Thoracic outlet syndrome & deteriorating verbal fluency: Not on your typical informed consent form

Informed consent: Your Golden Ticket to “affirmative” trans health care.

It’s simple. Go to a gender therapist, tell them how you identify and what medical treatments you intend to pursue. Said therapist refers you to an MD, whose job it is to inform you of what you’re about to embark on, including possible risks, and to obtain your consent. Done.

icath model

And while consent forms do tend to cover (in addition to the provider’s buttocks) the better-known effects and risks of hormone “therapy”–in the case of testosterone, things like elevated cardiac risk, deepened voice, hair growth/loss, and changes to sex drive and mood —there are other physical and neurological problems associated with marinating female brains and bodies in far more T than their biology would normally allow.

Researchers in neuroscience who study hormone effects have uncovered some of these impacts; clinician-researchers who focus on trans people are aware of them. But for some reason, the trans-identified females who’ll possibly bear the brunt aren’t fully informed.  Don’t these clinics owe it to their patients to even mention the ongoing research and clinical discoveries? [Note to readers: If you can supply us with informed consent forms which do mention any of the effects discussed in this post, please do so in the comments.]

On the neurology front, there is a significant and growing body of literature across disciplines showing the deleterious effect of testosterone on language skills. A 2016 brain imaging study found that even 4 weeks of testosterone “therapy” may shrink the zone of language in the brain of FTMs, corroborating multiple, prior studies showing an association of T levels with reduced verbal skills. In 2007, Dutch researchers Gooren and Gitay reviewed clinical data on over 700 FTMs from 1975-2004 and found a similar impact. An earlier 1995 study of testosterone treatment in trans-identified females showed a “deteriorating effect on verbal fluency tasks.”

But hey, you might get a bump in your mental rotation skills.  A 2016 fMRI study (coauthored by Peggy Cohen-Kettenis, one of the members of the Dutch team who pioneered the use of puberty blockers in pre-adolescents), studied “gynephilic” girls (otherwise known as “lesbians”) and found changes in brain regions typically activated during mental rotation tasks after just 10 months  on T.

burke et all 2016 gynephilic FTM

Whatever one’s opinions on the data, isn’t this cross-disciplinary, replicated body of research worth a mention, even as a footnote, on an informed consent form?

Moving on to the skeletal front, we found this recent discussion on the WPATH Facebook page amongst providers caring for post-mastectomy trans-identified females. Asked about tips for dealing with top-surgery induced adhesions and other problems, a primary care provider had this to say about adverse skeletal impacts of T on “estrogen-based” people:

T affects the body by increasing muscle size rather quickly. Often in people who were estrogen based to adulthood, that means a lot of muscle has to fit through a small bony prominences at the shoulder, elbow, and wrist this is often especially apparent. This often leads to things like thoracic outlet syndrome, and carpal tunnel syndrome like experiences.

Anyone who has ever suffered from thoracic outlet syndrome knows that it can be excruciatingly painful, last a long time, and can even be disabling and prevent a person from working;  in the worst cases, it can lead to more complications and a need for surgery.  Even if a trans-identified female doesn’t follow the path of many FTMs to becoming a bulked-up, gym/workout enthusiast, the increased risk is there because of the smaller skeletal structure of human females.


As with so much in trans health care, the wanted and unwanted effects of the “treatment” can lead to a need for more treatment (in the case of TOS or carpal tunnel, from physical therapists, orthopedists, and others).

TOS image

Deteriorating verbal fluency. Big muscles forcing through small bony prominences. What else is lurking in the research literature or clinical experience that hasn’t surfaced in media reports, or in the fine print at informed consent clinics? If you know of other under-reported testosterone impacts on trans-identified females, tell us about them in the comments.

One thing we can be sure of: More and more women are starting on testosterone at younger ages, and next to nothing is known about the long-term impacts.


35 thoughts on “Thoracic outlet syndrome & deteriorating verbal fluency: Not on your typical informed consent form

  1. Was just watching a YouTube video by Chase Ross (popular FTM YouTuber for the kiddies); it’s called “Trans 101: Ep 17 – Fertility.” (I’m not going to link to it.) The comments section is full of questions showing just how little trans-identified females know about testosterone effecting their fertility. One person wanted to know if a female with a phalloplasty could get another female pregnant; another asked if a feamle’s eggs could be harvested and frozen before she goes through puberty.

    Chase’s viewers are happy and fine now that Chase told them they can get pregnant down the road if they want to even if they use T; they have no idea of real problems including possible permanent infertility. Some of these people are already on T; some say they are starting soon. Despite being this far into the transition process, they appear to be getting their medical information from a YouTuber rather than from professional clinicians.

    Chase removed comments posted by someone who was warning viewers about possible permanent infertility and pointing out that their doctors should have fully informed them of risks — so not only are clinicians not properly warning their FTM patients of possible side effects and complications, it seems popular FTM personalities like Chase don’t want females to know or understand the full array of testosterone’s possible side effects, either.

    Trans-identified females are being hoodwinked and getting abused from all sides, it seems.

    I think for doctors who prescribe testosterone to teen and young adult females after one or two visits, “Informed Consent” means “It’s the patient’s responsibility to do their own research (and good luck with that)” rather than “the patient has been informed of the risks yet nevertheless consents to the treatment.”

    Liked by 7 people

    • Pre-pubescent kids who are put on puberty blockers, then go directly to cross-sex hormones, are rendered permanently sterile. Immature gametes can’t be banked. Top gender therapists openly acknowledge that. If Chase is saying otherwise, Chase is spreading misinformation. And as you note, even trans-identified females who go through puberty first can have major issues with their reproductive organs, even if they don’t want kids.

      Liked by 4 people

      • No, Chase wasn’t saying that, I just was amazed at the kinds of questions people are asking — questions that illustrate how little some of these young people know about the drugs they take or want to take. It seems many doctors are not doing a good job of informing their “informed consent” patients.

        Liked by 4 people

      • SkepticalMom, it’s almost like teens and very young adults are operating with immature brains and are demonstrating that they don’t have even a rudimentary grasp of what they’re doing.

        Liked by 8 people

    • Chase is one of the few trans YouTubers I’m still subscribed too, because of her fun personality. However, her videos from recent months are strongly making me reconsider staying subscribed! I think she began transitioning at about nineteen, and has admitted to lying about being further along in her transition just to get hormones quicker. It’s so sad that she’s not only compromised her own health with seven years of testosterone and now estrogen-blockers, but that she’s also giving false information to her viewers and not correcting people who believe, e.g., a woman who’s had a phalloplasty can get another woman pregnant.

      Liked by 4 people

      • I watched one of Chase’s videos where she said that she didn’t believe that being on T increases the chances of ovarian cancer and that she refuses to get a hysterectomy. She believes the link between T and ovarian cancer is part of a conspiracy to make trans people sterile. She said this in a video aimed at parents trying to make medical decisions for trans identified children. This person isn’t even remotely qualified to be giving out this kind of medial advice.

        Liked by 5 people

      • Thanks for the info, Gerbby. Hopefully most parents are wise enough not to consider advice from random YouTubers with no medical expertise or professional qualifications, but unfortunately, kids are entranced by UppercaseChase and soak up this person’s every word, taking her advice as gospel. UppercaseChase Ross is a dangerous propagandist and should have all her videos removed, or at least moderated as adult content. She is spreading dangerous misinformation to kids.

        Liked by 3 people

  2. I think that these “informed consent” forms should have a statement along the lines of, “You are signing on to be an experimental subject. However, there is, as of now, no study designed to systematically look at what might happen to you.”

    It likely wouldn’t give a teenager pause, but it might stop parents in their tracks. So, of course, it will never happen.

    Liked by 8 people

  3. Do the manufacturers of testosterone understand how this hormone is being used? no diagnostics, no counseling, informed consent with 18 year olds? fast-acting on female bodies? do they care? if not, why not? Perhaps we better do some digging on who these companies are and do some educating. The callousness with which this potent hormone is not just asked for by the these young women but is prescribed by so-called medical professionals is truly alarming.

    Liked by 4 people

    • They didn’t care when testosterone was being widely used as an illegal performance enhancing drug (anabolic steroids). Body builders and athletes are still killing themselves with it, so are teen boys who just want to get bigger muscles. It’s all about the money for the manufacturers.

      Liked by 5 people

      • However, we’re talking about endocrinologists who are PRESCRIBING this. Testosterone used for doping purposes in cycling was never legal and steroids aren’t, either. Using testosterone (and Lupron as a puberty blocker) is legit.Your pediatrician could write out a scrip for it, if she wanted. It’s not banned to use it as a treatment for a woman who trans-identifies. And, as such, there is no reason to NOT look at who is prescribing it and pointing out conflicts of interest and that it is bad practice.

        For instance, an endocrinologist is a paid consultant for AbbeVie, the manufacturer of Lupron. Lupron used as a puberty blocker is off-label, and promoting it with no research in peer journals, while being paid by a drug comapny at the least looks terrible. I would argue it IS terrible.

        If I can see that, why do no professionals feel that that is strange?

        Liked by 3 people

    • Perhaps there is overlap with the opiate crisis. Some cities and counties are suing the manufacturers of the opiates.It had to get to the tipping point. Are we there yet? Hmmm.

      Liked by 1 person

  4. ….my daughter is using testosterone. She admits it is a lifestyle and that she wants to pass as a man because she feels out of place with women. This is not gender dysphoria with a suicidal risk, this is an identity choice. By a thinking calculating mind. And she is not alone.

    This is NOT a medical need but a medical RISK by a young risk-taking teenager controlled by the teenage drive to fit in socially somewhere.

    Liked by 7 people

    • I am so sorry Nervous Wreck. This should not be allowed. It is a recreational use of these very harmful drugs.Your daughter was probably just fine until she got hooked on websites promoting T & T.
      I do think it is a very good sign that she is willing to communicate with you. Perhaps she will be open to new information.

      Liked by 3 people

  5. My heart goes out to you Nervous Wreck. It seems young people can no longer be gender-nonconforming, and leave their bodies alone. No, they feel the need to conform. It is heartbreaking, and my daughter may decide to follow the same path when she is a little older. We urgently need a large, randomised, representative survey of say 30 to 40 year olds; asking them about their gender identity journey. It may be eye-opening to these gender physicians to see how many lesbian, gay and heterosexual adults felt that they were the opposite gender when they were 4, 8, 12, 16, and even in their early twenties. There is a severe paucity of unbiased, well-designed research.

    Liked by 6 people

  6. I have no complaint with your post or the work you do, generally, as it is invaluable. But I am highly skeptical with testosterone’s ability to validate gender stereotypes(verbal skills/mental rotation). Given the way many FtM speak after starting ‘transition’, it makes me wonder if they’re responding to studies according to what they expect the results should be.


    • The cited studies aren’t based on questionnaires; they’re brain scans (looking at actual neurological changes) and/or standardized testing tasks. That said, no one is saying the changes are gargantuan, irreversible, or impervious to neuroplastic changes or socialization. The brain scan studies aren’t contingent on what the FTMs say or think (since they are before-and-after studies of actual brain region changes after as little as 1 month on testosterone). In the case of the Hahn et al study, the changes occurred in the brain areas (Broca and Wernicke) that are well known to pertain to language. In neurological and clinical studies of the brains of left-hemisphere stroke surivors, decades of research have provided clear data on the “zone of language” in the human brain.

      Is it possible that T-induced brain changes have no relationship to language abilities? Yes, but it’s a curious coincidence that these findings appear to correlate in replicated research with changed performance on standardized testing tasks.

      But just because T may affect the brain (which after all, is part of the body), it does not follow that female brains subjected to high doses of T are “really male.” They are still women! The fatal flaw in trans-activist reasoning is that outliers on a bell curve are in the “wrong” body.

      The 2016 fMRI study of “gynephilic” (lesbian) women mentioned in this post is of particular interest. As we know, young lesbians are being transitioned in pediatric gender clinics at an increasingly rapid pace. It may well be that (as the study implies) many lesbians show differences in typical interests and aptitudes. By insisting that these differences are purely socialized, even in the face of replicated evidence, gender skeptics can fall directly into the trap set by trans activists. If anything, data hints that there may be something different about the typical homosexual brain–emphasis on typical, which is neither deterministic nor indicative of what traits any one individual may exhibit.

      Whether that is true or not, far too many toddlers and little girls/boys are being “identified” as “trans” because of their early-onset, gender-atypical play behaviors and preferences. The Hines et al study (image below) of almost 5000 young people seems to indicate that whether those “gender nonconforming” young kids were strongly socialized to conform or NOT to gender norms (stereotypes, if you will), they persisted in defying those norms, and were likely to grow to be LG teens–whether supported in that or not.

      Many feminists have no trouble with the idea that being gay or lesbian may be innate, yet bridle at the possibility that any other neurological characteristics might accompany that (presumably) innate sexual preference. Neuroplasticity, culture, and biology work in a complex interplay that can’t be fully teased apart, but essentialism when it comes to either nature or nurture means ignoring one facet in order to amplify another.

      What is the impact of all of this when it comes to protecting kids who defy gender norms? A question worth pondering.

      Liked by 2 people

      • Thank you for explaining the studies, it is an interesting question.

        it does not follow that female brains subjected to high doses of T are “really male.”

        Well, of course. Hormones affect the brain, we might expect some difference. I don’t mean that the measure of it would only be affected if participants answered questionnaires- we know of stereotype threat, and the influence that can have on the performance of people not taking any kind of hormones or medications. People, including researchers, are still suggestible and influenced by their own beliefs.

        Saying that, I realize that I am too, and that it is the belief in social conditioning that causes me to doubt the results. Still, the question I have is: Why would testosterone have these effects on brain patterns? I can accept the link between homosexuality and atypical childhood interests, but the effects of testosterone seems a completely different claim. I don’t understand the connection between it and language skills or spatial reasoning. If there was a direct connection(ie, with no socialization/bias), then wouldn’t we expect a significant number of women to have superior linguistic ability, and men superior spatial reasoning? Yet, we know that the overall differences between the sexes are slight… so why should there be any change at all, even minor ones?


      • Brain scan studies showing the effect of even a short course of T on brain areas that correspond to certain behaviors/skills are interesting, and there are quite a number of them; whether those changes are so insignificant as to be meaningless is a matter of opinion. The Hahn study cited in the post is available in full text (no paywall) and has a bunch of links to prior research. You might want to check it out.

        Do you ever listen to drug ads on TV? Because of changes in US law, manufacturers now have to divulge any and all possible adverse effects of every drug, no matter how rare, and no matter how serious. Testosterone is a powerful drug. Obviously, most FTMs aren’t hospitalized with the most severe thoracic outlet syndrome complications; nor are FTMs rendered nonverbal or incoherent, even if T does affect the language centers of the brain. But speaking personally as someone who highly values my verbal fluency, as well as the small bony prominences in my shoulders and other joints, if I were to decide to take the drug called testosterone, I’d want to know about this research; at least be pointed to it (and there is a lot of it, not just one study) so I could make up my own mind. I’d also like to know that WPATH clinicians casually discuss things like TOS and carpal tunnel (effects they claim are common in FTMs). I’d want to feel confident, when I gave my consent, that my provider had informed me about all known physical, psychological, and neurological effects arising from this very powerful drug. Giving patients a handout listing all the most important research and clinical findings would also be the right thing to do.

        Liked by 4 people

    • Ok, but it doesn’t really validate stereotyping, because these differences are all averages. There will always be a significant portion of girls that are better at “masculine” things than most boys, and vice versa. The ability of sex hormones to modify brain activity doesn’t justify assuming each individuals ability is in line with the trends identified in the data. Also, basically everyone can improve various skills through practice, and there are very few cases where anyone needs to be exceptionally talented to do meaningful work. Most people can achieve competency and contribute in the pursuit of their choice. Think of sports, how many will ever be an Olympian? But if a woman lifts weights regularly she is likely to be able to squat more lbs than an untrained man. Men still carry a natural advantage in weight lifting, but in a practical sense the importance of that advantage pales in comparison to the importance of actually trying to improve.


      • Well, the variation in physical strength between men and women is so significant that there is virtually no sport where men can fairly compete with women. It’s not possible for a woman to even come close to the top men in almost all sports. No female golfer has ever made the final cut of a PGA Tournament without a special exemption, for example. Sure, the best female golfers are better than 99% of men who play casually, but they generally don’t even bother trying to compete against men professionally (although there is no rule against it), as it is just a waste of their time.

        Liked by 1 person

  7. This post and the comments raise another interesting point. Wouldn’t you think that, if transgenderism really does have a biological basis in the brain, as at least some of the proponents suggest, that they would be extremely supportive of a test and specifically a brain scan, to determine transgender status? One might assume that, before giving highly disruptive surgeries and drug therapies to people, they would want some type of confirmation that these things were medically appropriate in a given circumstance – and if it is so, as they claim, that there is a physical, biological basis for transgenderism, then this SHOULD be “diagnosable” at least theoretically. The fact that we don’t seem to hear a peep from the activist community, pressing for a definitive test, raises some interesting questions…

    Liked by 3 people

    • But what would the criterion be? Even if a brain scan showed that some people have brains more typical of the opposite sex, it’s a huge leap to say that means they are literally “born in the wrong body”. It just means they are unusual exemplars of their sex. Traditionally, many gay and lesbian people have fit that description, along with others who have defied typical stereotypes/traits. Trans activists like to claim “two spirit” people in some traditional cultures as “trans.” But if you really read about these people, we don’t see them claiming their bodies are wrong; we don’t see them demanding that they be seen/treated exactly the same as members of the opposite sex. They occupy a unique role in their societies, sometimes a respected one. No matter what a brain scan might show, it couldn’t be used to show that a person’s brain is healthy and “valid”, while somehow the entire rest of the body is wrong. But of course now that being “non-binary” or “gender fluid” is a thing, trans activists would only be shooting themselves in the foot to demand brain scans. After all, anyone and everyone should get hormones and surgery on demand if they want it. Would be pretty hard to justify for those people with “non-binary” brains. As in, most of us.

      Liked by 5 people

  8. Trans identified people seem to usually fall into two categories: Those who are gender atypical and feel they must ‘transition” because of that (Jazz Jennings), and the men (it’s always men) who fetishize dressing like a woman or looking like one (Bruce Jenner).

    Liked by 2 people

  9. Another severe side-effect of taking cross-sex hormones is the development of insulin resistance (type 2 diabetes):

    The endocrinologist my stepson was seeing for his type 1 diabetes who did not hesitate to offer cross-sex hormones when my kiddo announced his gender identity… did NOT mention this side effect, and in fact had no comment when I asked how these hormone treatments would impact his type 1 diabetes and bipolar disorder.

    My research of anecdotes suggests that trans people with type 1 diabetes have to steadily increase their dosage of insulin as they increase their dosage of cross-sex hormones (while I infer from the academic studies I have found, that higher levels of same-sex hormones increases insulin sensitivity and reduces the necessary insulin dosage.)

    Liked by 1 person

    • Interesting that he has type 1 diabetes as well. I wonder–and totally just throwing this out there–whether desires to transition have anything to do with feeling a lack of control over his body. Type 1 can involve a lot of lack of control over one’s body, and that could lead to hating your body and desiring to get control over it. And maybe that leads to wanting to change his body in any way he can…just thoughts…

      Liked by 1 person

  10. Inquiring minds are dying to know what the negative health effects would be from wearing a chest binder like those given away by Portland’s Transactive Gender Center, while bulking up and injecting testosterone?

    “Conclusions Transgender individuals using chest binders have abnormal lung function. The acute effect of wearing the binder appears to be an overall volume reduction with little other change. Abnormal lung function in the population may indicate a chronic effect of binder usage or generally poor respiratory health.”

    Liked by 2 people

  11. It is simply a sad situation and a perfect ugly storm of circumstances. The DSM 5 (a serious flawed guideline) and the medicalizing of gender. Kids and social media and the segregation of knowledge and the “illusion” of knowledge. The bizarre notion that someone can self-diagnose for something so long-term and life-changing.

    We are not alone as parents as this is a healthcare epidemic in 1st world countries and will grow in size. Ultimately the doctors and therapist will be held accountable. I see them as equivalents to “crack” dealers. They think they are “saving” these kids but what they are really doing is making them dependent on Western medicine. Going to gender clinics will now be a necessary lifestyle choice. I am disgusted and heartbroken.

    Liked by 2 people

  12. I understand your concerns, but gatekeeping trans people for so long that they will no longer be able to pass is not the way to go to stop “trenders”, the young people who transition without dysphoria and as an identity choice.
    Invalidating your children’s identity entirely will also make them lose trust to you.


    • So, despite the fact that testosterone is not FDA-approved for use in females, and despite the fact that there are no studies showing T is safe for females to use for longer than five years (FTMs who start using T in their teens can be expected to use T continually for five, six or even seven decades), and despite the evidence of serious health risks detailed in the article above, you are saying that parents and doctors should just let kids use testosterone — no questions asked — because passing as the opposite sex is what’s most important?

      It is getting easier and easier to spot comments left by teenagers.

      Liked by 1 person

    • My young teen was diagnosed with severe gender dysphoria. I opted to support my teen in developing their personality, not their physical body via medical and surgical transitioning. It lasted for 2 yrs and now there is desistence. My kid wouldn’t have been considered a gender trender. The only thing that prevented medical transitioning was me, and thankfully our therapist backed me up.

      My child trusts me to see a larger picture, to keep them safe, the know more about big medical decisions. My kids trust that I love and support them as people, not identities.

      Liked by 1 person

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