The male symbol in the poster in the Trinidad Medical Center OR is pointing in the wrong direction - up and left instead of up and right.
"Well, all my life I felt I was black!" - This is odd, considering that Cartman has pretended to be black on a number of occasions and Kyle hasn't felt offended by any of those the way a black kid might be. Same with Mr. Garrison, who, although he could play the female in a gay relationship and put on dresses for class, hasn't quite expressed a desire to be a full-on woman before, and all of a sudden he gets a sex-change operation.
Now that Mr. Garrison is a "woman" (it's a cosmetic change, since he didn't have ovaries installed), he can say he loves men without being gay about it. Now he'd be in denial if he said he doesn't love other women.
"Jews can't play basketball!" - "White Men Can't Jump"
Dr. Biber looks a bit like... Hans Blix from Team America. His name means "Beaver" in German, which gives an added meaning to his work in sex-change operations.
Dr. Biber should have moved Gerald's trachea to the back of the head, not the esophagus.
Dr. Biber's ridiculous operations and quack behavior are based on those of Dr. John Ronald Brown, who damaged many of his patients one way or another. But there really IS a Dr. Biber. Check out his site here!
The water coming out of Gerald's blowhole changes color as it touches the carpet.
The Planned Parenthood building looks a lot more modern than the Unplanned Parenthood building seen when Ms. Cartman wanted to abort Cartman long after he was born.
Women do not pee from the vagina. They piss from the urethra, which is in front of the vagina.
Kyle wears #4 on both uniforms he wears, but is called #8 when he substitutes for #11 at the all-state playoffs. For Saturday's airing, the announcer does say #4.
On the arena wall: An upside-down M, with the words "Gotta love it!" This is a spoof of McDonald's and its "I'm Loving It" campaign.