Spironolactone can be ineffective as an antiandrogen for many trans women

For trans women and transfeminine people who choose medical transition, one of the most common treatments is the use of hormonal medications to reduce testosterone levels and raise estrogen levels. By moving testosterone and estrogen levels into the normal female range, cross-sex hormone therapy diminishes masculine features and produces the development of feminine features.

However, one of the medications most commonly used to block testosterone for trans women in the United States may be one of the less effective medications for this purpose. A growing body of evidence suggests that spironolactone does not usefully lower testosterone into the female range for many trans women. Continue reading “Spironolactone can be ineffective as an antiandrogen for many trans women”

Even more data confirms: Trans people’s awareness of their gender long precedes disclosure to others

Last month, I looked at the findings of Restar et al. (2019) in Transgender Health, which examined the developmental trajectories and milestones of trans women aged 16 to 29 and found that their own awareness of their identity as women typically preceded their disclosure of their gender to others by several years. This is relevant to the uniquely poor methodology used in the “rapid onset gender dysphoria” study, in which reports from parents alone were used, and a child’s disclosure of their transness to a parent was equated with the time at which that child’s transgender identity actually appeared. It also comes to bear on the all-too-common objection heard by trans people from family members that they “never saw any signs” of the person’s transness – when all this means is that the trans person hadn’t yet decided to show any signs.

Findings such as those from Restar et al. overturn the naïve assumption of a developmental trajectory that starts with reading about trans people on Tumblr, continues with self-identification as trans 5 minutes later, and is followed by telling your parents 30 seconds after that realization. And another recent study offers further details on the developmental course of known and lived transgender identity among an even younger age group. Continue reading “Even more data confirms: Trans people’s awareness of their gender long precedes disclosure to others”

How soon can AFAB trans adolescents expect physical changes from testosterone?

As of this month, it’s been seven years since I started HRT, and I can still recall the excitement, anticipation, and impatience of waiting for the first physical results to appear. (It turned out to be 10 days after starting, with the first noticeable hint of breast and areolar changes.) I also remember the acute discomfort and deep sadness, ten years prior to that, of seeing my body grow more and more unsightly and uncomfortable hair every day, heading in exactly the wrong direction. It would have been fantastic if the dread of the latter could have been replaced with the joy of the former, and with the advent of puberty blockers, trans youth today increasingly have the opportunity to access that very possibility.

But even the Endocrine Society’s most recent version of its transgender treatment guidelines offers only rough estimates of the timeframes of physical changes from hormone treatments for trans adults, apparently based only on the authors’ general clinical experience, and nothing on trans youth using puberty blockers and cross-sex hormones to induce the correct puberty. A recent study helps to change that, examining just what the course of puberty looks like for adolescent trans boys. Continue reading “How soon can AFAB trans adolescents expect physical changes from testosterone?”

Contra “ROGD”: A recent cohort of youth evaluated at Amsterdam’s gender clinic does not have less intense gender dysphoria or greater psychological issues

Attempts to legitimize the lay anti-trans narrative-slash-conspiracy theory of “rapid onset gender dysphoria” as a genuine health condition are risky business, as specifying particular features of an alleged new clinical phenomenon places it in the dangerous realm of that which can be disproven. Littman (2018), in her extensively criticized paper on this supposed condition, claimed that “clinicians have reported that post-puberty presentations of gender dysphoria in natal females that appear to be rapid in onset is a phenomenon that they are seeing more and more in their clinic”, and cites parental reports that “clinicians failed to explore their child’s mental health, trauma, or any alternative causes for the child’s gender dysphoria.” Zucker (2019), commenting on “ROGD”, asserted:

Over the past dozen or so years, it is my view (and that of others) that a new subgroup of adolescents with gender dysphoria has appeared on the clinical scene. This subgroup appears to be comprised—at least so far—of a disproportionate percentage of birth-assigned females who do not have a history of gender dysphoria in childhood or even evidence of marked gender-variant or gender nonconforming behavior.

Littman, Zucker, and others have further implied that a shift in the sex ratio of adolescents presenting for evaluation for gender dysphoria toward those assigned female is itself indicative of the emergence of an entirely new kind of dysphoria. These assertions – that a clinically distinct new phenomenon has emerged over the past decade, and that this is embodied largely by apparently gender-dysphoric AFAB adolescents assigned female who experience serious psychiatric comorbidities that may be presenting only the appearance of gender dysphoria – are testable. And a recent study from Amsterdam’s VUmc gender clinic puts them to the test. Continue reading “Contra “ROGD”: A recent cohort of youth evaluated at Amsterdam’s gender clinic does not have less intense gender dysphoria or greater psychological issues”

Study: Spironolactone with medroxyprogesterone acetate suppresses testosterone in trans women more effectively than spironolactone alone

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

While spironolactone is one of the most commonly used antiandrogens in feminizing hormone therapy, some trans women are still unable to achieve suppression of their testosterone levels into the desired female range with spironolactone. A recent clinical study examined the potentially beneficial effects on trans women’s testosterone levels from adding a medication whose use in feminizing HRT has been hotly debated: the synthetic progestin medroxyprogesterone acetate (MPA). Continue reading “Study: Spironolactone with medroxyprogesterone acetate suppresses testosterone in trans women more effectively than spironolactone alone”