Bigger Balls, but Not Bigger Spirit

Gary Rheinschild and the New Americans

The cross-section of humanity, that of the interesting areas, that came my way happened when I was by coincidence introduced to Dr. Gary Rheinschild, who was a practitioner  specialized in urology, the penis, and the enlargement of that organ in order to improve body image. He worked to correct the side effects and complications more or less expected from such extreme body image quests from perfectionist female-to-male sex change candidates.

Dr. Rheinschild was introduced to me as someone whose work might be akin to mine, and perhaps the plastic and reconstructive surgery discipline would be able to offer items contributing to his patients. The patients were (“victims” as they termed themselves). After a year or so of professional consultation to assist Dr. Rheinschild with my approach learned through 30 years of work with my plastic surgery techniques, I made my fifth visit to his office and private operating room as part of my or rather our combined interdisciplinary effort to help those with this very special affliction. My approach to plastic surgery was novel to Dr. Rheinschild. I traveled down to the land of southern California.


The visit was to one of the places in America that was the personification of the advances that were progressing to improve life in American. I figured that it was here where the good life in America began. But to me, it was beginning to show that Southern California was a part of the America that was failing. I had landed in Anaheim near Santa Ana, California.

A visit to “Dr. R” is never mundane, despite the appearance of the building, which was completely glass and steel, perhaps only twenty to twenty-five years old, and beginning to show signs of wear. While waiting for surgery to begin, I was in an outer room reading USA Today in order to keep from falling asleep.

Right then some significant vignettes unfolded right in front of me, more interesting than could be written in USA Today. Here I describe to you two separate patients, one from “old” America and one from “new” America. I’m referring to an old or new state of mind; an old or new outlook on the world.

The first patient addressed the receptionist. “Hello, I’m Ronald Schmitt to see Dr. Rheinschild.” “You were supposed to pick me up from the airport, but the chauffeur you sent ran out of gas.” Many obvious signs of clinical depression hit me: he felt victimized by his circumstances; he was overwhelmed by challenges; he was focused on the negative. He was a giant, a retired American athlete, Neanderthal brow, blue eyes. He was a former center for the UC Berkeley basketball team in 1973-74 and now sold securities for retirement plans. He was the father of three successful children.

Dr. Rheinschild entered the room and began to read through the information that Ron had filled out. Then he asked, “Why didn’t you put your home address here, Ron?” Ron responded, “I’m not on best terms with my wife. She might call here sometime and someone might accidentally let her know where I’m living.”

Dr. Rheinschild asked, “What can we do for you, Ronald?”

“I’m 6’8” tall, and I want to be proportional.”

After we took a complete medical history, we proceeded to the exam. I remained as the scribe. Rheinschild measured Schmitt and sent me the measurements verbally. “Nine cm and 11 cm flaccid, 13 and 15 cm stretched; circumference 11-9-10-12 cm at various points on the shaft and glans.”

I mentioned, “These are normal Caucasian measurements, Mr. Schmitt.”

I was referring at that time, of knowledge gained from John Money, Ph.D., John Hopkins University. He had written an article analyzing the size of the penis in a number of patients.

“I know I’m normal. I want larger.”

Rheinschild said, “Does it get large with erections?”

“I don’t know. I’ve not had the opportunity,” Schmitt spoke with no emotion, no jokes, no inflection—all business.

This guy is clinically depressed. This is an issue with his marriage. I report him as depressed, as depressed can be. He has no erections. He needs more than a big penis.

I knew already that this was trouble. Later on in the hallway I asked Gary, “Do you think he’ll be better in his marriage, his self-image, his social life, or his joie de vivre?”


In sharp contrast to our second patient evaluation, Rudy Dominguez was sitting in the hallway at 7:00 a.m. when we arrived at the office. Rudy had had an experimental penis enhancing surgery two years ago at age 21. The surgery had been unsuccessful; the penis became shorter after its scaring due to healing. An area of skin had necrosed (was black and nonviable). He needed a skin graft of scrotal skin. The flap from the abdominal Scarpa‘s fascia had died, turned to oil, and leaked out. His penis was not enhanced. Similar to Anaheim, the river dried up.

“How are you?”

“Doctor, I’m great!” he said, jumping up out of his chair. He was 5’7”, with a neat crew cut, chiseled features, huge biceps and shoulders, all these new since his surgery. I find that the patient troubleshoots computers at the four branch offices of his company. He’s happy and he’s happily married.

Inside, at the immediate preoperative exam time, we find he is coughing up phlegm, phlegm, phlegm. He feels sick and was cancelled. Therefore his touch-up (actually major revisional surgery) will be at another time, but it will be easy: removal of excess fatty tissue and scars, a start-over operation, and then apply “the weights.”

[Side view of someone lying prone in bed with a tripod apparatus around pelvic area like a big tent. And from the peak of the tent inside comes down an elastic band hooking onto the penis with another sort of clampy apparatus. There’s a timed machine of the bed on the side that pulls upward with 1-3 lbs of traction for ten minutes twice daily for six to twenty-four months. Then we do some more dermofat grafts from the buttocks. There’s a suction device that holds the penis with a vacuum device to minus 6” mercury (Hg) pressure to hold the organ firmly in the line, up to the weights, the traction apparatus.]

Then, “Let’s do dermal fat grafts from the buttocks, put them along the shaft.” And, “Let’s set up another date for the first operation, Rudy.”

Rudy Dominguez is successful in every way, but his penis enhancement two years ago did not enhance his penis. But did that surgery enhance his life? Or are other factors important? Or is the equation so complex that we have to take all factors into consideration? Ronald Schmitt? Rudy Dominguez?


On arrival at my home base, my fax informed me that Diego, another hero of Dr. Rheinschild’s office in Anaheim—the registered nurse operating room technician whose uncle is one of the foremost laparoscopic surgeons in southern California. Diego, not certified as a surgeon and of questionable competence, performed much of Dr. R’s actual surgery—had been with deep regrets fired from his job for writing Nubain® prescriptions (a local anesthetic) and selling it to the patients.

Dr. Rheinschild offered an example only in retrospect. I, the medical and surgical consultant in my PS specialty, was a player in this story and not a part of the audience nor an observer, although I was not overly active in any decision. I was one of the actors in a play: visits to Dr. R. in Anaheim, southern California. “Anaheim” means “home near the river.” I wonder now if the river was dry because of the acts of mankind in that area that interfered with nature. And the acts of nature, which were attempting to work with the acts of man, could not jibe with what was happening. The analogy I thought of was that the acts of mankind in Southern California were coincidental with the drying up of the local river. Southern California enjoyed perhaps the most ideal life in America, but now that was over and the river was done with.

I thought that Rheinschild personally seemed to lament the fact that there were more Mexican people in his neighborhood in Anaheim than there had been when he was a child growing up, and that the entire scenario indicated he was an “old” American. Although he displayed the most advanced type of surgical technology and attempted to produce miracles, the real miracle of a new life in Southern California was not happening and it was the fault of us human mortals not of the march of nature and natural bad luck. 20 years later, in 2017, Trump is also telling us that immigration is the cause of failure in America. Both men did not consider that immigration is the transfusion rather than the bleeding. Immigration causes a new life and erases the older anarchic ideas.

The real miracle was Rudy Dominguez, who did not become depressed at the failure of his first surgery. His personal program included weightlifting and nutrition as well as penis enhancement, which was merely one factor in his goal of self-improvement—at any cost except transgression against his own moral standards. He jumped over the hurdle of the results of his first surgery and cheerfully moved forward, whereas to the “older” American, the giant athlete who felt his life was shattering around him, not having the surgery was a terrible blow, the straw that broke the camel’s back. This further proved that the mental always wins over the physical. The spirit is stronger than the circumstances.


In Anaheim, Santa Ana, the river was running dry and the culture was consuming itself. Dr. R. himself had had a long-time 40-year married life and had recently divorced. We went to his very nice new tract home, which had come off the assembly line of the “southern California building craze.” It was situated high on a hill overlooking the city, “$250,000, four bedrooms, two baths.” The monthly payment was not mentioned, but of course it was low. His son was recently jailed, convicted of drug use for the third time. Gary’s former wife had wanted to nurse him back to “health,” but Gary wanted to throw the book at the boy. “He had too many chances and too much recidivism.” He’d had one suicide attempt. The sad American story.

I told Rheinschild that, “Ronald feels I must invent a silicone prosthesis to fit around each testicle inside the scrotum, to make them appear larger…” I related this to him later when I came over to see Dr. R in the office. “Ronald thinks that if women are able to have breasts made to a larger size, why can’t men have some chance of ‘improvement’?” He sounded like a victim, and he sounded as if he felt men have less chance in life than women because they don’t have access to the tissue substitution technique of silicone.

Coincidentally, Schmitt was my grandmother’s name, and this is related separately in the story, “The Broken Grandpa: The Rudolph Schmitt Story.” Powerful genes require powerful influences to raise them to a higher level. Y arriba y arriba y arriba ire.


Ron although a great masculine person felt that not only his penis was small but he was inadequate in presenting his body to a woman. Ron expressed an intense desire for Dr. Rheinschild to increase its length with his surgery. Ron also asked me as a plastic surgeon to increase the size of his testicles just as a woman increase the size of her breast with silicone implants. In his imagination, he had devised spherical shaped shells to go around the testicles and yet allow blood circulation. Our measurement to the millimeter when compared to studies of the size of normal or average male genitalia showed no deficiency at all. The body image of the great specimen of a man was damaged badly, so badly that the he had been able to make the mistaken decision that surgery would be his Savior.

Here is another story you might like. In this one, the joke is on me! Circumcision of a Father of Five. 


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