How effective is gender reassignment treatment in curing or alleviating gender dysphoria? Does it work and what are the risks? We know from the stories of detransitioners that gender reassignment treatment was not effective in alleviating their underlying psychological problems, trauma or other co-morbidities and in some cases even increased dysphoria.

If medical professionals are too quick to diagnose gender dysphoria and recommend immediate cross-sex hormone therapy and irreversible reassignment surgery, the coexisting issues may remain undiagnosed and untreated.

The only long-term follow-up study of people undergoing sex reassignment surgery suggests that it is not the simple solution we are lead to believe. In particular, it may not be the ‘cure’ for suicidal ideation which is stressed to parents as the reason they must allow their children to start gender reassignment treatment.

Note: Although widely known as gender reassignment treatments, the more accurate term is sex reassignment as all treatments seek to change biological sex characteristics.

Long-Term Results of Sex Reassignment

Long-Term Follow-Up of Transsexual Persons Undergoing Sex Reassignment Surgery

Cohort Study in Sweden (2011)

“Conclusion: Persons with transsexualism, after sex reassignment, have considerably higher risks for mortality, suicidal behaviour, and psychiatric morbidity than the general population. Our findings suggest that sex reassignment, although alleviating gender dysphoria, may not suffice as treatment for transsexualism, and should inspire improved psychiatric and somatic care after sex reassignment for this patient group.”

Read the full study here.

A small recent short-term study of the Lebanese transgender population confirms these findings:

Psychiatric comorbidities in transsexualism: Study of a Lebanese transgender population (2016)

“The question of whether gender dysphoria is associated with psychiatric comorbidity has been addressed in several studies. Several cohort studies have shown that psychiatric comorbidity is one of the main features of poor prognosis following sex change therapy. Gender dysphoria is rare, with an estimated prevalence of 0.001% to 0.002% globally. The literature shows a high prevalence of psychiatric comorbidities in people with gender dysphoria, and that they are more common in male to female transsexuals. Data on long-term mortality show that transsexuals present a 51 % increase in mortality compared to the general population. This is mainly attributed to a six-fold increase in the number of suicides and a higher rate of psychiatric disorders and risky behaviors leading to HIV infection and substance abuse.”

Read the study summary here

 

Puberty Blockers

Note: there is no research on the long-term health effects of  Gonadotropin releasing hormone agonists, or GnRHas, (puberty blockers) used on ‘transgender’ children; the clinical research trials on the effects of treatments have simply not been done. There is, however, research on the long-term effects of blockers used for precocious puberty in girls and studies on the effects of Lupron (the most widely used agonist) on adult women, which we have documented below.

New report describes dangers of giving Lupron to kids

The problems documented in the Kaiser report include extremely brittle bones, anxiety, and seizures. In fact, the FDA told Kaiser Health News that it is currently reviewing the effect that Lupron has on pediatric patients and their nervous systems. But the agency has not yet placed a warning on the drug’s pediatric version describing the potential risk of seizures, bone loss, or mood disorders.

Read the report here

 

Side-Effect Risks of Lupron (most-prescribed brand of GNRH analog, or puberty blocker)

  • Joint disorder/pain
  • Depression
  • Hypertension
  • Weight changes
  • Hepato-biliary disorders
  • Convulsions
  • Interstitial lung disease

Read more here, here and here

 

Cognitive, Emotional, and Psychosocial Functioning of Girls Treated with Pharmacological Puberty Blockage for Idiopathic Central Precocious Puberty

In this longitudinal study, children took the IQ test before treatment and again after 2 years of treatment. It was found that their IQ dropped 7 points from 100 to 93. With 25 treated participants, this 7 point drop was significant (p = 0.002). In both studies the difference in the performance element of the test was greater than in the verbal element. The similarities between the findings of these two studies strengthens their reliability and increases the possibility that GnRHa treatment may have an adverse impact on cognitive functioning in children.

Read the full article here

 

Psychological assessments before and after treatment of early puberty in adopted children.

Intelligence quotient levels decreased significantly during treatment.

Read the study here

 

Lupron for Precocious Puberty and Beyond: Two Decades of Regulatory Silence

Not one of the experts seemed to understand the most basic hazards associated with this chemical,but were nonetheless tasked with evaluating its safety. How can these pediatricians and pediatric endocrinologists be unaware of such vital information pertaining to the hazardous status of a drug they are prescribing and injecting into children? And if the experts are not aware of hazards, then how can the parent and child make an informed decision about whether to accept treatment? Without this information, and the subsequent informed consent, this treatment becomes an experiment by definition;an experiment many parents may not be willing to involve their children in.

Read the full report here

GNRH analog therapy in girls with early puberty is associated with the achievement of predicted final height but also with increased risk of polycystic ovary syndrome (2010)

Conclusion: In girls with early puberty, GNRHa therapy is associated with the achievement of predicted final height; nevertheless, this treatment seems to act as an independent risk factor for the development of PCOS already during adolescence.

Read the full study here.

 

Chest Binding

McClean Clinic information (2014)

Risks include:

Compressed or broken ribs, punctured or collapsed lungs, back pain, compression of the spine, damaged breast tissue, damaged blood vessels, blood clots, inflamed ribs and heart attacks.

Read the full information here.

 

Health Impact Of Chest Binding Among Transgender Adults: A Community-Engaged Cross-Sectional Study

Culture, Health and Sexuality: An International Journal For Research, Intervention and Care, Oct 2015

“Of participants, 51.5% reported daily binding. Over 97% reported at least one of 28 negative outcomes attributed to binding. Frequency (days/week) was consistently associated with negative outcomes (22/28 outcomes).”

Read the abstract here

 

Cross-Sex Hormones

The use of testosterone on girls and women is NOT FDA-approved. Testosterone products are FDA-approved only for use in men who lack or have low testosterone levels in conjunction with an associated medical condition.

See more here.

Potentially the biggest risk for girls is the increase in red blood cells on a female body with a smaller cardiovascular system: women biologically have smaller hearts, vessels and arteries than men, so the known side-effect of blood-clotting is potentially a far greater risk for women.

See the FDA report here.

 

FDA Steps Up Warnings for Testosterone, Other Steroids (2016)

Reported serious adverse outcomes include heart attack, heart failure, stroke, depression, hostility, aggression, liver toxicity and male infertility. Individuals abusing high doses of testosterone have also reported withdrawal symptoms, such as depression, fatigue, irritability, loss of appetite, decreased libido and insomnia.

Read the report here

 

Effect of sex steroid use on cardiovascular risk in transsexual individuals: a systematic review and meta-analyses

Clinical Endocrinology (2009)

Conclusions: Very low quality evidence, downgraded due to methodological limitations of included studies, imprecision and heterogeneity, suggests that cross-sex hormone therapies increase serum triglycerides in MF and FM and have a trivial effect on HDL-cholesterol and systolic blood pressure in FM. Data about patient important outcomes are sparse and inconclusive.

Read the study here

 

Bone Mass in Young Adulthood Following Puberty Blockers and Cross-Sex Hormone Treatment in Adolescents With Gender Dysphoria (2014)

Results: Bone Mass Density (BMD) in transwomen decreased significantly from −0.8 to −1.4 and in transmen there was a trend for decrease from 0.2 to −0.3. Effects of the treatment in later life: Not Known.

Read the full study here

 

Mitochondrial Impairment and Oxidative Stress in Leukocytes after Testosterone Administration to Female‐To‐Male Transsexuals (2014)

“Treatment of FtMs with T can induce impairment of mitochondrial function and a state of oxidative stress. This effect should be taken into account in order to modulate possible comorbidities in these patients.”

(Mitochondria are known as the powerhouses of the cell. They are organelles that act like a digestive system which takes in nutrients, breaks them down, and creates energy rich molecules for the cell. Many of the reactions involved in cellular respiration happen in the mitochondria. Mitochondria are the working organelles that keep the cell full of energy. Oxidative stress is essentially an imbalance between the production of free radicals and the ability of the body to counteract or detoxify their harmful effects through neutralization by antioxidants.)

Read the research summary here

 

Masculinising Hormone Information

Gender Centre, Australia Fact Sheet (2014)

Irreversible changes after testosterone hormone therapy:

deepening of the voice;
growth of facial and body hair;
male pattern baldness (in some individuals);
enlargement of the clitoris;
growth spurt if given before the end of puberty; and
possible shrinking and/or softening of breasts (due to fat deposit redistribution)

Risks and side effects include:

Obstructive Sleep Apnoea
Increased Red Blood Cells
Polycythemia
Heart Disease
Diabetes
Stroke
Polycystic Ovarian Syndrome
Ovarian Cancer
Endometrial Cancer
Dyspareunia
Liver Conditions
Suppression of Clotting Factors
High Blood Pressure
Oedema
Acne
Seborrhoea
Can affect existing Mental Health issues

The long-term safety of testosterone is not fully understood. Most of the studies on hormone therapy involve non-trans men taking testosterone at different doses than F.T.M.s usually use, and F.T.M. bodies are not exactly the same as non-trans men’s bodies. There may be long-term risks that are not yet known.

Read the full page here.

 

Informed Consent For Testosterone Therapy

This standard Informed Consent form adds changes in brain structures and changes in emotions and moods to the list above, along with the admission that the outcomes of treatment are impossible to predict and an idea of the amount of health monitoring these patients will need to undergo for life.

View the form here

 

Surgery

Phalloplasty: The dream and the reality (2013)

“Complications encountered in this reconstructive effort include flap failure, urethral fistula, urethral stricture and stiffener related problems.”

Read the study here

 

Long-term outcome of forearm flee-flap phalloplasty in the treatment of transsexualism (2008)

Conclusion: Phalloplasty with a forearm free-flap leads to good results in term of flap survival and patient satisfaction. However, there was a high rate of complications. Patients must be clearly informed that the procedure can seldom be achieved in one stage.

Read the full study here.