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):


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


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

  1. I really don’t even know how to express in words the level of disgust I feel.

    I hope that this girl (and all of the other kids being experimented on) will eventually sue these doctors.

    Liked by 7 people

  2. One clarification that I feel needs to be made is that although the surgery is very similar to a double mastectomy (I have actually had a double mastectomy) the “chest reconstruction/top surgery” is not identical to a double mastectomy in that some breast tissue remains, as well as some nipple and areola tissue to reconstruct the grafted nipples – So, BREAST CANCER SCREENINGS ARE STIIL RECOMMENDED even when a person has had “chest reconstruction” but few transmen seem to be aware of this.

    I wonder how many have actually been informed that they have an ongoing risk for breast cancer.

    I drove a friend (who was an 30+ year old adult) to have the “chest reconstruction” done and I took care of my friend during the recovery process. The Doctor did not volunteer this information, but I asked directly and very deliberately if cancer screenings would continue to be necessary in the future. The Doctor said that yes, my friend would still need to have screenings for breast cancer. Interestingly, the paperwork listed the surgery as a double mastectomy (sometimes the surgery is coded as a breast reduction, which I feel is generally a more accurate description of the procedure.)

    My concern is that most transmen will not continue to seek breast cancer screenings, either because they were not informed of the ongoing need to do so or because they are too uncomfortable to seek a breast exam (or because medical practitioners may not be providing this service if they are not aware of the ongoing risk if the surgery was coded as a “double mastectomy” yet left a significant amount of breast tissue.)

    I have regrets over supporting my friend in pursuing this surgery. It did not solve the problem of dyshporia for him. He was not happy with the surgery and expressed with much anguish that now he ” just looked like an eleven year old boy.” In addition, the surgery itself left him with limited range of motion when reaching over his head and he has some residual numbness (even after a year.) He was not happy with the nipple placement as well and feels that his chest does not look natural. I have not seen his chest since it healed and so, I cannot comment on the appearance but i do remember, ironically, that his Doctor was very pleased with the outcome.

    I have seem several “top surgeries” at Pride parades. I have noticed that most transmen have significant hypertrophic scarring and some have “dog ear” flaps of skin laterally near their armpits. The “chest reconstruction” does not look much different than my own double mastectomy – (with the exception that I have no nipples at all as I did no pursue reconstruction of any kind.)

    The surgery is no minor procedure. It is certainly less intrusive than a hysterectomy (which I have also had) but there are still issues to contend with. The scars can be painful. I know that speaking for myself, (and for a friend mine who has also had a double mastectomy as the result of cancer) that the scars can feel raw and cause ongoing discomfort and pain. It has been 4 years since I had the double mastectomy and the scar tissue is still very sensitive and I have heard that this is fairly common.

    I have been told that my risk for breast cancer is no 0-2% and with me, all of the breast tissue that could have been removed was taken (but “top surgery” leaves more breast tissue as it is used to shape the chest, and therefore the risk of breast cancer often remains significant.)

    Whether a surgery is a true double mastectomy or a breast reduction, it is not a trivial procedure – nerves are cut and there are always risks for phantom pain. I was amazed that there was no discussion of the likelihood of ongoing pain. None told me, my friend who had the “chest reconstruction” or my other friend who had cancer that we would have issues with pain (that may never go away.)

    I read of a transman who breast feed his child but had great difficulty in doing so since the “top surgery” had removed much of his breast tissue. He needed to donated milk as he could not produce enough to feed his child. I wonder if young people even consider that they might want to have children eventually? Apparently, this person had not thought that far in advance.

    I understand the tissue with dysphoria as I have lived with severe body dysphoria for most of my life. What people don’t realize is that even after the breasts are removed, dysphoria may remain. A person may still not be able to “pass” and the chest may be flat or worse, uneven. My friend remains quite frustrated. He is dissatisfied with his “top surgery” and now even on Testosterone, he is not satisfied with is body. So much depends on genetics and if a person has a slight build and is not very tall or heavily muscled as a female, there is no guarantee that Testosterone can do much to change this. I wish that Doctors would take more time to explain that there are serious limits to what surgeries and hormones can offer.

    If a person does not “pass” as male, the new chest may still be a source of dysphoria. It is awkward to have people take second looks or to assume that a person is a young boy when they are actually in their 30’s.

    Most transmen will not talk about these issues but as a woman who is non-binary, I am open with talking about this type of thing, if someone asks. I would not have had this surgery if I were not having serious medical issues with my breasts (related to a prolactinoma) and extremely dense and cystic breast tissue.

    I regret supporting my friend in having his “chest reconstruction.” I feel that the surgery did not solve his problems and that he has become even more dysphoric since his “top surgery.” It seems like there is a snowball effect that I have witnessed in many people who are transiting with hormones and surgeries. It seems that as they get deeper into the process, they begin reaching more frantically for the next change but at each step more complications build up – and some of these complications are life threatening.

    I feel powerless to help my friend these day. He doesn’t care if this process of transition kills him.
    It is a difficult place to be – I want to be a faithful friend but how can I support a friend who is slowly killing themselves? The problem is that my friend (and the transmen that I have met) – do not want to be “transmen.” They want to have been born male and they don’t feel that life is worth living if they must live as a woman. But there is no way to go back in time and magically change their physical anatomy at birth – and so, they feel stuck between a rock and hard place.

    I wish that they could see everything that is “right” with their body. They have healthy bodies, legs that work, eyes that can see, intelligent minds … but none of this seems to matter.

    Liked by 7 people

    • Bit of a digression, but what on earth does “non-binary” even mean? NONE of us adhere perfectly to gender norms. We all deviate at least a little bit. “Non-binary” might as well mean “normal”.

      Liked by 2 people

      • Agreed – I think that few people sit at polar and extreme ends of stereotypical gender expression – and so, yes …. Non-binary is the “norm.”

        I am using the term here in the context of addressing my experience of being “radically non-binary” or very non stereotypical in my gender expression within a North American cultural context (I am routinely received to be male and this has been a common occurrence since I was a young child) but I do not identify as transgender.

        There really is no word to describe someone like me that I feel matches my experience. Some people would call me “Butch” but this holds certain connotations for some people that I am uncomfortable with. I do not subscribe to gender role playing. My appearance and mannerisms are not an adopted affect or something that I actively/intentionally cultivate but are traits that I have expressed naturally from early childhood. I guess the closet word to describe me would be androgynous or “radically non-binary” or a “masculine” or strong woman.


      • Why can’t you just be a woman?

        I object to the implication that I adhere to stereotypes because I don’t attach a “non-binary” when I talk of myself as woman.


    • Something else I seem to see among some people who go to plastic surgery out of dissatisfaction with their bodies (trans or otherwise) and then are not happy with the results is a sense of having “failed” or “done it wrong” and feelings of responsibility for what they see as their “bad outcome.”

      If you’re “born ugly” in some ways you can tell yourself, well, it’s just my luck. I didn’t cause it, it’s just how things are. But when you take active steps to “fix it” and then fail (by your eyes) now there’s all the endless “if only I’d picked another doctor” “if only I had a different procedure” “now I only have myself to blame” “I did this to myself” all this.

      There are plenty of narratives you can read where someone gets surgery (or SRS, FFS…) and at first is thrilled with the outcome, but then in the course of looking in the mirror or whatever, they notice some minute “flaw” – something is not quite even, or if they know just where to look they can see a telltale scar that points to SRS rather than regular vulva, etc. And then they obsess over it.

      Something else you remind me of too, so many of the “am I trans?” questioners are told to imagine a thought scenario where they are offered the choice to push a button and magically be “cis women” (if they’re potential MTF) or “cis men” (if they’re potential FTM) and told that if their answer is “yes I’d push the button” then it means they’re trans and will inevitably have dysphoria lifelong and so therefore absolutely must transition, the earlier the better (particularly in the case of MTF).

      This question is meaningless because in reality there IS NO SUCH CHOICE.

      People need to be realistic about what bodymods can do. I agree with you that the doctors really should be telling people about these limits and what they are likely to be able to achieve with their own bodies. So many FTM are very short even for women and with wide hips or a tendency to put fat on the lower body, they are simply never going to be able to have the frequently desired tall slim-hipped wide-shouldered physique, it is not in the cards and never will be. Looking like a moon faced early-teens boy is the true choice they’re presented with (and depending on hip width sometimes not even that) and need to think long and hard about that.

      Liked by 4 people

  3. This is a modern trend of female genital mutilation, – accept they are not justifying it with religion, just identity, the new religion. This cult of ‘men with fetishes’ is trying to normalize a human rights violation they have projected on to underage girls. The entire ‘transgender trend sexualizes children and puts the fear that the child might be gay to the parents.

    Liked by 2 people

  4. To Dana: There are people who subscribe to the belief that gender is binary but I feel (like you) that it is “non-binary” and follows a natural continuum with predispositions of where one might fall on the spectrum. When I think of a “non-binary” person in the context of talking about “transgenderism”, I think of someone who expresses traits that are so far from cultural gender stereotypes or “norm” that they are most often perceived to be the opposite sex.

    To make matters more complicated, trauma can however, interfere with gender expression as dysphoria is a very common response to physical and/or sexual trauma and dysphoria often plays a major role in the decision stop bind or to seek breast removal (although some transgender people do not have these inclinations toward body dysphoria but still suffer from gender dysphoria.)

    Now back to issues regarding the breasts. The dysphoria can be extreme and severe. Double mastectomy can ease some of the dysphoric symptoms but it may bring new issues with dysphoria and (physical pain) that may not have been anticipated. (That is my main point in adding my original post.)

    But double mastectomy is not the only possible way that a person deals with beast dysphoria (as binding is more common) but binding is also very problematic as it can cause permanent damage to bone structure (similar to wearing a corset) but affecting the sternum and ribs and the binder interferes with circulation to lymph nodes(especially if it is too tight or worn for many hours each day.) Issues with the lungs are also common. Some of the damage done form wearing a “binder” or binding the breasts with ace bandages (even worse) can be serious an irreversible.

    So – what is the right answer in helping people with severe body dysphoria? Naturally, one would want to help them make peace with their bodies (breasts in particular) but this is so much easier said than done, especially when sexual harassment (and or violence against women) is common and when images of women’s bodies in advertisements, media, film etc. are often exploitative and at times degrading to women. All things considered, I am amazed that more women do not suffer from body dysphoria of some kind.

    But again – what is the answer for someone with a child who is desperate to escape their body? I feel that in part of the answer is waiting for the person to be amateur enough to make the decision that best suits them. The other part is holding Doctors more accountable in carefully and thoroughly informing a patient of risks associated with the surgery and complications that may arise. Also, I think that Doctors should be more forthright about the limitations of what they can realistically deliver an when they are negligent or incompetent , yes – I think that lawsuits are in order.


  5. I find this so sickening. In a conversation with my child’s pediatrician, she told me that she occasionally has teenage girls who want breast implants, nose jobs, etc. The pediatrician always tells those girls and their parents no because they are not done growing. She recommends no plastic surgery (unless medically necessary) until AT LEAST 18 for girls and early 20s for boys. If doctors don’t recommend this surgery for cosmetic reasons for people under age 18 who are not happy with how they look, why do they willingly do it for these teens who have gender dysphoria who are not happy with how they look? Why is it not ok for one type of teen with a healthy body, but it is ok for another type of teen with a healthy body?

    Liked by 5 people

  6. There is a TED talk on this subject if anyone would like to participate in that conversation. I mentioned the 4thwavenow blog in their comments section:

    I am only a handful people speaking out – most people seem uninformed of the health risks of transiting children.


  7. This is just horrifying. Would this mother also sign for permission for her 15-year-old to get married or let her get a scratcher tattoo in someone’s basement because she just can’t bear waiting till she’s legally old enough? It’s like everyone has suddenly forgotten how much we grow and change from the time we’re teenagers, even in our early twenties.

    Liked by 2 people

    • This reminds me of the AIDS crisis when some parents of a 12 year old girl wanted to let her marry a ten year-old boy with AIDS that was dying. They started to discuss how they would have sex, but most of it was edited from the program.

      It is sick and horrifying how little females are valued to begin with. The ‘man’s gender trend is just another way to devalue females as humans, but on a larger scale.


  8. Serious question here. It is estimated that ten percent of adult women have polycystic ovarian syndrome (PCOS). This can cause a woman to involuntarily develop a number of “masculine traits,” such as thick facial hair, receding hair line, and male pattern fat accumulation (stomach paunch). Could a female patient force her health insurance plan to remedy these issues by citing “gender incongruence” with these traits? Or cite the WPATH guidelines?


    • Interestingly, one of the most common side-effects of taking testosterone for transgender FtM patients is PCOS. Hysterectomy is recommended in the first 5 years of starting testosterone as PCOS is associated with Uterine cancer. (I have no idea how this would relate to WPATH guidelines.) There is also another common challenge with taking testosterone that often occurs where the body converts excess Testosterone to Estrogen. What a nightmare! There are actually male body builders that develop breasts (even lactation) and other undesirable bodily issues (that I won’t detail here.) Similar issue can develop when a person who identifies as FtM uses testosterone. A friend of mine actually developed fuller hips while taking testosterone. What a bummer if you want to look “manly.” The dose keeps going up but it seems like a very bad road to be on. Obesity is a common problem with PCOS and excess body fat produces even more estrogen. It is a vicious cycle. I try to tell my friend of these medical facts but because the information is coming from me and not the Doctor, I am ignored. Pat Califia’s failing health is an excellent example of the negative health outcomes that result from long-term use of testosterone.

      All of this is making me feel sad. So many healthy people are now living with (premature) heart disease or other serious health issues from taking testosterone (or they are dying or have died too young.) And there is nothing that I feel that I can do. I speak out and I am labeled transphobic.


      • Hi Juniper: I have also heard about steroid-using male bodybuilders lactating. Oddly enough, some of them take Letrozole, a breast cancer medication, to make the lactating stop.


      • funny huh? How body builders have better access to that medicine for recreational reasons, and women with cancer have to jump through hoops to get any cancer treatment. That would be the sad part of the woman’s experience.


  9. I’m going to make this short and sweet.. My 16 1/2 year old is trans female to male. My kid was born with higher testosterone then females by quite a bit. Through out his whole life, strangers would call him a him.. Would bother me so much. K hated pink hated dresses and hated his hair being done. Even 1, 2, 3 years old and so on. I understand that some cases are pretty bogus and are stemmed from the effing internet. Not my kid. Even when I was pregnant, I was sure it was a boy. I seen the dots on the ultrasound. Maybe hermaphrodite(ish) although I’ve changed K’s diapers and K being an obvious female. But a swollen female parts. People, don’t judge. Let me remind you of the high testosterone test results. My kid needs this top surgery done. This kid was born to be viewed as male, unfortunately. I tried my hardest to force feminine clothes and hair things and makeup and even the flippin toys!! Some of you will never understand. Don’t judge. That’s God’s job.


  10. Shauna. I don’t think it is my place to judge any parent . God knows I’m sure people are judging me right now. We do the best we can within the society we live in. I do believe there is a small amount of people that after other avenues have been explored and addressed transitioning helps them lead a more fulfilling life. I just worry that because transactivism has gotten so mainstreM that we as a society are narrowing what our view of man or woman. And for many women it takes many years of struggle to learn to appreciate our bodies. I fear too many teen girls and young women won’t allow themselves that gift of time and maturity. I do wish you and your family the best though and don’t be afraid of being judged. All parents our judged. It comes with the job! But I believe loving parents have make many hard choices .


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