In 2015, Crane received a flurry of publicity as an innovator in vaginoplasty, which involves castrating and creating an artificial vagina for “male-to-female” patients, and phalloplasty, which involves creating and installing an artificial penis for “female-to-male” patients. He boasted of a one- to two-year waitlist and claimed to have one of the highest volumes of transgender surgeries in the United States.

Since then, business has boomed. Crane operates clinics in San Francisco, California, and Austin, Texas, employs a team of five doctors, and conducts procedures on more than 1,000 patients per year. As part of this caseload, his practice has veered into the disturbing new territory of non-binary surgery, which includes castration, eunuch, and nullification procedures, which Crane describes as the process of “removing all external genitalia to create a smooth transition from the abdomen to the groin.” Crane has also designed and performed hundreds of non-binary surgeries in which he fashions together both male and female genitalia for a single individual. That is, he creates an artificial penis for a woman, while retaining her vagina; or creates an artificial vagina for a man, while retaining his penis.