Transgender

"At least 1.6 million transgender adults and adolescents live in the United States,1 among whom an estimated 70% of transgender men have used testosterone as gender-affirming hormone therapy (GAHT). A vaginectomy is rare (<3%) in this population, and the majority of transgender men and gender diverse people retain their vagina. Testosterone GAHT likely impacts sexual function via several complex pathways. Testosterone GAHT is associated with vaginal atrophy, which may be associated with decreased lubrication and/or discomfort during sexual activity. At the same time, increased gender affirmation through testosterone use may be associated with improved sexual function."

"There is limited research on the sexual function of transgender men and gender diverse people assigned female at birth (AFAB). The evidence that exists suggests that, although testosterone GAHT is associated with increased desire and arousal, a high proportion of transgender men also reported dyspareunia (painful sex), a common symptom of vaginal atrophy. The prevalence of dyspareunia may be as high as 60% to 62% among transgender men, markedly higher than the prevalence reported among cisgender women (3%–48%)."

"In our study, testosterone use among transgender men and gender diverse people AFAB was associated with some domains of positive sexual function (such as a higher interest in sexual activity and ability to orgasm) and pain or discomfort during sexual activity. Specifically, we observed a strong, consistent association between current testosterone use and higher interest in sex, as well as vaginal or FGO pain during sexual activity."

"I'm non-binary, which means it's not just that I'm challenging the binary between male, female, man, woman, but between us and them. And in your statement, you said, "why don't I help them", as if this struggle is not your struggle too. The reason you don't fight for me is because you're not fighting for yourself fully. And any movement that's trying to emancipate men from the shackles of heteropatriarchy or emancipate women from traditional gender ideology has to have trans and non-binary people at the forefront, because we are actually the most honest. We're tracing the root, where did these ideas of manhood and womanhood come from? They come from a binary structure, and so that's why people like me, who are visibly gender nonconforming, who are both feminine and masculine and none of the above, we experience the brunt of all of these collective fantasies that were created that are killing other people, that are also killing us, it just looks different. And so one of the things that I try to do in my work is say, "don't show up for me because you wanna protect me, or you wanna help me. I don't need your help. I have an unshakeable and irrevocable sense of who I am, because I am divine." [...] I don't need to be legitimized, or I don't have anything to prove. What I want us to rephrase the conversation is, are you ready to heal? And I don't think the majority of people are ready to heal, and that's why they repress us as trans and gender variant people, because they've done this violence to themselves first. They've repressed their own femininity, they've repressed their own gender non-conformity, they've repressed their own ambivalence, they've repressed their own creativity. And so when they see us have the audacity to live a life without compromise, where we say there are no trade-offs, where we say we actually get to carve in a marrow of this earth and create our own goddamn beauty, instead of saying "thank you for teaching me another way to live", they try to disappear us because they did that to themselves first."

"Caeneus, a woman once, and once a man, But ending in the sex she first began."

"Research suggests that trans people compared to cisgender people self-report significantly lower sexual pleasure, with researchers in one study finding that being younger in age, having higher genital satisfaction, and being happier in general predicting more sexual pleasure in trans people (Gieles et al., 2023). Trans people often experience elevated rates of shame, genital dissatisfaction, and body image distortion, which researchers have found to be associated with reduced sexual functioning, alongside the complexities of how medical transition might impact sexual functioning and one’s experience of sex (Barcelos et al., 2022)."

"Staples et al. (2020) found that time since medical transition was associated with increased body satisfaction which reduced sexual distress, rather than gender-affirming surgeries alone. Furthermore, while HT is recognized to impact some trans people’s sexualities, a review of HT and trans sexuality argues that hormones alone are unlikely to change sexual attraction, rather, they impact how trans people interact with the world (Burns et al., 2024)."

"What is known suggests that trans people may experience both changing gendered embodiment and sexual habitus (one’s psychological, physical, and emotional repertoire of sex acts, fantasies, and attractions) in tandem around transition, leading to unique experiences (Schilt & Windsor, 2014). They may also face navigating normative gender scripts within sexual and romantic encounters, which offers both opportunities and challenges around affirmation (Lindley et al., 2020). Further, trans people may use a range of labels to identify their sexual orientation, which may also shift over time and intersect with generational, cultural, and personal meanings (Doorduin & van Berlo, 2014; Galupo et al., 2016). Research suggests that unique labeling and othering processes may occur as a result of this, as trans people navigate their identity within cisgenderist norms, which can also influence how one perceives oneself, one’s relationships, and how partners perceive them (Pollock & Eyre, 2012; Thurston & Allan, 2018; Yerke & Mitchell, 2011). For some, this offers opportunities and access to communities, while for others, this is constraining (Pipkin et al., 2023)."

"Because the transgender population is growing, a larger availability of transgender health care is needed. Other health care providers should familiarize themselves with transgender health care, because HT can influence diseases and interact with medication. Because not all people apply for the classic treatment approach, special attention should be given to those who choose less common forms of treatment."

"The number of people with gender identity issues seeking professional help increased dramatically in recent decades. The percentage of people who regretted gonadectomy remained small and did not show a tendency to increase."

"A total of 48 019 patients who underwent GAS were identified, including 25 099 (52.3%) who were aged 19 to 30 years. The most common procedures were breast and chest procedures, which occurred in 27 187 patients (56.6%), followed by genital reconstruction (16 872 [35.1%]) and other facial and cosmetic procedures (6669 [13.9%]). The absolute number of GAS procedures rose from 4552 in 2016 to a peak of 13 011 in 2019 and then declined slightly to 12 818 in 2020. Overall, 25 099 patients (52.3%) were aged 19 to 30 years, 10 476 (21.8%) were aged 31 to 40, and 3678 (7.7%) were aged12 to 18 years. When stratified by the type of procedure performed, breast and chest procedures made up a greater percentage of the surgical interventions in younger patients, while genital surgical procedures were greater in older patients."

"While numerous surgical interventions can be considered GAS, the procedures have been broadly classified as breast and chest surgical procedures, facial and cosmetic interventions, and genital reconstructive surgery. Prior studies have shown that GAS is associated with improved quality of life, high rates of satisfaction, and a reduction in gender dysphoria. Furthermore, some studies have reported that GAS is associated with decreased depression and anxiety.8 Lastly, the procedures appear to be associated with acceptable morbidity and reasonable rates of perioperative complications."

"These findings suggest that the number of GAS procedures performed in the US has increased dramatically, nearly tripling from 2016 to 2019. Breast and chest surgery is the most common class of procedure performed while patients are most likely to undergo surgery between the ages of 19 and 30 years. The number of genital surgical procedures performed increased with increasing age."

"Do we have a theory on why people are gay? No. They just are. The only reason we even feel like we need a theory about trans people is that society is so unaccepting of us that it’s constantly demanding we justify our own reality."

"I feel like trans culture is just so obsessed with reassuring ourselves that we’re valid, that we sometimes forget that the end goal of a political movement is not validity, it’s equality."