re: "Gender affirming care" surgeons are butchers and it should be banned for everyone

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No, and I expected you'd raise the point. I'm guessing a lot of practitioners would hesitate and sternly advise/warn against some 23 year old getting either, no? And why is that?

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Advise against? Recommend he/she thinks it over? Absolutely. I talk people out of surgery every day.

But, I respect that a 23 year old is an adult. And if they are dead set on getting a vasectomy, they should have access to that care.

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I don't know what they do - are they sound medical procedures in your view?

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They are 100% cosmetic procedures with a high complication profile. If I knew someone who was considering it, I would immediately call them and try to talk them out of it.

But again, I still do not support banning these surgeries. Even if part of me thinks surgeons who do this as kind of snake oil-y.

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So no limits? I want to voluntarily amputate my arm and I'm of sound mind, no ethical issue presented to the profession.

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Thats why I said consenting adultS, plural. You still need to find someone licensed and willing to do this "procedure" on you. And currently, elective arm amputation does not exist as a surgical procedure. Keep in mind, all of these gender affirming surgeries are/were treatment options for a plethora of other conditions that have nothing to do with gender.

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If your starting point is "the medical profession shouldn't preclude any surgeon from doing any procedure so long as informed consent is obtained, regardless of the likely harm/uselessness/etc. of the procedure" - ok. I struggle to believe that's really what you think, though.

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Of course thats not what I really think. I am a simple, evidence based physician. At the end of the day, every new procedure starts out somewhat "experimental." Look up Rotationplasty and imagine being the first surgeon explaining to a parent what you plan to do to their child

Anyways, thats to say I am not "grossed" out by these procedures in a way many people in the general public are--understandably so. My "line," so to speak, is what is supported by data versus what isn't. Any surgery, gender affirming or not, that has been studied and yet is not supported with evidence of its efficacy treating a certain condition, should not be offered to patients by surgeons.