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Counter-intuitive role testosterone plays in Gender Dysphoria

Counter-intuitive role testosterone plays in Gender Dysphoria

  By -- Mar 25, 2022

My 40 year old married son told us yesterday that he is transgender. He has two children ages 4 and 3. He has hidden it all these years. He says he can no longer hide it. He tells me that he is taking estrogen. I don't understand why medicine and therapy cannot help. We take medicine for all kinds of things after all. If he can take estrogen to make him more of a woman, why wouldn't the testosterone make him more of a man?

Thank you for your question. I can't speak directly about your son but I can address your question regarding hormones.

It may seem counter-intuitive but it is testosterone in some genetic males that inflames gender dysphoria. We know for a fact (something we learned over 50 years ago) that giving a gender dysphoric male testosterone makes the GD worse whereas administering estrogen--which lowers the level of testosteron--has a dramatic effect on making the dysphoria go away. The issue one may have with that is that it also feminizes the individual. Most gender dysphoric males are very comfortable with the side effect.

Another fact you should keep in mind is that your son probably had a normal level of fixed testosterone in his body prior to taking estrogen. That would not be unusual. Keep in mind that the average male body can only accommodate so much testosterone (about 1000 ng/dl) before the aromatization process kicks in and turns all excess testosterone into estrogen. That is another reason for not giving your son more testosterone.

Given that hormones are so involved with GD, indicates that the problem is not psychological and not subject to talk therapy. Some gender dysphoric males can keep the problem hidden for decades but it is not much of a life and it seems to get worse as one gets older. There seems to be no natural remission date. We often see men in their 60s and 70s and older who suffered their entire lifes with GD to accommodate others. People who do not treat it, die with it.

There is a medication that helps. For GD males it is estrogen. It might help if you think of it that way.

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