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Jan 23 2013

Fact-checking the 20/20 special on trans kids

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.

22 comments

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  1. 1
    Zoe

    I’m going in for some letters soon, and I’m seriously tempted to say I want to have a vagina installed.

    As a note, Kroger supermarkets (under various names), Target, Walgreens, and many other national chains carry oral estrogen for $4/2mg a month. This comes up to 25mg daily in order to cost $18,000. I don’t know the recommended regimen for transitioners that young, but that seems pretty damn excessive to me.

    1. 1.1
      Xanthë, Amy of my threads

      Zoe, I’m totally with you on wanting a vagina installed, stat.

      I’m living in socialist Australistan, and with my current HRT dosage the cost works out to $240 per annum. I think you might have left out at least one factor of 10 in your calculation, but it hardly matters — $18k/yr just for estrogen is pie in the sky.

    2. 1.2
      dangerousbeans

      I think my maths is off; using your prices and assuming 28 days/pack, I’m getting 690mg/day. Still, even at 25mg/day that’s twice the highest dose I have heard of.
      My HRT, in Australia, is ~$600/yr but that includes an antiandrogen.

    3. 1.3
      Zoe

      Xanthë – I’m going off the special price some commercial pharmacies offer for generic in the states.

      Overall, though, my math was off. US$4/2mg is US$2/1mg, at 365 doses a year, thats 18,000/365*2. Google tells me thats 98mg a day.

      You’d think that as a trained mathematician and algebra tutor, I’d be able to do basic arithmatic :/

    4. 1.4
      Zoe

      Double dunno what I’m thinking. That US$2/1mg is for 30 one day doses. That actually makes it 6 2/3 cents per mg. Rounding that to 7c, we get:

      18,000 * 365 (days in a year) to have the amount of money per day = US$49.31 per day
      Divided by the 7c per mg, we get 704mg per day.

      I don’t think I could survive that.

      1. Zoe

        FTB needs a way to edit posts.

  2. 2
    SG

    “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.”

    I have never felt like my body was wrong (although I’m finding that I enjoy the changes from HRT so far). What I realize is that for a long time I’ve had the feeling that it was wrong how other people see my gender, that the real me was invisible. I’d also say that being male seemed somewhat dissonant with how I felt myself to be, but I didn’t consciously think I was female. Because I am so different from the “classic” narratives, I didn’t realize that I am trans until I was 26, and I think it was just dumb luck that the realization did not come even later.

    The way my dysphoria presented happens to be very similar to how Jamison Green experienced his dysphoria. I actually took the metaphor about being invisible from his book, Becoming a Visible Man. Jamison Green also did not come to the realization that he is trans until later in his life, at 40. I recommend the book to anyone, male or female, who is struggling with their gender identity, although obviously trans men will get more practical use out of it.

  3. 3
    Kendall

    While the $18k/yr for estrogen is clearly wrong, as it would be for spironolactone, I have heard that sometimes much more expensive puberty blockers are used for children. While I’m unfamiliar with the specific drugs and their costs (this is not widespread knowledge in the forums I haunt) the reasons given have been that (1) they are safer for long-term use, which is necessary because (2) irreversible surgeries (i.e., orchiectomy) are delayed until after 18 so that the child can legally consent. So it’s possible that the $18k/yr is right but the cited treatment is wrong.

    But that’s just helping with some speculation. :D

  4. 4
    WMDKitty -- Survivor

    I see [1], [2], and [3] as awkward, clumsy attempts at “dumbing down” the issue so that J. Average American can begin to understand. I can see that the first two, however, are rather more problematic than the third, in that they do describe her as a “boy” when she, well, isn’t a boy.

    I think that, despite the issues you’ve pointed out with the program, this is a big step forward in presenting transgender individuals as sympathetic and halfway normal.

    So, not perfect, no, but a good thing.

  5. 5
    busterggi

    Perhaps we can only hope that someday people will realized that the primary sexual organ is not the penis or vagina but the brain.

  6. 6
    Gina Bennett

    And people wonder why I`m pulling out of the trans community. They over analyze EVERYTHING. I`ve been watching this documentary series since it started, and I`ve found no issue with it. Sure they got a few things wrong, but overall it`s better than most of the other documentaries out there. Barbara Walters did AMAZING

    1. 6.1
      Zinnia Jones

      Well, it’s not like this is necessarily the strongest basis for a community anyway. It’s just one thing that happens to occur among a small number of people all around the world. I can’t really be surprised when someone doesn’t feel they’re part of such an ad hoc community.

    2. 6.2
      dab

      ZJ’s reply is overly generous since your reasoning for “pulling out” is flawed. The objections raised, which did not discount the good points of the programme, are valid, even if they go into more depth than you personally like to deal with. Someone has to say it, and ZJ has one of the clearest writing styles to say it effectively. What exactly is the logic behind ‘It’s not awful, so I’m going to disparage any person who thinks it can stilll be better?”

  7. 7
    Marian Malo

    As much as we can find fault with details in reporting, let’s not forget that our society is finally starting to try to get a “handle on” trans people, and will screw up definitions more often than not. It’s learning – and even when it makes mistakes, things are improving. Yes, not as quickly as many of us would like – but I feel that in our childrens’ generation, being trans will be very much like being gay is today – for the most part accepted by the general population. (At least that’s true where I live – as they say, “your mileage will vary”.)

    So let’s be thankful that this isn’t a hatchet job, and do write into the producers of the show to correct their mistakes. I’ll bet that they have another show on Jazz, and that she will get more accurate reporting next time.

  8. 8
    Deanna Atkinson

    As for your final point regarding the cost of Estrogen. The $18,000/yr cost was in reference to the implanted pump to dispense T blockers. This is a very expensive procedure, conducted by few doctors in this country. There is a great difficulty (from what I have learned from someone who works with the families of gender non-conforming children) in getting the necessary treatment that Jazz is evidently receiving.

  9. 9
    Gyelle Spence

    Excellent analysis and lots of information in your essay. Thanks for not just leaving it at ‘this is wrong’ but for going the extra mile.

  10. 10
    Lauren G

    Children are not born knowing that pink is for girls (that only started in the 1950′s, it used to be the other way around) or that trucks ar for boys (there are women who drive big rigs, after all).

    Bur children are born knowing “Same and “Different”. I knew I was the same as the girls next door to me and different from the boys up the street long before I had any idea of gender.

    It would be a good thing if this idea got some exposure.

  11. 11
    Leah

    The report erred when they said estrogen cost that much. What they were really talking about is the GnRH inhibitors (puberty blockers). They are EXTREMELY expensive and $18,000 is in the ballpark for those.

  12. 12
    Giliell, professional cynic -Ilk-

    Children are not born knowing that pink is for girls (that only started in the 1950′s, it used to be the other way around) or that trucks ar for boys (there are women who drive big rigs, after all).

    Thank you.
    That’s something that always drives me mad about those “the child who knew” stories. Suddenly trans* people’s lives are exploited to rub gender-norms and stereotypes into everybody’s face.
    How can I complain about how my daughter’s choices are limited to different hues of pink when clearly trans girls show that pink is natural for girls? And suddenly I’m faced with either seeming to delegitimize the existence and choices of trans’ people or accepting the gendering of everything up to ice-cream.


    No. We live in a world in which gender is salient, highly prominent, everything is gendered and put into binaries and children choose the binary they feel most comfortable with (if they’re allowed to).
    It’s not so much about girls, cis and trans really wanting pink, pink, pink ponies*, but girls wanting girl-stuff because gender is highly policed and “wrong choices” get immediately “punished” (I guess even much more so for trans* children)**

    *Hobbyhorses used to be a typical boy-toy, because the men would later ride the horses. Now they are girl-toys (with pink! and glitter!) because horses have miraculously become girly, at least in Europe.

    **I noticed how my daughters choices started to narrow down once she started kindergarten and how they still vary depending on whether she goes there or is at home.

  13. 13
    Lauren G

    Giliell, that is so true. Children learn what they are “supposed” to like because when they see someone that is the same as them, they pick up on the cultural choices that are ingrained in these other children. It’s a little better now, but you are so right. Just looking at history and how children were raised even as recently as the early 20th century will show that what is “girly” and what is “boyish” have radically changed.

    I fear that the public will reason that “Pink is for girls and trucks are for boys” can’t be biologically ingrained. I want the public to know why these stereotypes came about.

  14. 14
    susan maasch

    Trans Youth Equality Foundation………. we enjoyed reading your coverage, excellent points, especially about that born a boy, now a girl bull……that is still used to sensationalize and it bugs us and our kids, but great show and great coverage here. We applaud Jazz’s parents and grandmother(who we have met) for their compassion and support, and by the way: in reference to other comments at the end, Lupron is a puberty blocker most recommended for pre puberty transition and it costs about 1300-1600- a month, covered by some and not covered by many. This is what endocrinologists use. Tested ,been used for over 40 years, considered safe as you weigh your risks and benefits. Cross sex hormones later being much much lower of course.

  15. 15
    calix

    I think the high cost of hormones they’re referring to may be for suppression of Luteinizing hormone, which is involved with the initial onset of puberty and therefore only used for people so young as Jazz. I have no idea how much LH suppression costs, but it is more than estrogen and something to consider perhaps.

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