Update: I contacted the author of this piece, and she had the following comment to add. I hope it gives heart to the parents of teens and young women who congregate here. It may not seem like your daughter is paying attention to you now, but your words may echo later. She said she is also open to responding to your questions in the comments section below.

My parents were a large part of my detransition; they planted a lot of radical seeds without my realizing it at the time. I really credit them quite a bit. I think I would be in a vastly different place if I had had their support in my transition.

Three years after it was originally posted on The Dirt From Dirt, this beautifully written piece by a young woman who “transitioned,” then made her way back home to female again, was recently pointed out to me. I recommend reading the whole thing, including the comments, which contain a great Q&A with the author. It’s bursting with insights that will be especially meaningful to parents of young women who are contemplating–or have already embarked on–transition. There are some particularly cogent passages on interactions with parents which will be very familiar to many regular readers here.

Anyone who wants to better understand the experience of female gender dysphoria, what motivates a teen or young woman to want to inject testosterone, and the complexities of parent-daughter dynamics through the whole process will find much to appreciate here.

The author (now in her late 20s) has recently stated that in the years since writing this piece, she has found healing by connecting with other women who understand her experience–understand why she distanced herself from femaleness. This community she’s found has been crucial to resisting the pressure to identify as male.

I would suggest that readers share responses to the piece in the comments section here; the article is three years old, so comments submitted to the original post on TheDirtFromDirt blog might not be seen.

A few tastes from the original–which, again, I urge everyone to read in its entirety, below. Boldface emphasis is mine.

With groups of guys, I was totally comfortable. I felt equal, like one of their peers. I was interested in the same things that interested them and related to the way they interacted with one other. There was a lot of music and video games, and not a lot of sitting around talking and gossiping. These were the ways that I interpreted “female-bonding” and “male-bonding” back in those days. I got very involved in the local music scene, playing guitar and bass in a lot of hardcore, punk, and metal bands. I used Craigslist and other local sites to find bands and band mates. I quickly learned to leave the fact that I was female out of my ads and emails. Being female impugned my credibility as a hardcore musician, it seemed to me. At the time, I thought it lucky that my name was very androgynous. More often than not, I was perceived as male.

My discomfort with my body never left me. My jealousy for my male peers grew. I bound my chest for the first time when I was 15, with duct tape over a tank top that I wore over my sports bra. I tucked my hair up into my hat, as I had continued to do since grade school. I swiped a button-down flannel shirt and some baggy jeans from my dad’s closet, tucked a sock into my underwear, and then took my girlfriend out to a movie. The feeling that all of this gave me was indescribable. For months, my girlfriend referred to me as her “boyfriend”—this, as a kind of sweet talk. I really liked it. When she saw me that night, I remember her face, and the way she looked so happy. I don’t remember anyone’s treating us any differently than they had in the past. I wasn’t trying to pass, as I didn’t even know what that meant yet. All I knew was that I hated my breasts. I felt as if I would have been much happier had I been born male; this would’ve allowed me to do and be all of the things I wanted to do and be, without getting hassled, without constantly feeling like an outsider.

On meeting with a “gender therapist”:

I graduated from university and attended counseling sessions with a gender therapist when I was 21. In our first meeting she informed me that she usually waits several months before seriously discussing medical transition with her clients. However, during this first meeting, she indicated she was comfortable discussing medical intervention and my feelings about it, because of my already extensive “real life experience” and the fact that she could “clearly see that I was a transsexual.” I informed her that I intended to medically transition as soon as I found the courage to tell my parents, and that I didn’t want to start without their at least being aware of my condition. She asked me to write down all of my earliest memories regarding gender and how I related to my body. She explained that we would use my writing as a starting point for our next meeting, during which we could begin discussing how I would come out to my parents.

Six meetings and three months later, I had my letter diagnosing me with “General Anxiety Disorder,” with a recommendation for hormone replacement as treatment. Still, I was no closer to actually telling my parents. She refrained from a “Gender Identity Disorder” diagnosis, because of my intention to live “stealth.” I saw my condition as purely medical and not something I wanted to acknowledge in the future. I had already drafted several letters and scrapped them all. I called the clinic and set up my first appointment for blood work.

On her parents’ reaction to her decision to transition:

My father was furious. My mother was heartbroken.

I still remember his calling me that night and telling me he loved me dearly and that his love for me would never change. However, he also told me he thought I was dead wrong about the decisions I was making. The next night I went to their house to talk about it in person. We had one of the longest conversations of my life. For about four hours, we picked apart the way I felt, why I felt that way, and what it meant. My father infuriated me when he told me that he actually thought I was pretty stereotypically female, in that I have a large amount of compassion and tend to be very sensitive. He asked me what I thought was different between myself and my mother—who is a very strong, driven person, and who embodies many of the qualities I strive to embody. I remember trying to explain to him that it all comes down to what people identify with in their brains, how they relate to their own bodies. I tried to tell him that it has nothing to do with characteristics like intelligence, compassion, athletic interests, or familial roles (e.g., “the breadwinner”). At every step he refuted me. He asked me if it were okay for women to want and think the things that I wanted and thought. I repeated over and over that it was, of course, okay. I asserted that it didn’t make such a woman any more of a man than my compassion made me a woman. At the time, I didn’t understand that he was bringing up all of these socially structured gendered expectations in order to encourage me to think critically about my identification and why I felt that way. All I felt was angry and trapped and disrespected. I left that night without feeling we had resolved anything. I was glad I had told them, glad I knew I still had their love. I was still so, so angry that they couldn’t just accept what I was telling them at face value.

I remember asking my father if he would still feel like a man if he woke up the next morning, inexplicably, with a vagina and breasts. He told me that he “wouldn’t give a fuck” and would go about life as normal. He told me the only thing that would change would be the way society reacted to him, but that it wouldn’t change who he was on the inside. I asked him if “who he was on the inside” was male. He told me that who he was on the inside had absolutely nothing to do with his reproductive ability or his genitals. I thought he was absolutely out of touch with the reality of the world, and of course he must have some internal sense of himself as a man, or as male. I’ve since come to realize that he meant exactly what he said.

We had a few more intensely strained conversations over the next few weeks on the subject, and eventually came around to agreeing that my parents love me and support me no matter what, but they did not believe in “gender identity.” They agreed to do whatever would make me comfortable, including refraining from using female terms regarding me, but neither of them thought they would come around to calling me “he” or their “son.” I took this as consolation enough, and resolved to move forward with my appointment to get testosterone.

There is much more at the original link. Do read it if you can.

A few days ago, I shared an inspiring video by the intrepid Peachyoghurt, a “gender nonconforming” woman who never outgrew being a tomboy. She wants to help our daughters realize they don’t have to “transition” to be happy in their own bodies. If you haven’t watched it yet, you owe it to yourself to take 3 minutes out of your day to do it now. If you’ve got more time, she’s got several other videos to check out as well.

Peachyoghurt is collaborating with me and others to create a YouTube channel that will feature videos like hers. If you are interested in participating, or know anyone who might be, write to: womenstaywomen at gmail dot com.  This channel. called “Women Forever,” will be a great counterbalance to the FTM Teen Transition Network (in other words, the huge mass of videos currently on YouTube exhorting our daughters to join the trend).

Human bodies are increasingly treated like used cars in our brave new world of gender identity. Body shops, aka “gender confirmation surgery clinics” have plenty of spare parts that are junked, discarded, or reinserted into different shells according to the body owner’s professed gender identity. And why not? It’s a lucrative new medical specialty, with plenty of eager new mechanics ready to serve their dysphoric clients.

First, you gotta redefine the car models to make the parts more interchangeable. Marketing is all in retail sales, so a good start would be excising the word “woman” from any discussion about giving birth. This makes the uterus a disembodied entity, decoupled from its formerly female mooring.

A group of midwives called Woman-Centered Midwifery recently wrote an open letter to the Midwives Alliance of North American (MANA), decrying MANA’s replacement of the word “woman” with “individual” in their literature and guidelines.

We are concerned that, except for in the trademarked section from the Midwives Model of Care, the word “woman” has been erased from the MANA core competencies document and replaced with “pregnant individual” and “birthing parent.” We recognize that the words maternal and motherbaby were not removed from the document, implying that the reviewers maintained a mutual and shared respect for the sanctity of the motherbaby unit in midwifery. But women are now all but missing from the language, as if we can separate woman from mother from baby. Woman is recognized now only in relation to her baby.  This is harmful to female adult humans; we women have fought long and hard to be recognized as autonomous beings.

The response from MANA (“birth for everybody”) was swift, and despite a lot of lofty and condescending verbiage, their message boiled down to this: You natural-birth midwives are just a pack of transphobes.

The purpose of this response is to explain why and how the Open Letter is harmful to transgender, genderqueer and intersex people, why midwifery documents should be gender inclusive, and why people of all genders should be welcomed into midwifery care. While we are focusing on birth-related care in this letter, it is important to notice the subtle and insidious ways the “open letter” attempts to erase the lives and narratives of transgender women and other women who cannot or do not give birth.

So trans men can give birth and MANA doesn’t want to refer to them as “women.” But surely we can all agree that trans women, whom MANA appears most concerned about “erasing,” cannot give birth, so “pregnant individuals” will never refer to them.

Not if groundbreaking gender surgeons get their way.

In Sweden, researchers have succeeded in transplanting a uterus “which resulted in the birth of a healthy and fully developed child, carried to term by its birth mother.”

According to Dr. Sherman Leis, founder of the Philadelphia Center for Transgender Surgery and a pioneer in surgical techniques for transgender men and women, “The brilliance of this scientific work and clinical trials in Sweden is that the uterus is being implanted in a way that does not require it being connected to the recipient’s Fallopian tubes or ovaries, which obviously a MTF patient does not have.”

So I predict a boom in the body spare parts business. Plenty of organ donors (who undoubtedly will be paid for their altruistic gestures) are likely already lining up. Heck, people are selling their kidneys on eBay, why not the bleeding, useless bag of monthly nuisances?

But here’s an idea to make the whole process more efficient. With all the dysphoric women wanting to rid themselves of their useless uteruses (typically damaged anyway by all the testosterone they’re injecting), why not set up an efficient assembly-line operation to quickly transfer the organ from the FTM to MTF with a minimum of fuss and bother? Instead of having to dig around for women–I mean, “uterus havers”– who are willing to have their spare part yanked out for the right price, why not line up the donors and recipients in tidy hospital wards, side by side, with all the tubes and surgical paraphernalia sitting companionably between them?

Think of the profits. Think of the lifelong friendships that will arise from these reproductive engine swaps. The trans men would sleep soundly, knowing that their worthless birthing bag was being skillfully transferred to a body that would use it properly. Mission accomplished for the surgical grease monkeys.

Of course, the ultimate goal is to get “trans kids” on the used part assembly lines as early as possible. So they won’t have to put up TOO long with internal organs that are just so wrong for them. Who needs a damn uterus and egg follicles when you’re six anyway? I can’t wait for the trans kids’ books: “Judy’s uterus was wrong but it was just perfect for little Jason, who now goes by ‘Jazey’.”

Why wait? Donate to the female repro organ donation center today. The uterus you give will brighten the future of a  REAL woman. And good luck with that phalloplasty, man!

Wow, oh wow, do we need more of these. YouTube should be flooded with vids like this. Beautiful girl, beautiful message. Go peachyoghurt!

The research says one of the risks for “gender nonconforming” kids to self harm or attempt suicide is unsupportive parents. This is what I call support. My parents gave me that support. A lot of us who grew up before the trans-trend had it.

Genderqueer? Trans? No way.

If more women make videos like this, maybe our girls won’t be so quick to abandon the female tribe.. Peachyoghurt’s got a whole YouTube channel full.

“There was no such thing as transgender back then. I was just a tomboy and I could do what I wanted. I never changed. I became my own woman.”

Enjoy! It’s a 3-minute mood lifter to lighten all the heavy stuff that usually gets posted here.

Update: Worried Doc is a dad.  

A few days ago, a commenter calling himself “worried doc” wrote to me. He is a  physician who is skeptical of the current transition trend. Not only is his own teenage son embarking on this medical journey. The young man is also enrolled in the new multicenter NIH study of pediatric medical transition. Here is the doctor’s story.

“First, Do No Harm”: The Gender Dysphoria Hustle

by Worried Doc

I am surprised and dismayed to find myself having to write this letter. I am a physician, having practiced for forty years as a specialist in primary care medicine. As such, I would occasionally have patients who would complain of “being in the wrong body”, not being comfortable with who they are, or similar concerns. Having no way in my practice to evaluate or deal at all with this constellation of symptoms, I would refer them to what I presumed was appropriate psychiatric care.

I have a very difficult teenage son. He has been treated for mental health issues for a number of years without improvement, and has also attended multiple residential psychiatric facilities where he was tagged with diagnoses including anxiety and depression with intermittent suicidal tendencies. What has emerged more recently and prominently is his expressed desire to become a woman, with the threat of suicide if he is thwarted in doing so. I would bring this up to his therapists, who simply washed their hands of it, stating that they don’t treat this problem and suggesting he move on to someone else who does.

My first experience with a therapist who deals with “gender dysphoria”– the state of one’s self-perceived gender being incongruent with one’s natal biology– was alarming. Her suggestion was to immediately start my son on a lifelong regimen of cross-sex hormones and prepare him for multiple surgeries, including chondrolaryngoplasty (scalpular scraping of the thyroid cartilage to reduce the size of the Adam’s Apple) and a procedure described to me simply as “down below”, in order to feminize him as quickly as possible. I later learned that “down below”, or “bottom surgery”, is a polite, casual euphemism for a bilateral orchiectomy (surgical castration) and penile inversion vaginoplasty: the skinning and removal of the penis, with the empty flap of penile and scrotal skin inverted into a newly-made body cavity to create a “neovagina”. These recommendations were all made during the first visit, with no further insight given as to the nature or cause of the situation at hand. I was, however, referred along to a doctor “who knows that stuff” at a major medical facility. Upon arriving at that office, I was met with a friendly physician’s assistant who performed a physical exam on my son, after which we were promptly instructed on how to proceed. Very little of the discussion was regarding diagnosis or etiology; the risks, benefits, and side effects of the proposed treatment went largely unaddressed. He was to be started on estrogen at this stage, despite there being only the most superficial of clinical work-ups required for the diagnosis of gender dysphoria. The diagnosis was based almost entirely on the self-reported say-so of my troubled 15-year-old son.

My son was not advised, nor was I, regarding the frequency and treatment of complications arising from male-to-female transgender hormone therapy. This off-label administration of hormones to children was foreign to me, though as a doctor I knew the names of the drugs involved, and I also knew their possible side effects: deep vein thrombophlebitis, permanent infertility, polycythemia, pulmonary embolism, and death. The issue of infertility was raised by myself, concerned about the risk of my son becoming sterile and therefore having no chance to have a family of his own one day. All care at the facility prescribing his cross-sex hormone treatment was provided by a PA; I never saw a physician. I have scoured the medical literature and found little legitimate science regarding the medical treatment of pediatric gender dysphoria, the long-term outcomes of such treatment, or the sudden, recent groundswell of young people diagnosed with this previously-uncommon condition: so much speculation, so many unanswered questions, so few studies.

I took an oath with my medical degree. It states, “first, do no harm”. I wrestle with that oath daily: advised of my son’s suicidal ideation– which, I was told, will only increase in severity if his feminization treatments are denied– his gender therapist told me he was “better a live girl than a dead boy”, and what parent could possibly disagree? And yet, as a doctor, I know what these drugs can do. When the time comes for my son’s sex reassignment surgeries, I– and he– will have to contend with another set of potentially life-threatening complications, including the possibility of a rectovaginal fistula, a hole between the neovagina and rectum that can require the use of a colostomy bag, and can also result in infection and death. I can only hope that the day will come when my child, and other children faced with gender dysphoria, will have safe, legal guidelines and regulations for the treatment of their dysphoria, and that those laws will be based on quality, unbiased scientific studies. This brave new world of radical, life-changing gender reassignment for children too young to drive or vote seems all too much like the Wild West.

As I write this letter, there is a study underway regarding the hormonal treatment of pediatric gender dysphoria, yet with tremendous conflicts of interest throughout: at least a few of the doctors running the study are, or have been, employed as consultants by the pharmaceutical companies that manufacture the hormones being used. Is this why my son was seemingly sped through the process of diagnosis and prescription, hustled into hormones? There remain far more questions than answers. Yes, there is now a study, but the terrible irony is that one of the study’s subjects is my own son.

This MRI study of brain changes in 18 women who are injecting testosterone to “transition” to male is getting a bit of traction in the press. (Apparently the researchers, from the European College of Neuropsychopharmacology, have only announced their findings; there is no published paper in the literature that I could find.)

Update: In response to several comments I’ve received, as well as some fruitful Twitter discussions with scientists and linguists, I would like to clarify a couple of points:

• By itself, this study tells us nothing definitive about the possible impact of testosterone on the female brain. Particularly since the researchers did not couple the MRI with pre- and post-testosterone cognitive-linguistic testing, we don’t know whether the reduction in gray matter in the subjects’ brains correlates with reduced verbal fluency. Even more informative would be functional MRI studies (fMRI) while the subjects are performing linguistic tasks. Obviously, the results should spur researchers to do studies on more subjects, along with objective linguistic test measures to see whether results are replicated and whether they do indicate a decline in linguistic skills. I have found 3 studies in the research literature which point to a statistically significant decline in verbal fluency in women who have increased circulating testosterone.
• Secondly, it is my opinion that the results of this study, along with a few others which assessed verbal fluency, should be shared with women who are contemplating testosterone “therapy.” It’s quite likely some of these women would go on to inject “T” anyway, but it’s also possible some would choose not to. Knowledge is power.
• To discover whether testosterone-induced brain changes seen on MRI are permanent, another important line of research would be to longitudinally study women who want to inject “T” for only a limited time period. Multiple followup MRIs (and cognitive-linguistic testing) would provide insight into whether testosterone’s effects are permanent or temporary in these cases.

The big news is that “T” administered to women results in decreased volume of gray matter in the all-important zone of language in the brain, Broca and Wernicke’s areas. And these changes occurred after only 4 weeks of testosterone treatment.

According to one of the researchers, Dr. Andreas Hahn,

It has been known for some time that higher testosterone is linked to smaller vocabulary in children and that verbal fluency skills decrease in female-to-male transsexuals after testosterone treatment. This fits in well with our finding of decreased grey matter volume. However, the strengthening of the white matter in these areas was a surprise. We think that when it comes to certain language skills, the loss of grey matter outweighs the strengthened white matter connection.

Think about that. “It has been known for some time…that verbal fluency skills decrease in female-to-male transsexuals….when it comes to certain language skills, the loss of grey matter…” We are potentially talking about a loss of brain cells here.

Call me alarmist, but this is such major news that all the gender specialists should be sitting up and taking notice and–oh, I don’t know, maybe expressing a few doubts about the wisdom of injecting male sex hormones into females? Or asking the women about to start on “T” whether a potential loss of neurons is something they actually want for their future? Seems there might be some need to question whether a  reduction in gray matter of the cerebral cortex is an acceptable risk to take for women who wish they were men?

The press coverage I’ve seen so far hasn’t hinted at any medical ethics concerns raised by the study results. For instance, the venerable Washington Post treats the whole thing as just another ha-ha “Men are from Mars, Women are from Venus” fluff piece. Heck, the title of the Post article is “Why Men Get Tongue-Tied.” They could at least have called it “Why Women are So Verbally Adept.” You know, throw a tiny bone to the fact that the subjects of this study were women? 

Instead, it’s all about the differences in how men and women communicate–which admittedly, is an interesting corollary. But hang on a minute. How can they even draw those conclusions? This study didn’t compare men and women. The journalists are jabbering glibly about differences between men and women, but the study looked at 18 women who had been injecting themselves with testosterone for a month, not men.

But you can’t entirely blame the predictably shallow, politically correct press for ignoring the elephant in the room–or should I say, the guinea pigs. The researchers themselves only seem interested in how these results illuminate the differences between men and women–not on the rather sobering implications for “gender reassignment.” The opening paragraph of the press release says

Brain imaging shows that testosterone therapy given as part of sex reassignment changes the brain structures and the pathway associated with speech and verbal fluency. This result supports research that women in general may deal with speech and interaction differently than men.

So let me see if I follow. If endogenous hormones are largely responsible for some rather crucial brain and communication differences between ADULT men and women, how in the hell are transgender people “really” the opposite sex from birth (as the activists and specialists firmly believe), if it takes hormone treatment to actually differentiate their brains?

What we see is a real quantitative difference in brain structure after prolonged exposure to testosterone. This would have been impossible to understand without looking at a transsexual population. In more general terms, these findings may suggest that the genuine difference between the brains of women and men is substantially attributable to the effects of circulating sex hormones. Moreover, the hormonal influence on human brain structure goes beyond early developmental phases and is still present in adulthood.

Right. “Circulating sex hormones” make the man (or woman). So, aren’t the researchers then pretty much stating that people who claim to have brains “born in the wrong body” don’t actually have the brains of the opposite sex until they undergo cross-sex hormone treatment? 

This intriguing neuroimaging study of transsexuals before and after their female-to-male gender reassignment suggests that even adult men and women differ in brain structure within regions involved in language and speech. In particular, female-to-male gender reassignment resulted in local brain matter decrease within language processing regions, which may explain why verbal abilities are often stronger in women.

Here’s an idea. How about we start doing some pre-treatment studies and surveys of young women who are considering “transition.” Hell, let’s ask the prepubescent girls and teens too, since the activists and gender docs seem to think the earlier they get on “T”, the better. Let’s ask them how they feel about a “brain matter decrease” that potentially could make them less adept with language. (We don’t know this but it’s a possibility).

Just a suggestion. Just a few words from the zone of language in this female brain, which has not been marinated in extra androgens, thank you very much.

Some other press coverage of this research. None mention that loss of gray matter in the zone of language might be cause for concern in “transitioning” females. In fact, they are all essentially rewrites of the press release provided by the researchers. I’d expect more from well established news outlets with high circulation, but that’s just me. (Tangentially, I did happen upon an interesting study showing higher circulating testosterone in children who stutter, inspiring me to look more deeply into the effects of testosterone on communication skills in the future.)

http://www.theatlantic.com/health/archive/2015/09/testosterone-brain/402967/

http://www.upi.com/Science_News/2015/08/31/Testosterone-therapy-reveals-differences-between-male-female-brains/8781441038348/

http://www.sciencedaily.com/releases/2015/08/150831001124.htm

http://www.telegraph.co.uk/news/science/11833715/sex-change-women-hormone-treatment-men-brain-traits.html

http://www.independent.co.uk/life-style/health-and-families/health-news/women-given-testosterone-during-gender-reassignment-process-start-to-think-more-like-men-10480140.html

http://www.slate.com/blogs/the_slatest/2015/08/31/testosterone_and_the_brain_new_study_suggests_sex_hormones_change_the_way.html