Patients who identify as “nonbinary” are being given bizarre alternative genital treatments at surgical facilities around the nation, and some states are allowing taxpayers to foot the tab for these procedures.
These procedures, also known as custom alternative solutions to more “traditional” trans penile surgeries, involve sex nullification, penis preserving gender reassignment surgery, and vaginal retention with metoidioplasty. All of these surgeries are performed in order to preserve the patient’s vaginal anatomy.
“Nonbinary” is a common identification that falls under the “umbrella” of transgender for persons who reject both traditionally masculine and traditionally feminine societal roles and assumptions. According to a poll conducted by UCLA in 2021, more than one million individuals in the United States identify as “nonbinary.” Plastic surgery facilities are providing customised operations that are catered to transgender patients as the transgender canopy grows to embrace an ever-growing range of gender identities, such as demi boy, eunuchs, gendervoids, maveriques, neutrois, and so on.
We are aware that some clients will not be interested in binary procedures particularly, and we respect their decision. We provide tailored surgical alternatives for individuals who identify as gender varied, gender expansive, or nonbinary. On the website of MoZaic Care, a surgery centre located in San Francisco that specialises in genital reconstructive surgery for transgender and “nonbinary” patients, it is written that some examples of these procedures involve penile maintenance vaginoplasty, uterine preservation with metoidioplasty, and nullification.
In accordance with the MoZaic Care website, the nullification operation, also known as a “Ken doll” surgery or annuloplasty, “removes external genitalia while retaining a urethral hole and anal opening.” Nullification surgery may also be referred to as “Ken doll” surgery. Although nullification is often promoted to men, MoZaic makes it available to both males and females. According to the information provided on the website for MoZaic, “If the patient was conceived with just a penis, it will also be eradicated in addition both testicles and the scrotum.” “In the event that the individual was born with only a vagina, her vagina will also be removed together with the clitoris and labia,” the surgeon said. Patients who have had nullification surgery may refer to themselves to others as a “null” or a “smoothie” to indicate the “smoothness” of their genital region after the operation.
“Basically for the nullification operation, they take the testicles, your sac, and the penis, and they basically just stitch the skin up into a tight vertical line which sort of fades away,” stated one guy who had had the procedure. If the surgeon is skilled enough, there won’t be a scar at the conclusion of the procedure, and the urethra will be moved such that it lies “sort of between your legs.”
Custom surgeries known as penile preservation vaginoplasty for men and vaginal preservation of metoidioplasty for women make it possible for a person to achieve the “hermaphrodite look” and have the looks of male and female genitalia during the same time. These procedures are offered to both sexes. Penile preservation vaginoplasty, also known as a “Phalgina” by MoZaic, is distinct from traditional vaginoplasty in that it does not involve a penectomy (the surgical excision of the penis) and instead uses the genital tissue that is removed from the scrotum during an orchiectomy (the removal of the testicles) to create a pseudovagina. Traditional vaginoplasty involves the surgical removal of the penis.
Hysterectomies and vaginoplasties are two of the more “traditional” types of transgender surgeries that are performed. These procedures are performed on minors as young as 15, provided that they are emancipated or “live apart from [their] grandparents or guardians, but instead manage own personal finances.”
On the MoZaic website, it is stated that the minimum age to get sterilisation genital operations via insurance plans financed by the federal government is 21 years old. The frequently asked questions pages for vaginoplasty & hysterectomy state that individuals who are federally sponsored (with Medi-cal or Medicaid) and who choose to have elective sterilisation surgery must be at least 21 years old. Sterilization of the genital organs is possible for individuals aged 18 if the procedure is covered by private insurance or if the patient pays for it out of their own cash.
At MoZaic, some of the acceptable insurance plans include the San Francisco Health Plan, which is a variation of Medi-Cal, as well as Blue Cross Covered California, which is another state-sponsored insurance programme. The state of California has passed legislation that makes it illegal for insurance companies to refuse to pay for transgender-related medical treatment. In the state budget for 2021 that Governor Gavin Newsom of California approved, 13 million dollars were set up for the Transgender Wellness & Equity Subsidize. This money will be used to fund the provision of these services. Although prior consent from a doctor is necessary, transgender and “gender diverse” individuals are seldom refused coverage by Medicare, and numerous advocacy organisations help people appeal Medicare decisions if they are denied coverage.
Dr Heidi Wittenberg, who serves as the director of MoZaic, has an impressive resume that includes a large number of genital operations.
Another surgeon at MoZaic, Dr Adam Bonnington, recently reached a milestone when he performed his 101st vaginoplasty in April of this year.
The Gender Institute of (SFMH), where “Gender Expansive/Non-binary Procedures” such as nullification surgeries, penile preservation vaginoplasty, or vaginal preserving metoidioplasty also were given, is also directed by Wittenberg, who serves as its Medical Director. Through its partnership with Dignity Health, SFMH is able to accept a wide variety of state-sponsored plans for health care and provide patients with assistance in connecting with federal financing to cover the cost of genital surgery.
According to the Billing Help and Frequently Asked Questions section of Dignity Health’s website, “If you need assistance paying your account, you may qualify for a programme that is funded by the government or the Dignity Health Payment Assistantship that may cover part or all of your debt.”
In accordance with the Cleveland Clinic, surveys have shown that approximately one out of four persons who identify as transgender or “nonbinary” prefer to have “gender affirmation” surgery. A report published in 2019 indicates that there has been a dramatic surge in the number of patients who use Medicare to assist their transition. “The number of Medicare beneficiaries who were recognised as transgender using claims data every year has climbed from 2088 enrollees in 2010 – 10,242 enrollees in 2016 (an increase of 390%),”
Recent research indicated that the Medicaid programmes in 34 of the 51 states (67%) fund gender-affirming hormone treatment (GAHT) and that 25 of the 51 states (49%) cover gender-affirming surgery (GAS).
On their website, MoZaic Care makes it quite clear that they adhere to all WPATH rules. The (WPATH) has just issued the 8th Edition of its revised Standards of Care, in which “Eunuchs” has been included as a gender identification option. People who self-identify as “Eunuch” are mainly guys who have a castration fetish and are looking to have a nullification procedure to remove the genitals. WPATH advises medical treatment and assistance for people who self-identify as “Eunuch.” At the 27th yearly WPATH conference, which will take place from September 16-20, 2022, Dr Wittenberg is slated to give a presentation.
Other medical facilities in the state of California, such as Post Street Surgery Center or Marin Health, also provide what is known as “nonbinary gender-affirming surgery” and take state-sponsored health insurance. “Non-standard gender-affirming surgery” is covered by private insurance, despite the fact that Align Surgical Associates from San Francisco does not take Medicaid, Medicare, and Medi-cal as a method of funding for patients. Dr Dev Gurjala, who works with Align Surgical, considers himself a “designer” of individualised procedures involving the genitourinary system.
Transgender patients in need of nullification surgery may turn to Ohio Health Hospital in Ohio, where Dr Chris McClung practises, and both he and the hospital accept a variety of Medicaid plans as payment. Although the Medicaid policy of the state of Ohio does not include coverage or treatment for transgender individuals, it has been reported by a number of news sites, such As the Washington Post & Bloomberg News, that state authorities have not been policing this exclusion since 2019.
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