Happy Birthday Baby!

Motherly advice

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Dear Miss Miller,

Ever since you were fifteen and first considered “just hormones and stuff,” I’ve been writing this letter in my head. Now that you’re almost eighteen and heading off to college soon, you will have more freedom to make life choices without Mom’s 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 don’t readily advertise is how cross-sex hormones and surgical interventions will affect your body.

We probably agree that it’s important to do your research and be an informed consumer. You wouldn’t buy a pair of platform sneakers without researching first, right? Doesn’t it make sense to take the same care with your body and your health?

I know you’ve recently said that you’re not inclined to medicalize your identity, but honey, I’ve seen your TikTok and I’ve met your friends. Far too many of them are taking cross-sex hormones and if I weren’t worried for you, I wouldn’t 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. 🥰

You’ve said in the past that “doctors know what they’re doing,” but sadly, that’s not always the case. Jazz Jennings, for example, who had the world’s 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 Jazz’s surgeons admitting that they don’t have a lot of experience with these types of surgeries, which essentially means that kids like Jazz are being experimented on.

Here’s 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 “top surgery,” 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, you’ll never be able to breastfeed. You might say, well that doesn’t matter, I don’t want kids anyway. I didn’t want kids at your age, either. In fact, I wasn’t 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. 💖

I know it’s considered transphobic to talk about regret, but putting politics aside, we’re talking about consumer regret. If you were thinking about buying something really expensive, wouldn’t you want to read the one star reviews before handing over your credit card? That’s what I don’t like about the concept that regret and detransition are “transphobic” 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 you’re talking about manipulating a healthy body with drugs and scalpels, you won’t realize how good you had until it’s gone.

Here’s 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 can’t empty your bladder fully. It hurts, multiple times a day, every day. That sounds really depressing.

Should you ever decide to go for “bottom surgery,” here is a third and final video. The ironic thing about bottom surgery is that it typically involves cutting into your top too—usually a forearm. But really your whole body is like a trans penis grocery store—or 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. 😉

Fun fact: the surgeon in this video bypasses the forearm in favor of the patient’s back. He also pairs festive holiday music with the visual imagery, which I bet we can agree is weird and creepy. 😱

Here’s 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 who’ve 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 testosterone—

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 — 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. 

2. Facial and body hair will thicken, darken, and grow faster. You could also experience male pattern baldness. 

3. Vocal cords will thicken and lengthen. 

4. Cheekbones tend to lower and the jaw becomes more prominent.

5. Fat mass decreases, especially in the hips, legs, arms and face. 

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 “micro” 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 can’t do anything about it, which is really, I’m going to be honest, it’s hard. Like mentally, it’s hard to know that, like, pain during sex will always be part of your life.

Here’s 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 I’m getting a hysterectomy is because, sorry if you’re 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 what’s supposed to be life’s, you know, nature’s 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, what’s the point? Ask yourself, “Is testosterone or surgery truly going to improve my life? Is there any way I can be happy without medically altering my body?” And finally, “Might it benefit me to wait a little longer before I make a decision that will impact my entire future?”

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 past—since sixth grade—you’ve been changing your mind again and again about your “gender identity.”

Doesn’t it make more sense to keep your options open, rather than cutting them away?

Perfect just the way you are

I love you,

xoxo

Mom

With more on this author.