British pediatrician Hilary Cass has a warning for distressed girls considering testosterone: taking this powerful hormone will make it hard — in some ways harder than mastectomy — to pass as a woman if they end up regretting medicalised gender change.

“I hate to say this, because I’ll get all sorts of kick back, but testosterone is a more effective hormone than estrogen in this context [as a cross-sex hormone],” Dr Cass said during a July 2 webinar on the implications of her landmark report for Australia.

“It is much easier to masculinise a woman than to feminise a man — and [testosterone] really acts very quickly,” she said.

And although a double mastectomy was “obviously irreversible,” Dr Cass said detransitioned women faced the “paradox” that “it is harder to pass as a woman if you’ve taken masculinising hormones at [age] 16.”

“By 18, it’s harder to reverse that and pass as a woman again, than it is if you’ve had a mastectomy — you can do more about that cosmetically than you can about having a deep voice and facial hair.

“It is important to say that, however careful the assessment [before hormonal treatment], it’s really difficult to determine with any sense of certainty which young people will go on to have an enduring trans identity.”

Although gender clinics claim there is little treatment regret, the Cass report says: “The percentage of [young] people treated with hormones who subsequently detransition remains unknown due to the lack of long-term follow-up studies, although there is suggestion that numbers are increasing.”

Given the risks and unknowns, the report urges “an extremely cautious clinical approach” to any cross-sex hormone provision at age 16, when this intervention becomes available under some treatment guidelines. In Australia, younger girls are put on testosterone, which is meant to be taken lifelong….

The recording of the July 2 Cass webinar, hosted by Australia’s National Association of Practising Psychiatrists, is here.

From Gender Clinic News