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Frequently Asked Questions? FAQs

Are there many levels of gender variance or is it just something that you have or don't have?

Gender Identity varies from having an unquestionable sense of being male to an equally unquestionable sense of being female. In fact this is the definition of being Cisgendered. Because gender identity is hormonally set by the genetalia of the developing baby, most people emerge at birth with sex and gender identity aligned. However, pre-natal hormone availability is subject to extraneous influences, creating a gender identity continuum with some people falling somewhere between the poles of the male/female binary. It is only when a person's location on the continuum crosses over the line into the other side from which they were assigned at birth, do we have the beginnings of clinical gender dysphoria. The further their feelings are from their birth assigned sex, the more intense the dysphoria, and the more likely he or she will only find relief by taking cross-sex hormones.

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Regarding, The Gender Variant Phenomenon, specifically what you refer to as Group 3. Besides the obvious path recommended by your paper, can you please refer me to any other known or suspected cure for the level of anxiety being experienced by these individuals?

There is no known "cure" for any of the people I refer to in the book, no matter what group I have placed them in, because there is no disease involved. The gender variant condition is a permanent state of existence. Individuals born gender variant, die gender variant. The only way to relieve the anxiety that a gender variant individual may be experiencing, is to accept their reality and make an adjustment to it. That can range from a simple acknowledgment to complete gender role transition. Fortunately we have the psychological know how, along with the hormonal and medical technology to help these individuals live full and productive lives.

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Counter-intuitive role testosterone plays in Gender Dysphoria

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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