If biology, human nature, and traditional ethics are seen as impediments, rather than as guides, then rational restraints no longer remain on what can be done; the only real limitation is the imagination. And the human mind, untethered from moral limits, can conjure up nightmares. The surgeon, armed with a scalpel and a genital-nullification robot, becomes the new arbiter of human nature.

The debate about transgender medicine is shifting. Legislators in 20 states have recently passed bills to restrict transgender medical interventions, such as puberty blockers, cross-sex hormones, and genital surgeries, for minors. And the tide of public opinion appears to be moving against “gender-affirming care,” a euphemism for child sex-change procedures not supported by the evidence and that often cause devastating consequences. Preventing such procedures for patients under age 18 has to be the baseline.

But opponents of gender medicine should not celebrate prematurely—the battle is far from won. And while restrictions on such procedures for minors are essential, more scrutiny should be focused on a lesser-known practice: “non-binary” surgeries for adults.

Curtis Crane is one of the doctors leading this movement. Crane is a University of Iowa and Dartmouth College-trained urologist and plastic surgeon who specializes in transgender medical interventions, including experimental non-binary surgeries. 

In 2015, Crane received a flurry of publicity as an innovator in vaginoplasty, which involves castrating and creating an artificial vagina for “male-to-female” patients, and phalloplasty, which involves creating and installing an artificial penis for “female-to-male” patients. He boasted of a one- to two-year waitlist and claimed to have one of the highest volumes of transgender surgeries in the United States.

Since then, business has boomed. Crane operates clinics in San Francisco, California, and Austin, Texas, employs a team of five doctors, and conducts procedures on more than 1,000 patients per year. As part of this caseload, his practice has veered into the disturbing new territory of non-binary surgery, which includes castration, eunuch, and nullification procedures, which Crane describes as the process of “removing all external genitalia to create a smooth transition from the abdomen to the groin.” Crane has also designed and performed hundreds of non-binary surgeries in which he fashions together both male and female genitalia for a single individual. That is, he creates an artificial penis for a woman, while retaining her vagina; or creates an artificial vagina for a man, while retaining his penis.

Crane recounted the story of performing his first non-binary genital surgery in a question-and-answer session for potential patients. “In the beginning of my practice, within the first year, I’d say, I had a trans man come to me, and he wanted a phalloplasty, but he wanted to keep his vagina,” Crane recalled.

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