Young women who’ve taken testosterone describe the experience as spiralling. Though testosterone affects the body overall, some of the most interesting clues – that it can cause intensifying distress and become addictive – come as trans-identified women detail their thought processes and emotions while on testosterone.
Why is testosterone addictive?
Clinical pharmacologist and neuroscientist, John Marriage, whose field is female reproductive endocrinology, says: ‘All medical treatments involving drugs (or exogenous hormones) have a placebo effect and this is usually tested before the procedure is allowed to be used.’
The widely recognised dopamine hit in anticipation of relief is even greater, Marriage notes, because patients are uncertain as to the hormone’s intended effects.
This may well explain the euphoria hit young women describe in the honeymoon period after starting testosterone. Bolstered by the socially reinforcing dynamic of transitioning, young women experience first elevated then diminished moods. ‘Transgenderism is the first “medical condition” reported to cause intense body dysphoria for many,’ according to Jennifer Bilek, who writes frequently about the trans movement.
Spiralling is a word familiar to transitioning. In the book, Inventing Transgender children and Young People, those young women who have discontinued testosterone theorise there is a trans spiral that testosterone triggers, the initial high is followed by a low ebb of distress which redoubles the felt need for additional biological alterations.
In the book Inventing Transgender Children and Young People, the authors present a theory on how transition traps patients in a cycle of seeking the ‘high’ first experienced at the onset of taking testosterone.
This diagram captures the dynamic that boosts and perpetuates transitioning. Notice the very acts that are intended as liberating – claiming a new name, wearing a binder, etc. – heighten dysphoria. Notably, a parent observed: ‘That first downward slope is exactly what we saw in our daughter as soon as her school formally transitioned her. We had an awful month while we complained until they stopped – complete turnaround in her now while we do watchful waiting and she’s kept busy in loads of activities.’ Another mum writes: ‘That’s what I noticed with my kid. The minute she started passing as a boy, her social anxiety went through the roof.’
Trans may serve as a catch-all term to explain any uncomfortable feelings around one’s body. In her work with dysphoric adolescents, Sasha Ayad notes that her patients who express generalised distress around their sex tend to attribute normal teen or young adult angst to being trans. They do so, Ayad suggests, because of the current transitioning craze.
She compares trans to the outbreak of eating disorders that spread from America to other parts of the globe as described in Ethan Watters’ book Crazy Like Us. The diagnosis of anorexia spread amid tight social groups, resembling patterns of female patients now rushing to transition (In the UK, young people referred for ‘gender treatment’ has increased from 97 in 2009 to 2,510 in 2017–2018, an over 4,000 per cent increase in 10 years). From her work with teens, Ayad has noticed trans is the kind of nebulous term that can provide validation.
Taking testosterone, as part of what might as well be a social media campaign, earns one social credit for independence, honesty, and bravery. Underlying issues get overlooked in favour of a TEN (trans-explanatory narrative). The explanatory power of TEN offers a perfect interpretive frame for GNC (gender nonconformity).
Testosterone distracts while providing added alertness. Later this may become ‘I need testosterone’ in the same way a smoker craves a cigarette whenever feeling stressed, or it may trigger deeper unexplored issues: ‘Testosterone made me more full of rage than I’ve ever been. I’d get scared. I’d self-harm and self-hate.’ (Pique Resilience Project). Why this occurs is unclear, yet detransitioners often refer to ‘spiralling’ in the context of taking testosterone.
The testosterone-path girls and young women are prescribed leads to becoming increasingly dysphoric by virtue of adding the additional life stressors of worsening health and by not addressing underlying mental health issues. Helena, one of the members of the Pique Resilience Project, a group of detransitioned women dedicated to spreading awareness of the medical industry’s treatment of trans-identified youth, details the kind of hellish torment she experienced on recognising her mental health issues were not improved by testosterone but in fact exacerbated.
Looking back on her dysphoria, Helena describes her mood shifts as they followed the trajectory of a downward plunge only reinforced by her own and her health providers’ ongoing single-sourcing attribution of her struggles to transphobia. She writes: ‘It’s not just that my providers neglected to thoroughly assess my mental health and ideas about transition, but of the aspects I did share they agreed and reinforced my idea that all of my issues were caused by being trans and having transphobic parents which would all be resolved when I transitioned.’
Helena, who notes she still experiences dysphoria occasionally, describes her exit from the testosterone spiral as a process of mindfulness, which entails monitoring what she is feeling and addressing her emotions more directly. Other women confirm the significance of learning to explore past trauma in order to address emotional health.
Dysphoria does not dissipate on testosterone but just reorients to other bodily features with the strangest surprise of all for females taking testosterone: ‘Dysphoria shifted to aspects of my body testosterone had not helped with, such as body shape (I have wide hips) and genitals, which I had not previously been dysphoric about. Genital dysphoria became particularly bad because testosterone also changed my sexual instincts and I felt a greater connection with a body part I did not have, and I felt unable to have a meaningful physical relationship because of that.’ In a mental health context, a shift is not a gain.
Undiagnosed or unexplored comorbidities, such as anxiety and depression, go unresolved as they are assumed part of the dysphoria itself or inevitable trans-liabilities. And, given the shifting quality of dysphoria, T does not appear to be eliminating distress long term – or any of the deeper issues, so much as redirecting an obsessive focus.
Generally, testosterone can produce dissociation from the body within the current social context in which a young woman is preoccupied with gaining and then maintaining a male appearance, yet the demands of upkeep actually intensify dysphoria. As one person put it: ‘transitioning only amplified my dissociation’.
Living between multiple worlds, who knows I’m out, who doesn’t, who am I stealth to, what name does this person know me by, was not good for my mental health overall,’ (Nic on Twitter). Other less obvious effects of testosterone pop up on Reddit and elsewhere: ‘Worsening of breast and hip dysphoria and developing genital dysphoria. Distress from uncomfortably high sex drive. Foggy brain. Feeling more dissociated from my body.’ Even after transitioning, body distress can be present.
The story of transitioning is told as a mode of self-realisation. But is that what really happens? Instead of liberating, testosterone and its gradually attendant health complications trap patients in a net of hormonal drug dependence and induced mood swings or dissociation.
Among other counselling professionals, Lisa Marchiano, a clinical social worker in Philadelphia, questions the merging of a young female’s self-actualisation with a corporate and marketing push featuring a particular definition of self, one achieved through an objectified protean self. Marchiano asks: ‘Could teen girls be latching on to the narrative supplied online and in the media to construct a story about themselves that serves to explain their feelings of difference while offering a path to transformation?’ It is a question looking far past the usual tale of happily-ever-transed.
Inhibiting the stepping free of the trans narrative are new problems arising as old ones are left unaddressed. That’s why, even after transitioning completely, patients often have yet to confront their underlying habits of mind or emotional states or process trauma. No wonder, those who have detransitioned tend to use words like ‘trapped’ in describing their experience of transitioning: ‘I feel like I was in a trap that I couldn’t find my way out of,’ writes Christina. ‘Your own avoidance of emotional pain was part of it, unconsciously suppressing thoughts and feelings. But I had a lot of help with that from outside too. I feel that in some ways, I was converted to transgender.’
In other words, clinicians act in ways that reinforce the spiral. In fact, medical staff can actually suggest the need to perpetuate the cycle of transitioning: Part of getting free of the trap of never-ending transitioning is recognising it for what it is. Detransitioners are outspoken in their firm declarations of independence, such that it is evident they have arrived at a painful reckoning and have no desire to get back on the transitioning treadmill.
Taking stock provides detransitioners with a firm ground to stand on going forward. And that is no small thing – we’re talking here not just alleviating suffering, which they have to learn more about themselves to do. Not just boycotting Mermaid cookies to prop up corporate entities. And not just stepping back from the online mediated performance of identity and adulation.
Not just breaking free of an obsession with a masculinised body, female detransitioners have to begin to tell their own stories: ‘HRT [hormone replacement therapy] isn’t harmless, it ruined my life. I want my body back!’
‘I was diagnosed with GID [gender identity disorder]/MTF [male to female] and prescribed cross-sex HRT. This caused irreversible harm to my body and didn’t solve my gender dysphoria. Now I’m a medical patient/customer for life.’
‘HRT seemed to help me mentally in the short term, but in the long term, it did far more harm than good, mentally and physically.’
Given the not so subtle targeting of girls and young women – and the female explosion in transitioning within the last decade, we know transitioning appeals predominantly to females who tend to report dissatisfaction with their bodies. One iatrogenic effect of testosterone is to amp the female tendency to objectify her own body, viewed in the trans context as a completely malleable object to be cosmetically modified by drugs and surgery.
Within the tightly -regulated social media and friend context where transitioning trends (as described in landmark research by Lisa Littman) physical effects of testosterone are minimised in the breathless ROGD (rapid-onset gender dysphoria) rush to transition, not unlike the quest for beauty or feminine perfection critiqued by feminists for ages.
Reading the comments of those who were able finally to separate themselves from the powerful trans narrative reads like a tale of survival. Ariel gave over her beautiful singing voice to achieve her dream of living another reality; these girls and young women gave up far more. Though they’ve been through the horrendous ravages of transitioning, they have learned to name those issues and step back from the engulfing emotions and trans concepts that caught their innocence like a mermaid tied to the mast of mercantile demand.
They are reclaiming their own narratives, often with a fierce clarity of expression that sees through the medical ‘guidance’ carrying them not to the safe harbour they’d anticipated but out to sea where they nearly drowned.
Vulnerable girls and young women are falling prey to subtle cues in group think tanks on social media, marketing ploys and white-coated authorities. Stopping testosterone and rejecting the false promise of trans appears to be their way out of dysphoria.
Achieving the stable state necessary to reject TEN can alleviate suffering, and as happens, open up the possibilities of finding joy, not in attention received by virtue of a testosterone-propped masculine persona but by recognising that even mermaids of the Disney may need to look down through the murky past to recognise the effects of trauma or other mental health issues. Only then do they start to make peace with fragile, floppy bodily flesh, unapologetically imperfect. This was the task left undone when setting out on a medicalised quest for fulfilment.
Dr Faith Kuzma earned a PhD in 20th-century literature from Ohio University, taught composition and literature and is now retired. She is a mother of a young adult with rapid onset gender dysphoria.