For transgender people who experience dysphoria around their genitals, the American Medical Association has called sex reassignment surgery a “medical necessity.”

President Trump called it “getting clipped,” according to Bob Woodward’s new book.

That’s the phrase the Washington Examiner zeroed in on after reviewing their copy of the journalist’s latest presidential chronicle, Fear: Trump in the White House.

Woodward reports in his book that Trump was falsely informed that sex reassignment surgery for transgender service members costs hundreds of thousands of dollars, to which the commander-in-chief responded, “What the fuck? They’re coming in here, they’re getting clipped. Not going to happen.” (In reality, the price listed for male-to-female sex reassignment surgery on the Philadelphia Center for Transgender Surgery website is around $20,000—a typical figure for the procedure.)

Shortly thereafter, Trump tweeted that transgender people would no longer be permitted to serve in the United States military.

“Getting clipped” isn’t just an offensive way to refer to a procedure that virtually every major medical association agrees can be a successful part of treatment for transgender people; it is also a fundamental misunderstanding of the procedure itself.

The idea that sex reassignment surgery for transgender women is a simple, castrating procedure—often described in crass terms as “getting your penis cut off”—is totally false.

I should know because I had the surgery almost five years ago. Don’t get me wrong, the surgery is gross in the same sense that all surgeries are gross. So, if you flip away from TLC anytime you see an operating table, you’ll want to skip this next sentence, too. But in my surgeon’s technique—as she notes on her website—the clitoris is created from the glans, and the penile skin and scrotal skin are used to create the vaginal lining.

“ Transgender women like me are not getting vaginas and clitorises created for us 'ex nihilo'; they’re made using the same tissue that would have developed into female anatomy anyway ”

It’s complicated but it also makes a lot of sense, too, because all of our genitals—male and female—came from the same starting place in fetal development. So, the point of male-to-female sex reassignment surgery—as my surgeon puts it—is to essentially “reverse the current anatomy to its earlier configuration.”

Transgender women like me are not getting vaginas and clitorises created for us ex nihilo; they’re made using the same tissue that would have developed into female anatomy anyway.

There’s a beauty to that, I think, that the mere anatomical description of the procedure doesn’t capture. The disgusting phrase “getting clipped”—reportedly uttered by Trump—certainly fails to convey the artfulness of the advanced surgical techniques used today.

The operation itself takes over three hours. “Getting clipped,” presumably, would happen much faster—and it’s unclear why it would cost $250,000.

A description like “getting clipped” also frames sex reassignment surgery for transgender women as primarily being about removing a penis, rather than creating a vagina. But is it any surprise that a man who once bragged about the size of his penis during a Republican presidential debate, would conceive of the surgery in those terms?

“ A phrase like “getting clipped” perpetuates the all-too-common cultural belief that transgender surgeries like mine are crude, medieval procedures ”

Indeed, the problem with a phrase like “getting clipped” isn’t just that it’s an incorrect way to describe the operation. One can hardly expect Trump, a man who doesn’t understand so many things, to understand this.

The sad truth is that, in willfully refusing to comprehend what surgery means for transgender people, Trump is joined by too many Americans: A phrase like “getting clipped” perpetuates the all-too-common cultural belief that transgender surgeries like mine are crude, medieval procedures.

In reality, medical organizations have long approved of them—and they lead to full, happy, dysphoria-free sex lives for transgender patients. Simply put, they are health care. Not elective. Not cosmetic. Not Frankensteinian experiments on the body. Just medicine for people who sorely need it.

But, of course, Trump—and the anti-LGBT Republicans who support the transgender troop ban that the president tweeted out on a whim last summer—will never be able to admit that transgender surgeries are a perfectly valid form of medical care.

After all, the entire premise of the ban—as Trump explained on Twitter—was that the military “cannot be burdened with the tremendous medical costs” that openly transgender service would bring with it.

In actuality, as The Daily Beast has previously reported, all available evidence shows that adding transition-related health benefits to a plan has a negligible impact on overall cost, given how low utilization rates tend to be.

A sentence like “they’re coming in here” seems to suggest that there’s some deluge of transgender recruits enlisting to risk their lives overseas all so that they can get a $20,000 operation. But there just aren’t that many transgender troops—and providing transition-related treatments to them would cost virtually nothing.

As Bloomberg noted last July, medical care for every transgender service member would amount to 0.0014 percent of the overall defense budget. Viagra, as many outlets delighted in observing, costs the military much, much more than transgender medicine.

So, while it’s disturbing to hear the grotesque language Trump reportedly used to describe transgender medical care, it’s even more alarming to hear from Woodward’s account that Trump allegedly uttered it at a key point in his decision-making process on the transgender troop ban last summer.

According to Woodward’s account—as the Examiner noted—Trump made his “getting clipped” comment after being fed lies about the cost of transgender surgery.

He was then given several options to handle the issue of openly transgender military service, which had become a flash point for social conservatives in the House of Representatives.

Only one of those options was a total ban on transgender military service. That was the one he chose, taking Pentagon officials and military leaders by complete surprise.

All along, the myth about President Trump’s views on LGBT issues is that he’s not all that prejudiced himself—he held up that rainbow flag, after all (albeit upside down)—but that he has made a devil’s bargain with social conservatives in his administration who are hell-bent on rolling back civil rights.

Of course, looking at Trump’s actual history with the LGBT community would not bear that out: He once complained about people not being able to “express their own thoughts” about openly gay NFL draftee Michael Sam kissing his boyfriend. He has, of course, repeatedly attacked Rosie O’Donnell and once threatened to have a friend “pick up her girlfriend,” as The Daily Beast noted in 2016.

“ It’s unclear what, exactly, Trump meant by that comment, but it seems clear that his approach to transgender issues has long been misguided, impulsive, and ill-informed ”

Perhaps most relevant for his later attacks on transgender rights, Trump also made the following bizarre remark to Barbara Walters in 2012 about transgender Miss Universe Canada contestant Jenna Talackova after deciding to allow her to compete: “I looked at her name—and somebody brought this up to me—‘Jenna Tal-’. Those are the first letters of her name. And it’s ‘genital.’ And I’m saying to myself, ‘Hmm… that’s strange. Could there be an ulterior motive?”

It’s unclear what, exactly, Trump meant by that comment, but it seems clear that his approach to transgender issues has long been misguided, impulsive, and ill-informed.

Six years ago, Trump was on national television making a weird, convoluted joke about a transgender woman’s genitalia.

One year ago, he was in the White House, reportedly referring to a potentially life-saving procedure as “getting clipped” before making a decision affecting the livelihoods of thousands of transgender Americans.

The “getting clipped” detail, like so many in Woodward’s book, doesn’t reveal anything fundamentally new about the president.

It is at once absolutely abhorrent and completely unsurprising that the president who has done more to attack transgender people than any other in history would say something so stupidly cruel. But for the record, President Trump, I didn’t get "clipped."