On the Science of Changing Sex

A Voice of Their Own

Posted in Transgender Youth, Transsexual Field Studies by Kay Brown on July 9, 2016

Or, What Do Transkids Think About Puberty Suppression?

transkids

Transkids after transition

In the media and especially in social media, we see lots of discussion regarding what is the appropriate standard of care for transkids.  Many adults seem to be horrified by the idea that kids should be treated at all.  Of course, anyone that thinks about it clearly will see that without puberty suppression, one is already making a decision to treat them with hormones, the ones that the body starts to make at puberty.  Thus, the justification for puberty suppression, under the notion that delaying it isn’t really making a hard and fast decision.

But what of transkids themselves?  What do they think about it all?  How about asking them?  Well, a recent paper does just that, as the paper describes them,

“They were between 13 and 18 years of age, with an average age of 16 years and 11 months, and a median age of 17 years and 4 months. All adolescents, except for one, were treated with puberty suppression. The mean age at which the adolescents started treatment with puberty suppression was 15 years and 10 months. The adolescent who was not treated with puberty suppression immediately started treatment with cross-sex hormones because she was above the age of 18 when treatment was indicated, which is in line with the Dutch protocol. Five adolescents were trans girls (natal boys with a female gender identity) and eight were trans boys (natal girls with a male gender identity).”

Note that puberty suppression was their only option until age 18, a state of affairs that I have argued, and will continue to argue, it both unnecessary and cruel, but better than nothing.  This protocol privileges desisters and indeed all non-gender-dysphoric teens in that an active or implicit decision to deliberately use endogenous hormones to masculinize or feminize (as the case may be) their bodies is socially sanctioned, actively encouraged even, but an active decision on the part of gender dysphoric teens is considered suspect and their ability to make such a decision is deemed problematic.  {Can nobody else see the double-standard?  Why, if this is all about not trusting teens to make this decision, are ALL teens not put on puberty blockers until they are adults?}  All evidence points to the age of 14 being an appropriate age to end, not begin, puberty suppression, to be replaced with conventional Hormone Replacement Therapy.  But concerns about transphobic public resistance prevents this evidence based medicine approach.

{On a personal note, I first learned about HRT at age 15, but my pediatrician recommended my mother send me to psychotherapy to “cure” me instead. I began actively requesting feminizing HRT from the Stanford Gender Dysphoria Clinic at age 17 in 1974.  I was denied this.  I had to wait until I was legally of age and began HRT very soon after my 18th birthday in the summer of ’75.  In those days, puberty suppression was not available.  I deeply regret what that delay did to my singing voice.}

So what did these modern teens have to say?  Here’s a typical comment,

“I think it is hard to set an age requirement. On the one hand I think 12 years is a good age minimum, on the other hand I think that a transgender whose puberty started earlier should have the possibility to start treatment with puberty suppression before the age of 12.” (trans girl; age: 13)

You may wish to read the rest of what they had to say at the actual paper at the link below, as it is not behind a paywall, thankfully.

Further Reading:

Essay on evidence for best age to end puberty suppression based on age of desisting gender dysphoria

Essay by Alejandra Velasquez at the transkids.us website on treatment recommendations for MTF transkids. {Note:  Ms. Velasquez was ~20 when she wrote the essay in 2004}

Essay on Advice to Parents of Transkids

References:

Vrouenraets, L. et al. “Perceptions of Sex, Gender, and Puberty Suppression: A Qualitative Analysis of Transgender Youth”
Archives of Sexual Behavior (2016). doi:10.1007/s10508-016-0764-9

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Brainstorm

Posted in Brain Sex, Confirming Two Type Taxonomy, Female-to-Male by Kay Brown on July 2, 2016

critical-thinkingA new review paper has just been published on the current status of brain structure research in transsexuality.  Interestingly, it was submitted to the Archives of Sexual Behavior two full years ago.  This suggests that it went through a rather thorough peer review.  For myself, the first thing I do when reading a review paper is to see that the reference list is comprehensive to ensure that the authors aren’t cherry-picking.  In this case, they are not.  The paper looks to be very complete and scientifically honest.  You may wish to read it yourself, as it is not behind a paywall, thankfully.

The paper is written rather densely, with a great deal of information and discussion; so much in fact, that I will likely be writing several essays covering a number of topics from it.  At the high level, my regular readers will not be surprised at the primary conclusions drawn from the review, as I had already written about a fair number of the brain research papers.  The authors offer this chief conclusion at the end of the paper,

“The review of the available data seems to support two existing hypotheses: (1) a brain-restricted intersexuality in homosexual MtFs and FtMs and (2) Blanchard’s insight on the existence of two brain phenotypes that differentiate “homosexual” and “nonhomosexual” MtFs”

The review of all of the available brain structure research fully supports the Two Type Taxonomy.  In light of this, the authors recommend that future researchers take care to distinguish between the two types, lamenting that some studies in the review had not made this distinction, and further, that it is important that the control groups also be concordant with sexual orientation,

“The study of mixed samples implicitly assumes that transsexuals are a homogeneous group. This is far from the truth with respect to the onset of GD and sexual orientation.  …  These observations signify that control groups in studies of the transsexual brain must be homogeneous in regards to sexual orientation.”

The authors did find separate studies of androphilic “homosexual” MTFs and non-gender dysphoric gay men that used the same methods, such that a tentative comparison could be made,

“The only study on the CTh [cortical thickness] of homosexual persons that do not present gender dysphoria is by the Savic group (Abé et al.). If we compare this study with that of Zubiaurre-Elorza et al. on the CTh of homosexual MtFs, we see both studies report sex differences showing an F > M pattern in similar structures of the right hemisphere. But there is only one region, the pars triangularis, in which homosexuals and homosexual MtFs both present differences. However, these changes are in opposite directions. The pars triangularis of homosexual MtFs is thicker than in heterosexual male controls, while for homosexuals it is thinner than in heterosexual males. Thus, it seems that for transsexuals this region is feminized but demasculinized [i.e.: “different that straight men, but not in the heterosexual female direction” – K. Brown] in homosexual individuals. Interestingly, in both studies, the affected pars triangularis is in the right hemisphere. Nevertheless, confirming Blanchard’s prediction still needs a specifically designed comparison of homosexual MtF, homosexual male, and heterosexual male and female people.”

This is interesting, that there is a difference between gay men and androphilic transwomen?  But the right hemisphere pars triangularis of all things?  For left hemisphere dominant people, this region of the brain is believed to be involved in the understanding and production of prosody, emotionally nuanced speech modulation.  We know this because individuals who have serious lesions in this area have trouble with prosody.

For more information, read the Wikipedia page on prosody.

Before anyone gets too excited about the possible implications for a neurological marker for androphilic transsexuality that differentiates them from gay men, we need to note that the brain exhibits neuroplasticity.  That is to say, that like a muscle, exercise of particular skills causes the brain to increase in volume and neuron number in those regions used to supply that skill.  If this is about language and more particularly, about language production that imparts an emotional / sexual identity / gender identity through one’s voice, the difference in this part of the brain may be caused by experience and practice.

For more information, read my essays on feminine speech production and on voice recognition.

On the other hand, it just might represent a real difference.  We need more studies.

References:

Guillamon, A et al., “A Review of the Status of Brain Structure Research in Transsexualism” Arch Sex Behav (2016). doi:10.1007/s10508-016-0768-5

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