Jamie Lauren Keiles Follows the Surgical and Philosophical Journey of Phalloplasty - The Open Notebook

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In the summer of 2019, New York Times Magazinecontributing writer Jamie Lauren Keiles met someone at New York City’s Riis Beach who had undergone phalloplasty, the years-long, multistage surgical construction of a penis. This encounter sparked a story idea for Keiles: What does it mean to have a penis, as a trans person? In a world where queer and trans activists have spent decades trying to shatter the relationship between gender and genitalia, a trans person pursuing phalloplasty has to wade into complicated waters. This, on top of the difficulty of tracking down the right team of surgeons and committing to years of expensive, high-risk medical procedures.

In their piece “How Ben Got His Penis,” published in the May 2022 health issue of The New York Times Magazine, Keiles follows one patient, Ben Simpson, along his entire phalloplasty journey, from deciding he wanted a penis, through countless doctor’s appointments and a series of major surgeries, to recovery. Keiles follows Ben’s mental and emotional journey, too, unraveling the tangled relationship many people have with the penis as a symbol of manhood.

As much as Keiles’ story is about just one person, it’s also a broader look at the winding history of gender-affirming healthcare. They capture the persistence of the surgeons who pursue this specialty and the smorgasbord of medical techniques required to build a penis from scratch.

Through reporting this story, Keiles learned that no two phalloplasty journeys are the same. Rather than formulaically constructing every penis in some imagined ideal cis image, patient-surgeon teams collaborate to build the penis that best serves the patient’s needs and desires. In an attempt to capture the diversity of phalloplasty experience, Keiles interviewed dozens of subjects about genitals, both the proverbial phallus and the literal penis. These vulnerable interviews, Keiles says, were informed by their own lived experience as a trans person—something they had yet to write about professionally.

While conveying the weighty challenges inherent in the trans medical pipeline, Keiles also skillfully infuses their writing with humor, capturing Ben’s levity, confidence, and, in the end, his delightfully unremarkable relationship with his body. Stories written about trans people too often adopt a dire, overly-respectful tone—perhaps overcorrecting for years of anti-trans sentiment, Keiles says. Accordingly, they hope their nuanced approach encourages more journalists to write about trans subjects the same way they would approach any other subject, with space for ambiguity, imperfection, and light. After all, how could one possibly write a piece about phalloplasty without chuckling a little? Genitals are, famously, comedy gold.

Keiles talked with Celia Ford about how they stitched together this longitudinal, subject-centered story over several years of reporting and how the story arc shifted from pitch to publication. They also shared what it means to be a trans journalist telling trans stories to a general audience and the importance of telling these stories candidly. (This interview has been edited for clarity and length).

What initially gave you the idea for this story?

I met someone who had phalloplasty, and he was talking about the experience. This guy was talking about all these different things coming together: history of science, medicine, the trans community’s feelings about what makes for a “good” body and what makes for a “good” surgical outcome, and how the incentives of different groups conflict.

I started hearing the makings of a really good story. I’m trans, but I’d never written about trans stuff. I feared that once I started writing about it, I’d become a “trans writer” and get put in a box. So, I tried to divorce this story from any anxiety around it being a “trans story,” and just tried to look at it like, “What if I covered this like I’d cover any other thing that’d make a good piece of magazine writing?”

You followed one patient, Ben Simpson, through the complicated multiyear process of phalloplasty. How did you first connect with him?

I interviewed a bunch of surgeons, trying to figure out which phalloplasty patient would be the most interesting character, and who had philosophical attitudes towards surgery that were in line with some of the ideas I was interested in exploring, like “What is it to have a penis?”

When I first got in touch with Ben through the surgeon, I liked him, but it was also a matter of scheduling—his surgery dates lined up with our initial deadlines. But the story kept getting moved around, and things kept getting put on hold. At some point, it became clear that this should just be a more longitudinal story. We were already following Ben: Why not keep following him?

I originally had this fantasy that Ben was going to be a representative case, but the more I learned about why people undergo this surgery, and how people think about their bodies, I realized that no one person could stand in as a generic phalloplasty patient. I think this ultimately made it a more interesting story, but I was a bit naïve about that in the beginning.

Over the year plus of reporting this piece, how did the story arc diverge from what you had in your original pitch?

It started out as a phalloplasty story, but as more of a philosophical, cultural story about what our bodies are for, with less focus on science and medicine. I initially pitched it a few years ago, and my editor wasn’t interested at all. Then, I pitched the same exact thing a year later, and then he was sointerested, and didn’t remember it being pitched before—like something culturally changed and gave the story a container it didn’t have before.

I started off being most interested in people and their individual bodies. Then, I got interested in this question of how you measure surgical outcomes, but a lot of that didn’t make it into the piece. It became this thing about all the different ways in which this surgery is perceived.

The fact that this story ended up getting shelved for two years [when I had to work on a few other projects] gave me the opportunity to do a lot of reading that I wouldn’t have been able to do otherwise. When the timeline stretched out and the money lined up, I was able to poke around all these different corners, into the history of trans medicine and surgery.

Since this ended up being a longitudinal piece, how did you handle the uncertainty of how Ben’s surgeries and recovery would unfold?

I knew conceptually, a few months before Ben’s implant surgery, that I wanted to end on the idea that it changed Ben’s life, but mostly just got him to a place where he could hang out and have a penis—he went through all this trouble just to be like, chilling. The pieces lined up, and Ben got to a place that mirrored what I thought the story was supposed to mean.

In some ways, it was harderto write the story because things went so well for him. Most people have a lot more difficulty than he did. I was prepared for the story to have more of a plot arc. This is when having a good relationship with your editor matters. If the plot took a left turn, and the story was totally different from what I pitched, I’d talk about it with my editors.

How did you decide to include or omit details of your own experience?

I thought about it a lot. A lot of readers, both trans and cis, really want you to say, in the first sentence of the story, “As a trans person …” But by sayingas a trans person, it cedes ground to the idea that I need disclaimers about my point of view. There’s a little bit of sick and twisted pleasure I get from saying, “I’m not going to do that at the beginning of a piece.” Ideally, I think when you come to reading any piece, you should be critical, thinking about what perspective the author is taking on.Everyone has a point of view.

That said, there are certain claims that I can make as a trans writer. I think a cis journalist could have done a good job on the story, but there are certain claims they might not have been able to make with as much authority as me—things that I could only know to be true if I could speak from the perspective of having encountered them. Adding personal perspective can serve the broader claims you want the piece to make or help to tell the story in a more capacious way.

How did you establish trust with your sources and handle concerns about privacy, especially when talking about sensitive topics like genitals and body dysmorphia?

I was surprised I didn’t have trouble getting people to talk to me. I do think this is something I find really pleasant about reporting on my own community—people are good at telling their stories, sometimes to a fault. Sometimes, I had to say, “Wait, that sounds like the way you would explain this to your family or your doctor. Tell me what you actuallythink.” I had to push back against narratives that people have prefabricated for others, not for themselves, which I find to be the most thrilling part of doing trans research or working on a trans story.

I didn’t have to walk on eggshells with Ben—I felt like I could follow his lead. He had a great sense of humor and always gave good interviews. I thought a lot about Ben, and protecting him. He’s a pretty offline guy, and he’s a lot braver than I am—he’s been living in a small town, being trans, for 10 years, and he’s not afraid of people. He did not want to be anonymous. He wanted pictures of himself published with the article. I was against it initially, but it felt paternalistic for me to say, “You needto be anonymous.” I made my voice heard, then went along with the subject’s feelings. I lost a lot of sleep worrying about Ben, but I don’t know how much, if any, sleep he lost worrying about himself.

But every single person I spoke to had a different comfort level. Through existing in a world where I’m trans, have trans friends, and have moved through the trans medical pipeline, I was familiar with which topics could make people uncomfortable, and how I could walk back, apologize, or move on when I stepped on someone’s toes.

But trans stuff aside, it’s just weird to interview someone about their genitals! It taught me a lot as an interviewer about how to follow someone’s lead on language choice, humor, and comfort level.

Speaking of genitals and humor, can you talk a bit about how you approached language in this piece?

Having language disputes was an interesting part of working on this story. A big argument I had, in fact-checking and copyediting, was like, “Are we allowed to call Ben’s penis a dick? Can Icall it a dick, or is only Ben allowed to call it a dick? How many times can we say dick? When is saying dickserving the accuracy of someone’s experience, versus being crass for the sake of being crass?”

I err on the side of saying “dick” as much as you want, because it’s funny, and it’s just how people talk. But the magazine said, “Okay, you’re going to get a certain number of ‘dicks’—how are you going to deploy them accurately?”

It does seem like humor is an important aspect of this story. Can you talk about your motivation behind that?

I don’t think many writers are given the freedom to pursue trans subjects with a sense of curiosity and humor. A lot of writing about trans people is really dire-seeming, and respectful to the point of almost becoming disrespectful. It’s unable to hold strangeness and humor at the same time as difficulty. I think we should treat trans adults like anyadults, who are allowed to make mistakes or laugh at themselves or feel ambiguous.

Something I feel very proud of accomplishing in this story is striking a tone that accurately captures Ben’s individual experience, and a lot of my own, in navigating trans medical bureaucracy. There’s a real humor to the quote-unquote “trans situation” that mainstream publications shouldn’t be afraid of.

Is there anything about the piece you wish you could go back and change?

In the beginning, I wasn’t sure if I’d follow a single person. But I did, and Ben ended up being a white, binary-presenting trans man. I think the media tends to uplift these kinds of “model patients” as the subjects of trans stories, and I think it does a disservice. We isolate the easiest stories to tell.

Someone else I interviewed was a Black trans police officer. I would have liked him to be more in the story because that really complicates the dominant narrative. I ended up going with Ben because of scheduling, but in the future, I’d like to make more of an effort to include stories that make a less tidy narrative. I like to believe that the reader can handle a less “media-ready” subject.

Given your efforts to establish trust with your sources, how did the trans community respond to the piece?

There was a strain of feedback saying, “Why are you airing our dirty laundry?” It’s basically a respectability-politics argument, like we’re never going to earn rights unless we put our best foot forward. But I’m a journalist in this capacity. I hope that my work furthers the rights of trans people (I’m trans—that would be nice!), but my goal here was just to tell an accurate story. I don’t think that things that are happening in reality are off-limits to be written about—journalism should tell the story of all things that are going on in the world.

When a few serious trans historians said they liked my story—people who have spent their lives going through this topic with a fine-toothed comb, while I’m just parachuting into their work—that was the biggest compliment to me.

Celia Ford is a sixth-year PhD candidate at the University of California, Berkeley’s Helen Wills Neuroscience Institute, where she studies how our brains make sense of the world, and how we update our expectations when the world changes. A TON early-career fellow supported by the Burroughs Wellcome Fund, Celia writes for the Berkeley Science Review and makes podcasts with NeuroCinema. In a past life, she was a drive-time alt-rock DJ at 95.5 WBRU FM. In a parallel universe, she is a pole dance instructor, bass guitarist, and devoted cat parent. You can follow her on Twitter @cogcelia.