August 13, 2013

What Science Says About Transmen

Am I the only one who’s noticed that a lot of the public discourse about transgender centers on transwomen? Maybe it’s just that I notice references to transwomen more, but I think it’s more than that; I think the media, and the public, and the Interwebz are all more interested in / offended by / concerned with men becoming women than they are women becoming men.

This seems to hold true in the sciences, as well. Many of the scientific studies I find either focus on the transwoman or, if they are inclusive of all trans, have skewed sample sizes like “35 male-to-female patients and 2 female-to-male patients”. Are FtMs just not volunteering for these studies? Are there simply fewer FtMs available? I don’t know for sure. 

Anyway, this is not to say that science hasn’t studied transmen. I have found a fair handful of them in PubMed published in the last year or two, and I think that, together, they paint an interesting picture of what science has discovered about the FtM experience.

First, there’s “Long-term evaluation of donor-site morbidity after radial forearm flap phalopllasty for transsexual men” in The Journal of Sexual Medicine (March 2013). This one is straightforward: it took a look at the long-term health and satisfaction of FtMs who had undergone phalloplasty using the skin on their inner forearms. They found that “Transsexual men, despite scarring the forearm, consider the radial forearm flap phalloplasty as worthwhile.” Translation: a little scarring is worth the price of a penis.

FtMs aren’t just happy with their phalloplasties, though. It looks like they’re satisfied with their breast reductions as well, according to “Long-term results of breast reduction in female-to-male transsexuals,” from the journal Polski Przeglad Chirurgiczny (Polish Surgery Overview, March 2012). It concluded that “the long-term results of breast reduction in FtM transsexual persons revealed good aesthetic effects.” I love it when science and common sense agree!

A third long-term study, “Effects of long-term high dose testosterone administration on vaginal epithelium structure and estrogen receptor-α and -β expression of young women” (International Journal of Impotence Research, April 2013), wanted to measure the effects of long-term testosterone treatment on the epithelial cells of the vagina, including their ability to absorb estrogen. [Yes, the article title says “young women,” but they used FtMs as their subjects.] They found that “Vaginal samples from FtM showed a loss of normal architecture of the epithelium, intermediate and superficial layers were completely lost, and glycogen content was depleted” and concluded that “[S]ystemic T administration at supraphysiological dosage, determines profound changes in histomorphology and reduces ERs expression and proliferation of vaginal epithelium.” Put another way, lots of testosterone makes vaginas less womanly.

Speaking of lady-bits, there’s also “Excessive androgen exposure in female-to-male transsexual persons of reproductive age induces hyperplasia of the ovarian cortex and stroma but not polycystic ovary morphology” from the journal Human Sexuality (February 2013). Instead of epithelial cells, this study wanted to study the effects of androgens on the ovarian cortex (the surface layer of the ovaries). The hypothesis was that FtM ovaries might display signs of polycystic ovary syndrome (PCOS), a condition that sometimes results in increased androgen production in ciswomen. The study concluded that administration of androgens to FtM individuals induces changes to the ovaries that echo those of women with Polycystic Ovary Syndrome, though the study does not attribute heightened androgen levels to the onset of PCOS. Granted, this study has some methodological issues (small sample size, lack of control data), but the gist is, again, that lots of testosterone changes the female anatomy into something less functional as female anatomy.

Of some interest in science is the question of a biological basis for transgender. One study, ”Biometric characteristics of the pelvis in female-to-male transsexuals” from Archives of Sexual Behavior (October 2012), decided to test this by examining the pelvic structure of a cohort of FtMs compared to control groups of both cismen and ciswomen. This one struck me as a bit odd, since most of these “biological differences” studies focus on brain structures, but their results did suggest there might be something further to study:   

[A] number of FtM transsexuals’ pelvic measurements reveal “masculinization,” which confirms current results demonstrating a shift in the somatometric traits of transsexual females towards male traits. A discriminant analysis based only on pelvic metric features shows some differences between the size of the pelvis and chromosomal sex in FtM transsexuals, which might indicate a biological basis for gender identity disorder.

In other words, FtM body measurements may, in general, skew more towards cismale averages than cisfemale averages. There’s no speculation in the abstract about why this may be — Hormonal differences? Chromosomal activity? — but it’s an interesting initial finding.

So what have we learned today? (1) FtM men are happy with the procedures they use; (2) androgens make lady parts less lady-like; and (3) scientists are spending a lot of time studying FtM transsexuals. Of the three, I think only the last one caught me by surprise. 

[An earlier version of this post appeared at Ali Finds Her Self.]

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