Trans Kids and Reproductive Choices

Trans kids today have new options for transition. Few people even know about these possibilities, although awareness is increasing. In my own pre-teen years, I noticed that my girlfriends were starting to change, and I felt different from them. In my private, inner thoughts, I believed I should be a gay boy, but that seemed so very far from what was possible in reality that I wondered from time to time if I was crazy. I didn't know about the existence of transgender people until I was an older teenager, and even then, I had no idea that trans kids could access any kind of specialized medical help.

Photo: Visit Cape May (Creative Commons)

Hormone blockers have long been used to delay the development of secondary sex characteristics in children experiencing precocious puberty. More recently, paediatricians have started prescribing them for trans kids. This prevents a female-to-male (FtM) trans boy from growing unwanted breasts and experiencing other pubescent changes. In the case of a male-to-female (MtF) trans girl, the blockers halt all the powerful effects of testosterone, including deepening of the voice and changing of the face shape. At age 16 or 18, depending on who you're talking to, patients can begin taking synthetic hormones so that they will develop the secondary sex characteristics of their intended gender, or they can take nothing and develop according to their genetics.

The effects of the hormone blockers are completely reversible. Nevertheless, if an FtM teenager takes them and then takes testosterone as a young adult, his female sexual organs will not mature. I don't know if they would ever mature if he stopped taking the testosterone some years later. Testosterone use in FtM trans guys who transitioned after puberty can cause female sex organs to atrophy, and may also result in polycystic ovary syndrome (PCOS), which can lead to permanent infertility. I haven't been able to find good information concerning its effect on individuals who used hormone blockers and never produced natal hormones.

If I'd known about hormone blockers and the possibility of transitioning earlier in my life, would I have done so? I don't know. I didn't have the social supports necessary for transition at that time. It's hard to separate such a support system from an individual's emotional readiness. I wonder if I may have been much happier earlier in my life if I'd been able to transition as a teenager. I don't know if the choice would have been as clear for me at age 12 or 14 as it was at 23.

If you had asked me when I was ten years old if I thought I would ever want to birth a baby, or even adopt one, I would have for sure said no. At age twenty and even twenty-four, I would have still said no. Nobody asked me. When discussing transition, I don't remember being asked by my therapist, family doctor or endocrinologist if I thought I ever would want to have kids. My surgeon definitely didn't talk to me about future breastfeeding. I'm guessing that most trans people and their health care providers assume that infertility is the price we pay for transitioning. Recently, some people have accused me of wanting to "have it all" – meaning the correct gender identity and my child. Well, isn't that what most others can enjoy?

I didn't contemplate having a relationship and a family until after I'd taken testosterone and had top surgery. I wasn't content enough before that to have any inkling of what I really wanted in that regard. Now, my son and my husband are the most precious parts of my life.

Do I think that trans kids shouldn't take hormone blockers so that they can maintain their reproductive potential? Do I think they shouldn't transition at a young age? No and no. Each individual has to make his or her own decision. Others can guess at how badly someone needs to transition and when, but only the person contemplating transition can really know. Some trans kids suffer from such severe gender dysphoria that they are depressed and even suicidal. These children often feel that they need to transition as soon as possible. Others, like I was, can kind of manage by keeping very busy and not being terribly self-aware – they might not need to transition as urgently.

Sometimes I wish that I could wake up in the morning with a physiologically male body, but I would never trade my baby for anything. Most of the time, I enjoy traveling my unique path. I am comfortable enough with my male-sounding voice, my beard, and my flat chest. The parts of me that I don't love so much are what helped to make the family I love so deeply. This is my conundrum.

Hormones!

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Many of us have heard before about the importance of hormones during childbirth and breastfeeding. Natural oxytocin, together with other hormones in a "love cocktail", can help you transcend the pain often associated with labour and then assist you in falling head over heels for, and breastfeeding, your baby. I am lucky enough to have had the pleasure of listening, live, to the renowned obstetrician Michel Odent speak in his lovely French accent about “ze luuuuuve coq-tail-uh”. It’s enough to make even the most prudish gay man swoon. You, too, can enjoy Mr. Odent by watching him on YouTube here.

Dr. Michel Odent

But my own hormones cause people a little confusion sometimes, so with this post I’ll attempt to clear things up. “How do you know that this is safe for your baby, what with all those hormones you’re taking?” Number one most common misconception about a transgender pregnancy: people tend to assume that I continued to take testosterone while carrying the baby.

I can see how someone might think this. After all, my voice remained low, and I continued to grow facial hair, and these are (wonderfully for me) masculine traits. However, once testosterone thickened my vocal chords, ceasing injecting it into myself could never thin them. This is why male to female transsexuals often spend much time and energy learning how to speak in a higher-pitched, female voice – it is not easy to sound feminine once they have gone through a biologically male puberty (and, for the record, it's actually all way more complicated than I'm making it seem, so if you like you can read up on it here). Again, after testosterone use had developed new hair follicles on my face, nothing but electrolysis could permanently remove my beard, as female to male transsexuals unfortunately know all too well. As an aside, this is a large part of the argument in favour of providing transgender teens with hormone blockers to delay the onset of puberty – as a trans kid, once puberty hits, it’s like you’ve boarded a fast-moving express train with zero stops to a country you have no desire to visit. Oh, right, and there is NO train that can take you back unless you practically build the tracks (and train) yourself.

On the other hand, testosterone leaves the bloodstream and tissues within ten days, said my endocrinologist. We consulted with him about the idea of trying to conceive, and he paused for a few minutes, looking thoughtful. Then he said, “well, just stop taking the testosterone, and wait for your cycles to return to normal. When they do, you’ll know that you are ready to try. The eggs should still be there…. I can’t see any problem. If I think of anything else, I’ll get back to you.” He never did.

Within two weeks of my last testosterone injection, I got a period. My cycles were immediately regular, even to the time of day, but we waited through four or five of them before trying. We got pregnant on the first attempt, and the entire pregnancy was utterly normal and healthy, as is our child.

I haven’t started taking testosterone again yet because it would seriously inhibit the hormones that affect breastfeeding, plus we haven’t decided for the time being if we’d like to have more kids. Gotta learn how to take care of this 11 month old little ball of energy first!