Three-year study examines trans women’s breast development from feminizing HRT

Zinnia JonesFor trans women and transfeminine people who are considering or at the very beginning of feminizing hormone therapy, one of the most common points of concern – and uncertainty – is breast development. How soon will it start, how fast will it happen, how long will it take, and how large will they become? “What will my breasts look like?” can be a question that many trans women have pondered for years before we ever take the step of bringing them into being.

It’s also a question that, for a given individual, can’t be reliably predicted or answered definitively ahead of time – the only way to find out is to go through with it and discover this firsthand. As with cis women, the dimensions of breast development can vary substantially among trans women on HRT. And while we may not be able to offer a specific answer for an individual, we can obtain information on the typical scope and range of that development among trans women as a group, and how that may differ from the ranges of development exhibited by cis women. Continue reading

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Special considerations for breast augmentation in trans women

Note: This post contains illustrations of breast anatomy.

Zinnia JonesAmong trans women and transfeminine people, breast augmentation surgery is both frequently sought after and frequently received compared to the population of cis women. According to the 2015 U.S. Trans Survey, 8% of assigned-male respondents had received breast augmentation and a further 36% wished to undergo the procedure; in the Netherlands, 40% of trans women who received treatment at Amsterdam’s VU University gender clinic between 1972 and 2018 had undergone this surgery, and 85% reported that this was because they were unsatisfied with the degree of growth from hormone therapy alone. Conversely, only an estimated 1% of cis women in the United States have breast implants (Maher et al., 2020).

While the many different approaches to breast augmentation have long been a specialty centered on cis women’s bodies, these techniques are not necessarily as effective or appropriate for trans women’s bodies. A recent report by surgeons and physicians at the Johns Hopkins Center for Transgender Health (yes, that Johns Hopkins) reviews the particular considerations that must be taken into account when choosing surgical techniques for breast augmentation in trans women.

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Posted in Breast, Outcomes of transition, Surgery, Transfeminine | Tagged , | 3 Comments

No, not all trans people “always knew” since childhood

Zinnia JonesThe infamous “rapid-onset gender dysphoria” study by Littman (2018) made use of a peculiar methodology to support its conclusions: querying only parents on when they became aware that their child was transgender, and treating the acquisition of this awareness ac synonymous with the moment their child “became” transgender. This approach mirrored the common folk notion among unaccepting parents that their child “never showed any signs” of being transgender, and therefore must be mistaken about their newly-voiced gender identity and almost surely must be cisgender after all. This unique approach doesn’t assess a trans person’s timeline of gender identity development, only a cis parent’s desire to believe that their child’s transness is false and fleeting so that they can count on the certainty of ultimately having an assumed-cisgender child once more.

For this reason, the “ROGD” study produced conclusions directly at odds with the existing literature on trans identity development and disclosure. When trans people themselves are surveyed, studies repeatedly find that they were aware of their trans identity for many years prior to their first disclosure to another person – information that is completely erased when cis people are surveyed on when a trans person came out to them. Various publications identify a gap of several years between initial self-awareness of a trans identity and initial disclosure of this identity to others. And a recent study further illuminates the differing experiences of trans youth throughout the process of clarifying their gender identity. Continue reading

Posted in Gender dysphoria, Sociological research, Trans youth, Transphobia and prejudice | Tagged , | 2 Comments

Trans men and transmasculine people on testosterone can grow prostate tissue

Zinnia JonesThe general public’s knowledge of the nature of the physical changes induced by medical transition can be surprisingly spotty: trans women’s breasts are often wrongly assumed to be implants; our long-healed neovaginas are cruelly mischaracterized as “open wounds”; HRT is thought to be something we take merely for the sake of it rather than serving a functional purpose. In reality, cross-sex hormone therapy activates the expression of certain genes possessed by everyone whether assigned male or assigned female, and causes development of the associated secondary sex characteristics. Trans women taking estrogen will grow breast tissue with the same anatomy as that of cis women. The neovagina can differentiate into layers of cells highly similar to normal vaginal tissue (Grosse et al., 2017). And a recent study has reported on a “novel and previously unrecognized” finding: the growth of prostate tissue within the vaginal tract of trans men and transmasculine people taking testosterone. Continue reading

Posted in Biology of transition, Endocrinology, Transmasculine | Tagged , , | 1 Comment

Open questions: Trans men and transmasculine people can experience abdominal and pelvic pain after starting testosterone

Zinnia JonesCollaboration between the transgender community and health researchers plays an essential role in ensuring that our population’s knowledge and interests are acknowledged and represented in medicine. When researchers neglect to reach out and utilize the community’s collected experiences and shared knowledge, it’s easy for them to overlook significant issues that are widely recognized among trans people but make almost no appearance in medical literature. For instance, consider the phenomenon of chronic depersonalization disorder in trans people, which we’ve frequently described as intense and unremitting before starting HRT, and suddenly disappearing once we’re on HRT. Yet the specific symptoms of depersonalization among trans people have only barely been studied in medical publications. Conversely, trans people often find themselves without access to the language, to the term depersonalization, to describe these symptoms as what they are.

Better communication between the trans and medical communities can be mutually enriching, with medical professionals becoming aware of key issues among the trans population that they may have overlooked, and trans people being able to tap into the resources of medical researchers to investigate and more rigorously clarify various aspects of our health. And one such collaboration has recently shed light on a previously unstudied issue: the emergence of new abdomino-pelvic pain in trans men and transmasculine people after beginning treatment with testosterone. Continue reading

Posted in Endocrinology, Transgender medicine, Transmasculine | Tagged , , , | 1 Comment