In modern Western history, there is no prior precedent for adults publicly advocating for minors under the age of 18 to undergo major, elective surgeries on healthy tissue. Surgeons don’t tout breast augmentation or reduction for minor girls. Even adult women have a difficult time finding surgeons who will perform elective hysterectomies, since most doctors are reluctant to permanently deny future fertility to healthy women of reproductive age. After all, these women might change their minds later. (It never seems to enter anyone’s mind that a 20-year-old FTM might also change their mind but…never mind.)
In an earlier post, I wrote about the successful lobbying by TransActive of Portland, Oregon, along with their enablers and allies, to lower the age at which parental consent is required for these permanent procedures in the state of Oregon. The Oregon Health Plan, Oregon’s taxpayer-funded Medicaid equivalent, now also covers transition services, thanks to lobbyists like Jenn Burleton. TransActive transition-promoters were also overjoyed that there is now no longer a LOWER age limit for “gender confirmation surgery” WITH parental consent.
The demand for early access to surgery is growing, and there are surgeons happy to profit from this trend.
Generally speaking, Dr. Crane appears to have an “anything goes” approach to surgery, if discussions between gender specialists on the WPATH public Facebook page are any indication. According to one satisfied patient, Crane is happy to provide his clients with any potpourri of surgeries they desire, regardless of “identity”:
Dr. Crane practices in California, so he can’t yet offer these surgeries to 15-year-old California residents over the objections of “unsupportive” parents like doctors can in Oregon. For Oregon teens, I’ve seen many recommendations lauding Dr. Juliana Hansen and Dr. Jennifer Murphy, both of whom offer mastectomies for “gender reassignment” at the Oregon Health Sciences University plastic surgery clinic in Portland. Hansen and Murphy, both with training in breast reconstruction, have undoubtedly parlayed their prior clinical experience with treating breast cancer patients, who had to have breasts removed due to an actual medical emergency.
But of course, in several states, lobbyists have managed to convince lawmakers that these surgeries are medically necessary, and that insurers must include them in their policies. Given that the AMA, the American Psychiatric Association, and WPATH (World Professional Association for Transgender Health) have all jumped on board with the idea that transition procedures are a matter of medical necessity, insurers can’t be far behind. In fact, just a few days ago, this article reported that over 400 US companies include gender reassignment in their company insurance policies, up from only 49 in 2009. For policies in the state of Oregon, these companies would presumably have to offer SRS to 15-year-old patients, whether their parents approved or not.
Are there any providers who see a problem with permanent surgical interventions for young people? At least two, Dr. Charles Garramone, who heads a clinic in Florida, and Dr. Kathy Rumer in Philadelphia, talked good sense in an interview in the New Yorker magazine in 2013.
Charles Garramone, a plastic surgeon in the Fort Lauderdale area, will not perform sex-reassignment operations on minors, because, he says, “patients need to have a mature outlook in terms of being able to really understand the irreversibility of this surgery.” In addition, Garramone thinks that the skeletal structure underlying the chest of a sixteen-year-old may change enough over time so that a second surgery will be required.
Kathy Rumer, a plastic surgeon outside of Philadelphia who has a large transgender practice, also declines to perform reassignment surgery on minors. “I have had parents plead with me,” she says. “And I can feel for them. But I don’t want someone coming back to me when they are twenty-five saying, ‘I didn’t really want this. It was my parents.’ Adolescents are really in flux. I wouldn’t want to make a permanent change based on that stage of life, which can be difficult, no matter what you’re going through.”
It’s hard to understand how any parent of a teen could “plead” with a surgeon to irrevocably alter the body of their child, but as we have seen recently, there seem to be an awful lot of parents who want to hop on the transition bandwagon with their offspring as quickly as they possibly can.
And when it comes to top surgery, with online role models like this, an eager teen might just see any resulting scars as a super cool body modification to show off to friends. Hey, scars are sexy.
“I have lots of scars, all over my body, but my top surgery scars are my favorite. They’re this warm, gentle reminder of how hard I’ve worked to be me. They represent so much fucking work. They’re my ultimate love note.”