A trans-identified male associated with the world’s leading transgender health lobby group is drawing attention for speculating about experimental “artistic and creative” genital surgeries. Laura A. Jacobs, a New York-based psychotherapist who influenced the development of transgender health guidelines regarding “gender dysphoria” in adolescents, previously contributed a chapter to an anthology in which he promotes BDSM practices, including “age play” and “genital torture.”

Video footage of a TedX talk given three years ago by Jacobs began circulating on social media this week, drawing criticism for Jacobs’ bizarre statements about “gender affirming” surgeries.

In the clip, which was shared by Gays Against Groomers and Helen Joyce, Jacobs states: “Medical interventions allow some of us to change our primary and secondary sex characteristics… but it’s clear that cisgender bodies are still the reference point. Will technology give us options that are artistic and creative? Do we have to stick to penis and vagina norms? Can we have genitalia that look like flowers or abstract sculpture? Can we have multiple? Can they be interchangeable?”

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