The following letter was submitted by “Sleepless Parent,” the mother of a boy who recently announced he is transgender.
Dear well-meaning relatives,
Yes, you. The ones who, when my son abruptly “came out” as transgender on his Facebook page, sent him a quick message of support and encouragement, and then promptly got on with your own lives without a second thought. Then when I offered to share just a page or two of the vast research I had done during many sleepless nights, you quite bluntly told me that you couldn’t be bothered to read it.
Perhaps you can’t be bothered to read this letter either. But since you claim to care about my son and his well-being, let me share with you his future that you are so blithely supporting.
The fit, perfectly healthy young man who never needed to see a doctor will now be a medical patient for the rest of his life. He will be taking extremely high doses of off-label drugs. These drugs may make him permanently sterile.
This drug regimen that he will be on forever, which you seem to believe is “safe,” comes with the risk of all of these side effects: 
- Brain aneurysm
- Deep venous thrombosis (DVT)
- Pulmonary embolism
- Cardiovascular disease
- Pancreatic cancer
- Liver disease
- Gall stones
- Kidney failure
- Type 2 diabetes
- Pituitary gland tumors
- Breast cancer
In addition, as a male-to-female transgender his risk of contracting HIV is now 50 times higher than the general population.
He will spend tens of thousands of dollars for painful surgeries, each one of which carries with it the risk of serious complications, up to and including death. If he goes through with the genital mutilation euphemistically referred to as gender reassignment surgery, the best outcome he can hope for is a long, painful recovery and a need to dilate the “neovagina” with a dildo-like apparatus every day for the rest of his life. However, there is a high probability of complications, which can range from such “minor” issues as bleeding, a putrid smell, or trouble urinating, to far more serious complications such as a fistula tear, a complication which can result in wearing a colostomy bag for life.
Let’s assume for the sake of argument that none of this plethora of scenarios happens, and he ingests enough drugs and undergoes enough surgeries in order to successfully “pass” as a woman. His gender dysphoria will finally be cured, right? No, even after he has reconstructed his body to be “congruent” with what his mind believes, the possibility that he will attempt suicide actually increases with time, and can be up to 19 times higher than the average person. 
So, dear relatives, by telling me that I should be “supportive” of his transition, you are actually telling me that I should be encouraging my child to increase the likelihood that he will suffer serious life-threatening diseases or commit suicide.
So please – back off. Because you’re not the ones who will be there for him when someone has to pick up the pieces – that will be me, his “hateful, transphobic” parent.
 Appendix B, pages 97-100
 Pages 12-15
 Warning: graphic surgical pictures