But now is the time to learn more, stop listening to scaremongers, and start having real, honest, respectful conversations. We hope this will help. The best estimate at the moment is that around 1 per cent of the population might identify as trans, including people who identify as non-binary. That would mean about , trans and non-binary people in Britain, out of a population of over 60 million. Some trans people might not have the language or understanding of what it means to be trans until later in life.
My wife knew I was feminine and sort of queer, as I tarnsexual a professional drag queen early on in Happy transexual relationship. Defreyne cautions that he should have regular cancer screenings — no one knows whether testosterone Happy transexual will raise the risk of ovarian or uterine cancer over time. This is what I want, but there is no guarantee it will make me happier. When you were first coming out, where did you find community? I transitioned only a couple years out of college. I never got the gender tranesxual and Meghan allen xxx always struggled with it. Search Article search Search. I have found community everywhere. Feelings, however, can and do change.
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Next Thursday, I will get a vagina. The procedure will last around six hours, and I will be in recovery for at least three months. Until the day I die, my body will regard the vagina as a wound; as a result, it will require regular, painful attention to maintain.
This is what I want, but there is no guarantee it will make me happier. I like to say that being trans is the second-worst thing that ever happened to me.
The worst was being born a boy. But in my experience, at least: Dysphoria feels like being unable to get warm, no matter how many layers you put on. It feels like hunger without appetite. It feels like grieving. It feels like having nothing to grieve. Many conservatives call this crazy. A popular right-wing narrative holds that gender dysphoria is a clinical delusion; hence, feeding that delusion with hormones and surgeries constitutes a violation of medical ethics.
Just ask the Heritage Foundation fellow Ryan T. In this view, it is not only fair to refuse trans people the care they seek; it is also kind.
A therapist with a suicidal client does not draw the bath and supply the razor. Take it from my father, a pediatrician, who once remarked to me that he would no sooner prescribe puberty blockers to a gender dysphoric child than he would give a distemper shot to someone who believed she was a dog.
Naturally, a liberal counternarrative exists, and it has become increasingly mainstream. Transgender people are not deluded, advocates say, but they are suffering; therefore, medical professionals have a duty to ease that suffering.
In this view, dysphoria is more akin to a herniated disc — a source of debilitating but treatable pain. A gender-affirmative model will almost certainly lead to more and higher-quality care for transgender patients. Singal is Mr. Neither has any issue with gatekeeping per se; they differ, modestly, on how the gate is to be kept. The thing is, this is wrong. I feel demonstrably worse since I started on hormones. One reason is that, absent the levees of the closet, years of repressed longing for the girlhood I never had have flooded my consciousness.
I am a marshland of regret. Another reason is that I take estrogen — effectively, delayed-release sadness, a little aquamarine pill that more or less guarantees a good weep within six to eight hours. I know what beautiful looks like. Killing is icky. I want the tears; I want the pain. Left to their own devices, people will rarely pursue what makes them feel good in the long term. Desire and happiness are independent agents.
Transgender people have been forced, for decades, to rely for care on a medical establishment that regards them with both suspicion and condescension.
And yet as things stand today, there is still only one way to obtain hormones and surgery: to pretend that these treatments will make the pain go away. When doctors and patients disagree, the exercise of this prerogative can, itself, be harmful. Nonmaleficence is a principle violated in its very observation. Let me be clear: I believe that surgeries of all kinds can and do make an enormous difference in the lives of trans people. Beyond this, no amount of pain, anticipated or continuing, justifies its withholding.
Nothing, not even surgery, will grant me the mute simplicity of having always been a woman. The negative passions — grief, self-loathing, shame, regret — are as much a human right as universal health care, or food. There are no good outcomes in transition. There are only people, begging to be taken seriously. Andrea Long Chu is an essayist and a critic. Log In. I was not suicidal before hormones. Now I often am.
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Transgender surgery can improve life for most, study confirms
Benita Arren was the third person to join an innovative study of transgender individuals in Belgium. Credit: Bea Uhart. Benita Arren wishes that the human body came with instructions. About a decade ago, Arren was struggling with inner conflict. Then in her forties, married with two children and busy with a job in Antwerp, Belgium, she found them resurfacing. The masculine persona in her head — how she had long known herself to be — was falling away, leaving her feeling as though she had no personality at all.
Hoping that she was experiencing a temporary condition, Arren sought out the closest thing she could find to a handbook for the human experience: the Diagnostic and Statistical Manual of Mental Disorders , a compendium of mental illness and neurological diversity used by psychiatrists. It described what she was going through, but to her dismay, it indicated that these feelings were not going to change. By the time she walked in the door, she had learnt everything she could about the counselling she was required to take and the treatments she might anticipate if she decided to make the transition to live as a woman.
He had just launched a study — the first of its kind — that would follow people such as Arren through their transition and for years afterwards. Arren would be the third person to enrol. On a snowy day earlier this year, she returned to the hospital, as she does annually, to give blood and answer surveys.
He is busy these days: the study has now reached 2, participants across 4 clinics in Europe. That has left scientists and physicians with little data about the long-term effects of such treatment on health, such as cancer susceptibility, or how the brain and body change as people transition both socially and medically.
ENIGI and a handful of other emerging studies could provide invaluable information. Media attention on transgender issues and a general shift in public opinion over the past decade has allowed more people than ever to open up about how they identify and to seek treatment.
ENIGI and a few other studies hope to change that by providing data on the best treatments and outcomes. The research could also reveal some of the basic biology underlying differences among sexes. Tantalizing hints are already beginning to emerge about the respective roles of hormones and genetics in gender identity. And findings are beginning to clarify the medical and psychological impacts of transitioning.
The topic was not discussed. Nevertheless, he moved on to launch the ENIGI consortium in , at a time when things were starting to improve for transgender people in Europe. But patients at the hospital had all received different courses of treatment: physicians generally use their own judgement in choosing a hormone and dosage for each person. It can sometimes be hard to recruit transgender people to studies: a history of discrimination and exploitation has left many reluctant to trust researchers.
Like Arren, nearly everyone he asked to be part of the study said yes. In fact, limited resources have occasionally forced him to turn people away.
The cohort grew as taboos around being transgender started to recede in Belgium. In , a popular television presenter came out. His growing visibility brought more people to the university, and to the study.
Ghent University Hospital enrolled more than participants in , compared to the year before, and the hospital now has a waiting list.
The numbers mean that the ENIGI researchers can finally draw some significant conclusions about the effects of standard care. So far, hormone treatments seem to be safe, with few side effects. The most common complaints from people are lowered sexual desire and voice changes.
But the most significant change the researchers have measured is something positive — a decrease in anxiety and depression after treatment 1. Tristana Woudstra, a year-old university student with waist-length curly hair, tells Defreyne that her hips hurt from the oestrogen treatment she began taking nine months ago.
The hospital sees participants every three months at first and eventually once per year, collecting data each time. After a consultation, participants typically have their blood taken. Researchers track biological indicators, such as stress hormones and immune markers.
Later, they collate these with other data, such as psychological examinations, brain scans and DNA sequences. Senne Misplon, a transgender man, describes his experience taking testosterone. Collecting all of these different data gives the ENIGI researchers a comprehensive look at how treatment affects different people. The impacts are complex, Defreyne says, and can be difficult to parse from those associated with the psychological counselling and the personal growth that many experience.
Giving cross-sex hormones to rodents can alter their sexual behaviour, but no one knows whether a rat thinks of itself as male or female. And lumping people with complex gender and sexual identities into large groups might mask subtle differences and conflate unrelated characteristics. For instance, transgender men might be attracted to men, women or all genders, and might have differences in their brain activity and response to hormones as a result.
Making matters worse, the terminology used in the literature can be confusing; uninformed authors often swap gender terms, especially in older publications. People who transition early in life, for instance, might have different brain characteristics from those who transition later, owing to the way their brains are shaped by societal gender roles or biological factors, such as hormones during puberty. Researchers debate what kind of differences — if any — exist between male and female brains, and many such studies have been poorly interpreted.
But scientists who study gender issues think that the confusion could be partly the result of a simplistic view of sex and gender identity. Sven Mueller is studying the effects of gender transition on mental health and well-being. For instance, some studies have found that men and women use different parts of their brains to rotate objects in their minds.
His team has collected more than brain scans from transgender people, many from ENIGI, as well as from other parts of the world.
Mueller, a psychologist by training, wants to know whether there are hormonal and neurological links between mental health and gender identity. Societal acceptance and support can improve mental health, and although depression rates drop after treatment, the levels of depression and suicide are still above normal.
The work could help to explain why some people are more resilient than others, and lead to better treatment. At the very least, Mueller says, the findings could help to make mental-health professionals aware of the challenges that transgender people face.
In the examination room in Ghent, a year-old transgender man named Ewan is describing how his facial hair has grown since he last visited the clinic six months ago. Defreyne asks about his chest hair. Ewan was happy to enrol in the study, but has no personal interest in the scientific questions. They live in a village near Ghent with 5 dogs, 24 chinchillas and an assortment of other animals.
Dunya says she was never put off by Ewan being transgender. Ewan decided not to have other surgeries apart from his mastectomy. He says he is disturbed by the surgical process to create a penis. He also opted to keep his ovaries and uterus. Defreyne cautions that he should have regular cancer screenings — no one knows whether testosterone treatments will raise the risk of ovarian or uterine cancer over time. Ewan regularly travels to Ghent, where a team closely monitors his response to hormone therapy.
ENIGI and other studies hope to address health questions such as this, a tall order in a field with little research and few answers. Safer worries that, in the absence of controlled research studies, physicians are vulnerable to influence from anecdotes and single-patient case studies. Some of these will overplay the health risks, he says. The Endocrine Society, for example, warns doctors to consider a potential link between androgen hormone treatment and reproductive tract cancer — a risk that could be important to people such as Ewan.
But this link has not been proved in a controlled study. Different countries tend to use different hormone formulations, and some physicians use progesterone in addition to oestrogen, but the approaches have never been directly compared against one another. Other researchers are looking for ways to collect data on a large number of transgender individuals, such as mining health records. But because of inconsistencies in the terminology used by physicians and administrators, it can be tricky, says Vin Tangpricha, an endocrinologist at Emory University in Atlanta, Georgia.
The group has found more than 6, such records. But such associations might not be meaningful — one way to identify causes is to do a prospective study like ENIGI. And such efforts are picking up. In , the NIH launched a prospective study of transgender adolescents. Questions of how — and when — to allow transgender youth to transition medically and socially are among the stickiest in the field. Although transgender issues are becoming more mainstream, the topic remains politically charged.
The researchers must tread carefully to avoid making things more difficult for a group that is already stigmatized. A study involving 2, transgender people is starting to reveal the long-term effects of hormone treatment and gender transition. Mental health tends to rank highly among health concerns, along with HIV. And yet transgender women have largely been excluded from studies on prophylactic HIV treatments, or have been erroneously lumped together with men who have sex with men.
There are reasons to believe that high doses of oestrogen could affect how HIV works in the body and stymie common approaches to treating it, but no one has ever looked at the question explicitly.
As the science picks up steam, however, some researchers worry that physicians might feel pressure to move new findings and observations into practice too quickly. For one thing, the cohort is almost entirely white and all of the participants grew up in Europe. Their experiences might differ from those of transgender people with different backgrounds or who live in countries with more restrictive attitudes. The cohort also only includes people seeking formal medical treatment, which often excludes sex workers and people who buy hormones from the black market.
And the researchers do not yet have a study for people who identify as neither male nor female. He often takes the long view, a necessity when conducting a study that could last several lifetimes.
Its value to science might still take time to emerge, but for people such as Arren, the study has already brought some comfort. Today, she says she feels entirely female, but it took a long time to get that way. Heylens, G. Burke, S. Psychiatry Neurosci. Getahun, D. Download references. An essential round-up of science news, opinion and analysis, delivered to your inbox every weekday.