Are there ethical limits to what surgeons should be permitted to do in an age when gender affirmation surgery is permitted? Consider the underground cult of “gender nullification”. Last year, British police arrested seven men after allegations of grievous bodily harm. They had gathered in a flat in north London for live-streamed removal of their penis and testicles.

The apparent inspiration for this is a Japanese artist, Mao Sugiyama, who had his genitals removed, cooked and served to guests at a dinner in 2012 when he was 22 years old. He charged the guests £160 each.

According to an article in the Daily Mail, many of these so-called “nullos” opt for a ‘smoothie’, a procedure that leaves them with a smooth groin. Unsurprisingly, this has not been the subject of academic study, although there may be 10,000 to 15,000 voluntary “nullos” worldwide. There are internet forums for discussing the issue.

In 2021 the Daily Beast surveyed this controversial practice in a long and extensively researched article. Until recently, amateur “cutters” were responsible for underground surgeries. But as gender-affirming surgery becomes more acceptable, their profession seems to be fading.

The “nullification” movement, according to the very sympathetic description of it in the Daily Beast, deserves to be respected. Its participants are not suffering from a pathology. One anthropologist claimed to have heard of a man who knew from the age of 6 that he was a eunuch, although he waited until his 30s to become one.  

Nor do they merit tabloid melodrama or major legal crackdowns. Instead, they are largely the result of society’s failure to fully acknowledge, truly respect, and adequately serve deeply marginalized gender identities.

Indeed, being a eunuch is a legitimate gender identity, says Shawn Francis Benedict, a minister at the LGBTQI+ affirming Ray Of Hope Church, in New York.

“I have found hundreds of books on the existence of castration, eunuchs, and other identities from every culture, every age, even every religion,” he said. “The only thing exceptional and weird about them is to be so uneducated to think that they are exceptional or weird.”

Into the ‘90s and early 2000s, Benedict added, “If a person called a doctor to ask about, for example, keeping their penis and putting a vagina in behind it, that was an absolute hang-up-the-phone-on-you request.”

It’s far easier today, says the Reverend. “It’s nowhere near as weird and difficult to try to become a eunuch now as it was 30 years ago. Now, we have doctors who don’t even blink when you say you want to just remove your testicles, or just add a vagina. I never saw this coming”.

This must put more pressure on doctors. As the author of the Daily Beast article observes: “We need to fully understand and respect why people make the choices they do, and deliver the support they need.”