Quantifying testosterone’s suppression of estrogen levels in trans men

Posted on February 29, 2020 by Zinnia Jones

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

Zinnia JonesWhile trans women on HRT typically require testosterone blockers in addition to estrogen to reduce testosterone to the desired levels and produce effective feminization, trans men generally require only testosterone to achieve physical masculinization. However, one potential concern is the effect of aromatase, an enzyme which can convert testosterone into estrogen. Testosterone treatment in cis men has been associated with high estrogen levels in 20% of men in one study (Tan, Cook, & Reilly, 2015), and can produce physical effects such as gynecomastia (Rhoden & Morgentaler, 2004).

Testosterone treatment for trans men aims to induce testosterone levels within the typical male range (Hembree et al., 2017), while levels of estrogen are not usually as much of a concern, although clinicians have raised the possibilities that testosterone treatment could cause either unwanted high estrogen levels through aromatization or unhealthily low estrogen levels through suppression of estrogen production. A recent study of 746 trans men and transmasculine people taking testosterone seeks to answer these questions, measuring the effects of testosterone on their estrogen levels. Continue reading →

Posted in Endocrinology, Transmasculine | Tagged , | 1 Comment

Another look at androgen receptor gene variants in trans women

Posted on February 29, 2020 by Zinnia Jones

Zinnia JonesGender identity, including in trans people, appears to have a physical basis and a biological underpinning, and the Endocrine Society has stated that numerous features suggest trans people’s genders are a matter of likely prenatal development:

Such evidence stems from scientific studies suggesting that: 1) attempts to change gender identity in intersex patients to match external genitalia or chromosomes are typically unsuccessful; 2) identical twins (who share the exact same genetic background) are more likely to both experience transgender identity as compared to fraternal (non-identical) twins; 3) among individuals with female chromosomes (XX), rates of male gender identity are higher for those exposed to higher levels of androgens in utero relative to those without such exposure, and male (XY)-chromosome individuals with complete androgen insensitivity syndrome typically have female gender identity; and 4) there are associations of certain brain scan or staining patterns with gender identity rather than external genitalia or chromosomes.

The developmental origin of gender identity has led researchers to look for distinct genetic features that may play a role in the development of a gender identity contrary to assigned sex. One area of focus is genes related to sex hormones, as differences in the functioning of sex hormones may affect the degree of prenatal masculinization of the brain, potentially altering gender identity even as the rest of the body develops normally (Foreman et al., 2019). Hare et al. (2009) reported the promising result that among 112 trans women, a greater number of repeats of the CAG sequence were present in the androgen receptor (AR) gene compared to cisgender men. The authors note that this longer length results in androgens such as testosterone being less effective at activating the androgen receptor, possibly resulting in reduced brain masculinization prenatally. Continue reading →

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The diverse range of hair transplantation options for trans people

Posted on February 29, 2020 by Zinnia Jones

Note: Some images depict small amounts of blood.

Zinnia JonesHair is an item of significant concern for trans people during transition: hair, its style, and its presence or absence in various areas can be a factor both in one’s experience of gender dysphoria as well as how one’s gender is seen and attributed by others. The most widely known form of hair management is laser hair removal or electrolysis used by trans women and transfeminine people for the permanent removal of unwanted facial and body hair, including from the genitals prior to vaginoplasty. Trans women may also experience male-pattern baldness from years of prior testosterone exposure, making use of treatments such as minoxidil to stimulate scalp hair regrowth (although a degree of scalp hair regrowth has sometimes been reported as a result of HRT alone).

However, a much wider variety of possibilities for hair restoration, alteration, and management – including many I’d never heard of until now – are available for both trans women and trans men through surgical means. Bared & Epstein (2019) provide an enlightening summary of these techniques and the results that can be achieved. Continue reading →

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New study examines HRT’s effects on sexual desire in trans people

Posted on February 29, 2020 by Zinnia Jones

Zinnia JonesOne of the most unexpected changes experienced by trans people after starting HRT can be its wide-ranging and sometimes drastic effects on almost every aspect of our sexuality. Psychologically, achieving a better alignment with your own self often seems to help trans people clarify exactly who and what it is that they actually desire. Sex drive can take a vastly different shape: trans women have reported the remission of almost compulsive urges that required frequent sexual release, while some trans men experience an increase in their libido. The physical experience of sexual arousal can shift substantially, with trans women sometimes noting a strikingly full-bodied experience of being turned on and trans men experiencing arousal as being more genitally focused than before. Trans women have even reported the development of entirely new physical connections, such as nipple stimulation directly producing genital sensations.

Much of these reported changes are anecdotal, shared within the trans community as we compare notes on our experiences in an attempt to learn the specifics of what HRT might do for us and what we might expect as we continue transitioning. These qualitative reports are significant and useful, providing detailed information beyond the more general lists of changes we’re typically given by medical providers when starting HRT. And the sexuality-related experiences of trans people, running certain sex hormone levels on “nonstandard hardware” and complicated by the presence of dysphoria with one’s body and assigned gender, can be distinct in various ways from those of cis people, calling into question the conventional assumption that more testosterone means more libido and less testosterone means less libido. And a recent study, while necessarily more coarse-grained than descriptions of personal experiences, helps to clarify just how much sexual desire tends to fluctuate in trans women and trans men while undergoing HRT. Continue reading →

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How much does testosterone deepen voice pitch for trans men?

Posted on February 29, 2020 by Zinnia Jones

Zinnia JonesThe effects of sex hormones on the vocal cords are a one-way process: male-typical levels of testosterone, whether from natal puberty in those assigned male or from the administration of testosterone in trans men, produces growth and thickening of the vocal cords and a corresponding drop in pitch (Schneider & Courey, 2016). The later use of testosterone blockers and estrogen by trans women who’ve already undergone natal puberty cannot reverse these changes to the vocal cords, and voice feminization for trans women can involve vocal and speech exercises directed toward producing a more feminine-sounding voice (Gelfer & Van Dong, 2013), as well as vocal surgery to alter the structure of the vocal cords and reduce their testosterone-induced growth (Schwarz et al., 2017).

In light of the challenges faced by trans women and transfeminine people in attaining a female-typical voice, many have expressed an assumption that trans men and transmasculine people will tend to have an “easier” experience in achieving their desired voice due to the effects of testosterone. But this is not necessarily the case: the influence of testosterone on voice can vary significantly between individual trans men, and not all trans men will develop a male-typical voice solely from testosterone. Continue reading →

Posted in Outcomes of transition, Transmasculine, Voice | Tagged , | 1 Comment