“Top surgery”–the removal of both breasts with subsequent “chest reconstruction” –is the holy surgical grail for many females who identify as trans male.
Once strictly a prerogative for adult females in the United States, there is a growing trend for younger “trans teens” to pursue double mastectomy as early as possible. In the United States, the age of medical consent for major medical procedures without parental involvement is typically 18 years, with a few exceptions–notably for “emancipated” or married minors, and for contraception/birth control services, which are generally available to teens at an earlier age. There are also a few states with a lower age of medical majority, Oregon being one of them (age 15).
But the push is on by trans activists to lower the age of consent for trans-identified teens to undergo general anesthesia and major surgeries (both “top” and “bottom”), and to force both private insurance policies and taxpayer-funded state health plans to cover the procedures as a medical necessity.
Going under the surgeon’s knife is always a risky business. Apart from the questionable wisdom of colluding with a pubescent girl’s notion that she is “really a boy,” mastectomy and general anesthesia carry risks of complications. (Interestingly, “gender dysphoria” is no longer considered a mental disorder in the DSM-5, but a normal variant in the human condition–which somehow still requires extreme medical intervention.)
For any other condition, major surgeries requiring general anesthesia would be seen as last resorts. It would be considered a miracle cure to be celebrated if a 15-year-old cancer patient were able to go into remission sans surgeries and chemotherapy.
For any other condition, everyone involved in the process–the patient, their families, doctors–would be looking for the least-invasive, least extreme, least permanent treatment approach. And the very last thing they would do is lobby legislatures for less parental involvement in these life-altering decisions that affect an adolescent girl.
As I have written about previously, these activist gender organizations are already proudly and secretly handing out free breast binders to kids with “unsupportive parents.” But they aren’t stopping there. They are doing their best–and succeeding–at further eroding the involvement of a child’s most trusted adults in permanent medical decisions.
Let’s take a closer look at Oregon, where, in 2014, TransActive Gender Center successfully lobbied the state legislature to include transgender hormones and surgeries for children on the tax-payer funded Oregon Health Plan (OHP), which is Oregon’s version of Medicaid for low income people. (There is not enough room in this post to cover the many medically necessary procedures that are not covered under the OHP.)
And TransActive just had another victory. Only a few days ago, it was instrumental in ensuring there is NO lower age limit for “transgender surgeries” WITH parental consent. This means that a parent can decide (because let’s be very clear: when it comes to an 11 or 12 year old or even younger, it is the PARENT who is making the executive decision) to allow their young child to have even her ovaries and uterus surgically removed. Here we see Jenn Burleton, executive director of TransActive, celebrating on Burleton’s public Facebook page:
In the comments, supporters are jubilant. Only one injects a note of caution:
It’s good but I hope these parents and kids have the benefit of LOTS of counseling
In response, Devin Kit Crosland (scroll down for profile), a female-to-male trans-identified individual who heads up TransActive’s “In a Bind” free breast binder program for minors, helpfully points out that, in Oregon, kids age 14 and up can already get transgender counseling, without interference from “parents who aren’t supportive or aren’t educated on the issues.”:
On its public Facebook page, Transactive crows about the ways it has helped to make it that much easier for a young girl who wants to remove her breasts:
We’re down to one referral letter (instead of two) for both cross-sex hormones and “top surgery,” on the taxpayer-funded Oregon Health Plan. What’s next on TransActive’s agenda? No letter at all? An online, on-demand dispensary for testosterone, and same-day, walk-in clinics for double mastectomies? No lower age limit for “gender affirming” surgeries without parental consent?
TransActive is aptly named. These are activists, and they want to make sure girls in other US states–your daughter, too–can get these surgeries without the pesky interference of any “unsupportive” mom or dad.
The same Facebook victory thread on Jenn Burleton’s public page shows supporters asking how they can change the laws in their own states. Burleton makes it clear that TransActive isn’t just some Oregon-focused local organization. No, Burleton wants to move this agenda forward across the nation:
For those interested, TransActive Gender Center will share the testimony we prepared for adding and protecting this coverage in Oregon with anyone working on securing or interested in securing the same or similar coverage in their state. PLEASE… do not pursue this dialogue on Facebook!
Send an email to advocacy@transactiveonline.org
So what are the gender nonconforming young people supposed to do while they’re waiting for the taxpayers in their state to pony up for their breasts to be removed? After all, these surgeries are expensive. In most states, unlike Oregon, health plans still consider “top surgeries” elective and not medically necessary.
The Internet is abuzz with ideas and resources. The site topsurgery.net aggregates lists of “top surgeons” and self-funding ideas. Many people set up online charities for themselves, asking complete strangers on the Internet to donate to their cause. All the fundraising sites I found were fully publicly accessible, with not a few run by teens under age 18. A Google search for “top surgery gofundme” results in 1900 hits. The tag “top surgery FTM” turns up plenty of results on Tumblr. And a search of the GoFundMe site itself with keywords “top surgery” currently turns up 455 people looking for donors–with several of the potential surgery patients under the age of 18. Parents are even getting in on the act, putting up online fundraising sites for their kids, evidently even for young people with developmental disabilities.
Medical “gofundmes” are nothing new in the US, where plenty of people are still uninsured or underinsured. People needing cancer treatments or surgeries have been funding themselves through bake sales and online fundraisers for quite some time. And while, as I noted earlier, being “transgender” is now no longer considered a psychological disorder, it is a non-disorder which requires extreme medical treatments, so it’s natural that people are hitting the interwebs to raise cash.
And what about the “top surgeons” who do the work? Space does not allow a full review in this post of the hundreds of top surgeon sites popping up all over the web, but it’s obvious this is a growing and lucrative business. To take just one example, Dr. Hope Sherie has a display ad that appears all over topsurgery.net, with her own page on that site promoting herself as
Highest Level of Top Surgery Care on the East Coast
Dr. Sherie, along with the other surgeons featured on topsurgery.net, posts before-and-after photos, including several showing the results of years of breast binding vs. the post-surgical results. She also helpfully lets us know that she’ll be at the Gender Odyssey conference, a pow-wow for transgender activists, medical providers, trans people, and their families that meets yearly and begins this Friday, August 21, in Seattle, WA.
A look at the advertisers on the home page for the conference shows several plastic surgeons, as well as some organizations–like the Center For Lesbian Rights–that might not be staying exactly true to their original mission, if you think about it; but that’s a subject for a future post.
I want to close this post by addressing a few sincere questions to the transactivists and medical/psych providers who might have landed on this page.
I expect that most, if not all, of you feel you are doing the right thing for these girls. You are not monsters. But I have to wonder: do you ever engage in any soul searching? Do you ever ask yourselves, “Am I doing the right thing?” Is your sleep ever troubled by the suspicion that at least some of these young women will regret the permanent changes you have allowed them to make to themselves?
Many of the parents who write to me are losing a lot of sleep. They are constantly searching their own consciences, wanting only to do right by the children they have known for so many years. They know their children far better than you do. It seems to me that every adult who is involved in the weighty business of encouraging other people’s children to pursue a path of medical transition ought to just stop. Think.
It’s not enough that some of you are going to study these kids in the future. What of the people who may be irrevocably damaged by the treatments being administered right now?
Is this work you are doing something you will regret someday? Will you go to your grave confident you have “done no harm?” You have the future of our precious children in your hands. Respect us–both parents and our kids–enough to honestly ask yourself: AM I doing the right thing?
Reblogged this on Stop Trans Chauvinism.
I am feeling deep despair. Everyone thinks parents are disposable. It is completely depressing.
Yes. I understand the despair. Too well. But many parents really don’t understand what’s going on. This information is important for them to see. And they need to understand that there are activists who are pushing this agenda forward. A lot of people are just asleep. That may be changing.
You are doing important work here. And I was drowning before my millionth Google search turned up your blog. Thank you.
If you look at my blog theme picture, you’ll see that I’m underwater too, investigating this wreck with all of you. I also feel like I’m drowning at times, but in the words of the great poet Adrienne Rich, I’m trying to shine a bright light on “the thing itself and not the myth.” We are all in this together, in the wreckage, the mythology, left by the third wave. But I have hope that what we bring back to the surface might just save a few of our kids from succumbing…
There is no way that people like Burleton are doing anything but legitimising their fetish on the bodies of children. Any normal person would say “let’s gather lots of proof together, talk to the parents and child extensively, make absolutely sure this is a viable solution for a case of dysphoria” even if we accept it IS (which I am not sure of in the slightest). They wouldn’t say “Nah, we need less proof” and fucking campaign for that.
That’s dodgy as hell and it is because a lot of the leading lights (not all) are thoroughly unpleasant bastards. I’m preaching to the converted here because all of you know much better than I ever could, but whenever an adult says effectively “We need to bypass the parents to get to the children” something has gone massively wrong.
I don’t see how the gender essentialists, doctors and families alike, can ignore known teen behavior patterns (not to mention the lack of science backing up gender essentialism). I understand feeling desperate for answers, and I understand doctors who think, “these families are SO upset, their kids are SO upset, we have to do SOMETHING and maybe this will work.” But I don’t understand how they can ignore known teen behavior patterns like they do, and decide that in this particular area, teens absolutely KNOW what is right for themselves, justifying hormonal and surgical treatments that are not reversible.
This subreddit on “stuff I really believed as a teen that I now think is appalling” is apropos, if painful: https://www.reddit.com/r/AskReddit/comments/3hg3hn/reddit_what_was_your_its_totally_not_a_phase/
I mean, take a gander. From wicca to goth to skater culture, from thinking you’re asexual or bi or even gay and then changing your mind, from girls in boy’s clothes and short hair and boys dressing like glam rockers, rabid environmentalism, communism, vegetarianism, anime, Christianity, atheism, Pokemon, World of Warcraft, you name it — these kids once passionately embraced it and later discovered that it wasn’t a forever thing. And not a few comments from putative transmen who later just decided they were girls who were not ever gonna be very girly.
It’s a good thread. I wish all the docs out there who are writing support letters for these minors seeking hormones and surgeries would read it and really …READ it.
meanwhile? My heart breaks for these girls who have cut up (or hope to cut up, or are in the process of cutting up) their physically healthy bodies. They are too young to understand that bodies can fail even when given the best of care, and that it behooves you to take the best possible care of that machine — because when that machine starts to go bad, it can be a very terrible situation. They’re too young to understand the pain of becoming intimately enmeshed in medical treatment and maintenance. They’re too young. They’re invincible. They’re convinced there’s a simple fix for whatever feelings are giving them such pain.
but their parents, and the grownups who are advising them? They’re not kids. And they ought to know better.
I am a therapist who works with teens. The trans craze has been devastating for me, as I work mainly with medical folk who don’t consider the complex psychology of what is happening to our kids.
Tomorrow is my last day of working with the teens. I can’t tolerate what is happening. When I’ve tried to speak out about it at team meetings I’m looked upon like a backwards hater. It kills me because I’ve devoted my life to helping others become strong in who they are.
Your blog is so helpful, beyond helpful. I could say much more but I’m on my phone and rushing. Contact me privately through email if you wish. My heart does break for the kids, and the parents… This trans wave is a destructive force. It has occupied my mind for more than a year now. Finally realized I had to resign when the new medical director of our teen program turned out to be super hot on jumping on the trans bandwagon.
How wonderful to hear from you. I know there are others like you out there. I will be contacting you privately. Thank you for coming here, and please keep contributing. Would love to see your opinion on this piece about a psychotherapist who is also questioning the trans trend?
http://4thwavenow.com/2015/07/30/one-psychologist-who-gets-it-trans-kids-and-their-parents-deserve-something-different/
Do you know if there are other psychologists who have your same idea about trans issue? Maybe there are a lot but they remain silent
Here’s a link to a relevant paper, and some quotes from it. Note that the paper was published in 2008. PubMed tells you how many times a paper has been cited, a rough idea of how influential it’s been among researchers. This paper had only 3 citations: one reply, the authors’ response to that reply, and a case study of a single transgender person who is happy with his reassignment. Other than that it’s been ignored.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2697020/
“A treatment of this kind changes the individual’s sexual experience both in fantasy and in behavior. It restricts sexual appetite and functionality and thereby prevents the individual from having age-appropriate (socio-)sexual experiences that he or she can then evaluate in the framework of the diagnostic-therapeutic process. As a result, it becomes nearly impossible to discover the sexual preference structure and ultimate gender identity developing under the influence of the native sex hormones ”
“Children and adolescents generally lack the emotional and cognitive maturity needed to consent to a treatment that will have lifelong consequences. The fact must be taken into account that children with GID have an above average prevalence of deficient social skills, behavioral abnormalities, and psychiatric comorbidities (5, 8) and are therefore particularly susceptible to the temptation of a supposedly rapid solution to all of their problems.”
“In the authors’ view, development inhibiting (LHRH analogues) or body altering (estrogens/androgens) hormone therapy should not be initiated before the patient’s psychosexual development is complete, in view of the current lack of scientific data on these forms of treatment and the potential danger of aggravating a gender identity disorder. ”
“The diagnosis of a transsexual, i.e., irreversible, GID is permissible only when the individual’s psychosexual development is complete and after his or her sexual preference structure has been elucidated. A further prerequisite is that the sexual preference structure must have become established without any influence from extraneous hormones. It follows that the use of puberty-inhibiting LHRH analogues or sex steroids of the opposite sex during adolescence, at any chronological age, would seem to be appropriate only in rare cases for strict indications, when it is certain that nascent transsexualism is the correct diagnosis.”
4thwavenow, I hope you don’t mind me stopping by. I read here from time to time, but have refrained from commenting, as I am not a parent. (I’m a middle-aged lesbian, critical of trans ideology and absolutely opposed to the transing of children.) However, some things about the article olaru linked to have inspired a monster post.
olaru — I read through the paper and was fairly creeped out by it. I’m glad they’re urging caution about putting kids on Lupron; however, they clearly think that there is such a thing as “nascent transsexualism,” and that rejecting stereotypical sex role behavior and clothing can be a sign of a disorder. Nowhere do they suggest that this might simply be a healthy assertion of individual likes and dislikes. They also come very close to suggesting that there’s something mildly pathological or disordered about homosexuality. The authors believe in gender, gender roles, and gender identity. They don’t want to push kids to transition, but they don’t necessarily think it’s healthy to be too different from the norm.
The emphasis on psychosexual development seems a little blinkered to me, too — they appear to see transsexualism as a form of supergayness. That doesn’t leave much room for understanding the heterosexual girls who decide they’re boys because that looks to them like their last, best chance to be treated as human. Then there’s the way they suggest that kids develop GID because their parents have mental problems. I see the long shadow of Freud here — it’s always the family, never society. There’s no acknowledgement that from a very early age, we are all bombarded with influences other than those of our families. From kindergarten on (or even earlier), kids spend half their waking lives outside the home, surrounded by same-age peers who are modeling their own ideas about sex roles on what they see on TV (or nowadays, the iPad their distracted parents gave them when they were in the stroller), and supervised by overworked adults who may not be paying much attention, or may be gender-policing the hell of their charges when they do.)
I would not be too quick to view the authors of this paper as advocates for the idea of just letting kids be themselves. I don’t have time to do any digging, but it would not surprise me if they turned out to be basically in the “gays haven’t properly adjusted to their sex role” camp. They use the term “ego dystonic homosexuality,” for example, which is used almost exclusively by advocates of reparative therapy — at least in the US. (I notice these people are German.)
Someone linked to one of Maria Catt’s essays in the comments to another post. In another piece of hers, called “Ice Balls,” she writes this:
“It was easier to blame my pervasive discomfort on gender rather than trauma- everyone I had told about my various traumatic incidents had not seemed to think they were a big deal. They didn’t seem big enough to explain this constant, intense disassociation I kept running up against. My misery was big enough only a big explanation could suffice.”
I think this is profound. Girls’ trauma rarely gets acknowledged or taken seriously. Too many mental health providers see trauma symptoms as signs of an underlying disorder, or just the natural state of teenaged girls — hormone-addled, hysterical, fucked-up. If the trauma’s the subtle kind — for example, the kind that comes from dealing with daily sexual harassment at school that would constitute “hostile workplace” harassment anywhere else — it’s absolutely invisible to most people in the mental health biz. They don’t stop to consider that a girl stuck in an environment like that can’t just walk away — she’s trapped. Those incidents of harassment and gender-policing tend to be ongoing; over time, they’re enough to cause serious distress, even without a major event like sexual assault. But if everyone’s telling you that your experiences can’t possibly be enough to cause so much pain, you may start looking around for a Big Explanation — unconsciously or even consciously. A Big, Internal, Personal Explanation that focuses on the individual and what needs to be fixed about her, not the fucked up external circumstances that are causing her to divert all her energy towards surviving rather than thriving.
Thirty years ago, that Big Explanation might have been something other than trans — for example, it might have been deciding you had an addiction (or if you really didn’t, cultivating one for the sake of its explanatory power). Then there’d be an obvious next step and path to healing — you could join a recovery program. That’s where the support was, and it being a recovering addict was something the larger society recognized and had a name and a certain grudging respect for. I suspect that being trans may be serving a similar purpose for a lot of teenaged girls and young women.
The therapists who can help are the ones who recognize that trauma can be subtle. Oh, and that girls are people.
You absolutely don’t have to be a parent to comment here! You’re welcome anytime.
Loup-loup, what a brilliant comment. One of the things I have also wondered about is the link between issues in teenage girls manifesting as trans vs other self-image and self-harm conditions such as anorexia. Are we seeing a move from one to another or is the trans trend an expansion, catching up others in its net ? As the original article says there are often other comorbidities, and this again is something that the medical profession as a whole seems reluctant to address.
The sociologists and psychologists could make themselves useful and be researching this, if they weren’t so tangled up in the trans cult circus.
Loup-loup garou,I see why you were creeped out, and I should have included a warning with my link – I do apologize. I absolutely agree that this paper, and much of the field, are overly focused on individuals and not enough on the broader social issues. This is true in so much research, and needs to change. And I agree with the quote from Maria Katt, and everything you write after it.
I have just done a search on the first author; his work has mostly been on anorexia nervosa, both treatment per se and surveys of treatment efficacy. He’s done work on body image issues among anorexics and elite gymnasts, and as far as I can tell from the abstracts, he’s alert to the intense, destructive pressures young women face. Another paper on gender dysphoria is about the need for clinicians to be aware that GD and its possible causes are extremely variable among dysphoric people, and that therapists need to tailor individual treatments accordingly (exactly what today’s poster says can’t be done now). I didn’t find anything to object to in any of the abstracts I read.
I don’t think we can assume that we’re always seeing the authors’ own attitudes here. They quote the diagnostic standards, but without comment. I couldn’t agree with you more about the gendered assumptions in those standards, but quoting them here was appropriate, I think. A lot of the weird stuff about causes and such is in the literature review, again that needs to be included whether the authors agree with it or not.
They say, of their own patients, “The “motive for switching” [away from GD and the desire to transition] among the 15 adolescents in the group was mainly a rejected (egodystonic) homosexual orientation (see figure), the development of which would have been arrested by puberty-blocking treatments.” In context, I interpret that as saying, “these kids turned out gay, so they didn’t need to transition, but we might not have figured this out if we’d put them on hormones.” A lot of us are worried about exactly that – on the assumption that being gay is just fine, and transition should be a treatment of last resort, because its medical consequences may be severe.
With respect to reparative therapy, they say “Contrary to earlier assumptions, gender identity cannot be changed by external influences alone, i.e., attempts at so-called “re-education,” even when these attempts are begun as early as the first year of life (13)…”.
With respect to parents’ possible psychological issues, they cite other published studies for that – they aren’t just supposing it. Again, this is a survey of current practice and knowledge – they are saying that this is something that therapists need to be alert to. And it’s quite different from assuming that all parents of kids with GD have some psychopathology, it’s just one of many factors to consider.
I’m writing this after seeing today’s post from another professional appalled at the current rush to transition children. I don’t know if the professional climate is different in Germany, but I think it’s brave of them to take the position they have, and disturbing that they been cited so rarely. For me the good here far outweighs the shortcomings.
olaru, I see your point about the authors’ needing to adhere to disciplinary conventions — and I probably didn’t give that enough weight. “Nascent transsexualism,” though…yikes.
Olaru, one thing French psychanalysts and the like agree on, is that they have no way of changing an adult man’s decision to become transsexual. If they say no, he’ll go elsewhere (that has been known for a long time). On oldish interviews i’ve read, they say that kids can be helped fairly simply, and teens too but they have to deal with their sense of urgency (where waiting a week is seen as torture).
In a ‘conservative’ framework, it makes sense to say that some people become fixed on transsexuality.
Thanks for the link. I think this quote was notable as well:
“Two further reasons for the rising demand for sex changes among minors would appear to be the “feasibility delusion”—the notion that modern medicine can effect a sex change with no problem at all—and a tendency to view the choice of one’s own sex as a type of fundamental right (e10).”
A comment found on Facebook about this post:
“I have history of breast cancer in my maternal line but I can’t waltz in to the hospital and say I want both breasts removed for my future health and peace of mind. Maybe I should claim to be a man?”
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I am a 46-year-old transgender female and I also worry how easy it is becomming to get hormones and puberty blockers. I did everything I could think of and went to get help wherever I can find it before I finally decided to transition in my 40s. I think A person is doing a disservice to themselves by not seeking as much help as possible before transitioning.
Oh, mama. The children should all be helped to work through the misogny and machismosim that have so influenced our crap-fest of gender long before they are dx with gender dysphoria. The incidence of gender dysphoria is low. No reason to see all these kids transitioning.
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This is a good thing. I’m glad theyre fighting against abusive parenting. Trans kids deserve surgery
I’m so glad kids can get top surgery without worrying about their transphobic parents! 15 does seem a teensy bit young, that’s fair. Maybe they could offer hormone blockers until they were 16+. that would seem to solve your issue. Also, it isn’t the parent’s life. The kid should be able to live their life! my parents are accepting but they won’t even consider the fact that I (16N) know what I want done with my body. They love me, and I know they’re worried because they don’t understand the problem and therefore can’t understand why this is necessary and important, but it is. Wish I lived in Oregon! Great news, thanks for sharing haha!!!
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