This week let’s take a break from genetics and ask: “Among transgender people seeking medical treatment, how many want what treatment? Among those who are not seeking out the traditional transition, what are their reasons?” As you might have guessed, a paper from the Netherlands was just online published ahead of print addressing these very questions.
360 people seeking treatment at a specific clinic in the Netherlands were surveyed; 233 (64.7%) of them were assigned male at birth (AMAB; mostly trans feminine) and 127 (35.3%) were assigned female at birth (AFAB; mostly trans masculine). Because this was a survey specifically asking about trans people who may fall outside the gender binary, I’ll stick to the AFAB/AMAB terminology.
The researchers also defined “full” and “partial” transition. For the purposes of this study, “full” transition was either:
- Antiandrogens + estrogen + orchiectomy + vaginoplasty, for AMAB people
- Androgens + mastectomy + hysterectomy/oophorectomy + phalloplasty or metoidioplasty, for AFAB people
Variations on these were considered “partial” transition, even if they included more surgeries (such as facial feminization surgery or breast augmentation). By using the terms “full” and “partial”, neither the researchers nor I are trying to imply that one form of transition is any better, desirable, or more “complete” than any other. It’s a historical term, and used here only as a label for one set of treatments that have been considered a “standard” treatment.
So — what did the 360 people want? 10 weren’t sure yet (2.8%). Overall, 253 (70%) wanted “full” treatment. and 97 (27%) wanted “partial” treatment. Of the 97 who wanted a “partial” treatment, 47 cited surgical risks and concerns about the ultimate result, 19 had no genital dysphoria and felt genital surgery wasn’t important for them, 5 felt they were too old, 4 had a non-binary gender identity, 1 was afraid of social rejection, 1 wanted to remain fertile, 1 wanted to go outside the country for surgery, and the others declined to answer.
If you look at the data differently, AFAB and AMAB people wanted different things. Among the 225 AMAB people who knew what they wanted, 180 (77%) wanted “full” treatment. Only 45 (19%) wanted a different treatment. 12 wanted hormones only, another 12 wanted hormones and breast augmentation, and another 10 wanted hormones and breast augmentation and facial feminization surgery.
AFAB people were less likely to want “full” treatment — only 73 of 125 (57%) wanted “full” treatment. Of those, 35 wanted phalloplasty, 12 wanted metoidioplasty, and 26 were uncertain. 52 of 125 (41%) wanted “partial” treatment, with the majority (31) wanting androgens, mastectomy and hysterectomy and 18 wanting androgens and mastectomy without hysterectomy.
That’s quite a difference between AMAB and AFAB people — 77% vs 57% wanting “full” treatment. When the reasons were compared, AFAB people were most likely to be concerned about the risks and results of surgery. AMAB people, on the other hands, were more likely to report feeling that genital surgery was unnecessary.
Of course, this was just one survey within one culture. However, it’s interesting food for thought and gives one set of ballpark figures for who wants what treatment.
Want to read the study for yourself? The abstract is publicly available!