Ask Matt: My Genderqueer Child Wants to Use Testosterone

A reader writes: “I have a question about how to support my teen daughter. She is 19 and decided this past year that she identifies as genderqueer, which she describes as ‘being neither male nor female, but only herself as an individual.’

“Until she was 18, we saw no sign of this; for example, she used to wear very long hair and dresses at 17, but now is dressing and wearing her hair ‘butch,’ to use her words. She did not express discontent to us with her gender when growing up. She also identifies as bisexual, which we have been aware of and supportive of since she was in high school.

“She says that she has great discomfort with her biologically female body so has decided to go onto testosterone hormones in order to have a more gender ambiguous body, ie, to look and sound less female. She is not interested in transitioning to becoming male. However, she does want to drop her voice to sound like a man and hopes to change her facial structure.

“Her father and I support her feelings about her gender identity – at least we think we do – but we are very concerned that she is apparently being given medical permission to go onto male hormones so quickly. We would like for her to slow the process down and take more time to decide.

“One reason is that she is struggling with other mental health issues, such as depression and ADD, with which she was just diagnosed this past year and still has not yet found the right combination of therapy and medication to treat either one. We’d like to see those under control before she adds any hormones at all to the mix. She seems OK with this part of our objection and says she will give it two months.

“A second concern is that she seems to have identified so recently as genderqueer that we wonder whether she can really know whether this is a deep-seated identity issue that must play out with hormonal therapy for her to feel comfortable in her body, or if it is part of normal exploration of what gender means to her in a culture that has pretty rigid and narrow expectations of what it means to be female. She also has never dated or kissed anyone (either male or female) and seems to fear vulnerability of her body within the context of a romantic or sexual relationship, and we wonder if that is also relevant.

“When we expressed these latter concerns to her, she told us we were being ‘transphobic.’ We think there is a difference between being transphobic and telling your child that we think she needs more time to discern.

“She is seeing a mental health professional who specializes in gender identity issues, and tells us that he is 100 percent behind her going on hormones. Yet he has only met her for five or six sessions total, over the course of two months. She does not allow us to have any contact with him or with her doctor, and due to her age, he cannot release any information to us. (We have NOT tried to contact the therapist.)

“Five or six sessions seems to us not to be enough to go through a good discernment process as to whether to take hormones to permanently change the pitch of her voice and facial characteristics. (If the process were reversible, we would be less concerned.) We’d really like help understanding how to support her effectively.”

I understand your concerns, and I wish that I could put you at ease one way or the other, but I don’t think I can. Regardless, let’s look a little bit at each of these concerns separately. (I am not sure what pronoun to use for your child, so I am going to use the gender-neutral “ze” pronoun.)

You say that ze has shown no signs of gender issues previously, and that ze even wore long hair and dresses a couple of years ago. This is not unusual. It’s not the most common scenario, but it’s not all that uncommon, either. I was very traditionally feminine before I transitioned – right up until the point when my therapist told me she wasn’t going to write my letter for hormones until I stopped wearing makeup, dresses, and long hair.

I know quite a few people who have expressed a more traditional gender, and sometimes even a hyper-masculine or hyper-feminine persona, prior to either realizing or dealing with their gender issues. So the fact that ze did not give off “clues” to this is not as much of a concern to me as some of the other things that you talk about. I think you should let this one go, particularly because I get the impression that the “butch” haircut and other more masculine expressions are not really the problem for you.

But ze wants to go on male hormones to have a more gender-ambiguous body. Honestly, a lot of people have done this, but I see a little bit of irony here, because male hormones cause male physical changes. That’s not a gender-ambiguous body – that’s a male body.

A deep voice, facial hair, redistribution of body fat and muscle mass into a male body pattern, clitoral growth, and male pattern baldness, if the person has the gene for it, are just some of the things that testosterone can produce. A person does not get to pick and choose which of these things will happen.

If your child is on testosterone long enough to produce a lower voice and changes in facial structure (which is generally a widening of the face), ze might also start to grow a beard, develop body hair, lose hair on the head (although ze is kind of young for this), and develop other characteristics that are not gender neutral, but that are male.

There are also some health risks associated with testosterone, including the possibility of increased cholesterol, increased blood pressure, and increased red-blood-cell count. Again, your child is young, so these are probably not as much of a concern as they will be later. But I hope that ze is aware of both the visible and invisible changes that are associated with the use of this hormone.

It’s possible that ze wants to go on testosterone just long enough to have a lower voice and a more “masculine” face, but again, there is no guarantee as to how rapidly any of these things will happen and in what order. Ze could have a full beard before hir voice goes down at all. Each person responds differently to this hormone.

The good thing is that ze has listened to your concerns about hir mental health issues and has agreed to wait at least a couple of months before starting hormones so that ze can see how hir other medications might impact hir. If ze has listened to you in this area, ze might listen to you with regard to your concerns about the permanent changes that ze might experience. Ze might listen to you with regard to potential health risks and possible unwanted physical changes, such as facial hair or baldness.

But I also hope that hir medical doctor – the one who will be issuing hir hormones – will go over all this stuff with hir as well. My doctor made me sign a release that outlined the physical changes and possible health risks associated with testosterone. I don’t know if every doctor does this, but I hope that doctors are at least reviewing this with their patients.

I also agree that five or six sessions might not be enough to determine whether or not this is the most appropriate and beneficial course of action. But you say that ze is seeing a gender specialist, and he might know something that you and I do not.

There are two bottom lines here (if that’s possible). The first is that although I have used myself as an example with regard to transition, that’s exactly what I was doing – I was transitioning, something that your child has said that ze doesn’t want to do. When I started testosterone, it was with the goal of living as a man – or at least as a trans man – in the world, so any physical changes were expected and welcome.

And because I tend to be a little more traditional, I also tend to be somewhat conservative when it comes to using an extremely strong hormone that will result in permanent changes that cannot always be gauged in advance. I would like to hear from some genderqueer readers who were designated female at birth who are taking testosterone for the purpose of appearing more androgynous. How is that working out? What thoughts and suggestions do you have?

The second bottom line is that your child is 19 years old. Regardless of how you feel or what you want, ze can and will do what ze wants to do. And sometimes you just have to let go and let the chips fall as they will. I’m not trying to minimize your concern or say that it’s wrong. (And I don’t think your concern is “transphobic” – that word gets thrown around a lot, and its casual usage has minimized its true meaning.)

But there does come a point when things are no longer within your power to change. And I think there are far worse things that could probably happen than this.

Readers, what do you think? And genderqueer readers on T, as I said above, I would love to hear your experiences.