Males

  • 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]

  • One study showed that, without social transition, nearly two-thirds of pre-teen gender-dysphoric males grow up to be gay or bisexual. Expand
    One study showed that, without social transition, nearly two-thirds of pre-teen gender-dysphoric males grow up to be gay or bisexual.

    A University of Toronto study [1] found that 63.6% of boys with early onset gender dysphoria, who received ‘watchful waiting’ treatment and no pre-pubertal social transition, grew up to be gay or bisexual. 

    Only 12% of the study participants continued to identify as transfeminine. 

    REFERENCES

    [1] Singh, D., Bradley, S.J. & Zucker, K.J. (2021). A Follow-Up Study of Boys With Gender Identity Disorder. Frontiers in Psychology 12. [Link]

  • The chances of developing osteoporosis and cardiovascular problems increase with feminizing hormones. Expand
    The chances of developing osteoporosis and cardiovascular problems increase with feminizing hormones.

    A 2012 paper [1] found that a quarter of the male-to-female transsexuals it studied had osteoporosis at the lumbar spine and radius.

    In the same study, 6% of male-to-female transsexuals experienced a thromboembolic event (a blood clot causing obstruction), and another 6% experienced other cardiovascular problems. These effects were observed after only 11.3 years of hormone treatment on average.

    A further study [2] found that long-term bone mineral density decreases in transwomen who take cross-sex hormones in the long term.

    REFERENCES

    [1] Wierckx, K., Mueller, S., Weyers, S., Van Caenegem, E., Roef, G., Heylens, G. & T’Sjoen, G. (2012). Long-Term Evaluation of Cross-Sex Hormone Treatment in Transsexual Persons. The Journal of Sexual Medicine 9 (10): 2641-2651. [Link]

    [2] Delgado-Ruiz, R., Swanson, P., & Romanos, G. (2019). Systematic Review of the Long-Term Effects of Transgender Hormone Therapy on Bone Markers and Bone Mineral Density and Their Potential Effects in Implant Therapy. Journal of clinical medicine 8 (6): 784. [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]

  • While long-term study is lacking, one case study suggests that tucking can affect fertility. Expand
    While long-term study is lacking, one case study suggests that tucking can affect fertility.

    In a case study [1] of one transwoman, tucking resulted in oligospermia – an abnormally low sperm count – affecting fertility. Elevation of the testes because of tucking may contribute to heat stress and consequent impairment of spermatogenesis.

    After cessation of tucking and the provision of a new sperm sample, the sperm count in the patient was improved, and the semen had increased opacification.

    A further study [2] found that tucking could create a suboptimal environment for spermatogenesis.

    REFERENCES

    [1] Trussler, J. T., & Carrasquillo, R. J. (2020). Cryptozoospermia Associated With Genital Tucking Behavior in a Transwoman. Reviews in urology, 22 (4), 170–173. [Link]

    [2] Debarbo, C.J.M. (2020). Rare cause of testicular torsion in a transwoman: A case report. Urology Case Reports 33. [Link]

  • One case study suggests that tucking can cause testicular torsion. Expand
    One case study suggests that tucking can cause testicular torsion.

    A case study [1] found that one transwoman had testicular torsion as a result of tucking.

    Testicular torsion – the rotation of the testes and subsequent arterial constriction – can present as severe acute unilateral scrotal pain, nausea, and vomiting. If permanent ischemic damage results, delay in treatment may be associated with decreased fertility, or may necessitate orchiectomy [2].

    REFERENCES

    [1] Debarbo, C.J.M. (2020). Rare cause of testicular torsion in a transwoman: A case report. Urology Case Reports 33. [Link]

    [2] Sharp, V. J., Kieran, K. & Arlen, A. M. (2013). Testicular Torsion: Diagnosis, Evaluation, and Management. Am Fam Physician 88 (12): 835-840. [Link]

  • In one survey, 50% of transwomen who tucked were concerned about negative health effects. Expand
    In one survey, 50% of transwomen who tucked were concerned about negative health effects.

    A survey [1] of transwomen who tucked (the process of reducing the visible male crotch bulge) reported that half were concerned about the health effects of tucking. 

    Their reported symptoms included itching (28%), rash (21%), testicular pain (17%), penile pain (14%), and skin infections (12%).

    In addition, patients may be reluctant to seek medical care for testicular complaints and when they do, it may be already late to salvage the testis. [2]

    REFERENCES

    [1] 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]

    [2] Debarbo, C.J.M. (2020). Rare cause of testicular torsion in a transwoman: A case report. Urology Case Reports 33. [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]

  • Feminizing hormones reduce sexual function in males. Expand
    Feminizing hormones reduce sexual function in males.

    Feminizing hormonal treatments lead to a lessening drive, erectile dysfunction, and shrinking of testes and penis [1], significantly compromising sexual function.

    A Belgian doctoral thesis study [2] found that 69.7% of transwomen reported a decrease in sexual desire — while the opposite effect is found in transmen.

    REFERENCES

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

    [2] Elaut, E. (2014). Biopsychosocial factors in the sexual desire of contraception‐using couples and trans persons. Doctoral thesis, University of Ghent. [Link]

  • Vaginoplasty can result in fistula, stenosis, necrosis, prolapse and even death. Expand
    Vaginoplasty can result in fistula, stenosis, necrosis, prolapse and even death.

    Male-to-female genital surgery (vaginoplasty) is associated with significant long-term complications: there is a 2% risk of fistula, 14% risk of stenosis (abnormal narrowing), 1% risk of necrosis (tissue death) and 4% risk of prolapse [1].

    One systematic review [2] found an overall complication rate of 32.5%.

    A Dutch study [3] of 55 (out of an original 70) adolescents treated with puberty blockers, cross sex hormones, and genital surgery, showed that among 22 male-to-female patients who underwent vaginoplasty, one adolescent died as a result of necrotizing fasciitis after the surgery.

    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] Dreher, P.C., Edwards, D., Hager, S., Dennis, M., Belkoff, A., Mora, J., Tarry, S. & Rumer, K.L. (2018). Complications of the neovagina in male-to-female transgender surgery: A systematic review and meta-analysis with discussion of management. Clin Anat. 31 (2):191-199. [Link]

    [3] de Vries, A., McGuire, T., Steensma, E., Wagenaar, T., Doreleijers, P. & Cohen-Kettenis, P. (2014). Young adult psychological outcome after puberty suppression and gender reassignment. [Link]

  • Around 1 in 5 vaginoplasty surgeries lead to corrective surgery. Expand
    Around 1 in 5 vaginoplasty surgeries lead to corrective surgery.

    A systematic review [1] of neo-vagina surgeries found a re-operation rate of 21.7% for non-esthetic reasons.

    A Brazilian paper [2] found a somewhat lower, but similar, reoperation rate of 16.8%.

    REFERENCES

    [1] Dreher, P.C., Edwards, D., Hager, S., Dennis, M., Belkoff, A., Mora, J., Tarry, S. & Rumer, K.L. (2018). Complications of the neovagina in male-to-female transgender surgery: A systematic review and meta-analysis with discussion of management. Clin Anat. 31 (2):191-199. [Link]

    [2] Moisés da Silva, G.V., Lobato, M.I.R., Silva, D.C., Schwarz, K., Fontanari, A.M.V., Costa, A.B., Tavares, P.M., Gorgen, A.R.H., Cabral, R.D. & Rosito, T.E. (2021). Male-to-Female Gender-Affirming Surgery: 20-Year Review of Technique and Surgical Results. Frontiers in Surgery 8. [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]

  • 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]