Salty, I need to clarify one point. Even though the evidence is accumulating that trans brains are different than cis brains and most closely resemble the gender with which the person identifies, does not mean that there are any definitive diagnostic tests as of yet. My experience in finding I did not have a particular testosterone processing gene was related to an attempt to try to track down why I was suffering from sexual dysfunction and reacted so badly to finasteride. The purpose of the investigation was not related to my transgender status. Unfortunately, at the moment there is no one single thing that can be used to definitively say that someone is trans or not. It is based upon accumulation of lots of different kinds of evidence drawn from different disciplines and would be difficult to do for anyone without a lot of time and money. The easy way to identify trans brains is to dissect them, but that defeats the purpose for those of us who would prefer to stay alive! I mentioned the post mortem studies done beginning in the 90s. At that time it was discovered that the amygdala, putamen, hypothalamus and prefrontal cortex were structurally the same in transgender women as in cis women, but different than in males. Other studies were done of men undergoing castration for treatment of aggressive prostate cancer to determine whether this was hormonally related. As it turns out it wasn’t. The structural differences appear to have occurred during fetal development, not in response to changing hormonal influences. The important thing is for the larger community to understand that transness is a medical, not a psychological, condition which is based upon a potpourri of genetics, neurochemistry and brain structure fixed in utero. The fact that we do not have a single definitive test does not make this any less true.
To take my story one step further, another area of study that has been done is to look at the experiences of men undergoing prostate cancer therapy who have had their penis and testicles removed and those of trans women who have undergone the same as part of GAS. Since I recently did this, I can speak somewhat definitively. Men who are castrated because of prostate cancer, experience phantom pain and/or a sense that their testicles are still there. Trans women do not. In my case I have not experienced any of these things. Indeed my main impression when I woke up after my surgery was how streamlined I felt. I wrote a brief article on that experience in Medium. I’ve shared it several times since then in discussions with others. I’ve never felt like I lost or am missing something and post operative discomfort has been minimal. I never used any of the opioids prescribed . I feel complete, not mutilated. This is a very different experience than cis men would have. Again this is not definitive, but this is the second thing that indicates the truth of my trans identity. As time goes on I’m sure I will come up with more. I am now kind of interested in participating in the research at the Cleveland Clinic using MRIs to distinguish the activity between trans brains and male brains. It appears they can differentiate the two. That would be a third arrow in my quiver of proof. The bottom line is I think we need to be cautious in claiming there are definitive tests. There are not as of yet but there is a large body of scientific proof which tends to demonstrate the fact that the trans brain more resembles that of the gender with which it identifies than a natal brain. As time goes on I suspect the evidence will be consolidated into a more complete picture of the trans identity and result in the development of more definitive testing to prove it. We are hardly there yet however. The risk of course is that someone comes up with a test that they consider to be definitive which then becomes the new medical gatekeeper to determine those who can receive affirming care versus those who are rejected. That would open up a whole new can of worms and is a scenario where medical science should move thoughtfully and cautiously.
One last thing which I believe to be important, but which I have not addressed as of yet, is the different attitudes between trans women and males towards the physiologic and hormonal changes that occur as part of affirming care. These were questions I asked myself early on, because they were suggested as being important indicators by those who transitioned decades ago. They include (but are not limited to):
Do you fantasize about having your penis and testicles removed?
Do you long for well developed breasts?
Do you wish you were more emotional and could cry easier?
Do you fantasize about being the recipient in penetrative sex?
Do you want a vagina?
Do you wish you could give birth?
Would you like to breast-feed?
Would you like narrower arms and legs and wider hips?
In my case, the answer was yes to all of these. Cis males, regardless of sexual orientation, are appalled in particular by the concepts of being castrated and growing breasts. These were two of the things I longed for the most. One of the things the finasteride therapy I mentioned in a previous comment did to me, was to give me a pair of size C breasts. I was not repulsed, I found I liked them-a lot. That was an early indicator that I was on the right track. I do not know where you are on your own journey, but I suspect that as long as you keep digging and objectively look at what you discover, you will know that much more clearly the person you really are. I think your article may be the first one I have read that you have written. It was clear and concise, somewhat unusual for many Medium Writers. I will keep my eyes open for more of your offerings.
