“Top surgery”–the removal of both breasts with subsequent “chest reconstruction” –is the holy surgical grail for many females who identify as trans male.

Once strictly a prerogative for adult females in the United States, there is a growing trend for younger “trans teens” to pursue double mastectomy as early as possible. In the United States, the age of medical consent for major medical procedures without parental involvement is typically 18 years, with a few exceptions–notably for “emancipated” or married minors, and for contraception/birth control services, which are generally available to teens at an earlier age. There are also a few states with a lower age of medical majority, Oregon being one of them (age 15).

But the push is on by trans activists to lower the age of consent for trans-identified teens to undergo general anesthesia and major surgeries (both “top” and “bottom”), and to force both private insurance policies and taxpayer-funded state health plans to cover the procedures as a medical necessity.

Going under the surgeon’s knife is always a risky business. Apart from the questionable wisdom of colluding with a pubescent girl’s notion that she is “really a boy,” mastectomy and general anesthesia carry risks of complications. (Interestingly, “gender dysphoria” is no longer considered a mental disorder in the DSM-5, but a normal variant in the human condition–which somehow still requires extreme medical intervention.)

For any other condition, major surgeries requiring general anesthesia would be seen as last resorts. It would be considered a miracle cure to be celebrated if a 15-year-old cancer patient were able to go into remission sans surgeries and chemotherapy.

For any other condition, everyone involved in the process–the patient, their families, doctors–would be looking for the least-invasive, least extreme, least permanent treatment approach. And the very last thing they would do is lobby legislatures for less parental involvement in these life-altering decisions that affect an adolescent girl.

As I have written about previously, these activist gender organizations are already proudly and secretly handing out free breast binders to kids with “unsupportive parents.” But they aren’t stopping there. They are doing their best–and succeeding–at further eroding the involvement of a child’s most trusted adults in permanent medical decisions.

Let’s take a closer look at Oregon, where, in 2014, TransActive Gender Center successfully lobbied the state legislature to include transgender hormones and surgeries for children on the tax-payer funded Oregon Health Plan (OHP), which is Oregon’s version of Medicaid for low income people. (There is not enough room in this post to cover the many medically necessary procedures that are not covered under the OHP.)

And TransActive just had another victory. Only a few days ago, it was instrumental in ensuring there is NO lower age limit for “transgender surgeries” WITH parental consent. This means that a parent can decide (because let’s be very clear: when it comes to an 11 or 12 year old or even younger, it is the PARENT who is making the executive decision) to allow their young child to have even her ovaries and uterus surgically removed. Here we see Jenn Burleton, executive director of TransActive, celebrating on Burleton’s public Facebook page:

In the comments, supporters are jubilant. Only one injects a note of caution:

It’s good but I hope these parents and kids have the benefit of LOTS of counseling

In response, Devin Kit Crosland (scroll down for profile), a female-to-male trans-identified individual who heads up TransActive’s “In a Bind” free breast binder program for minors, helpfully points out that, in Oregon, kids age 14 and up can already get transgender counseling, without interference from “parents who aren’t supportive or aren’t educated on the issues.”:

On its public Facebook page, Transactive crows about the ways it has helped to make it that much easier for a young girl who wants to remove her breasts:

We’re down to one referral letter (instead of two) for both cross-sex hormones and “top surgery,” on the taxpayer-funded Oregon Health Plan. What’s next on TransActive’s agenda? No letter at all? An online, on-demand dispensary for testosterone, and same-day, walk-in clinics for double mastectomies? No lower age limit for “gender affirming” surgeries without parental consent?

TransActive is aptly named. These are activists, and they want to make sure girls in other US states–your daughter, too–can get these surgeries without the pesky interference of any “unsupportive” mom or dad.

The same Facebook victory thread on Jenn Burleton’s public page shows supporters asking how they can change the laws in their own states. Burleton makes it clear that TransActive isn’t just some Oregon-focused local organization. No, Burleton wants to move this agenda forward across the nation:

For those interested, TransActive Gender Center will share the testimony we prepared for adding and protecting this coverage in Oregon with anyone working on securing or interested in securing the same or similar coverage in their state. PLEASE… do not pursue this dialogue on Facebook! Send an email to advocacy@transactiveonline.org

So what are the gender nonconforming young people supposed to do while they’re waiting for the taxpayers in their state to pony up for their breasts to be removed? After all, these surgeries are expensive. In most states, unlike Oregon, health plans still consider “top surgeries” elective and not medically necessary.

The Internet is abuzz with ideas and resources. The site topsurgery.net aggregates lists of “top surgeons” and self-funding ideas. Many people set up online charities for themselves, asking complete strangers on the Internet to donate to their cause. All the fundraising sites I found were fully publicly accessible, with not a few run by teens under age 18. A Google search for “top surgery gofundme” results in 1900 hits. The tag “top surgery FTM” turns up plenty of results on Tumblr. And a search of the GoFundMe site itself with keywords “top surgery” currently turns up 455 people looking for donors–with several of the potential surgery patients under the age of 18. Parents are even getting in on the act, putting up online fundraising sites for their kids, evidently even for young people with developmental disabilities.

Medical “gofundmes” are nothing new in the US, where plenty of people are still uninsured or underinsured. People needing cancer treatments or surgeries have been funding themselves through bake sales and online fundraisers for quite some time. And while, as I noted earlier, being “transgender” is now no longer considered a psychological disorder, it is a non-disorder which requires extreme medical treatments, so it’s natural that people are hitting the interwebs to raise cash.

And what about the “top surgeons” who do the work? Space does not allow a full review in this post of the hundreds of top surgeon sites popping up all over the web, but it’s obvious this is a growing and lucrative business. To take just one example, Dr. Hope Sherie has a display ad that appears all over topsurgery.net, with her own page on that site promoting herself as

Highest Level of Top Surgery Care on the East Coast

Dr. Sherie, along with the other surgeons featured on topsurgery.net, posts before-and-after photos, including several showing the results of years of breast binding vs. the post-surgical results. She also helpfully lets us know that she’ll be at the Gender Odyssey conference, a pow-wow for transgender activists, medical providers, trans people, and their families that meets yearly and begins this Friday, August 21, in Seattle, WA.

A look at the advertisers on the home page for the conference shows several plastic surgeons, as well as some organizations–like the Center For Lesbian Rights–that might not be staying exactly true to their original mission, if you think about it; but that’s a subject for a future post.

I want to close this post by addressing a few sincere questions to the transactivists and medical/psych providers who might have landed on this page.

I expect that most, if not all, of you feel you are doing the right thing for these girls. You are not monsters. But I have to wonder: do you ever engage in any soul searching? Do you ever ask yourselves, “Am I doing the right thing?” Is your sleep ever troubled by the suspicion that at least some of these young women will regret the permanent changes you have allowed them to make to themselves?

Many of the parents who write to me are losing a lot of sleep. They are constantly searching their own consciences, wanting only to do right by the children they have known for so many years. They know their children far better than you do. It seems to me that every adult who is involved in the weighty business of encouraging other people’s children to pursue a path of medical transition ought to just stop. Think.

It’s not enough that some of you are going to study these kids in the future. What of the people who may be irrevocably damaged by the treatments being administered right now?

Is this work you are doing something you will regret someday? Will you go to your grave confident you have “done no harm?” You have the future of our precious children in your hands. Respect us–both parents and our kids–enough to honestly ask yourself: AM I doing the right thing?

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