Sourcing a complete and credible summary document of the harms of medical gender transition is a challenge in this rapidly evolving field. The long-term outcomes of medical gender affirmation interventions are unknown. There are no long-term studies to assess the degree of harm for children and young people taking puberty blockers and cross-sex hormones. In addition, the practice of prescribing puberty blockers to children for this off-label purpose is relatively recent.
A partial list of known side-effects can be found in the Endocrine Society Clinical Practice Guideline. See Table 10.
What is not relatable in reading a list of potential side-effects and risks are the human impacts of these treatments. We document these below.
Side Effects of the Blockade of Normal Puberty
The Human Stories of Side Effects of the Blockade of Normal Puberty
A BC-based therapist recently reported to us that a young client on PBs recently fractured both arms in a minor fall. An Ontario-based teacher recently reported to us that a teenage student in her class is having uncomfortable hot-flashes. Another teacher in Ontario has reported to us that one of her students who has been on puberty blockers for three years has difficulty standing straight and is using a cane. It is unclear whether the parents or physicians of these children recognize the potential link between the puberty blocker usage and bone fragility. It is also unclear to whom one would report this kind of harm.
The following chart indicates the normal accrual of bone density through puberty. With the initiation of puberty blockers, bone density has been seen to flatline and even decline. It is unclear whether the introduction of cross-sex hormones normalizes bone density. Research suggests that while bone density improves, it is significantly below population standards.
The interference with normal bone development is an obvious and major short term risk:
More information regarding the accrual of bone mass can be found here: The Effect of Puberty Blockers on the Accrual of Bone Mass | SEGM
Sweden has reported 13 cases of “medical injury” from the initiation of puberty blockers. In one case where the mother has spoken out publicly, we know that there has been significant decay of the spinal column causing ongoing pain and mobility issues and that the child’s teeth did not develop normally.
Side Effects of Cross-Sex Hormones:
Concerned individuals reported to us that a young Toronto woman in her early 20s died while waiting for a liver transplant. She had been on testosterone (PB usage unknown) and then developed liver failure from “all the meds she was on.”
It is unclear what the physiological impact of testosterone is on the female body and mind.
Females have always been less likely to complete suicide attempts, although more likely to engage in suicidal ideation and to attempt suicide. Unfortunately, we’re aware of two female detransitioners who died by suicide in the last 14 months in Canada. One of them wrote a haunting poem on one of her social media accounts on International Women’s Day just weeks before her death. The poem illuminated her sense of loss of her female self.
Jamie Reed, a whistleblower in the US, has provided testimony about some of the side effects of high levels of testosterone that clinicians noticed. For example:
“Other girls were disturbed by the effects of testosterone on their clitoris, which enlarges and grows into what looks like a microphallus, or a tiny penis. I counseled one patient whose enlarged clitoris now extended below her vulva, and it chafed and rubbed painfully in her jeans. I advised her to get the kind of compression undergarments worn by biological men who dress to pass as female. At the end of the call I thought to myself, “Wow, we hurt this kid.” “
A “17-year-old biological female patient who was on testosterone. She said she was bleeding from the vagina. In less than an hour she had soaked through an extra heavy pad, her jeans, and a towel she had wrapped around her waist. The nurse at the center told her to go to the emergency room right away.
We found out later this girl had had intercourse, and because testosterone thins the vaginal tissues, her vaginal canal had ripped open. She had to be sedated and given surgery to repair the damage. She wasn’t the only vaginal laceration case we heard about.”
It’s rather easy to dismiss a list of side effects that may include clitoromegaly and vaginal thinning as minimal “tolerable” side effects of transing on a consent form. But the reality is profoundly worse.
It also suggests serious deliberation is needed as to whether young people are able to give consent to treatments that result in these outcomes.
While some studies have shown benefit or “satisfaction” with gender-affirming surgeries, the follow-up time has been brief, not long enough to address outcomes. Some studies that initially reported positive outcomes were later corrected after multiple researchers brought concerns to the editor.
Phalloplasty complications include, but are not limited to: urinary tract stenosis, loss of erotic sensation, necrosis or infection of the phallus, and wound breakdown, which often occurs at the perineal-scrotal junction. There is also a concern for rectal injury. Revision surgeries are common.
Mastectomy complications include, but are not limited to: infection, necrosis, drain blockage, dehiscence, loss of sensation, nerve damage, excessive scarring, blood clots, edema, hematoma, graft complications. Revision surgeries may be required.
Vaginoplasty complications include, but are not limited to: fistulas, granulation tissue, urinary tract infections, lack of sensation, anorgasmia. Vaginoplasty also requires life-long maintenance care with its own complications.
The Human Stories of Gender- Affirming Surgeries
Male-to-female indigneous Canadian Duchess Lois (Twitter @duchess_elle ) has applied for MAID (assisted dying) due to the many painful complications from vaginoplasty, about which she did not feel she was fully informed by her doctors. Her case has been accepted and she is going through the waiting period.
Numerous Canadian detransitioners have expressed that their mastectomy sites are numb and painful and a recurring reminder of some loss that they feel. Reconstructive surgery is not easy to access. While the original surgeries were very accessible in their home provinces and cities, the Montreal clinic appears to be the only option for reconstructive surgery. Unfortunately, many detransitioners suffer extreme anxiety and depression and are unable to consider travel for this kind of medical procedure.
We are aware of several other Canadian trans people considering MAID due to ongoing mental and physical suffering. When these individuals contact us, we help them find qualified therapists who are equipped to support them on an individualized and complex journey of healing.