Science AMA Series: I'm Dr Helen Webberley, I am a gender specialist and I offer support, advice and treatment to gender variant people, via my online clinic GenderGP. AMA!

Abstract

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I am a transgender man who has recently been diagnosed with autism and begun questioning whether or not I am actually transgender because of this.

Have all the people you have worked with been tested for autism (or any other mental differences)? Is it possible that gender dysphoria is actually just a symptom of something else?

Thank you in advance.

JayJLeas

There is an identified link between gender variance and autism, and not enough is known on the cause and effect relationship between the two. However, it is important to treat the presenting symptoms, and if the feelings of gender variance have been long-standing and persistent, then they are likely to continue whether there is associated autistic traits as well.

Dr Helen Webberley


  1. What is your take on the rise of openly gender non-binary individuals?

  2. What are your recommendations for people who are gender non-binary & interested in starting hormones?

  3. How do you compare gender non-binary to the traditional expectations of a "passing" transgender person just a decade or two ago?

  4. How do you relate the dysphoria or uncertainty in gender to variances in sexuality that they may (or may not) experience following hormones when dealing with young patients?

Mattel_Necks

  1. I think a lot of people feel much more comfortable about speaking up about their gender feelings, and explaining that they may not fit the current binary male / female ideology. In the same way that we are free to express our sexuality, I welcome those who wish to express and explore their gender identity.

  2. Some people feel that they fit more in the middle of the gender spectrum than at one end or the other. Some feel they are both female and male to a varying degree, and some feel that they are neither male nor female. From a medical point of view, it is massively important to have some hormones, so having no hormones should not be an option. However, if people wish to balance their hormones and have both male and female hormones then that should be a discussion open to them.

  3. I think our modern society is much more open to the concept of a full gender spectrum than 'one or the other'. These feelings have always been there, but today people are allowed to express them outwardly.

  4. Gender and sexuality are entwined but unrelated. One's sexuality may shift when the hormone influences are changed.

Thank you for the very interesting questions, Dr Helen Webberley

Dr Helen Webberley


I apologize if this comes off as a simpleton's question, I am not a PhD or a MD, just a student of psychology.

How often is it that a person has regressed to their original gender (or assigned-at-birth sex)?

It seems that today, we as a society are more open to the idea of not having our gender assigned at birth and are encouraging people to live their life how they feel they should at very early ages. I am wondering, if I may be blunt, how many people found out that living as another gender wasn't for them.

I apologize if this question comes off as rude or inconsiderate to anyone that has transitioned in any way.

00093293

Hi, thank you for your question. We don't have enough long term research studies to know exactly how many people 'detransition', but we do know that people who have known for a very long time that their assigned gender didn't feel right to them, are very likely to persist with these feelings throughout their life.

There seems to be a lot more 'regret' in those who were unable to transition for whatever reason, than in those who made the decision to transition in a supported and balanced environment.

Dr Helen Webberley


I work with children in primary school and one of the students was born female but somewhat identifies as a boy. She hasn't fully transitioned and I don't want to put a label on her or influence her gender identity one way or the other. Many of the classmates know her as female, though she is mistaken for a boy by strangers. She doesn't mind being labelled as female or male currently. The child feels most comfortable using the boy's bathroom, but feels very badly when others say she is a girl and shouldn't be in there. And on the other side, she is often scolded by other students in the school when choosing to use the girl's bathroom because she gets mistaken as a boy. We have offered her the use of a gender neutral bathroom but she doesn't feel comfortable using it. How do I best support this child when it comes to bathroom issues?

Iveg0tthis

Thank you for your question and for your support for this child. Please don't think you can influence her one way or the other just by being supportive. Your school should have a clear policy for gender and sexuality and religion and ethnic background - equally. I suggest getting in touch with mermaids Children's charity - they have some wonderful resources for schools. Dr Helen Webberley


How do you know?

I'm at a point where I'm really questioning my gender identity, but I'm really not sure about anything at the moment, is there something I can do to help clarify it for myself. It hurts my feelings whenever people tell my how masculine I am, which they do a lot, I don't like the way I look, despite being in really good shape, and I have a couple of friends who I use feminine pronouns with, and it just feels so right. I am however not sure, I don't know how how far I want to take things, and I don't really want to start the transitioning process before I know for sure. I've kind of always struggled with this.

How much will hormones help when you're a pretty masculine almost 30 year old?

Is there a genetic component? My mom had gender identity issues as a kid, and both one of my sisters and me doesn't really consider us the gender we were born as, but aren't sure if we're the other.

Is it possible to get hormones despite not being sure if you actually completely trans and not knowing if you want to do the full transition? Just to take the edge off the masculinity

Edit: formatting and reuploaded from my throwaway because I'm not out

throwaway_is_taken_7

Hi there, there are many people who have exactly these feelings and thoughts.

For people whose hormones don't feel 'right' because they are of a balance more associated with the opposite gender, taking the opposite hormones as medicines, can often help psychologically as well as making subtle exterior changes.

Many people ask me for gentle help, to see how they feel on treatment, without going 'all the way'.

We aren't aware of a genetic or inherited component to gender variance, although just by virtue of it being a common condition in some degree or other, it will occur in families.

I hope this helps, Dr Helen Webberley


I'm transgender and have been on hormones for just about a decade. I have moved around a lot in the past couple years, and it is extremely difficult to get restarted at a new physician. Nearly every one I go to requires all the doctors/psychologist letters confirming I'm transgender, bloodwork I've had done a million times, before they will give me a T prescription. It seems as though most doctors that do take on trans patients are used to only seeing people starting out. Do you have any advice for older trans people on continuing medical care?

Edit: wanted to clarify that I'm in the US.

indistrustofmerits

If you have been assessed and diagnosed and given a treatment management plan then that should stay with you for the rest of your life.

Your new doctor should feel comfortable in reading the letters from your past physicians and continue your treatment. Too many patients are not allowed the right treatment when they change doctors and suffer as a result.

Imagine if someone with cancer, asthma, diabetes etc all had to go and get re-diagnosed every time they moved!

Fight for your rights! If your doctor says they don't know enough about it then perhaps suggest they should read up on it!

Dr Helen Webberley


Hi there! Thanks for answering questions. My friend is in the middle of transitioning from male to female. Everybody around her (family, friends) and even she thinks she has autism. This is really impacting her life and relationships, but she refuses to get diagnosed and help for it because she's afraid she will be unable to get reassignment surgery.

Does being diagnosed with autism/Asperger's mean that the person will be unable to get a letter from the doctor recommending reassignment surgery? Thanks!

RainbowGlitterBurger

Oh dear, she should not be discriminated against because of any autistic traits, but sometimes it can make medical decisions harder to make. I suppose it depends on how much a formal diagnosis of autism would actually help her with there life and relationships. Dr Helen Webberley


I've heard that suicide and depression rates in the trans population are exceptionally high. Beyond counseling with a trained psychologist, what else can be done to tackle this problem?

aminoacetate

The rates of suicide and self-harm are by far the highest in those who are either denied the opportunity to transition (socially, medically or surgically), or in those who are persecuted for their difference.

In people who are accepted and have their thoughts and feelings and needs addressed and heard - the distress and mark drops off dramatically.

It is not the gender variance that causes the harm, it is the lack of support and the victimisation.

Dr Helen Webberley


It seems to me there's a difference between a cisgendered individual who doesn't want to conform to typical gender norms and transgender individuals who feel they are living in the wrong body. In younger individuals, how do you make sure you're parsing these two related things apart? Do people ever say that they feel like they're the wrong gender simply because they don't identify with their gender norms (boys who like to wear dresses, eg)?

I wonder about this blurred line between gender nonconforming and transgenderism. Society in general is trending towards being more accepting of nontraditional individuals. If we as a society begin to say "it's okay to be a boy who likes wearing dresses and doing traditionally feminine things" do you think we'll see fewer people identifying as trans? In other words, do you think if who you are begins to have less to do with what body you're born with (if it becomes okay to live whatever lifestyle regardless of your sex/gender), people will want to change their body less? Or is the body dysmorphia dysphoria completely separate from the lifestyle people want to live? (Maybe I'm imagining that people feel transgendered if they identify more with the opposite sex culturally, and if that's a completely inaccurate assumption please tell me by all means)

WhereAreMyMinds

Your gender identity is very different to your gender expression, although of course there is overlap. If it was as easy as wearing the clothes of a particular gender then there would not be so many people distressed about their body and mind not being aligned. Dr Helen Webberley


What do you think the NHS in England needs to do to improve healthcare and waiting times for people suffering from gender identity issues? Followup - what do you think the NHS in Wales should do?

With waiting times at GICs in England varying from 15 months to 4 years for a first appointment, it does lead people like me to your services.

What do you think the root cause of this is, lack of Doctors willing to enter this area, lack of NHS funding or something else?

You currently offer a service where you essentially offer a bridging prescription and blood test monitoring. Have you ever considered setting up a fully established private practice, similar to Gendercare or others that can provide a formal diagnosis and also refer people for private surgery?

Finally, thank you for your treatment over the past 15 months. I'm hoping to have my first GIC appointment by the end of May, and without your service, I would have probably resorted to DIY hormones while waiting.

Mintopia_

Hi there, my answer is simple - and it is where my research is pointing. This should be managed and treated safely and simply in General Practice - by your GP. The gender clinics should be reserved for those who have very tricky needs or medical problems. Dr Helen Webberley


Is there a way to determine if a person is transgender by objective means? What I mean is that if there is way to determine if a person is transgender by through pure 3rd party observation of one's action or the measurement of certain biological indication (hormone/genes/gland secretion) Or is the recognition of transgender person always through self-experssion/self-diagnosis)?

TheLovecraftPorn

There are many people who wish we had a blood test or a scan or a physical measurement that would give us a clear diagnosis for gender variance. However, there isn't one and as with many other medical conditions (e.g. depression, angina, irritable bowel syndrome, migraine), all the x-ray and laboratory investigations may be normal, but the diagnosis is able to be made from the history alone.

Dr Helen Webberley


I've heard that the frontal cortex doesn't finish maturation until 20-25 or so. What effect do transition hormones have on the brain's development, especially in teenagers who transition?

nwbruce

From a medical viewpoint there is no change in gender feelings when comparing children who identify as trans from a very early age, to those who wait to start medical treatment until after the age of 20-25. Feelings of gender variance often start very early and then are likely to persist into later life. We do not see a change at the age of 20-25.

We often see a massive improvement in mental health in teenagers who have gender dysphoria once their hormones are switched to the correct ones for their gender.

Dr Helen Webberley


What is the biggest misconception you find yourself explaining on a regular basis?

Kat6567

That the majority of trans children will turn out not to be trans after all.

Let’s Call An End To The 84% Myth:

http://www.huffingtonpost.co.uk/dr-helen-webberley/lets-call-an-end-to-the-8_b_12842978.html

So many trans adolescents are enduring the irreversible changes of their natural puberty just in case they 'change their minds.'

Dr Helen Webberley


Do you feel if there weren't these gender norms there wouldn't be a "trans" as then people could dress/act the way they wanted without scrutiny?

VerteNinja

I think that if people were allowed to dress / act the way they wanted without scrutiny would help an awful lot of trans people.

However it wouldn't help the fact that the body that you are born with and the characteristics that develop during puberty, and the hormones that circulate through the body feel very mismatched to trans people's true gender.

Dr Helen Webberley


Thank you for the AMA! I've noticed in the past five years, as reddit's popularity continues to grow, that there is a growing minority of transphobic users on here.

Certainly you have direct experience with advising others how to deal with transphobic family members. I guess my question is: how can I change my communities attitudes on transgender folks effectively? Should I argue with hateful bigots with all my might?

Thank you for providing good sources, and for helping the LGBT. You've made a positive impact on so many people just today!

JEOVHANNNSY

Thank you for your kind comments. There will always be haters and people who don't understand. But hopefully as awareness and acceptance increases, this will decrease. Minority groups have endured hardship throughout history, but time and education helps.

I don't argue with the hateful bigots, I ignore them. But those who are willing to listen and learn have my undivided attention.

Dr Helen Webberley


I actually have a question. I have always felt uncomfortable with my gender, I was treated male and made to feel ashamed of my body. I am bisexual and I always felt more like a guy in a girl's body, my question is can someone who doesn't feel like they belong in their gender ever feel comfortable with their gender? I don't particularly want to physically change myself and I don't really feel like I fully am male or female mentally, it's kind of confusing and it makes me feel like I don't belong anywhere. I'm not sure how to even try to feel comfortable with my gender.

Acrophobe

It sounds like a real struggle to understand it going on inside you. I would really recommend talking to someone who is used to hearing stories from people whose gender can seem confusing at times. You are not alone in this, so do find someone to verbalise this with. Good luck :) Dr Helen Webberley


How can a parent know that a child's desire to transition is genuine? Is there an age that is usually treated as a threshold below which it shouldn't happen?

AFreebornManoftheUSA

I think it is essential to listen to your child. If they are telling you that their gender doesn't feel right then they need to feel safe in exploring their feelings and thoughts and to experiment with expressing their gender in speech and clothes and play.

Some Mums tell me that they noticed something wasn't right from as early as 6 months old! When a child is able to recognise themselves in the mirror and recognise that bodies and clothes and expressions are different in different people, they often start to notice that their body doesn't feel right to them, or that playing with the boys (or girls) doesn't fit for them.

You can't force your child to be gender variant and you can't force them not to be. Listen to them, believe what they say and allow them the opportunity to explore as they develop.

Dr Helen Webberley


Has delaying the onset of puberty via blockers been found to cause any detrimental effects on the patient after they've then gone through puberty afterwards, regardless of their decision on gender?

That is to ask, has there been any findings of negatives with the brain and body developing at different paces, or putting off full physical development until several years later than it would normally occur?

Draculea

Hi, we don't know of any adverse effects. Puberty happens at different times for different children, so there is a big natural variance anyway. We do know that children who are forced into a late puberty) either naturally or medically) can suffer with low self esteem and confidence compared with their more developed peers - but this is more an argument for early treatment with gender affirming hormones than not using puberty blockers. Dr Helen Webberley


Well I've had a lot of coffee this morning and ended up replying to most of the comments already. Oops. I'm just really excited to see this topic come up in such a popular subreddit! I'm intersex and trans, see my post history for the juicy details. Anyways, here's my question:

I and a few others have come up with the idea that transgenderism should be considered an intersex condition, and that it doesn't make sense to limit the definition of "intersex" to someone whose body has had mixed sex characteristics since birth alone. Arguments for this are that there seems to evidence of neurological differences in trans people, and that once medical transition begins, a trans person develops to be physically neither male nor female, which is just as relevant to their healthcare as someone with the same physical state who was born that way. Plus, "intersex" already covers a very wide range of conditions, so it's not like trans people should be excluded just because they "don't have the same experiences". In my experience, there's a lot more overlap than people might think. What do you think of this?

0t0k0n0k0

Thank you for your help!!!

That is an interesting thought. I know many trans people who don't want to be classified at all, and don't want to be considered as having a condition, so it is difficult to classify something without causing offence.

I prefer to think of it as a normal human variance, but one which sometimes needs a bit of medical help!

Keep answering, there are so many interested people here today!

Dr Helen Webberley


Have there been any studies investigating the attitudes of adults who transitioned while they were still minors? Is there any evidence to estimate the risk that a child who transitions with medical intervention will regret that permanent decision when they are an adult? If there is no evidence to predict the risk of regretting a major, lifelong decision, how can it justifiable to prescribe hormonal therapy to these children, some of whom have not even reached puberty?

abesys22

We don't have a lot of data on people who are unhappy with their transition because when all goes well, they transition and fall happily into their place in society.

We do, however, see a lot of people who wish they had had the opportunity to transition, but did not have the chance to do so when they were young, and have had to live their life in a way that never felt comfortable to them.

For clarity, we would and should never give hormone therapy to children who have not reached puberty. Treatment is aimed at making evaluations and plans ready for when puberty starts, so that if those feelings of gender variance persist into puberty then puberty blockers are ready to stop the irreversible changes that puberty brings.

Dr Helen Webberley


Hi, Dr. Webberley,

How often do you encounter patients questioning their gender who realize through therapy that they are not transgender or gender-variant?

understandinggender

Gender variance is a spectrum, it's not really a 'you are' or 'you aren't situation. I guess it is more to do with 'does your gender variance cause you enough upset to transition?' and if so how far - just a subtle change in clothes or social constructs, or go all the way?

Dr Helen Webberley


Dear Dr. Webberley,

  • Given the lack of data on how transgender hormone replacement therapy affects the body long term, how do you approach talking about the risks and long-term/lifelong effects of these treatments?
  • Are there guidelines or a standard for discussing the impact of estrogens/androgens and their blockers on health beyond secondary sex characteristics (ie osteoporosis, thrombosis, uterine/prostate cancers),
  • Are there any current standards for monitoring patients long term? *What data would you be most interested in seeing regarding the treatment of transgender patients?
Redsawx

The current medical treatment and management guidelines focus on giving patients the treatment which switches their hormones from a male pattern to a female pattern and vice versa.

the treatments given are actually very 'natural' in that we give oestrogen (in the same way we give postmenopausal women oestrogen) and we give testosterone (in the same way we give older men testosterone replacement therapy). Some could argue that these are very natural medicines compared with some that we use for other medical conditions.

The blockers are designed to lower the natural production of hormones, and the safest and best evaluated are the GnRH agonists (the same that we use to suppress female hormones in the treatment of endometriosis, or male hormones in the treatment of prostate cancer).

So we do have evaluations on the effectiveness and safety of these medicines in many conditions, including the current studies on the treatment of trans patients.

We know there is higher incidence of breast cancer in trans women (because they grow breasts and have oestrogen) and a lower incidence of prostate cancer in trans women (because their testosterone is less.)

We know that transmit have a higher incidence of heart attacks (as they lose the protection of their oestrogen).

We know that trans women have a higher incidence of blood clots in the venous system - just as natal women do.

We also, very importantly, know the very high incidence of mental health issues amongst trans people who are denied the right treatment for whatever reason, or for those who are persecuted because of their 'difference'. This causes a much higher morbidity and mortality that hormonal manipulation does.

Dr Helen Webberley


As someone who is starting hormones soon, I've seen a lot of anecdotal evidence about near-immediate mental effects, but I haven't seen anything backing it up. In your experience, are there immediate direct psychological effects of hormones?

pixlepix

My patients often tell me of the immediate peace that they feel once the right hormone balance is in their body rather than the wrong one. Exciting times, good luck :)

Dr Helen Webberley


Hi, so... I am a guy in my early 30s who was recently diagnosed as autistic and has been recognised as suffering from other mental issues such as anxiety and depression for a long time (upwards of a decade diagnosed). Over the past 5 or 6 years or so I have also begun to seriously question my gender identity, realising that there is a good chance that I identify as a woman and (maybe) always have. However, I noticed that this questioning coincided with both the realisation that I was autistic (something that was suggested to me and I thought was true long before my official diagnosis) and a general increase in 'awareness' of trans and other gender issues, at least online anyway, which is where I spend most of my time); I have also noticed that since I came to these realisations, I have been feeling it much more strongly (I recently started cross-dressing, for example).
My question then (lest this degenerate into confused rambling without a point) is, is how common is it to come to these realisations at my age? (I get the impression that it is fairly late, most people on trans forums seem to be younger than me.) It possible that after discovering gender issues I have attributed those causes to my own problems without any real basis for doing so? Or conversely, has my discovery of these issues finally given a name to something that has been 'wrong' my whole life that I didn't know how to express until now? And finally, what exactly is the relationship between autism and confused gender identity? I have read that there is a link, or at least some common overlap, which probably had a hand in my realisation, but I don't really understand it.

Anyway, thanks for doing this and sorry for the big ol' chunk of text.
- A confused person.

KingKittyWizard

Hi there, there is seemingly a higher incidence of autistic behaviours in those who are gender variant and vice versa, but we don't clearly know why or how or which is the case and which is the effect. Not everyone who has feelings about their gender recognises these from a very early age, there may be many reasons why you have started to question later in life. We do, however, know that talking this through with someone who is experienced can help unravel some of the thoughts and tie them together. Dr Helen Webberley


Hi, so... I am a guy in my early 30s who was recently diagnosed as autistic and has been recognised as suffering from other mental issues such as anxiety and depression for a long time (upwards of a decade diagnosed). Over the past 5 or 6 years or so I have also begun to seriously question my gender identity, realising that there is a good chance that I identify as a woman and (maybe) always have. However, I noticed that this questioning coincided with both the realisation that I was autistic (something that was suggested to me and I thought was true long before my official diagnosis) and a general increase in 'awareness' of trans and other gender issues, at least online anyway, which is where I spend most of my time); I have also noticed that since I came to these realisations, I have been feeling it much more strongly (I recently started cross-dressing, for example).
My question then (lest this degenerate into confused rambling without a point) is, is how common is it to come to these realisations at my age? (I get the impression that it is fairly late, most people on trans forums seem to be younger than me.) It possible that after discovering gender issues I have attributed those causes to my own problems without any real basis for doing so? Or conversely, has my discovery of these issues finally given a name to something that has been 'wrong' my whole life that I didn't know how to express until now? And finally, what exactly is the relationship between autism and confused gender identity? I have read that there is a link, or at least some common overlap, which probably had a hand in my realisation, but I don't really understand it.

Anyway, thanks for doing this and sorry for the big ol' chunk of text.
- A confused person.

KingKittyWizard

Hi there, there is seemingly a higher incidence of autistic behaviours in those who are gender variant and vice versa, but we don't clearly know why or how or which is the case and which is the effect. Not everyone who has feelings about their gender recognises these from a very early age, there may be many reasons why you have started to question later in life. We do, however, know that talking this through with someone who is experienced can help unravel some of the thoughts and tie them together. Dr Helen Webberley


How do you figure out if people are differently gendered or if they are suffering from some form of dysphoria or other mental issue instead?

MrXian

Gender difference is when the feelings of someone's gender seem different to them than those that society would traditionally assume someone with those genitals to have.

The dysphoria is when the feelings of the gender variance cause psychological upset. Of course we have to make sure that the feelings are not caused by a mental illness but gender variance as such, is not a mental illness.

However, there is a high incidence of stress, anxiety and depression caused by untreated gender dysphoria.

Dr Helen Webberley


Can you help me understand why Gender dysphoria is not considered a mental illness, while something like anorexia is? I have a cousin who transitioned and, while i am supportive of her decision, i still do not really understand it. I guess to me they both seem similar, you look into the mirror and see something that you are not.

adenine212

Gender variance is longstanding (present from birth, even if not recognised at birth) and persistent (will continue lifelong unless it is purposefully suppressed) and cannot be 'cured'.

Dr Helen Webberley


I am sorry for this simple question but what does a gender specialist do, what does it mean and what do you knwo about genders that non specialist dont?

Riganthor

As a gender specialist, I run my own gender clinic www.gendergp.co.uk and it means that I have lots of experience and knowledge around treating the psychological and physical manifestations of gender variance.

Doctors tend to develop special interests and knowledge in different medical conditions so that we can know a little bit about everything and a lot about a smaller number of things.

Dr Helen Webberley


So, what exactly is gender, and why do we need a separate concept from sex? I totally get why one might feel the need to change their sex and undergo the relevant procedures/treatments. But I've never found a consistent definition of gender.

lucaxx85

This is a very common and key question - what IS gender? In a recent Twitter conversation we asked #whatmakesmeawoman https://twitter.com/hashtag/whatmakesmeawoman?src=hash

Many people describe how it is a feeling deep within, an innate sense on self, something that you can't steely define.

Biological Sex is based on your chromosomes and genitals. Gender Identity is how you feel in terms of your femaleness and maleness or somewhere in between. Gender Expression is how you express your gender to yourself and those around you.

Dr Helen Webberley


I'm a gay man with a long history of supporting the trans community (I represented LGBT people to Microsoft management for 7 years, and my biggest accomplishment was probably getting MS to add nondiscrimination for trans people to its policies) and I'm trying to get my head around this non-binary gender stuff.

My first reaction was "this is a fad with college kids (almost all lebsians) who like saying things that upset their elders." However, I've since chatted with an F->M transsexual who told me that taking the hormones but skipping the surgery brought him to a place where he felt comfortable most of the time. (He told me he invited people to use whatever pronoun made them comfortable.)

I've also read that there is an extremely rare group of people who are truly gender-fluid, meaning that their mental gender changes from male to female (so they're only trans part of the time), but they don't control when the changes happen.

I looked into intersexed people, and I learned that they don't like being lumped into the LGBT camp at all, nor do they like being told they have intermediate gender.

Is there more to it than those three groups? That is college kids playing games, F->M transsexuals, and gender-fluid people?

GregHullender

Gender needs to be considered as being on a spectrum from M to F and back again, and all the way between. A person's place on that spectrum may shift subtly with time and motion, back and fore.

Intersex is a different condition whereby there is a hormonal problem which makes it difficult to work out what the genitals are as they have not been clearly defined during development.

Biological sex is about the chromosomes inside your cells and the genitals on your outside. Gender Identity is about feminine and masculine and how you feel inside your body and mind. Gender Expression is how your express your gender identity to yourself and those around you. (I could of course talk for hours on this subject, but that is it in a nutshell!)

Dr Helen Webberley


Can you be asexually/romantically attracted to members of the same sex but physically attracted to members of the opposite sex?

Spiwolf7

Yes!


How do you feel about statements made claiming that there is no biological basis for sex and how does that relates to gender?

phwak

I think that if we had the chance to go back to the beginning of time knowing what we know now, that we would not define someone's gender by looking at their genitals.

In the same way that we should not presume that someone with a penis will be attracted to women, we would allow people to identify with a gender that feels right for them.

We would also not presume that sexuality and gender are static, binary (one or the other) features. We would allow children and adults the freedom of exploration to identify and express themselves in a way that they feel comfortable with.

Dr Helen Webberley


I just want to thank you for all your hard work and research. I'm a transgender person myself so I believe that any and all research done into the topic further validates our existence and gives the scientific community more exposure to other trans individuals. In addition, extensive research helps the medical community with treatment of transgender individuals.

Thank you,
- Alice

For an actual question, I have heard that the brain patterns of transgender individuals more closely match those of the gender they identify as. Is there any credibility to this claim or is it just hearsay?

_Lady_Deadpool_

Thank you, Alice. There have been shown to be some patterns that match, but nothing really conclusive or diagnostic. Dr Webberley


As a dysphoric (but non-transitioning) lesbian, I've seen concern among some gay and lesbian people that gender non-conforming children who express attraction to their gender are sometimes encouraged into transition by conservative parents who would rather have a gender-conforming straight trans kid than a GNC gay one. However, with the exception of some organizations like Mermaids, it seems like these claims are mostly based on hearsay and speculation.

In your experience, are these concerns based in reality? Have you ever seen or heard of anything like this happening? (I know there's not much solid research on this specific question.) If this is something that happens, what do you think is the best way to prevent it? If it's not something that happens with any regularity, what's the best way to allay these people's concerns?

whils

I don't think you can 'make ' someone GNC or gay. There wouldn't be a doctor who would allow parents to coerce their child into transition for this reason. You only have to listen to the person to hear the enormous difference between sexuality and gender.

Dr Helen Webberley


Could you offer your own definition of gender? It is often variable between everyone you ask and to have an expert opinion would be nice

Arsenalsxc

Biological sex is about the chromosomes inside your cells and the genitals on your outside.

Gender Identity is about feminine and masculine and how you feel inside your body and mind.

Gender Expression is how your express your gender identity to yourself and those around you.

(I could of course talk for hours on this subject, but that is it in a nutshell!)

Dr Helen Webberley


What separates transgenderism and body dysmorphic disorder?

jabanobotha

Body Dysmorphic Syndrome (BDS) is when someone feels that a part of their body doesn't look or feel right to them, and this starts to have an impact on the way they feel and their day to day life.

Feelings of gender variance have some overlap where the body assigned does not feel matched to their true gender, and this can lead to feelings of distress and affect people's lives very deeply.

Dr Helen Webberley


I have a friend trough the internet who is a lot younger than me who tentatively identifies as a woman, though only expresses it online. I've tried to encourage her to seek out more professional help or advice, or at least someone who has a better idea of what she's going through, but she seems quite spooked by the whole thing. As a cis dude (albeit one with many trans friends irl) I don't feel remotely qualified to provide advice though she only seems to turn to me for help (she also lives in a conservative american state). Can you recommend any decent educational websites that aren't too... full on? Something that might give her advice on being a closeted trans teen? I feel very out of my depth!

BlastedScallywags

In the UK we have several excellent resources, I am not sure what is available in your country.

http://www.tranzwiki.net

Dr Helen Webberley


How can someone who wants to help get involved? What are ways to contribute?

saipei

Kindness, advice, support, charity work, volunteering - help me out! www.gendergp.co.uk


So, how permanent are the effects of HRT. Like, if I took HRT over the course of a couple years and lost my supply or something, would I revert?

Reon98

We have to consider that some of the effects are going to be irreversible, especially the breast growth, jaw angulation or voice changes. If you stop treatment, your natural hormone production would resume. Dr Helen Webberley


What are your thoughts on the extremely high suicide rates in the transgender community and the increase in physicians refusing to administer hormone therapy as a result?

Athaza

I feel that suicide and self harm and distress are mostly because of the lack of available help and support, and should definitely not be a reason not to help!! Dr Helen Webberley


Hello there Doctor!

I'm a 26 year old UK resident suffering with gender dysphoria (MtF). My biggest desire is to transition but the idea of being required to face five years of therapy before even being allowed access to hormones terrifies me, as I already believe I've left it too late to pass sufficiently without adding more time onto that number. I'm even more terrified that they might deny access altogether based on their judgment.

My question is, what would your advice be to go about approaching transitioning, if any? Can I expedite the process in any way or am I stuck with the above prospects as my only choice? My ultimate goal is both hormones and surgery, that much I know for certain.

naughtyanon

My view on therapy is that we could all do with a therapist in their pocket, to full out when struggling with something or when about to face a challenge.

I do not think it should be forced on someone as a hurdle to get over to be allowed treatment for their condition.

My medical model allows people access to therapy as and when needed, alongside the hormonal and surgical transitions.

Dr Helen Webberley


Are prenatal hormones[M.Hines] largely accountable for gender development and incongruence?

Is gender differentiation messy and people fit into the most comfortable box (typically cis)?

Why does it seem like gender related studies are uncommon?

Pyrollamasteak

It is sometimes hard to study issues that don't have concrete indices to count - such as blood tests or brain scans. Feelings can be harder to do research on. Also, many trans people who have successfully transitioned slip back quietly into society and get lost to follow up. Dr Helen Webberley


This might sound a bit negative, but my motives are simply to understand something I find very difficult/fascinating:

How early would you say kids (pre 18/22) are in a position to take the decision to begin switching genders? How/when does brain development factor into this as a potential occluding factor?

Do you have any statistics about people who have transitioned as children (pre 18/20yrs old) and then regretted it after their brain has been more fully formed?

mylarrito

I have talked to many, many children who truly and strongly identify with the opposite gender to that which they were presumed to be when they were born.

They would tell you that they don't 'want to be a boy' but 'they ARE a boy. They would tell you that they don't want to be a boy who is 'allowed' to wear girl's clothes, they ARE a girl wanting to wear girl's clothes.

They would also tell you the distress they feel when they are forced to identify in a way that their parents / teachers / peers feel they should, rather than the way they feel is right for them.

They will describe the discomfort they feel when made to go in the wrong toilet or changing room, or when they are not accepted by the gender group with whom they would most like to play.

If you ask them if they will ever 'change their mind' about being a boy or a girl, they will think the same of you - will you ever change your mind?

They don't call it 'switching' gender, they call it being allowed to identify with their true gender. The regrets come when their body starts changing in a way that really doesn't feel right to them, that's when anxiety, stress, self-harm, suicide really start. I know because I have seen it.

Children and adolescents who have long-standing feelings of gender variance that persist into puberty, who are given the treatment to stop the 'wrong' puberty have really good outcomes. The reason that we don't see them is because they are fully and happily integrated into society in the right body, with the right gender, and they are no longer visible as being 'different'.

The ones that are not given the right treatment early enough may always be visible because the secondary sex characteristics that were allowed to develop unwillingly, will remain for the rest of their lives.

Dr Helen Webberley


What's the oldest age someone's ever been referred to you? Are a lot of the trans people you see teenagers? Twenties? Older?

oboeplum

93

Dr Helen Webberley


What are your thoughts on Iran's public healthcare system covering gender reassignment surgeries and other trans medical expenses, particularly in the context of the rampant homophobia there?

Keshaluvr887

Does anyone else have any thoughts on this? Dr Helen Webberley


I live in Belarus and the process of transitioning, specifically the part where you get your gender in all IDs changed (which is then followed by all the necessary medicinal and surgical treatment [which is free btw]) seems very confirmatory here. Don't know if it's the same in other countries, but I guess it might be at least somewhat similar.

By "confirmatory" I mean that if a person decides that they are transgender they may just answer "properly" (while answering truthfully/half-truthfully of course) on countless interviews and then they get the diagnosis they want, so they only need doctors for bureaucratic confirmation of things they have already decided they objectively are.

I was in the process of going through these "confirmation hearings", while being a pre-almost-everything, but my appearance allowed me to pass a girl in public, when I thought "The doctors will only hear from me what I have convinced myself in. And this will be the only thing they will tell me back. But it's a real possibility that I might be wrong, that I'm unknowingly fooling myself and them. It might be that I have a case of "I'd prefer to have been born a girl" and not a case of "I'm a girl". I can't take this risk of subjectivity"

So I guess my question is - is it at all possible to diagnose gender dysphoria/transgenderism objectively, without basing your opinion solely on what the supposedly transgender person tells you?

OdeToJoy_by

As a doctor, I have heard a lot of different experiences and histories of how gender variance affects different people, and how it differs from sexuality, or make-believe, or fantasy. I also listen out for when people tell me what they think I want to hear.

We don't have blood tests, x-rays or scans, so we can only listen to your subjective story and examine your feelings and what they mean to you, and help you decide what the best course of action is for you.

Dr Helen Webberley


Dr. Webberly,

You've mentioned your stance on the safety and efficacy of hormone therapy. Are there any outlier cases in which you'd recommend a specific individual NOT undergo therapy for safety reasons? Any cases of individuals who experience rare and dangerous reactions?

WafflestheAndal

Ironically the treatment is very safe - you are just swapping hormone profiles to be the same as all the other men / women out there :)

Dr Helen Webberley


Hi Dr. Webberley

Trans girl here, I've been looking into the history of spironolactone and estradiol (2 common meds for mtf's) and it seems they are both repurposed for trans related care (as a lot of drugs are). My question is what's the outlook for new drugs for transition, specifically relating to minimizing the health issues associated with the meds (dvt)?

Freybae

The gold standard is to use puberty blocking injections (GnRH agonists) to lower testosterone and then replace it with oestrogen to give you the same hormone pattern (and then the same risk) as any other woman. Dr Helen Webberley


Hi Dr. Webberly

We often hear that gender is learned - that, for example, we teach young boys not to cry and girls not to take charge, thereby creating the gender-specific behaviors we are familiar with in adults. But the existence of transgender individuals seems to argue that gender is not learned at all and that we are born with a specific gender. How can we reconcile these two ideas?

cats_are_the_worst

You cannot make a sensitive boy not cry at sad stuff. You can't make a strong girl take a step back and become meek. You can't make a child change how their true gender feels on the inside - you can't make them trans and you can't make them not trans. Dr Helen Webberley


First, thank you for taking the time to do the AMA.

I have two friends who are M to F and are attracted to women. I did some research and spoke to some friends who are a part of the LGBT community that, while undergoing treatment, the person's sexual orientation preference might change. Could you provide some studies or explanation as what causes the sexual preference to change?

littlemoondragon

Thank you for your question. I always advise people that their sexuality and sexual preferences may shift slightly or even a lot when they undergo treatment for gender variance. This may be due to the acceptance of living in the right gender role, or may be a hormonal influence, or maybe a mixture of lots of factors.

There is no right or wrong, just keeping an open mind :)

Dr Helen Webberley


Should trans youth be allowed to transition pre-puberty, or should they be on puberty blockers until they are 18?

Pyrollamasteak

My feeling is that trans youth should be able to go through puberty at the time that feels right for them, and in line with their peers - rather than at an aged defined time. Dr Helen Webberley


I've always wondered how should a transgender person fill out a medical form? For instance if they identify as female but (please bear with my lack of a better understanding) are a male, should they fill themselves out as female still or does that hold medical repercussions. What if they're post-op but were originally "male"?

I'm all for individual identification especially with the amount of hate that the community receives, but I've always wondered if this progressiveness is getting too out of hand and is hurting the medical community.

almightyalf

People should be allowed to use the pronoun that they prefer and that makes them feel most comfortable.

If a person who identifies as 'he' still has, for example, a womb - then he should still be offered cervical screening along with best medical practice for screening.

The medical community should adapt to people's needs rather than feel hurt by variance.

Dr Helen Webberley


Okay I'll jump in, hoping this question hasn't been asked yet. Anyways, as an autogynephiliac I've contemplated quite often if I actually end up as trans somewhere in the future. While I'm inclined to say no, the fact that I'm posting here does show that it's not something I take lightly nor that my answer is anywhere near certain.

That in mind: what's your experience with autogynephile or autoandrophile patients? Do people actually cite that as a reason to transition or is that just a small minority?

ApsidalMosaic

These concepts do not feature in my medical practice.

Dr Helen Webberley


Thank you for this AMA.

Do you feel that the subtle change in definition from the DSM-IV to the DSM-V, going from Gender Identity Disorder (GID) to the now Gender Dysphoria, is a positive change or a negative change?

Do you feel that the categorization of this identification contributes to the stigmas surrounding Gender Dysphoria?

I am relatively ignorant to the whole subject, but I have a few transgender friends, and I thought it was interesting to categorize their condition as a "disorder" or something analogous.

Thanks again!

DragonFive

Not all people who have gender variance experience dysphoria. And many don't like to perceive it as a 'disorder'. Will we ever get the name right....? Dr Helen Webberley


I have a hard time really understanding what it feels like to be transgender. How would you explain the struggles of a transgender to an introvert who has never struggled much with his own identity?

DanAugustus

Many say that it is like a volcano, it can sit quietly but then bubble near the surface and then go away again. Sometimes it just explodes and you have to either get help or show the world who you really are and stop living the lie. Dr Helen Webberley


Dr Webberley,

Thank you for your work providing treatment for transgender individuals. Thank you for coming onto Reddit to discuss what is seen by many as a difficult topic.

I have many transgender friends, the majority of whom are currently undergoing HRT. Most of them occasionally have episodes of severe gender dysphoria, which causes them a lot of distress. As a friend and an ally, what can I say or do to make their life easier in situations like this?

Thank you again for your time.

PM_ME_SERGALS

Do the same as I do - be there, listen, hold their hand, care for them, help them through the low days and rejoice the good days :)


As an individual who is currently seriously questioning their gender identity, are there any resources you would recommend for a questioning individual to help them work out whether they are Transgender?

confused_maybe_trans


Hi,

What theories are there for the causation of being transgender? If there are not any solid/possible theories, is there any suggestive evidence on a causation?

Also, tomorrow will be my first full week of being on testosterone, thanks to you. So thank you for that, I am already so much more confident.

ReeceSewell10

Hello!

We don't know what, if anything, 'causes' it. I actually think it is just a normal variation of a deliciously variant human race.

Dr Helen Webberley


I know a few trans people and soem cross dressers, and they've have a lot of conversations about it, but no one is an expert...

How does crossdressing fit into people being trans?

Is it a good indicator, are there other questions that should go with that? Public vs private, sexual reasons vs feeling right, and so on?

Also, whats your thoughts with some doctors forcing their patients to go out cross dressing "to prove it" before giving them HRT meds? Seems like a good way to traumatize someone.

emma2b

Sine people get physical, emotional or sexual comfort out of wearing the clothes traditionally designed for the opposite gender. For trans people, wearing the clothes that suits their gender just feels right. Dr Helen Webberley


How does the field in general, or you specifically, handle children who believe they're in the wrong gender as a symptom of a separate psychological state? For instance, low self-esteem, quirks of family dynamics, or confusion between gender identity and gender expression?

What is the prevailing opinion regarding the desistance rate among children who present with gender dysphoria? reported here as 43%, well over half of those who responded to follow up

freakytiki34

More recent medical opinion feels that longstanding feelings of gender variance that persist into adolescence are very unlikely to go away. The incidence of low self esteem seems to be much more in those trans children who are denied help rather than being the cause of their gender variance. Dr Helen Webberley


My girlfriend has often said that as a child she wished she was a boy so she could play with her brothers, and having been raised by only her father... she wanted that father son bond. Being 2017 and transgendered children a thing, would you have suggest hormone treatment for her?

RobisaII

Gender variance in children goes a whole lot deeper than single thoughts such as these. It is about feeling that you are a boy rather than wishing you are one. Dr Helen Webberley


Hello Dr Webberley thanks for doing this AMA. I'm a trans woman living in Massachusetts. I'm completely clueless as to what to do regarding grs. I'm not indecisive over having the surgery but am very confused about the myriad of options out there, on top of which how I'd pay for it when I'm currently poor and on state healthcare... and then, on top of THAT, there's Trump and his proposals with healthcare. I'd there a call center or counseling service for people like me? Perhaps an online course? Thanks! :-)

MTFMuffins

Is there anyone in the USA who would be better placed to answer this for me? Dr Helen Webberley


If, in the future, there was a safe medical intervention that could eliminate gender dysphoria by making the person accepting of the gender they were assigned at birth; would you welcome such a development?

Iaskmanyquestionsok

No, I would rather see a time when all people were accepted for who they are rather than who we think they should be. Dr Helen Webberley


My brother has Klinefelter's Syndrome (he has XXY chromosomes) Do you feel as if he my have a hard time assimilating as a boy because of this? Growing up he seemed to have to try extra hard to be a typical boy because of the example his older brother. I question if he never is honest with himself because that's not what society/parents/social norms shows that he should be...

Tysflys

Whoever someone has a difference, it can be hard to feel you 100% fit in with 'norms'. Just support and encourage him to be who he feels rather that who he feels he should be. Dr Helen Webberley


Given that:

  1. There are some posited differences in brain structure between trans people and cis people;

  2. Computers are being used to diagnose certain conditions based on scans;

Do you think one day we'll be able to diagnose gender dysmorphia via brain scans?

PM_ME_UR_OBSIDIAN

Personally I think it is too complex and inherent and natural to ever be able to be conclusively shown up on a scan or blood test. Dr Helen Webberley


[deleted]

[deleted]

I guess my advice is that if you don't want to get in a 'big fight' with someone who maybe does understand the concept, then you should either keep your views to yourself, or try and learn about and understand it.

For many, pronouns are very important. How would you feel if someone called you 'she' when clearly you feel like a 'he'?

Dr Helen Webberley


Greetings Dr Webberley, and thank you for this AMA!

In at least some circles, one notices a proliferation of gender types and gender-like constructs, ranging from non-binarity & gender fluidity to otherkin. Some of these are, to many, downright bizarre. Are these diverse constructs of equal merit, and to what extent are they based in reality and deserving of serious consideration?

Gargatua13013

Sometime human nature just finds things bizarre, especially things we don't personally understand. I know that there are many gender identities, and to 'name' them would be wrong - I see it more as a spectrum. Dr Helen Webberley


The Chemical Atrazine has been in the public eye for some time now in relation to its potential effects on gender expression in mammals. What impact, if any, do you believe Atrazine has on the average person?

LordDongler

I don't know!

Dr Helen Webberley


Thank you for doing this AMA! What research is available on changes to sexual response in transgender women following hormone therapy, and following genital surgery?

ladylattemotif

Hi, I'm not sure - and I expect the answer is not enough. If you have an interest or have any data then do get in touch. Dr Helen Webberley


How relevant is birth gender for medical treatment throughout life? Where I'm from, transgender people can change what their ID says in the "gender" space. And I always felt curious if it could complicate medical care for future doctors treating the person. Is there any risk involved?

Personally I don't see anything wrong with the distinction between: male, trans-male, female, trans-female if it helps emergency care in case of accident or serious disease, but I also don't know if it involves any psychological factor that might affect the person negatively.

(Sorry if I offended anyone, but I don't know the details and it's why I'm asking)

OneOfTheLostOnes

Your biological sex matters in terms of anatomy and body parts when medical care is needed in the future. The doctor needs to know what body parts you have and if they can't tell then you may need to tell them. The same applies for your blood laboratory indices - you may need to consider whether your normal range is female or male.

Biological sex is about the chromosomes inside your cells and the genitals on your outside. Gender Identity is about feminine and masculine and how you feel inside your body and mind. Gender Expression is how your express your gender identity to yourself and those around you. (I could of course talk for hours on this subject, but that is it in a nutshell!) Dr Helen Webberley


What's some good advice to people that are questioning?

Mikzalable

Listen to your own questions, ask the trans support organisations, ask the forums - talk and question and listen. Dr Webberley


As someone with very little experience in this area, I see two competing liberal viewpoints: 1) Be happy with who you are (self acceptance); 2) Change yourself to match the real you. How do you differentiate patients who need one vs. the other? Are we currently in a societal shift away from the self-acceptance ideology?

sherlocksrobot

Harry Benjamin MD - The Forefather of Transgender Care:

He is famously quoted as saying: “I ask myself, in mercy, or in common sense, if we cannot alter the conviction to fit the body, should we not, in certain circumstances, alter the body to fit the conviction?”

http://www.huffingtonpost.co.uk/dr-helen-webberley/harry-benjamin-md_b_10475890.html

Dr Helen Webberley


Transgenderism in children is being diagnosed younger and younger even going as low as 3 years old. Most adults though have no memories from this age. Is this too young and if not how can they know a child at this age is transgender? What is the confidence interval?

AsterJ

The child may not remember as far back as three, but Mums and Dads and photos do! We do not treat very young children, but we listen to the stories and prepare the way should the feelings if gender variance persist. Dr Helen Webberley


Could you recommend some studies that have been done to get me started with understanding gender variance?

BaldricBlack


About what percentage of the population suffers from gender dysphoria? And are there any other symptoms of it other than feelings?

hicksbilt

It is way more common than you would think. It is a complex set of feelings and emotions, there is no t'test' for it. Dr Helen Webberley


Do you always recommend hormone treatment and or surgeries to gender non conforming people Or is there an effort to try and find the root of their discomfort? Also, do you treat only people with sex disforia, or anyone who is gender non conforming?

RipleyRiot

True gender variance doesn't have a root, or a cause, it is just as it is. Not everyone wants or needs medial intervention. Dr Helen Webberley


Are there any online (or other resources) that can be used to explain/discuss/open a dialogue about gender issues with high school aged kids?

Courtnall14

ask the MermaidsUK charity, they have some wonderful resources for kids. Dr Helen Webberley


Is gender dysphoria treated in any other way than transitioning to appear like the opposite sex? For example, do you recommend patients to try therapy to feel more at ease with the bodies they were born with?

Mustasaari

Often by the time people access medical help, they have done a lot of soul searching and questioning. I would never try and force anyone to try and feel more at easy with their body as it is, but I would explore what this means to them and how they feel about it. Dr Helen Webberley


What do you tell people when they say that there are only 2 genders? Even when they don't understand the idea that gender is a spectrum, not a set of boxes

DaveyTickler

I would say that gender is more of a spectrum than a certain small number of genders. In which case, I guess there are infinite variations of how someone feels that their gender identifies. Dr Helen Webberley


[deleted]

[deleted]

Private options do not have to break the bank, look into your options and see whether it is worth the funds or whether you can wait for free treatment on the NHS. Dr Helen Webberley


Hi Dr. Webberley So I already submitted, but figured since there's so many comments it might not have been seen. My question was about college age trans and nb people and regulations on us in college sports. I'm non-binary/transmasculine, and play on a women's volleyball team. No one on my team knows I'm gender queer because I'm scared not identifying female won't allow me to to play on a women's volleyball team. My school doesn't have a men's team and only a club coed team and I wouldn't enjoy that level of play as much as the varsity team.

Do you know what regulations I will/would have to abide by when/if I decide to come out to them? Would I even be slowed to continue play?

Bite_Me_Mari

Hi, this is really tricky and I don't know that there are definite answers. Medically, if you have not taken any medication to transition then you should be allowed to play with those who share the same hormone pattern as you do. I'm sorry I can't help more. Does anyone else know of any legislation? Dr Helen Webberley


Hi - I hope you can answer this as I have a loved one in my life that is directly experiencing this and I have not been able to get a rational vs political response online so far.

First, I agree with the overall concept that gender is more fluid than we traditionally interpret it. I know men and women, both gay and straight, on every point of a gender line – or maybe gender triangle is better, with “none” being one of the choices. And I would (and do) advocate that society should not discriminate against people anywhere in that spectrum.

That said, I have a lot of problems with surgical and chemical intervention in this process. So here is my question. I hope I don’t come across as disrespectful – I am honestly trying to understand this thinking.

It seems that the obvious treatment for, say, a male who feels female would be to first investigate the underlying psychological cause, if any, of this feeling and address that. After that, if the feeling is still there, then help him accept and understand that he is in fact a male who feels female, and that is OK, and teach him how to embrace that feminine side, vs. try to chemically or surgically make him female.

I say this because AFAIK this is how we would treat any other form dysphoria. If I came to you and said I feel like I should be a cat, not a human, you would probably not help me surgically try to become a cat. Or, for a more realistic example, if I was a black man and I told you I feel like I should be white, you probably would not recommend that I bleach my skin and have craniofacial surgery to look more white. If I told you I was attracted to men, you would help me embrace my sexual orientation and help me live as a gay male rather than surgical change to a female to match my sexual preference.

So why is gender treated differently?

Do we go to this extreme for gender because of social pressure? Is it that society will reject a male who is “pretending” to be female but is OK with it if the “disguise” is convincing? Or to put it another way, if make-up and clothing and behavior training alone could make a male socially indistinguishable from a female, would hormones/surgery still be recommended? In short, is there any medical / scientific reason justifying this approach?

In the last few weeks I have read a ton of published studies on gender and I have not found any that sheds light on this.

Thanks for your answer!

davevr

It can be very tricky to understand. Your gender is inherent, a feeling inside you that doesn't change and doesn't go away. It may not match your biological sex. Why would a 'man' 'want to be a woman' if they didn't feel they were one? Dr Helen Webberley


Haven't seen this question yet, so I hope I don't repeat, but what are some of the alternatives to HRT for an individual with gender dysphoria? The current culture seems to push for automatic acceptance of the perceived gender, but I imagine transitioning may not always be the ultimately desired choice for an individual. Have there been any recent developments in the use of psychotherapy to treat gender dysphoria?

rangkloic

You can't 'treat' gender dysphoria. It can't be cured and they can't 'get better'. But we can help people to live more comfortably with their gender through discussion, counselling, psychotherapy, social transition, hormone therapy, surgery - or any of the above. Dr Helen Webberley


What do you think about children and gender reassignment? Not sure if that is the correct term, I mean children having surgery/ treatment to change their gender?

curiousonly

Children who are gender variant have the opportunity to be given treatment to align their gender with their actual gender. We call this gender-affirming treatment.

They wouldn't describe is at 'changing' their gender, more aligning their gender to make their body fit more with the way they feel inside.

Teenagers would never be given irreversible treatments until it was really thought the best thing to do and they were mature enough to make decisions.

Dr Helen Webberley


What is your opinion on the argument that there are more then 2 genders? Is there actually some proof to it? Is that a personal view or one shared in the NHS body?

mumble8721

Gender is a spectrum, not one or the other. Dr Helen Webberley


What do you think to the idea that developing a gender that does not match your biological sex should be treated as a developmental disorder and corrected, rather than being encouraged?

CosmicX1

I think it should be managed sensitively and with compassion, encouraging people to express themselves and live in a way that feels most comfortable to them.

You can't encourage it and make it more intense, you can't discourage it and make it go away. You can, however, allow social, medical and surgical transition that can help someone feel more in line with their gender, body and mind.

Dr Helen Webberley


Can you speak to the ethical concerns and implications of younger and younger people who have decided their anatomy doesn't match their gender, often before their brains are fully developed?

In these cases where children are making these decisions extremely young, are there ethical concerns about parents who enable/encourage such decisions?

UsuallyJustATP-Shirt

I feel very sad for the children and adolescents who have very strong feelings of gender variance but do not have the support of their families and friends. This is SO much more of a problem than parents encouraging their children to be gender variant, which is extremely rare these days. Dr Helen Webberley


Thanks, Dr. Webberley, for sharing your expertise.

Some people like to try to argue about the "legitimacy" of trans people using the sex binary (XX/XY) and insisting that, the majority of the time, there are two sexes and people are in some sense always going to be bound by those chromosomes, no matter what gender they wish to express. They make an exception for people who are born with more or less X or Y chromosomes, but generally insist that our sex is firmly established by our chromosome set. How would you respond to this?

worried_abt_u

Biological sex is about the chromosomes inside your cells and the genitals on your outside. Gender Identity is about feminine and masculine and how you feel inside your body and mind. Gender Expression is how your express your gender identity to yourself and those around you. (I could of course talk for hours on this subject, but that is it in a nutshell!) Dr Helen Webberley


What is your take on the firing of Kenneth Zucker? For the unfamiliar, Zucker is a psychologist in Toronto and editor of the scientific journal Archives of Sexual Behavior. He got fired after a number of activist organizations accused him and his clinic as promoting reparative therapies; the organizations presented a lot of weak, easily-falsified evidence, but because of the political/PR impact, he was fired.

Bloaf

Reparative therapies for gender variance have no place in modern medical management.

Transgender Kids: Does Zucker Know Best?

http://www.huffingtonpost.co.uk/dr-helen-webberley/transgender-kids-does-zuc_b_14226610.html

Dr Helen Webberley


Thank you for your time, Dr. Webberly. I'm an undergrad psychology student with an interest in clinical neuroscience, I have a couple of questions about your treatment philosophy specific to individuals seeking an orchiectomy.

In your opinion, what differentiates the belief that one needs to undergo an orchiectomy to match a cognitive schema, like gender, from a delusion (like those believed to underly other forms of body dysmorphia)?

Second: deep brain stimulation seems to have some success in treating patients with severe body dysmorphia (in the context of severe anorexia). Has this been investigated as a possible treatment approach for those suffering from gender dysphoria and are considering an orchiectomy?

edit: I'm surprised that I have negative karma for asking these questions, sort of, in /r/science, but I guess if it made it to the front page I am not that surprised. Purely apolitical question, I am asking an expert a question based on what literature has been available to me so far. She did give an answer- but unfortunately, she didn't really distinctly indicate how the BDS-related delusions about, for example, body mass/weight, differ from those with gender dysphoria...

paperfludude

Body Dysmorphic Syndrome (BDS) is when someone feels that a part of their body doesn't look or feel right to them, and this starts to have an impact on the way they feel and their day to day life. Feelings of gender variance have some overlap where the body assigned does not feel matched to their true gender, and this can lead to feelings of distress and affect people's lives very deeply. Dr Helen Webberley


What are your thoughts on the disproportionately high suicide rates amongst transgender people? Do you feel the condition should be categorised as a mental illnes?

Ultimate_Fuccboi

The suicide is because of the distress caused by the lack of understanding and the discrimination, rather than the condition itself.

Dr Webberley


Do you feel that the modern social justice movement has helped or hindered the people you work with?

(Not trying to start a flamewar people, it's a genuine question.)

Tethalamin

I'm not sure what you mean? Dr Helen Webberley


How big a percentage of your clients experience gender dysphoria and how many have a different root cause? To give a personal example, an acquaintance of mine had already started transitioning when she realized that she was only looking for validation and didn't actually want to be a man. Depression and other mental health issues were obviously also present.

Keetek

Before anyone starts treatment, they should have had a careful look at how long these thoughts had been there and how deep they lie. Nobody can ever know 100%, but we can get close. Dr Helen Webberley


are male born trans gender people born with some equivalent of a female brain? honest question.

asthingsgo

We don't really know what 'causes' it! We just know it exists and it is very real. Dr Helen Webberley


Is there a simple test that you can get done at the doctor that would determine/show your sex chromosomes?

I have seen people can be physically a woman in every way, but not neccessarily be XX. And vice versa/all different combos, etc.

allthewool

You can have a blood test to show your chromosome pattern. Dr Helen Webberley


Have you met a M to F transgender that has a "biological clock" or a biological yearning to physically bear children?

FoamHoam

Definitely, the urge to bear children can be overwhelmingly strong in all women. Dr Helen Webberley


Thoughts on the naming of sexes and genders being shared, despite their potential misalignment, and how this affects progress in public perception? One of the first things people who know nothing about trans people say is "you are a man because you have XY and that is a fact". And it is, on that level of biology, right? But a trans person will not feel like their actual self (not their physical self) is a man. So they transition in the way they prefer and call themselves a woman. But still have male biology to a certain extent. As a person on the periphery of all this, I start to get confused because on one hand I understand that a biological male with a female psyche who has transitioned to a mostly female anatomy still retains essentially male biology, but on the other hand they aren't "a man" in any other way as far as they are concerned. So is the sex then still male, while the gender is female? Medically, is a trans person their gender or their sex?

[deleted]

Biological sex is about the chromosomes inside your cells and the genitals on your outside. Gender Identity is about feminine and masculine and how you feel inside your body and mind. Gender Expression is how your express your gender identity to yourself and those around you. (I could of course talk for hours on this subject, but that is it in a nutshell!) Dr Helen Webberley


What's the ratio of gender variant people to gender non-variant people in a large population?

laalpacagrande

Much higher than we think! Dr Helen Webberley


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