Anatomy of disinformation: Blaire White lies about puberty blockers and vaginoplasty

Previously: Debunking myths about youth transition

I hate covering anything related to Blaire White. It’s absolutely crushing to watch her recklessly inflict falsehoods on the public’s understanding of trans issues and I genuinely wish she would stop so that I never have to write about her again. Sadly, here we are once more.

Not content with disregarding the established medical consensus and evidence on youth transition, or telling impossible lies about a 9-year-old trans girl and her family, Blaire White has now turned her attention to Jazz Jennings, a teenage trans girl and star of TLC’s I Am Jazz. On June 26, Blaire White tweeted about “why children should NOT be allowed to transition”, claiming that Jennings is unable to have vaginoplasty (surgical construction of a vagina and vulva from penile and scrotal tissue) due to genital underdevelopment as a result of using puberty blockers:

The headline she quotes is of unknown origin and does not appear to be taken from any news story; the earliest that the phrase appears in Google results (down to the “complicatons” misspelling) is in the title of a submission to the /r/Gender_Critical subreddit, a community for generally transphobic content, on June 20.

This title is completely inaccurate and overtly misrepresents the linked People.com story. Nothing in the article states that vaginoplasty would not be possible for Jennings, and she speaks at length about her intention to have surgery:

“It’s been a journey for sure. I haven’t gotten the procedure yet, but this season you’ll see me go on consultations and finding the surgeon of my choice.”

While Jennings admitted the surgery is “a very serious procedure,” fear isn’t preventing her from getting it.

“With any surgery, there’s always fears. And I know my mom, she’s especially fearful because she doesn’t like me going under anesthesia and all that stuff,” Jennings explained. “But for me, I’m not really worried about it. I’m actually kind of excited. This is something I’ve always looked forward to. I don’t know — it’s going to be fun.”

In a later Us Weekly article, Jennings notes that this is simply a question of different surgical techniques:

Jazz added that during season 3, fans will see her go on four different consultations. “Basically there’s a new wave of trans youth that are coming and that means there has to be groundbreaking surgeries for people who have taken blockers and don’t have a lot of growth,” she explained to Us. “That’s been the major problem with my surgery. Since I’ve been on blockers for so long, I don’t have a lot of growth and you’ll see this season if it can still work.”

Had Blaire White read anything about the girl whose medical history she’s discussing, she would have found that Jennings has already had these surgical consultations, and that the appearance of uncertainty merely serves to attract viewers to a reality show. There is nothing to indicate that Jennings would be unable to have vaginoplasty due to taking puberty blockers, and it is blatantly dishonest to claim otherwise.

The apparent assumption that medical specialists working with trans youth would have overlooked such an issue is rather astonishing. Contrary to public perception, puberty blockers are not a new or recent development, and several studies discuss vaginoplasty procedures for trans girls who have taken puberty blockers.

In a 1997 followup study of the first cohort of adolescent patients at a Netherlands gender clinic (again, this was published 20 years ago), seven trans women were stated to have undergone vaginoplasty after treatment with puberty blockers (Cohen-Kettenis & van Goozen, 1997). At the time of followup, ranging from one to five years after surgery, none of the included subjects expressed regret about transitioning. Not only was it possible for them to obtain vaginas, but their vaginas are likely older than Blaire White.

A 2014 study included an additional 22 trans women who had received vaginoplasty following treatment with puberty blockers (de Vries et al., 2014). All of the subjects said they were “very or fairly satisfied with their surgeries”, and none expressed regret over treatment with puberty blockers, cross-sex hormones, or surgery.

Gijs & Brewaeys (2007) explicitly state that surgical techniques for vaginoplasty are capable of accommodating a potential shortage of donor tissue in trans girls on puberty blockers:

A final argument against the hormonal suppression for MFs is that in a non-normal pubertal phallic growth, the penile tissue available for vaginoplasty may be less than optimal. However, appropriate techniques exist to overcome the shortage of tissue.

A publication on guidelines for medical transition in adolescents (Hembree, 2011) also states that different surgical techniques are viable and effective for this population:

The skin of the penis and scrotum are used in the construction of a vagina and labia during genital surgery for transsexual women (MtF). The amount of male genital tissue available at Tanner stage 2 is limited and may alter the techniques required for genital reconstruction at age 18. Surgeons have published good results in adolescents following puberty suppression and estrogen administration at age 16.

Milrod (2014) elaborates on specific methods used in surgical treatment of trans girls on puberty blockers who may have insufficient genital tissue:

One of the disadvantages in adolescent girls who have been treated with GnRH analogues at an early age is the possibility of insufficient skin for penile inversion vaginoplasty. Several authors refer to autologous skin grafting from donor sites, tissue expanders, or the use of sigmoid colon tissue as viable solutions to this problem. For teenagers who begin gonadal treatment during midpuberty or later, this may not be a concern as there is generally enough tissue available for the construction of a neovagina.

In a later survey of of 20 surgeons with experience performing vaginoplasty on trans women – including 11 who’ve operated on minors, and at least one who operated on a 15-year-old – these specialists explain their approaches to dealing with the limitations posed by underdeveloped genitals (Milrod & Karasic, 2017):

There was little concern over the younger adolescent and her ability to physically withstand the invasive procedure compared with a middle-age or elderly patient; however, almost all surgeons remarked on the penoscrotal hypoplasia or limited penile shaft size that would ensue after the use of puberty-suppressing gonadotropin-releasing hormone analogues, sometimes for as long as 3 years. Two surgeons who reported operating on minors commented, “… they are coming in after being put on blockers, so they have 11-year-old genitalia” (surgeon 9) and “… you are really doing vaginoplasty on a micropenis” (surgeon 16). Most participants emphasized that the surgical techniques were the same for all patients no matter the age; of those who had performed the procedure on several minors, the use of flank skin grafts most commonly resolved the problem of inadequate tissue availability. In other reported measures, surgeon 2 implanted a scrotal tissue expander that required periodic infusion during 2 months, and surgeon 14 used donor tissue matrix (LifeCell, Branchburg, NJ, USA), deeming it “nicely successful” and thereby avoiding patient exposure to external flank scarring. The alternative procedure of using sigmoid- or ileum-derived grafts to create the neovagina was seen as a last resort by a few participants who stated diversion colitis, excessive secretion, persistent odors, and potential leakage of stool into the peritoneum as some of the concomitant morbidities.

Clearly these experienced surgeons are not particularly concerned about obstacles posed by the use of puberty blockers. Rather than arguing that trans youth should wait for a longer period of time before transitioning, many of these surgeons were comfortable operating on trans girls even younger than 18 who have shown they are capable of offering meaningful and informed consent. The authors further note that trans girls on puberty blockers can be acceptable candidates for the same vaginal construction techniques widely used in some adult trans women and cis women:

In particular, plastic surgeons were biased toward penile inversion augmented by scrotal grafts, sometimes adding flank grafts, tissue expanders, or donor matrix tissue, and decisively rejecting intestinal vaginoplasty that would require no such additional measures and eliminate the need for lifelong dilatation. However, although diversion colitis, excess mucus, or malodor were cited by the American surgeons as negative sequelae, a meta-review of 21 studies using data on cisgender women with vaginal agenesis and transgender women reported no occurrence of diversion colitis; in addition, odor occurrence in the ileal neovagina was not observed and transient excessive discharge decreased to acceptable levels within 6 months in sigmoid-derived and ileal vaginoplasty. Bowel vaginoplasty in transgender women is performed to a greater extent in Europe, where genitourinary surgery maintains a presence in public health-funded transgender care and acceptable patient satisfaction rates have been documented on a relatively consistent basis, most recently in a sample of postadolescent transgender women. The authors surmise that as rates of GCS in adolescent minors treated with gonadal steroids begin to increase, colon vaginoplasty in the United States could become a more commonly available alternative to penile inversion, particularly as more urologic surgeons obtain training in the procedure and additional outcome studies are published in the future.

To sum up:

• Jazz Jennings appears to have every intention of getting vaginoplasty, and there is no reason to think this would be medically impossible for her.
• Numerous trans women have had vaginoplasty successfully after treatment with puberty blockers as adolescents, and this has been happening for more than 20 years.
• Trans girls with underdeveloped genital tissue due to puberty blockers can still have vaginoplasty using various techniques that are used in other trans women who did not use puberty blockers, completely undermining the argument that trans youth should not transition for this reason.

Blaire White’s claims aren’t simply false in the sense of happening to get a fact wrong. They are pervasively false, in the same way that it would be false to say bees can talk, the moon is a triangle, and Swiss cheese falls up.

Nevertheless, this myth has taken hold with surprising speed and vigor. In mere days following her false statements, numerous Blaire White devotees have helpfully showed up to share their newfound knowledge with me:

In a stroke and with no apparent sense of conflictedness, Blaire White and her followers pivot from concern that kids will regret transition to concern that they won’t, from outrage that youth can transition to outrage that they allegedly can’t, from being afraid that these children are wrong to being afraid that they are right. (“I never borrowed your vase, I returned it to you intact, and it was broken when I got it.”) Those who dismissed all available medical evidence on youth transition as mere quackery and condemned relevant expertise as progressive folly suddenly rush to learn anything about these procedures that they can load into their shotgun arguments.

And now, thousands of people hold dangerously misinformed opinions about trans youth based on not just the denial of contemporary scientific consensus, but the ignorance of decades of medical reality. The rest of us are left to pick up the pieces for however many years or decades these falsehoods last, helpless to do anything but wait for Blaire White’s next spasm of deception.

Stop lying about trans kids; stop lying about trans healthcare; just stop lying.

References

• Cohen-Kettenis, P. T., & van Goozen, S. H. (1997). Sex reassignment of adolescent transsexuals: a follow-up study. Journal of the American Academy of Child and Adolescent Psychiatry, 36(2), 263–271.
• de Vries, A. L. C., McGuire, J. K., Steensma, T. D., Wagenaar, E. C. F., Doreleijers, T. A. H., & Cohen-Kettenis, P. T. (2014). Young adult psychological outcome after puberty suppression and gender reassignment. Pediatrics, 134(4), 696–704.
• Gijs, L., & Brewaeys, A. (2007). Surgical treatment of gender dysphoria in adults and adolescents: recent developments, effectiveness, and challenges. Annual Review of Sex Research, 18(1), 178–224.
• Hembree, W. C. (2011). Guidelines for pubertal suspension and gender reassignment for transgender adolescents. Child and Adolescent Psychiatric Clinics of North America, 20(4), 725–732.
• Milrod, C. (2014). How young is too young: ethical concerns in genital surgery of the transgender MTF adolescent. Journal of Sexual Medicine, 11(2), 338–346.
• Milrod, C., & Karasic, D. H. (2017). Age is just a number: WPATH-affiliated surgeons’ experiences and attitudes toward vaginoplasty in transgender females under 18 years of age in the United States. Journal of Sexual Medicine, 14(4), 624–634.