operations like this one.
He does, however, debunk the idea of 'girl orgasms'.
Speaking of orgasms, Cid also posted a video to demonstrate he can still cum out of his hole
Cid is hoping to start making porn soon. He would use that extra money to get a beard transplant.
But first he has yet another surgery coming up to further expand the ditch.
Cid is also an autist, which might (partly) be the source of his dysphoric feelings.
Meanwhile, Volo recently had a type of 'gender affirming' surgery himself: he's had a penis pump installed to resolve his erectile dysfunction. During the recovery period he had to walk around with his penis pumped up for weeks, without being able to use it for sex.
Here's a pic of Volo with his dick sticking out of bandages one day post-op, while Cid "dilates his beautiful pussy"
Volo also made a video talking about his implant, showing where the pump is. He'll post a pumping demo later.
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If there is any evidence that sexual perversion is almost completely psychosexual and has nothing to do with your bits or hormones a lot of the time to me it's those two. Neither of their genitals function properly and one of them is entirely castrated and yet they want surgical interventions to simulate how men and women are supposed to fit together.
Update on Cid the stinkditch sub and his dom Volo (Steelepups)
Cid is still very content with his decision to have a vaginoplasty. This is the most recent result pic after having a revision done last September.
To be fair, a lot of gay and lesbian communities have had it with troons and that is why they are becoming increasingly vocal about "LGB without the T".
If Troons and Pooners weren't such performative lunatics, fags and lesbians would still be supporting them. The ONLY reason they are now pretending to not agree with them is because Troon/Pooner behaviour is so outrageous that even Normies who were browbeaten into Supporting Gay Marriage are starting to ask questions, and the Pedogays are worried that they might lose their access to vulnerable children again if society wakes up to what they're really about.
Anyway, here we see the latest in "propatranda":
"I was having a sexual relationship with this man for months, and I just found out he's actually a woman!!!"
This obviously never happened.
Tara the Trandroid: after getting the bones his face pummeled in the hopes of turning into a Disney princess, a tranny actually winds up looking far more like the spooky animatronic from notorious surrealist video I Feel Fantastic, down to the eerie emptiness in his eyes. JoyNola (Dr. Weinfeld; facial feminization surgery (FFS)) Link | Archive
I had FFS with Dr Weinfeld in Austin on Jan 16th. I’m so happy with the results! Procedures: Type 3 cranioplasty(coronal incision), orbital reduction, brow lift, rhinoplasty, lip lift, genioplasty osteotomy with plates. We talked about face/neck lift at some point, but that is more about looking a lil younger. Just some quick before/after photos. I threw in a couple with wig/makeup, but I’m actually really happy being out and about with just a scarf head cover.
This troon, however, is not feeling so fantastic after his FFS as he reports being left with alleged "structural disfigurement" - and to make matters worse, the butcher who botched him appears to have gone ghost to escape retribution, forcing OP to seek a revision from a different surgeon completely. Without before pictures, it's hard to tell exactly whether he's fucked up or just kind of ugly, but given that FFS is a scam in general it's hard to feel much sympathy for a fool and his money being parted. Used-Meaning6857 (Dr. Artur Fahradyan; facial feminization surgery (FFS)) Link | Archive
I am posting this to provide a detailed warning for anyone considering Dr. Artur Fahradyan in Ventura/Thousand Oaks for FFS. At 7 months post-op (July 2025), I am left with a face that I believe is structurally disfigured and a surgeon who has completely abandoned my care.
The "Hostile" Pre-Op Environment:
On the morning of my surgery, my plane was delayed. When I arrived, Dr. Fahradyan was visibly angry and acted with total hostility toward me. I felt extremely vulnerable and terrified, but because I had already paid and flown in, I felt I had no choice but to proceed. He never explained the procedures in detail, and I now believe he took advantage of my desperation.
Alleged Non-Consensual Procedures (Cheeks):
Since surgery, my cheeks have become significantly fuller in a way that looks unnatural. I explicitly told him I did not want fat grafting, yet my face suggests otherwise. Despite repeated requests for my surgical log, the office refuses to provide the "list" of what was actually done to me. I suspect he performed procedures I specifically declined.
Visual and Structural Disfigurement (See Photos):
• The "Witch’s Chin": My mentalis muscle appears to have been detached and never re-anchored. This has caused severe soft-tissue sagging (ptosis) that makes my profile look "hooked" and aged.
• The Jaw "Step-Off": There is a sharp, jagged bone ledge where the jaw was cut. It was not smoothed down, leaving my jawline looking like a "shelf." This is, in my opinion, an objective disfigurement.
• A Proven Pattern: I have spoken to other patients of his who have the exact same ledge and sagging. This confirms that these results are not a "healing anomaly" but a signature of his surgical technique.
Patient Abandonment & Ghosting (I Have Receipts):
I have not had a single follow-up appointment. I have text receipts begging his staff (Jenny) for help with employment paperwork so I wouldn't lose my job. I have been met with total silence since November. I have been left to deal with a potentially botched recovery with zero medical guidance from the person who performed the surgery.
In my opinion, Dr. Fahradyan is a surgeon who lacks basic professional empathy and produces results that I consider structurally unsound. I am now seeking a revision specialist in Houston, TX to fix what he has done.
Another patient of Dr. Fahradyan also mentions the doctor's uniquely lacking bedside manner, though this one wisely went with getting some extremely stupid boob implants rather than getting his face hacked up. Still, between the face on the previous troon and the tits on this one, one thing is quite evident: Dr. Fahradyan is dipping his pen in many inkwells, likely in the hopes of making bank off of the transgender populace while it is still legal to do so. Careful not to become the Butcher of Rochester like your colleague Dr. Rumer, bud! AlyssaCGillespie (Dr. Artur Fahradyan; breast augmentation) Link | Archive
265cc both breasts by Dr Fahradyan at Rochester MN Mayo
There was "slight" hematoma in my left breast. Has gone away. I'm mostly satisfied with a few small nitpicks. Dr. Fahradyan seemed very distant and didn't really consult me on sizes. During my final consultation he came and basically said "okay we're gonna order these three sizes and try to get you as big as we can. When I told him a cup size he said it probably wasnt possible and misjudged me at the time as an A cup.
I understand that cup sizes are not normally how most surgeons will discuss sizes for implants but I did not feel very listened to. Was basically my only option with insurance though so I went through with it.
Tldr: I have nitpicks but am ultimately satisfied with the result. Doctor wasn't very communicative.
Speaking of top surgeries, this TiF's scars have healed over quite well compared to many other results (as her scars are quite pale and thin instead of red and ropey), but there's just one little problem: her surgeon left behind some of her areola, leading her chest to have two funny little brown spots where her breasts once sat naturally. This one is actually quite interesting if just to see the comparison of the free nipple grafts to the original color of her nipples, which makes the new nips look bloodless and dead. Creepy! Legitimate-Fox8514 (Dr. Chun Hyoung Rhim; bilateral cosmetic mastectomy) Link | Archive
So I got top surgery 3 and half years ago and I've had this discoloration under my nipples. It's definitely gotten smaller over the years and it's pretty soft and sensitive but it doesn't hurt and was wondering is this really normal? or like does anyone else have this even after years of having surgery?
Un-fourchette-nate: alt_account_1741 returns to give us an update on the manhole carved into him by Dr. Brassard of GRS Montreal and even after close to two months post-op, the area beneath his horror-pit still seems raw, bloody and exposed. But hey, it's fine because OP is the only one concerned about it. Has anyone noticed how unflappable and apathetic SRS surgeons tend to be? I know surgeons often skew more insensitive, but gender surgeons in particular seem downright soulless. Last Post Link | Archive
Winter_Hovercraft163 is back to put her ignorance on full display as she isn't sure whether her monstrous genital set-up is quite accurate to real male anatomy. I think if you're going to have your crotch pureed into a mutilated mimicry of man-meat, you should - at the very least - know what actual men look like before going under the knife. But that runs the risk of taking precious yacht money from starving surgeons, and we can't have that, now can we? Last Post Link | Archive
Hey! Looking for some advice on positioning, because things feel off, but I’m not educated enough on anatomy to know what exactly is wrong. I know the phallo is definitely way too high up and I’m hoping it’ll be lowered in the future, but I’m wondering if things are also off with the scrotum? Is it way too low? I haven’t gotten implants yet, but if it is too low, is there usually any way to move it up?
Or does the positioning look fine as is? I’m not sure how things will work out when burial happens, but I assume the phallo would be placed right over the meta site? In that case, is the scrotoplasty positioning fine?
Now for our stories.
Pagliacci of pronouns Veinscrawler has decided that the warzone that lurks beneath his waistband was not enough of an indignity to suffer and is now hopeful about getting his rib cage wham-bam-thank-you-it's-ma'am'd into a more feminine shape, which is probably some form of copium as his plans with Dr. Alford are completely dead in the water due to issues in the doctor's personal life forcing her to take leave. I suppose if you're already suffering from horrible chronic pain all the time, I can see the logic in going "Fuck it, just bulldoze every bone in my beleagured body!"; it's not as if he's ever going to feel comfortable in his skin ever again, so might as well use the pitiful sod as a guinea pig. Last Post Link | Archive
I’m very aware that the general medical consensus on reducing rib cage width is that it is impossible. I’m asking if there is any, literally any, example of a surgical method that could hypothetically reduce the width of a person’s upper ribcage.
I don’t care if it would be life-threatening or carry a high risk of long-term complications. I’m already planning to have clavicle reduction surgery and my lowermost 2-4 ribs removed, and pretty much any other invasive surgery I can get that doesn’t involve the addition of lots of hardware. And I’m already dealing with long-term complications from other surgeries I’ve had in the past.
I would very much appreciate a lack of any responses to the effect of “it’s not reasonable or healthy to seek out extreme surgeries like these” because I genuinely don’t care what other people think about it. I’m not willing to live in my current body indefinitely. I’ve tried it for over 15 years already, and I can’t stand being miserable with no end in sight any longer. I’d genuinely rather take the chance of dying on an operating table than continue living like this.
Things have been rather tumultuous for this MTF after allowing controversial surgeon Dr. Stiller turn part of his colon into a psuedopussy, with complications ranging from minor prolapsing and pelvic floor tightness to literally being unable to expel leftover water from his fauxgina which can apparently have some odoriferous effects. But back in October, he insisted that he had absolutely no regrets, so we'll see if this bird changes his tune over time... WitchChemistry (Dr. Geoffrey Stiller; colovaginoplasty) Link | Archive
For relevance to this, I had colovaginoplasty a year ago.
I've run into a new experience after hitting my 1 year out from surgery. I dilate and douche once a week now. I get intense pelvic muscle spasms during dilation that are so strong that they make my vaginal tissue bleed slightly. I am unsure what to do about this. Perhaps dilate more but for shorter periods? The pelvic floor muscle spasms only seems to start about 15 minutes into dilating and I am supposed to do it for 30 minutes. A side effect of this is that when I douche afterwards my pelvic floor is still contracting to an extreme degree. It even traps some of the water I use to douche up inside me for ~20 or 30 minutes. Eventually my pelvic floor relaxes and it all comes out at once. Not very convenient or fun. I am looking into pelvic floor physical therapy but honestly my experience has been so fraught with challenges that it is difficult to be optimistic.
Has anyone else experienced pelvic floor difficulties to this extreme degree?
Lastly, a rapist in the making is curious to hear from other consent accident-prone casanovettes about whether her fantasies of keeping her vaginal canal intact while simultaneously getting a phalloplasty are realistic; many doodz try to warn her away from being dishonest as it could get her in legal trouble, but our horny heroine remains steadfast in her desire to assault men without their knowledge. The reason she's so determined to deceive? "I just want to have sex like a normal gay dude which is impossible now even with the most well intentioned guys," she writes, as if being clueless and insensitive is somehow deserving of rape. You do not hate these people enough! jmh1881v2 (future phalloplasty) Link | Archive
Just something I’ve wondered. I’ve heard of trans guys going stealth during hookups post op. I don’t plan to get a vnectomy because I like to use it for bottoming and it doesn’t cause my any dysphoria. But I’m wondering if it’s possible to go stealth while topping?
My surgery is scheduled for next year, and honestly I’m just so sick of guys treating me differently for being trans. I just want to have sex like a normal guy
Before I say anything else, I want to be extremely clear that I am **only looking to chat with people who are 100% post op who have attempted to go stealth.** I posted a similar questions yesterday and the thread just ended up devolving into a discussion about why I shouldn’t go stealth. I appreciate that everyone has their own opinions but at the end of the day this is my life and I am capable of making my own choices, and I would appreciate if everyone here could respect that. Anyone who tries to argue with me about the morality of going stealth will be blocked.
With that said-
I have surgery planned for next year. I plan to get medical tattooing and an ED, but as of now am planning not get a vaginectomy though I’m still debating that. I’m mostly trying to gauge how possible it is to go stealth during hookups and if anyone has done so successfully. I’d like to experience sex as a normal, cis guy at least once without all of the noise and ignorance that I deal with now. So, if anyone has done this successfully I’d love to chat, especially anyone without vnectomy
Don't encourage them. You ever hear the Internet urban legend of the doll maker who would take little girls from Eastern European orphanages, chop their arms and legs off and turn them into sex dolls? That's definitely someone's fetish and I absolutely believe someone who would cut their dick off would do that.
That Doesn't Happen! (Or: Queensland proves the accusations to be true) Context
In January 2025, the director-general of Queensland Health issued a directive banning doctors from prescribing puberty blockers and hormones to new child patients with gender dysphoria.
A mother of a 14-year-old trans-identified child took a case to the Supreme Court on the basis that correct processes had not been followed to make the directive. The directive was overturned in late October; the health minister issued a new directive six hours later to reinstate the freeze.
*Note that page numbers equate to the PDF page number, and not the report itself.
Acronym dictionary:
PB = puberty blockers
GAHT = gender affirming hormone therapy
TGD = trans and gender diverse
QCGS = Queensland Children's Gender Service
While the major reviews have generally found the evidence base is insufficient or inconclusive, each of those reviews has also been criticised. Critics variously claim overstatement of benefit, overstatement of harm and selective presentation of the evidence. We have also noted that clarity of findings tends to be confounded by the conflation of evidence about risks and outcomes of PB, GAHT and other factors. This is seen, for example, in some of the narrative regarding suicide and mental health outcomes where there is a tendency towards overgeneralisation and simplification resulting in flawed conclusions about the relationship between treatment and outcomes.
Some underlying ethical principles are that medical treatment should be ‘evidence based’ and 'do no harm’. However, the application of those principles in this area is not straightforward. The evidence is not strong and is mixed. There is potential for harm both by prescribing and by not prescribing and those decisions are made in the context of a disputed area in healthcare with diverse, polarised, strong and variably informed views. [pg. 39]
The QCGS Service Evaluation described that QCGS's triage of new referrals as follows: (a) all Aboriginal and Torres Strait Islander referrals and referrals for those in out of home care and under the care of the Queensland Department of Child Safety are triaged as 'Category 1'; (b) referrals for pre-pubertal children are generally triaged as 'Category 3'; (c) all remaining referrals are placed as 'Category 2' or 'Category 3'. [pg. 65]
While beyond the scope of this Review to consider, the Work Instruction [what QCGS staff were given to follow] also addresses individualised assessments regarding chest reconstructive surgery, stating that such surgery may be in the best interest of an older adolescent in exceptional circumstances. [pg. 68]
Data provided to the Panel indicates that QCGS initiated PB in 117 patients in 2019 (median age 15 with ages ranging between 9 and 17). That number fell to 81 patients in 2022 (median age 13 with ages ranging between 9 and 17) and 24 in 2024 (median age 12 with ages ranging from 10 to 15 years). For GAHT, data provided to the Panel indicates that QCGS initiated 88 patients in 2019, 103 patients in 2022 and 85 patients in 2024 (median age in each of those years being 16 with ages ranging from 14 to 17 or 18 years). In each year for which the Panel was provided data, some patients who commenced GAHT had previously received PB and others had not. These numbers broadly reflect expected trends based on QCGS clinicians' descriptions of the way QCGS practice has evolved in recent years (such as the lowering median age for initiation of PB). [pg. 68]
from some parents, described feelings of grief or loss when their child persisted in their TGD identity, and that those parents did not feel their experience was recognised;
from some families, described feelings of concern that affirmation was seen as the inevitable and desired outcome, and that there was insufficient consideration of alternatives to PB and/or GAHT;
…others said it was not clear what the service would provide and felt that they were not welcome if they questioned the practitioners. Some family members, particularly parents, were concerned that there was immediate affirmation on arrival at the service, and that this potentially led to drivers of distress other than gender being overlooked;
from some service users, common reports that the assessment process was long and thorough, and from others who described an experience which they did not feel was sufficiently thorough in providing a genuine assessment;
from some service users, that the typically slow assessment process was an endorsement that the assessment of the young person and their family was thorough, though others considered it overly cautious;
varying accounts of collaboration of QCGS with external providers (including in the MDT context), including some private practitioners who reported frustration with poor or no communication or responsiveness to contact;
general agreement amongst all those consulted with that medical contraindications may exist that would preclude certain medical treatment pathways, with some agreement that there may be circumstances where a person is not psychologically ready for medical treatment. [pg. 69]
The Panel was informed that QCGS has not had the capacity to capture in an accessible/searchable way (other than individual entry into each patient's clinical notes) information such as:
(a) diagnoses of gender dysphoria;
(b) the medication or dosage prescribed or administered;
(c) observed or reported side effects and/or effectiveness of medications;
(d) the number of patients who undergo fertility preservation procedures;
(e) reason for discharge; and
(f) presence or absence of co-occurring conditions.
We note the absence of QCGS annual reporting on service activity, outcomes and safety and quality data. The impact of this absence is that the service does not know at any given time what its patient cohort looks like in detail. [pg. 70]
The Panel heard in consultation from some health practitioners, concerns about notifications (complaints) being made about them because they do or do not provide gender affirming care to young persons. [pg. 77]
Some submissions expressed a view that, if practitioners were mandated to adopt a gender affirming model of care prior to assessment, this could create tacit pressure to override personal clinical judgement or suppress genuine clinical exploration leading to moral distress for the practitioner, and potential misdiagnosis for the young person. Some practitioners working with TGD youth spoke about their experiences of professional and social attack. Others had been the subject of regulatory investigation, which caused deep personal and professional distress. [pg. 94]
views that a diagnosis is pathologising and a source of oppression, and that medicalisation of TGD identities is unnecessary and stigmatising;
that diagnosis is a barrier to access to treatment and should not be required to access GAHT treatments – some individuals reported that a desire for treatments of a child with agency is sufficient justification;
that adolescents can experience less dysphoria than required by the diagnostic criteria but still want and may benefit from PB and/or GAHT, and may be unfairly excluded from treatment in the public system if diagnosis is used as an essential criterion;
that diagnosis does not help to predict which adolescents will desist or detransition and the stability of diagnosis from adolescence to adulthood is unclear;
that a singular diagnosis can overshadow the complexity of an adolescent’s concurrent mental health conditions and/or psychosocial predicament;
concerns regarding whether diagnosis and treatment of gender dysphoria within a specialist gender service is the gateway to broader medical, psychiatric and social interventions and supports, is a one-stop shop or whether the adolescent should be accessing other services for issues other than their diagnosis of gender dysphoria;
that the possibility of future regret is, for some families, a lower concern when weighed with the short to medium term benefit they predict or have experienced.
Some families of individuals with lived experience described suicide risk as a lever aimed to coerce them into supporting PB and/or GAHT;
that information on social media had been helpful or harmful;
and from some, that social transition and support toward medical pathways had been supported by schools without parental knowledge or consent. [pg. 98-99]
Consistent with the literature, the Panel observed an extremely complex heterogeneous population, including a high correlation with ASD, Attention Deficit/Hyperactivity Disorder and generalised anxiety. While the reasons for this high correlation are complex and unclear, there has been an increase in the number of young people presenting with gender-related distress. Many of these people meet diagnostic criteria for gender dysphoria. It is also apparent that many have co-occurring mental health conditions that may also lead to distress and which may need treatment in their own right. [pg. 99]
In meetings with some parents, the Panel heard of the fears often held about their child’s potential suicide risk if the parent did not affirm the child's gender or if treatment for gender dysphoria did not proceed. The phrase "better a trans child than a dead child" was often stated to us. The Panel heard the view that not publicly providing PB and GAHT in Queensland hurts TGD children and there is not enough concern about the risk of denied treatment and its relationship to suicide. The Panel also heard perceptions that a coercive environment is created when unquestioning gender affirmation, with or without access to PB or GAHT, was expressly linked to reduced suicidality for young people experiencing gender-related distress. For some parents this was experienced as being placed under pressure to agree to treatment without experiencing fulsome assessment or consideration which shut down further genuine discussion. [pg. 101]
During consultation, the Panel heard concerns about online grooming of young people questioning their gender identity, especially via Reddit and YouTube, and how this led to some parents feeling marginalised, powerless and very concerned about their child’s wellbeing. This form of unquestioning online environment presents another barrier to exploring other or co-occurring issues or conditions. Some parents described feeling risk of being framed as transphobic and unsupportive if they appeared to disagree or want more information independent of what was online. [pg. 103]
from some parents, feelings that their child had 'learnt what to say’ and may appear informed but have a very limited concept of what they are requesting or agreeing to, especially in relation to long term impacts;
from some (and particularly from parents), that they must be fully informed of the risks associated with treatment to consent. Those advocating for an 'affirmative care' model claim that while parents should be informed, it is abusive for parents to forcefully revoke treatment [pg. 107]
Regarding the consent process, we were advised by QCGS that:
(a) when parents were ambivalent or against treatment, greater time and effort was made to provide relevant information and give time for these issues to be discussed;
(b) before a recommendation for PB or GAHT is made, there was a thorough assessment and consideration of other causes of distress. PB and/or GAHT were only considered when there was an established diagnosis of gender dysphoria. All other treatment options and interventions such as social transition, breast binding and menstrual suppression were expected to be considered;
(c) when there is disagreement between parents or between parent and child, every attempt was made to engage with all, to explain the risks and benefits and to allow time for questions to be asked and decisions to be made (although this was not the experience of some parents we heard from); and
(d) if the parent(s) did not agree to treatment, then treatment was delayed, and a decision to proceed with treatment was not made if the parent(s) were not in agreement. [pg. 118]
Are we done? No! Let’s dive into the Health Service Investigation report, which is a lovely 213 pages. Once again, page numbers relate to the PDF itself, not the document.
Acronym dictionary:
CSHS = Cairns Sexual Health Service
CHQHHS = Children's Health Queensland
PGHS = pediatric gender health service
The CSHS was treating clients under the age of 18 for gender dysphoria from at least 2008, and possibly earlier, as part of the adult Gender Health Service [services were delivered out of the same building with no separation between child and adult clients]. There was therefore no consultation with CHQHHS in relation to the commencement of services for paediatric gender clients. There was no formal approval process for the establishment of PGHS at CSHS. For most of the time of the PGHS’s existence, CHHHS, the Board and the CE did not have direct knowledge of the CSHS providing PGHS. There were no formal arrangements put in place for monitoring the PGHS following establishment, nor regular service evaluation, Chief Executive, Executive, or Board oversight. In summary, the PGHS at CSHS have been operating for over 20 years and were never formally established. As the service evolved gradually, it was not subject to the greater rigour and structured oversight of a newly implemented service. [pg. 6-7]
2016/17: Concerns were raised about walk-ins receiving gender-affirming treatment without a child psychiatrist’s diagnosis of gender dysphoria.
June 2018: The arrangement for [staff name redacted] to manage under 16s in conjunction with the statewide service and [staff name redacted] was not working. Issues included clients seen without full multidisciplinary consultation, no MDT, lack of communication, and under 16 seen at the CSHS due to walk-ins. [pg. 36]
2022: Requests for puberty blocking for under 14s by the CSHS – resulting in Individual Patient Approval and (October 2022) advice sought from QCGS.
2022-2023: The Director of Medical Services received approximately 3 to 4 Individual Patient Approval requests for puberty blockers; declined the request based on national guidance. [pg. 38]
2023: In early 2023, staff commenced reviewing younger clients through the CSHS (10 years of age and above). The QCGS was also referring patients with a management plan, to the CSHS for ongoing care and treatment.
May 2024: A clinician escalated to Executive an attempt by [staff name redacted] to prescribe Lucrin outside state guidelines. The Individual Patient Approval was refused by Pharmacy due to lack of an Multidisciplinary Team (MDT) and paediatric endocrinologist input. [pg. 39]
"I actually cannot remember when we started to see such young people”, one psychologist first encountered a transgender client under 18 in 2005. A poster presentation of “The 10 Year Evolution of Transgender Health Care in a Far North Queensland Sexual Health Service” included data showing an under 18 clients first presented in 2008. [pg. 50]
Age cut off for intake was unclear. It was reported that CSHS documentation described the service as accepting clients aged 10 and over. In ontrast, age ranges for treatment at QCGS are split into an over and under 15 pathway. The age range for referral in the CSHS flowchart for September 2024 was divided into over and under 14 years. [pg. 62]
The ASOCTG Version 1.3 requires MDT involvement in complex clinical decision making. For the 3 clients who received Stage 1 care (blockers) through CSHS in the Clinical Review period, there was no documentation that an MDT took place. For 17 clients commenced on GAHT, there was no documentation of an MDT for 15 cases. Case conferences were sometimes referred to as MDTs in notes but did not meet the ASOCTG standard. In some client cases, there was minimal documented MDT input prior to puberty blocker initiation, no case conference or MDT consensus before treatment, and significant concerns raised at MDTs in late 2024, after treatment had begun. [pg. 69]
In late January 2025, the CHHHS had difficulty in identifying all current children and young people receiving PGHS under the care of the CSHS, due to limited reporting available through the RIVeR system [patient management system]. There was uncertainty about the number of under 18 gender patients, with systems and records unclear, leading to difficulty in identifying who was on the books and their treatment status. To identify the Clinical Review patient cohort, the CHHHS had to extract and match data from a range of systems including the iPharmacy system. Assistance was required from multiple staff to identify paediatric clients, as information was spread across different spreadsheets. The CHHHS initially identified a total of 23 clients, but later CHHHS and the Clinical Reviewers identified further clients during the review. [pg. 77]
One clinician noted that scope for GPs in CSHS does not mention paediatrics. Another clinician noted that sexual health work is often with adolescents, as this is appropriate for issues such as contraception. But they reflected that it was 'embarrassing' to realise they were operating outside their scope of practice in treating paediatric patients for gender dysphoria. [pg. 84]
Doctors occasionally listed themselves as approvers for medications, when 2-step approval was actually required. This approval step could be missed. [pg. 85]
In 2024, none of the CSHS doctors (including Staff ) had a scope of practice that specified assessment and treatment of gender diverse children and adolescents. Several doctors fit the description of “specialist medical prescriber” and could write continuation scripts. [pg. 86]
One doctor at the CSHS expected to focus on reproductive health training but discovered within the first weeks that assessing young people under 18 for gender-related care was part of their role. They reported that this expectation differed from prior experience, where care of minors was consultant-led and registrars were not involved.
One CSHS doctor stated that their training and supervision were limited, with significant periods where they were the only doctor on site, supported only by an intern. They described their scope of practice as adult medicine and noted: “What are you doing assessing 14-year-olds?”
The reviewers noted that registrars and interns interacted with clients under limited supervision by and that the seniority of medical input was not appropriate. They reported feeling professionally isolated and pressured to take on consultant-level responsibilities before being ready, particularly after completing exams in mid-2024. From 2020 registrars were mainly assessing new clients, which a senior doctor noted “is not appropriate or good.”
The gender clinic was led by the registrars not the consultants. Registrars reported that they had to be assertive about not seeing under 18s on their own and insisting on a consultant presence. Prior to 2025, training pathways and supervision processes for registrars in relation to paediatric gender care were not structured or well documented. Registrars often relied on senior clinicians’ advice rather than written guidelines, with limited documentation of governance processes. Registrar supervision was identified as a risk, with registrars working in the area without adequate oversight. [pg. 90-91]
Training was largely “learned on the job” and through consultation and supervision from the QCGS, as well as conferences and quarterly education sessions. [pg. 95]
In 2018 there were anecdotal reports from senior medical staff regarding misdiagnosis of patients with gender dysphoria when they had mental health conditions, and comments suggesting non-adherence to guidelines. Instead of triggering closer scrutiny of adherence to guidelines, the issue wasn’t followed up. [pg. 105]
Incident reporting was limited and not systematically used for learning. There was no consistent monitoring of clinical outcomes, adverse events, or evaluation of service performance. Routine audits were poorly completed and this was not addressed. Quality improvement systems and risk management structures were either absent or inconsistently applied. Staff reported that complaints, adverse events, and risks were not reviewed within a formal governance framework. [pg. 139]
There was no culture of data reporting for the PGHS. Clinical indicators, outcome measures, and key performance data were not collected for much of the service’s operation, with only activity data monitored. Compliance with guidelines was not verified, and critical monitoring requirements such as bone density testing and parental involvement were missed. Adherence to best practice relied on informal practices and individual clinician discretion rather than systematic oversight. Patient reported outcome measures were used primarily for assessment rather than outcome evaluation. [pg. 139]
Stage 2 Care (Gender Affirming Hormone Treatment)
There were 32 clients contained in this cohort. Of these clients, 17 were commenced on GAHT by CSHS. The average age at commencement of GAHT was 15.5 years.
Notably, [redacted number] clients commenced GAHT at 14 years of age. According to international standards, initiating GAHT before 16 years is generally reserved for exceptional circumstances. On review, these cases did not present factors that would constitute exceptional circumstances as per the guidelines.
For the 17 clients that were commenced GAHT:
- Of the 17 clients that were clinically assessed, 12 did not have appropriate clinical assessment including Tanner staging.
- Of the 17 clients that required psychometric testing there was no documentation of this having occurred in 3 cases.
- Of the 17 clients that required investigation prior to treatments commencing, 3 clients did not have this completed.
- Of the 17 clients whose care should have been considered at an MDT, this did not happen for 15 of the clients.
- Of the 17 clients that should have been referred for fertility counselling, 7 were not documented as being referred.
- Of the 17 clients that consented to treatment, 12 were not consented correctly.
- Of the 13 clients that required a Gillick competency assessment, this was not undertaken correctly and in an acceptable manner for 9 clients.
- Of the 17 clients that required ongoing surveillance monitoring, 12 clients did not have follow-up as per the standard.
- Of the 17 clients where correspondence to stakeholders was considered important, this was considered insufficient in 16 cases.
With respect to holistic care for 17 clients who received GAHT:
- 7 did not have documentation of receiving advice in relation to the impact of medical interventions.
- 11 did not have documentation of receiving advice in relation to surgical interventions.
- 7 did not have documentation of being provided with education regarding gender identity, local supports for young people, siblings and parents.
- 13 did not have documentation of being provided with support or documentation to assist the client to change identity documents.
- 9 did not have documentation of being provided with education to enable the client and family to make informed decisions.
- 12 did not have documentation as being advised on, or referred, for speech therapy support. [pg. 155-156]
A review in December 2024 of 17 patient records showed major deficiencies, including incomplete clinical notes, missing baseline tests, absence of consent documentation, long prescription intervals, and lack of paediatric or mental health input.
Some children as young as 12 were commenced on puberty blockers, with others on testosterone, without adequate documentation of assessments or monitoring. There was little evidence of consistent documentation of Gillick competence assessments in 2024; in many cases they were either not done or not recorded. [pg. 161]
When questioned about best practice guidelines followed in this period, some staff emphasised that “each person’s gender journey was their own” and there was no right or wrong pathway. Individualised care is critical, however this approach failed to recognise that certain steps in a pathway are mandatory in order to ensure effective, appropriate and safe care. [pg. 173]
One CHHHS staff member noted that there were informal complaints made by patients who felt pressured to join trans support groups. These were not on the records reviewed. Another staff member noted that parents who objected to aspects of care had their concerns dismissed, contributing to complaints. “I don't know the details of them, but you know, I would imagine they're valid complaints because one of the issues with the culture was that if a parent had any objection related to their diagnosis of gender dysphoria or the pathway towards puberty blockers, they were basically alienated."
The DMS became aware of complaints only after November 2024, including that parents were not consulted in treatment decisions or felt dismissed by the team. Two parents contacted the service in December 2024 with complaints, including concerns about inadequate assessment and exclusion from care processes. Parents reported concerns that their children, who had multiple mental health conditions, were assessed as Gillick competent without adequate safeguards, and those who questioned care were labelled “aggressive” in records despite correspondence showing otherwise. The Chief Executive observed that the service had “pushed patients’ families away,” raising questions about whether decisions were driven more by a philosophical than a clinical approach. [pg. 183]
And after all of this, the push for Queensland to unfreeze services continues. The failure of health professionals to the nation's children should be indictable, and yet...
WARNING: Botched FFS & Patient Abandonment – Dr. Artur Fahradyan (Ventura, CA) – My Experience with Disfigurement and Potential Non-Consensual Surgery
