Welcome to Gender Analysis

Gender Analysis is a web series launched in 2014 exploring transgender science and life experiences in depth, and revealing the many insights to be found at their intersection. We take a closer look at fields such as sociology, public health, psychiatry, cognitive science, and more, weaving these diverse perspectives into a deeper understanding of gender-related phenomena. Gender Analysis goes beyond the 101s to educate both trans and cis viewers on some of the most fascinating dimensions of our lives – and the pressing issues we face in society.

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New episodes of Gender Analysis are published several times a month and are backed by our generous supporters on Patreon. Want to learn more? Check out our instant index for a quick introduction to the wide range of topics we cover:

Curious about…?

Gender dysphoria Self-discovery
How hormones work Bathroom bills
Finding a doctor Treatments for trans youth
Passing Sexuality
Transness and autism Paul McHugh
Regret and detransition Sex chromosomes
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Lower doses of cyproterone acetate may be similarly effective for blocking testosterone, with a lower risk of adverse effects


Disclaimer: I am not a medical professional and this is not medical advice.

Zinnia JonesCyproterone acetate (CPA) is an oral antiandrogen widely used outside the United States (Angus et al., 2019) as a part of feminizing HRT in combination with estrogen. In recent years, increasing evidence has emerged that long-term or high-dose use of CPA, such as in transition treatment for transfeminine people, is associated with a substantially elevated risk of developing meningiomas (Gil et al., 2011). These typically benign brain tumors can cause symptoms such as vision loss, headaches, muscle weakness, and seizures, and can require treatment with radiation or surgery.

The mechanism of CPA’s role in promoting the growth of these tumors is well-understood. CPA is an antiandrogen that occupies androgen receptors as an antagonist to block the binding of androgens like testosterone and prevent them from producing physically masculinizing effects, while also functioning as an antigonadotropin to direct the body to stop producing and releasing androgens. However, CPA is not only an antiandrogen – it’s also a progestogen, binding to progesterone receptors as an agonist and producing a very strong progestogenic effect. Additionally, the antiandrogenic and progestogenic effects of CPA are imbalanced, and so the doses needed to suppress testosterone in transfeminine people also produce a significant excess of progestogenic activity (Hammerstein, 1990). Continue reading

Posted in Endocrinology, Oncology, Transfeminine, Transgender medicine | Tagged , , , | 1 Comment

Once-yearly implanted puberty blockers may last for two years or more

Disclaimer: I am not a medical professional and this is not medical advice.

Zinnia JonesGnRH agonists are a class of medications that reversibly block the progression of natal puberty both in cis youth with precocious (early) puberty and in trans adolescents, allowing trans youth time for decision-making about whether to proceed with more permanent medical transition or discontinue blockers and resume their natal puberty. These drugs work at the pituitary gland to halt the release of LH and FSH which stimulate the production and release of sex hormones, meaning that trans girls on GnRH agonists will temporarily stop producing testosterone and trans boys will stop producing estrogen. If trans youth wish to go on to transition, they can continue taking blockers while receiving cross-sex hormones for the induction of their desired puberty. Continue reading

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Trans women and transfeminine people taking HRT are far less likely to develop prostate cancer

Zinnia JonesConcerns over supposedly cancer-causing effects of cross-sex hormone therapy are an area in which public alarm has often pulled far ahead of the facts on transition and transgender health. For instance, in 2019, the Telegraph breathlessly reported that the “risk of breast cancer rises 46 times for trans women after hormone therapy”. What this framing omitted is that the study found trans women had a 70% lower likelihood of developing breast cancer compared to cis women, that the “absolute risk of breast cancer in transgender people remains low”, and that “following breast cancer screening guidelines for cisgender people seems sufficient for transgender people using hormone treatment” (de Blok et al., 2019).

Abigail Shrier, in her recent book Irreversible Damage: The Transgender Craze Seducing Our Teenage Daughters, referred to a “suspected risk” of uterine and endometrial cancer in trans men taking testosterone, then upgraded this suspicion to the overt claim that testosterone “can raise the risk of endometrial cancer significantly” in an interview at the Heritage Foundation’s Daily Signal; Jonathon Van Maren’s review of Shrier’s book makes the completely separate claim that puberty-blocking medications used for trans adolescents “create a higher risk of” cancer, an assertion that was not made by Shrier. Continue reading

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Clascoterone, an upcoming topical antiandrogen for acne and hair loss treatment without systemic effects

Zinnia JonesFor trans men, transmasculine and nonbinary people who choose medical transition with testosterone, this treatment can sometimes lead to acne breakouts on the face or body. Testosterone has been found to causes increased skin production of sebum in trans men, which is a factor in the development of acne (Giltay & Gooren, 2000), and the Endocrine Society (Hembree et al., 2017) and the World Professional Association for Transgender Health (Coleman et al., 2012) have noted that acne can begin to develop as soon as one month after starting HRT.

Acne can represent a significant burden for trans people taking testosterone: Wierckx et al. (2014) reported that after 6 months of treatment, 82.4% of trans men developed facial acne and 88.2% experienced acne on their chest or back, and half of the participants in the study began using acne treatments such as topical benzoyl peroxide or oral antibiotics. Notably, Motosko et al. (2019) found that 52% of trans men on testosterone in their study sample experienced acne, compared to only 6.7% of cis men. Higher levels of testosterone also appear to be associated with a greater likelihood of developing acne (Park et al., 2019). Continue reading

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Don’t go bananas over spironolactone and potassium

Disclaimer: I am not a medical professional and this is not medical advice.

Zinnia JonesSpironolactone has recently been in the news due to apparently unfounded concerns that taking it could increase the chances of contracting pandemic coronavirus or suffering from more severe COVID-19, so this is a good time to examine one of the classic misconceptions about this medication: the potential risk of elevated levels of potassium.

While spironolactone is widely used as a part of transfeminine hormone therapy (particularly in areas such as the United States where the antiandrogen cyproterone acetate is not available) to inhibit the masculinizing action of testosterone in those who still have testes, this is not the purpose it was originally meant to serve. Instead, it’s one of a class of drugs known as potassium-sparing diuretics used to treat high blood pressure and congestive heart failure by promoting greater excretion of water through urination, reducing blood volume and therefore reducing blood pressure; in this role, its antiandrogenic action is a side effect. Continue reading

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