Mom forces insurance company to cover double mastectomy for her 15-year-old, with support of WPATH & Dan Karasic, MD

A 15-year-old cannot vote, sign a contract, drink, or get a tattoo. You can’t rent a car until you’re 25 years old. And in the US, the FDA has just proposed regulations to prevent minors from even using tanning beds.

Why all the restrictions? Well, last I checked, developmental psychologists, cognitive scientists, and informed members of the general public were aware that adolescents don’t have the cognitive wherewithal—the judgment, foresight, or awareness of future consequences–to make major, life-changing decisions, let alone suffer a bad sunburn. There has been so much replicated behavioral and neuroscientific research done on the subject of executive function in young people that it’s now considered settled science.

So the changes that happen between 18 and 25 are a continuation of the process that starts around puberty, and 18 year olds are about halfway through that process. Their prefrontal cortex is not yet fully developed. That’s the part of the brain that helps you to inhibit impulses and to plan and organize your behavior to reach a goal.

And the other part of the brain that is different in adolescence is that the brain’s reward system becomes highly active right around the time of puberty and then gradually goes back to an adult level, which it reaches around age 25 and that makes adolescents and young adults more interested in entering uncertain situations to seek out and try to find whether there might be a possibility of gaining something from those situations…one of the side effects of these changes in the reward system is that adolescents and young adults become much more sensitive to peer pressure than they they were earlier or will be as adults.

Another very readable (and amusing) article, “Dude, where’s my frontal cortex?,” sums it up thusly:

The frontal cortex is the most recently evolved part of the human brain. It’s where the sensible mature stuff happens: long-term planning, executive function, impulse control, and emotional regulation. It’s what makes you do the right thing when it’s the harder thing to do. But its neurons are not fully wired up until your mid-20s.

But the gender specialists at the helm of the World Professional Association for Transgender Health (WPATH) apparently never received the decades-old bulletin on adolescent brain development (or lack thereof), or so it seems. In the Brave New World of transgender “health care,” a 15-year-old can ask for and receive a double mastectomy, with mom’s blessing and collaboration. (In Oregon, a kid can decide to have her breasts removed whether mom approves or not, thanks to trans activists like Jenn Burleton and TransActive).

Last July, a mom posted to the WPATH public Facebook page, looking for advice on how to get “chest reconstruction” for her 15-year-old (i.e.,  double mastectomy. Why can’t these people use actual medical terminology, even amongst themselves? Do the providers and parents also get “triggered” by seeing a reference to female anatomy?)

[Note: For privacy reasons, I have chosen not to directly link to the (nevertheless) publicly viewable thread on the WPATH Facebook page.]

Seems mom’s insurance company balked at  covering elective removal of breast tissue in people under 18.

WPATH mom of 15 yr old

Psychiatrist Dan Karasic, one of the key contributors to the WPATH Standards of Care (SOC), and provider at the San Francisco Center for Excellence in Transgender Health, is happy to help, citing the SOC chapter and verse (page 21 to be exact) that WPATH fully supports “chest surgery” for minors, although it’s apparently still “too limiting” for his taste:

WPATH mom 2

Mom has already picked out the surgeon for her child, and another commenter, former Transgender Law Center employee Jason Tescher, recommends she try to “force” her insurance company to cover the cost (per the doctor’s website, $8500):

tescher

The WPATH thread went dark until today (more on that in a minute). But who is Dr. Mangubat?

mangubat

In addition to being a popular presenter at Gender Odyssey, the yearly shindig for all things transgender, Dr. Mangubat is apparently well known as a surgeon who’s an easy touch for those looking for double mastectomies. As recently as six days ago,  underage top surgery seekers on Reddit were recommending him:

Also, the surgeon I went to (Dr. Mangubat) did not require any kind of letter and I don’t think he requires patients to be on T either, but I could be wrong on that. It was as easy as emailing his office to set up a consultation and then I was immediately able to schedule the surgery.

As to the mom’s efforts to get insurance to cover the removal of her child’s breasts,  an update appeared moments ago on the WPATH thread. Mom shares her good news: the insurance company has agreed to reimburse her for the double mastectomy that they “couldn’t wait for” and had done in August.

insurance appeal

Dr. Karasic couldn’t be happier.

karasic happy

It’s likely only a matter of time before insurance coverage for teen surgery will be the norm. The Obama administration recently proposed new rules that will require all insurance companies to pay for “transition” services. One wonders just how many “identities” the transgender umbrella will cover when it comes to federally mandated health care services?

The entire Reddit thread that references Dr. Mangubat  (as well as two other surgeons I’ve previously written about–Dr. Curtis Crane in San Francisco, and Dr. McLean in Ontario) is worth reading in this regard, because it’s primarily about “nonbinary” people who don’t identify as FTM getting access to “top surgery” on demand–exactly what providers like Dan Karasic promote and what is already happening, apparently, in San Francisco at taxpayer expense, as I detailed in a recent post.

As I also discussed in that post, Karasic is a major WPATH player pushing for the elimination of “gender dysphoria” as a requirement for “transition” services; he wants to  replace GD with a new diagnostic code, “gender incongruence,” which would do away with the need for any distress, dysphoria, or disorder but still allow for billing for what amounts to a lifestyle choice–for anyone who claims “gender incongruence,” on demand.

So we know Karasic and WPATH are OK with 15-year-olds who ID as FTM undergoing irreversible surgeries. Does he also believe, as he does for adult patients, that a 15-year-old (or 13-year old?) who identifies as genderqueer, gender fluid, or non-binary should ALSO get insurance-funded double mastectomies?

 

Parents, keep listening to your gut—not the gender therapist

A few months ago, my teenage daughter stopped trying to “pass” as male. She dropped the self-defined-as-male uniform, the stereotyped swagger and the fake-deepened voice and just—moved on. Her fervent desire to be seen and treated as a boy faded away, just as other formerly unshakable ideas and urges had in the past. And our relationship has never been better.

Although I’ve allowed myself to exhale, just a little, she will remain at risk, because every sector of society—the media, the government, the schools, medicine and psychology–is now saturated with the message that trans is real; trans is good;  and if you’re a “gender nonconforming” girl–one who prefers the clothing, activities, and hairstyle more typical of the opposite sex– you just might actually be a boy.

What did I, and the other adults who love her, do? It hasn’t been easy. In fact, for a time it was a living hell, a purgatory of slammed doors, stony silence, yelling matches, and mostly—waiting.

There was no magic answer. We rode it out. I learned something about keeping my mouth shut. About saying my piece and then leaving it be.  About living with uncertainty.  We didn’t cater to demands for instant gratification.  We paid for and encouraged activities that would get her out into nature and off the Internet. Mostly, we waited.

We drew a clear line in the sand: There would be no money to pay for a gender therapist, testosterone, or a binder. If she wanted to pursue those things at the age of medical majority, that would be her choice—and it would be on her dime. At the same time, we let her know that her clothing and hairstyle choices were hers to make. Not always successfully, we tried to calmly and sparingly convey the message that however she dressed, whatever interests she pursued, she was a female—perhaps an unusual one, but a young woman nevertheless, who might someday become a role model to show other girls just how amazing and truly expansive a woman can be.

Like many who read this blog, I phoned gender therapists during the weeks after her announcement that she was trans. Without even meeting my child in the flesh, all four of these therapists talked to me like this trans thing was a done deal. I wrote about one of those conversations here. One very friendly therapist, who identifies as FTM and whose website stressed “his” commitment to “informed consent,” assured me that there was no need for my daughter to first experience a sexual or romantic relationship before deciding whether she was trans. “Most of the young people just skip that step now,” the therapist said.

Skip that step? I thought back to my own adolescence. I didn’t even begin to have a clear idea of who I was, as a sexual being, until after I’d had more than one relationship. It took years for me to come to know my body’s nuances and intricacies, its capacity for pleasure, how I might feel in relation to another.

This same therapist signed my kid up for a “trans teen” support group scheduled for the following week—again, without ever having met her. “There’s nothing you or I can do about your daughter being trans,” said another therapist… on the phone, without having met my kid. Yet another therapist refused to talk to me at all; insisted she’d have to have a private appointment with my kid first.

Contrary to the myth promulgated by the transition promoters, at least in the United States, there is no slow and careful assessment of these kids who profess to be trans. The trend is to kick out the gatekeepers, and  move towards a simple model of “informed consent”: If you say you’re trans, you are–no matter how young and no matter when you “realized” you were trans.

All these therapists seemed well meaning enough. They believed they were doing the correct thing. But with each conversation, I felt more and more uneasy. My gut feeling that something wasn’t right led me to research, to question…to put the brakes on. And the more I read, and thought, and understood, the more determined I became to find an alternative. I started this blog out of sheer desperation. I needed to find someone, anyone, who understood what I was going through. I needed other parents to talk to—badly.

My kid never did go to a gender therapist. Never did sit in a room full of “trans teens.” If she had, I feel certain she’d be sporting a beard right now.

When I first started blogging, I got a lot of hate mail. In every anonymous drive-by comment, the hater referred to my “son” who would grow up to hate my guts. “He” would surely commit suicide, and more than one of them wished me a lifetime of misery when that inevitably happened. Even the mildest posts resulted in hostile reblogs from strangers who had not the slightest idea of my family’s situation.

At first, these anonymous barbs stung, but it didn’t take long for me to realize that I could rely on my inner parental compass. Because, see, I know my daughter. I knew, when she suddenly began spouting the gender-policed jargon planted in her head by Tumblr trans activists, that this wasn’t who she really was. This was a girl who, all through childhood, was never “gender conforming” but who was secure in herself because I’d made sure she knew, via my words and my example, that girls could be and do anything.

Most of all, I knew she needed me—not to blindly “support” and give in to her every demand, but to simply BE THERE, even as a limit; a steady place she could push and rail against. It was scary, and painful, being on the receiving end of teen outrage.  Because a teenager does have the right to make some of their own decisions. And because no parent gets it right all the time. (Paradoxically, part of being a halfway decent parent is knowing how imperfect you are at the job.) But one thing became more and more clear to me:  my child did not need a parent who would collaborate in sending her down a road to being a permanent medical patient. In fact, she needed protection from the very same people who were sending me hate mail on Tumblr.

Not so long ago, child and adolescent psychologists—people who actually study the development of young human beings—were frequently cited and quoted. These experts, as well as every other rational adult, were well aware that kids shift identities: try this one on, shed it like a snake skin, try on another. Younger kids go through a long and wonderful period of make believe and magical thinking. They are actually convinced they ARE the identity they try on. And adolescents are renowned for trying on hairstyles, belief systems, clothing styles—only to discard them after a few weeks, months, or maybe even years.

In contrast to today’s transgender-soaked paradigm, when a kid’s announcement that they are the opposite sex is taken at face value, it has been previously acknowledged–for decades–that parents are largely responsible for the inculcation of gender stereotypes into their children’s minds. Children aren’t born hating their sexed bodies. They only grow to reject themselves when someone they look up to promotes the idea that their likes and dislikes in clothing, toys, activities, or other pursuits are seen as incongruent with their natal sex.

 A child’s burgeoning sense of self, or self-concept, is a result of the multitude of ideas, attitudes, behaviors, and beliefs that he or she is exposed to. The information that surrounds the child and which the child internalizes comes to the child within the family arena through parent-child interactions, role modeling, reinforcement for desired behaviors, and parental approval or disapproval (Santrock, 1994). As children move into the larger world of friends and school, many of their ideas and beliefs are reinforced by those around them. A further reinforcement of acceptable and appropriate behavior is shown to children through the media, in particular, television. Through all these socialization agents, children learn gender stereotyped behavior. As children develop, these gender stereotypes become firmly entrenched beliefs and thus, are a part of the child’s self-concept.

… Often, parents give subtle messages regarding gender and what is acceptable for each gender – messages that are internalized by the developing child (Arliss, 1991). Sex role stereotypes are well established in early childhood. Messages about what is appropriate based on gender are so strong that even when children are exposed to different attitudes and experiences, they will revert to stereotyped choices (Haslett, Geis, & Carter, 1992).

But now, we have people like this: the mother of a six-year-old girl who has “transitioned” to male, writing storybooks to indoctrinate kindergartners. To suggest to them that they, too, might really be the opposite sex:

“Can the doctor have made a mistake? Was I supposed to have been born a boy? Am I the only kid in the world like this?”

Deep down, Jo Hirst had been anticipating these questions. And she knew she had to get the answers right.

It was bedtime, and her six-year-old was curled up on her lap. Assigned female at birth, from 18 months of age Hirst’s son* had never wanted to wear female clothing and always played with boys.

I challenge anyone to find me a single account of a “transgender child” which does NOT resort to talking about toys, hairstyle, clothing, or play stereotypes to justify the diagnosis of “trans” in a young child.

Our kids are being cheated of the opportunity, the breathing space, to simply explore who they are without a gaggle of adults jumping in to interfere with the process by “validating” their frequently transient identities. Kids are being encouraged to freeze their sense of self in a moment in time, during the period of life when everything is in flux. And even though key researchers have said over and over again that most gender dysphoric kids “desist” and grow up to be gay or lesbian; even though the latest research denies any such thing as a “male” or “female” brain, parents are encouraged to socially transition their kids, put them on “puberty blockers,” and refer to them by “preferred pronouns.”

For very young children, this cementing of the child’s identity in a period when they most need the freedom to simply play and explore—to “make believe”—is essentially stunting the child’s development.

Young children go through a stage where it is difficult for them to distinguish reality from fantasy.  Among many other things, it’s why we have ratings on films. A young child can’t understand that the monster onscreen is not real.

Research indicates that children begin to learn the difference between fantasy and reality between the ages of 3 and 5 (University of Texas, 2006).  However, in various contexts, situations, or individual circumstances, children may still have difficulty discerning the difference between fantasy and reality as old as age 8 or 9, and even through age 11 or 12. For some children this tendency may be stronger than with others.

Just exactly what is motivating doctors and psychologists to jettison decades of research and clinical practice in favor of a completely unsubstantiated and unproven hypothesis of “transgender from birth”? The glib answer is: suicide. But if a gender nonconforming youth expresses the desire to self harm, encouraging that youth to further dissociate from their whole selves (because the body and mind, contrary to the bleating of trans activists, are not separate units, but a whole) is not a responsible way to support mental health.  As this commenter said in a recent post on GenderTrender:

 Wow. Conservatives aren’t the only ones who suck at science. Brain sex? Seriously? If you’re allegedly born in the wrong body, why doesn’t your brain count as part of the “wrong body”? Your brain is telling the truth but the rest of your body is a liar? Wtf? This shit is as sensible as scientology.

And when it comes to teens,

 Teens often pick up on cues and assimilate ideas presented in movies/films viewed in the movie theater and other sources, (online sources for watching movies now eclipse movie theater viewings or film DVD rentals for teens), and while teens already understand the difference between fantasy and reality, they may still absorb or become attached to ideas that are powerfully presented in films but that have no basis in reality, the teen not having enough experience or knowledge to sort propaganda from fact, fiction from reality. Films, television programs, music and statements from celebrities can [and do] become a part of the thinking and emotional/psychological makeup of teens and children.

This used to be a “duh” thing. Are teens influenced by what they imbibe, what’s in fashion, what celebrities (like Jazz Jennings and “Caitlyn” Jenner and Laverne Cox) are doing,  what their peers are saying and doing? Might socially isolated teens be even more swayed by what they see on social media, while they sit for hours, alone in their rooms?

Facebook depression,” defined as emotional disturbance that develops when preteens and teens spend a great deal of time on social media sites, is now a very real malady. Recent studies have shown that comparisons are the main cause of Facebook depression; the study showed that down-comparison (comparing with inferiors) was just as likely to cause depression as up-comparison (comparing with people better than oneself).

…Other risks of extensive social networking among youth are loss of privacy, sharing too much information, and disconnect from reality.

My daughter, like so many others I’ve now heard about, emerged from months of self-imposed social isolation and YouTube/Reddit binges, to announce, out of the blue, that she was transgender. And simply for questioning this, for refusing to hop aboard the train, I’ve been labeled a “child abuser” of my “son”? Until the last few years, parents who recognized that teens go through phases weren’t considered abusive. They were considered well informed.

Not so long ago, parents and helping professionals neither interfered with nor bolstered a particular identity that a kid was trying on. Everyone understood this was an important part of growing up: to allow our young to experiment, to see what worked and what didn’t. It’s called the development of a self. It takes years. It’s not even complete at 21. The self doesn’t emerge, fully formed and immutable at birth. It develops in response to experience, to love, and to adversity.

Given my own daughter’s desistence from the idea that she is or was ever “transgender,” I feel even more strongly that parents are right to resist the push by every sector of society to identify “gender dysphoric” young people as “trans.”

So you bet I’m going to keep doing what I can to support parents who want to challenge and at least delay an adolescent’s decision to permanently alter body and mind with hormones and surgeries. You bet I’m going to try to save my own kid from what amounts to a cult that won’t let you leave if you change your mind, without serious social consequences. You bet I’m going to continue to protect my daughter and others like her from a lifetime of difficulty, from the rapacious medical industry that is profiting from the regressive resurgence and marketing of gender stereotypes.

You can also bet that I’m going to continue shedding light on the frankly insane practice of labeling very young children as transgender, grooming and conditioning them as preschoolers to believe their own bodies are somehow wrong and alien, that they must undergo teasing and torment from other children, that they must wear prosthetics to amplify or hide their own genitalia to be accepted as they are. Or just as bad: That the entire world must be browbeaten into redefining  biological reality such that “some girls have penises” and “some boys have vaginas.”

And this work is not just about protecting kids. It’s also about supporting family members and friends who are so deeply affected by the transgender narrative.  The trans activists, the media, the doctors and psychiatrists–none of them talk about the terrible damage done to the family system, to the fabric of close relationships, when a child “transitions.”  All the activists have to say is that the skeptical parents and loved ones are “transphobes.” No one talks about the fact that the majority of these dysphoric kids would grow up to be gay or lesbian adults if not interfered with;  adults with healthy, intact bodies, not poisoned by drugs and carved up by surgeons’ knives.

So we have to keep talking about it. We have to keep the lights on in our corner of the Internet, even if only to document this strange medical and cultural fad for future historians.

Thanks to everyone who is traveling this road with me. While I know we often feel swamped and hopeless, we have each other for strength and courage. And for now, that will have to be enough.