madman
Super Moderator
Abstract
An increasing number of transgender and gender-expansive adolescents are seeking gender care at clinics and hospital programs and requesting gender-affirming hormonal treatment. Many are approved for this form of care to enhance their gender health. The interventions can either include suppression of testosterone and introduction of estrogen for transfeminine youth or suppression of estrogen and introduction of testosterone for transmasculine youth.
This review article focuses on the psychosocial experiences of youth who have completed their endogenous puberty and are now requesting one of these two forms of gender-affirming hormonal treatment. Calling on research data, established standards of care and practice guidelines, and clinical observations, an investigation is made of the comparative profiles of these two subgroups of transgender/gender-expansive youth; their gender-related experiences prior to receiving hormonal treatment; the relationship between the physical changes and psychological experiences that accompany the introduction of testosterone or suppression of testosterone with replacement with estrogen; the intrapersonal and interpersonal implications of the treatment; considerations of fertility preservation for future family building; the role of the family in the decision-making process prior to starting a course of hormone therapy; and the capacity of youth to make informed decisions about these partially irreversible medical interventions. The review concludes with outlining the task for the medical provider who offers gender-affirming hormonal care to a youth under the age of majority: to work with the family and allied professionals involved in the youth’s care to assure that the youth’s gender health is enhanced, barriers to care are removed, and mental health risks are reduced, whether the T is coming out or going in.
Introduction
From its Greek derivations, the word “andrology” literally translates to “the study of man.” Historically, that meant those individuals born with XY chromosomes. Presently, andrology refers to the branch of medicine concerned with the anatomy, functions, and disorders of the male reproductive system. A key aspect of that reproductive system is testosterone, the hormone that shapes a particular form of secondary sex characteristics, among other things. A group of youth is now showing up in increasingly large numbers at pediatric gender clinics across the globe with a specific focus on that exact hormone. Some are youth with testosterone running through their bodies asking that it be suppressed and replaced with the hormone associated with the field of gynecology, not andrology—that would be estrogen. The others are youth without testosterone pumping through their bodies but asking that it be introduced, and their estrogen put in hibernation. Both groups encompass our transgender or gender non-binary adolescents coming to our gender programs requesting gender-affirming hormonal interventions to consolidate their gender identities and presentations (Coleman et al, 2012; Hembree et al. 2017). Both groups are the focus of this review article on the psychosocial effects of post-pubertal youth asking either that the T be taken out, or the T be put in as they strive to actualize their authentic gender identity.
*A Profile of the Youth Requesting Removal of T
All of the above-mentioned youth share in common the following: they would like to discontinue having testosterone being their adult sex hormone and request replacing the testosterone with estrogen, either to allow them to live full-time as a woman with a body more in accordance with that gender identity (transfeminine youth) or to create their own iteration of gender that is neither male nor female but their own unique gender mosaic. The youth asking to take the T out look forward to breast development, redistribution of body fat to create wider hips and a narrower torso, reduced muscle mass, and softer skin.
*A Profile of the Youth Requesting Infusion of T
Some may be in search of a full dose of testosterone that will generate the secondary sex characteristics associated with post-pubertal males in our culture—facial and body hair, deepened voice, enhanced muscle mass, squared-off facial structure, Adam’s Apple, redistribution of body fat to create smaller hips, broader torsos. Regarding primary sex characteristics, they might also be in search of a medical intervention that will result in their clitoris enlarging enough to approximate a micro-penis, which they learn can occur with the introduction of testosterone.
Others, more likely of the non-binary cohort, may simply desire a “touch” of testosterone—just enough to create a slight deepening of the voice or light peach fuzz above the lip, for example.
*-T or + T: Body changes and Presentation to the World
*- T or +T: Anticipating Body Changes and Associated Internal Feelings
*- T or +T: Effects on Psychological Functions
To summarize, evidence of the psychological effects of either taking the T out or putting the T in include a decrease in gender dysphoria, increase in general well-being, and positive feelings that the youths’ bodies are now better aligned with their gender identities
*- T or +T: Shifts in One’s Social World
*What About the Gametes and Future Family Building?
*Should youth require parental consent to either remove T or put T in?
Conclusion
The cohort of youth who come to medical providers after completing puberty and request gender-affirming hormones both have a great deal in common and also extensive variation among them. Those who were designated female at birth and identify as transmasculine or lean toward masculine will want to suppress the estrogen in their bodies and replace it with testosterone. Those designated males at birth and identifying as transfeminine or leaning toward feminine will want to suppress the testosterone in their bodies and replace it with estrogen. To date, clinical observations and research data indicate these youth may range in age from 12 to 18. No matter what their request and no matter what their stated gender identity, the task for the medical provider will be to work with the family and allied professionals involved in the youth’s care to assure that the youth’s gender health is enhanced, barriers to care are removed, and mental health risks are reduced, whether the T is coming out or going in.
An increasing number of transgender and gender-expansive adolescents are seeking gender care at clinics and hospital programs and requesting gender-affirming hormonal treatment. Many are approved for this form of care to enhance their gender health. The interventions can either include suppression of testosterone and introduction of estrogen for transfeminine youth or suppression of estrogen and introduction of testosterone for transmasculine youth.
This review article focuses on the psychosocial experiences of youth who have completed their endogenous puberty and are now requesting one of these two forms of gender-affirming hormonal treatment. Calling on research data, established standards of care and practice guidelines, and clinical observations, an investigation is made of the comparative profiles of these two subgroups of transgender/gender-expansive youth; their gender-related experiences prior to receiving hormonal treatment; the relationship between the physical changes and psychological experiences that accompany the introduction of testosterone or suppression of testosterone with replacement with estrogen; the intrapersonal and interpersonal implications of the treatment; considerations of fertility preservation for future family building; the role of the family in the decision-making process prior to starting a course of hormone therapy; and the capacity of youth to make informed decisions about these partially irreversible medical interventions. The review concludes with outlining the task for the medical provider who offers gender-affirming hormonal care to a youth under the age of majority: to work with the family and allied professionals involved in the youth’s care to assure that the youth’s gender health is enhanced, barriers to care are removed, and mental health risks are reduced, whether the T is coming out or going in.
Introduction
From its Greek derivations, the word “andrology” literally translates to “the study of man.” Historically, that meant those individuals born with XY chromosomes. Presently, andrology refers to the branch of medicine concerned with the anatomy, functions, and disorders of the male reproductive system. A key aspect of that reproductive system is testosterone, the hormone that shapes a particular form of secondary sex characteristics, among other things. A group of youth is now showing up in increasingly large numbers at pediatric gender clinics across the globe with a specific focus on that exact hormone. Some are youth with testosterone running through their bodies asking that it be suppressed and replaced with the hormone associated with the field of gynecology, not andrology—that would be estrogen. The others are youth without testosterone pumping through their bodies but asking that it be introduced, and their estrogen put in hibernation. Both groups encompass our transgender or gender non-binary adolescents coming to our gender programs requesting gender-affirming hormonal interventions to consolidate their gender identities and presentations (Coleman et al, 2012; Hembree et al. 2017). Both groups are the focus of this review article on the psychosocial effects of post-pubertal youth asking either that the T be taken out, or the T be put in as they strive to actualize their authentic gender identity.
*A Profile of the Youth Requesting Removal of T
All of the above-mentioned youth share in common the following: they would like to discontinue having testosterone being their adult sex hormone and request replacing the testosterone with estrogen, either to allow them to live full-time as a woman with a body more in accordance with that gender identity (transfeminine youth) or to create their own iteration of gender that is neither male nor female but their own unique gender mosaic. The youth asking to take the T out look forward to breast development, redistribution of body fat to create wider hips and a narrower torso, reduced muscle mass, and softer skin.
*A Profile of the Youth Requesting Infusion of T
Some may be in search of a full dose of testosterone that will generate the secondary sex characteristics associated with post-pubertal males in our culture—facial and body hair, deepened voice, enhanced muscle mass, squared-off facial structure, Adam’s Apple, redistribution of body fat to create smaller hips, broader torsos. Regarding primary sex characteristics, they might also be in search of a medical intervention that will result in their clitoris enlarging enough to approximate a micro-penis, which they learn can occur with the introduction of testosterone.
Others, more likely of the non-binary cohort, may simply desire a “touch” of testosterone—just enough to create a slight deepening of the voice or light peach fuzz above the lip, for example.
*-T or + T: Body changes and Presentation to the World
*- T or +T: Anticipating Body Changes and Associated Internal Feelings
*- T or +T: Effects on Psychological Functions
To summarize, evidence of the psychological effects of either taking the T out or putting the T in include a decrease in gender dysphoria, increase in general well-being, and positive feelings that the youths’ bodies are now better aligned with their gender identities
*- T or +T: Shifts in One’s Social World
*What About the Gametes and Future Family Building?
*Should youth require parental consent to either remove T or put T in?
Conclusion
The cohort of youth who come to medical providers after completing puberty and request gender-affirming hormones both have a great deal in common and also extensive variation among them. Those who were designated female at birth and identify as transmasculine or lean toward masculine will want to suppress the estrogen in their bodies and replace it with testosterone. Those designated males at birth and identifying as transfeminine or leaning toward feminine will want to suppress the testosterone in their bodies and replace it with estrogen. To date, clinical observations and research data indicate these youth may range in age from 12 to 18. No matter what their request and no matter what their stated gender identity, the task for the medical provider will be to work with the family and allied professionals involved in the youth’s care to assure that the youth’s gender health is enhanced, barriers to care are removed, and mental health risks are reduced, whether the T is coming out or going in.
