66 - The Realities of Surgical Procedures on Those With Gender Confusion

On Feb. 5th, R4R covered the groundbreaking news that the American Society of Plastic Surgeons (ASPS) and the American Medical Association (AMA) are no longer recommending surgical procedures for minors in an effort to resolve their confusion or insecurity about their gender.

Sadly, some individuals remain convinced that these procedures are helpful and even needed, without fully understanding the risks and limitations involved in these surgeries. This edition of R4R covers a talk which may be prove helpful to those who are disappointed by the change of course by the ASPS and AMA.

On Dec 20, 2025, Genspect posted a video featuring Dr Patrick Lappert, a plastic surgeon with over 40 years of experience and a Christian[1], who presented on “Informed Consent: The Impact of Transition Surgery.” In this talk, Dr. Lappert examines what “informed consent” should mean versus how it is practiced in gender-affirmation surgery. He argues that current practices fail ethical, medical, and evidentiary standards, particularly for young or psychologically vulnerable patients. He also notes that what can be constructed in these surgeries is a far cry from what many believe is possible, leading to loss of function and many complications.

“Informed” Consent

Dr. Lappert points out that families are pressured with exaggerated suicide statistics and moral urgency to allow their children to proceed with surgery in an attempt to “treat” distress over their gender. Yet obtaining consent under duress “is invalid.” He also states, “If your claim is that you’re doing the surgery to prevent suicide, by definition, a person who is suicidal is incompetent to give consent.” One needs to be capable of thinking through the risks, limitations, and long-term consequences of going through these surgeries before one can provide consent. Dr. Lappert also said of the “affirmation-only” approach: “This is fraudulent behavior. It’s an intentional concealment of alternatives of care.”

Principles of Plastic Surgery

Dr. Lappert outlines the difference between reconstructive and cosmetic surgery. Cosmetic surgery is aimed at enhancing one’s appearance, focused on aesthetics, with no impact on function. In contrast, “Reconstructive surgery begins by defining a defect. In the case of ‘affirmation surgery,’ your first step is an intentional mutilation.” Acknowledging mutilation to be a strong term, Dr. Lappert notes that causing a loss in structure and function is consistent with the use of that word. “The patient arrives in the operating room whole. That person is whole, fully functional. …You caused the loss. Now you’ve got a reconstruction to do.” So plastic surgeons practicing “gender affirmation surgeries” are causing problems rather than resolving them.

Poor Surgical Outcomes

This may be difficult for some to hear, but Dr. Lappert describes the best these procedures can offer is “counterfeit” organs. For women wishing to appear to be men:

· “When you do a phalloplasty, you’re not creating a functioning penis.”

· “You’re creating a cylinder of flesh through which urine is conducted.”

· “It’s basically an elegant urostomy.”

· “Meanwhile, the public thinks we’re creating fully functional penises, which is obviously not the case.”

And for men wishing to appear to be women:

· “That’s not a vagina. It’s not a reproductive organ. It’s basically just a wound that’s lined with living tissue.”

· Due to the proximity of the urethra and the anus, “Both urinary and fecal fistulas are well reported in these constructs.”

These procedures cut nerves that eliminate future erotic sensation. At best, protective sensation is preserved, which helps the client recognize pain. There is also compromised blood flow to the tissue, leading to other complications, with chronic wounds being common.

Dr. Lappert has stark words also for the lack of evidence-based medicine behind these procedures:

· “All of what’s being offered to children and adults is experimental surgery by definition.”

· “There is no level three evidence. None.”

· “There is no validated test instrument in gender affirmation surgery.”

As well as a lack of a proper standard of care:

· “Claiming a standard of care is a misrepresentation of facts.”

· “It’s not a treatment guideline by definition. It’s not a standard of care by definition.”

· “They misrepresent the risk and they misrepresent the benefit.”

In 2023, R4R covered the lack of research behind the recommendations of WPATH – the self-proclaimed “World Professional Association for Transgender Health.” Their latest “Standard of Care” was released in 2022, and contained chapters of bizarre recommendations.[2] Many countries have become aware of the lack of evidence backing these experimental procedures, and have begun to outlaw them for use on children.[3]

True Treatment

The real problem with individuals who have distress about their appearance is not resolved through surgery. Speaking from his decades of experience as a plastic surgeon and a Christian, Dr. Lambert said:

· “Persons who seek surgery to change their appearance must be carefully examined for spiritual wounds.” (Often originating in childhood trauma.)

· “Body dysmorphic disorder frequently presents to the plastic surgeon.”

· “This aesthetic explanation is like a bandage that keeps the wound covered. Beneath it, the wound continues to fester as the sorrow and isolation deepens.”

Gender affirmation becomes an obsessive-compulsive process, escalating when prior steps fail.

His words rang true before this audience of many non-Christians at the conference. He continued:

“The care of these children is a work of mercy. …We are not in the service of a political position or our own favored ideology; we are in the service of life in its fullness. …A life lived for the good of others is the true human identity that we are all called to.”

Dr. Lappert’s talk is a powerful outline of the realities of the shortcomings of surgical procedures aimed at those with distress over their bodies. Creating new problems will not bring the resolution many desire. The spiritual wounds need to be addressed through truly compassionate and skilled care. Supporting children through puberty has been shown to help the vast majority of these cases. Adults should be aware that medicalization is not the long-term answer they may be hoping for. This talk is recommended to help people understand and reconsider these procedures.

Let us continue to pray for all those who have been caught in the web of gender ideology, and for those who are spearheading efforts to help meet the underlying needs of their souls.

[1] https://www.healthgrades.com/physician/dr-patrick-lappert-3ft2d, https://couragerc.org/speaker/deacon-patrick-lappert-md/

[2] WPATH, Part I – History, R4R, Jan 24, 2023

WPATH, Part II – Activist Ideology Replacing Therapeutic Psychology, R4R, Jan 26, 2023

WPATH, Part III – Lack of Research, R4R, Jan 31, 2023

WPATH, Part IV – Bizarre Recommendations, R4R, Feb 2, 2023

WPATH, Part V – More Bizarre Recommendations, R4R, Feb 7, 2023

WPATH, Part VI – Resources Revealing the Truth, R4R, Feb 9, 2023

[3] Standing for Evidence-Based Care In England and Australia, R4R, Jul 25, 2023.