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We're starting the process with Ting, who wants a vagina. The network of moms is supportive. Nicole is a junior in high school, planning surgery between junior and senior year. She's doing great.

"Speaker 0: A phalloplasty is a procedure to basically create a penis or a phallus for an individual who was born biological female and who seeks transition to, a male, gender." "Speaker 0: The procedure is done with plastic surgeons and urologists." "Speaker 0: The urologists manipulate the tissues in the surrounding area to lengthen the urethra." "Speaker 0: A new scrotum is created and, some of the anatomical parts of, the female anatomy are removed." "Speaker 0: We typically utilize tissue from elsewhere." "Speaker 0: For example, the forearm or the thigh is used." "Speaker 0: The plastic surgeons are also responsible for, providing sensation by doing the nerve coaptation so that the new phallus will have sensation, and also responsible for reestablishing the blood supply, and also to shape it in a way that appears more physiologically and anatomically like a natural one."

Dr. Money concluded the interview by discussing the concept of gender identity. He acknowledged that it can be difficult for individuals to talk about their gender identity, whether they identify as male or female, boy or girl, or man or woman. Many people have come to his office with similar feelings, unable to discuss this important aspect of their lives. Dr. Money assured the person being interviewed that he would be the one person in the world they could confide in.

Talking is definitely a topic that comes up for transgender and gender diverse folks, particularly people who have a feminine or female gender identity and were perhaps assigned male sex at birth. Gender dysphoria is that negative or that uncomfortable distressed feeling that possibly comes with having a gender identity that's different than your sex assigned at birth. So when I think about talking, wanna make sure that people are talking in safe ways. talk to a gender affirming medical provider that's involved in their, child's care or that's involved in your care. I would really recommend that people take breaks from tucking. Pain might feel like an uncomfortable sensation or a tingly sensation, and that's definitely something you'd wanna take a break from and then talk with your medical provider about.

I offer support to find gender affirming care for youth, even if they need to go out of state. If parents are unsupportive, some kids choose to get emancipated at 16 to make their own medical decisions. Dealing with transphobic parents can be tough, especially if they are very right-leaning. It's important to find a chosen family of friends who accept you. I can send you a binder discreetly if needed.

Speaker 1 had gynecomastia surgery because he was tired of worrying about what clothes to wear. During a follow-up appointment, he tells Dr. Duffer that one nipple seems to get more erect than the other and sticks out a little more. Dr. Duffer says that Speaker 1 looks really good and natural and that one side of his chest is firmer, possibly due to more scar tissue. Speaker 1 says he noticed tissue when he was 13 and it never went away with working out or dieting. He researched plastic surgeons and was nervous at first due to swelling, but the results were priceless. He doesn't have to obsess over what to wear anymore. Later, Speaker 1, who is Officer Sewell, offers the doctor and another person a ride to a gay bar. He then invites a cop to hang out with them later at the gay bar.

I'm a trans guy. I've never been to the gynecologist. Today's the fucking day. I asked that they put a note on it: this is a trans guy; he's gonna present male. I called today to make sure the note's on my chart. She said, "The notes on your chart that you're, a trans man and blah blah blah." Okay. Cool. Have a good day, miss Allen. She works at a women's health clinic, and my name is fucking Sasha. Jesus Christ, guys. Full transparency, I'm tweaking out. My anxiety for my fucking audition for The Voice was, like, here. My gyno visit is here. If anything weird occurs, like, people with good intention can just say things uncomfortable and awkward. I don't have the mental capacity; but all I know is afterwards, I'm getting a sweet treat and I'll tell you how it goes. So fucking pray for me.

A lot of parents have questions about social transition at a young age. There are no exact guidelines. Again, everybody has their own gender journey and everything feels right or wrong depending on the family. However, many kids do decide to pursue a social transition. Usually that will start with changing their name or their pronouns. They might want to just try dressing a different way or using a different name at home to get used to it and for the family to get used to it. Some people might want to do it on a vacation where they don't really know anyone as a way to try it out. And then slowly over time they might move into using that more with loved ones at school or with friends. However, kids do benefit from social transition over time.

Speaker 0, a representative from Fairhope of Goodyear, informs Kelly, a 14-year-old who came out as trans to their parents, that they only provide services to individuals over 18. However, Speaker 0 suggests contacting Comenity Healthcare for assistance. Kelly expresses their worries, and Speaker 0 reassures them and provides the number for Comenity Healthcare. Kelly thanks Speaker 0 and ends the call. Kelly then calls Community Healthcare Network and speaks with Speaker 2. Kelly explains their situation and asks for help. Speaker 2 offers primary care, hormonal therapy, and mental health services. They assure Kelly that their parents won't find out and schedule an appointment for August 31st. Kelly provides their information, including their preferred name, Michael, and expresses their nervousness. Speaker 2 completes the chart and tags it for privacy. Kelly expresses concern about their parents finding out and Speaker 2 reassures them. The call ends with Kelly sharing their worries about their parents' reaction.

Special interest groups influenced Jids to offer physical interventions to children at a young age without strong evidence. Important information about puberty blockers and surgical risks was not shared with families due to fear of backlash. Lack of communication within Jids led to crucial details being overlooked. Written information on surgery implications was only provided in 2019. Families need full information on interventions for informed consent.

Max, who identifies as a boy, is visiting the doctor to discuss hormone blockers to prevent puberty. He has started experiencing some breast growth and feels uncomfortable. His parent expresses concern about medical interventions and their effects on bone health and psychosocial development. The doctor explains that hormone blockers can halt puberty progression and reassures that if Max changes his mind, he can still go through female puberty later. The procedure involves inserting a small implant in Max's arm, which will last about 14 to 18 months. The entire process is quick, taking only about 10 to 15 minutes.

There is not one surgery that every transgender person wants. Many transgender people have no interest in having surgery. For other people, they undergo medical transition involving use of gender affirming hormone treatments. And for others, they may have one or more surgeries. They may have top surgery, which is surgery on the chest or breasts. They may have bottom surgery, surgery on the genitals. They may have facial feminization. Trans women may have a tracheal shave to reduce their Adam's apple. No two trans people have the same needs to resolve their gender dysphoria. So you can never make an assumption that any trans person wants any particular surgery or any surgery at all.

I will be hanging out with the daughters of my mom's friend while they have a meeting. Jazz is an inspiration as a transgender role model. She shared her surgery experience honestly. Charlie plans to have surgery after high school due to bullying. I recently had surgery with complications, but now I feel great. Stitches came apart a week after surgery, causing pain and distress.

Young people and their families need detailed information on physical interventions to make informed decisions. These discussions may be challenging but are necessary.

For bottom surgery, hair removal is extremely important. For hair removal for a vaginoplasty, you can use laser. And because we're usually using penile inversion vaginoplasty, we need that hair to be removed because that's going to be the inside of the new lining of the cavity. Not only do we not want hair in there, it also can cause a lot of complications. So we go through that with you before, and then we do many hair checks as well to make sure that you're on the right path.

"The eligibility for getting gender affirming surgeries at Boston Children's Hospital is basically the same as it would be for most other hospitals or surgeons in The United States." "And that's the case because we all follow the World Professional Association for Transgender Health or WPATH standards of care." "For top surgery, you are requested, but not required to have been on gender affirming hormones for at least a year." "If you're a trans woman, it's really encouraged that you be on estrogen for at least a year because you want to maximize your natural breast growth." "Many surgical centers require you to be 18." "At Boston Children's Hospital for top surgeries, we'll see people as young as age 15 if they've been affirmed in their gender for a long period of time and don't really have any other life complications that make surgery inappropriate."

"Hi, I'm Maria. I use pronouns she, her, hers, and you're gonna meet a lot of folks, and don't be overwhelmed." "It's very much a two way conversation." "After that, Doctor. Ghanour and myself will come in to wrap up the consult, go over surgery in detail." "At that time, we'll ask you to change to do an exam that's very quick, have you change back into your normal clothes to then sit down and discuss everything with or without your parents, depending on your age and what your family desires." "We tell you to write down all your questions, to email anytime, to call anytime." "It can be very overwhelming and we give you a lot of information, but that first visit is mostly informational with one exam."

Admiral Rachel Levine, a pediatrician and the assistant secretary for the Department of Health and Human Services, addresses concerns about children transitioning before 18. She emphasizes the challenges of adolescence, particularly for those experiencing gender dysphoria. If a child feels female but is undergoing male puberty, it can be distressing. Critics argue that children are too young to make such decisions. Levine clarifies that for prepubertal children, no medical procedures are performed; instead, they are supported through therapy to explore their feelings.

We are often asked by surgeons or physicians to write letters, but in reality, it is for insurance companies. We have to use the DSM in our letters for insurance purposes. Although I am not a fan of the DSM, it is important to mention this requirement to the client. Insurance companies require a diagnosis for surgery, which stems from a history of pathologizing and categorizing queer people. Despite the minimal trust, we use the diagnosis to ensure clients receive the necessary treatment.

Many patients in the GEMS Clinic know their gender well before adulthood; some children know from birth or seemingly from the womb, and they will usually express identity with phrases like "I'm a girl" or "I'm a boy" and continue to explore through age two and three, and usually up to the ages of nine. At the clinic, a psychologist discusses gender with the child and their family and helps ensure they have space and support to explore their gender and do well throughout their development. Parents’ questions are common, and the main guidance is to be supportive—"just be supportive" and "love your child and support them and just allow them to express themselves"—since parental support protects against depression, suicidality, and anxiety. Resources in the GEMS program include individual gender assessments and GEMZ parent nights to learn about interventions and psychosocial aspects.

This boy just had top surgery, and I want to share our journey. After the surgery, I was called to the Recovery Room. The surgeon was working on him, and there was a lot of blood coming from his scars. They informed me that they needed to take him back for more surgery because a blood vessel had popped. Unfortunately, we lost his right armpit hair during the process, but the left one remained untouched.

"Sometimes it may be just a phase of development where they're exploring their gender identity and they're kind of getting a sense of who they are, but a lot of children do end up identifying as that gender into young adulthood and adulthood." "The only real way we know for sure that they're going to continue in that gender identity is just to allow them to develop over time." "And so that's what we recommend to parents is to give them the space." "Even if parents are concerned that it's a phase, we never want to tell the child that they shouldn't be expressing their gender identity or that they should be, ashamed for the way that they're expressing their identity because that can be quite harmful." "We just want to give the child a chance to develop and explore on their own."

I often see youth who have already undergone medical interventions due to a backlog in mental health support. Children may not fully understand the impact of these interventions, making it challenging to discuss. It can be especially difficult for young adolescents starting puberty suppression. We aim to make kids happy in the moment, but it's crucial to consider the long-term effects on their development. This is a growing challenge in our field that requires further exploration.

- "Vaginoplasty is a relatively big procedure." - "It takes about between four to six hours in the Operating Room and therefore there is some swelling involved, there's some pain involved." - "But most of the times we actually administer epidural anesthesia as well, which helps a lot with the pain management for the patient." - "A very big component of the vaginoplasty procedure is the post op care." - "Seven to ten days after the procedure, the patient is required to start doing dilations." - "In the dilations, they are using different sizes of dilators gradually, and they need to do that several times a day for minutes a day." - "The reason for that is because otherwise the cavity will not be maintained and the old reconstruction can be lost."

If you're transgender or nonbinary and feel uncomfortable with your puberty experiences, you're not alone. Puberty blockers can temporarily halt the changes caused by hormones like testosterone and estrogen, giving you more time to figure out your gender identity. It's okay to not have all the answers right now, as understanding yourself takes time. Talking to a trusted adult, nurse, or doctor can be helpful. To learn more, visit plannedparenthood.org/teens.