At a recent talk at Duke University on "Trans & Gender Diverse Policies, Care, Practices, & Wellbeing," surgeon and "trans affirming" doctor Marci Bowers, who transitioned at the age of 38, admitted that children who undergo transition before puberty will never have adult sexual function or experience orgasm.
"An observation that I had," said Bowers, "every single child who was, or adolescent, who was truly blocked at Tanner stage 2," which is the beginning of physical development, when hormones begin their work of advancing a child to adulthood, "has never experienced orgasm. I mean, it's really about zero."
This raises huge and glaring red flags about the concept of "informed consent" for children and teens who are ushered into transition. How can a child, or a pre-teen, who has never experienced sexual satisfaction, orgasm, sexual intimacy, consent to giving that up?
Bowers, proudly advertises the fact that she has both delivered 2,000 babies and performed 2,000 castrations on biological men who identify as transgender, performing vaginoplasties, "is recognized as a pioneer in the field of Gender Affirming Surgery." As such, Bowers spoke to those assembled about "Teen Transitions."
ABC in 2015 called Bowers "the first openly transgender person in the world to perform transgender surgery," noting that "Marci was born as Mark and always felt as if she were woman trapped in a man's body." Bowers fathered three children before having "gender affirming" surgery, and called that process "incredible."
Part of that "incredible" process, according to Bowers' talk at Duke, is that a teen who doesn't want to be the biological sex that they are is able to stop their natural puberty with puberty blockers, a drug called Lupron, and then use hormones to force their body to go through the puberty of the opposite sex, is "really, really exciting."
But, Bowers said, there were two major problems with children undergoing medical "gender affirmation" prior to experiencing natural puberty. The biggest issue, according to Bowers, is one that no amount of surgery can ever fix, and it is the issue of having no sexual function and no ability to achieve sexual pleasure.
"These are the cases," Bowers said, "assigned male at birth, so trans feminine, and it's because they never in their lives are exposed to testosterone. That doesn't change, that doesn't change. So blockers prevent the rise of testosterone.
"And they don't really go on testosterone at around surgery or into adulthood. And so we don't know they're going to have this sensation, there's no question about that. But are they going to be able to really achieve sexual satisfaction? It's important in relationships, and I know that from my work with female genital mutilation survivors, that that the lack of being able to be intimate with a partner is very important. And so this is what really raised the red flag for me, is to say, look, we're gonna really, we need to have our eyes open about it."
Bowers, who had three children before undergoing gender transition in middle-age, said that this concern should change the "informed consent models" where children are told what they are giving up—sexual function, sexual pleasure, intimacy in relationships, having children—and then agree to it before they even have any idea what those things truly are.
"These are to be answered questions: So can we avoid puberty and get good adult results? And secondly, how do we? How do we assure someone that they're going to be able to be sexually responsive? Do we remove the blockers during the course of their adolescence? And let a little bit of puberty come back? Do we delay it a little bit? Maybe into tanners three or four? Maybe before they have their first orgasms? Maybe? Or? Or do we add testosterone later in their adolescence or early adulthood? Or at or around the time of surgery, enough not to cause a secondary sex characteristics they were trying to avoid, but maybe beneficial to enhance this ability. So these are these are questions that I of course, I'm very interested in," Bowers said.
After seeing thousands of patients and being a "pioneer" in trans medicine, Bowers said that an additional concern is that when a boy child undergoes this process, the penis does not grow, which makes it hard to take that genital material and surgically give it the appearance of the genital area of the opposite sex.
"And the two problems that that, frankly, I became concerned about was the lack of skin for you know, in creating a female vulva," Bowers said. "So that's troubling and, but you know, we got better, we got better techniques, we -- we've worked around it, still, the majority of people are very, very happy with their outcomes. But it, it probably could be better. And if there was more skin, so how can we get that? How can we get what we need to do surgically without making somebody go through a secondary of puberty that they don't want to go through? So that's one question for the future. And I hope we'll answer that."
When there is not enough genital material to use to create the appearance of a vagina, and to line the opening of a neo-vagina, oftentimes other parts of the body are used. Transgender Surgery Thailand notes that the two most common techniques "are Penile Inversion Vaginoplasty and Rectosigmoid Vaginoplasty. The skin graft is normally used for the vaginal lining during sex reassignment surgery (SRS), however the colon graft can also be used as an alternative surgical procedure in primary sex change surgery as well as corrective surgical procedure in the post-status SRS patients who have unsatisfactory depth of vagina."
The problem of not having enough material to create a neo-vagina was one experienced by "trans teen" Jazz Jennings, who underwent an extremely public gender transition, complete with reality TV show and many interviews.
"Being on the blockers is something that I don't regret at all," Jennings said. "But the only, you know, downside to it was that I didn't have enough growth down below. So there wasn't enough tissue to work with when it came to the surgery," And it was very challenging to find a doctor, a surgeon who was willing to perform the operation on me just 'cause I'm such a difficult case."
According to Bowers, this kind of "difficult case" is what can be expected for boys who go on puberty blockers with the eventual goal of castration and surgery.
The state of Florida has made changes in the guidance for "gender affirming care," and has been called hateful for doing so.
"Children experiencing gender dysphoria [a distressful disconnect between a feeling of' 'gender identity' and birth sex] should be supported by family and seek counseling, not pushed into an irreversible decision before they reach 18," Florida Surgeon General Dr. Joseph Lapado said.
He noted that "Countries such as Sweden, Finland, France, and the United Kingdom are currently reviewing, reevaluating, stopping, or advising caution on the treatment of gender dysphoria in children and adolescents."
"The current evidence does not support the use of puberty blockers, hormone treatments, or surgical procedures for children and adolescents," Lapado said.
The White House has encouraged parents to "affirm" their kids, regardless of sterility and lack of sexual function. The Department of Justice seeks to target states that protect children and teens from this fate.
