Age is just a number when it comes to neovagina surgeries

Trans activists constantly tell us “no one operates on minors.”  After all, the WPATH Standards of Care itself officially recommends genital surgeries only for those over the age of 18.

Anyone who has read this blog for awhile knows that such surgeries are already being performed on minors, at least in the United States. But how many know that gender doctors are openly discussing the advantages of early genital surgeries in highly respected medical journals?

karasic jsm piece in press

This piece, brand-new in the Journal of Sexual Medicine, co-written by Dan Karasic of UCSF’s Center for Excellence in Transgender Health, and Christine Milrod, psychotherapist at LA’s Southern California Transgender Counseling Center, makes it clear that WPATH members have been doing plenty of underage surgeries. And most surgeons quoted in the article [currently behind a paywall], despite a few concerns, are moving full speed ahead.

Their main criterion for determining surgical candidacy for vaginoplasty seems to be whether a young person can adhere to the “dilation schedule” necessary to keep the surgical wound (aka neovagina) from closing up. Any worries about brain development? Executive function? Ability to understand the many social, medical, and psychological consequences of this irreversible decision? Evidently not.

Age is just a number.  The “dedication” to adhere to the “dilation schedule” is a marker of maturity!

karasic jsm adhere to dilationIs there any lower limit for these surgeries? One surgeon opines that there “might” be a minimum age, but “I don’t know what that should be.”

(Heck, there are probably 8-year-olds who could adhere to the dilation schedule, so let’s not hem ourselves in with some arbitrary number.)

karasic jsm 2

Besides, college students are far too busy in their freshman year to keep up with their dilation schedules. Lots of other extracurricular activities to distract them!

karasic jsm maturity

How do you operate on stunted genitalia, after all those years on puberty blockers? Micropenises can be a problem in terms of creating an adult neovagina, but donor tissue and “scrotal tissue expanders” can be successful in some cases. Better than the alternative which some surgeons use, given the “concomitant morbidities” of persistent odors, colitis, and leakage of stool.

karasic jsm micropenis

And worries about potential lawsuits? Pshaw. We can’t get actual informed consent, but we’ve got the parents on board, and after all those years of gender affirmation, who’ll let a few side effects or lingering regrets get in the way?

karasic jsm consent

It’s a crap shoot they’re willing to take–even if a few of these young trans women end up unhappy with what they’re left with, like the six trans men currently suing one of the top gender surgeons in the US right now. After all, that’s what medical malpractice insurance is for.

32 thoughts on “Age is just a number when it comes to neovagina surgeries

  1. So wait, let me get this straight. The reason to give a high school student a vaginoplasty is because once college starts, the person will be too busy or distracted to keep up with the dilation schedule, okay. The person is too immature not to be distracted by lots of new experiences, friends, etc., but not so immature that they can’t agree to have their penis removed? What, is someone MORE mature and able to give informed consent in high school and then becomes LESS mature in college? How does that work?

    It starts to sound more and more like the real plan here is to make sure kids get these surgeries before they have a chance to grow up and realize they may not want or need them after all.

    The other horrifying aspect to this article is the frank admission that once a boy has been on puberty blockers for a while, he really doesn’t even have any choice but to transition (because of the micro-penis problem). Remind me again about how “blockers” are safe and 100% reversible?

    Liked by 12 people

    • If a boy were to go off blockers (and estrogen, which he’s presumably on for a while before they talk of SRS) his penis would grow at that point, with testosterone from the testicles. So in a sense, yeah, “reversible” (would maybe need to have moobs removed, goodness knows whatever side effects from the blockers later, but the penis would “fix itself” at least somewhat).

      Thing is though, I never hear of any of these kids actually stopping the blockers and resuming normal puberty. It’s always a fast track to cross-sex hormones, to the point that the docs are even phrasing it in those terms half the time – this “tides them over until they’re ready for estrogen” or whatever.

      I’m not too surprised either, when you consider that a lot of these kids did “social transition” at age 5 or 6, they’ve spent pretty much their entire formative years living “as girls,” they’ve spent their entire lives insisting that this is “not a phase, no” and that they really are “girls inside,” and more than that, they know that their parents have built up their own self-identities around being “heroic parents of trans kids,” up to and including taking out massive loans to fight legal battles to get their kids permission to use the girls’ locker room at school and all the rest of it.

      What kid is going to recant under such pressure? They have absolutely no context for how 5 or 10 years seems like no time at all once you’re an adult, they have no context for making decisions on fertility or any of that stuff, and they don’t want to upset their parents or have anyone call them frauds. They don’t know how that stuff will eventually blow over, how no one cares about your elementary life or even your high school life once you’re out in the world with a career.

      Back to the micropenis though I’m actually quite interested to see that the doctors are having to confront the issue. I’ve been wondering just how Jazz Jennings is going to manage to get SRS (which he says he wants, as of the end of Season 2) given that he has a prepubescent tiny penis and no testicles descended.

      If they end up with the flank grafts, it’s going to be a major tell, just like the scars on FTM people are. Years ago no one knew what those scars were from but now? Everyone knows.

      Liked by 9 people

      • I really do wonder, too, whether it’s actually possible to simply “suspend” puberty in someone using Lupron and then “turn it back on” no matter how much time has passed or how much older the person has gotten. There are other hormonal developments during puberty that don’t stop just because a child is taking Lupron; although estradiol and testosterone play a large part in puberty they aren’t the totality of the story. If puberty were blocked at, say, age 12 and then “un-blocked” without cross-sex steroids at age 17, would the person be able to “recover” those 5 years of growth completely as normal? Be as tall as he/she would have been? Have exactly the same brain development? No skeletal issues?

        I am not aware that there have been ANY studies on this, and I’ve looked for them. I know there’s a theory (100% safe and reversible!!!) that’s rolled out to apprehensive parents, and heaven knows I’m not in favor of turning any more kids into lab rats to find out, but it would still be interesting to know if there were even any case studies to back up the theory.

        Liked by 3 people

      • @worriedmom – I’m with you on the skepticism of whether that “resumed” puberty would be “normal” or not. As you say, there’s a lot going on. For that matter, I’m not so sure that the “on blockers, then on estrogen” actually is anything really like a “regular female puberty” either, despite the fact that everyone insists it is. There’s this idea that somehow the “perfect” MTF trans kids (“without any testosterone poisoning at all!”) end up just like “regular girls” other than the slight inconvenience of the physical phallus, but I’m skeptical.

        Of course they can’t do a study of any “resumed’ puberty without some group to survey, and I haven’t heard ANY stories of these “resumed” kids. Kids who go on blockers and then don’t to go cross-sex hormones after all – where are they?

        Liked by 3 people

      • There should be some knowledge of how puberty blockers affects children who are given them for sensible reasons such as starting puberty at 6, and who are allowed to start puberty at, say, 8 or 9.

        However, that doesn’t necessarily mean that it is the same for transgender puberty blocking – I imagine there is an age window where puberty normally happens, and puberty blockers are only fully reversible if stopped at an appropriate age.

        Liked by 1 person

  2. Neo vaginas have no physical function outside of sexual activity. This is an irreversible decision about future sexual activity, made by teens. The most mature teen in the world is not capable of understanding adult sexuality, and is incapable of making permanent decisions about how they will be able to experience it. How can a puberty blocked minor understand what they are losing from these surgeries? They’ve been robbed of normal sexual function by Lupron and hormones already.

    Liked by 10 people

    • I doubt these boys even know and understand how a normal vagina works. I bet doctors, their parents and trans activists claim that the surgery will create the real thing. They will think that normal vaginas will be like the horrible mess they have down there after surgery.

      Liked by 5 people

    • This is a very good point I hadn’t seen made before.

      This is what happens when you use a ‘medical treatment’ created for fetishishists on kids.

      Liked by 1 person

  3. Surgeons want to cut. It’s what they’ve been trained for.
    It’s not surprising they want to operate when they think they will get the best outcome.
    Guess what? It’s not about the surgeon!

    Liked by 7 people

  4. As a mother and a teacher this really upsets me. The kids are not complete, they are beautifully naive, and the beauty of being young and insecure is being molested by this terrible cult.

    Liked by 7 people

  5. The first few years after college are absolutely pivotal and, at least in my experience, are when a lot of kids finally feel safe to come out as gay. Kids who identify as trans need to time to be exposed to the world outside of secondary school before making permanent and potentially harmful changes to their bodies.

    If I had a loved one who was dead-set on transitioning, I would want them to wait as long as possible before going under the knife. Considering that the human brain doesn’t stop developing until the mid-twenties, waiting until then seems reasonable. But the doctors are only in it to make a buck (or a million). Plastic surgeons make their money off of people being dissatisfied with their looks so it’s in their best interest to convince people they need surgery.

    Liked by 9 people

  6. One reality that makes this so glaringly unethical is that a very large percent of adult MTF transitioners opt not to have bottom surgery. This is what a mature adult decides when faced with this. The answer is often no.

    Liked by 9 people

  7. I am horrified. Simply horrified. What the hell are we allowing these people to do to our kids? For what other mental health issue is such radical, permanent surgery on children even being DISCUSSED?

    Liked by 6 people

    • As well as the separateness to other mental health issues with which it’s being treated, there’s a curious absence in their thinking of disabled kids. Those who have actually necessary surgery, and those who have ongoing issues to manage. We’re meant to accept these kids are mature enough to decide but not mature enough to manage the care needed, and that college is just so busy no one could possibly take care of themselves when starting it, especially with particular self-care tasks. WTF. Because it’s not like anyone else EVER does that, out of actual medical necessity! God help the teen diabetics, ones who need to take painkillers and other meds constantly, ones who need to use a wheelchair, etc, then! How can these particulate kids be meant to be that immature, yet capable of making such a life changing and, let’s not hedge here, quite likely life ruining decision? What makes these kids so different?

      Other than that nothing is physically wrong with them, and this so clearly isn’t about helping them. I think Sellmaeth is right abut it being a sexual thing (college is so hectic, wink wink).

      …you know what? It isn’t nice, but I kind of wish those surgeons would suffer some more physically, because that’s the only way they’re going to get it. And the creeps deserve it, not sorry.

      Liked by 2 people

      • What makes these kids so different? They’re a brand new surgical challenge and a lucrative branch of medicine. I’ve read somewhere, I think Psychology Today, that low empathy is necessary quality in a surgeon. Over identifying emotionally with a patient makes it difficult to cut them open.

        But there’s no balance. Unlike someone needing life saving surgery, like a heart transplant, there’s no necessity for this so the histronics about suicide are brought up. The trans-lobby has convinced people (parents, doctors, even themselves?) of this false dichotomy. Transition or suicide. No other options. That’s what needs to be disrupted.


  8. Did the penultimate sample there say that they use donor tissue? Does this mean someone is signing their organ donor cards hoping to save lives and part of his or her arm or leg gets used to create a fake penis?

    Liked by 2 people

    • Good question. I must get an organ donor card and make sure I clearly state that no part of my body is to be used to make fake penises. (I don’t know whether we still have an opt-in system, or an opt-out one now)

      Though I don’t understand how that would work – they have to give medication to keep the body from rejecting a donated organ, wouldn’t that be the same with tissue? Doesn’t really seem worth it. Not that the whole procedure seems remotely ethical or healthy.

      Liked by 1 person

      • I know a little bit about transplantation and you are right, Mimi. In order for the patient’s body not to reject tissue from a foreign donor, the patient would have to be on anti-rejection medication for life. I do not believe this is what is under discussion here; rather, tissue is taken from other areas of the patient’s own body, so the patient does not run into the rejection issue.

        What does seem to happen, though, is that due to the volume and amount of tissue taken, the patient winds up with very significant scarring. I have seen pictures of forearms from which tissue is taken and they look markedly smaller. Some people seem to get forearm tattoos to cover up the scarring but this isn’t an option for everyone, of course.

        Liked by 1 person

      • @worriedmum
        I’d wonder about the possibility of nerve damage and other pain and discomfort with such significant scarring, as well.

        It’s just insane surgery is being treated so cavalierly. People’s bodies do NOT just snap back to normal.


  9. So, young patients are resilient?

    “It was not easy. She retched for days afterward. She could hardly eat. She did not seem empowered; she seemed regressed.”

    “Before the surgery, she had been impish and playful. Now she buried her nose in her Nintendo 3DS and cracked a rare smile at an old text message consisting entirely of “Meow,” “Meow.”

    “Her father felt helpless as she refused food and lost about 20 pounds. Dr. McGinn said it was not unusual for patients to become depressed after surgery and compared this to postpartum depression.”

    Correction: June 16, 2015: An earlier version of a picture caption with this article misstated the circumstances of Katherine Boone’s suicide threat. She cut herself when she was 17, not 16, and when she had already begun gender reassignment, not before.

    So the kid was cutting on himself after starting hormones and after “affirmation.”

    Liked by 3 people

  10. This is so horrifying and unethical! I doubt the average transed boy knows about a dilation schedule, or understands what it actually means. There’s really no function to a neovagina other than sex. The results for underage boys must look even more artificial than those of fully grown men. Again, why is such a different standard suddenly being applied when it comes to trans issues? We don’t let minors drive, vote, drink alcohol, get married, live independently, take out mortgages, or get tattoos and most non-earlobe piercings.

    I wish more surgeons were like my awesome plastic surgeon, who first removed a dysplastic nevis and then removed all the burn scar tissue on my stomach and abdomen after my car accident. I actually had to make a case to her for the latter two surgeries, and convince her of their medical need. She didn’t happily schedule a date and time or start cutting the moment I brought it up. Meanwhile, these surgeons operating on minors are only too happy to remove healthy body parts for no good reason.

    Liked by 3 people

    • “The results for underage boys must look even more artificial than those of fully grown men.”

      I doubt they will feel much. I mean they will never know what an actual vagina feels like – but compared to adult mtfs who HAD puberty and thus more or less normal development – the results will be much worse.

      Liked by 3 people

  11. I think I saw somewhere that the younger a child transitions, the more likely they are to “fully” transition. Has anybody seen a study on this?


  12. Also, it seems the article is arguing that a) these underage boys are mature enough to understand risks and aftercare and b) immature enough to require parents who will actually enforce care.

    Did anyone READ THIS before it was published? I mean, it’s making two completely opposite arguments.

    Liked by 7 people

    • It makes perfect sense if you consider that the neovagina was invented as a means of making intersex children “normal”. I remember reading about this somewhere … they actually sliced little children up and created fuckholes, so men could later fuck the poor kid.The penetration with a dildo was forced on the child. And this was considered a medical procedure.

      I think there was a bit of change of mind as more intersex children grew up and sued over this, but that’s basically the mindset.

      The goal is not to make the child happy, the goal is to succeed in making the child a sex object for men. Letting teens grow up would only get in the way of that.


      • This topic is intensely upsetting so I get you feel very strongly about it, but as a mom I’m asking you to consider your language. These are kids we’re talking about. I’m not telling you what you can and can’t say. I’m just telling you that reading about ‘fuckholes’ and ‘fuck the child’ is equally upsetting.


  13. I don’t know if it’s reassuring or not that something like 75% of MtF transitioners decide not to have full reassignment. This is about the money for these doctors.


  14. Pingback: Vaginoplasty surgery on minors – The Reed Centre

  15. Pingback: Child Transition: the Myth of Informed Consent | Lily Maynard

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