Females

  • The profile of people seeking transition has shifted drastically, from overwhelmingly middle-aged males to predominantly adolescent females. Expand
    The profile of people seeking transition has shifted drastically, from overwhelmingly middle-aged males to predominantly adolescent females.

    A 2017 paper [1] notes that “in adolescents, there has been a recent inversion in the sex ratio from one favouring birth-assigned males to one favouring birth-assigned females.” By contrast, over 90% of transsexual adults in the 1960s were male [2].

    In fact, there was hardly any scientific literature before 2012 on girls ages 11 to 21 ever having developed gender dysphoria at all. Yet of the young people described in Lisa Littman’s 2018 seminal paper on young people [3], 82.8% were female.

    The data for the UK’s Gender Identity Development Service [4] show that 138 children were referred in 2011, and most of those children were boys. By 2021, however, a complete sex ratio reversal had occurred, and the clinic saw 2383 children that year, with almost 70% being female.

    A 2017 article by Lisa Marchiano [5] collated data from different clinics around the world and found international evidence for this shift in distribution.

    REFERENCES

    [1] Zucker, K. J. (2017). Epidemiology of gender dysphoria and transgender identity. Sexual Health 14 (5): 404-411. [Link]

    [2] Barrett, J. (2015). Written evidence submitted by British Association of Gender Identity Specialists to the Transgender Equality Inquiry. data.parliament.uk [Link]

    [3] Littman, L. (2018). Rapid-onset gender dysphoria in adolescents and young adults: A study of parental reports. PLOS ONE, 13 (8). [Link]

    [4] Gender Identity Development Service (2021). Referrals to GIDS, financial years 2010-11 to 2020-21. [Link]

    [5] Marchiano, L. (2017). Outbreak: On Transgender Teens and Psychic Epidemics. Psychological Perspectives 60 (3): 345-366. [Link]

  • Female-to-male genital reconstruction surgery has a high negative outcome rate, including urethral compromise and worsened mental health. Expand
    Female-to-male genital reconstruction surgery has a high negative outcome rate, including urethral compromise and worsened mental health.

    The results of a 2021 international survey [1] of 129 female-to-male patients who underwent genital reconstruction surgery support anecdotal reports that complication rates following genital reconstruction are higher than are commonly reported in the surgical literature. 

    Complication rates, including urethral compromise, and worsened mental health outcomes remain high for gender affirming penile reconstruction. In total, the 129 patients reported 281 complications requiring 142 revisions.

    Another paper [2] found a 70% complication rate in one type of female-to-male genital reconstruction surgery.

    Even with the “radial forearm free flap” method of creating a synthetic penis — “considered by many as the gold standard for phalloplasty” [3] — there are high rates of complications, with up to 64% urethroplasty related complications [4].

    REFERENCES

    [1] Robinson, I.S., Blasdel, G., Cohen, O., Zhao, L.C. & Bluebond-Langner, R. (2021). Surgical Outcomes Following Gender Affirming Penile Reconstruction: Patient-Reported Outcomes From a Multi-Center, International Survey of 129 Transmasculine Patients. J Sex Med 18 (4): 800-811. [Link]

    [2] Bettocchi, C., Ralph, D.J. & Pryor, J.P. (2005). Pedicled pubic phalloplasty in females with gender dysphoria. BJU Int. 95:120–4. [Link]

    [3] Rashid, M. & Tamimy, M. S. (2013). Phalloplasty: The dream and the reality. Indian J Plast Surg 46 (2): 283-293. [Link]

    [4] Fang, R.H., Lin, J.T. & Ma S. (1994). Phalloplasty for female transsexuals with sensate free forearm flap. Microsurgery 15: 349–52. [Link]

  • Medical transition puts both males and females at risk of infertility. Expand
    Medical transition puts both males and females at risk of infertility.

    A wide-ranging study [1] found that gender-related drug regimens place patients at risk of infertility:

    Suppression of puberty with gonadotropin-releasing hormone agonist analogs (GnRHa) in the pediatric transgender patient can pause the maturation of germ cells, and thus, affect fertility potential. Testosterone therapy in transgender men can suppress ovulation and alter ovarian histology, while estrogen therapy in transgender women can lead to impaired spermatogenesis and testicular atrophy. The effect of hormone therapy on fertility is potentially reversible, but the extent is unclear.

    On surgeries, the study noted that cross-sex surgery

    that includes hysterectomy and oophorectomy in transmen or orchiectomy in transwomen results in permanent sterility.

    REFERENCES

    [1] Cheng, P.J., Pastuszak, A.W., Myers, J.B., Goodwin, I.A. & Hotaling, J.M. (2019). Fertility concerns of the transgender patient. Transl Androl Urol. 8 (3): 209-218. [Link]

  • There is an array of negative health effects associate with chest binding. Expand
    There is an array of negative health effects associate with chest binding.

    There is a range of negative effects which chest binding can cause [1].

    A survey [2] of transmen who engaged in breast binding found that 68% were concerned about the health effects. The most common symptoms associated with binding were back pain (65%), shortness of breath (48.6%), bad posture (32%), chest pain (30%), and light-headedness (30%).

    REFERENCES

    [1] Peitzmeier, S., Gardner, I., Weinand, J., Corbet A. & Acevedo, K. (2017). Health impact of chest binding among transgender adults: a community-engaged, cross-sectional study. Culture, Health & Sexuality 19 (1): 64-75. [Link]

    [2] Poteat, T., Malik, M., & Cooney, E. (2018). Understanding the health effects of binding and tucking for gender affirmation. Journal of Clinical and Translational Science 2 (Suppl 1), 76. [Link]

  • There is evidence that chest binding has a statistically significant impact on lung function. Expand
    There is evidence that chest binding has a statistically significant impact on lung function.

    A study [1] found that:

    Transgender individuals using chest binders have abnormal lung function. The acute effect of wearing the binder appears to be an overall volume reduction with little other change.

    REFERENCES

    [1] Cumming, R., Sylvester, K. & Fuld, J.P. (2016). Understanding the effects on lung function of chest binder use in the transgender population. Thorax 71. [Link]

  • A study which looked at 27 different negative health effects of binding found that some do not show for years. Expand
    A study which looked at 27 different negative health effects of binding found that some do not show for years.

    A survey [1] of 1800 females who used breast binders reported a number of negative health effects which develop over time. Some of these effects are felt immediately. However, in other cases, it can take years for the negative health effects to be fully seen:

    REFERENCES

    [1] Peitzmeier, S.M., Silberholz, J., Gardner, I.H., Weinand, J. & Acevedo, K. (2021). Time to First Onset of Chest Binding-Related Symptoms in Transgender Youth. Pediatrics 147 (3). [Link]

  • Long-term testosterone use in natal females can cause vaginal atrophy, which makes sex painful. Expand
    Long-term testosterone use in natal females can cause vaginal atrophy, which makes sex painful.

    A study [1] of 16 female-to-male transgender individuals concluded that long-term testosterone administration leads to vaginal atrophy (Baldassarre et al., 2013). The study noted that:

    Vaginal samples from FtM showed a loss of normal architecture of the epithelium, intermediate and superficial layers were completely lost, and glycogen content was depleted.

    Vaginal atrophy, characterized by thinning of vaginal walls and poor lubrication of vaginal tissues, leads to tearing, micro abrasions, bleeding, and painful intercourse.

    REFERENCES

    [1] Baldassarre, M., Giannone, F., Foschini, M., Battaglia, C., Busacchi, P., Venturoli, S., & Meriggiola, M. (2013). Effects of long-term high dose testosterone administration on vaginal epithelium structure and estrogen receptor-α and -β expression of young women. International Journal Of Impotence Research, 25 (5): 172-177. [Link]

  • In one study, 11% of transmen who took testosterone developed a condition called erythrocytosis, which impacts red blood cells and slows the blood flow. Expand
    In one study, 11% of transmen who took testosterone developed a condition called erythrocytosis, which impacts red blood cells and slows the blood flow.

    A study [1] of 776 transmen who took testosterone demonstrated that 11% of them developed erythrocytosis, a condition which slows the blood flow, and can lead to headaches, confusion, high blood pressure, nosebleeds, blurred vision, itching and fatigue.

    REFERENCES

    [1] Madsen, M.C., van Dijk, D. Wiepjes, C.M., Conemans, E.B., Thijs, A. & den Heijer, M. (2021). Erythrocytosis in a Large Cohort of Trans Men Using Testosterone: A Long-Term Follow-Up Study on Prevalence, Determinants, and Exposure Years. The Journal of Clinical Endocrinology & Metabolism 106 (6): 1710–1717. [Link]

  • Genital surgeries tend to reduce the capacity for orgasm in males, and may do so in females. Expand
    Genital surgeries tend to reduce the capacity for orgasm in males, and may do so in females.

    One study showed that around 30% of male-to-female genital surgeries result in the inability to orgasm [1].

    Figures on female-to-male transitioners are less clear. However, a clinical follow-up study [2] of 38 transmen – 29 of whom had received phalloplasty, and 9 metoidioplasty – found that reported loss of orgasmic capacity was more marginally common than reported gain of orgasmic capacity.

    The negative intrapsychic and interpersonal consequences of anorgasmia (the inability to climax) is well-documented, and applies equally to transgender individuals [3].

    REFERENCES

    [1] Manrique, O., Adabi, K., Martinez-Jorge, J., Ciudad, P., Nicoli, F. and Kiranantawat, K. (2018). Complications and Patient-Reported Outcomes in Male-to-Female Vaginoplasty—Where We Are Today. Annals of Plastic Surgery 80 (6): 684-691. [Link]

    [2] van de Grift, T., Pigot, G., Kreukels, B., Bouman, M., & Mullender, M. (2019). Transmen’s Experienced Sexuality and Genital Gender-Affirming Surgery: Findings From a Clinical Follow-Up Study. Journal Of Sex & Marital Therapy 45 (3): 201-205. [Link]

    [3] Levine, S. (2018). Informed Consent for Transgendered Patients. Journal Of Sex & Marital Therapy, 45(3), 218-229. [Link]

  • There is evidence that up to a quarter of transgender genital surgeries result in incontinence. Expand
    There is evidence that up to a quarter of transgender genital surgeries result in incontinence.

    A systematic literature review [1] found that 21% of male-to-female patients and 25% of female-to-male patients suffered from incontinence as a result of transgender genital surgery.

    One recent study [2] estimates the number of post-operative transsexuals suffering stress incontinence to be 23%. This study was not a literature review, and almost all of the participants were male-to-female.

    REFERENCES

    [1] Nassiri, N., Maas, M., Basin, M., Cacciamani, G.E. & Doumanian, L.R. (2020). Urethral complications after gender reassignment surgery: a systematic review. Int J Impot Res. [Link]

    [2] Kuhn, A., Santi, A. & Birkhäuser, M. (2011). Vaginal prolapse, pelvic floor function, and related symptoms 16 years after sex reassignment surgery in transsexuals. Fertil Steril. 95: 2379-82. [Link]

  • Only 5%-10% of transwomen get genital surgery, compared to 25%-50% of transmen. Expand
    Only 5%-10% of transwomen get genital surgery, compared to 25%-50% of transmen.

    A 2019 paper [1] reports that “Genital GCS is generally less common than chest surgery, with prevalence rates of about 25–50% for transgender men and 5–10% for transgender women […] For transgender women, genital GCS comprises a number of procedures, including vaginoplasty (most commonly intestinal or penile inversion) with labiaplasty and/or clitoroplasty, penectomy, and orchiectomy. Transgender women report bottom surgery at rates between 5–13% […]. Even more transgender women desire bottom surgery in the future: between 45–54% […]”

    REFERENCES

    [1] Nolan, I. T., Kuhner, C. J. & Dy, G. W. (2019). Demographic and temporal trends in transgender identities and gender confirming surgery. Translational Andrology and Urology, 8 (3). [Link]

  • Transmen are four or five times as likely as females in general to suffer a heart attack. Expand
    Transmen are four or five times as likely as females in general to suffer a heart attack.

    A 2019 study [1] found that post-operative female-to-male transgender people were 4.9 times as likely to suffer a myocardial infarction (heart attack) than women in general.

    Another study [2] also found a somewhat smaller yet still large discrepancy, concluding that transmen were 3.69 more likely to suffer a heart attack than women in general.

    REFERENCES

    [1] Alzahrani, T. Nguyen, T., Ryan, A., Dwairy, A. McCaffrey, J., Yunus, R., Forgione, J., Krepp, J., Nagy, C., Mazhari, R. & Reiner, J. (2019). Cardiovascular Disease Risk Factors and Myocardial Infarction in the Transgender Population. Circulation: Cardiovascular Quality and Outcomes 12 (4). [Link]

    [2] Nota, N.M., Wiepjes, C.M., de Blok, C.J.M., Gooren, L.J.G., Kreukels, B.P.D. & den Heijer, M. (2019). Occurrence of Acute Cardiovascular Events in Transgender Individuals Receiving Hormone Therapy: Results From a Large Cohort Study. Circulation 139: 1461-1462. [Link]

  • In one study, female detransitioners were three times more likely to be lesbians than to be straight. Expand
    In one study, female detransitioners were three times more likely to be lesbians than to be straight.

    A study [1] of 100 detransitioners, the majority of whom were female, showed that 26.1% of the females were homosexual before they transitioned.

    Only 8.7% considered themselves heterosexual.

    REFERENCES

    [1] Littman, L. (2021). Individuals Treated for Gender Dysphoria with Medical and/or Surgical Transition Who Subsequently Detransitioned: A Survey of 100 Detransitioners. Arch Sex Behav. [Link]

  • In one study of detransitioners, males were three times more likely than females to have transitioned for erotic reasons. Expand
    In one study of detransitioners, males were three times more likely than females to have transitioned for erotic reasons.

    In a study [1] of 100 detransitioners, 38.7% of males identified with the comment “I had erotic reasons for wanting to transition”.

    The figure for females was a third of this, at 13%.

    REFERENCES

    [1] Littman, L. (2021). Individuals Treated for Gender Dysphoria with Medical and/or Surgical Transition Who Subsequently Detransitioned: A Survey of 100 Detransitioners. Arch Sex Behav. [Link]

  • There are 2 sexes: males and female. Biological sex is not a spectrum. Expand
    There are 2 sexes: male and female. Biological sex is not a spectrum.

    According to an Endocrine Society Scientific Statement [1],

    Sex is dichotomous, with sex determination in the fertilized zygote stemming from unequal expression of sex chromosomal genes.

    Sex differences in baseline physiology and associated mechanisms form the foundation for understanding sex differences in diseases pathology, treatments, and outcomes. 

    The erroneous claim that biological sex is a spectrum, or non-dichotomous, is often used to justify the ideological assertion that all humans are ‘assigned sex at birth’. In fact, biological sex is encoded in every cell of the body [2].

    REFERENCES

    [1] Bhargava, A., Arnold, A.P., Bangasser, D.A., Denton, K.M., Gupta, A., Hilliard Krause, L.M., Mayer, E.A., McCarthy, M., Miller, W.L., Raznahan, A. & Verma, R. (2021). Considering Sex as a Biological Variable in Basic and Clinical Studies: An Endocrine Society Scientific Statement. Endocrine Reviews 42 (3): 219-258. [Link]

    [2] Shah, K. McCormack, C. & Bradbury, N. (2014). Do you know the sex of your cells?’ American Journal of Physiology – Cell Physiology, C3-C18, 306, 1. [Link]

  • It is not true that 1.7% of the population is ‘born between the sexes’. The proportion of people with DSDs (‘intersex’ conditions) is 0.018%. Expand
    It is not true that 1.7% of the population is ‘born between the sexes’. The proportion of people with DSDs (‘intersex’ conditions) is 0.018%.

    Conditions in which chromosomal sex is inconsistent with phenotypic sex, or in which the phenotype is not classifiable as either male or female, occur in 0.018% of the population [1].

    The claim that 1.7% of the population is ‘intersex’ [2] includes conditions which most clinicians do not recognize as intersex [1], and is often wrongly used to back up the ideological assertion that ‘sex is a spectrum’, or that biological sex is not dimorphic.

    The philosopher Kathleen Stock points out that she would be considered as “intersex” under Fausto-Sterling’s “preposterously over-demanding conditions on sex category membership”, as she lost an ovary in early adulthood [3], which would count as “intersex” according to Fausto-Sterling.

    REFERENCES

    [1] Sax, L. (2002). How common is intersex? a response to Anne Fausto-Sterling. J Sex Res. 39 (3): 174-8. [Link]

    [2] Fausto-Sterling, A. (2000). Sexing the Body: Gender Politics and the Construction of Sexuality. New York: Basic Books. [Link]

    [3] Stock, K. (2021). Material Girls. Little, Brown Book Group: p.56 [Link]