The hidden long-term risks of youth gender transition (by Eliza Mondegreen)

 

New research in the International Urogynecology Journal raises serious concerns about testosterone use among trans-identified female patients. Researchers found that 94% of the patients they studied had developed pelvic floor dysfunction since starting testosterone. What’s more, 87% suffered from issues with bladder control; 53% reported sexual dysfunction, such as pain during intercourse; and 74% reported experiencing issues with bowel movements, such as constipation or faecal incontinence.

In an interview with the Telegraph, physiotherapist Elaine Miller warned that young adult females taking testosterone appear to be on “exactly the same trajectory” as women undergoing menopause — except that they’re encountering these issues 20 or 30 years ahead of schedule. Miller spoke about the toll complications like this can take on a person’s life: “Wetting yourself is something that just is not socially acceptable, and it stops people from exercising, it stops them from having intimate relationships, it stops them from travelling, it has work impacts.”

There’s a serious disconnect between emerging evidence of transition’s risks and harms, and the ways young people view these interventions. In the online spaces that I study, young people talk about their bodies using casual, often dismissive language, as though they were embarking on a do-it-yourself home-remodelling project. They talk about how they prefer their bodies to run on “T” (testosterone), not “E” (oestrogen). They deride puberty as “oestrogen poisoning” or “testosterone poisoning”. They are also startlingly alienated from their bodies’ natural functions, always seeking fresh euphemisms to hide uncomfortable realities, such as the young woman who wrote that she could only cope with the “dysphoria” her period caused by “seeing it in a[n] impersonal and logically [sic], usually thinking ‘The cycle is occurring to this vessel.’”

Young people and gender clinicians alike increasingly speak of detransition as no big deal — just another stop along an edifying journey of self-discovery. Jack Turban and Johanna Olson-Kennedy, two of the leading gender clinicians in the US, refer to “dynamic desires for gender-affirming medical interventions”. Others prefer the term “retransition”, which suggests a kind of equivalence between the initial decision to intervene on a patient’s healthy body and any subsequent interventions on an altered body. Olson-Kennedy has waved away concerns about potential surgical regret among her young female patients: “If you want breasts at a later point in your life, you can go and get them.”

But transition — and detransition — is nothing like customising an avatar or tearing out a kitchen. What hormonal and surgical interventions can offer to patients struggling with gender dysphoria is severely limited. When these interventions “succeed”, they imperfectly imitate physical features and functions that medical technology cannot, in fact, replicate. When these interventions go wrong, the complications can be life-altering, even fatal. Meanwhile, every intervention takes an unpredictable toll on the body. Over the coming decades, as this mass medical experiment plays out, I worry that we will see growing numbers of young people suffering from the kinds of diseases and disabilities that typically emerge only in old age.

To make matters worse, researchers also expressed concern that patients may avoid seeking help for transition complications, citing fear of encountering discrimination in healthcare settings, as well as discomfort and distress dealing with body parts and functions. Patients may also fear losing access to interventions they have come to believe are not just identity-affirming but life-saving. Discussions in online forums frequently turn to complications patients are reluctant to bring to their doctors’ attention, lest they lose access to hormones.

For all the trans community’s talk about bodily autonomy, there’s little focus on the ways medical complications can strip away the freedom to live one’s life as one pleases. Young people flocking to gender clinics today may not realise what life on a medical leash means. Too many will find out in the course of time.

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Eliza Mondegreen is a graduate student in psychiatry and the author of Writing Behavior on Substack.

 

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