CMRT Considerations for Gender Affirming Surgery and Hormone Therapy

Clinical systems age. Patients, research questions, and social understanding change around them. Chiropractic Manipulative Reflex Technique, or CMRT, was developed by Major Bertrand DeJarnette over several decades, with its last major text update in 1966. That history matters because the original CMRT framework did not directly address care for patients undergoing or having undergone gender-affirming surgery and hormone therapy.

That leaves a practical question for clinicians who use CMRT: when applying organ-related reflex work, especially uterine or prostate considerations, should care be guided by anatomy present at birth, current anatomy, hormonal status, surgical history, or some combination?

The short answer from Moore and Blum’s article is cautious and clinically sensible: begin with the patient’s original biological presentation when using gender-related CMRT reflexes, then adapt if the clinical response suggests another approach is needed. Because direct evidence is limited, this remains a matter of biological plausibility, clinical reasoning, and careful patient-centered care.

CMRT decisions may depend on anatomy, surgical history, and patient response.

Why CMRT raises new questions in gender-affirming care

CMRT was designed in a different clinical and cultural era. At the time DeJarnette developed and updated the technique, healthcare texts rarely considered the distinction between anatomy, gender identity, surgical transition, and endocrine management.

Today, those distinctions matter.

Gender-affirming surgery may alter external or internal anatomy. Hormone replacement therapy may change endocrine patterns and tissue behavior over time. A patient may also have retained organs, removed organs, reconstructed anatomy, or symptoms that do not map neatly onto standard categories.

For CMRT practitioners, this creates a specific challenge. Traditional protocols often associate reflex patterns with organs such as the uterus or prostate. But when a patient has undergone gender-affirming procedures, the clinician must ask:

• What anatomy is currently present?

• What anatomy was present earlier in life?

• What surgeries have been performed?

• What hormone therapy is the patient using?

• How does the patient actually respond to care?

  
  

The article does not claim to settle these questions. It frames them as a new clinical area where evidence has not yet caught up with practice.

What earlier CMRT case studies suggest

Moore and Blum point to two CMRT-related case studies as useful analogies. Neither case involved gender-affirming care, but both raise an important principle: clinical response may depend on how anatomy and reflex patterns interact, even when the situation does not fit the usual model.

One case involved a patient with situs inversus, a condition in which organ placement is reversed from its typical position. The patient did not respond as expected to standard CMRT application. After imaging showed reversed organ presentation, the practitioner reversed the treatment contacts. The patient then had a positive response.

That case suggests that organ location and reflex contact patterns can matter. It also shows the value of investigating why a patient does not respond as expected rather than assuming the technique has failed.

The second case involved a patient who had undergone gallbladder removal. Even after surgery, the patient continued to experience pain described as phantom gallbladder referred pain. CMRT reflexes and manipulations were applied after surgery, and the reported pain improved rapidly and did not return over long-term follow-up.

This case raises a different possibility. A removed organ may no longer be physically present, but the nervous system may still express patterns that seem related to it. That does not prove how CMRT should be applied after gender-affirming surgery, but it gives clinicians a reason to think carefully before relying only on current anatomy.

A practical way to think about uterine and prostate CMRT

The main clinical proposal in the article is conservative. In patients undergoing or having undergone gender-affirming surgery and hormone therapy, the initial CMRT approach may be guided by birth anatomy. If the patient does not respond as expected, the practitioner may then consider adapting care toward the patient’s current gender presentation and clinical state.

That does not mean using a rigid formula. It means starting with the most biologically plausible model available, then letting patient response guide the next step.

A careful approach may include:

• Taking a respectful surgical and hormone therapy history

• Asking about retained or removed reproductive organs when clinically relevant

• Avoiding assumptions based on appearance, name, or gender identity

• Explaining why a particular reflex contact is being considered

• Getting informed consent before sensitive care

• Reassessing response after each application

• Coordinating with other healthcare providers when needed

  
  

This is especially important because terms such as “uterine” and “prostate” may carry emotional weight for some patients. Clinical language should be accurate, but it should also be respectful. A patient’s gender identity should not be treated as a complication. It is part of the context in which care is delivered.

Clear explanation and consent are central when care involves sensitive anatomy.

Why evidence is still limited

The article is clear that there is not enough direct research to make firm claims about CMRT protocols for patients who have had gender-affirming surgery or hormone replacement therapy. That matters.

Case studies can be helpful, especially when they reveal clinical patterns or raise new questions. But they do not provide the same level of evidence as larger controlled studies. The situs inversus and phantom gallbladder cases support the idea that adaptation may be reasonable, not that one protocol is proven.

For now, CMRT considerations for gender affirming surgery and hormone therapy should be viewed as a developing clinical discussion. The safest path is to combine low-risk care, close observation, patient communication, and humility about what is not yet known.

The takeaway for CMRT practitioners

Gender-affirming care asks clinicians to think beyond old categories without abandoning careful anatomy-based reasoning. For CMRT, Moore and Blum suggest a practical starting point: begin with the patient’s birth anatomy when considering uterine or prostate reflex applications, then adjust if the patient’s response points in another direction.

That approach respects both the history of CMRT and the reality of modern patient care. It also leaves room for better evidence in the future.

This post is for informational purposes only and is not medical advice. Patients should consult qualified healthcare professionals for personal care decisions.

Citation

Moore, Jeffrey, DC, and Charles Blum, DC. “Chiropractic Manipulative Reflex Technique (CMRT): Considerations for Uterine or Prostate Treatment Application for Patients’ Undergoing/Undergone Gender-Affirming Surgery and Hormonal Replacement Therapy.”

References discussed in the article include case studies by Zablotney and Blum on situs inversus and Blum on phantom gallbladder referred pain after cholecystectomy.