If you or someone you know is considering hormone replacement or gender reassignment surgery, it's important to know what you're getting into. With a lot of modern gender affirmation culture, you're being ushered into medicalization without proper awareness of what could happen. The idea is to not scare you but the result has been the creation of detransitioners - people who regret their medical transition.

Before May 2016 the phrase "detransition" doesn't show up in Google Trends with the exception of a single blip in March of 2012. After 2016 the searches grow. But in 2022, after pandemic gender exploration, the term absolutely explodes in popularity. More conerningly OR, ME, UT, MA, VT, MT, NH, RI, & CO lead the pack in interest. If you narrow down to "detransition transgender" there's not a single search until October 2019.

It's clear from our behavior that we've made an overcorrection. My way of dealing with that is to simply break through the cloud of affirmation and provide you with all the information I'd give to someone who asks me in real life. This blog is the entirety of that information. If you get to the end of this and are still willing to risk it, that alone proves your commitment and authenticity. You will have 100% of my backing and support for your journey to being the person you need to be.

 

Gender is Immutable

While you can do many things to look like another gender or remove characteristics of your birth sex, science is unable to actually change what gametes your body produces or rewrite your DNA to accept a change in hormone production - you have a high liklihoodof  health complications from hormones eventually.

The density of your body will not change very much, meaning you will physically feel like your natural sex to people who touch you. You also will almost always still smell like the gender you were born even after decades. Both impact dating potential and confidence. This will primarily be an issue with heterosexual and homosexual partners. Pan and bisexual partners are more likely to welcome the variety.

 

Experimentation

Despite the marketing, gender reassignment surgery (GRS) is experimental at its core. While some procedures like breast augmentation, facial feminization, hysterectomy, oophorectomy, and mastectomy are medical standard, the collection of procedures known as bottom surgery are all being studied. Your case is likely to be used for research purposes. You should expect to be surrounded by medical students and curious professionals for the duration. You may have to work to find a provider that will offer privacy amd dignity. 

 

The Seriousness of Gender Transition

No matter how mentally soothing it may be to have unwanted body parts removed, these procedures involve sterilizing and permanently disfiguring your body from its natural shape. Essentially, you are amputating some of the most crucial parts of your body.

The reality, often overlooked, is that gender reassignment surgery and gender affirmation surgery on a perfectly healthy human body can be considered forms of mutilation. In the same way that amputating any other healthy and functioning body part for mental well-being is also mutilation. Your body does not know about your mental illness and may react to GRS like an attack. It may seek to restore itself in ways that make your body unbearable to live in. Gender transition is a significant and irreversible step, one that should never be taken lightly. This includes the use of hormones.

 

Hormone Replacement

 

Misconceptions About Hormones

There is a common misconception that hormones are not a big deal and that their effects can be easily reversed. This is unequivocally false. Even after just a few months, the effects of hormone therapy can become permanent. If you later decide you want your natural body back, you will find that your natural voice, face shape, and hair growth have been permanently altered by a few months of hormone therapy.

 

Health Risks of Hormone Therapy

Hormones used for gender reassignment or confirmation carry serious and potentially dangerous risks, comparable to taking steroids for performance gains in the gym. There are numerous medical issues associated with the introduction of these chemicals into your body. For instance, taking testosterone alone increases the risk of a heart attack and vaginal atrophy. While taking estrogen can cause testicular atrophy and permanently impair your ability to have children.

 

Emotional Changes

Estrogen

For individuals transitioning from male to female (MTF), estrogen can increase emotional sensitivity. Many report heightened feelings of empathy, increased ability to cry, and a broader range of emotional experiences. This can lead to a deeper connection with emotions and a richer emotional life.

Testosterone

For those transitioning from female to male (FTM), testosterone often reduces emotional sensitivity. Some may find it harder to cry or feel that their emotional responses are more subdued. This can sometimes lead to feeling emotionally disconnected or less expressive.

Mood Swings

Both estrogen and testosterone can cause mood swings, particularly in the early stages of hormone therapy. The body is adjusting to new hormonal levels, which can lead to periods of irritability, sadness, or anxiety. Over time, as hormone levels stabilize, many individuals find their mood becomes more consistent.

 

Personality & Cognition Changes

Estrogen

MTF individuals may notice shifts in their interests and behaviors. For example, some report a newfound interest in traditionally feminine activities or changes in social behavior, becoming more nurturing or collaborative. Estrogen can influence cognitive functions, such as memory and verbal skills. MTF individuals may find improvements in tasks requiring empathy and communication but might experience challenges with spatial tasks.

Testosterone

FTM individuals might experience an increase in traditionally masculine behaviors, such as assertiveness or a greater interest in physical activities. Some also report changes in hobbies and social interactions, preferring more direct communication styles. Testosterone often enhances spatial abilities and can influence decision-making processes. FTM individuals might notice a more analytical approach to problem-solving but could find verbal fluency affected.

 

Gender Reassignment Surgery

Male-to-Female (MTF) Surgery

MTF surgery often includes procedures like vaginoplasty, breast augmentation, and facial feminization. Each of these surgeries comes with its own set of risks. Vaginoplasty, for example, involves creating a neovagina, which can lead to complications such as infections, fistulas (abnormal connections between organs), and narrowing of the vaginal canal. Breast augmentation and facial surgeries also carry the risks typical of cosmetic procedures, including adverse reactions to anesthesia, scarring, and dissatisfaction with the results.

Female-to-Male (FTM) Surgery

FTM surgery commonly includes chest masculinization (top surgery) and phalloplasty or metoidioplasty (creating a penis). Phalloplasty is particularly complex, involving the creation of a neophallus using tissue from other parts of the body, which can lead to complications like tissue rejection, urinary complications, and issues with sexual function. Top surgery, while generally less complex, still carries risks such as hematomas, nipple necrosis, and loss of sensation.

Post-Surgical Maintenance

Both MTF and FTM surgeries require ongoing maintenance and follow-up care. MTF individuals may need to regularly dilate their neovagina to prevent closure, a process that can be uncomfortable and time-consuming. Regular check-ups with healthcare providers are essential to monitor for any complications or infections.

For FTM individuals, maintaining the results of phalloplasty or metoidioplasty can be challenging. Urinary complications are common, requiring careful monitoring and sometimes additional surgeries to correct issues. Chest masculinization may require revisions to address scarring or to achieve the desired aesthetic result.

Long-Term Complications

Long-term complications are a significant concern for those undergoing gender reassignment surgery. These can include chronic pain, scarring, and loss of function. For MTF individuals, issues such as vaginal stenosis (narrowing) and difficulties with sexual function are common. For FTM individuals, complications with the urinary tract and issues with the neophallus can persist long after the initial surgery. This includes scarring, pain, and loss of use. Moreover, both groups may experience psychological impacts if the results do not meet their expectations or if they encounter significant complications. It is crucial for individuals to have a strong support system and access to mental health resources throughout their transition journey.

The Timing of Gender Transition

Gender transition is a decision that should never be made before fully experiencing and understanding the natural development of one's physical adult body. It's a universal fact that adolescents feel uncomfortable in their bodies. Adolescents and even adults may not fully comprehend what it feels like to be in their body and may mistakenly believe that their discomfort is solely due to gender dysphoria.

Long-Term Consequences

The truth is, no one can truly understand what it feels like to be you, except you. Many young people who transition do not end up staying that way because the gender dysphoria or bodily discomfort they experience often stems from other sources. However, once they have taken hormones or undergone surgical procedures, they are left with permanent scars, damage, and disfigurement. These irreversible changes can prevent them from ever becoming the full, healthy adults they could have been.

 

Full Bibliography of modern gender affirming care research & guidelines