Comprehensive Bibliography for Gender Affirmation Culture Concerns

Comprehensive Bibliography for Gender Affirmation Culture Concerns

With discussion of the negatives of gender affirming care and the potential risks of gender reassignment surgeries, there's a justified concern that there's harm or misinformation in the statements. That’s primarily my fault for failing to support my arguments enough – I typically rely on the trust of my audience to follow me and most of you did. Thank you. But someone asked "do you have any proof of your claims?" Sadly, I have more than I wish ever existed starting just a few paragraphs later in this article.


The lesson plan for Pride Month took over 6 months of research and collaboration with fellow Sexual Psychologist Kiara Vann & Childhood Development Specialist Juanita Thorne. Although small and not typically boastful, The Butters is a fact based sexual health education company first and foremost. Our team is packed with knowledge and thoughtfulness. Our goal is to enable people to make the best decisions for themselves through education. I've been studying psychology and human sexuality academically for 22 years and teaching for 14. I helped create the Human Sexuality minor at Eastern Michigan University - yes this is also my autistic special interest, if you're wondering. I'm thrilled to be able to show you how I and we work a bit more.

What I rely on most for up-to-date information is primarily firsthand accounts typically found via YouTube and insights gleamed from my personal counseling clients but we've got academic sources as well. Obviously I keep confidence for private conversations. Those insights were anonymized in the previous articles on the topic. This is a collection of videos, quotes from YouTube videos of firsthand experiences, articles for further reading and links to more info about the risks related to surgery.

I recognize the sensitivity and complexity of this issue. I too brushed it off, until people came to me personally. Hopefully this info is as enlightening for you as it was for me.


In their own words:

“I started testosterone when I was 18 through informed consent. I had a tele health appt with a doctor at a gender clinic. I was diagnosed with dysphoria after this very same appt, after being asked stereotypical questions about my childhood. I got my testosterone a few weeks later after getting my bloodwork done. Then later had an in-person appt to learn how to inject myself… I reached my goal of passing as stealth all the time… But still had dysphoria.”


“Before that (bottom) surgery my life as a trans woman was nice…”


"Detransition is not about demonizing trans people. When people talk about detransition, it’s often framed as a right-wing issue, with comments like, 'Oh, they made the wrong decision, so trans people are not real. They will change their mind; it’s just a phase.'"


 "I took testosterone for six years. It helps masculinize the body, affecting fat redistribution, hair, and voice. Transitioning looks very different for each person; how you express your gender—how you want to look—is defined by each individual. When I reflect back and think about what was difficult about being male, I realize I was often prejudged as aggressive, unclean, or not in touch with myself. That’s not who I was.


As I began to embrace my masculine expression, my beard grew fuller, my voice deepened, and I started to look like a cis male. However, I felt increasingly disconnected from those around me. I didn’t feel like I belonged, and this led me into a deep depression for about a month or two. Eventually, I realized I needed to figure out what was going on with me. I came to understand that I didn’t have to be on hormones for the rest of my life.


When I decided to detransition, my primary care physician told me I could simply stop taking hormones. She advised me to take it slow, adjust to the changes in my body, and allow myself time. She emphasized the importance of having empathy and compassion for myself, to accept and understand why I was going through these experiences. It turned out to be a beautiful journey of self-discovery and acceptance."


"…In my head, it was like a sort of movie where I saw my life play out in different ways. There was one reality where I stayed in this relationship, and he proposed to me in the way I wanted, which was on a beach. I've always wanted to be proposed to on a beach, but then I would be proposed to while looking how I did—with facial hair, short hair, a chest binder, and feeling huge and gross (gross in my eyes). And then what? I would have my wedding and wear a tux? I never wanted to wear a tux. Then what? I get top surgery and then get pregnant?


There was this other reality that I had when I was little, this version of myself that I had always sort of envisioned. Even throughout my transition, I always felt deep in my soul that I was eventually going to live as a woman again, as a female again. There was always this little voice that would kind of say, 'Do you really never imagine yourself wearing a wedding dress? Do you really never see yourself with long, pretty hair and makeup, like your mom?' I just felt it. I felt it. I'm very intuitive; I feel things so deeply, and I thought that throughout the entire transition..."


"I was like, 'God, just wake me up as a boy. Don't let anybody remember that I was a girl, and my life will be perfect.' Clearly, that didn't happen. I was always kind of jealous of the boys. Nobody ever tried to get them to wear a dress, obviously. No one ever told them they weren't ladylike. In my mind, I was just another boy—I didn't fit in with the other girls. I have always felt more masculine, which is okay, by the way; you don't have to be a boy just because you're more masculine.


I was experiencing so much depression because I didn't feel like that was me. I just did not feel like I was supposed to be a girl; I felt like I was supposed to be a man. So, around the end of my 19th year, I decided to go on testosterone. I went to a handful of visits with a counselor, and the counselor wrote me a note to an endocrinologist saying that I had dysphoria and should go on hormones. So, I went to the endocrinologist, and during my first visit, I got my testosterone."


"You know, that's when I started the journey of seeking out treatment. I guess I went through GenderGP. They were pretty quick to prescribe me because they use the informed consent model, which is bad. Informed consent is this idea that you can transition based on being informed. You know, I was not informed. I couldn't have been informed. Nobody knows the extent and side effects of these medical procedures. That’s kind of scary to me.


From taking hormones almost immediately, I was getting side effects. I remember just being tired all the time, drained. I used to work 13-hour shifts in a restaurant, and it never used to be a problem, but for the first time, I was struggling with that—just struggling in general, you know. I also started getting problems in my eyes. I was getting dry eyes for the first time. I've always been into computers and gaming and stuff, so I just thought it was nothing and kind of brushed it off.


It wasn’t until about three months in, when my eye symptoms got really bad, that I went to an optometrist. They told me that the oil glands in my eyes—some of them—had died off and shut down. That was quite terrifying, this idea that I had permanently damaged myself. You know, especially feeling like your eyes are so important. It’s been over again now since I’ve stopped taking hormones, but I still suffer with issues every day. My eyes are just red, burning, and crispy constantly. It’s a mild hell, I’d say."


"In the school playground, I was the dirty, smelly kid that was bullied. The girls' playground was separate from the boys' playground; the boys' playground was concrete and violent. The girls' playground was up some steps, and you couldn't see in—it was protected with shrubbery and hedge rows, and you could see that there was a lawn, flowers, and laughter. Because of what I went through as a kid, I was seeking wholeness.


I closed myself off in my mother, I closed myself off in the appearance of femininity in the dressing-up box at play school because it was so different from the reality of my life as a little boy. That became a habitual coping strategy. After a lot of therapy and introspection, the boy that I was sought wholeness with my mother, who was also absent. We need tenderness, safety, protection, and love, and I was just looking for that."


"When I was a teen or after I had just turned 15, I came out to my family. I went through a lot of old notes today where I was talking about why I thought I was trans. Most of the reasons were because I wanted to look like a guy, to be perceived as a guy. I had just gone through a very traumatic sexual experience with an older man on the internet (thankfully not in real life), but it was still extremely traumatic for me. It affected my confidence, my sense of self-worth, and my desire for people to perceive me as a woman. The reason that whole thing happened was because I was a female existing on the internet, so I wanted to change my gender.


After that happened, I got very active in the trans communities on Reddit and Twitter and spent most of my time online. I didn't have any friends or go to school at that point, so the only people I talked to on a daily basis were from the online trans community. About a year later, I started testosterone at 16. I had been seeing a therapist who tried to tell me she didn't want me to transition. When she told me that, I was like, 'F*** you, I'm not ever coming back here.' I then went to a therapist from the LGBT Center who was ready to get me on hormones from day one. She was excited and ready to help me transition.


Six months went by with her, but she was an awful therapist. Every session, she would talk about her life, telling me stories from when she was growing up as a lesbian. I was like, 'Okay, you're my therapist, but okay.' After those six months, I got on testosterone, and I was so excited for all the changes. I wanted my voice to drop, broad shoulders, facial hair—I wanted to be seen as a boy. All of that happened for me almost immediately after starting testosterone at age 16. My voice dropped a lot, probably because I was still a teenager, and that hasn't changed much since going off testosterone, which is likely a permanent change for me.


I got all the changes I wanted within the first six months. I was totally passing as a guy, probably even within the first month because my voice dropped immediately. I felt a lump in my throat within the first week, and I remember how excited I was that I wouldn't be perceived as female anymore. It's ironic now because my voice drop is the biggest thing I'm insecure about as a woman.


So, I got all the changes I wanted through hormones. In the first year, I still looked very young—like a 12-year-old boy with a fat face and gross sideburns. My face started to thin out, and I looked more like a teenage boy around 17 or 18, which was my age at the time. I gained a lot of weight in the second year because I was eating a lot of pasta every day. I gained weight, which made me insecure, but I was happy because I was living as a man for the first time and totally passing as a man.


I changed my name and gender marker, living completely socially as male. Then I got a girlfriend, and everything was at the top of my life. I got everything I wanted from transitioning and didn't think about being trans anymore. My girlfriend was great; we had great intimacy with no problems related to being trans. But from 18 to 19, I started questioning my gender identity again. I graduated high school, broke up with my girlfriend, and felt really sad about the relationship. I didn't know what to do with my life, hadn't gotten into any colleges, and was really confused about where I was going next.


I didn't like my body, was really fat, and hadn't had top surgery. I thought a lot about myself that summer, started losing weight through exercise, and went vegan. I felt really good about myself—probably the best I'd ever felt. Losing weight made me feel weird, like how could I feel so good just from losing weight? I lost about 50 pounds, exercised, ate healthily, and liked my body. After starting testosterone, I stopped having bottom dysphoria, which should have been a red flag. I had intense bottom dysphoria before testosterone, but once I started it, it disappeared.


I never felt dysphoric about not having a penis throughout my entire time on testosterone. Once I lost weight, started expressing myself through clothing, I began questioning my gender identity again. I thought about being gender fluid, non-binary, or something else. I started enjoying shopping for the first time, always wearing my binder because I never got top surgery. I thought, 'What if I had worn a bra with this?' but I had never been comfortable with my breasts.


I met non-binary and transmasculine people who were comfortable with their bodies, and I wished I could do that. I went through a long period, from early 2019 to the end of summer, questioning my transition. I wondered, 'What if I had never transitioned? What if I had just learned to love myself?' But I thought, 'I can't have that anymore; I made my decision.'


In fall 2018 and spring 2019, I did college applications, worked over the summer, and got into my state school. The week I moved out, I realized I could express myself however I wanted. My hair started falling out in clumps, which was a source of confidence for me. I Googled 'trans guys who go off testosterone because of hair loss' and found the detransitioning subreddit. I saw a post that clicked with me, realizing I could be a cis woman again.


I stopped hormones, let my body do its thing, and understood I hadn't gone too far. I wasn't trapped in an inauthentic life anymore. Transitioning made me happy, but living as a woman was more authentic. I learned that I shouldn't have transitioned. I needed friends, meaningful relationships, and school to reconcile my female identity with myself. That's where I am now."


"I was maybe eight or nine when I hit puberty, and it was around this time that my anxiety started. Then, I began feeling discomfort within myself. When I got into high school, I fell in with an LGBT friend group. In this group, everyone’s identity was so fully aligned with their sexuality or gender that I began to believe this was normal. I thought it was normal to have your only personality trait be your gender or sexuality.


This was how I thought all friendships worked—your gender or sexuality was central to your identity. Many of my friends would say their only personality was their gender or sexuality. I thought people were supposed to be that way, living in a sort of righteous bubble that defied societal conventions. We idolized people like Elliot Page or Hunter.


Eventually, I realized I was trans and decided to fully transition. I struggled with my body a lot when I was younger. Finally, I decided to fully transition, aiming for procedures like a double mastectomy or bottom surgery. I thought this would make me happy. When you're young, you don't assess the information you take in. When I saw information about transitioning, I thought it was the solution to my body and femininity issues.


Very early in my life, I decided that as soon as I turned 16 or 18, or raised enough money, I would run away from home, get a double mastectomy, and go on testosterone because I was non-binary. I didn’t feel comfortable being feminine. My parents weren't against trans people, but the whole culture of LGBT teens is that you're misunderstood by your parents. I perceived my relationship with my parents in this way, whether or not it was true.


Now I know my parents love me no matter what, but I still found reasons to resent them and isolate myself from them. Many people I admired had issues with their parents, and this influenced me. This is a charged issue, and I don't intend to criminalize my parents, but I'm skeptical of a movement that isolates children from their parents and encourages them to step away and find a 'found family' instead of cooperating and trying to understand their biological family.


I had a terrible relationship with my parents and the rest of my family. It was easy to fall into the mindset of 'no one understands me' because I felt my issues were unique. Later, when I spoke about feeling feminine when I was younger, I realized it didn’t mean transitioning was the answer. One of the biggest issues I have now is that transitioning is seen as a positive solution when the real solution is often self-acceptance. No one explained to me that puberty is a difficult time emotionally. I knew hormones were high and my body would change, but no one told me how strange it feels to transition from childhood to adulthood. The difficulty of that transition does not necessarily point to your gender identity; it points to your own discomfort and mental health."


"When I was 18, I started identifying as male from a biological female. I found that identity on YouTube. I watched a lot of YouTube videos and found that many girls my age felt like they were boys and started identifying as male. I asked everyone in my life to call me by a male name and use male pronouns, which they did. This is known as social transition. So, I went through a social transition from female to male when I was 18. By the time I turned 19, I started taking testosterone, and about a year after that, I had a double mastectomy (top surgery) and had my breasts removed. A couple of years later, I had a hysterectomy to remove my uterus and ovaries.


Something went seriously wrong during that surgery; they left arteries open, and I wasn't recovering well. They kept me at the hospital, unable to figure out what was wrong until an ultrasound revealed I had been bleeding internally for hours. They rushed me into emergency surgery, which fixed the issue, but I had three blood transfusions before I was able to leave the hospital.


My relationship with my parents and peers was good. I had no history of trauma; my parents were married, and I had a little sister. We had a really good home life and school life. I was socially awkward at times but had friends in elementary school. Middle school was harder, but overall, I was a good student with friends. In high school, I became more comfortable being myself and making friends. I played sports and identified with my biological sex. I was a tomboy, very into sports, and enjoyed it.


I didn't think I was a boy while in school, but I did start identifying as a lesbian during my junior year of high school. I don't think I was necessarily attracted to women; I just felt like I fit better into the category of a lesbian than anything else. Being a tomboy made it difficult to fit in with other women, especially in middle school. I went to a Catholic school and wore uniforms, refusing to wear dresses or skirts. I wore pants and cut my hair short, looking more like one of the boys.


In high school, I played sports and had friends with other female athletes. Being a tomboy wasn't necessarily hard, but I wore boys' clothes, which separated me from other women. Not being interested in dating boys or having a sexual relationship made me feel disconnected from other girls my age. Everyone else was starting birth control and talking about sex with their boyfriends, which wasn't on my mind at all.


Growing up, I didn't hear much talk from other women about the difficulties of becoming a woman, but it seemed there were many expectations around acting like a proper lady. That felt overwhelming, but not necessarily scary. At 18, I felt like I only wanted to wear boys' clothes. Before, I had a mix of men's and women's clothing, but then I only wanted men's clothing and felt an overwhelming need to cut my hair.


When I cut my hair and wore boys' clothing, strangers sometimes mistook me for a boy. I enjoyed being called 'buddy' or 'sir,' which made me feel good. Looking online for why I felt this way, I came across YouTube videos of girls transitioning to male. They described feelings of dysphoria and the euphoria of being affirmed as male, which made me feel great.


These videos about starting testosterone, having a deep voice, and more masculine features made me want that. I was chasing the feeling of being on top of the world with my outward appearance. Reflecting on my childhood, I saw my memories differently. I was always a tomboy, never feeling like I was supposed to be a boy, but I kept reading those emotions into my childhood.


So, I started pursuing social transition. I asked everyone to call me by a male name and use male pronouns. My family and friends supported me in this process. Eventually, I underwent medical procedures like testosterone therapy and surgeries to align my body with my gender identity."


"It was a little off, but it was my first real consultation. Papa said he knew what to expect, but I didn't really know what exactly I should be looking for or what to hear from the surgeons. The nurses were super nice and very helpful, but the actual surgeon was kind of arrogant and standoffish. I remember asking to see pictures of some of his patients, and he hesitated, which should have been a red flag. But when you want something, you look past the ugly, only to end up in a place where you're not happy.


I don't regret transitioning at all. I'm happy to be Ryan. But if I knew then what I know now, I would not have done it."


"My first year and a half were pretty good. People accepted me positively most of the time, and I can't recall any horrible experiences with anyone. Of course, some people were a bit upset and doubted the entire transition. My dad even resorted to ignoring most of my existence, but that wasnt enough to get me down… I'm not exactly sure when it happened, but somewhere in 2017, the transition started to affect me negatively each day. Being transgender is quite rough. I didn't know whether people were looking at me because that's what people do, or if they were looking at me because I was somehow weird as a girl.


I never really passed well. There are some good images, but that's mostly because I picked the best out of a million others. In real life, I just had too many doubts and felt paranoid and insecure. I got called a boy a lot. Many people only understood after a long conversation. I started losing my willpower and didn't know what I was fighting for anymore. I just didn't have the motivation to act like a girl anymore.

It was around that time that we also moved to a different home. Just like I left the house, Tina vanished with it. But, as bad as it may sound, I feel good now. At the end of January 2018, my brother went on holidays and needed someone to watch over his cats. I stayed at his apartment, and it felt like an eternity, but it was perfect for me to reflect."


"I thought at the time that I had been wanting it forever, okay, and thinking about it a lot. But now, looking back, it was like a year before I got it that I decided I wanted it. It felt like I'd been struggling my whole life and that this was the only way to fix it. Gender-affirming therapists told me that gender transition was the only solution to gender dysphoria.


Well, I can look back now and see that it was a whole mess of other issues: an eating disorder, my autism not liking change, and a whole lot of other stuff. But at the time, that's what I was diagnosed with, and that's what they were telling me I had. They told me, 'This is the only way to fix it,' so what else was I going to do, basically?"


"Every pain, every dysfunction, every bit of abuse—I began to block that out by becoming this person. I started watching videos and blogs online of trans women speaking about their experiences, and from that, I began to identify with this feeling of not fitting in as a child, not feeling like I was in the right body. I thought, 'Wow, this is what makes me come alive, what makes me happy.' Men looked at me; I was seen as an attractive figure. I was fuckable.


I remember the pills arriving in the mail. I was self-medicating at the time, buying pills from New Zealand without any idea what I was buying, but I was determined to get them because I had a goal. I was trying, thinking, 'This is what's going to save me. This is everything.' The goal was to change the outside to match the inside.


I see the therapist; we had a couple of sessions, and she asked me about my childhood. Every single YouTube video I watched was ammunition to get what I wanted. I watched every single YouTube video I needed to in order to get what I wanted, even without realizing it. This was me, not even being conscious of the words I was saying, but knowing this was what I wanted.


Calvin was shit. Calvin wasn't good at anything. Managers dropped Calvin. His own parents couldn't love him—how could anyone else? Being gay was a constant reminder of how defective Calvin was."


What other experts and reporters say:


Rethinking youth transition in Sweden, Norway, and Denmark. We set our plan after their forward-thinking research. Let's continue to follow now that all three countries have changed guidelines.

Patient safety for children and adolescents with gender incongruence

Danish Health Authority (


 Norway’s guidance on paediatric gender treatment is unsafe, says review | The BMJ


This documentary was most impactful. While hosted in English on a Mormon page, it was produced by Sweden's equivalent of PBS or BBC, SVT (Sveriges Television). It is funded primarily through a public service tax and is known for its commitment to impartiality, public service, and a wide range of programming, including news, documentaries, entertainment, and educational content. The documentary is also hosted on liberal  leaning channels but without english voiceover.


Part 1 -

Part 2 -

Part 3 -

Part 4 -


Demographics and gender-related measures in younger and older adolescents presenting to a gender service | European Child & Adolescent Psychiatry (


Detransition Among Transgender and Gender-Diverse People—An Increasing and Increasingly Complex Phenomenon

The Journal of Clinical Endocrinology & Metabolism, Volume 107, Issue 10, October 2022, Pages e4261–e4262,



RealClearScience - An article discussing the rise of detransition and its implications in gender-affirming care.

"For years, transgender advocates touted large studies from the Netherlands and Sweden showing that rates of detransition are around 1% or lower. They also noted analyses showing that few transgender people regret their choice to transition. However, the findings of those studies were based on data collected before 2015, dating back as far as 1960."

We Need to Talk About Transgender Detransition. It's On the Rise. | RealClearScience!


Verywell Health - Provides an overview of retransition and detransition, including meaning and statistics.

Despite the limited body of research on the subject, detransitioning is thought to be pursued for a number of reasons, including:3

  • Difficulty coping with the stigma of being gender non-conforming (regarded as a form of minority stress)
  • Developing a more nuanced relationship with one's own gender, sometimes as a result of transitioning
  • Regret about transitioning ("transition regret")


Retransition or Detransition: Meaning, Statistics:,and%20permanent.%20Retransition%20is%20a%20relatively%20uncommon%20occurrence.


Oxford Academic - A study that reports cases of detransition and regret among patients at a gender identity clinic.

"With the increase in numbers of persons presenting for gender-affirming care, shift to informed consent, likely reduced proportion of TGD people receiving an adequate mental health evaluation, and a change in the distribution of TGD people to more assigned female at birth and nonbinary individuals, there is reason to believe that the numbers of detransitioners may increase. It is quite possible that low reported rates of detransition and regret in previous populations will no longer apply to current populations. More research is needed to compare care and outcomes between the less restrictive informed consent model and the stricter interdisciplinary model pioneered in the Netherlands. Although the rates of discontinuing hormones and detransition may change over time, our compassionate care can remain a constant."


Detransition Among Transgender and Gender-Diverse People—An Increasing and Increasingly Complex Phenomenon | The Journal of Clinical Endocrinology & Metabolism | Oxford Academic (


Reuters - A comprehensive look at the phenomenon of detransitioning, the challenges faced by detransitioners, and the need for robust data and support systems.

Why detransitioners are crucial to the science of gender care (


Gender Reassignment Surgery Preparation Risks & Precautions

Gender Affirmation: Do I Need Surgery? | Johns Hopkins Medicine


Vaginoplasty for Gender Affirmation | Johns Hopkins Medicine


Preparing for Gender Affirmation Surgery: Ask the Experts | Johns Hopkins Medicine


Vaginoplasty procedures, complications and aftercare | Gender Affirming Health Program (


Gender Affirmation Surgery: What Happens, Benefits & Recovery (


Gender Affirmation Surgeries: Common Questions and Answers (


Outcome of Vaginoplasty in Male-to-Female Transgenders: A Systematic Review of Surgical Techniques | The Journal of Sexual Medicine | Oxford Academic (


Aesthetic and Functional Outcomes of Neovaginoplasty Using Penile Skin in Male to Female Transsexuals | The Journal of Sexual Medicine | Oxford Academic (


Bottom Surgery: Cost, Recovery, Procedure Details, and More (

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