I went to the Tavistock as a young person - AMA

[MAW1993]

I attended the Tavistock from 2008 to 2011, beginning when I was about 15. I made this post because I saw the many questions people asked on a previous AMA. Unfortunately, the OP was uncomfortable answering some of them, and I felt there may be a need for an AMA with someone who can be more open.

Also, just to add to the comments back along the thread where people shared that the way you express yourself in writing feels somewhat ‘female’. I agree with this (if it’s not offensive to you). Again, it reminds me of something I find hard to put into words, that my trans son has a different ‘vibe’ rationally to my two cis sons. I guess it must be socialisation- it’s partly about a willingness/ ability to see others’ perspectives I think.

Relationally not rationally

I absolutely do not believe that gender critical feminists want to see harm come to trans people. Although there are some positions that I don't agree with, I am angered by the constant comparisons made between groups who actively want to harm trans people and feminists who simply do not agree with transgender ideology to some extent. Wanting to protect single sex spaces, women and girls in sports, or female healthcare is in no way comparable to the actions of those who assault, rape or murder trans people. In my experience, the people making these comparisons are are typically those who are unlikely to ever face such an experience, and use those of us who have suffered violence and abuse as pawns with which to manipulate debate to their favour. I can see that your intention was to reassure me and I appreciate the openness, self reflection, and decency you showed in response to @SqueakyDinosaur.

My mother was heart broken about what felt to her like the death of the girl I once was, and the life I could have had. It is very hard for me to know I caused that pain to her when deciding to transition. However, time has been a great healer for us both, and we have a very strong relationship today. As she has gotten older, her health has declined significantly, and it is a privilege to be able to help and support her as she once did for me.

I appreciate that some people believe that medical/surgical transition is never the correct option. I respect the right of others to hold that view, my concern only comes when people attempt to restrict the choices of others. By that, I do not mean putting safeguards in place to protect vulnerable people. I mean aiming to prevent transition at all costs, even where attempts to find a better solution have failed. In truth, most people's positions lie within a grey area between unquestioning affirmation and denial in all circumstances, which is harder to codify, and must be considered on an individual basis.

As to my opinion on the new NHS guidance. I must be honest that I hadn't considered the issue of side room availability until it was raised. It is absolutely true that side rooms are often at a premium in hospital settings, and are essential to ensuring infection control and the protection of immunosuppressed people. People identifying as trans is sufficiently common now that I can see how the low supply of these rooms could pose an issue.

My instinctive response would be to reserve the use of side rooms for people who are no longer read as their biological sex, in those scenarios where demand outstrips supply. I am aware that that would benefit me to the exclusion of other trans people, and so it may seem like an unfair and self centred response. However, speaking personally, the discomfort I feel existing in female spaces relates to the stares and hostility it results in. The changes that I have made to my body have provided me great relief, but cannot be separated from the fact that they result in me being read as male. I actually miss many female spaces, particularly with women who were gender-non-conforming and/or lesbian. I know this is probably hard to understand, as someone who has asserted a desire to be male, but my distress has always related to my anatomy rather than being read as female in and of itself.

As such, accessing female spaces was not problematic for me until I was read as male. When I first transitioned I avoided using the female toilets at my sixth form college (and was provided an alternative provision). This was for two main reasons - I worried that I might make girls feel uncomfortable, and I also worried that it would lead to people interrogating the decision I had made. However, when out in public around people who did not know about my decision, and having yet to make any physical changes to my body, I would use the women's toilet. Whilst I have always been quite masculine, and it was not rare for me to be mistaken for a boy, I would still be read as a butch girl/woman when using the female toilets and never had any issues before the use of hormones. (Single occupancy gender neutral toilets didn't really exist by and large when I was a teenager and so that was not an option at that time.)

I still think the use of a side room is the best option for all trans people where it is possible. I appreciate why that might be seen as a privilege, and generally I feel like we do not make enough efforts to protect people's privacy in hospital (even in single sex spaces), which leads to understandable resentment. I would say though that the state of hospital accommodation is not the fault of trans people, and I think it is fairer to hold the government accountable for it. It serves their interest for us to try and drag everyone down to the same level rather than advocate for improvements for all patients.

I have been placed on single sex wards, both male and female, since transition. Both were very uncomfortable experiences for me. I was placed on a male ward before and after a cystoscopy. It was populated by mostly elderly men, and it wasn't that I felt threatened by a specific individual. However, I generally feel vulnerable and on edge in male single sex spaces. I don't know whether that is excessive paranoia now that I am consistently read as male, but regardless it induces extreme and unwavering anxiety. Explanations and consent taking by the care team could be heard by all as there was only a curtain pulled and it was a quiet ward. Due to the differences in male vs female cystoscopy, those discussions made my biological sex clear. I didn't feel comfortable to remain but also didn't have the confidence to ask to be moved, as I already had a lot of anxiety regarding the procedure. Instead, I requested that they keep the curtain pulled around my bed. I do recognise that beyond my own feelings of discomfort, it was unfair to the men on that ward who were also undergoing an invasive intimate procedure and at the very least deserved the privacy and dignity afforded by being on a ward with other men.

In terms of female wards, I had to spend a lot of time on them due to the multiple surgeries required to correct the injury, and had a particularly long stay after the infection I suffered following the first surgery. It was very uncomfortable as I was stared at a lot by other patients and their families, and I was already in a very bad place mentally and physically. The nursing and medical teams were very kind and they did make efforts to maintain my dignity, but again there is always an issue with everything being heard by all the patients around. That did alleviate most of the staring from other patients, and there as an older woman next to me who clearly made a special effort to smile and be welcoming to me, which I thought was very kind. However, it felt very exposing to have details regarding the injuries, the assault, and that I was trans widely disseminated, even if it was not intentional.

As I have said above, I don't think these failures to protect patient privacy are unique to me, or to trans people. However, I do think there are specific challenges faced by trans people placed on single sex wards when they are read as the opposite sex. I also want to be clear that I am not attempting to attack the justifiable concern felt by women undergoing gynaecological care and faced with exposure to a person that appeared biologically male. However, I can't deny that the experience was very difficult for me on a personal level.

I believe @SqueakyDinosaur may have misinterpreted a response I made outlining some of the findings of the Cass review. Surgery for under 18s was not advocated for at any point within the report. Furthermore, the current treatment options for the adults were not the focus of the review (though some aspects of adult care were considered), but I understand that NHS England intend to carry out a review focusing on adult services now.

What was stated was that there exists a subset of children presenting for whom there existed some, but inadequate quality, evidence of benefit regarding the use of puberty blockers. This group consists of children who present with consistent and severe sex dysphoria from childhood, and for whom these feelings persist into adolescence.

There is more evidence surrounding the outcomes for children presenting this way in childhood - the majority desist with the onset of puberty, but those that do not very rarely improve or desist in adulthood. This is what led to two recommendations:

One was that there should be an attempt to keep options open for children presenting before puberty, because most will desist with the onset of puberty. The concern was that affirmation and social transition could put these children on an irreversible path, and make it more likely for sex dysphoria to persist after puberty begins, or for children to feel they had no choice but to continue with transition.

The other was that for those children for whom dysphoria persists during puberty, they should be included within a research protocol into the use of puberty blockers with the aim of collecting better quality evidence and facilitating appropriate follow up.

Unsurprisingly considering the decisions I have made, I do believe that surgery was the right choice for me, and will be for others too. But that is not based on the findings of the Cass report.

Hi again 👋I hope you and your family are well.

My mum also found the pronoun thing very hard. I have always been of the belief that what was important was that she loved me and supported me. Furthermore, I think it is unreasonable to expect someone to use a new name and pronouns perfectly after an entire childhood using the opposite. That doesn't necessarily make it easy, but there needs to be understanding and empathy on both sides.

Although she kept her feelings from me at the time, I know now that my mother went through a period of grief. She felt she had lost her daughter and the happy future she wanted for me. However, she had also noticed that something was wrong from a very young age so there was a tinge of relief to finally know what it was. As a child she had began to suspect that I may grow up to be a lesbian and that was the source of my unhappiness and shyness surrounding my body. She was shocked about what it transpired to be, but she says now that thinking back there was always a fear deep down that it was something more than just a matter of sexuality.

She doesn't really feel that way today. Although my appearance has changed drastically, and that was very hard for her, my personality and world view has not (beyond the normal changes that occur with increasing maturity and adulthood). I know she still worries about the possibility of another episode of violence, the way I have closed myself off to romantic relationships, and my desire to undergo phalloplasty. However, I think she is reassured by the amount of time I took before making that decision, that I have made changes to minimise the risk of complications (quitting smoking and focusing on fitness and a healthy diet), and the fact that I am fully aware of the possible complications and have given serious thought as to whether I could live with it not going as I would hope.

It took my dad about 2-3 years to be able to acknowledge that I had transitioned and was living as a trans man. He mainly tried to ignore it and distanced himself from it all. There was a gradual process of acceptance that the situation existed, but it took several years more before he was able to to come to terms with it. Today, he is very similar to my mum, in that he finds it hard to think of me as he did before.

I think it was also very hard for them both as they had fertility issues. They were overjoyed to have my brother but also really wanted a daughter to complete the family. My mum fell pregnant with me not that long after. They weren't specifically trying to conceive or expecting it, as they were satisfied just to have a child at all, but they were particularly excited and overjoyed when my sex was determined. So obviously my decision to use hormones and surgery to change my body and to live as a trans man was really difficult for them to deal with.

I do think you need to give yourself grace. This isn't easy for any parent, and that doesn't mean you don't love your child or are prejudiced in any way. Just by loving him unconditionally, and being supportive in the ways that you can, you have provided a very powerful message.

You mentioned that it is hard for him to discuss his feelings. I struggled in a similar way when I was younger. Talking about things like your genitalia or sexuality with your parents is tough for any young person. However, something that helped me was to write down my feelings in a letter and receive a response in the same format.

It gave us both room to read the response in private, feel and react in the way that we needed, and then spend time composing our response in a way we felt avoided misinterpretation or saying the wrong thing in the heat of the moment. It is a technique my social worker recommended, and the way I ended up telling my mum was by writing a letter with the social worker's help, which she then read out for me in a meeting between the three of us. I wrote a letter to my mum after the assault also. I have always found hard to talk about it out loud to anyone, but particularly with those I am closest to. That is still something I am not able to speak about readily today, but find it much easier to communicate through writing as I have here.

I hope this is helpful for you, and as always I wish you both the best.

I'm not offended. I think it is simply a lie to deny that being raised as a girl has influenced my personality and the way I interact with the world. My brother is also a thoughtful person, and we were both raised to be kind and empathetic. However, there are still undeniable differences between us, and the capacity we have to be open to the opinions of others over matters that are emotional or personal to us. My mum avoids some discussions with him, as he doesn't have as much tolerance of her differences in opinion as I do.

For example, both him and I were opposed to Brexit and disappointed by the results of the referendum. My parents both voted to leave the union and that resulted in conflict with my brother for a while. Notably both myself and my mother would attempt to change the subject and keep things cordial, whilst my brother and father would argue quite vehemently with one another. I knew the discord was distressing to my mother, and her health has not been very good in recent years. I felt quite angry with him that he was unwilling to bite his tongue and agree to disagree for her sake. Fortunately, it is all water under the bridge now, but it is undeniable that there was significant contrast between the way that the he and my father dealt with the situation compared to us.

Thank you OP for your full replies to both my questions. I really appreciate them, particularly your comment about giving myself grace ❤️ It sounds like the passage of time and gradual adaptation to your new presentation of yourself has worked for your family, and I think it will be similar for mine.

Yes, I completely relate to your comments about your brother, and that’s the sort of thing I mean. It might sound trite if you haven’t been the parent of a trans child or are gender critical to say that he ‘feels’ different - some people would say of course he does, he was born a girl! But my child has thought of themselves as a boy for most of their life, is unusually physically confident and daring for a girl, looks very convincing as a boy, etc. So I find it very interesting that those relational differences are still there. It links back to the info you were sharing a while ago about studies looking for a biological explanation for being trans.

On another note, particularly as a medical person, what do you think about emerging discussion about medical treatment for trans people? I’ve had information shared with me from a couple of sources about current clinical uncertainty about how to treat trans people who’ve had hormone treatment, when they have certain conditions. E.g. if someone has renal or cardiac conditions for example, different medication doses might be given to men and women. So it might be hard to determine whether for example someone born female but on male hormones is now effectively functionally ‘male’ and should have the dose given to men. Have I understood this right?

I definitely think things will become easier for you all. My father was not capable of the kind of acceptance that you have displayed, and yet our relationship has still mended over time.

My mother always tried to treat us both very equally and not limit us based on our sex. My father was more traditional, but regardless he did all the same things with us both - going swimming, playing football etc. They both wanted us to have opportunities and loved us equally. However, I think it is simply impossible for the society in which we exist not to influence how we develop. I'm also sure there were probably some unconscious differences between us despite the best of intentions. It was also more apparent outside the home, of course.

I definitely think that a genetic or developmental component could be involved in sex dysphoria, however I don't think the evidence that exists is sufficient to characterise that, beyond identifying it as an area for more research. I ultimately believe that socialisation is the predominant factor that leads to the difference in behaviour seen between men and women. But that is just my opinion based on my personal experiences, not scientific research.

I think it is good that people are beginning to consider these issues. Long term research should hopefully begin to address the evidence gap. My understanding is that at present a pragmatic approach is typically taken, whereby the more cautious approach is used (e.g. the lower safe dosage indicated) and followed up with monitoring. Obviously the use of cross sex hormones is an important factor, but I think in general we are becoming much more knowledgeable about the significant variations between individuals. The capacity to process the human genome has allowed for the identification of factors that influence how people respond to treatments, and to better stratify patients so they can get the most effective one.

In particularly, I'm thinking of some of the genetic lesions identified in cancers, and how that is often used to guide treatment now over the more traditional staging and grading approaches of the past. I must admit that as someone who has only completed 2 years of a medical degree I don't have anything like the knowledge base of a doctor though.

Thank you for your reply I can see you have given these problems a lot of thought. I think we will have to agree to disagree on certain things. But I do agree that adults are entitled to make decisions regarding their body even if I do not share your confidence of their benefit. I am not trying to be antagonistic or offensive, just to emphasise that I believe in bodily autonomy for all, as long as there are enough safeguards put in place for the mentally ill and at risk.

I think it was unethical for you to be placed on a male ward, as men are also entitled to same sex privacy too. But I recognise that you are aware of that, and that there was a significant power dynamic involved that made it difficult for you to articulate your feelings.

I am sad to hear about your other experiences in hospital. I do understand why those women were worried and it sounds like the whole situation was not handled properly for all involved. I think it is very bad form that they discussed your private health care needs where other people could hear. We all deserve confidentiality in health care. I have noticed the same thing and it seems like some doctors think that their voice won’t travel outside a curtain.

I will always believe that female people deserve access to female spaces, but I can see why that is difficult in your circumstances. However as a feminist and a lesbian, transmen and detransitioned women will always be welcomed by me no matter their appearance, changes made to their body, or differences of opinion.

That is providing they are respectful to women who are not trans-identified and allow them space to be open about their concerns. It appears that applies to you based on your posts here.

You have mentioned phalloplasty. Can I ask you some questions about this? By its nature they are very personal and you might not want to answer those kinds of questions which I will understand. You also might have already had these thoughts yourself and I recognise that you have attempted to thoroughly research it.

But they are the questions I would be asking my child if it was their intention.

Yes, I am happy to answer any question to the best of my ability. I don't think it is possible to discuss these issues without questions that are deeply personal.

Thank you for another detailed reply OP. Just to add, I’m not surprised you found it so difficult to talk about your assault with your mum. It’s one of my fears that my trans child might be ‘outed’ and attacked. I don’t presume to know what you and your mum might have felt, but you must both have been through very painful journeys about this. Once again, I’m very glad you have a supportive family.

Thank you for being so open. I do have a real desire to understand your perspective, but I am aware of some very serious complications and drawbacks which I find quite concerning. I know you are an adult, and clearly a smart one. This is not meant to be an interrogation but a discussion of factors that are important in this decision making. They are the questions I would hope a therapist or surgeon would asked my child, if it were one of them who was contemplating this.

Are you aware of the following complications of phalloplasty surgery?
Urethral strictures
Urethral fistulas
Urinary retention
Separation of the vaginectomy wound
Wound separation of the phallus
Gangrene and loss of the phallus
Skin graft failure on the arm
Loss of function in the hand
Loss of sensation in the clitoris
Loss of the ability to orgasm
Erosion of the erectile device through the skin

Have you thought about whether your previous surgeries and scar tissue in that region will affect the result or prevent the surgery?

Will you be able to cope with not sharing in pleasure and satisfaction when making love with a partner? Have you thought about whether the lack of sensation will impair intimacy and connection?

Have you considered whether this change to your body could restrict your dating pool?

The phallus created does not closely resemble or function in the same way as a penis, is that something you could cope with?

The scar on your arm will be very visible and may mean that people can identify that you are female, is that a worry for you?

Have you thought about whether it would be valuable to explore your body, despite that being upsetting? That can be alone and in private, so doesn’t mean having to be exposed in front of another. I ask because I know there has been an issue with young people having puberty blockers and never developing the ability to climax which cannot be fixed by surgery. I don’t know if it would work the same way with someone who did not use those drugs but hasn’t explored that part of their life.

Again I appreciate these are very personal questions and if they are too much please feel free to ignore them. You seem like you have put a lot of thought into things and may have already thought about these issues, but I know that a lack is of proper informed consent has been an ongoing issue in transgender surgeries.

Yes I find it hard to speak to my mum which I think has upset her in the past. However, truthfully I just find it easier to speak about some things with strangers or people I don't know closely. I think it is because it doesn't feel like it is real, or that I am talking about me, but then I can't distance myself in the same way when it is someone who knows me properly.

I would say that that incident happened over a decade ago. Attitudes have changed a lot since then, and it wasn't a common thing even then. Bullying and some harassment was a lot more typical. I know she was distraught as something like that had always been one of her biggest fears, and she had been worried about me working away from home anyway. Again though, time heals many things.

@TicklishLemur your questions are fine and I am happy to answer them. Some people may find it all a bit TMI so they should decide if it is something they want to read but you are right that we cannot discuss such things without being to the point.

Are you aware of the following complications of phalloplasty surgery?

Urethral strictures
Urethral fistulas
Urinary retention
Yes I am aware of the complications. The most common ones are urethral strictures or fistulas which most people get. It is a complication that you have to accept, and if it requires the longer use of the suprapubic catheter then I am prepared to deal with that. They repair any urethral issues, but only after giving them a few months because some heal on their own. Urinary retention is not an issue as there is always a suprapubic catheter placed in addition to a catheter in the neourethera to maintain its patency.

Separation of the vaginectomy wound
The vaginectomy procedure has a lot less complications because they use a different technique now that is less invasive. Instead of removing the full thickness, they ablate the surface epithelium and the underlying muscle fibres adhere to one another. There is still risk, but it is low and acceptable to me.

Wound separation of the phallus
Gangrene and loss of the phallus
Wound separation is not rare but the resulting scars are normally manageable with revision during the later stages. More severe instances are a lot more problematic, but the risks of that are closely related to the risk of complete loss and I have taken actions to try and reduce the risk in all the ways that I can.

Loss of the neophallus itself is my greatest fear, and I know I would really struggle to cope with that outcome. It was a question I asked the surgeon during my consultation. I was reassured by his response, because although it had occurred for 2 patients they had both been smokers. They then required that people had stopped smoking for at least 6 months before having surgery and had not seen a recurrence since the new policy at the time of my consultation.

This potential outcome is why I quit smoking immediately after the consultation and have not taken it back up. It is also why I go to the gym on a regular basis, eat healthily and try to ensure that my cardiovascular health is as strong as possible, as the main issue leading to this outcome is ischaemia. Another issue is being overweight or obese, but that is not something that I struggle with. I know there are BMI limits but I'm not sure precisely where they draw the line since it wasn't applicable to me.

Skin graft failure on the arm
I also know that partial or complete failure of the skin craft covering the forearm defect can occur. It is then left to heal by secondary intentions which takes longer and results in a more disfiguring scar. Again, those are risks I am willing to take and it is an outcome I could live with.

Loss of function in the hand
I know there have been reports of neuropathy, pain and decreased function in the hand of the donor arm. That is a concern, but it is also rare so I am willing to take the risk. A more common complication is swelling of the hand, which is normally managed with compression garments.

Loss of sensation in the clitoris
Loss of the ability to orgasm
I was concerned about sexual sensation and asked the surgeon about this too. He explained that the dorsal clitoral nerve branches into two. They leave one branch in place and perform nerve coaptation with the other and a cutaneous nerve from the forearm graft. Whilst the axons of the forearm nerve die, they leave behind the supporting tissues and cells. This allows for the coapted clitoral nerve axons to grow along the path of the old nerve. I am not aware of patients who have lost sensation within the clitoris as one of the branches is left. However, I know some people have a harder time finding it if they choose to have it buried within the neophallus, which is the option I intend to take. The surgeon stated that no patient who had been able to orgasm before surgery had been left unable to afterwards.

Erosion of the erectile device through the skin
Erosion of the device has become less common for three reasons. One is that they stopped using rigid devices, and only use inflatable ones now. They are a lot softer and less likely to erode. Secondly, they wrap the cylinder within a polyester fibre sheath that acts like the male corpus cavernosum and then attach it to the pubic bone. Finally with the advent of better techniques, most people end up with sensation which greatly diminishes the risk of erosion occurring as pain would be apparent first.

You're brilliant OP

Have you thought about whether your previous surgeries and scar tissue in that region will affect the result or prevent the surgery?
Yes I did worry that my previous surgery would prevent me having phalloplasty. It did restrict some of my options - I am not suitable the suprapubic technique due to scars. However, I always wanted to use the forearm technique as I think it results in a more natural appearance and it also has the highest chance of developing sexual and tactile sensation. One concern was that even with this technique, they need to use a piece of the vagina to connect the old and new urethra. There was concern as to whether there would be enough healthy/normal tissue, however when the surgeon examined me he said there was enough for them to work with.

Will you be able to cope with not sharing in pleasure and satisfaction when making love with a partner? Have you thought about whether the lack of sensation will impair intimacy and connection?
There is a possibility that the neophallus will never develop erotic or tactile sensation. However, the clitoris is buried within its base and remains sensate so it is not the case that I will have feel no pleasure when having sex.

It often takes several years for the coapted nerve to grow. I am aware of a Dutch study of patients who underwent the forearm technique which found that 88.5% of patients developed some degree of erogenous sensation, and 92.3% developed some tactile sensation, despite a relatively short follow up period averaging 2 years. The patient group was quite small (59), but realistically not that many people undergo this surgery so that will always be a limitation.

I'm part of a private Facebook group for people intending to, or who have undergone the procedure and the majority do develop erotic sensation with the forearm technique. I'm aware of a few people who have not, and if that happens to me I will be very disappointed. However, as I will still have sensation in the clitoris I don't think I will be any worse off than I am now.

Have you considered whether this change to your body could restrict your dating pool?
I think all the changes to my body have restricted my dating pool. I can't imagine that many people who would find me attractive initially would feel the same after I disclose my background. I know it is probably off putting for most people. I hope that I will eventually meet someone who can love me despite that.

The phallus created does not closely resemble or function in the same way as a penis, is that something you could cope with?
It is true that it does not perfectly resemble a penis. However, I would say that there is a lot of misinformation and a lot of people base their understanding off of incomplete or outdated procedures. I have seen some results that I think would be hard to distinguish without close attention, but that is uncommon. Medical tattooing to match the skin tone to the shade of the rest of the skin of the genitalia (which is normally darker than the rest of the body) has a significant impact on the aesthetic outcome.

I would like it to look as normal as possible, however I am not someone who would expose my body to anyone other than a partner or a healthcare professional. If it does not look completely normal then I can live with that.

In terms of function, I know that it will never be capable of a natural erection, ejaculation, or the same degree of sensation as a normal penis. However, it should be capable of urination, is likely to achieve some sexual sensation, and will be capable of erection with an erectile device. That is the best that is currently available and I really do think it will be transformative for me despite its limitations.

The scar on your arm will be very visible and may mean that people can identify that you are female, is that a worry for you?
I am worried about the scar, but I would be covering my arm anyway as it cannot be exposed to sunlight for a period after surgery. I then intend to get a tattoo to cover it up. I was initially worried about how I could achieve that with the bare below the elbows procedure that exist in healthcare now (to minimise infections). However, I found out that there are disposable sleeves that can be used by people with skin conditions or for religious reasons.

Have you thought about whether it would be valuable to explore your body, despite that being upsetting? That can be alone and in private, so doesn’t mean having to be exposed in front of another. I ask because I know there has been an issue with young people having puberty blockers and never developing the ability to climax which cannot be fixed by surgery. I don’t know if it would work the same way with someone who did not use those drugs but hasn’t explored that part of their life.
If you are talking about masturbation then it is something I tried in the past. Libido rises with testosterone treatment and there is also growth and increased sensitivity which unsurprisingly can cause frustration. However, I was not able to have a positive experience because of my sex dysphoria and also because sexual activity causes flashbacks. However, I know that I am capable of orgasm, because I have had a few sexual dreams that have resulted in that outcome.

Thank you, your response is very in depth. I hope that things will go as you are hoping. As someone who experienced CSA I understand how these experiences shatter the relationship we have with our body and sexuality. I am sad to hear how that trauma is still effecting your life, but I understand why that is the case considering your experiences. I want you to know that flashbacks are a very common reaction, it doesn’t mean you are broken, and most importantly you are not alone. There are therapists who can help you with these feelings, and even though that was not helpful for you in the past it doesn’t mean that it can’t be an option in the future.

You are welcome not to take my advice, but I would like to caution you from my own experience that this is a problem that is very likely to crop up again if or when you begin a relationship. It is important for both you and your partner to be aware of that possibility, and to seek the support you deserve. Your partner will need to be able to be patient, understanding and able to cope with her own emotional response to the situation. You would need to provide her with the same empathy, but I can see that is a strength of yours.

I’m not saying you have assumed this, but I do also want to point out that it is unlikely that surgically altering your genitalia will prevent the flashbacks and fight or flight response. Although it was not to the same degree my body was very different when I met my partner compared to when I was a child, but it did not stop that trauma coming back to the surface. It can be a strain on a relationship, but with the right person and the right support it can be managed and make your bond even stronger.

Thank you, I will think about what you have said. I don't think I am ready for it at the moment but maybe it will be an option for me in the future.

I am very sorry to hear about what happened to you as a child. I am glad you have found a caring partner who supports you and vice versa. It is the kind of relationship I hope can be a part of my future.

Hi OP I hope you don’t mind but I have another question. It has recently come out that testosterone use in biological females has been linked to an almost 100% rate of urinary incontinence from a very young age. Is this a side effect you are aware of, or have suffered yourself?

I had an issue in the past but not anymore as I had physiotherapy. It wasn't related to using testosterone though.

Can I ask what makes you sure it isn’t connected?

Sorry just read you said urinary incontinence. I have never had an issue with that. I had some issues after a colostomy reversal but that happens in a lot of people so I think it's very unlikely to be connected.

I have some further questions for you if it’s ok OP. I’m sorry for the staggered approach I have taken over the days here, but these questions have been touched on before and generated a lot of anger from other people at the time. That made me reluctant to ask them earlier, but it is clear to me now that myself and several others are wondering the same thing and it could be valuable if it could be discussed.