Last Saturday’s 20/20 special on Jazz, a pre-teen trans girl, was generally better than most media coverage of trans people. It avoided most of the common pitfalls of trans documentaries, while being thoroughly humanizing and about as respectful as a mainstream story on the topic can be. For the most part, it wasn’t needlessly salacious, and where other news outlets might have been tempted to portray Jazz as somehow being damaged or raised inappropriately by her parents, the report made it clear that she’s very well-adjusted and happy.

Their coverage was wholly sympathetic, never depicting this as some kind of tragedy, and with no token inclusion of “family values” bigots to offer some “other side” to whether this girl should be free to live her life. They didn’t insist on using her former name at any point, and there was no use of male pronouns. They let Jazz speak for herself, and she told them she didn’t see being trans as a “disorder”. They drew attention to the fact that transition-related treatments are mostly not covered by insurance plans in the US. And when they did insist on talking about genital surgery, they accurately described it as an inversion of the penis while avoiding ugly references to “chopping it off”.

It’s a sorry state of affairs when the most we can ask for is not to be treated as family tragedies, mutilated freaks or sexual perverts. Praising the good points of this report feels a lot like saying “hooray, this story on gay parents made no reference to pedophiles and didn’t include even one scene of bareback porn! Somebody get them a GLAAD award!” But at a time when much news coverage falls short of even that, and major papers still consider it acceptable to publish op-eds calling trans women “dicks in chicks’ clothing”, this stood out as an oasis of relative decency.

Nevertheless, as a mainstream report on trans people, it predictably contained several instances of misleading phrasing and inaccurate information. Jazz was twice described as “a boy living as a girl” and “a boy who wants to be a girl”1, as well as “a child born in the wrong body”2. There was a strong focus on her “pink cleats” and her bedroom “filled with girly things, dresses and dolls”3. There were references to an “ultimate surgery to become fully female”4, and breast augmentation was treated as a standard part of transitioning5. Viewers were told that “once Jazz begins taking estrogen, she will be permanently infertile”6, and that “the cross-hormone therapy is irreversible”7. And treatment with estrogen was described as costing more than $18,000 a year8.

If you’re not sure what’s wrong with these statements, you might want to try your hand at figuring it out before skipping to the footnotes for the answers.

Overall, this show still served a useful purpose, while mostly managing to avoid promoting harmful misconceptions. It showed that children who are trans can have a good life just like everyone else, and that living as their identified gender is healthy for them. It let a general audience know that there are treatment options available to correct these children’s bodies and help avert the damaging effects of puberty. For parents out there who don’t understand why their child seems to identify more closely with another gender, this story gives them the basic conceptual vocabulary they need in order to comprehend the situation and most effectively support that child.

The report could have been improved with more medically accurate information – as is, some aspects of transitioning were made to seem more imposing, epically significant, and financially inaccessible than they are in reality. The use of certain gender stereotypes was also troubling. But the central message was still one of normalcy, happiness, respect and empowerment, elements which have often been almost totally absent from many stories about us. Future media coverage of trans people would benefit from a similar approach.

1. Take away the qualifiers, and phrases like “a boy living as a girl” are still describing her as “a boy”. This suggests that a “boy” is something she is, whereas being a girl is merely something she does – an activity or ambition, akin to playing soccer. This downplays her identity as a girl, when the significance of her gender is clearly integral to the entire story.

2. The metaphor of having the “wrong body” is a simplified explanation meant to convey the fact that someone’s identified gender can indeed differ from their assigned sex. It’s intended to counter the notion that someone’s body cannot possibly be “wrong” and that a person must identify as what their anatomy would seem to dictate. However, while many trans people do experience significant distress at the state of their body, there are also many others who did not always feel that their body was strictly “wrong” for them.

The widespread promotion of this very basic explanation is not harmless – it has sometimes led trans people to believe that they couldn’t really be trans if they didn’t experience the sense of “wrongness” and overwhelming discomfort with their body that’s implied by this metaphor. Yet these trans people are still trans nonetheless, because they prefer to live as a gender other than their assigned sex. While the presence of this bodily dysphoria can strongly indicate that someone is trans, its absence does not preclude them from being trans, either.

3. The emphasis on Jazz’s interest in feminine-coded items is obviously meant to legitimize her identity as a girl. It’s intended to show that despite being told by her family, society, and her own body that she’s supposed to be a boy, her female identity was still strong enough to emerge in this fashion. And while that’s a valid and important point to make, demonstrating it with these particular examples runs the risk of delegitimizing the genders of other trans people who did not exhibit such gender-stereotyped interests at an early age.

Trans people who clearly and overtly identified as another gender from early childhood, like Jazz, are currently only a small minority. Not everyone “just knew” for as long as they could remember or had a strong sense of identifying as another gender. For many trans people, this realization does not occur until adolescence, young adulthood, or even later. Because this expectation of self-awareness in childhood is so prevalent, trans people and those around them may doubt that they could actually be trans if there was no indication of it in their youth.

But the absence of this early awareness or expression of their true gender isn’t because they’re not really trans. It can be due to the deficiencies of introspection that are common in children and people in general, or a lack of access to information about what it means to be trans, or their own conscious repression of any display of gender-transgressive interests – because they know they would face severe disapproval and consequences.

Conversely, there are boys who take a strong interest in pink things and other feminine-designated items, while still identifying as boys. There are also tomboyish girls who don’t consider themselves to be anything other than girls, regardless of their masculine-designated interests. Obviously, most cis people are not walking stereotypes of masculinity or femininity – people show diversity in their interests, behaviors and attitudes. Trans people are no different, and Jazz would be no less of a girl if her bedroom were full of motorcycles and football posters.

4. Genital surgery is neither an “ultimate surgery”, nor does it mean that someone is “fully female” or male. Most people still consider a vagina or penis to be the final word on whether someone is a woman or a man, so it’s easy to see why they chose to use this as a euphemism for the relevant surgery. (I’d imagine someone decided against calling it “having a vagina installed” in the promos.) But not all trans people pursue surgical transition, and there isn’t any one “ultimate surgery”. Full genital reassignment surgery isn’t the only surgery for trans women – there’s orchiectomy, facial feminization surgery, breast augmentation, tracheal shave, and vocal cord surgery as well.

Trans women may choose to have any combination of these surgeries (if they have a choice in the matter), or none at all. Not everyone wants them, not everyone is medically capable of having them, and not everyone can afford them. As was mentioned on the show, these procedures are often not covered by insurance, and can cost tens of thousands of dollars out of pocket. Many trans people are not in a position to pay for this.

But someone is not any less “fully female” or male just because of the configuration of their body. A trans woman who has a penis is still a woman, no less female or more male than women who’ve had genital surgery. That’s why Jazz, who hasn’t had any surgeries, is still a girl, and the show itself referred to her as such. Assuming that someone’s manhood or womanhood depends on their genitals just provides another excuse for misgendering trans people, calling women “he” and men “she”, despite the fact that their physical anatomy doesn’t define their identity at all. Wasn’t that pretty much the entire point of the show, anyway?

5. While some trans women seek breast augmentation, many are able to achieve breast growth that they consider satisfactory from HRT alone.

6. Trans women who begin HRT as adults, without having had any intervention in their own endogenous (“male”) puberty, have sometimes been known to regain fertility if they discontinue HRT. There is little data on why some regain their fertility while others don’t. Some trans women remain fertile even while on hormones. This is why trans women have to take the same precautions to avoid impregnating their fertile partners, if their sexual activities are of such a nature that this is possible. There seems to be no information about the effects on fertility for trans women whose first puberty has been entirely averted in favor of inducing female puberty, but it can’t be assumed that starting hormones is certain to deprive you of your fertility on a permanent basis.

7. Some of the effects of HRT are reversible, and others are not. Breast tissue grown while on HRT can recede somewhat if HRT is discontinued. Genital shrinkage can reverse. As mentioned above, fertility may or may not return, if it was ever lost. Without the suppression of testosterone, masculinization will resume, with the same effects as in cis men – facial and body hair growth, rougher skin, possible male-pattern baldness, and so on.

For trans women who transition early enough to avert endogenous puberty in favor of female puberty, their overall bone structure and body shape will be like that of a cis woman who’s been through puberty. That particular effect is indeed fixed and irreversible. But it should also be taken into account that allowing young trans girls to undergo their own uninterrupted endogenous puberty is irreversible in exactly the same sense as induced female puberty. In either case, they will have to deal with the permanent effects arising from this. In portraying this intervention as something that can’t be undone, it should be made clear that allowing endogenous puberty to proceed carries the same risks – it is just as much of a permanent step with permanent consequences.

8. The treatment to delay puberty tends to be more expensive than standard HRT regimens (estrogen, anti-androgens, and optionally progesterone) for trans women, and there is no conceivable scenario where estrogen alone would cost more than $18,000 a year. To put this in perspective, at the going rates for neovaginoplasty, this is roughly equivalent to having one neovaginoplasty in Thailand a year. This number seems to be off by a factor of 10 to 100. In some areas, oral estrogen can be obtained for less than $20 a month. Even subdermal pellets, the most expensive method of administration, would have to cost $1,500 a month for this to add up.