The debate about transgender medicine is shifting. Legislators in 20 states have recently passed bills to restrict transgender medical interventions, such as puberty blockers, cross-sex hormones, and genital surgeries, for minors. And the tide of public opinion appears to be moving against “gender-affirming care,” a euphemism for child sex-change procedures not supported by the evidence and that often cause devastating consequences. Preventing such procedures for patients under age 18 has to be the baseline.

But opponents of gender medicine should not celebrate prematurely—the battle is far from won. And while restrictions on such procedures for minors are essential, more scrutiny should be focused on a lesser-known practice: “non-binary” surgeries for adults.

Curtis Crane is one of the doctors leading this movement. Crane is a University of Iowa and Dartmouth College-trained urologist and plastic surgeon who specializes in transgender medical interventions, including experimental non-binary surgeries.

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.