This story starts with an Instagram account, and it ends with one.
A little over three years ago, Dr. Christopher Salgado, a prominent surgeon specializing in transgender healthcare and genital reconstruction surgeries at the University of Miami, created an account called @SexSurgeon. Things went horribly awry.
On the account, Salgado published photos that he says were meant to demystify complex surgical procedures and educate his followers. The effort failed in spectacular fashion in early 2019, when a news blog, The TransAdvocate, called attention to numerous posts that depicted graphic images of surgeries, accompanied by mocking and demeaning captions and hashtags.
In one post, he shared X-ray images of a patient with a dildo stuck in their rectum, accompanied by the caption, "This mishap during anal intercourse could've been avoided if the transman had a real phalloplasty," and used the hashtags "#realdicksmatter" and "#rectumraiders."
In another, on Valentine’s Day in 2019, he uploaded a photo of what appeared to be a bisected penis configured to look like a heart with the hashtag "#whatthefuckisthat." Another post, about the medically diagnosed condition known as micropenis included the derisive hashtag #Asianpenis.
Salgado never faced disciplinary action from the Florida Board of Medicine, but the blowback and the repercussions were swift. Word of the page spread to Facebook and community groups for people seeking gender-affirming surgeries. Outrage ensued. UM administrators were alerted to the Instagram page and social media furor, prompting them to suspend Salgado pending their investigation. The surgeon's two-decade career began to implode.
He spared the university the investigation. He deleted the Instagram account on February 16, 2019, and resigned.
In an interview with the New York Times the following month, Salgado said that in the wake of the scandal, he felt the university was biased against him. He said some of the images posted on the account were photos taken by others and that his motives for sharing them had been misconstrued. And he blamed hackers for an unspecified number of the hashtags, saying he'd received multiple security alerts about unauthorized logins from an IP address in Turkey — alerts he said he'd ignored.
Yet only a month after his resignation, Salgado opened a private practice, Constructive Surgery Associates in Coral Way.
He still cares primarily for trans and gender-nonconforming patients, many of whom seek gender-affirming surgeries.
In his first interview since his resignation, Salgado tells New Times he’s trying to right a wrong and earn back trust.
"The purpose [of the @SexSurgeon account] initially was to be scientific about it, but it turned out not to be so and I hurt people. I still apologize to anybody, anybody that I even remotely hurt for this," Salgado says. "I got scared by everything and put my head in the sand" instead of immediately owning up. "That’s one lesson," he says. "Probably the lesser lesson."
Though he continues to contend that the most egregious content posted on the Instagram account was the work of unidentified Ukrainian hackers, he admits that he authored many of the hashtags himself. And in owning his errors, he doesn't point the finger at so-called cancel culture. His downfall, he concedes, was the consequence of poor decision-making on his part. He's still apologizing and probably will continue doing so for the rest of his career. When he sees a new patient for the first time, he often tells them about the mistake that nearly ended his career. His policy now is one of full disclosure.
"At one point, I was like, 'Am I still going to be able to do gender surgeries?' Patients started calling me and they’re like 'What happened?'" Salgado says. "I really love this patient population. I feel like I’ve learned something every day from them, and so that’s going to continue."
Salgado says he now performs more gender-affirming surgeries than ever before, estimating that these procedures comprise up to 90 percent of his caseload, whereas they represented about 60 percent of all procedures in 2019.
"I spend a lot of time with my patients really getting to know them, really getting to know more of the struggles that they have not only surgically but also socially," Salgado says. "I've become way more sensitive to the patient population now."
But when it comes to the repercussions of indiscretions like these, there is damage that has already been done regardless of how sorry someone may be says Nikole Parker, director of transgender equality for the LGBTQ advocacy group Equality Florida.
"The relationship with your surgeon or medical provider is sacred," says Parker, who is a trans woman. "Being transgender and finding people to trust in the first place is already extremely difficult, so finding a medical provider that you feel you can trust and has your best interests at heart? Once you find that, and for that to be breached, is the ultimate betrayal."
Speaking in general terms and not specifically to Salgado’s Instagram debacle, Parker says the damage has lasting consequences for marginalized communities: "Why would you want to go to another surgeon or medical provider if you’ve already been completely embarrassed and exploited by another one?"
Sometimes, Salgado says, a prospective patient will recognize his name or face from a news story and decline treatment.
"There are some patients who probably won’t come to me because of that," he says. "But I encourage them to ask me about it."
On his new Instagram account, @ConstructiveSurgery, Salgado posts first-person patient testimonials, screenshots of news articles relating to the trans community, and before-and-after images. The hashtags — such as "#transvisibility," "#transisbeautiful," and "#topsurgery" — are more tasteful and professional.