Starting puberty blockers at the onset of puberty is standard care for trans youth. Starting HRT could be, too.

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

Zinnia JonesIf a transgender or gender-questioning youth is experiencing the distress of gender dysphoria about changes to their growing body, when – if at all – should they be treated with puberty blockers to pause any progression of their puberty? Before trying to answer that, let’s look at some recent perspectives offered in the media:

  • The Daily Mail described Dr. Helen Webberly and her practice treating transgender youth as “selling puberty blockers to children as young as 12” and stated that she was “giving hormones to children, including 12-year-olds.”
  • Another Daily Mail article stated that Webberly had prescribed puberty blockers to 11-year-olds and testosterone to 12-year-olds.
  • The Manchester Evening News reported that Webberly “gave puberty blockers to kids”, saying that she “had been prescribing hormones and ‘puberty blockers’ to children as young as 12”.
  • The right-wing Daily Wire interviewed a father who sought to interfere with his child’s continued treatment at a Minnesota gender clinic, obtaining “a court order in 2020 to prevent his son, now 11, from receiving further medical intervention at the clinic, which he claims was ‘weeks away’ from issuing a referral for puberty-blocking drugs.” On his website, the father adds that “Because he has reached stage 2 on the SMR, according to the experts at the gender clinic, a treatment of puberty blockers is considered the next ‘standard of care’”.

These accusations suggest it is self-evidently wrong to provide puberty blockers to trans youth at ages 11-12 or cross-sex hormone therapy at age 12. But is this treatment actually so outrageously out of the norm – or out of the norm at all? Again, when should youth with gender dysphoria be given puberty blockers? Continue reading

Posted in Biology of transition, Endocrinology, Media, Trans youth, Transgender medicine, Transphobia and prejudice | Tagged , , , , , , , , , , | Leave a comment

“Conveyer belt” fallacy against youth transition is missing a crucial piece: all the off-ramps before transitioning

Zinnia JonesAnti-trans advocates have spent years attempting to popularize a folk notion of the process by which trans youth pursue transition, a dramatic picture that scarcely resembles the clinical reality of evaluation and possible treatment for transgender children and adolescents. In this telling, the protocol of GnRH agonists to reversibly delay puberty prior to any decision about HRT is little more than a formality, with puberty blockers actually serving as a “conveyor belt” that universally leads those who take them to continue on to cross-sex hormone therapy. Because of this alleged inevitability, the choice of whether to continue or discontinue transitioning is painted as no choice at all in practice. Arch-transphobe Paul McHugh has long promoted the inevitability argument:

The lack of data on gender dysphoria patients who have withdrawn from puberty-suppressing regimens and resumed normal development raises again the very important question of whether these treatments contribute to the persistence of gender dysphoria in patients who might otherwise have resolved their feelings of being the opposite sex. As noted above, most children who are diagnosed with gender dysphoria will eventually stop identifying as the opposite sex. The fact that cross-gender identification apparently persists for virtually all who undergo puberty suppression could indicate that these treatments increase the likelihood that the patients’ cross-gender identification will persist.

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Posted in Gender dysphoria, Hoaxes, Trans youth, Transphobia and prejudice | Tagged , , , , | Leave a comment

Second report of trans man undergoing successful fertility preservation without stopping testosterone – this time producing a viable embryo and live birth

Zinnia JonesOver the past few years, several studies have explored how the use of testosterone as part of transmasculine transition can affect the potential for fertility in those who still have ovaries. These findings have represented a steady progression toward overturning much of the conventional wisdom on fertility in the context of HRT. Although it has long been known that testosterone is not an effective contraceptive for trans men and transmasculine people who still have a uterus and ovaries, and both intended and unintended pregnancies have been reported while on testosterone (Light et al., 2014), pausing HRT to undergo fertility preservation procedures such as oocyte (egg) retrieval has been a widespread practice. This pause can lead to undesired effects, such as worsening gender dysphoria and the resumption of physical feminization (Armuand et al., 2017).

Along these lines, researchers have examined how long of a pause in testosterone is needed for successful retrieval of viable eggs, and the findings have been promising: Among a group of trans men who had been taking testosterone for an average of 3.7 years and paused HRT for an average of 4 months, all were able to retrieve normal numbers of oocytes that later led to successful pregnancies. In another case report, one trans man paused testosterone for only 24 days and underwent successful oocyte retrieval and preservation during this time. And this year, clinicians reported that a trans man who had been on HRT for 18 months had successful fertility preservation of 22 oocytes while not pausing testosterone at all. Continue reading

Posted in Biology of transition, Endocrinology, Fertility and reproduction, Transmasculine | Tagged , , | Leave a comment

Additional data confirms 10mg of cyproterone acetate (CPA) is effective for testosterone suppression in trans women

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

Zinnia JonesThe antiandrogen cyproterone acetate (CPA), taken as a daily pill, is commonly used outside of the United States as part of hormone therapy to suppress testosterone levels in trans women and transfeminine people who still have their testes (Hembree et al., 2017). Although CPA blocks the action of testosterone at androgen receptors and reduces the body’s production of testosterone, it also strongly stimulates progesterone receptors, potentially producing undesirable effects.

In recent years, increasing attention has been given to the role of CPA in spurring the growth of meningiomas, brain tumors which are usually benign and frequently express progesterone receptors (Roser et al., 2004). While these tumors may have already existed at a very small size without any apparent symptoms, and in many cases may remain unnoticed indefinitely (Yano et al., 2006), the presence of a strong progestogen such as CPA can cause them to grow over time to a size that produces symptoms such as headaches, vision loss, and seizures. Meningiomas are also known to be responsive to the body’s own progesterone levels, with cis women being significantly more likely than cis men to develop meningiomas (Sun et al., 2015), but CPA’s progestogenic effect is substantially stronger than that of progesterone itself (Hammerstein, 1990), and numerous cases of meningioma in trans women taking CPA have been reported in the literature (Nota et al., 2018). Continue reading

Posted in Antiandrogens, Endocrinology, Oncology, Progestogens, Transgender medicine | Tagged , , | Leave a comment

Three decades and hundreds of transfeminine breast augmentations show rare regret and trends toward larger implants

Zinnia JonesTrans women and transfeminine people seeking breast augmentation as part of medical transition face certain concerns distinct from cis women who may receive this surgery. Our anatomical baseline is very different from that of adult cis women, with a recent study finding that 7 in 10 trans women developed breasts of less than an A-cup after three years of feminizing hormone therapy, and only 58% stating that they were satisfied with their breast size.

This surgery is also in heavy demand among trans women, as around 80% either received this surgery or desired to receive it, and 85% of recipients stated they sought the surgery because of insufficient breast growth on HRT. Given anatomical differences in our upper body shape and size, the Johns Hopkins Center for Transgender Health has published information on specific techniques and approaches to produce the best aesthetic results for post-pubertal trans women.

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Posted in Breast, Oncology, Outcomes of transition, Surgery, Transfeminine, Transgender medicine | Tagged , | Leave a comment