This article contains graphic details about transgender body mutilation and sex acts.
Ashe underwent a gender-change surgery in 2016 at the Oregon Health and Science University (OHSU) Hospital in Portland, to change his appearance from male to female. A mere 13 months later, Ashe was suicidal. Now, two years after surgery, Ashe wants to undo the surgery. (Ashe is a pseudonym.)
I found Ashe a bright, intelligent man who sincerely wants transgender people to have access to the care they need and want. But in his opinion, much improvement is needed in the OHSU Transgender Health Program (THP), which its website touts as “one of the most comprehensive and highest volume gender programs in the nation.”
The program may be “most comprehensive and highest volume,” but what prospective patients care most deeply about is the quality of outcomes, not the quantity. To measure the quality of the health program, the data need to be measured, collected, and reported transparently in an unbiased way. Transparency and accountability about outcomes are some of the things Ashe told me he desires to see change.
Ashe is one of 16 patients he knows who are dissatisfied with their experience, nine of whom anonymously participated in a July 2018 letter to OHSU to point out their concerns and suggest specific recommendations to take transgender patient care to a higher level. Frustrated by the lack of response, and wanting the OHSU THP to provide better information to future transgender patients, Ashe gave me permission to publish his story and the group’s permission to publish their letter.
‘I Was Very Much Pushed into Transition’
The first recommendations in the letter are to implement advanced transgender-specific surgical training for the surgeons and a formal grievance procedure for the patients. Ashe told me in an email he felt rushed and pushed into having surgery by all his medical providers — therapist, general practitioner and surgeon. He wrote:
The doctor [Dr. Daniel Dugi III] basically used a bunch of trans people to experiment on and gain experience without being properly trained. I was denied by him for an orchiectomy [removal of the testicles] and coerced into having SRS [Sex Reassignment surgery] by him and my GP [general practitioner] who was stressing that I needed to be castrated ASAP. I had previously told my therapists who wrote my letters [of approval] I never wanted surgery. I feel like I was very much pushed into transition as an answer to my mental health problems that were ignored by my ‘gender’ therapist.
The OHSU THP surgeon, Dugi, a urologist with a fellowship in trauma, reconstructive urology, and prosthetics, became interested in sex-change surgery during his career at OHSU. In 2015, with the blessing of OHSU, Dugi traveled to Belgium and Serbia to receive training and practiced the vaginoplasty procedure (formation of a vagina out of male genitalia) on cadavers. In May 2016, he performed his first vaginoplasty at OHSU. Three months later, Ashe was on the gurney, headed for vaginoplasty surgery with Dugi.
No wonder Ashe felt that the surgeon was experimenting on him — Dugi was in the earliest stages of his newfound specialty. Other patients of Dugi dating from two years ago to January 2018 are among those who shared their surgical complications in the letter:
Patient 1. I had surgery with Dr. Dugi almost a year ago. … The most significant issue being what appears to be an unfinished urethroplasty, leaving a hole where my urethra should be, large enough to place a thumb into. … The scrotum still was hair-producing, scrotal tissue was still used internally. I subsequently have internal hair growth. My clitoris is exceptionally large, and I have substantial holes on either side that never healed shut. My general aesthetic is not anatomical. I have what is believed to be permanent nerve damage in my right ankle, from the surgical positioning of my body during my 12-hour surgery.
Patient 2. I had surgery with Dr. Dugi a couple years ago. … I’ve had extreme difficulty achieving orgasm to the extent that I no longer bother masturbating. I’ve had maybe ten orgasms in nearly two years, and rarely via sex. This lack of stimulation has led to me having near constant sexual dreams like I’m a teenager again, which is distracting and frustrating.
Patient 3. I had gender confirmation surgery with Dr. Dugi a year ago [2017] this July 29th … Stimulus and response of my clitoris is marginal at best, and totally depressing at worst. Ninety per cent of the time that I urinate, I have an orgasm. Not sure how this came about, but the novelty has certainly paled significantly. The cosmetic appearance/value of the GCS I received isn’t all that great …
Patient 4. Drs. Dugi and Berli performed my phalloplasty surgery (construction of a penis) almost two years ago. I had numerous complications, including lingering bad side effects from anesthesia and surgical trauma. Both surgeons misrepresented their expertise, experience, and readiness. My first of three surgeries was incomplete, and took 17 hours, more than twice as long as it should have. My penis is half as long as it’s supposed to be due to poor surgical technique and cutting the flap shorter than agreed …
Patient 5. [Ashe is Patient 5 and his story in the letter is similar to what he shared in his email above.]
Patient 6. I had vaginoplasty in January with Dr. Dugi. I was off work for 8 weeks on medical leave. I had a series of post-op appointments after my surgery. I voiced concerns, as I felt like I was not urinating normally, and was assured that everything was fine. I experienced a “waterfall effect” when I was urinating, with no control over urine stream. My urethra lacks external structure to guide urine flow. I knew it was a major surgery, and the reality is that it would take time to heal. I knew for sure that there was something wrong when I began to experience discharge and became sick …
As the stories in the letter to the university clearly show, the number of surgical complications in this small group far exceeds the program’s publicly stated total of three. These six stories and three more in the letter demonstrate why the group recommends that the OHSU THP begin collecting, evaluating, and independently reviewing patient results.
From their experience, they clearly see that the current data available from the program, reported by the surgeons themselves and not from an independent body, severely underreports the true number of surgical complications. They wrote:
To be honest, the number of ‘issues’ we are aware of, represent higher rates of complications than what are expected with these surgeries.
We feel the THP at OHSU has not been honest in reporting its outcomes thus far. While there is not currently a data system tracking outcomes for patients, the program has publicly stated that there have been a total of 3 surgical complications. We need a standardized process of assessment, with agreed upon benchmarks as determined by patients and surgeons … Ethical concerns abound when surgeons self-report their data, and determine the variable of success on behalf of the patient at the points of query. Further concerns are found when the THP is reporting a number significantly lower than what is factual based on patient stories. This discrepancy must be addressed by the THP at OHSU immediately.
Of Course Taxpayers Are Paying for This
OHSU THP is the major provider of sex change surgery in Oregon. In January 2015, Oregon Medicaid (known as Oregon Health Plan) started paying for sex reassignment surgery — the same year that Dugi went abroad for training. State regulators estimated 175 patients would use the benefit that first year at a cost to taxpayers of less than $150,000. The reality was different by orders of magnitude — more than 700 people used it and the budget was three times higher than estimated.
Any Oregon resident whose income falls below a certain threshold is eligible for Medicaid benefits. A quick look on social media shows one solution being touted for free gender change surgery is to move to Oregon, keep one’s income below the limit, and allow Medicaid to pay the entire cost.
Ashe told me he believes the OHSU THP is prone to fast-tracking Medicaid recipients for gender-change surgery. The group letter shares concerns about potential harm done as a result to the indigent patients at OHSU THP:
What is perhaps the most troubling to us, are the demographics associated with who is accessing surgery at the THP at OHSU. While OHSU is not responsible for holding a monopoly on genital surgery options, the fact remains that most recipients of Medicaid in Oregon who seek these surgeries, are funneled toward the THP at OHSU. The intersection of no additional options for low-income folks on Medicaid, and a program that has had as many issues as the THP has, means that too many people have come out of the program harmed without the financial or social means to do anything about it… While we do not believe that this is the intention on the part of the THP, the facts remain.
Historically, doctors and hospitals don’t get rich by treating Medicaid patients, but if they are looking to establish a transgender health program quickly, Medicaid patients would be an extra source of cases, over and above self-paying and insured patients. Certainly, the perception that THP gained surgical experience at the expense of low-income folks because that population lacks the wherewithal to fight back bears further investigation.
Having taxpayers pay for gender changes for poor people might sound humanitarian and caring to some people, but neglects to answer the longer-term funding questions, such as: Who pays for fixing surgical complications? Who pays for gender change reversals when patients like Ashe want to detransition? Will Medicaid pay? Will the surgeons work for free? Will OSHU THP provide the care and absorb the costs?
No Psych Evaluation Required to Change Your Life Forever
For Ashe, now 24, the OHSU THP failed to provide effective pre-surgical protocols to keep him from having surgery he didn’t want. He says at the time of his surgery the THP did not require an extensive psychiatric evaluation.
In fact, many gender clinics (and their clients) are opposed to psychiatric evaluations, even though that could help prevent people like Ashe from being suicidal after surgery. I can tell you from my personal view 35 years post-surgery that people who take their own lives after surgery are the collateral damage inflicted by the existing flawed transgender health system. Psychiatric evaluation before life-altering surgery is a must.
As the group letter points out, putting improvements in place is fundamental to safeguarding patients. Their recommendations include transparency of the data regarding gender change outcomes, independent evaluation, and access to formal grievance procedures. But in today’s transgender medical environment, the proverbial foxes are guarding the hen house and negative outcomes are kept under wraps. Ashe says when he raised questions about his care, his claims were dismissed by the hospital as being irrelevant.
Based on the people who write me with sex change regret, the happenings at OHSU THP aren’t rare occurrences. Stories hauntingly similar have come into my inbox over the years and are captured in my book, “Trans Life Survivors,” from people like Ashe who felt they were rushed into surgery or whose feelings later changed and they want to detransition.
Ashe said he didn’t want the surgery, but his therapists approved him, his GP pushed him, and his gender therapist ignored his mental health issues. Like most people with gender dysphoria, Ashe trusted the medical professionals’ expert advice and went ahead with surgery, only to realize after that surgery was a mistake.
My own sex change surgery story 35 years ago exhibits the same themes — a rush to surgery, failure to diagnose or treat co-existing mental health problems, and later, regret and detransition. Fortunately, I survived it all.
As I’ve written before, I believe that true compassion for this segment of our society that is suffering is shown by raising factual issues, based on scientific research, and having the best minds follow the evidence to provide the best scientifically proven care. Packaging the issue in the wrapper of political correctness or withholding the negative findings is not care or compassion.
