What are the downsides of hormone blockers?
Iām not aware of medical downsides, if thatās what you mean. When the drugs are withdrawn, biological puberty progresses as it would have. Iāll leave the question of emotional downsides to folks with more experience.
I donāt really think a 13 year old has the maturity to choose to have surgery, and forever give up the possibility of reproduction. Which is why I think ā given the devastating effects of the āwrongā puberty (to which I can personally attest) ā hormone blockers are the best approach. People need to understand that doctors donāt give hormone blockers to a 13-year old who decided two weeks ago that theyāre trans. Anyone receiving that treatment has shown consistent, severe gender dysphoria for many years, usually back to early childhood. Itās not done on a whim. (Which means, of course, that many trans people who donāt exhibit the severest gender dysphoria in childhood, but will grow up and transition eventually anyway, wonāt be considered eligible for it. But I donāt really see any way of avoiding that.)
I am completely against any medical intervention for children prior to puberty. There are many, many, many kids who exhibit signs of gender dysphoria when young and for all the world appear to be transgender under adult understanding of that concept, who, once they go through puberty, become completely comfortable in their assigned gender. Kids have notoriously rigid views of gender roles and donāt necessarily have the vocabulary or the emotional sophistication to understand what they are actually feeling let alone to express it accurately. Very very few kids who exhibit gender dysphoria when young actually turn out to be transgender. Iām fine with letting kids present as whatever gender they want and to allow them to be as fluid as they want about it. Iām against any medical intervention until very late adolescence but certainly after puberty. Just because a little girl wears boy clothing, adopts a male name and writes first person essays from the point of view of a boy at ages 5 through 12 does not mean she actually is a boy, or permanently wants to be one. It may just be that she likes skateboards and snakes and draws inappropriate conclusions from those preferences.
This is pretty much in the realm of magic. By 18, oneās identity is long since formed, and one has a right to itā¦ Itās like asking āif there were a magic pill you could give to an 18-year old gay man to make him straight, should you do so?ā I suppose the better question would be, if you could somehow ācureā transness or being gay or lesbian in a small child, should you? Iām not going to try to answer that question, because itās not a realistic possibility right now. And because I donāt think of being gay or trans as being ādiseases.ā Itās too much like debating eugenics.
And besides, if I had been given a magic pill at age 4 to make me not-trans, I wouldnāt be remotely the same person I am now. In many ways, I think Iām a better person for being trans. Itās certainly enabled me to empathize better with other people who belong to marginalized groups, and grew up as outsiders. Including my own son. Really, itās like asking me what I would be like if I werenāt Jewish. I canāt really imagine either.
āIf the cause of gender dysphoria is hormone levels in utero, then what would happen if there was a hormone treatment that could reverse the effect?ā
Then many parents would choose the treatment, and there would be fewer trans people, just as there are fewer people with Down syndrome than there would be if we didnāt have prenatal diagnosis. Also, there would be furious disagreement about the ethics of the treatment.
Notelling, you make all sorts of definitive statements ā like ā[v]ery very few kids who exhibit gender dysphoria when young actually turn out to be transgenderā ā for which thereās no evidence other than a couple of very small studies done 50 or more years ago. (In fact, one of them was done by the father of a girl who was a classmate and good friend of mine throughout elementary school; if I had been a little less secretive outside the home about my feelings, and had ended up in his study, I would have been wrongly counted myself as someone who didnāt turn out to be transgender!)
I think the more important problem, though, is that ā like many people ā youāre making erroneous assumptions about who receives this kind of treatment. Nobodyās turning tomboys into trans men. I donāt think you understand the severity and consistency of the dysphoria (and how far back into very early childhood it goes) in those who receive such treatment. If puberty blockers are prohibited for even the severest cases of gender dysphoria, then youāre essentially putting unproven ideological assumptions over the alleviation of very real suffering, and making peopleās future lives extraordinarily difficult. Not only by forcing people to go through the wrong puberty (and I donāt know how I can persuade you how awful it was for me, how much I suffered, and how much I still viscerally despise what it did to me), but by making future transition much more complicated, given the physical effects of puberty. Puberty blockers are reversible. Puberty isnāt.
But Donna, I think you are looking at it from the point of view of someone who in fact turned out to be trans. I think in considering whether to intervene medically on behalf of kids you have to consider also the points of view of those who exhibited all signs of severe and pervasive gender dysphoria during childhood who turned out not to be trans after puberty. It is easy to say after the fact āOh she was just a tomboy; thatās different.ā It is not so easy to sort kids before puberty.
I wouldnāt ācureā a gay or lesbian baby, even if there were magic abilities to determine a babyās sexual orientation and change it. But if I knew that my infant was trans, and didnāt have parts that matched his or her brain, and there were some magic way to turn the baby non-trans, Iād do it. Right now, the alternative is to wait until the kid is older and then embark on a long, complicated process, with serious to fatal possible complications, to have the kid transition to the other gender.
Trans people should transition, if they want to. But we have to admit that right now, the process of transitioning is a major medical process. Iād just as soon my kid didnāt go through it, if I had the choice. Itās not like being gay. A gay person is gay, and there is nothing medical they need to do to transition to gayness.
No, it isnāt easy. I guess the question is, how much suffering should be deliberately caused to gender dysphoric kids by forcing them to go through puberty ā especially when puberty has already begun and they hate its effects ā based on the theoretical possibility that some (unknown) percentage of them might turn out not to be trans, based on dubious studies done 50 years ago (all of people who were assigned male at birth, so far as I know)? As far as āthe points of view of those who exhibited all signs of severe and pervasive gender dysphoria during childhood who turned out not to be trans after puberty,ā how many documented cases like that are there, really? As I said, Iāve read accounts of some of the āboysā in those studies who in fact did turn out, decades later, to identify as trans and transition. Thereās just a big difference between being an āeffeminateā boy, or a girl whoās a tomboy, and the kind of severe gender dysphoria weāre talking about. For example, friends of mine perceived my son as probably being gay from the time he was 2 or 3 years old ā it was pretty obvious then, and it still is, given the extent he gets harassed on the street on a daily basis, with strangers calling him the āfā word. And I donāt think he strongly identified as a āboyā in childhood, either. On the other hand, even though he engaged in cross-gender play once in a while, he never once said he wanted to be a girl. And he liked the effects of male puberty a lot, from what he told me ā nothing at all like my reaction to it. Contrary to what some might assume, he is not at all the kind of kid who would be a candidate for this kind of thing.
Well, Cardinal Fang, I understand what youāre saying, but itās really all in the realm of fantasy right now. And perhaps by the time thereās a āmagic pillā to make a trans child non-trans by changing their brain to match their body, thereāll also be a different magic pill that will enable their body to grow up in a way that perfectly matches the way their brain feels. And then weāll be back to square one!
And, as I said before, I donāt know If I would really have wanted my parents to give me the first kind of magic pill as a small child, if it existed. My life would obviously have been much easier in many ways if I could have grown up as a non-trans boy (even though Iād rather have grown up as a non-trans girl, if weāre talking magic!), without all the decades of severe dysphoria, and the suffering I went through with all the complications from surgery back in 2009. But then again, I wouldnāt be me, would I? I canāt even really imagine what I would have been like.
'Very very few kids who exhibit gender dysphoria when young actually turn out to be transgender. Iām fine with letting kids present as whatever gender they want and to allow them to be as fluid as they want about it. Iām against any medical intervention until very late adolescence but certainly after puberty. "
There are several troubling things in this argument that need addressing. First of all,I have seen some of the āstudiesā you are quoting, and they are out of date for many reasons.
I have heard critics, usually in the blogsphere, claiming that āJonny likes to play with his sisters dolls, so letās turn him into a girlā (along with the usual rant about the emasculinization of America, etc), as if this just happens on a whim. As Donna pointed out, the kids we are talking about have been living as their gender identity for years, they have been under the care of therapists and other experts, when it comes to kids they are a lot more stringent with them then they are with adults (put it this way, there are surgeons who will take your money as an adult and do the GRS if you have the money, even the slimiest of them would not touch a kid, and no professional is going to certify a young kid for surgery, believe me, they care too much to do that). The tomboys, the effeminate boys, the boys who like dress up, probably never even get to the step of cross living or seeing professionals, they get weeded out pretty early. One of the problems with earlier studies is that they lumped together all kids who seemed to be gender non normative, so of course a lot of them later on decided they werenāt girls or boys, it was a sample that contained kids who simply were questioning; these days, I would bet if you took a group of the kids we are talking about, the ones who cross live, who are seeing counselors and such, very few of them would revertā¦the earlier study basically was bogus, it was including apples and oranges.
Again, this isnāt parents and kids deciding āokay, give my kid blockers, etcā, there is a process around this to protect the kids, for obvious reasons.
The other thing to keep in mind is that the medical intervention with young kids is limited, they donāt do hormones or surgery, they use hormone blockers. Why? For the very reason that the blockers are not permanent , that if the kid one day says āheck, I am no girlā or āI am a girlā, they can stop them, and the body will go through puberty. All the blockers do is stop the hormones being produced from taking effect, they donāt suppress the production, and if you stop taking the blockers, the kid will go through puberty as their body is producing hormones for. Yes, there can be side effects to the blockers, but guess what, so do other medical treaments, ever read the disclaimers on most prescription meds? lol.
And not using the blockers is cruel if the kid ends up being trans. Like I said, if the kid eventually decides they arenāt trans, they can revert, stop taking the blockers, and there will be no permanent changes (unlike with hormones). However, when puberty hits changes happen that even if the kid later on goes on hormones, will be hard and costly to fix. When boys hit puberty, it isnāt just body hair and beard (bad enough), the bones become larger and thicker, the shape of the skull changes (ie the brow bossa, the ridges over the eyes), the chin becomes larger, fingers and hands and feet grow bigger, all kinds of things that later on will make it a lot harder to pass as women. For girls, they will start menstruating, their body will remain smaller, and of course will develop the other characteristics, like breasts and such, along with bone development (I believe even the hipās bone structure changes at puberty, though I could be wrong about that). Worse, when those hormones hit, it causes even more dysphoria, testosterone to a kid who feels they are a girl feels alien, as do estrogens when they id as a boy, hormones are a lot more than the physical, they also change the emotional and intellectual patterns of the brain, and if your brain is cross wired, every description you read of trans folks will tell you it is a living hell, even for those not quite sure they are dysphoric, changes at puberty are not welcome. On top of everything else, the changes that puberty does can be very expensive to reverse, if a boy develops a heavy beard it can cost a lot to remove it (taking hormones does not remove the beard), getting rid of the brow ridge and the heavy bone structure in the face can cost many tens of thousands of dollars, for a F to M the top surgery can be very expensive, as can getting excess fat removed that make the figure appear like a girl, and other things are not really fixable, like large hands and feet.
āIf the cause of gender dysphoria is hormone levels in utero, then what would happen if there was a hormone treatment that could reverse the effect? Take a 4 month treatment at age 18 and like magic, your feelings āmatchā your body. Would it then be appropriate to recommend or choose to take such a medical approach?ā
That would have to be up to the person involved, if such a ācureā was possible, knowing the difficulties of being trans in this society, some may take it, the same way if there was a way to ācureā homosexuality some might take it (more than likely, if such a thing was possible, I am sure there would be more than a few from certain quarters, who would be all about forcing the ācureā on trans and gay people). I doubt very much such a magic pill exists, the brain is wired in utero and believe me, doctors back in the dark ages, and some a-holes today still promote the idea that the cure is to give the person massive doses of āappropriateā hormones, but it doesnāt work, just makes them more depressed.Again, it would be appropriate if the person themselves chose to be ācuredā, it should be up to them. The thing is, though, that cure does not exist and likely will never exist, and we have to talk about what we have today and what we have to offer young trans people.
If we are supposed to be a land of self determination, then the answer is it should be up to a person to make their own choices. If parents working with therapists and such see how unhappy their kid was as a boy letās say, let her live as a girl, see her happy, and there are no indications it is something else, then why shouldnāt they get her age appropriate treatment? If by the time they are 16 or 17, and have been living as a girl for 10 years or more, have been under the care of professionals, seems happy and well adjusted, then maybe HRT and GRS is appropriate. We arenāt talking walking into an āSRS clinic R USā as a boy and walking out a girl, we are talking the end game of a long process, and the only ones who should be involved in that decision are the parents, the child, and professionals. There should be protocol there, requirements (a lot of adult trans folks are not happy about gatekeepers and such, but they are adults, when it comes to kids, there do need to be rules).
āI think in considering whether to intervene medically on behalf of kids you have to consider also the points of view of those who exhibited all signs of severe and pervasive gender dysphoria during childhood who turned out not to be trans after pubertyā
As Donna and I pointed out in another post, the situation you are talking about is not that likely to happen these days, the statement made here may have been true a long time ago, but today, after close to 50 years of research and study and dealing with trans people of all ages, there is a lot more knowledge about how to treat kids who exhibit signs of being gender dysphoric, and with that has come expertise in weeding out pretty early the kids who are merely different with their gender expression. it isnāt perfect, nothing is, but the other part of this is with young kids, the things they do with them are non permanent, Donna and I both seem to be in agreement that young kids should have nothing done to them that is permanent. Hormone blockers are not permanent, they delay puberty, until such a time as a)the kid decides to revert, which apparently few do these days, or they are old enough to start HRT and eventually do GRS. The process with young kids takes into consideration it is possible they will change their minds, and among other things they donāt start the permanent stuff until the kid has been living as their desired gender for many years and has been evaluated, and the likelyhood that a kid would cross live as a girl/boy for 10 years, working with therapists and such, and suddenly say "I am not thatā is pretty slim. The other factor is it is only in recent times that parents have even thought of allowing their kids to cross live, with the studies you are talking about, the kids for the most part never got to explore actually living as the gender they thought they were. If you took the effeminate boy and made him live as a girl full time or the tomboy and made her live as a boy full time, they likely might like it for a while, but would likely throw it off quite soon after doing it, the problem with the earlier studies is very, very few kids were allowed to ātry it outāā¦these days, as kids are being allowed to live and dress appropriate to their perceived gender, it tends to weed out the kids who simply are gender non conforming or whatnot.
There is a parallel to this with adult transwomen and hormones, the changes hormones make on a personās body end up being a kind of test, those who are not sure, those who might be on some sort of fantasy trip and whatnot, when the changes hit can realize it isnāt for them; with young kids, living full time as a girl or boy will likely become tiresome to a kid who is not truly dysphoric IMO.
Sorry for the delay in responding.
The idea of questioning oneās gender and ultimately identifying as oneās birth sex/gender is interesting. I think itās important not to class people who question their gender or even begin transition and then decide that they really do identify as cisgender as āfaking,ā ādishonest,ā āwishy-washy,ā or ābad PR for trans people,ā etc. As with sexuality, questioning and realizing that you are straight or cis doesnāt mean that your questions were ill-founded or dishonest, just that you asked them and got answers.
@Hanna : Actually, Iām a psychology researcher and counselor (PhD student, natch), so Iām very familiar with how we as a field conceptualize and classify things. 
Personally, I donāt think gender dysphoria should be in the DSM (and felt that way long before it ever occurred to me to question my gender/sex), though I understand that there are benefits to retaining it for insurance purposes. It just strikes me as analogous to the way that we classified same-sex attraction as a mental illness 30-40 years ago. IMO, the research points more clearly to trans-ness being a birth defect of sorts than it does to it being a pathology, With that being said, the DSM 5 criteria for gender dysphoria do actually allow for entirely physical/genital-related dysphoria, though the significant impairment/distress criterion remains (which I think is a bot of a shame, as it basically says that your dysphoria needs to be making you really miserable before you can take any medical steps to transition, even reversible ones).
In terms of identity, Iāll admit it baffles me a bit that people seem to read this as something non-binary when it feels very binary to me. The body I want is a distinctly, unambiguously male body. Actually, one of things that worries me is that the steps that would address my dysphoria the most are all/both surgical, which means that they would be costly and come at the end of a long process. In fact, most trans men donāt get them (and many donāt want them, especially bottom surgery) while if I could get only the surgeries, Iād be very okay with that. Some of the hormone effects sound nice (more of a male body shape, for example), while some are things I could do without (increased body hair and baldness, neither of which I have ever thought looked good on anyone).
Like I said, I have no clue where Iāll end up with all this. In 6 years, maybe Iāll laugh at every thinking I was male. Or maybe Iāll be transitioned and laugh at ever thinking I was female. Regardless, I canāt do anything about it in my current department (where most of the faculty, most of the undergrads, and a good portion of the grad students are openly ant-LGBTāIāve had to painstakingly hide my non-straightness), so I guess I should just focus on graduating (that pesky dissertation) and getting a job. Plus, transitioning sounds like a massive endeavor.
Anyway, sorry for talking this thread so far afield!
(Oh, and to whoever askedāIām 27. Why do you ask?)
@psych-
Nice written thoughts. As far as people saying gender is non binary, the reason behind that statement varies. Some believe gender like gender expression is a construct, so if people wouldnāt get hung up on it, they wouldnāt need to transition since gender isnāt so rigid that you need to change yourself to fit some cultural norm or whatnot (it is in reality, to me, making gender identity and gender expression the same thing, and they arenāt). Others claim that since we are all in the middle of this mish mash that is not binary, why canāt you simply express yourself as you want, and you will be fine? The biggest problem with this argument to me is that gender can be binary, while everyone is probably a mix of male and female traits, for lack of a better term, a lot of people do identify strongly with the binary, and to claim that that isnāt true is invalidating their feelings, their identity, it is as bad as denying that there are people who are multi gender or non gendered or whatever.
As far as your feelings, there are more than a few men who donāt like baldness or body hair, hair removal is a big business for men these days, and baldness cures are not exactly a small industry lol (not to mention that you may not go bald with male hormones). One of the things where you have to give yourself a break is if your feelings seem to be non standard, there is nothing that says you should embrace baldness or body hair, the same way that a M to F trans woman doesnāt have to embrace the negative aspects of female hormones, like emotions all over the place, or embrace that being a woman means dressing like a grandma or dressing like a hoochy, you get my point. There are transwomen who have no desire to get rid of their male genitals, as much as they otherwise feel like women, others canāt wait for it all to match, no two are alike.
It is why it is all a process, why people have to explore. Support groups are great because you get a feeling where you lie and you often find people in the same boat, and realize you are not unique. Expressing your gender, however you choose to do it, can tell you a lot. Hormones are a test as well, and if you decide at some point to take them, you may find they donāt match what you need. As you wrote, there is nothing wrong about questioning and then figuring out it isnāt for you, this is not a simple journey for many people, so much hinges on our identity, and that is complex.
Well . . . my Vanity Fair finally arrived in the mail today. I am about half way through the piece. I think that actually reading it will answer a lot of the ābut what about X and what about Y?ā questions. So far it is very balanced and really not about the photo spread.
As an aside I have to say that my doggy LOVES the Tom Ford sample that came in this issue. She begs for the perfume and cologne pages and sits and waits while I tear them out for her. Iāll take that over rolling in dead things any day. She is a good smelling dog this evening!
@saintfan can your dog teach mine? She much prefers duck poop 
Have you offered her cologne sample pages? Mine gets down and rubs her neck and body all over them - kind of diving in repetitively.
I find it hard to conceive of a university psych department where most of the faculty and students are anti-LGBT in this day and age.
@consolation -Same here with the exception of very conservative and/or religious universities. There was an issue a few years ago at Eastern Michigan when a psych student refused to counsel someone because of his (?) sexuality (the details are a little fuzzy) and she was expelled from the program. I remember there was outrage from those who supported her and the school essentially argued that they canāt allow a student/employee to discriminate. EMU eventually settled out of court. Not sure what happened to her after thatā¦