How old does one have to be to consent to a mastectomy? Only 13, it appears. An article in JAMA Pediatrics on “Chest Dysphoria in Transmasculine Minors and Young Adults” at a US clinic was based on a survey which included 2 girls (transmale) who were 13 years old and had both breasts removed and 5 who were only 14.

According to the authors, who are based at the Center for Transyouth Health and Development at Children’s Hospital Los Angeles, “All postsurgical participants (68 of 68; 100%) affirmed the statement, ‘It was a good decision to undergo chest reconstruction.’”

Since the girls were overwhelmingly positive about their operation, the authors contend that “Professional guidelines and clinical practice should recommend patients for chest surgery based on individual need rather than chronologic age.”

However, it’s unclear whether the girls (transmales) had enough time for a mature evaluation of their life-changing decision. For nearly all the 68 participants in the survey, only two years had passed. To affirm that there were “very low rates of regret” among minors seems a bit premature. For instance, a study of women who had a single or double mastectomy found that they were quite unrealistic about life after surgery. “Patients generally thought mastectomy would be worse than it was, and they thought reconstruction would be better than it was,” said the lead author.

The other side of the coin is that the “chest dysphoria” of “transmasculine minors” was said to be so severe that it affected their health. They often resorted to chest binding, which is associated with “pain, rib fractures, light-headedness, weakness, skin infection” and other ailments.

This seems to be the justification for the authors’ conclusion that “Youth should be referred for chest surgery based on their individual needs, rather than their age or time spent taking medication. Individualized, patient-centered care plans should be considered the standard of care for all transgender adolescents, and referrals should be made accordingly.”

The article barely mentioned the role of parents and families in the minors’ decisions.



