Transition: the Data
Is transition actually that good for you?
I have heard the story a million times over;
“Gender is sex, there are only XX and XY. You are born male or female, you can’t change that. Facts don’t care about your feelings.”
As a Trans person myself, I’ve struggled with this kind of thinking for a while. Today I’ve decided to look through the data myself.
People not well versed in the science of biology often think of it as a very black and white discipline. Whereas truthfully all science is a lot of grey area. Nothing can ever really be “proven” with science, its less ‘yes or no’ and more of a sliding scale from ‘disproved to strongly suggested.’
We can equivocally say that something does not fit the data, but positive scientific results, always come with caveats. You will never see reputable scientific articles that say something with 100% percent accuracy, data can only strongly suggest, there will always be a ‘what if’ to consider, a 0.0000001% chance that we are wrong.
The discussion of what makes someone trans has kicked up in recent years. As being Transgender becomes much more common and accepted, so do its dissenters. For many people they seem to think that being Transgender is a mental illness, and to perpetuate this illusory reality, is harmful to not only the patient but to society as a whole.
Often we hear people say that Transition is not beneficial to the patient. That often the patient does not feel any happier from Gender Reassignment Therapies (GRT) and Surgery (GRS). I’ve had people say that Trans people end up regretting their choice, leading to de-transition, depression, and suicide.
So the first question is: Does transition actually help Trans People?
In this study by Weinforth et al., Titled “Quality Of Life Following Male-To-Female Sex Reassignment Surgery”, we can find results that weigh very much in the direction of ‘yes’.
They analysed results from studies who primarily used: “SF-36” and “WHOQOL-100”, two very reliable and widely used questionnaires for measuring health-related quality of life, in regards to a course of treatment. They are used to assess whether treatment is beneficial to a patients mental health, physical health, and quality of life.
In several studies that used SF-36 as a questionnaire, they found that after GRS, patients were found to have an improvement in:
“social functioning”, “physical” and “emotional role functioning”, “general health perceptions”, “vitality”, and “mental health”.
It also found that when comparing trans women who did not receive GRS, to Cis women, that their mental health was reported at significantly lower levels.
Although, results showed that post-surgery, some trans people reported increased physical pain and decreased physical function. However it was concluded that after 5 years, reported physical pain levels dropped to levels comparable to the general public.
In regards to the other questionnaire, studies using the WHOQOL-100 found; an increase in sexual activity and improvements in social relationships.
Studies that used other scales to collect data found that post-operative trans people reported “a high degree” of ‘“subjective happiness”, of “satisfaction with life”, and “subjective well being”.
Though we have mountains of positive, I am not one to tell just one side of a story: some studies did find deterioration in areas such as physical health, independence, energy, fatigue, sleep, mobility and activities in daily living. However this study in particular was primarily focused on MtF Trans Women, who transitioned and lived in Brazil. Brazil is notoriously xenophobic towards Trans People, so the fact that these people struggled in their daily life is no surprise.
I may be killed in the street in any given moment.
Though some other countries are generally more accepting of trans people and LGBTQ+ people, there will always be people who disagree with them, so there will always be a societal aspect of this to consider.
Another downside was ‘increased urinary incontinence’. While this may sound like post-op trans people just walk around wetting themselves constantly, you have to understand that GRS is a surgery undertaken in and around the area responsible for peeing. During surgery the urethra is moved around and in some surgeries, shortened.
Surgery of this kind disrupts the muscles groups responsible for holding in urine in a pinch, so it is natural for incontinence to rise but this should only be a small increase.
There is good data here that suggests that transition has a positive effect on areas such as; “ mental health/wellbeing, sexuality, and life satisfaction — as well as on quality of life overall.”
So we can treat the symptoms of Gender Dysphoria, but can we prove that it is a real disorder? As Mr Shapiro says:
Facts don’t care about your feelings.
Sexual dimorphism is the differences in the biology of a species from male to female. Most easily noticeable in other species such as the Peafowl.
The male, Peacock (Left), is famous for its impressive and colourful plumage, whereas the female, Peahen (Right) is fairly innocuous, sporting a much more neutral colour palette.
These differences are much more than skin deep however and have been identified as differences in the brain, usually caused by different sex hormones — Estrogen or Testosterone.
In several studies performed over the last 20 years on rodents, researchers have been quietly attempting to figure out the cause of the differences between the male and female rodents brains. Schwarz et al. found that during pregnancy, they could introduce sex hormones at a ‘critical period’, which would result in a rat that expressed less masculine behaviours. They could control the gender expression of a rat through hormones, before the rat was even born.
Although some may say that gender is in the mind, psychology is still biology. Just like other mental health issues such as depression and anxiety, there is a physical biological effect causing these issues. Theisen et al. wanted to try to understand the physical aspect of gender dysphoria and where it begins.
During pregnancy, natal males are expected to have a rapid surge of testosterone which is then repurposed to Estrogen. This estrogen is used to initiate pathways in the brain that counter-intuitively promote pathway growth, which are linked to male characteristics. Conversely, in natal females, the ovaries lay dormant and do not release this influx of Estrogen, resulting in a lack of pathways that promote male behaviour.
In the rodent trial, the rats were exposed to a substrate which either prevented the release of the testosterone in males, or excited the ovaries in the females. This neo-natal intervention caused the rats to show not just cross-sex behaviour, but cross-sex neurodevelopment.
This suggests that the presence, or absence, of testosterone during the critical period of pregnancy, can shape sex-specific pathways permanently.
Theisen et al. Identified several rare gene variants that would result in or were linked to these physiological differences. After sequencing the DNA of 30 transgender people (17 trans women and 13 trans men), these rare gene variants were found to be present, in varying combinations, in the subjects.
This suggests that trans people are affected during pregnancy by these hormone influxes or absences, which then alter sex-specific pathways in their brain permanently.
It suggests that being trans could be something you are born as.
While I agree and understand that science is an art of data suggestion, the data presented here gives us a lot of answers.
- Being trans is something you are likely born as, due to a critical period of hormone dispersal during pregnancy.
- The treatment of transition is heavily favoured as being helpful to the patient.
- Facts do not care about your feelings.
Quoted in this article
- Quality of Life Following Male-To-Female Sex Reassignment Surgery
- The Use of Whole Exome Sequencing in a Cohort of Transgender Individuals to Identify Rare Genetic Variants
- Quality of life improves early after gender reassignment surgery in transgender women.
- The role of neonatal NMDA receptor activation in defeminization and masculinization of sex behavior in the rat
Researched for this article
- Genomic Characteristics of Gender Dysphoria Patients and Identification of Rare Mutations in RYR3 Gene
- Neuroimmunology and neuroepigenetics in the establishment of sex differences in the brain
- Visualizing Sexual Dimorphism in the Brain
- Cellular mechanisms of estradiol-mediated sexual differentiation of the brain