An Update on Youth Gender Surgeries
It would be helpful if we could operate with the same set of facts
A few months ago, I published a piece about the research (pasted below) showing that adolescents as young as 13 were undergoing gender-affirming surgeries. My goal was to help people on the left—who believe the talking point that kids aren’t getting these surgical interventions, including double mastectomy, orchiectomy or vaginoplasty—get accurate information. In theory, if those for and against gender-affirming medical interventions for minors can operate from the same set of facts, it might be easier to hammer out some sound policy. (I know—it’s a wild theory).
Over the last couple of weeks, more information about these surgeries has come to light. It’s worth taking a few minutes to go through these Twitter threads, which show the data from published research and make it clear that children under 18 are partaking of these surgeries. This op-ed by Brandon Showalter includes a detailed list of such studies. Because we have no government (or even private) agencies keeping track, we don’t know how common they are; a study from just one hospital shows 65 double mastectomies on minors over a three-year period. We also don’t know how patients feel about these decisions in the long-term. We don’t know if this is the best way to treat gender dysphoria. We don’t know much, other than that this is happening.
Not only was it now clear to the general public that these surgeries were occurring, but Boston Children’s Hospital was promoting its gender surgery center, announcing in its own videos that kids as young as 15 were having their breasts removed, and kids as young as 17 having their penises removed to create neo-vaginas according to a now-erased web page. I know adults who are happy they had these surgeries, and I know adults who are unhappy they had these surgeries. But at least no one is denying they occurred.
Some members of the public didn’t react well to news that young people were receiving these surgeries, because they believe children should not be getting these surgeries, seeing them not as medically necessary but as psychologically and aesthetically desirable in the moment. NPR reported that doctors providing this care were “facing harassment and even death threats over the medical care they offer to transgender kids.” The reason, they asserted, was that Libs of TikTok or conservative media was “casting gender-affirming care as child abuse and mutilation.” Libs of TikTok—which publishes liberals’ own content—was banned from Facebook after the alleged threats.
There was no consideration of the possibility that the harassment was stemming from people feeling strongly that these surgeries were inappropriate for children. There was no asking questions about what it means to have surgeries so young, and what the research says about them. In fact, BCH told NPR, “We do not and have never performed gender-affirming hysterectomies for anyone under the age of 18.”
This is odd because, well, they advertise performing surgeries on younger kids, but I guess NPR didn’t check? The mainstream and left media continued to paint the medical staff as victims rather than press them about their actions. Yes, it’s truly horrible that critics responded to the reality of these surgeries with death threats. That’s not only reprehensible, it gets in the way of what should be our goal, which is to get to a place where opposing sides can discuss and debate, where sane, evidence-based policy is a real possibility. Once those providers become victims, it obfuscates the reason for opponents’ fury, which is that they really are performing these surgeries, and that the research we have—the systematic evidence reviews done in Florida, Finland, Sweden and the UK—makes it unclear if they’re safe, effective, or appropriate.
Plenty of people on the left use these same intimidation tactics, too. None of that is helpful if what you want is to move the US closer to cautious, evidence-based European models in its approach to treating children with gender dysphoria. But perhaps that’s not what either side wants. Maybe what they want is to win a culture war, and not help kids.
Either way, the mainstream media, which could be mitigating between the two sides, is instead assuming one side is right, the other hopelessly bigoted, and much of the liberal public follows suit. By allowing the narrative to be simple and one-sided, and filtering information though a lens of confirmation bias instead of truth-seeking, the mainstream and left media keeps the public misinformed, the very opposite of their job.
Is this because of ideological capture? Is it a good business model? Is it because of “Trump derangement syndrome,” which is a way to dismiss people concerned about his behavior but also might be an ideological sickness that has spread through liberal America and from which we are apparently helpless to recover? I don’t know. But let’s try to find a common set of facts where we can, and start there.
“I just feel so foolish,” Grace said to me. We were sitting in a Greenwich Village diner, commiserating over how we’d both been duped, or allowed ourselves to be duped, by the gender culture wars. Grace appeared last year on the 60 Minutes segment on detransitioners—so far one of the only mainstream media pieces that has delved into this important subject, and, famously, the only 60 Minutes segment in history which was vociferously objected to before it aired.
If I’d been duped into believing, and reporting, that the science of gender-affirming care was settled, Grace had been duped into partaking of that care, and one thing she felt so foolish about was believing that a double mastectomy would alleviate her suffering. Instead, it increased it, and began her course-correction to detransition.
But why wouldn’t we believe it? After all, the AMA, the AAP and loads of other medical and psychological associations—not to mention the President—have endorsed these medical interventions for young people with gender dysphoria, despite the fact that multiple other countries have abandoned or pulled back on them in the past two years.
And perhaps we also believed what so many others who support gender affirming care for minors do: that children don’t get surgeries. This is the “fact” most often repeated/hurled at me on Twitter.
It’s not true. The World Professional Association for Transgender Health (WPATH) Standards of Care 7 (which are actually recommendations) suggested that “fully irreversible” surgeries not be performed on those under 18, except for “masculinizing surgery,” which could be performed as early as 16. More proof? This study on the effects of such surgeries for kids: the youngest participants are 13.
And today, Suzi Weiss published a piece in Common Sense with the stories of several girls who’d had mastectomies as teens and came to regret them. If that doesn’t sway you, try perusing the more than 42,000 GoFundMe campaigns* that mention top surgery.
Despite the growing number of young adults regretting the surgeries they had as teens, the draft of forthcoming SOC8 so far suggests lowering the ages for surgical interventions:
15 years and above for chest masculinization; unless there are significant, compelling reasons to take an individualized approach, considering the factors unique to the adolescent treatment frame.
16 years and above for breast augmentation, facial surgery (including rhinoplasty, tracheal shave, and genioplasty) as part of gender affirming treatment; unless there are significant, compelling reasons to take an individualized approach, considering the factors unique to the adolescent treatment frame.
17 and above for metoidioplasty, orchidectomy [sic], vaginoplasty, and hysterectomy and fronto-orbital remodeling as part of gender affirming treatment unless there are significant, compelling reasons to take an individualized approach, considering the factors unique to the adolescent treatment frame.
18 years or above for phalloplasty, unless there are significant, compelling reasons to take an individualized approach, considering the factors unique to the adolescent treatment frame
Meanwhile, many are pushing the miracle cure of mastectomies like so much snake oil. One doctor in particular—Grace’s doctor, in fact—has been accused of aggressively pushing mastectomy surgeries to children on TikTok. Dr. Sidhbh Gallagher calls this invasive surgery “yeeting the teets,” and complains when she only has a couple of surgeries a week.
Rethink Identity Medicine Ethics, or ReIME, shared a summary of a complaint filed with the FTC by several organizations concerned that Gallagher has marketed her services “to a vulnerable and impressionable population of children and youth (demonstrably as young as 13 years old), experiencing distress with their gender identity and developing bodies, and convert them into her patients.” A complaint was also sent to the American Society of Plastic Surgeons but was returned when Gallagher’s representation that she was a member turned out to be false.
Another complaint, filed by attorney Kendra Parris, includes dozens of exhibits of marketing to kids, including celebrating double mastectomies for teens. “I do not believe the people following Dr. Gallagher’s social media pages are receiving completely accurate information about the risks and potential complications of the surgeries she’s advertising,” Parris wrote to me.
Yes, the kid looks happy, and I recognize that adults modify their bodies in ways all the time that might not make sense to other adults. I know women who’ve removed their breasts, or reduced them or augmented them, and felt better. A friend who teaches photography at a college told me his students are taking pictures of their mastectomy scars all the time; they’re proud of them, they make art out of them.
But this is a kid, and the picture above shows a young girl with cutting scars, a sign of mental distress—and this is just one of many chronicled in Parris’s complaint. So many young people, including Grace (who was over 18 at the time of her surgery), thought removing their breasts would alleviate that distress and found the opposite. Were these kids informed about stories like Grace’s? And do they know that we have no high-quality long-term research that shows these surgeries lead to improved mental health?
And is the general public, especially the left, informed? An editor once suggested to me that I be careful using the word “detransitioner” in stories because a doctor had noted it was fraught for trans people and detransition was rarely due to regret (though we haven’t nearly enough evidence to make such a claim), and almost none of the stories and op-eds I’ve pitched to mainstream outlets, trying to diversify the media narrative, have made it through. Unless lefties are reading independent journalists like Jesse Singal, Wesley Yang, Helen Joyce, Common Sense with Bari Weiss, Andrew Sullivan, Kathleen Stock, Debra Soh or Abigail Shrier (are there others? If so, please leave in comments, below), or are seeking information from groups like Genspect, SEGM or ReIME, they are only getting a tiny sliver of the story about the science of gender-affirming care for kids. If the left and center don’t know about detransitioners, and don’t know about kids getting surgeries—and the media’s not reporting it—we can’t have honest debate and discussion about how to treat the ever-increasing number of children and adolescents with gender dysphoria.
Please share this with your ill-informed lefty and liberal friends. Now they, too, will know.
*42,000 was what came up in a search at the time of writing. A few months later, the number was just over 12,670. These may not all be active or current campaigns, but may have been 42,000 over the course of the site’s history.
Another excellent article. These are vitally important issues and questions you are writing about and mainstream/centrist/liberal journalists and media outlets are failing in their mission and ethics by not faintly and accurately covering this. Ignoring and spinning things is causing real and lasting harm to our children.
If I am remembering correctly, I heard an interview with Grace (one of the detransitioners interviewed by 60 Minutes) where she said she was embarrassed to admit that one of the reasons she rushed into having her breast removed is that trump had just been elected and she believed the frightened rhetoric that Trump would outlaw all surgeries, so she had to get hers while she still had the chance. I really dislike the term “Trump Derangement Syndrome” because “derangement” is such a loaded, emotional word that it sends the very people who need to consider the message it’s trying to communicate into defense and retaliate mode. I am someone who wanted Trump out of office from day one, who too often got sucked into the highly emotional, breathless comments verse of everything actually wrong and perceived-to-be wrong that he did. Now with some 20/20 hindsight, I see the idea of Trump Derangement Syndrome is a valid concern that should be calmly and rationally analyzed and discussed (despite its unhelpful name). It has done real harm, and the current medical scandal you are writing about is one of the most painful examples.
the threats (if there were any) could be part of phenomenon of gop becoming more vocal on the issue. gop media consumers act much differenly than other gc peoples. some make threats? who knew? or the threats were fake and generated by gender activists in an effort to malign gc ppl. the truth will come out. we didnt get here overnight. keep up the fight. even vote for a republican or turn off the house wifi to keep kids away from the depths of the internet if necessary. the key to freedom of speach and winning other rights back is to chip away at the propaganda that has been so successful.