The detransitioners: what happens when trans men want to be women again?

The detransitioners: what happens when trans men want to be women again?

Laura Dodsworth meets the individuals whose stories are rarely told

Ellie, 21, didn’t foresee the emotional changes of testosterone © L AU R A D O D S WO RT H

Laura Dodsworth

W

Sunday July 12 2020, 12.01am BST, The Sunday Times

hen I told people I was going to create a photographic series about trans men who wanted to “detransition” and become women again, I was told to expect a

backlash. Actually, I was told I would be crucified — look at what happened to JK Rowling recently. At the very least I’d better take a holiday from Twitter. One person told me I should not be focusing on detransitioners when trans people are still struggling for acceptance.

But this would be to silence key voices when we should be having an

inclusive and nuanced discussion about gender identity, especially at a time when the government is deciding how, or whether, it will reform the Gender Recognition Act 2004.

I know trans people for whom social and medical transition has been the best outcome. For many people it can be a positive experience. I fully appreciate that. But it doesn’t work out for everyone, and it is not sustainable, or fair, to silence one community to serve another.

The women in my project, who are from the UK and other European countries, have all encountered anger, disbelief and trolling online.

Detransition — when someone ceases to identify as transgender and may take steps to reverse their social or medical transition — is a controversial concept.

It adds to concerns that children and young people may begin the process of transitioning yet later regret it. In April, the government announced plans to ban under-18s from having gender reassignment surgery. Currently under-18s are allowed surgery only with parental consent.

There has been a surge of children, particularly girls, identifying as trans in recent years. In England, 74% of children and young people referred to the Tavistock Gender Identity Clinic are girls. Why this increase among girls? The reason is not yet clear, but Penny Mordaunt, when she was minister for women and equalities, promised an inquiry.

This is one reason why I felt drawn to document female detransitioners. I wanted to understand and depict their circular and painful gender journey. For me, the idea of having my breasts, ovaries and womb removed, and then wanting them back, creates a feeling so unnerving that I can’t occupy it for long — that’s why my artistic lens focused on women.

I’m not shy of the taboo. I spent five years photographing and interviewing men and women about their breasts, penises and vulvas for my books Bare Reality, Manhood and Womanhood and the film

100 Vaginas. I’ve documented the realities of our bodies and interviewed my subjects extensively about the relationship between sex and gender.

In 2018 the Government Equalities O

ce estimated there were

anything from 200,000 to 500,000 trans people in the UK. It is not known how many of those have surgically transitioned. In 2014 there were 172 sex reassignment operations performed on the NHS — double the 83 of a decade earlier. The figures do not take private surgeries into account. There are no accurate figures for the number

of people detransitioning. Most of the detransitioners I spoke to never went back to the doctor who performed their original transition, and to all intents and purposes may be considered a success story by their therapist or medical team. Charlie Evans, who set up the Detransition Advocacy Network in the UK, says she has been contacted by hundreds of detransitioners. I spoke to various people with experience in the field — doctors, therapists, nurses, endocrinologists — and while no one wanted to be quoted, o the record they predict this is merely the beginning.

I fear that the detransitioned women I interviewed are canaries in the coalmine. Not only for detransitioners, but for womanhood. They all, in some combination, found being a woman too di

cult, too

dangerous or too disgusting. “I put the problem inside myself,” says one, “when actually it is with how the outside world sees women who don’t conform to feminine norms.”

These interviews, and my wider research, have uncovered common themes of girls who felt they didn’t fit typical feminine stereotypes, and felt uncomfortable in today’s hypersexualised culture. High rates of sexual abuse, harassment, autism, self-harm, personal rejection of being lesbian and homophobia all play a part. Feminism has made life better for women, but is it any easier to be in possession of a female body? Cosmetic surgery continues to grow in popularity as women chase the feminine ideal — females underwent 92% of all procedures recorded by the British Association of Aesthetic Plastic Surgeons in 2018, and breast enlargement remains the most popular. But at the other end of the scale, globally, there are thousands of “gofundmes” for “top surgery” — female-to-male double mastectomies. I wonder how many might come to regret their surgery?

If you read the stories on the Detrans subreddit online forum, detransition has been a di

cult experience for many. How should

this be addressed? The women I spoke to said they were all accepted as trans fairly unquestioningly by therapists and doctors. Should the assessment be more thorough and investigative? Does the current “a

rmative” treatment model allow the “wrong people” to transition

— people for whom simply being a girl, a woman, a lesbian, could have been an acceptable and happy experience?

Detransitioners have chosen the salamander as their mascot because of its ability to regenerate organs and limbs. It’s a positive symbol.

Though women who fully surgically transitioned will never be able to regenerate or replace their missing organs (see panel), it’s not too much to hope that they can feel emotionally and psychologically complete.

“I want to work on accepting my body exactly the way it is now,” Ellie, pictured on the cover of this magazine, told me. “This is what should have been encouraged from the beginning.” lauradodsworth.com

Sinead, 29

© L AU R A D O D S WO RT H

People on Twitter have told me I’m not genuinely trans, that I’m transphobic, or that I am a sock account. There are people who refuse to accept there are a growing number of detransitioners. Some think that just our existence hurts trans people. On the other hand I have found it hard to hear some feminists refer to detransitioned women as mutilated, or say trans women are grotesque, because I have trans friends.

I wanted to be a boy when I was younger. From 15 it intensified. I googled “I’m a woman but I wish I was a man” and through the power of the internet I found out about [gender] dysphoria and transition.

I had an extreme envy of men and an extreme resentment of myself. I just thought men were better. In a way I had my own strange kind of sexism.

A few painful and di

cult things have happened to me that I think

were behind me wanting to be a man and not be a woman. I know I was not in the wrong, but they are things I can’t talk about publicly.

What I know now is that transitioning wasn’t the way to deal with those things. You go to the gender clinic and within a couple of months you’re on testosterone. The psychiatrist said I was trans. I thought if they prescribed me testosterone then I must be trans.

Aside from general questions, no one explored if there were other issues or challenged me.

I’ve tried to talk about background issues with therapists, but gender dysphoria was seen as the cause of my problems and not a symptom of them. Actually I think my gender issues came out of mental health issues, not the other way around.

I felt better when I went out as “Sean”, especially when the testosterone kicked in and my fat redistributed and my voice got deeper. Men stopped looking at me. I thought transitioning was the best thing I had ever done. I was so happy. © L AU R A D O D S WO RT H

The fact is, though, I’ve never drunk as much as when I was Sean. I still hated that I was

female. I was still depressed. I still had to drink myself blind to forget.

Going to the pub as Sean wasn’t enough to counter that, and I had a breakdown. After that I knew I had to deal with the problems. I realised that I wasn’t trans, and I should never have gone down the medical route.

When I first detransitioned it was hard to accept that I wasn’t a trans man or a “normal” woman either. These days I’m completely apathetic about the results of the testosterone and the mastectomy scars. I don’t like them, I don’t hate them. And that’s progress.

But I still have those dark nights when I sit alone in a room and I think I’m ruined, disfigured and damaged, and I’m not even 30 yet.

And then I get better nights when I think it could be worse. I could have got a phalloplasty. I don’t want to be insensitive to other detransitioned women who did get a phalloplasty, but I’m glad I didn’t get one.

I don’t like shaving — I didn’t shave when I was Sean — but if I go to the shops now I shave my face and if I’m wearing a V-neck top I shave my chest. I always wear a hat so people can’t see my baldie bit. I’d like to work towards more confidence. Dating is o the table for me, at least for now. I feel like I would have to tell someone about my trans past and that I have been masculinised.

I’m in group chats with other detransitioners. I know about 100 detransitioned women myself. But we all know others who aren’t

active online or in group chats. The o

cial numbers of

detransitioners aren’t collected, they aren’t known at the moment.

But I think we are the tip of the iceberg. There will be many of us to come.

I wish the psychiatrist at the gender identity clinic [in the UK] had given me a better assessment. Part of me wants to go back to the clinic to look my psychiatrist in the face again, but I know that’s driven by anger. I don’t think they can help me, so there is no point in going back.

I want detransitioners to know they are not alone and they can come forward and find other people to talk to. I hope when people see these stories and photographs, they will see that even though we have been changed by testosterone and surgery we are still strong and beautiful, just in a less stereotypical way. We are still women.

Ellie, 21

© L AU R A D O D S WO RT H

I came out as lesbian to my family in Belgium when I was 15. They were OK with it and I felt quite comfortable dating girls. At some point, though, I started to question myself a lot. I couldn’t picture myself growing up to be a woman. I found a trans organisation in Europe o ering psychological appointments, and so I went and told them what was going on in my head. I was surprised by their advice; they only told me about masculinising treatments and surgeries. I think it was a completely di erent answer to the one I was really looking for, so I came out very confused, but they had planted a seed.

I started watching popular videos on YouTube about girls becoming good-looking boys. I began to think that my body would look better if I took testosterone. I set myself a goal of looking male. And that quickly went from being a goal to feeling like a need. By the time I

was 16 I had strong [gender] dysphoria. I decided to tell my parents because at that age I couldn’t access treatment without them. To start with they were very supportive, but the next day it was a di erent story. They both said they accepted me the way I was, and I could present myself any way I wanted, but they would have concerns about my health if I took hormones. My mother told me she was worried I would regret it. I thought she was transphobic.

My parents took me to see a psychologist, who told us that I was not trans, otherwise I would have known from the age of about three. He said I should wait till I was 18. I was upset that he discredited me in front of my parents.

I convinced my parents to come with me to the trans organisation I had first been to. The doctor they referred us to was completely di erent. He said why wait till 18, when I would have better results if I started taking testosterone straight away? He said that the e ects of taking testosterone were reversible and there was nothing to worry about, which shocked me because I knew this wasn’t always true.

[Some of the e ects from taking testosterone may not be reversible, depending on how long the hormone is taken.] But I knew this was what my parents needed to hear to agree, so I didn’t say anything.

I didn’t foresee the emotional changes of testosterone. It felt like I became numb. I used to cry a lot as a way to relieve my emotions, but I cried only twice in four years on testosterone. I liked the physical changes. I am tall and have always had quite a masculine body, but once I started on testosterone people always read me as male.

I started using the boys’ changing rooms at school and changed to the boys’ sports teams. My next goal became a mastectomy because it made me very uncomfortable to be a boy with breasts.

I used to play basketball competitively and would train every day.

That stopped as soon as I started on testosterone because it would have been considered doping. I hadn’t changed my gender, so o

cially I couldn’t play with boys either. When I moved to Germany

to go to university nobody knew I was trans, people just assumed I was male. I was very quiet about that. And I started playing basketball again, in a male team. Everyone on the team thought I was a guy, but I felt completely out of place. Realising I didn’t really belong in male spaces is part of what drove me to detransition. Playing sport in a male team made it clear that I just don’t have the same socialisation as the men. Women are competitive, but not in the same way as men.

It slowly stopped making sense being a guy.

I started reading more about feminism and understanding things di erently. It’s hard to grow up and not really see other masculine

lesbian women. I had put the problem inside myself, when actually it is with how the outside world sees women who don’t conform to feminine norms. I just wanted to be human, neutral, myself. I felt as if the only way I could be myself was to look like a guy. Transition was not the ideal solution, but it did help me. Some detransitioned people want reversal surgery. I’ve realised that the way forward for me is to accept myself as I am now. I will always have an Adam’s apple, and my hands and wrists are probably broader than they would have been because I started on testosterone when I was still growing. I struggle most with my deep voice and my beard. I will always have a beard now.

It’s hard that I don’t feel like I belong in female spaces any more. I don’t want to make women feel uncomfortable and be questioned. I use the men’s changing rooms, but I don’t feel comfortable in there either. It sucks.

My transition was not necessary, but I don’t want to be regretful. I want to work on accepting my body exactly the way it is now. This is what should have been encouraged from the beginning.

Lucy, 23

© L AU R A D O D S WO RT H

I couldn’t relate to very feminine, heterosexual women when I was growing up in Germany. My mum is a housewife and a mother, and I value that, but I just couldn’t imagine myself living that way. My dad is into sport, and I related to him more. I knew only one slightly more

masculine woman who had short hair when I was growing up. Since detransitioning I have met many more gender non-conforming women similar to me. I often think if I’d had people like that in my life when I was a teenager, I don’t think I would have been trans.

Anorexia made it easy for me to fall into developing [gender] dysphoria and wanting to transition because I had already spent so much time focusing on my body and wanting to change it with dieting and starving. From 15 to 17 it was really bad. When my weight went down to 39kg [just over six stone] my parents basically forced me into treatment. I was in and out of treatment centres, and eventually my weight stabilised, although I then developed bulimia, which I still deal with.

Even though my breasts were small, AA cup, I wanted them removed.

I researched online and found a site that sold chest binders and another site that basically informed me about transsexualism being a thing. I started reading stories about trans men. So many said that they always identified with male characters in stories as a child, that they were tomboys, that they couldn’t imagine life as a woman; I felt the same way. I realised I didn’t need simply to hate my female body, I could change it.

Before I came out I was pretty confident. I didn’t think it was a bad thing to be a lesbian, but then the reactions came. I started dating one of my classmates. We sat together, we were cute with each other and would hold hands, so people noticed fairly quickly. We got some pretty nasty treatment. No one wanted to be in the locker room with us any more. I’m a really romantic person and it felt disgusting to be reduced to my sexuality. It made me feel horrible about being a lesbian.

It’s easy to see now how becoming trans happened pretty much at the same time. At a certain point, when you pass as male, you can just blend in with the rest of society. When I did transition, people stopped shouting “Lesbians!” at us in the street, because I looked more male. There are double standards about appearance too. When I didn’t shave my legs my classmates bullied me. Later, when I identified as a trans man, it suddenly became completely OK, because men don’t have to shave their legs. That felt really freeing and transition felt like the right thing for me.

I couldn’t have sex with my girlfriend — I didn’t want her to see me as a woman even though she knew I was female and was attracted to women. It’s so sad, but I never even let her touch my breasts before I got them removed. I thought of lesbian sex as not being real sex, and I wanted to get a phalloplasty one day so I could have “real sex”.

I started seeing a therapist, the only one in my home town in Germany who had ever worked with trans people. He was really into gender roles — he would tell me that if I want to be a man I had to get a new masculine mountain bike because I had one that was for women. He referred me for a mastectomy and hormones. Looking back, I cannot understand why he didn’t explore my eating disorders, how I felt about being a lesbian and also my obsessive compulsive disorder symptoms. For example, despite not sleeping with men, I had an extreme fear of getting pregnant. I was so paranoid I would buy pregnancy tests even though there was no chance. When I had just turned 20 I started hormones, followed by my mastectomy six months later. Then I had revision surgery because my areolae were stretched and they left breast tissue on one side. Three months after the revision I had a hysterectomy and ovariectomy. It all happened really quickly.

If you are looking for information about transitioning, you can find websites that list therapists who work with trans people. It’s so easy.

You find one who is really a

rming, and you can walk out of one

appointment with a prescription for testosterone.

My family were extremely supportive. I don’t want to make them sound bad, but I think it was partly because they were desperate to find a solution for my eating disorder. The idea that I was “born in the wrong body” and we could fix my body gave them hope that it might all be fine. They had a lot of trust in all of these doctors.

Talking about detransitioning online has mostly been good for me, because now I’m not alone with it any more. I found all of these women I can now call friends. But it’s also been di

cult online —

trans people have called me a liar and I’ve been told I should be ashamed because I took resources away from real trans people. For some reason it’s never blamed on the surgeons or doctors. I’ve already lost parts of my body over all of this, so words from trans people can’t really hurt me. The nasty things they say to detransitioners are nothing compared with the pain I feel over having lost organs.

I’m horrified that when I went for the hysterectomy they didn’t emphasise to me how important these organs are. Now it’s too late.

I’m 23 and I am basically in menopause already, with all the health implications that come with that. I can’t comprehend how doctors could let this happen, because they would never approve a 21-year-old woman for a complete hysterectomy for no medical reason. But once that woman identifies as a man, suddenly it’s really easy to get.

I broke up with my first girlfriend a month before my hysterectomy. I haven’t had a relationship since and I think it’s going to take a while

because right now I feel horrible about my body. I don’t feel this way about other detransitioning women, but I feel mutilated.

Lee, 62

© L AU R A D O D S WO RT H

I transitioned when I was 44. I thought I’d be a di erent person as a man, happier and more confident, but my life was still screwed up. I saw a counsellor for five years, which helped me understand why my life has been so complicated. I thought I wanted to be male. But how would I know what it’s like to be a male? I’ve never been one. I can’t be. I’m an approximation of a male on the outside, but really I’m a woman on testosterone who has had surgery. This is just my opinion, and other people can have their views, but I don’t think there is such a thing as being born in the wrong body. I think that the causes often begin in childhood.

I see the cause of my transition as being my mother, grandmother and father. My brother was idolised by my mother and grandmother. He was the golden child who could do no wrong, their “little darling”. I was a “little heathen” and a “hussy”; I could do nothing right. My mother was always angry with me and very critical. I spent most of my childhood saying sorry and pleading with her. I hated my body from when I was a child. I thought I was fat. I hated the frilly dresses my mother would put me in. I wanted to wear the same clothes as my brother and have the same haircut as him, but she wouldn’t let me.

My body felt like a prison when puberty started. I thought my periods

were like a nightmare, it seemed so wrong to have blood coming out of my body.

When I was 15 my father got in touch with us after many years. I was pleased to hear from him. He would take my brother and me out and he bought us things — a stereo, clothes — and gave us money. He seemed like the perfect father. He invited us to stay at his house and my mother didn’t want us to go, but wouldn’t say why not. Of course I went anyway.

The first evening he raped me. He came in the next morning and he did it again. Afterwards I think I sat in the lavatory for about an hour.

It’s like I didn’t know where I was.

Later my mother told me how violent he had been. She told me about a time he’d hung me out of the window by my ankle when I was a toddler to scare her. I have a feeling I was sexually abused as a child before she left him.

One morning when I was 44 I saw a female-to-male transgender person on television. I’d never seen one before. I thought: “That could be me.” It seemed like it might be the answer. I went to see a gender doctor privately in London. On the first appointment he said, “Let’s not waste any more time,” and injected me with testosterone. It was what I wanted, but I now think it was wrong — what I really needed was psychotherapy. I was screwed up. It was my head that needed help, not my body. I really liked the testosterone. It took a long time to get a beard and body hair, but I built up muscle very quickly.

I hated my breasts and couldn’t wait to get rid of them. I know a lot of trans men bind, but I didn’t because you can’t exercise in the gym with a binder, they are very uncomfortable. So I had a mastectomy a couple of months after starting testosterone. Within a couple more years I had a hysterectomy and ovariectomy, prosthetic testicles put in and a metoidioplasty, which is supposed to make your clitoris look like a small penis. In reality mine wasn’t big enough, just quarter of an inch. I ended up having a vaginectomy. Then I had a phalloplasty.

They took skin from my arms. The scars are still prominent. It’s a very serious and complicated procedure and I didn’t heal easily. I had to take antibiotics many times.

I’ve had a lot of counselling, and I came to this huge realisation that I regretted transition. I wish I could go back to how I was before I saw the gender doctor.

I thought I would detransition, but I’ve decided I can’t physically do it.

My body can’t take it. I’m not sure I’d survive all the surgeries. I’d be battling my body for the rest of my life. I have to accept my body the

way it is now. On the outside people see a little bloke. Inside I’m a traumatised little girl. But I’m more accepting of myself for the first time ever. I just wish I’d been helped to accept myself earlier.

Thomasin, 20

© L AU R A D O D S WO RT H

I was a trans man for 2½ years.

When I think of growing up, everything was pink or blue. I played with Barbie and pink stu because that’s what I was given. I probably would have played with my brother’s Hot Wheels toy cars if I’d felt there was a choice. Overnight, when I was 13, all the girls started wearing make-up. I tried to fit in, but I didn’t really want to. I felt like I had gone wrong compared with all the other girls.

I knew I didn’t feel attracted to boys sexually and it was obvious I felt di erent to other girls. I went online and found the term “asexual” on Tumblr. At school we’d been taught about being gay, but I don’t remember the term lesbian ever coming up. I thought that if I didn’t fancy boys then I must be asexual.

I recently found one of my first Tumblr posts, which went along the lines of: “I don’t like wearing dresses like other girls, I don’t want to put make-up on, could I be agender?” I applied how I felt about sexuality to gender: I don’t fancy boys so I must be asexual; I don’t feel like girls so I must be agender.

I soon felt confused by agender and non-binary, and I thought it would be easier to say I was a boy and decided I was transgender. I joined some transgender groups on Facebook. Some older trans people started messaging with me, which, in hindsight, was pretty ropey. I had just turned 16 and one person I was talking to was a man who identified as a trans woman in his forties. I don’t think it was OK that he talked to a 16-year-old girl the way he did. If I’d tell him I had doubts about being trans, he’d say doubts are normal and I should ignore them.

When I was 16 I decided to come out publicly as trans. I gave my parents a letter one morning on my way to school, basically saying you know me as your daughter but I am your son, Percey, and I need this to survive. Don’t get the wrong idea about them, but they went o the handle. My dad took it quite badly because he felt like he was losing his daughter. He asked why I thought I was a man. I think it’s interesting now that I couldn’t give him an answer.

They did some research online and read that it was best to let me transition and support me. So they helped me to get referred to a gender identity clinic in the UK. Online there is a lot of advice about how to behave in your meeting at the gender identity clinic so you’ll get what you want. With a lot of pushing I got referred to an adult gender clinic because I wanted hormones and a mastectomy. However, by my second appointment I decided I didn’t want hormones at all. At the time I was saying I didn’t need hormones to be a man, but I think I was scared. I always had doubts about being a trans man. But either someone would say it’s normal to have doubts, or I would tell myself that.

I still wanted a mastectomy — wanting not to have breasts never changed — but I went back to being non-binary. I also still wanted a hysterectomy. I have really bad cycles, on-the-floor-in-pain kind of stu . I need time o every month. Honestly, I think the fact that I hate my periods is part of why I felt I was trans.

I was told I could be waiting for months. I’m grateful now that I didn’t have the mastectomy, but at the time I was self-harming and felt terrible.

I can’t explain why I changed my mind about being trans, but kind of overnight when I was 18 I realised I may want kids. I don’t know what to put it down to — except maybe age and maturity. I started seeing holes in me being trans. I started questioning everything again.

Then some unexpected words came out of my mouth: “I need to accept womanhood.” It was so strange because I couldn’t say the word

woman before — it used to make me feel ill, but it just changed.

A lot of people have said to me I was never trans. Well, I was. I was seen by my GP, the gender identity clinic — people accepted it, I changed my passport, all my documentation.

I feel better about my body as a woman than I used to. But I can’t turn around a lifetime of feelings in one year. I accept my breasts now. I used to only be able to shower or bath once a month when I was trans because I hated my body so much. I do it every day now and that’s an improvement!

I’ve accepted that I like women. I get that there are people with serious gender dysphoria, but I think the biggest reason that women are transitioning is because they can’t accept they are lesbians.

I got the “Valid” tattoo when I was non-binary to say I know myself best, I’m valid. I know other detransitioned women regret surgery choices and they have all my respect for everything they have gone through, but I’m glad the tattoo is the worst thing I came out of this with. I’d like to think it’s technically still applicable: I’ve accepted I am “valid” as a woman.

Detransitioners chose the salamander as their mascot because of its ability to regenerate organs and limbs ALAMY

● What are the medical procedures?

Transitioning Transitioning is when someone changes their gender presentation and/or sex characteristics to match their internal sense of gender.

There are di erent ways of transitioning: social (changing your name, pronoun, clothes), legal (changing your legal name, legal gender) and medical (taking hormones, surgery). People do not by law have to undergo medical treatment or physical changes in order to qualify for a gender recognition certificate, although in practice campaigners say the process is overly bureaucratic and “medicalised”.

A ďŹ rst stage in the “gender a

rming� process is counselling.

Hormone treatment may follow. From female to male, taking testosterone causes the growth of body and facial hair and deepens the voice. The clitoris can enlarge and libido and mood may alter. Fat will go from the hips and thighs, muscle will build on arms and legs.

Periods may become heavier or irregular before stopping altogether as testosterone halts egg release/ovulation, though the long-term e ects on fertility are not known.

A next step can be a double mastectomy, to remove the breasts, or chest reconstruction. Surgeons can also perform a phalloplasty, where a penis is made from skin (including fat and nerves) from the forearms, abdomen or thighs; or metoidioplasty, where the clitoris is surgically freed from the membranes that hold it in place to give the appearance of a small penis. Both surgeries may be accompanied by testicular implants.

Someone may also choose to have a vaginectomy, to remove the vaginal canal and close the opening; a hysterectomy (removing the uterus) and an oophorectomy (removing the ovaries). These are complicated surgeries that are generally spread over a year to 18 months.

Detransitioning Detransitioning is the halting or reversing of a transition. It can be di

cult to come o testosterone, as extreme changes in hormone

levels can cause anxiety and depression. Hormone replacement therapy may be needed to mitigate the early onset of menopause.

A mastectomy cannot be reversed, although cosmetic surgery (breast implants) may be an option. It will, however, be di

cult to preserve

full sensation and breastfeeding will not be possible. Hysterectomy, oophorectomy and vaginectomy are all permanent and cannot be reversed.

A phalloplasty can be surgically removed. Surgery to create a new vagina may be possible, but it will require abdominal surgery; the clitoris should still be intact, but there will be little sensation from the vagina itself.