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Dear Miss Miller,
Ever since you were fifteen and first considered âjust hormones and stuff,â Iâve been writing this letter in my head. Now that youâre almost eighteen and heading off to college soon, you will have more freedom to make life choices without Momâs permission. So now, here is the most important advice I may ever give you.
Many colleges proudly cover transition-related medical expenses under student health insurance which, after all of my research over the last two years, I find criminal, because what the universities donât readily advertise is how cross-sex hormones and surgical interventions will affect your body.
We probably agree that itâs important to do your research and be an informed consumer. You wouldnât buy a pair of platform sneakers without researching first, right? Doesnât it make sense to take the same care with your body and your health?
I know youâve recently said that youâre not inclined to medicalize your identity, but honey, Iâve seen your TikTok and Iâve met your friends. Far too many of them are taking cross-sex hormones and if I werenât worried for you, I wouldnât be doing my job as your mom.
First, here is a video is of an eighteen year old boy (same age as you) receiving a vaginoplasty after being on puberty blockers and estrogen for some years. I know you already have a vagina, but in the spirit of inclusivity, I thought best to share. đ„°
Youâve said in the past that âdoctors know what theyâre doing,â but sadly, thatâs not always the case. Jazz Jennings, for example, who had the worldâs most renowned vaginoplasty surgeon, had a horrible experience with multiple complications and corrective surgeries. You can watch a short video about that here, which includes another one of Jazzâs surgeons admitting that they donât have a lot of experience with these types of surgeries, which essentially means that kids like Jazz are being experimented on.
Hereâs detransitioner Shapeshifter, detailing his vaginoplasty regret.
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Since you would be going the FtM route, this next video is up your alley. It details âtop surgery,â including breast removal and nipple grafting.
Top surgery is praised for making a person more comfortable after years of wearing binders, which, though nonsurgical, have been reported to cause numerous problems like difficulty breathing, chronic back pain, spinal changes and broken ribs. Maybe this is why you never mentioned anything when your binder mysteriously disappeared one day.
Because a double-mastectomy is invasive surgery, even more complications can arise, like dying flesh, incisions popping open and nipples falling off. Plus, youâll never be able to breastfeed. You might say, well that doesnât matter, I donât want kids anyway. I didnât want kids at your age, either. In fact, I wasnât ready to consider having a baby until I was thirty-four years old. Once I had your brother and you, though, I was so thankful for what my body could do, and nursing you was one of the most amazing experiences of my whole life. I know, ew, right? Just wait till it happens for you. đ
I know itâs considered transphobic to talk about regret, but putting politics aside, weâre talking about consumer regret. If you were thinking about buying something really expensive, wouldnât you want to read the one star reviews before handing over your credit card? Thatâs what I donât like about the concept that regret and detransition are âtransphobicâ to even mention because those topics harms the trans community. When you think about it though, it harms the trans community to NOT talk about it. Everyone deserves to have the most information possible when it comes to medicine and surgery of any kind, but when youâre talking about manipulating a healthy body with drugs and scalpels, you wonât realize how good you had until itâs gone.
Hereâs Grace Lidinsky-Smith on top-surgery regret.
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Complication rates for surgeries of ANY kind are reported to be anywhere from 5.8% to 43.5% percent. FtM bottom surgeries have the highest complication rate, of up to 76.5%, usually regarding the urethra, which is your pee tube. Imagine, after years of going to the bathroom without even thinking about it, the everyday act of peeing is suddenly painful, ineffective, messy and time-consuming. You dribble, you canât empty your bladder fully. It hurts, multiple times a day, every day. That sounds really depressing.
Should you ever decide to go for âbottom surgery,â here is a third and final video. The ironic thing about bottom surgery is that it typically involves cutting into your top tooâusually a forearm. But really your whole body is like a trans penis grocery storeâor a skin island as this surgeon calls it, which reminds me of Buffalo Bill from Silence of the Lambs. And you know who his character is based on. We talked about it at dinner a couple months ago. đ
Fun fact: the surgeon in this video bypasses the forearm in favor of the patientâs back. He also pairs festive holiday music with the visual imagery, which I bet we can agree is weird and creepy. đ±
Hereâs a quote from the surgeon in the video description, with some bold-faced statistics (emphasis mine):
I do not make the urinary tract at the tip of the penis [but] place it at the base of the penis. Because even after the most successful urinary tract construction, there is a 50% risk of urinary constriction, urea stones and fistula. Despite this technique, SOME of my patients reported that they could urinate while standing.
I cannot imagine the pain of recovery from a surgery like this, but there are people out there whoâve lived through it and have spoken about their experiences.
Here is trans man Scott Newgent on phalloplasty regret.
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Finally, no advice to a transgender medicine consumer would be complete without including information about nonsurgical care, so here is a handy list of changes that can likely occur should you choose to inject your healthy body with testosteroneâ
From the Mayo Clinic:
Complications can include:
Weight gain
Acne
Male-pattern baldness
Sleep apnea
A rise in cholesterol, which may increase the risk of heart problems
High blood pressure
Making too many red blood cells â a condition called polycythemia
Type 2 diabetes
Blood clots in a deep vein or in the lungs
Infertility
Drying and thinning of the lining of the vagina
Pelvic pain
Discomfort in the clitoris
And from Business Insider, edited for clarity and brevity by me:
1. Skin will thicken and become more oilier. You may also notice more acne.Â
2. Facial and body hair will thicken, darken, and grow faster. You could also experience male pattern baldness.Â
3. Vocal cords will thicken and lengthen.Â
4. Cheekbones tend to lower and the jaw becomes more prominent.
5. Fat mass decreases, especially in the hips, legs, arms and face.Â
6. Muscle grows bigger and faster if you resistance train.
7. Periods become lighter, shorter and arrive later before stopping completely.
8. Fertility decreases, but if you still have ovaries and a uterus you can still get pregnant, even if menstruation stops.
9. Sex drive increases.
10. Clitoris grows into a âmicroâ penis and could grow up to two inches or larger depending on your genetics. Vaginal walls become thinner. Natural lubrication decreases. Penetrative sex may cause vaginal tissue to tear, which increases the risk of STDs and HIV.  Pelvic pain may arise.
Speaking of natural lubrication, vaginas and pain, here's an honest conversation between two trans men, Buck Angel and Marcus Dib.
Regarding vaginal atrophy, Marcus says:
You basically canât do anything about it, which is really, Iâm going to be honest, itâs hard. Like mentally, itâs hard to know that, like, pain during sex will always be part of your life.
Hereâs another trans man, Aydian Dowling, explaining the excruciating pain he and many of his trans-identifying friends feel when achieving orgasm.
Aydian says:
The number one reason Iâm getting a hysterectomy is because, sorry if youâre listening Mom, haha, but, at the very peak when I orgasm, I experience an extreme cramping feeling. More than just when I used to get menstrual cramping⊠I am at whatâs supposed to be lifeâs, you know, natureâs beautiful pleasure and it literally feels like someone takes two knives and shoves them into here (gestures at abdomen) and twists and turns them. And that goes on anywhere from a minute to six, seven minutes.
Transitioned and detransitioned women have reported additional symptoms like rage, deteriorating mental health, emotional numbness and physical violence.
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In the end, any happiness you get from transition of any type must outweigh the potential harms. Otherwise, whatâs the point? Ask yourself, âIs testosterone or surgery truly going to improve my life? Is there any way I can be happy without medically altering my body?â And finally, âMight it benefit me to wait a little longer before I make a decision that will impact my entire future?â
Experience romance. Share a kiss with someone you really like. Travel. Allow your prefrontal cortex to fully mature. The more developed and experienced you are, the smarter ALL your decisions will be:
Finally, remember you have your whole life ahead of you. No one can predict the future, but we do know that in the pastâsince sixth gradeâyouâve been changing your mind again and again about your âgender identity.â
Doesnât it make more sense to keep your options open, rather than cutting them away?
I love you,
xoxo
Mom
With more on this author.
So bitterly sweet It makes my heart ache at the attempt to urge the nonsense to stop, using such logic and light hearted desperation.... I hope she choses well,as does my son and all the other parents kids that are represented here đđđđđ
While I agree with the general principle of waiting for minors to reach a certain level of maturity before undergoing surgical treatments for gender dysphoria, I can't help but notice the glaring inconsistency in how brain scan evidence is being used in this discussion.
When brain scans suggest that teenagers' decision-making capacities are still developing, everyone cheers and accepts this as solid scientific proof that we should delay major, irreversible decisions. And to be clear, I agree that there's a strong case for caution and waiting, as long as appropriate support and accommodations are provided in the meantime.
But here's where the double standard becomes painfully apparent: when we use brain imaging technology/scans to study transgender individuals and find compelling evidence of neurological differences that align with their expressed gender identities, suddenly the science is dismissed as "ideology," the researchers are accused of having an agenda, and the very existence of transgender people is called into question. (https://www.youtube.com/watch?v=8QScpDGqwsQ)
You can't have it both ways. If you're going to invoke neuroscience to argue for delaying transition, you don't get to ignore neuroscience when it shows that being transgender has a biological basis. If you demand rigorous evidence and caution for transgender health care, you don't get to dismiss rigorous evidence out of hand when it challenges your preconceptions.
The reality is that there's a growing body of scientific research, from brain scans to twin studies to genetic analyses, that points to a complex interplay of biological, psychological, and social factors in the development of gender identity. This research has been conducted by reputable scientists, published in peer-reviewed journals, and endorsed by major medical organizations.
Dismissing this evidence as "fake science" or a "cult" isn't just intellectually dishonest - it's a betrayal of the very principles of scientific inquiry and evidence-based reasoning that you claim to uphold - well, as far as I can tell, you uphold it *only when it suits you*. It's a reflection of a deep discomfort with the implications of this research - namely, that transgender identities are real, valid, and deserving of respect and appropriate medical care.
And there's the rub. If we're going to have an honest, productive conversation about transgender health care, we need to be consistent in our standards of evidence and open to following the science wherever it leads. We need to listen to each other with empathy and good faith, acknowledging_both_the concerns of *parents* _and_ the *lived experiences of transgender individuals*. Only then can we find common ground and develop policies that prioritize the health and well-being of all youth, trans, not trans alike.
But this requires a commitment to intellectual honesty and consistency. It means accepting scientific evidence even when it challenges our assumptions. It means being willing to grapple with complexity and nuance, rather than retreating into simplistic binaries and dismissive rhetoric.