Talk:Gender-affirming surgery (male-to-female)

removed

Removed "Prior to any surgeries, transsexual and transgendered people must usually abide by the Standards of Care for Gender Identity Disorders set by the Harry Benjamin International Gender Dysphoria Association." and replaced again with "Prior to any surgeries, transgendered or transsexual people usually undergo hormone replacement therapy."

The formal requirements of SRS are discussed at lenght in Sex reassignement surgery and in Standards of Care for Gender Identity Disorders. This page is only about the surgery itself. This was done after reaching consent about the matter, see Talk:List of transgender-related topics. Also, the HBIGA-SoCs are not the only SoCs in the world; the Wikipedia is an international project and should not have a US-POV.

Also removed under "see also" Transsexuality and Sex reassignment surgery. The first link is POV, since not only transsexual people have SRS, and the second unnecessary, because it is already the very first link in the article. Also, the List of transgender-related topics was done so that a single link is sufficient; both links are of course on that list, together with many other important ones. -- AlexR 10:47, 16 May 2004 (UTC)

Fetish???

OK, I am at a complete loss... "fetishistic content" removed? I totally don't get what you are talking about in the prior revision.Nick

And then you realised... I guess you hadn't looked? It had been up for months. Awful.

I hope people will rally round and support my latest version? Lots of work...--Bluegreen 9 July 2005 15:09 (UTC)

Actually, BlueGreen, I went back and looked. Consider that concession rescinded. Comparing the page where you made the comment about fetishistic comments with the revision before shows NOTHING that could be construed as fetishistic. I subsequently did agree that Julie's SUBSEQUENT comments might be considered so, but not the ones you commented on. So please be so kind as to show us exactly what the fetishistic content was in her version. ::http://en.wikipedia.org/w/index.php?title=Sex_reassignment_surgery_male-to-female&diff=18308930&oldid=16453318

You could have actually gotten a concession on that point simply because I was unwilling to take the time to trace that back... of course until you make snarky replies like the above. Then I'll be happy to go back and demonstrate where you were wrong. Julie's subsequent comments about body piercing might be considered so, but NOT the ones she made that you commented on. Nick

She - and I don't think she's bothering to be here on Discussion - made it worse after I pointed it out, but, as I clearly showed in the writing that has disgracefully simply been reverted, portraying the sexual organ of women as myself as a permanently raw wound into which we ourselves are supposedly forever obliged to thrust hard, penile objects is both a total lie, and totally suited to the arousal of women-hating, pain and blood fetishists and to pointing them towards post-SRS women as targets. It is also very damaging to both women's self image and their trust in partners who might have such ideas. And it helps perpetuate the very damaging image, which is very comon amongst your professional peers, causing much danger, of post-SRS women as being obessed with penetration and careless of our health. And please don't try suggesting I have a problem with penetraton.

You, as a doctor, and especially if you have post-SRS patients, should surely know that a post-SRS vagina, lined completely with skin, and not meant in any way to be raw (if it is there is something wrong which can be treated, and should be treated) is not at all like an open wound, or any of the perforations of the skin you "agreed" might be substituted for her image of body jewellery piercings, where raw skin is just waiting to bond and heal. Do you really not know better? Have you ever had a post-SRS patient who was supposed to have and be themselves dilating a raw vagina? What is even more disgraceful is that the point I raised of vaginal topical estrogen treatment, which can normalise any tendency for vaginal skin to be too vulnerable to abrasion and infection, dry and and slow to heal, was instantly negated by your utterly incorrect medical "information" frightener, for which I see no apology. You seem happy - despite being shown that the dose in question is far, far too small to be factored into total estrogen dose at all - to have that misinformation still up, in your name, as your revision. So that's knowingly giving false medical advice, whilst identified as a registered doctor, including to your own patients, who you have said read this site. Are you happy doing that? --Bluegreen 05:25, 10 July 2005 (UTC)

So if topical estrogen is not absorbed in significant amounts, why are topical agents associated (like oral or parenteral estrogens) with an increase in the incidence of breast cancer, strokes, and heart attacks? Why does the clinical standard for using topical estrogens in post menopausal women who have uteri require cyclical treatment with a progesterone so that endometrial hyperplasia does not happen due to unopposed estrogen? Certainly this is not as significant of an effect as oral or parenteral estrogen, however the drug is absorbed systemically in non-negligible amounts, and thus must be calculated into the total regimen. Nick

You are wilfully confusing the special products for vaginal use, simply to supply the lining of the vagina, which have such a low content that "factoring them in" is ridiculous, with products designed to deliver the same amount as tablets but through the skin, like patches and gels. How are you going to "factor in" an increase of 25 micrograms of estradiol a day for a couple of weeks then perhaps one a week tops therafter? Miss one 2 milligram tablet every 18 months?--Bluegreen 05:59, 12 July 2005 (UTC)

And I say again: quote the fetishistic content in Julie's original post that you made that comment about and to which I linked above. If it is there in history, it should be no problem for you to quote it. Please be so kind to do so. Nick

I did, above. If you think it is acceptable and not fetishistic then I think that says all we need to know about your attitude to the women who ask for or have had done the procedure which is the topic of this article.--Bluegreen 05:59, 12 July 2005 (UTC)

Also, many (I would say most) patients cannot maintain their vaginal depth and with intercourse alone. Many transwomen will develop significant stenosis without vigilant dialation. The implication that just having penetrative vaginal intercourse is adequate is dangerous for most transwomen. So that was fixed. Nick

Do you have reliable citations on that, apart from anxiety ridden "maintenance" sites where women have had the fear of the bejeezus instilled into them, just to be sure? Or perhaps you did a proper survey? Being on several m2f post-srs lists, and having talked with several surgeons, some of whom have done proper surveys of patient outcomes, I can tell you are wrong in your generalisation. I've provided a range of references. One from a top SRS surgeon's instructions page, and two of peer-reviewed papers reporting results of McIndoe and Coloplasty (Sigmoid Resection), where it is clear that coitus was usually sufficient. There's no obvious reason why penile flap inversion should lead to a greater problem. I shall look for more references. Most aren't on the Web unfortunately.Bluegreen 05:25, 10 July 2005 (UTC)

By this comment, “There's no obvious reason why penile flap inversion should lead to a greater problem” you demonstrate your complete and total ignorance. There is a hugely obvious reason that this is the case, to anyone with even a modicum of actual medical knowledge. Of course since you also indicate your 'knowledge' is basically what you read on the internet, I could see why that would not be obvious to you. Nick

Since it is very obvious my knowledge is far from only from the Net - a lie you keep repeating but that doesn't make it true - and there really is no obvious reason why a penile flap should shrink any more than a free graft or an entirely stretched vagina, for both of which I gave good peer-reviewed references for there not being a problem usually relying upon penile dilation, in addition to the printed word of the top surgeon in the USA referring actually to penile flap, I will take it that you are trying to pull "medically qualified" superiority and simply covering up that your generalisation was based on nothing. So PPOV again.--Bluegreen 05:25, 10 July 2005 (UTC)

Are you really that ignorant? I mean, even if I had no freaking clue about medicine, I would have... you know... done a little research. But hey, that's just me.

Of course the fact that not only are the tissues used in a sigmoid flap and a penile inversion of extremely different qualities with regard to distensability, muscular content, secretion of mucous, etc. But they are about as far away different tissues as you can get in humans because they are not even fricken derived from the same embryonic germ layer. I mean, these puppies break off from each other about the time of gastrulation.Nick

You make out you have reading difficulties. The citations were with regard to McIndoe (free grafts from thigh usually), Vecchietti dilation (identical skin), and penile flap. No sigmoid flap.--Bluegreen 05:59, 12 July 2005 (UTC)

As a post-srs woman, I think it is important that this article not feed so many masturbatory fantasies (and if you don't know what I'm talking about on that I suggest you look and see the neat solution the authors of the vulva page used), that the women for whom the procedures are done are repelled (I hope you appreciate that we are not all hardened sex workers, in fact, contrary to stereotypes, most are very much the opposite), so I'm against detailing all the many variations of dilation that surgeons use, and recommend. But I hope you know that regimes that use virtually continuous dilation for months are even more unlikely to then require the "weekly for life" regime some prominent sites pathetically preach. We're writing for the world here, including parents and neighbours, so why not leave it to the individual women and their surgeons on that?--Bluegreen 9 July 2005 15:09 (UTC)

With regard to whether or not I think transgender women are 'hardened sex workers,' I find that insulting both to me and my patients. I treat transgender people who are attorneys, computer engineers, students, and political activists. I also treat transgender people who are sex workers, homeless, and drug dependent. However, unlike you, I do not have a pejorative attitude toward the latter. Some transgender people are sex-workers – often because they can find no other way to survive in a society that condemns them. Faced with the choice of starving or freezing to death, placing themselves at risk of rape and murder in a shelter system that victimizes them because of their gender identity, or selling their bodies for money, many transgender people may choose the last option in desperation and fear. Making these uniquely unfortunate people invisible in the community because you find them distasteful is not only callous, but frankly repulsive. Nick

Bullshit. I clearly only contrasted sex-workers with women who aren't used to or comfortable with non-private discussion of penetration. Are you claiming hardened sex workers are not comfortable with that? Is "hardened" in some way an inappropriate adjective for being used to dealing with the subject of penetration? There was absolutely nothing anti-sex workers, which, incidentally is the preferred term.

Once again you're ignoring the issue at hand - unbalanced content repelling the supposed intended readership of the arIicle - in favour of a rant.

I'm taken aback that you say so much about your patients in using them to boost your supposed credibility, and that you group the TS and TG so much by occupation; isn't that somehwat stereotypical in itself? I knew very little about your practice and patients, and really don't think it is my business to know or for you to say, but I presumed you would have welcomed the chance to say that it is a widespead problem amongst your medical peers that they have been misled to expect that trans women (non-, pre- or post-SRS) they encounter as parients will be sex workers, or at least "highly sexed", which then leads them to bring other stereotypes and related anxieties into play that can disrupt their ability to give proper medical care. And you could have boasted how that doesn't apply to you and how all the ERs you've worked in have been so much better informed on such issues as a result of your presence. But instead you chose to explode into false assumptions and a lecture, to the choir.

Or don't you know that many doctors have that false knowledge, and react like that, in big cities in the USA, right now? And, as I outlined above, since you have already commented on how medical people use this site for information, that isn't helped by the present version of the article emphasising how post-SRS women have apparently willingly signed-up for, and apparently don't at all mind being repeatedly penetrated into a raw wound of a vagina. Not obsessed at all by penetration and careless of our health according to that image, are we? Doctors, and paramedics, shouldn't be at all worried that they might encounter something extrmely unusual and problematic if they take on or encounter a post-SRS patient, by that image, should they? Especially since the image is approved, indeed posted (since it is your revision) by a trans, and "trans-informed" medical practitioner and ER specialist (that is a correct interpretation of your Wikipedia profile isn't it?).--Bluegreen 05:25, 10 July 2005 (UTC)

BlueGreen, you yourself were kvetching that there was not anything on the internet when you searched for a reply to my argument. That makes a strong implication about the major source of your knowledge.Nick

More bullshit. I was apologising for not being able to give you more online links than I had, that's all.--Bluegreen 05:59, 12 July 2005 (UTC)

Of course you also cite 'printed word of the top surgeon in the USA' (which is funny in and of itself, as if there were a rating system whereby you could assign Mary is #1, Joe is #2, Chris is #3...)Nick

You are insisting on controlling this article yet have no idea of the US surgeons specialising in the procedure. and have the nerve to ridicule someone who does.--Bluegreen 05:59, 12 July 2005 (UTC)

However, apparently it doesn't sit well with you that I cite not only other works...Nick

I asked you for a citation, and none materialised.--Bluegreen 05:59, 12 July 2005 (UTC)

...but also my own personal clinical experience as a transgender physician who has a weekly clinic where he provides care for transgender people. You see that as “trying to pull 'medically qualified' superiority.” You don't like it when I say... gee... I treat these people myself and your statements do not represent the clinical reality that I see. So of course you imply that I am somehow making this all up and in fact went to medical school, completed a residency and chief residency, passed my boards and specialty boards, and now every month go to the trouble of doing 40 hours of pro bono care at a clinic seventy miles from my house... just so I can use that cred to dis you on the internet and sound all super smart and stuff.Nick

But it is exactly what you just did again.--Bluegreen 05:59, 12 July 2005 (UTC)

How did you know?

BlueGreen: “Or don't you know that many doctors have that false knowledge, and react like that, in big cities in the USA, right now?”

Well, since you are presumably stating that my posted view is 'false knowledge'...Nick

There is no need to presume. I said exactly what the issues are: the false information, in the currently posted article which is your revision, that post-SRS women are obsessed with penetration without regard to their health, have vaginas like unhealed wounds, and are different enough that physicians should be deterred from providing medical care, or are more likely to give poor care.--Bluegreen 05:59, 12 July 2005 (UTC)

...what the I would say yes... in fact, I would say the majority of practitioners in the US today who treat transgender patients agree with the lions share of what I have said – all that 'false knowledge' would be whats called: the medical literature and the prevailing clinical view. But then they also agree with me that childhood immunizations are a good idea, there should be seatbelt and helmet laws, and we should have a single payer national health insurance system. However there are also nutjobs out there who will object to immunizations, helmet/seatbelt laws, and SPNHI, just as you are calling my views 'false knowledge.'

But you are quite correct in one point. I am very aware that practitioners and patients look to these pages for information. And that is precisely why I and many others take the time to see that your biased POV posts don't stay up.Nick

So you are acting together to dictate the POV. I see the two of you are already notorious for this sort of behaviour, including this sort of "discussion".--Bluegreen 05:59, 12 July 2005 (UTC)

BlueGreen, you are obviously being pushed off the deep end. You say: “One from a top SRS surgeon's instructions page, and two of peer-reviewed papers reporting results of McIndoe and Coloplasty (Sigmoid Resection), where it is clear that coitus was usually sufficient. There's no obvious reason why penile flap inversion should lead to a greater problem.” (my bolds) Then when I say that a sigmoid flap and a penile inversion are not comparable in this regard, you then reply: “You make out you have reading difficulties. The citations were with regard to McIndoe (free grafts from thigh usually), Vecchietti dilation (identical skin), and penile flap. No sigmoid flap.”

Like do you really think we are all so stupid as to not be able to look.... oh say 20 lines up in the post and see your original comment?

The Sigmoid reference is obviously directly relevant to women who have a sigmoid one too, AKA a coloplasty. It is relevant to those who have a penile flap only in that the lower section is similar. Isn't that obvious? Or do you think male and female colons are different tissue?--Bluegreen 09:39, 12 July 2005 (UTC)

Actually, no it isn't obvious... however, what is becoming obvious is that you don't even have a basic grasp of anatomy or histology. Its not that a male and female colon are different, but that the skin of a penis is different from a piece of colon from either a man or a woman. Those are entirely different kinds of tissue and will behave in entirely different ways. Its like comparing a 30 pound sack of concrete on your back with a parachute and assuming that well gee, since they are both heavy things that you carry on your back, both should work about the same should you jump out of an airplane with them. And like believing a sack of concrete and a parachute are the same, its not only obviously wrong but it is dangerous as well to anyone who would follow your fool-hardy advice. Nick

...Just like your claim that you described the so called fetishistic content in Julie's post. You didn't. We aren't all stupid. Sometimes I may be too lazy to argue, but when you are obviously pushing a dangerous agenda which you don't even understand places people's lives and bodies at risk – then I'll find a way to make time. So I say again.... why not just tell us what the fetishistic content in this version was? http://en.wikipedia.org/w/index.php?title=Sex_reassignment_surgery_male-to-female&diff=18308930&oldid=16453318 Instead of saying 'I already said so, Julie said it' why not just cut and paste where you told us what it was (or better yet, Julie's original comment) and thus make me look stupid?

You don't seem to want to address the content of the current version with your name on it.--Bluegreen 09:39, 12 July 2005 (UTC)

And I am not talking about anything said AFTER that post. I will be happy to address that after you answer my question. I am talking about the fact that when you wrote this revision, you made the comment on your revision “outdated and fetishistic content amended .“ I made the comment that there was no fetishistic content in Julie's revision. If you compare the two you will see nothing that you changed was fetishistic. Nick

Also, with regards to estrogen supplementation after orchiectomy, and whether topically applied estrogen needs to be included: first off, you should be on average female HRT doses after orchiectomy. The range is 0.5-2, so you are high-balling it with regards to the estradiol dose. Secondly, 2g/day of estradiol cream gives you about 0.2mg of estradiol. If you were on average female replacement doses... that is anywhere between about 1/3-1/10 your daily dose using my calculator. Hardly one pill every 18 days and hardly something that is inconsequential... that is of course unless you are chugging down estrogen at unnecessary, unadvised doses post-orchiectomy? Or perhaps unless you are advising other transwomen to do so? And do you want references for the appropriateness of using lower dosing post orchiectomy? OK. NP. Futterweit W. “Endocrine therapy of transsexualism and potential complications of long term therapy.” ASB 27(2) 1998. The Tom Waddell Protocols: http://www.dph.sf.ca.us/chn/HlthCtrs/HlthCtrDocs/TransGendprotocols.pdf, Tangpricha V, et al “Endocrinologic Treatment of Gender Identity Disorders.” Endo Pract 9(1) 2003. Feldman and Brockting. “Transgender Health” Minn Med. 86(7) 2003.

Doctor Nick, your units of measurement are all mixed up, and you cannot even read the word "months". You do know that a milligram is a thousanth of a gram and a microgram is a thousanth of a milligram? I said nothing at all about my own doses, or advisng anyone, or pre-SRS and Post-SRS variations, I only mentioned standard pill sizes.

Actually you were almost right in one regard, I typed my unit wrong once. I had actually been up for 28 hours when I write that, so I am not surprised. But then that's why I don't work or write rxs post call. However, the math is still exactly the same as is my correct final answer. (I fixed the original above and added the missing m in bold so you can see where I added it.)

So while I mistyped my explanation of it, my calculation was quite correct: 2g/day of estradiol cream = 0.2mg of estradiol delivered, which is still exactly what I said: 1/3 to 1/10 the daily dose at appropriate doses of estradiol (i.e. 0.5-2mg/day of oral estradiol.) If you would like the reference that 1g of estradiol vaginal is equivalent to 0.1mg of estradiol, I can find you one online, but I actually got that from my palm (epocrates.) However, 1g of estradiol cream is 0.1mg or 100mcg. Either way, 2g per vagina daily is 10-33% of the daily dose of estrogen suggested by pretty much everyone for any post-orchiectomy transwoman.

So we still have the same conclusion: either it is not a trivial dose (as it is 10-33% of the total daily dose) OR the person for whom you are doing the calculation is taking entirely too much estrogen than is safe for a post-orchiectomy transwoman.Nick

Your calculation is totally incorrect, and your units of measurement, even though you have gone back and changed your posting, are still either mixed up, or missing, I never mentioned "estradiol cream", never mind using 2g of it vaginally. There is no estradiol cream made for vaginal use (there are estradiol gel products for external use, which would be very uncomfortable used on such sensitive tissue, and there are is a conjugated equine estrogen cream for vaginal use, which is a totally different matter. What I specifically referred to (including a link to specifications of the product), was an estradiol vaginal tablet, the content of which is as I mentioned, 1/100th of that you keep insisting on "calculating". You keep imagining, having apparently totally misread (yet again), that I did any calculations for any person.--Bluegreen 11:49, 16 August 2005 (UTC)

You are wrong about many things, and obviously do not have a clue about the use of estrogens. There most certainly is estradiol vaginal cream despite the fact that you are unaware of its existence. Here are several discussions of its use:

• [From American Family Physician]
• [A blurb from Drug Digest]
• [From Drugs.com]

But most importantly, I use and prescribe Estrace to my patients. So simply because you are not aware that the drug exists, that does not mean that it doesn't. Though what totally amazes me is that you are so certain about your vast knowledge of medicine that you don't even take the time to google the term and find the gazillion references google gives for estradiol vaginal cream.

And my calculations (which I went in detail to explain) are correct. But then your belief that they are wrong is comparable to the fact that you don't believe that Estrace exists. NickGorton 17:41, 16 August 2005 (UTC)

I would thank you to not try to interfere in the doctor-patient relationship between me and my prescriber, it's totally unprofessional. Do you discuss doses with your patients in this cavalier manner? Are you for real?--Bluegreen 09:39, 12 July 2005 (UTC)

Er... BlueGreen, if you don't want to talk about the drugs you take, don't post your comments about them on the internet for millions of people to read. Moreover, you have something entirely wrong here. I am a doctor, but I am not your doctor. If AlexR makes a post to Wikipedia (and the world) which says that his doctor prescribed for him 600mg a week of testosterone cypionate, I can make a post in response that I think his doctor is not following standards of acceptable care and that I believe he (AlexR) is doing something very dangerous to his body.

I made no mention of what drugs or doses I am prescribed, only what doses are in common products. You, as a doctor (you say) took it upon yourself to make adverse comments on something you alleged my doctor was prescribing, baselessly. Most doctors would think that inappropriate. To be honest virtually everything you say about "female" hormones in transsexual treatment is inappropriate, which is why your page on the subject on Wikipedia is flagged as dangerous.--Bluegreen 11:49, 16 August 2005 (UTC)

Again you are wrong. But then if you can show me a medical ethics treatise that agrees with you, or the survey you are quoting that shows that 'most doctors' agree with you, I'll be happy to concede the point.

However more to the point, there are tons of examples of physicians stating that practitioners doing X, Y, or Z are doing the wrong things. And as I said, if you are going to post what you and your doctor do on the freaking internet, you should damn well expect comments – especially if what you suggest does not meet acceptable standard of care.

BlueGreen, on July 12th you said: “I would thank you to not try to interfere in the doctor-patient relationship between me and my prescriber.” With regards to your doctor, either one of two things is the case: what you described is what your doc is prescribing you or it isn't. If it was then you posted your experience on the internet and I commented on it. If it wasn't then why are you suggesting that I shouldn't interfere with you and your doc's 'doctor-patient' relationship. Sorry, but you can't have it both ways.NickGorton 17:41, 16 August 2005 (UTC)

If you want to say (on the internet for everyone to read) that you are taking enough estradiol to make 2g/day of vaginal estradiol cream a trivial amount, then I (or anyone else who knows what is acceptable care for a post-op transwoman) can tell you: either you are wrong in your calculation, or you are taking too much oral estrogen. If you feel your privacy is threatened by this, then don't post it on the fricken internet. Moreover, if you post that your doctor is doing X and X is obviously not acceptable medical care, not only will I say that he is wrong, but I feel a responsibility to do so. If anything I think it is my responsibility to tell people what acceptable care is, especially when someone is advocating care that is dangerous and does not meet the standard of care. Its not interfering with your private doctor-patient relationship, it is protecting people from patently wrong information.

It is difficult to think of anything more dangerous than a "doctor" who completely misreads things, and furthermore doesn't pay any attention when it is pointed out.--Bluegreen 11:49, 16 August 2005 (UTC)

Oh, I can think of something much more dangerous. Someone who is neither medically trained, nor even aware of the common drugs that are available (that would be you... [“There is no estradiol cream made for vaginal use”]) trying to alter reference material on the internet to suit her own personal agenda. NickGorton 17:41, 16 August 2005 (UTC)

So in addition to not assuming that we can read what you wrote 20 lines previously, why not also assume that I am quite familiar with negotiating E doses with transgender women and while I was born in the morning, it wasn't yesterday morning. I always double check the math.

Clearly. :-))))--Bluegreen 09:39, 12 July 2005 (UTC)

Yep, and even sleep deprived, my math was correct, 2g/day of vaginal estradiol is 10-33% of the total daily (appropriate) dose for a transwoman after orchiectomy.

Please stop giving dangerous medical advice.--Bluegreen 11:49, 16 August 2005 (UTC)

BlueGreen, you have more than adequately proved in this last post you made that you have no clue about current medical practice. You even say that a drug product that has been commercially available for years doesn't exist. Neither I, nor the other people who actually know what they are talking about will stop editing out your misinformation. So you can bitch and whine all you want here. You can say that Estrace doesn't exist. You can say I'm a bad doctor, Alex is evil, and Julie has been hoodwinked by the medical establishment. But that will not change either the veracity of what we sat nor the fact that any misinformation you post will be reverted. NickGorton 17:41, 16 August 2005 (UTC)

Lastly, with regard to my “attitude to the women who ask for or have had done the procedure “... actually, there quite a few of them who have no problem with my attitude. One of them brought me cookies last week. And I got two hugs that clinic too (three if you count my non-trans patients as well.) Nick

Wanting hugging is a side-effect of some hormones. Best way to get one is to give one. Don't take it personally.--Bluegreen 09:39, 12 July 2005 (UTC)

Compromise edit

Ah, ok I see.

Julie, I agree with you about the majority of the edits you've done, however I think that there is a point to be said about not comparing it to body piercings for two reasons. First, its adequately stated in the paragraph above. Second it does compare it with something that can be quite offensive to some transgender women as this is used to denigrate their reality as simply something that is a fetish or sexual drive. Thats not to say that piercing is bad or always sexual or fetishistic. However, there are examples that are less damaging and hurtful to transgender women that you could use. Like, for example, the fact that other artificial openings that medicine creates are closed by the body.... gastrostomy tubes, myringotomy, etc. and that these must be kept open by PEG tubes and PE tubes respectively. Or just leave it at the wound example. Nick

Hello, I didn't mean for my example to cause any discomfort to anyone. I just wrote it because that's how I've always justified the need for dilation, and I thought it would be the easiest example to have. Maybe we could list an alternative like you discussed? Julie-Anne Driver 05:12, 10 July 2005 (UTC)

Hi Julie. sorry I just posted saying I didn't thnk you were here. Our postings crossed in the edit.

It being how you've always justified it (why do you need to justify it?) doesn't explain your repeatedly replacing my alternative and less damaging version, and with a more fetishitic version still (even if you didn't realise it could be fetishitic), such that even Nick noticed.

The analogy really is inappropriate, after the first few days the issues are only skin that hasn't been totally anchored contracting, which eventually stops, either because it gets more anchored or it gains cells to match the stretched size, and, separately, that muscles or ligaments maintain their flexibility. At your age the skin is going to be better at contracting, but also faster to grow new cells, than in someone older. But women/girls younger than you have already got long past the stage of needing regular dilation whilst still having plentiful volume. One I know dilates about every three months, "just in case", and it's not much of a problem. But then surgeons and patients vary.

The only way your vagina could close is if the lining were to drop and give you a prolapse, or it got raw inside and the sides stuck and grew together. Both of which would be correctible, with medical help. You don't actually experience your vagina whilst dilating as a raw wound, do you? If so I would really urge you to seek help, because it doesn't need to, and shouldn't be that way.

As I showed in my version with references, many women find het. sex enough to maintain volume. Which leaves those who aren't het., or with a partner who uses a dildo, or don't have dependable sex needing to follow some other regime, but, as I said above, that is surely not something for which Wikipedia is suited as an instruction manual, or not in the main article on SRS?

I wasn't sure if you were intending your image as a deterrent to having SRS, which is why I put in my version a paragraph about having SRS for the wrong reasons. I don't think most who need it would be put off having it by the risk of pain sometimes (dilating or during sex) but parents and such might put more pressure on them not to have it using that, so it would be a double-edged thing.--Bluegreen 06:29, 10 July 2005 (UTC)

Proper vaginal dilation should be practiced by all post-op women, and here's why.

Because the skin of the vagina isn't strong enough to fight the pelvic muscles contracting, it will gradually close in on itself. Proper dilation will prevent this.Julie-Anne Driver 00:50, 11 July 2005 (UTC)

You are misinformed. All vaginas fold flat when not in use, the pelvic muscles have no effect to diminish the size during that time.--Bluegreen 06:23, 12 July 2005 (UTC)

Wrong. All non-reconstructed vaginas will not have their size diminished by the pelvic muscles. That is not true of almost all reconstructed neo-vaginas. You are again not considering the fact that just because they are in the same place and do they same thing, they are not the same tissue and are not going to work in the same way. Nick

My surgeon, and any other reputable surgeon, will also tell you this. They will also tell you that sexual intercourse is not a substitute, referring to a patient who came back to him after a few years with a very narrow vagina, due to lack of maintenance, as they thought sexual intercourse was enough to keep the vagina open. I'm a lesbian, yet I dilate because I want to have the same capabilities as my partner.

There will be women who are happy with more narrow vaginas, and that's their choice, but actively discouraging dilation to others is a recipe for disaster. Julie-Anne Driver 00:50, 11 July 2005 (UTC)

Nowhere did I discourage women from dilating. Did you see the link to TM's instructions? In fact I thoroughly discussed all the issues. Is this the best explanation you have for repeatedly reposting a description that has harmed both the public's and medical professionals' understanding of our lives?--Bluegreen 06:23, 12 July 2005 (UTC)

Because you are stating that dialation does not need to be done if someone is having sex. That is not true, and Julie is correcting your dangerous statements simply because you keep making them. Nick

Using plain "NPOV" to explain entire article reversions

Wikipedia just doesn't seem to be working with trans articles, probably because most people are either not interested or are afraid to be involved. There isn't the broad involvement to ensure good articles and people can get away with having outragous stuff up, for months. My entire, very carefully written and referenced verson being just simply reverted to one it evidence was badly wrong (and you cannot see something as NPOV and wrong) on the plain, bald, pretext of NPOV, with no explanation on the Discussion page, no example, no selectivity is a perfect example. Should I take it that I should have included for the fundie viewpoint? The fetishists? The psychoananlysts? The advocates of reparative therapy? The advocates of different surgeons?--Bluegreen 07:02, 10 July 2005 (UTC)

You might, for example, have left out the claim that a person's credibility is somehow tied to her having had vaginoplasty.-- AlexR 08:05, 10 July 2005 (UTC)

Where do you think you see such a such a claim? Exactly?--Bluegreen 06:41, 12 July 2005 (UTC)

...Not to mention all other points already amply discussed. I see no reason to repeat everything Nick already said. AlexR 08:05, 10 July 2005 (UTC)

No, of course not.--Bluegreen 06:41, 12 July 2005 (UTC)

Besides, I reverted that while on RC patrol, that is always a time where I am not very verbal. AlexR 08:05, 10 July 2005 (UTC)

So you totally reverted my carefully written and referenced article as being a piece of vandalism? That seem the Wikipedia meaning of "on RC patrol". Would you care to explain that?

Particularly, if being verbal is just repeating what was already said before, and therefore unnecessary. Oh, and BTW, NPOV and the WikiWay work just fine on all trans-related articles. That is, unless you understand NPOV to be unquestioning acceptance of your personal POV. That however is a misunderstanding of NPOV, and not a sign that NPOV somehow doesn't work. -- AlexR 08:05, 10 July 2005 (UTC)

But I see others have had just these same problems with you two before, pushing your agenda like this, and twisting and turning in the process. They don't seem to think Wikiway works with you two without intervention. And there isn't enough around here presently. Which is exactly what I said.--Bluegreen 06:41, 12 July 2005 (UTC)

The end of the first paragraph "other procedures" linked to back to this same article. I removed the link because it was confusing.

link to same page

The end of the first paragraph "other procedures" linked to back to this same article. I removed the link because it was confusing.--Lavi 18:20, 28 June 2006 (UTC)

Regarding vaginoplasty

I remembered once I've found on a website about SRS, it had a video showing the vaginoplasty. This kind of vaginoplasty didn't remove anything of the male sexual organ. The whole thing was entirely shrunk and inverted into the body. Then a tube, looks like a plastic tube, was inserted. If anyone watched this before, or at least read this site, please make a link to it. Thanks! --Edmundkh 11:11, 13 December 2006 (UTC)

I believe you're talking about penile inversion vaginoplasty; that's the standard "base" technique most surgeons use. As to the link, I don't think's it's appropriate for encyclopaedia (poor quality, extremely graphic content, and also not easily available atm as far as i can see)). There was a youtube of it, but it got removed. Cheers! Lauren^♫/∆ 02:55, 6 May 2007 (UTC)

The link I mean, may be external link. Thanks God, I've been waited for so f***ing long for a respond!! --Edmundkh 09:09, 8 May 2007 (UTC)

I would question the reference to "appearance of and, as far as possible, the function of female genitalia". An operation can make a penis look rather like a vagina - but in no way can the function of the vagina be recreated.203.184.41.226 (talk) 06:01, 11 September 2012 (UTC)

The claim is correct, since biologically speaking, the function of the vagina is to allow intromission of the penis… it's the other parts and functions of the female reproductive system that can't be duplicated - the ovaries, the womb, etc.

See Anne Lawrence's Notes on Genital Dimensions. thanks - bonze blayk (talk) 11:48, 11 September 2012 (UTC)

Prostate

Is prostate removed during male to female sex change? —Preceding unsigned comment added by 83.21.178.250 (talk) 13:21, 10 August 2008 (UTC)

No. In the majority of the cases the prostate is retained, as removing it is considered high risk due to the proximity of the bladder.

Removal of Most of Article

Because of the fact check going back to August 2007 and the lack of any sources referenced, except for one broken link, I have removed most of the article, excepting the templates, links, introduction, etc. I think it would be good if future editors first found cites for the introductory paragraph and then not add anything without reliable sources. I will add that this article is now a stub. Cornince (talk) 11:37, 12 November 2008 (UTC)

Well done.
— James Cantor (talk) 12:46, 12 November 2008 (UTC)

Thank you for that. It's Jan, 2018 now, and still, there is lack of source referrals in much of the article. I think it would be a good idea to again remove much of this article, which reads like WP:OR, and a promotional sales pitch without talking about the risks and negative long-term outcomes. I will begin on this as I have time. Juliet Sabine (talk) 22:08, 1 January 2018 (UTC)

Requested move

The following discussion is an archived discussion of a requested move. Please do not modify it. Subsequent comments should be made in a new section on the talk page. No further edits should be made to this section.

The result of the move request was: not moved Armbrust, B.Ed. ^{Let's talk}_{about my edits?} 10:21, 3 March 2012 (UTC)

---

Sex reassignment surgery (male-to-female) → Surgery for trans women – - We need to avoid using terminology implying that trans women actually were men prior to their period of surgery. Georgia guy (talk) 20:51, 24 February 2012 (UTC)

• Oppose We need clarity in titles, since the bodyplan of the person starting out is male and it ends up with a female bodyplan, the title is fine. 70.24.251.71 (talk) 08:03, 25 February 2012 (UTC)

  Comment. Does anyone believe there should be a rule that the first vote to oppose in a requested move must come from a registered Wikipedian?? Georgia guy (talk) 12:45, 25 February 2012 (UTC)

• Support. Readers can form their own views of how to define male or female in this context. It is better to use neutral terminology than to have an article title which prejudges the issue. --BrownHairedGirl (talk) • (contribs) 23:24, 25 February 2012 (UTC)
• Oppose. Comment WP should use what the RS's on the surgery use. Although it is popular in non-surgical RS's to use sex-of-identity, identity is not undergoing surgery. The language in the surgical literature may, of course, change of over time, but it is not WP's place to lead that charge.— James Cantor (talk) 23:57, 25 February 2012 (UTC)

  First, what does RS stand for?? As for you first sentence, it contradicts WP:NPOV because it's saying "Wikipedia should use what this person uses." This can be re-worded as "Wikipedia should use this person's point of view." Any faulty info?? Georgia guy (talk) 00:09, 26 February 2012 (UTC)

  "RS" stands for "reliable source," such as recognized encyclopedias, high end newspapers, and so on. That material needs to be backed up by reliable sources is one of the main principles of editing here. We can't put in whatever we personally believe (for better or for worse). You can read the complete rule at WP:RS. I hope that's a help.— James Cantor (talk) 00:20, 26 February 2012 (UTC)

  How do you decide whether a source is reliable?? Do you follow any set rules?? Let's examine this (this might seem like going off the subject, but it doesn't if you understand that the subject is an example of a reliable source)

  Suppose you saw from a Disney fan's web site "I think Toy Story 4 will be released in 2015." Is this a reliable source?? The answer is no. Suppose you went to http://disneypictures.com and they say that revealed that Toy Story 4 will be released in 2015. Is this a reliable source?? The answer is yes, because it is Disney's official web site. Georgia guy (talk) 00:25, 26 February 2012 (UTC)

  Yes, Wikipedia does indeed follow a set of rules for deciding what counts as an reliable source. It is available at the WP:RS page I directed you to earlier. For sources whose status is unclear, discussion and guidance can be had from posting the issues at the Reliable Source Noticeboard at WP:RS/N.— James Cantor (talk) 14:31, 26 February 2012 (UTC)

  (ec, indents tweaked) For medical articles, you should also read the related WP:MEDRS. --Mirokado (talk) 01:18, 26 February 2012 (UTC)

• Oppose. As IP70.24.251.71 put so well, the current title is clear and refers to the operation and its direction, not the self-identification of the person involved. Also, the proposed title is far too vague: the article is about the reassignment surgery itself, not about surgery in general for people who have undergone the reassigment (I imagine that some surgical procedures have to be modified if the subject has previously had this sort of operation). --Mirokado (talk) 01:18, 26 February 2012 (UTC)

  Comment. Your argument is saying "...and refers to the operation and its direction". The title implies that trans women actually were men, not women with the wrong body, before the surgery. Thus, the title implies that the surgery is just changing one's body for no particular reason as opposed to correcting one's body because so that it matches its direction. Georgia guy (talk) 01:23, 26 February 2012 (UTC)

  Please state your own opinion in your own section, so the closing admin can easily identify and weigh the individual contributions. I think what I said was quite clear and I was not addressing the extra points you make in your comment. Please move it to your own top-level bullet section. --Mirokado (talk) 01:48, 26 February 2012 (UTC)

• Oppose - Sex reassignment surgery is by far and away the most commonly used term to describe the topic. Biologically the subjects were men before the procedure, which is why the procedure is being performed. Casliber (talk · contribs) 07:01, 26 February 2012 (UTC)

  Comment. Your vote does not reveal that it still would have been a vote to oppose if the proposed title were Sex reassignment surgery (trans women). Georgia guy (talk) 12:42, 26 February 2012 (UTC)

  But the present title doesn't indicate that "male" refers to "biological" maleness (whatever that means) rather than identity; readers who don't know much about the subject are likely to assume it refers to both. SRS may be a more common term, but it also has important issues with respect to POV and factual accuracy. The policies on article naming do indicate that generally speaking, the most common name should be chosen as the title of the article, but do they say anything about what to do when the most common name reflects or perpetuates a misconception or particular point of view? —Psychonaut (talk) 08:59, 1 March 2012 (UTC)

• Comment. For those interested, there is an analogous proposal and discussion from the same nominator at Talk:Hormone_replacement_therapy_(male-to-female)#Requested_move. — James Cantor (talk) 18:06, 26 February 2012 (UTC)
• Support. The present title could easily be misconstrued as referring to the gender identity of the patient, and not of the physical body parts being corrected. The proposed title has no such problem. —Psychonaut (talk) 08:51, 1 March 2012 (UTC)
• Oppose. "Male-to-female" appears to be the preferred term in the medical sphere, and is instantly understandable by all readers, whereas "transwomen" is extremely ambiguous to lay-readers (does it mean women who were formerly men or women who wish to become men?). --DAJF (talk) 02:08, 2 March 2012 (UTC)

  Neither. Transgendered individuals were not "formerly" anything. The misunderstanding embodied in your comment is a perfect example of how the present title is misleading. —Psychonaut (talk) 09:25, 2 March 2012 (UTC)

The above discussion is preserved as an archive of a requested move. Please do not modify it. Subsequent comments should be made in a new section on this talk page. No further edits should be made to this section.

Move discussion in progress

There is a move discussion in progress on Talk:Sex reassignment surgery which affects this page. Please participate on that page and not in this talk page section. Thank you. —RMCD bot 15:14, 1 March 2016 (UTC)

Sources

"Regular application of estrogen into the vagina, for which there are several standard products, may help, but this must be calculated into total estrogen dose."

Can someone provide the source for this line? I think it might be factually incorrect and I'd like permission to remove it. I'd go as far as saying the whole article should be flagged because it has no sources.

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"Treated as an open wound"

I don't want to get into an edit war here, but the idea that the body treats a neo-vagina as an open wound is plainly absurd. This is rhetoric used by anti-transgender people to both scare, and delegitimize transgender people.

I'll say that the entire article seems to mostly be out of date with modern surgical practices. The thailand procedures are very common and are not described here.

The vagina will not "close up" if you do not dilate, except in the very early stages of healing (when raw sutures are exposed to each other). Once the initial healing is complete, there is no risk of that. The risk is some loss of depth and loss of flexibility. None of the sources provided state anything otherwise.

Trysha ^(talk) 21:39, 8 January 2018 (UTC)

Hi, Trysha. As seen here, an IP (who seems to have been you) removed more than just the "open wound" part, and I restored the material with academic sources. We follow what WP:Reliable sources state with WP:Due weight and they are clear that dilation is needed, with one of the sources I included stating, "Dilators of increasing size are regularly inserted into the vagina at time intervals according to the surgeon's instructions. Dilation is required less often over time, but it may be recommended indefinitely." Because of what the latter sources states, I also included the following in the section: "Over time, dilation is required less often, but it may be required indefinitely in some cases." Either way, I was focused more so on the loss of all of the content. As for the "open wound" part specifically and you removing it, it is not simply "anti-transgender people" rhetoric. Although some anti-transgender people may state this, I have never known an anti-transgender person to focus on that aspect. The vast majority of laypeople know nothing about this aspect of genital surgery. They simply think that a penis is cut off, although many of them know that having an opening is part of the surgery. I am far from anti-transgender and also once stated, "Those who get the surgery to construct a vagina, meaning to create an entire vagina, need to dilate the vagina; this is because the vagina will begin to narrow and close, like a wound healing itself." Over the years, I have come across academic sources and sources by transgender people stating that the body treats the opening like a wound to be sealed. Why do you think dilation is needed during the early process and less often over time and that the opening will otherwise try to close up, resulting in vaginal stenosis? That stated, I haven't noticed the "a wound" wording as being prevalent in the medical literature. And although the "a wound" aspect can help readers understand why dilation is needed, I am not hard-pressed on the wound aspect being re-added. I replaced the mention with mention of vaginal stenosis (which was already noted in the article) instead and added a small "recommendations" piece. We can also bring WP:Med editors in on this matter. Flyer22 Reborn (talk) 00:11, 9 January 2018 (UTC) Flyer22 Reborn (talk) 00:26, 9 January 2018 (UTC)

A Commons file used on this page has been nominated for speedy deletion

The following Wikimedia Commons file used on this page has been nominated for speedy deletion:

• Marci Bowers at Denver Health Transgender Surgery.jpg

You can see the reason for deletion at the file description page linked above. —Community Tech bot (talk) 10:07, 15 April 2019 (UTC)

Incompleteness of the article

I have no personal or professional stake in this subject, but as 'transgender' issues are increasingly in the news, curiosity brought me to this article. Presumably it will be the first port of call for many others. It therefore seems desirable for the article to provide at least brief coverage of all aspects that are likely to occur to readers, if only in the form of links to other articles. Relevant topics that don't seem to be covered at present include: a) urination. In the standard male anatomy, urine passes through the urethra down the centre of the penis and out through the opening (meatus) at its tip. In the standard female anatomy, the urethra is a separate tube passing outside the vagina, and opening into the vestibule. Urine does not normally pass through the vagina itself. Neither of these arrangements seem to be possible with penile inversion, but I do not see any explanation in the present article of what *does* happen. Is a separate opening created, or is the urethra included with the 'inverted' penis? If the latter, urine presumably flows out through the 'vagina'. If so, there must be practical issues of hygiene etc. b) semen. In the standard male anatomy, seminal fluid is produced mainly by the seminal vesicles, stored in the prostate gland, and mixed with spermatozoa from the testicles at the time of ejaculation. (Fluid is also produced by Cowper's glands at and before ejaculation.) Ejaculation itself involves contraction of muscles around the relevant ducts. Obviously in the case of male-female surgery the testes are removed, so no spermatozoa are produced, but it isn't clear what happens to the rest of the apparatus, or to its functions. According to a comment on this Talk page, the prostate gland is usually retained, and I guess the same would apply to the other components - or are they removed to make space for the 'vagina'? c) ejaculation. Assuming that the prostate and other glands are retained, seminal fluid will still be produced, unless perhaps production is suppressed by female hormones. If there is orgasm, however induced (including 'wet dreams'), the seminal fluid is presumably released through the constructed 'vagina'. The present article may not be the place for detailed explanations, but I think these obvious major issues should at least be mentioned.2A00:23C8:7906:1301:AC7E:C960:BA3F:BB94 (talk) 15:48, 21 February 2021 (UTC)

Overhaul and adding sources

Prior to my changes, this article had many statements with no source attached, or sources that contradicted what was written in the article. One example of this is "Over time, dilation is required less often, but it may be required indefinitely in some cases." The citation for this was ". . . Dilation is required less often over time, but it may be recommended indefinitely.". As well, many of the unsourced statements were phrased in ways that could make gender-affirming surgery seem like haphazard medicine or inherently prone to poor outcomes, rather than a well-established medical practice no more or less prone to complications than any other practice:

"Surgeon's requirements, procedures, and recommendations vary enormously in the days before and after, and the months following these procedures." This statement is true, but it also is true for any other type of medical procedure. Its inclusion in tandem with other statements made implies gender-affirming care in particular is unorganised and unprofessional, which is a politically loaded and factually incorrect line of thinking frequently used to create legislation that denies trans people healthcare they need. I'm not saying anyone had bad intentions in writing this, but I don't think it needs to be here.

"Since plastic surgery involves skin, it is never an exact procedure." Again, while this is true, it isn't appropriate to include here.

"Supporters of colovaginoplasty state that this method is better than use of skin grafts for the reason that colon is already mucosal, whereas skin is not. Lubrication is needed when having sex and occasional douching is advised so that bacteria do not start to grow and give off odors." Not only does this statement present bowel vaginoplasty as needing "supporters" rather than being an established part of gender-affirming healthcare, it presents uncited information that makes bowel vaginoplasty out to be inferior or as making one "dirty" as fact. I found no references to foul smells as an outcome of bowel vaginoplasty during the research for the edits I've made so far. Perhaps I'll find the source for a statement like this as my research continues, but so far I haven't found it.

Many of the statements made originally, both unsourced and sourced with contradictory information, paint a strong picture of transfeminine genital surgery as being inherently prone to poor outcomes and resulting in a lifetime of discomfort at the best of times. As well, the structure of it is confusing at times. These issues are not present in the FtM equivalent of this page, so I am trying to bring this page up to that standard. Oystersauce99 (talk) 01:44, 22 September 2022 (UTC)

Agree with most of what you have written, with the exception of the last sentence: there is no need to bring this page up to any other page present in Wikipedia; for one thing, Wikipedia is not a reliable source, so you cannot be sure that the other page is anything that should be emulated, and they are definitely not a standard. Better to just stick with your earlier comments about unsourced or contradictory information, and bring the article up to the standards of the policies and guidelines of Wikipedia, and you can pretty much ignore how they do it in the other article. Thanks for your comments, Mathglot (talk) 08:40, 22 September 2022 (UTC)

After the move to Gender-affirming surgery

@WanderingWanda and Sideswipe9th: It seems Ingenuity already moved this article and Gender-affirming surgery (female-to-male) while closing the move to Gender-affirming surgery, although they missed out Sex reassignment therapy (not sure why) and they didn't move them to the titles were suggested (ie. Feminizing surgery and Masculinizing surgery). – Scyrme (talk) 18:53, 30 November 2022 (UTC)

@Scyrme: I didn't move Sex reassignment therapy because the nominator suggested it should be merged with Transgender health care instead. I moved the FTM and MTF articles to the current titles to keep them consistent with the main article for the time being. Whether they should be moved to Feminizing surgery and Masculinizing surgery will need another RM to decide. — Ingenuity (talk • contribs) 19:04, 30 November 2022 (UTC)

History

Are any editors in favour of merging the subtopic 'History' with the homonymous subtopic in vaginoplasty? After all, the current section only focuses on vaginoplasty. As it doesn't seem feasible to write an entire history section on all gender-affirming surgeries, it may be a better idea to add a history section to the pages of the respective procedures and leave the rest of the page as it is. Cixous (talk) 19:23, 24 March 2024 (UTC)

No, the history section in this article here focuses on surgery in the context of gender affirming care. The fact that the majority of this is Vaginoplasty is secondary to that. So the current article is the better location for the content. Raladic (talk) 15:21, 25 March 2024 (UTC)

Thanks for your reply! Even if we want to keep the section, I'd say it does need rigorous rewriting, as it mostly focuses on the people receiving the vaginoplasty rather than vaginoplasty itself. Obviously both aspects belong to its history, but now the development history of vaginoplasty (or other gender-affirming surgeries for that matter) is largely left out. Cixous (talk) 13:19, 29 March 2024 (UTC)

Requested move 4 December 2024

• Gender-affirming surgery (male-to-female) → Feminizing gender-affirming surgery
• Gender-affirming surgery (female-to-male) → Masculinizing gender-affirming surgery

– Move these two articles to use WP:NATURAL disambiguation instead and updating to modern terminology used in WP:MEDRS in line with the sibling articles of Feminizing hormone therapy and Masculinizing hormone therapy per our policy of medical article titles WP:MEDTITLE. For reference, refer to modern medical sources Mayo clinic, Cleveland clinic, John's Hopkins all using this as terminology. Raladic (talk) 18:55, 4 December 2024 (UTC)

Note: WikiProject Sexology and sexuality and WikiProject LGBTQ+ studies have been notified of this discussion. Raladic (talk) 18:58, 4 December 2024 (UTC)