Testosterone ramps up chest dysphoria, which leads to top surgery, and on it goes

Hi, I’m a pediatrician who used to be far more active on this website. I have a lifetime membership since I was an early joiner. I was big on Howard Dean, that’s how I found Markos. I got really interested in permaculture and kind of faded away from this place a few years ago as my attention moved away from politics.

However, I’ve been sucked back in to a tiny corner of politics via my job. Over the past couple of years I’ve started seeing more and more young women announce that they are transgender. I wrote about my first four such patients here:

www.kevinmd.com/…

That was last October, about the time I joined Twitter (@JuliaMasonMD1) to also state my concerns. It’s been . . . interesting. Honestly I’m feeling politically homeless right now. I’ve always been liberal, and before I had personal experience with transgender medicine I sort of conflated trans rights with gay rights in my head.

I can’t do that any more.

There are some very important differences between being gay and being trans. If you are gay, you just want to be left alone, to love whom you choose and marry whom you love. Gay rights activists tell kids that it gets better. When Kinsey studied human sexuality over 60 years ago, he postulated that about 10% of the population was gay. That estimate has not changed a whole lot in the past 6 decades, despite major social changes.

Conversely, trans activists want more than to be left alone, and they tell kids that they need hormones and surgery to be better. The incidence of trans identifying kids has increased by crazy amounts, and the gender distribution has changed as well. Gender dysphoria used to be extremely rare, less than 0.5% of the population, and it was almost entirely boys saying they were or wished to be girls. Now there is a whole new cohort who discover they are trans right around puberty, in adolescence or even young adulthood, and these are mostly female.

The table I’m showing above is from a paper by a gender doctor at my alma mater — Children’s Hospital Los Angeles. She has one of the busiest pediatric gender clinics in the country. She’s starting young trans men (natal females) on testosterone at pretty young ages, and then finds that after starting to get male characteristics like a beard and a deeper voice “their chest dysphoria goes through the roof.” I’m quoting from this video of her presenting this research:

So her patients have increasing unhappiness about their breasts, and the solution is surgical removal of the breasts. The chart shows this happening with 13 yr olds, which, I don’t know, strikes me a too young for such a decision. Teenagers can have some deeply held beliefs that they later change. It’s normal for teenagers to explore different identities. It’s not normal for doctors to prescribe hormones and refer for surgery for ideas/feelings that are less than a year old, but that is happening.

And so, of course, we are seeing more and more detransitioners. These are people, mostly female but also male, who started medical treatment, like testosterone injections, and then changed their mind. (Generally if a person socially transitioned and then reverted back to their birth gender, that’s called desisted, but not everybody is using these terms in the same way.)

I’ve personally met with people who regret their transition. Even my textbook FTM patient (described in my KevinMD article linked above) has recently told me that they’re considering going off testosterone, because every time a girlfriend leaves him they “hook up with a real man.” He’s just 19 years old, started testosterone age 16.

I recently realized that I have a chance of engaging in dialogue with people who think slowing down pediatric transition is transphobic, by posting here. I know that most of the loud reactions to pediatric transition are coming from conservatives, and I worry that tribalism is going to lead most liberals/progressives to assume that if the state legislature of Texas or South Dakota says something is bad, then it must be fine.

I look forward to answering any questions people may have, although it may take me a couple of hours — I’m starting my afternoon clinic. I may not respond to insults — I’ve got a lot going on and have to prioritize constructive engagement — but I’m hopeful there are other people out there who were unaware of what’s happening and want to know more.