“The money is flowing” to “suck people in:” Vaginoplasty & the case of Jazz Jennings

Social media has been abuzz the last few days with the release of a trailer advertising the upcoming third season of “I Am Jazz.” It’s only a two-minute clip, but it packs a wallop. We see Jazz crying while saying “I just really hate myself” which is intense enough (given Jazz’s admission in the prior season of being suicidally depressed). But the big news is Jazz’s desire to seek bottom surgery. In the trailer, we see Jazz in three different doctors’ offices. The news isn’t good.

Doctor #1: You’re about to turn 16 so…I think it’s feasible that you could have bottom surgery.

Doctor #2 : We’re just now getting children who have been on puberty blocking hormones. When it comes to the surgery, we don’t have the raw materials we need.

Doctor #3: Testosterone suppression did you two big favors here (gestures at his chest, pantomiming breasts) but it didn’t do you any favors “down there.”

Doc two big favors

The benefits & drawbacks of blocking testosterone

The “raw materials” down there are, of course, the child-like male genitals Jazz would have, having been on puberty blockers (since age 10) and estrogen (since at least age 12), according to the first episode of “I Am Jazz” in Season 1. The most commonly performed procedure in the United States to create a facsimile of female genitalia, called “one-stage penile inversion” is more complicated and requires more steps when the male genitalia are the size of a prepubescent child.

A prior 4thWaveNow post, “Age is Just a Number,” touched on a few points from an April 2017 article in the Journal of Sexual Medicine co-authored by gender therapist Christine Milrod and USPATH head and UCSF gender psychiatrist Dan Karasic, which discussed exactly Jazz’s situation: “bottom surgery” for minor boys. The prior post emphasized some surgeons’ belief that minors should have the procedure done while still in high school so that their parents can ensure compliance; even be “active” in the dilation routine required to keep the neovagina open to “maintain the vaginal depth involved” before the teen becomes distracted by college.

But there is much more to say about not only the surgeons who operate on minors, but also those who recommend SRS for puberty-blocked preadolescents.

Of the 20 (anonymous) surgeons surveyed in the Milrod-Karasic article, 11 admitted to operating on boys under the age of 18. Unless Jazz seeks the procedure overseas, it’s highly likely it will be one of these surgeons who will do Jazz’s “bottom surgery,” should it take place before age 18.

From the get-go, co-authors Christine Milrod and Dan Karasic make clear that the growing trend of operating on minors is out of compliance with the current WPATH Standards of Care (SOC 7). But it’s evident from this and other writings that Milrod and Karasic –both proponents of “affirmative gender care” for minors—are interested in changing those standards for the next version (SOC 8). And they are not alone; lowering the age for genital surgery is a very popular topic among top gender clinicians like Johanna Olson-Kennedy and others.

Who are these 11 surgeons? Not even one has ever published on the issue:

The surgeons who perform the procedure on transgender minors have, without exception, refrained from publishing any peer-reviewed outcome data or technical articles on this small but increasingly important population….

…When asked about the lack of published data on surgery in minors, most participants asserted that GCS in all age groups had been a very small part of surgical medicine until very recently and that data on large volumes of procedures were not yet available. Some also cited the perceived “taboo” or outright stigma in performing the surgery and therefore a certain reluctance to share results or specific techniques.

But there are a few surgeons (whether they are part of the group surveyed for this article, we don’t know) who have been featured in news articles about genital surgeries on males under the age of 18. One of them, cited by Milrod and Karasic in a footnote, is Dr. Gary Alter, who in 2014 performed vaginoplasty on a 16-year-old.

Alter surgery

Dr. Gary Alter first removed the testicles and inserted a tissue expander (similar to an internal balloon) in the scrotum several months prior to the final sex change. The expander was progressively filled with fluid through a port during several follow-up visits in order to stretch the scrotal skin and yield enough skin as a graft to line the neovagina. The expander thus enabled the patient to avoid taking skin harvested from the flanks with the resulting unsightly scars. After 2.5 months, the expander was removed during the vaginoplasty and clitoral creation.

Just as Jazz’s doctors said: without the necessary “raw material” of a mature penis and scrotum, surgical fashioning of an approximation of female genitalia requires some rejiggering.

Interestingly, the article about Dr. Alter tells us that the 16-year-old’s psychotherapist was none other than Christine Milrod. who penned a piece “How Young is Too Young” in the Journal of Sexual Medicine in 2014. In it, Milrod argues for new guidelines that would allow underage surgeries on a “case-by-case basis.

milrod jsm 2

Professionals across disciplines treating female-affirmed adolescents can utilize the proposed ethical guidelines to facilitate decision making on a case-by-case basis to protect both patients and practitioners. These guidelines may also be used in support of more open discussions and disclosures of surgical results that could further the advancement of treatment in this emerging population.

“This emerging population”—male minors seeking genital surgeries.

Gary Alter is not the only one who has performed vaginoplasty on underage males. This 2015 New York Times piece features another surgeon, Dr. Christine McGinn (a late transitioning, former military MD):

Several doctors said they had performed surgery on minors. Kat’s surgeon, Dr. Christine McGinn, estimated that she had done more than 30 operations on children under 18, about half of them vaginoplasties for biological boys becoming girls, and the other half double mastectomies for girls becoming boys.

.. Kat’s parents trusted her not only as a specialist, but also as a role model: She had been a dashing male doctor in the Navy, before becoming a beautiful female doctor in civilian life.

When questioning the ethics involved in performing risky, irreversible, sterilizing surgeries on people too young to give informed consent, it’s easy to point the finger only at the surgeons. But as is made abundantly clear in the Milrod-Karasic article, it is psychotherapists like Christine Milrod who are heavily relied upon by the surgeons to make the correct referrals. No minor simply walks into a surgeon’s office to ask for SRS without first being referred by a gender therapist.

Nearly all participants reported an overwhelming reliance on mental health practitioners to assess the minor’s psychological readiness for surgery. Statements including “completely” (Surgeon 9) or “extremely” (Surgeon 10) were used to emphasize trust in the diagnostic expertise of mental health providers.

Surgeon 3 concurred: “I rely on them entirely. I need to make sure that the patients have realistic expectations, that they are not. I need to judge their maturity level and that they can handle pretty significant stress of any surgical procedure. But I don’t pretend to be a psychologist or have any expertise in the diagnosis of gender dysphoria, that’s a decision that needs experts.

Surgeons operate; psychologists assess maturity and readiness. But even with the blessing and recommendations of a gender therapist, some of the surveyed surgeons clearly have some understanding of the immaturity of a 15-year-old brain. Here’s what Surgeon 18 had to say:

In addition, a few participants urged caution, suggesting that some adolescents engage in gender exploration as part of a developmental phase and as part of the current zeitgeist: “I think it goes along the lines of a young person’s mind still being in the developmental stage. Things may happen and they may reorient their thinking, not just whether they are trans or not, but they may reorient their thinking about which surgery will serve their transgender needs. It is not a binary or tertiary model where they are just gay, straight, bisexual, or trans; there are a whole host of colors in-between. Many trans patients do not want GCS—it could be that at 15 they do, and at 25 they do not.”

Surgeon 19 even alludes to social contagion and the fact that kids are being taught indoctrinated about trans issues in school as a factor in some of them thinking they’re trans:

Depending on how old they are, there are a lot of classes that adolescents, even preadolescents in elementary schools, are getting these days. And they are trying to figure out if they are doing it because it is a new norm, versus what they really want. I have seen some … children go through phases of in and out, of thinking transgender. So that would be my concern—is it because it is popular now?

Karasic and Milrod note that a third of the surveyed surgeons believe the current WPATH recommendation for no surgeries under 18 should stand (only a third?) But the main thrust of this article seems to be that minors should be allowed genital surgery on a “case by case” basis; as if some 15 year olds can be 100% sure they are doing the right thing, while others might not. (How to tell?)  Milrod and Karasic say the surveyed surgeons are not worried about a potentially misdiagnosed client who might regret what they’ve done later on:

Despite the legal impossibility to obtain informed consent from the underage patient, the vast majority of participants were not concerned with malpractice lawsuits from parents or even from the patients as adults in the future. Engaging in best practices, maintaining open communication with the patient and her parents, and above all providing good results were seen as protective measures against any legal action.

Do Milrod, Karasic, and the confident surgeons quoted in the article believe some younger adolescents develop their frontal lobes faster than others? Do they think that just because a 15-year-old says “I’m 100% sure this is what I want” (what adolescent doesn’t say such a thing?), they can be trusted to know how they’ll feel in perpetuity? No one in the “gender care” field seems to be calling for MRI screening of frontal lobe density, weight, or size as a possible screening tool to differentiate the “true trans” teens (who really ought to have their testicles removed and their penises inverted) from the others who might change their minds.

Despite a lack of concern about misdiagnosis, many of the surgeons voiced concern about a severe lack of expertise in the field. Here’s Surgeon 14:

I believe that anyone who is performing vulvoplasty should have a fellowship training that is at least one year. It is going to be a rough period figuring that out, but I think we will get there eventually. I have seen horrific unethical practices by surgeons who lie about their experience and horrific results surgically as a result of that. We are using transgender people as guinea pigs and the medical profession allows this to happen. WPATH has the ability to have some teeth and regulate this more. But we don’t.

Then there’s the heady opportunity to ride the bucking bronco of this new medical trend:

The term Wild West also was used by a few highly experienced surgeons who were alarmed at the absence of surgical standards and the ease of entering the subspecialty without any documented training. To remedy the potential influx of “a bunch of solo practitioners, basically cowboys or cowgirls who kind of build their little house, advertise, and suck people in” (surgeon 13), several participants called on the WPATH to assume a larger role in demanding more stringent professional requirements and contribute toward sponsoring fellowships and surgical trainings across the country.

It’s hard to argue with a call for more training and expertise if these surgeries are going to be performed. But the underlying ethical question remains unanswered: Should minors be operated on? Especially when (as Surgeon 14 goes on to say) a new crop of poorly trained entrepreneurial surgeons is keen to profit on the trans trend:

…And now all of a sudden because it’s in the media, and really, the biggest reason for why everyone is doing it now, is the money is flowing. Because now insurance is paying. And now all these institutions have to have a program yesterday. And they are not doing it correctly, in my opinion. Seeing a week’s worth of surgery—maybe for a mastectomy, or maybe for an orchiectomy, or some of these other surgeries that are closely related, but this surgery is very advanced. The complications have severe consequences on patients’ lives and you can’t learn it in a week. And that is what’s happening; someone is going to see someone with a reputable name; they learn for a week, and they start doing them. And that is completely unethical!

 So we’ve established that there is a dearth of skilled surgeons, and that the penile inversion procedure is problematic for males (like Jazz) who have stunted genitalia resulting from years on GnRh agonists (puberty blocking hormones). But there is an alternate procedure that can be done: crafting a neovagina out of intestinal tissue. It turns out that this procedure is done in Europe far more than in the USA (where, according to the Milrod-Karasic article, there is a strong bias toward “one-stage penile inversion”).

In particular, plastic surgeons were biased toward penile inversion augmented by scrotal grafts, sometimes adding flank grafts, tissue expanders, or donor matrix tissue,27e29 and decisively rejecting intestinal vaginoplasty that would require no such additional measures and eliminate the need for lifelong dilatation.

Indeed, several Dutch studies can be found in the literature that discuss advantages of intestinal vaginoplasty for patients who have been on puberty blockers for many years. Arresting puberty seems to have spawned a whole new specialty for Dutch surgeons. In this 2016 article, Primary Total Laparoscopic Sigmoid Vaginoplasty in Transgender Women with Penoscrotal Hypoplasia,” the, authors report generally good outcomes, apart from the fact that 1 of 42 subjects died from septic shock and multiorgan failure, and 17.1 percent suffered “long-term complications that needed a secondary correction.”

Dutch 2016 intestinal abstract

No doubt, Dutch surgeons are benefiting from the fact that pubertal blockade for gender dysphoric youth was pioneered in the Netherlands–a breakthrough heralded by the first US doctor to use it, Norman Spack, whose infamous statement about his enthusiasm for the practice was captured in the aforementioned New York Times article:

Dr. Spack recalled being at a meeting in Europe about 15 years ago, when he learned that the Dutch were using puberty blockers in transgender early adolescents.

I was salivating,” he recalled. “I said we had to do this.”

So, what does all this mean for Jazz? Clearly, the chemical stunting of Jazz’s genitalia–aka “penoscrotal hypoplasia”—is what prompted one of his/her doctors to say in the “I Am Jazz” trailer that “you can’t have the surgery you want.” But the intestinal method is available, at least in Europe. Then again as recently as 2015, Jazz seemed sort of ok with his/her birth genitals:

Surgery is a very big deal as it can be dangerous and very painful. While speaking with her doctor about the possibility of getting surgery someday, Jazz admitted that she has gotten used to her body just the way it is. She said she doesn’t feel awkward when looking down and seeing and seeing what’s there, but says, “Hey, thingaminga, how are you?”

In the promo for the new season, Jazz says “I’ve always dreamed of getting this procedure.” But this is only the trailer, so we don’t know what happens next until the season premiere in June. Maybe Jazz’s surgeon will go ahead with the modified penile inversion, involving donor skin grafts from Jazz’s own body, scrotal expanders, and all the rest. For the “cowboy and cowgirl” entrepreneurs who have hung out their shingle to “suck people in,” Jazz’s immature genitalia may be just another surgical challenge to overcome in the exciting new frontier of medical experimentation on teens frozen—like ancient insects in amber– in prepubescence; teens who, more likely than not, would have grown up to be gay in the bygone days before Big Medicine and Big Pharma stepped in to medicalize adolescent identity crises–as even the DSM-5 attests:

DSM 5 gay

But let’s not forget what several surgeons in the Milrod-Karasic article said: That they trust “completely” or “extremely” that gender therapists like Diane Ehrensaft, Christine Milrod, and all the other “affirmative” therapists will recommend surgery only for the correctly diagnosed youth in their care. So anyone questioning the increase in medical transition of minors should, above all, scrutinize the practices of these gender therapists.  Just how careful are they not to make a mistake? As Christine Milrod herself describes in her own “How Young is Too Young” piece,

[there is] “a genuine expression of fear among clinicians in making the wrong diagnosis, based on the fact that young people often experiment with gender role behavior as a consequence of normative identity development, and perhaps more so when the adolescent is gender variant”

OK, but given that “informed consent” is the current trend in practice, whereby adolescents who say they are trans are taken at their word while “gatekeeping” is derided, how easy will it be for US gender therapists to avoid making a wrong diagnosis—or any diagnosis at all?

Instead of grappling with these vexing issues, our media, academia, entertainment industry, and politicians remain in thrall to a medical fad which has resulted in a child celebrity whose most private struggles have been leveraged into a marketing bonanza.

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60 thoughts on ““The money is flowing” to “suck people in:” Vaginoplasty & the case of Jazz Jennings

  1. There are a lot of similarities between this issue and teen bariatric surgeries. There are also predatory, undertrained surgeons permanently altering major organ systems there too. I think the insurance industry needs to wise up and the predators will stay in cosmetic surgery clinics.

    Liked by 3 people

  2. What would happen to Jazz if he went off the drugs at this point?

    This is a very disturbing story. 20 or 30 years ago, he would have grown into a feminine gay boy.

    Liked by 6 people

    • Totally.
      Also, a lot of the demand to treat gender-nonconforming kids as the opposite sex immediately, and to provide hormones and surgery at young ages is based on the claim that otherwise such kids are “at risk” of drug use. I have to ask, if you were looking back at this moment 20 or 30 years out, which drug you’d rather have seen such a child having had experimented with – hormone blockers or weed?

      Liked by 5 people

    • Jazz would have turned into Robert Tonner. No doubt Tonner would have been in this poor kid’s shoes 50 yrs ago if the trans agenda had been around then, something even he couldn’t think of when he designed this doll which is nothing more than a symbol for this craziness.

      Like

  3. This is such a depressing, frustrating, disturbing story, on so many levels. It was even more disturbing to hear, on the former Transition Radio, evidence that Jazz’s mother is feeding him false memories and grooming him behind the scenes. Most tellingly, “She only knows transition is best because that’s what adults have told her.” No matter what happens to this child, it won’t end well for anyone.

    It does seem like Jazz’s story has been a major impetus for the overnight, disproportionate explosion in “trans kids.” I can’t remember hearing about this in mainstream media before Jazz got famous.

    Liked by 7 people

    • Carrie-Anne, while I agree that the show has added substantial impetus to the “teen-trans-narrative,” I wonder whether the focus on Jazz’ struggles may also help to take some of the power out of the movement. I’m thinking of the “teen pregnancy reality shows” here, like “16 and Pregnant” and “Teen Mom.” At the time, people worried that they would glorify teen pregnancy and encourage even more girls to become pregnant prematurely… apparently what happened, though, is that they did just the opposite: http://www.economist.com/blogs/democracyinamerica/2014/01/reality-television-and-teenage-pregnancy

      The shows did not shy away from showing the economic, emotional, and physical struggles entailed in having a baby at such a young age, and research showed that exposure to them made a girl LESS likely to become pregnant rather than moreso! I am hoping that the producers of the Jazz program will also show the “reality” of what is happening to this poor kid. It is one thing when the child is very young, and inherently quite adorable, and it’s easy to steer your mind away from things like heavy cancer drugs and genital surgery. But that is where the “teen-trans” path eventually leads to, and it’s good for people to know that.

      Liked by 4 people

      • Carrie Anne, I definitely encountered media about trans kids long before Jazz got a TV show. The Oregonian ran a whole series about a MTT tween being raised in a Portland suburb.

        At the time I read that series, I naively bought into the claims. The poor kid. The poor family. The difficult situation!

        One difference is that the story of the Oregon MTT made a huge deal about privacy, while now, young teens and tweens are announcing their “identity” all over the internet.

        Worriedmom

        I see your point about 16 & Pregnant. But consider the fact that we’re talking about different types of “stars” and audiences. The population of young trans-identifying tweens, teens & young 20s often have other problems, and problems like bipolar disorder often include a component of liking to create, and be at the center of, drama. Reports of high percentages of suicide attempts can be reports of dramatic gestures designed to get all attention focused on them. I fear that unbalanced young people seeing what appears to us to be a complicated and unhappy life might see inspiration for ways to gin up further drama.

        Liked by 1 person

      • Generally speaking, creating drama and suicide declarations are not symptoms of bipolarity. Those symptoms would better fit a borderline or other Cluster B personality disorder.

        And, ask me how I know? All the various diagnoses my kid has had. Seriously, the psychological profession, at least in my family’s case, has a TERRIBLE hit-or-miss quality to it. Which, to my way of thinking, means they sure as hell shouldn’t be throwing major drugs, cross-sex hormones, and irreversible surgery into it.

        Liked by 3 people

      • I will admit to having watched all of “I am Jazz” both season 1 and season 2, and I’m looking forward to season 3.

        I’ve been wondering just how in the heck they are going to do SRS with Jazz’s tiny genitalia for quite some time now, and I’m sort of amazed that it seems the doctors are just now realizing the conundrum when as a garden variety TV watcher the question has been on my mind for so long.

        Now that I’ve admitted my terrible TV habits… there is some talk of SRS at the end of season 2. Jazz is shown wondering if he wants to get the surgery or not, and he comes to the (tentative, it seems) conclusion that yes he does, as it’s the “next step.”

        Season 2 also has discussion of breast augmentation, as it seems that Jazz has tuberous breast deformity. They stress that it’s not something that only happens to MTF trans people, but just reading around the internet it seems a large concern for quite a lot of them. Additionally, many of the DIY-practicing MTF people on the internet swear by progesterone to make their breasts more “natural” and in season 2 of “I am Jazz” they also hint at this, but explain that Jazz was unable to continue taking progesterone because it threw him into a very dark depression (or exacerbated his already existing depression).

        Which brings me to the final part, season 2 talked quite a bit about Jazz having depression. One of the side effects of that depression is that he has drifted away from the friends he had in season 1. Season 1, he has a fairly good circle of female friends at school, seems to be socializing pretty normally. Toward the end of season 1, the friends start pairing off with boys, and this leaves Jazz out, as boys aren’t interested in him for the most part, and he also isn’t so interested in romance or following any of that drama.

        So, opening of season 2, he’s isolated, has no real friends at school. Over the course of the season, we see him withdrawing quite a bit, and Mom is worried (the show has pushed the “we worry about suicide, trans kids suicide if they don’t get treatment” line VERY HARD from the start, but this is extra). Mom pushes him to get more involved in the trans scene in their area.

        By the end, it seems that Jazz is pretty much socializing mostly with trans kids, most of whom are FTM with wild colored hair (and just look like regular girls to me…) but also has a closer MTF friend, who began transitioning at age 14 and so doesn’t pass at all. So, some discussion happens about that.

        But so what we see over the course of the entire show is, at first it was this “look, Jazz is just another girl, fits in perfectly, is a star, everything is fine, sparkly mermaids, yay!” but it’s really becoming darker, the second season it’s clear that no, Jazz isn’t “just another girl,” even though he has had the “perfect transition” (going on blockers before any puberty, etc) he’s STILL ending up pretty much segregated off in the “trans community” once everyone starts going through puberty.

        Makes me wonder if this will end up similar to the pregnant teen reality shows, as something people decide isn’t so glamorous after all.

        As for the SRS question – perhaps he will choose Thailand? They have a procedure there which isn’t penile inversion, but still requires dilation. They use the scrotal skin to make the neovagina and the penile skin to make the neolabia, unlike inversion where the penis becomes the neovagina and the scrotum becomes the labia. Those surgeons have been practicing for a while, but not on prepubscent baby genitalia as far as I know, so all the issues with needing more “material” and grafts would definitely still apply…

        Liked by 1 person

    • @katiesan
      Absolutely, and I’d not be inclined to take a Borderline diagnosis at face value especially if for a female (as usually is). A notoriously misused diagnosis that may be applied for misogynistic reasons to silence or ignore ‘non compliant’ female patients (ie. female patients who don’t just accept whatever the professional says without question, or patients otherwise perceived as ‘difficult’ cases, as a way for the professional to wash their hands of them).

      Liked by 1 person

  4. That poor kid! No child should be exploited like that, what his parents are doing to him is so wrong. Like even people who support transitioning children and teens should object to Jazz being made into a public spectacle where his genitalia is discussed on television for the public’s entertainment. Best wishes to you Jazz.

    Great article, you are an excellent journalist, I really wish this blog got mainstream international attention.

    Liked by 2 people

    • I feel for the grandparents, too. They seem like good-intentioned, loving people who have been dragged into transworld by the attention-seeking (almost used another word, beginning with “wh”) mother, soley for the purpose of parroting the Jazz-is-trans storyline.

      They remind me a lot of my in-laws.

      Liked by 1 person

  5. All of these “doctors” should be investigated by the appropriate medical licensing boards and barred from clinical practice — especially those who mutilate underage children. In California, you can file complaints against California-licensed physicians and surgeons here: http://www.mbc.ca.gov/Consumers/Complaints/

    Every US state has a similar online complaint system. In other high-income countries there is likely to be something comparable.

    I have already filed complaints against the Kryger twins, two plastic surgeon brothers in southern California who last year hacked the breasts off an adopted 14-year old girl with fetal alcohol syndrome — simply because she claimed she was really a boy.

    It’s an insider’s game of course and it’s not a sure thing that any of these butchers would actually be investigated. It may happen if lots of people file very focused and articulate complaints.

    Liked by 5 people

      • Wow, I just googled and multiple sites report 3.8%. I guess the number I had heard back in college was 10%, not 20. So that is quite something, a fad at best.

        Like

      • Here’s the link to the Heat Street story that reported on the Harris Poll:
        https://heatst.com/?s=new+study+1+in+5+millennials+are+lgbtq

        Until I saw this, the only numbers I had seen were things like gay men being about 3% of the male population (this proportion being reported as far back as the Roman empire), with lesbians being 1-5% of women, and “intersex” (the umbrella term for people with genetic deformities that include malformed genitals, and usually other organ deformities as well as mental handicaps) at 0.03% of the population.

        Like

    • Do you think that just maybe it has always been this way but people hid their true identity or orientation? Being LGBTQQUIAAP was so looked down upon that it was common for these people to be killed for coming out. It does still happen today, but thankfully a lot more people are accepting and are not as ignorant. Obviously society still has a long way to go because there are still some ignorant people. What harm are they doing to you? None. Live and let live. To each their own.

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      • If you’re an adult, or the ppl you are talking about are, hey, go for it, whatever. If you’re talking about our minor kids, and our young-adult kids whose brains have not reached executive function maturity (generally, age 25 or so), then — “what harm are they doing” is a loaded question. Testosterone in the natal female body in particular is not a benign drug. “Blockers” are absolutely not benign drugs. Surgeries (double mastectomies, genital surgeries, hysterectomies) are far from risk-free. So pardon us parents if a bunch of us are not so stoked about seeing our kids go down this experimental path. Grownups get to make self-destructive choices, but … our kids are not grown-ups. Not to mention the fact that the vast majority of us here have kids with ‘sudden onset’ gender dysphoria and pre-existing mental health conditions.

        YOU go live and let live, OK? Just don’t bother trying to guilt us over here with accusations of non-acceptance and ignorance. We’re way past the point where those words are going to make any impact on us.

        Liked by 5 people

  6. I feel so bad for Jazz. I’m sure there’s a lot of scripted and manufactured drama, but these are real concerns and Jazz has been misinformed. Also, putting a kid on TV and building their entire life around a transgender identity is fucked, all their medical and personal problems viewed by millions, and what if Jazz ever wants to detransition?

    Liked by 9 people

    • I do feel for Jazz and wish things go as best they can.

      That said, yeah, how could Jazz ever detransition at this point? The pressure has got to be intense, because it’s not only Jazz’s identity, but the entire family’s identity (and particular Mom’s identity) that is completely built around being this “family of a trans kid, courageously breaking down barriers” and all the rest of it.

      I will say were Jazz ever to detransition, I’d buy the tell-all book in a heartbeat. Heck, even if Jazz doesn’t, if Jazz ever writes a book as an actual adult completely originally without any outside “input” or ghostwriters, I’d probably get it, just to wonder, what was really going on.

      Liked by 2 people

  7. This whole thing makes me so sad for Jazz. Just watching the promo for the new season, I see a kid who:
    A) Is refusing to see a therapist when their parents feel strongly that they need it;
    B) Has family that has always been supportive of their trans identity and the world at large cheering for them;
    C) Even with support still appears to suffer from depression and dysphoria (puberty blockers and cross-sex hormones don’t seem to have solved the dysphoria issue);
    D) Is demanding major surgery with serious potential complications, even though their parents want them to wait until after high school.

    At what point do the parents say no, this is too big a risk? At what point do the parents say that their teenager needs to wait until adulthood to make such an irreversible decision?

    Liked by 3 people

    • I wonder if Jazz is refusing to see a therapist because he knows that the therapist that his parents will choose will be a “gender specialist” who will continue to support the Jazz-is-a-girl narrative.

      Liked by 2 people

      • I don’t think so. I get the impression that Jazz, like most teens, thinks he has all of the answers. He probably thinks that bottom surgery will solve his dysphoria. His parents, like all of us here, will have to put the brakes on and tell him no if they don’t think the surgery is the best thing for him.
        It really makes me sad to see his personal health issues play out on national tv. I hope he can find a way to be happy without having such major surgery.

        Like

    • TheMom, I, too hope Jazz is able to find happiness without major body-altering surgery. I also hope — and this might be just as important as avoiding surgery — that Jazz is able to leave the spotlight behind and carve out a private life for himself. I’m sure Jazz’s mom has the family under some sort of contractual obligation to the network for the time being, but once Jazz is of age I hope he can retreat from his mother and the transcult, retreat from the cult of celebrity, and give himself some time out of the glare of the media to finish growing up, figure out what he really wants for himself and live life on his own terms.

      Liked by 1 person

      • Absolutely agree. No matter what Jazz or any of these kids decide to do in the future, they need to have lives that aren’t all about their gender identity.

        Liked by 1 person

    • Poor, poor Jazz. I don’t think things will be easy for him, but as a male, there will always be at least a few female caretakers around him to help. Contrast this with the situation of so many women, who legitimately need care but get nothing. I had some severe emotional problems when I was younger, but still an adult, and legitimately needed care, but was on my own almost all of the time. I still have some residues of those problems. The situation of so many women is a lot worse than poor ol’ Jazz will ever have it.

      Liked by 2 people

      • So true. And when women try to turn to relationships with other women for that because of how that’s what men do, they so often discover so very much more able-ism, and anti fragile women attitudes, in non heterosexual women’s social spaces, finding very anti support there which throws them back into struggling alone.

        Liked by 1 person

  8. Some priceless quotes from surgeon Marci Bowers. Strange that a surgeon would admit gender is fluid and then operate on a trans person.

    “Dr. Marci Bowers, a San Mateo obstetrician and gynecologist who is widely recognized as being the first transgender doctor to successfully perform gender-affirming surgeries, said she has relaxed a previous rule that stipulated operations can only take place after “demonstrable progress” has been made in “consolidating one’s gender identity” – a welcoming nod to the 5 percent of her patients who are nonbinary.”

    ”So too, gender expression and a broader notion of gender identity has opened my eyes to the fact that there is really no other measure in science or nature where there are only two choices. Gender is clearly fluid and broader than male and female.”

    http://www.sfgate.com/health/article/Young-people-exploring-nonbinary-gender-roles-5225994.php

    “While this group is small, Bowers believes that some binary transgender patients may eventually segue into a nonbinary identity, perhaps as a result of witnessing the openness of gender expression in the younger generation.”

    http://www.sfgate.com/health/article/Young-people-exploring-nonbinary-gender-roles-5225994.php

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  9. This question may have been answered somewhere else but what is the attitude of American medical insurance companies to trans procedures? How willingly have they gone along with it? They often fight tooth and nail to get out of providing coverage and interestingly trans writer Leslie Feinberg skewered them on their handling of Lyme disease. Knowing which way they jumped would help illustrate what forces are at play here.

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  10. The issue of insurance companies’ attitudes towards transgender coverage is not simple, and would require greatly more discussion than a comment here. The short answer is: it varies. We have a multi-player system in the U.S. in terms of insurance providers, these include: the federal government via Medicaid and Medicare as administered through the states, private insurance provided by employers, private insurance purchased by individuals (via the Affordable Care Act), and the Veteran’s Administration. There are many permutations and details concerning coverage even within these entities – for instance, providers of private employer-based coverage can offer differing coverage depending on the employer.

    Some state governments have mandated that Medicaid provide trans health care, for instance, the state of Oregon: http://www.oregonlive.com/transgender-health/2016/04/oregon_health_plan_transgender.html Most state Medicaid programs, which cover primarily low-income and disabled people, still do not cover many transgender procedures, however. In addition, some states have required that private health insurers cover transgender procedures: http://www.topsurgery.net/costs/ftm-top-surgery-insurance-coverage.htm provides a list although I’m not sure it’s current.

    My general impression is that although initially many public and private health insurers resisted providing transgender health coverage, the increasing trend in the U.S. is for such coverage to be provided. This has been prompted by intensive lobbying by the medical profession and activist groups. As you know, medical costs in the U.S. are brutally high compared to those in countries with a single-payer system, and transgender procedures in particular can be extraordinarily pricey (I have seen $100,000 as a baseline charge for phalloplasty, for instance). The high price tag of transgender procedures may have served as something of a “natural gate keeper.” The wider availability of coverage for these procedures is almost certainly fueling a corresponding rise in their performance.

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    • It’s only an insult to refer to Jazz as he if you think there is something wrong with a male being feminine or that being a man is limited to males who adhere to sex stereotypes.

      Agree with Aiden down below, I use pronouns based on sex in gender critical sites as it leads to clarity and I use a person’s preferred pronouns in public out of courtesy.

      Referring to Jazz as a girl whose possible vaginoplasty is being exploited for the public’s entertainment and a media corporation’s profit is confusing.

      Liked by 1 person

  11. Is anyone else reading these comments made uneasy by the regular use of masculine pronouns for Jazz? I don’t watch the show, and I share in the horror of the idea of genital surgery for a minor, but I also can’t find myself needing to use pronouns that differ from those preferred by Jazz and family. I am just curious — is the decision to use male pronouns based on age or a rejection of the validity of changing pronouns for self-identified trans people? I am asking out of true curiosity and not meaning to attack and I think some of my discomfort comes from a video that detransitioner Carey Callahan (whose blog is https://mariacatt.com/) put out about people not using people’s preferred pronouns and her feeling that doing so was unkind and disrespectful. In fairness I know that many people here would disagree with my choice to use my child’s preferred pronouns, and I know why I do it, but I am unable to say whether it is or is not going to be the best for my child in the long run (my child is seriously depressed and I just cannot add to her distress on a daily basis by constantly highlighting my skepticism about her gender identity). Anyway, just wondering about your thought process and wondering if anyone else feels uncomfortable reading it.

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    • I don’t know, I don’t think anybody is intentionally hurting your feelings, or your child’s feelings, or Jazz’s feelings for that matter. What I do think is that a lot of us are getting a bit weary of tiptoeing around worrying about pronouns. I have been asked to call people by pronouns that have changed by the month. I have been asked to call people by pronouns that are severely at odds with the way they appear. I have been asked to call people pronouns that are imaginary words. I don’t “mis-pronoun” people on purpose, but it’s also not my main mission in life, to avoid making such a “mistake” (even when, technically, it isn’t a mistake). There are even people, and I am not one of them (yet) who believe that being asked to use pronouns that affirm something which in their own minds is objectively false, are also the victims of unkindness and disrespect.

      I understand that every parent here has the right to make his or her decisions regarding parenting. All (I think) we want is for people to be making a truly informed decision. None of us can guarantee that any of the parenting decisions we make will be the correct ones in the long run. We all hope for the best outcome for all of our kids… if for you that involves using your child’s requested pronouns, and you’re good with that, that’s the end of the analysis. Many of us have not made that decision, and good for us, too!

      Liked by 8 people

    • I’d probably be more likely just to refer to Jazz as ‘they’ and be done with it, grammar be damned. I don’t know what pronoun they actually prefer, but I’m not enough of a radfem to insist on ‘he’ when it would clearly be abhorrent to the person at this point in time. MIght not get all the way to ‘she’ but … yeah.

      OTOH — my own kid (now 18 going on 19) still goes by original female name in all contexts and and hasn’t asked for anything else, in school or at home or from friends, though I think the facebook account now has “they.” Three years into the “maybe I’m trans” life–the short hair and the guy clothes and a couple years of binding–the kid still has her female name, which in fact gives me some hope that it actually means something she’s not that eager to jettison.

      On the days when she’s feeling badly dysphoric she’s determined to go to an informed consent clinic RIGHT NOW (I really thought she WAS going a couple months back). And then … two days later she is off on another more pressing topic, until the bad dysphoria crops up again. I don’t know what I’d do if she asked me to use another name and “him.” I’d probably just switch to using gender-neutral pronouns like “sweetie” in direct address, and using signifiers like “my younger kid” or “your sister” when referring in third person. I’m not going to be all up in kid’s face with pronouns kid strenuously rejects (if that point comes) but I’m also not going to pretend like I’m ever going to embrace idea that kid is actually male. (Much less the idea that kid has always BEEN male.) Kid knows my feelings about that.

      FWIW. Your mileage may vary.

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    • I’m guilty of doing it upthread.

      A lot of gender-critical sites and forums have a policy of using pronouns by biological sex for clarity, as transgender issues are actually the topic of discussion. That’s why I wrote as I did in my comment.

      That said, in other non-trans-focused forums, the wider internet, and certainly in person, I generally use preferred pronouns as a matter of courtesy. I suspect there are quite a few others like me.

      Liked by 2 people

    • You can avoid gendered pronouns pretty easily if you need to be polite. Outside of concerns of politeness there’s little reason to use preferred pronouns. “she/he” can either communicate biological sex, or your acceptance of genderist ideology. You can’t rightly blaspheme unless you are a believer.

      Liked by 1 person

  12. This is so extremely frustrating and now the news that Caitlyn Jenner has admitted to having “bottom surgery”. Okay, she certainly old enough to decide something this major, but what kind of message is that sending to struggling confused kids, that going to this extreme is going to be the key to happiness. There is so much online to educate these kids regarding transition regret and that even after going to the extremes that Caitlyn Jenner and Jazz Jennings have does not guarantee happiness. Many transgender people still have mental health issues and are at risk for suicide even after transition, but the media doesn’t bother to highlight those cases at all. It will be interesting to see how Caitlyn feels and also Jazz Jennings in 5, 10 or even 15 yrs from now. Transgender individuals still experience gender dysphoria after starting transitioning and even after totally done transition. What is going to take for the media to start telling BOTH sides of this issue??

    Liked by 3 people

  13. it seems that some apologists have entered the field here….why would a person who is critical or questioning of the transgender agenda use the pronoun of the transgender lobby to placate the transgender lobby. a boy born a boy is a “he” and a girl born a girl is a “she.” let’s not tiptoe amongst the tulips here. my brother became my sister in 1975, and it was, and still is, confusing to refer to my sibling with the cross-sex pronoun. i do refer to her as “‘she” now, however, because after so many years of cross-sex hormones, she suffered massive strokes and embolisms, and MS and has been completely paralysed since 1985; she can harm nobody and has no life, outside of the confines of her body, to speak of….why shouldn’t i be kind and call her a “she.”
    this is the real tragedy of the misinformation campaign out there, not the pronoun dance; it is that these drugs and procedures have very serious side effects that kill, maim and harm. this is not being studied nor tracked by any medical professional we see together.
    i do refer to bruce jenner, as bruce jenner.

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    • So I just want to quickly explain why I would use someone’s preferred pronouns and suggest that I am not an apologist but that I come to this issue with a lot of humility, ambivalence, and skepticism all around. I am somewhat agnostic on the question of whether gender and sex can be distinguished, and while I mostly struggle with that concept, I am more open to the possibility that there are people who feel crippling dysphoria that can only or perhaps best be relieved by seeking to make there bodies resemble the opposite sex and being treated socially as the opposite sex. I came to this community because I am skeptical of the surge in teens — especially girls– who are identifying as trans out of the blue and I am troubled that the medical community that seeks to serve gender identity issues has seemingly closed its eyes to the possibility that these children are not the same as those adults (and some children) who have found tremendous relief in transition. So I am not in the camp that no one should be able to ask to be called by a pronoun of their choosing because when another person tells me that it causes them distress to be called by something else I cannot understand what benefit results from my refusal to respect their choice. Avoidance of pronouns is a strategy — one that works better when composing a post on a website (note that I did not use any pronouns for Jazz) than in real life with one’s own child (the effort of pronoun avoidance seemed to highlight my conflict with my child as much as using the pronoun she rejected) — but so is deference. I don’t think being polite with reference to actual individual people is tantamount to supporting “the trans lobby”. And I have no qualms whatsoever about using Caitlin Jenner’s chosen name. To do otherwise feels disrespectful to me in a manner that brings me no comfort. But I wrote my post because I was just wondering if anyone else feels a little muddled about these things, not because I felt hurt or disrespected, but because if one day Jazz were to come along and read these posts I might expect that the choice to use male pronouns would undermine the spirit of concern for Jazz’s well being that I believe truly underlies these comments.

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  14. .. i just hope these children sue the hell out of the adults who lied to them. i hope the courts support them in their future quest for reparation. This is not any kind of consent i recognise. there is too little information, even if they were giving consent as adults.

    Liked by 1 person

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  16. Please call Illinois Governor Rauner to ask him to please NOT sign the bill to change gender on birth certificates, thanks for your consideration!

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  17. Please help defeat HB 1785 in Illinois, it would allow the changing if sex on birth certificates, call the Governor at 312-814-2121

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  18. I watched Jazz’s show last night for the first time, because I was curious and am seeing more and more trans folk. I have a question that perhaps regular watchers know: why is it that we learn so many highly personal things about Jazz’s body and sexuality, but have no idea what else she is interested in? What’s her favorite subject in school? I understand that the purpose of the show is to educate folks about trans issues, but there is more to a person that her gender identity. Yes, I agree, that’s a huge issue, but people are also multidimensional.

    I am not a medical doctor, not a psychologist, but a teacher– and university professor. I have no basis for an educated opinion about hormones and surgeries (but do feel that we should use whatever pronouns the person asks us to use (although I cannot stretch to ‘they,’ as I am of the generation in which grammar was a major part of my elementary education. I am very content to use ‘ze,’ though, because language is fluid and grows with the culture. Plus, kindness…).

    However, back to the ‘multi-dimensional’ point, what else is Jazz curious about? I do have an educated opinion about education that no one seems to be tackling–and it is an issue that is also important to identity. It seemed that everyone on the show assumed that the best thing for Jazz is to complete high school, then immediately continue to college–no questions asked. Yet there is no mention of what else might be interesting to her to study, sure there is gender studies, I guess. My point is that I object to the idea that college is where you really grow up, “drink and sleep with girls,” as I think Jazz stated on the show. I hate this assumption! Time and time again, I see students with far less complicated lives do this and get very little out of their college education.

    There is absolutely nothing wrong with a gap year, or two, or three –to grow up and have experiences, find out what interests them, learn who they are. In my day, we said, “find yourself.” College is not a ‘kinder-garden,’ a place to store your children with relative safety until they come to a level of maturity via drinking and having sex. It is a place where learners should come with curiosity about the world and how it works, and then undertake higher level learning to address those questions. In my experience, it is much more successful if the person is already an adult with some life experiences (doing their social experimenting beforehand) to help with their questions.

    Jazz, if you are out there, please consider a post-secondary internship, service work–building homes or whatever, travel…. You will get so much more out of the VERY expensive post secondary education if you are a little more worldly. I know you are still a few years away from making this life choice, but as you clearly are tackling some very grown-up issues now, it is not too soon to question this assumption as well.

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  19. Has any doctor mentioned balloon expansion instead of hormones to expand the penile tissue? Not that fun initially but you get the skin expansion.

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  20. This is SAD, and disturbing, that JAZZ has endured such abuse, mental, psychological, and physical. children below puberty are all sexless empty voids, free to explore everything in their environment without question, without labels, without care in the world. when we reach puberty we then develop into what we will be as an adult, we shed the childish ways and fulfill our destiny. Jazz will never be able to do that, robbed of that by madd doctors and uncaring experimental liberal human testing parents… well i guess they had enough kids that they truly loved, and a spare to screw with… they did that in the old days, when they made Eunuchs

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  21. Jazz Jennings is a tragedy. Starting at age two (when he was obviously too young to even understand concepts like sex and gender, or the implications of being pumped full of estrogen and testosterone blocking drugs) he has been fasttracked toward early “transitioning” which is another word for castration and mutilation. I would be willing to bet none of the therapists ever explored the idea of accepting himself as an intact but gender atypical male. Of all the transsexual youth in America he had the most advantages- affluent, and tolerant parents, access to state of the art medicine. And now he may end up with a completely non functional neovagina because chemical castration has left him with a micropenis that is too small to be inverted into a vagina. Where were all the therapists and doctors over the past 6 years when he was receiving hormone blockers? Probably counting the dollars they’ve made off of Jazz and laughing all the way to the bank.

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  22. This article was very well written and quite informative. I believe Jazz is “really” female, not some confused teen experimenting with the idea of transforming his/her body. But the risks of the surgery that she wants to have may outweigh the benefits to her, psychologically. If she decides on the vaginoplasty, she will have to undergo a more radical procedure, an experimental procedure, that carries the risk of death. It seems to me that she should wait until she is more mature before making this momentous decision. At sixteen, she is still a child, as we can see from her roller-coaster shifts in attitude from time to time. If she is comfortable with having a micro-penis and doesn’t regard her penis and scrotum as alien parts of her body, she may decide to keep them and find her own definition of romance and sex.

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    • How can Jazz be “really” female when Jazz is male? It’s no wonder Jazz thinks he is a girl — every influential adult in Jazz’s life has been telling Jazz he is a girl since toddlerhood. I do not believe Jazz’s behavior and beliefs are an act, but I also do not believe Jazz is “really” a girl, as this is impossible. I think Jazz is so sincere in his belief because Jazz has been so very thoroughly conditioned.

      As far as the neovagina creation procedure being experimental, everything that has been done to Jazz thus far is experimental — the diagnosis as age three after one visit with a therapist (according to this article: http://www.browardpalmbeach.com/news/see-dick-be-jane-6307520), the years of conditioning to believe he is a girl, the puberty blockers, the estrogen — none of these substances and procedures have been proven to be safe or appropriate medical treatment for children. The proposed neovagina procedure is just the latest experiment for which Jazz will be used as a human guinea pig.

      And lucky Jazz — Jazz’s bumpy, lengthy ride on this experimental roller coaster takes place in front of a worldwide TV audience. It was revealed in a recent episode that Jazz is not currently getting psychotherapy because Jazz doesn’t like it and doesn’t want any. I hope Jazz’s parents and doctors will put their collective foot down, so to speak, and see to it that Jazz gets a thorough psychological evaluation and long-term, ongoing therapy. I can only imagine the poor kid must need it very badly.

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  23. It isn’t any wonder the poor kid doesn’t want therapy. How do you have therapy while you are being filmed for a TLC show. I admit a morbid fascination, but I can’t sit through an hour of this show. I felt really bad for Jazz that his mother forced him to do therapy in public. The therapist was so condescending it made me sick. They called her “cousin”. If this is really a relative, this can’t be ethical. Hell, it can’t be ethical to do therapy on television.
    I believe the mother is the sick twisted person living out her own problems through this child. If Jazz were to say he wanted to be a male, it would ruin the mother’s world. I’d like to know what the father’s colleagues at work think. He’s so completely controlled by the wife.
    What sort of parents allow a child to make decisions about taking potentially harmful drugs? If the older boys wanted to take steroids to be more proficient at sports, would that be ok if they were suicidal over their athletic abiliity?

    Liked by 1 person

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