• Is masculinsation right for you?
• Understanding Detransition
  • Risk factors for regret
• Ask yourself these questions
• What masculinisation options are there?
  • Easily reversible changes
  • Potentially reversible changes
  • Long-term, unlikely to be reversible changes
  • Permanent and irreversible changes
• References

Is masculinisation right for you?

     The MANual was created in mind for those already undergoing masculinisation—as my friend jokingly remarked on this section, “I can’t wait to detransition so I can read this!” The both of us are very comfortable with our non-binary gender identities: Eileen more outwardly gender-nonconforming and using they/them pronouns, myself overtly masculine and male-passing and using exclusively he/him pronouns (except when I’m angry—you know someone’s in trouble when my fiancée is using she/her to refer to me). For us, both medical transition and social/legal transition were helpful in allowing us to live our lives fully as our best adult selves. As far as I can tell, neither of us regret our decisions to go forward with the modalities we chose; yet with the increasing access to transgender treatments and affirmation, we, as members of a progressive society, I believe, have a social responsibility to address and include those who detransition, whatever their reasons are for detransitioning—reasons that are varied amongsts individuals, and frequently diametrically opposed to the reasons of other detransitioners.

     I will say that for myself, my reasons for seeking masculinisation should have immediately disbarred me from going forward with testosterone therapy (which I pursued and am happily maintaining) and a referral for a double mastectomy (which I never went forward with), had I been under the care of a provider actually interested in differential diagnosis, and a background in (or at least respect for) the field of marriage and family therapy. In another world, I would have had the causes of my dysphoria addressed first before a resumption of an inquiry into transgender treatments, and I probably would have lived a very fulfilling life as a bisexual woman, married to either a cis man or a butch lesbian. Yet despite this counterfactual history, I do not regret masculinisation, and am happy and intent on continuing to live life under a decidedly masculine identity.

     That is my case. For many others with a history similar to mine, they have chosen to either desist or detransition from transgender treatment entirely; either because further development of masculinisation was no longer correct for them, continuing masculinisation was no longer correct for them, or, sadly, masculinisation was never correct for them in the first place.

     So: How can you tell if masculinisation is right for you?

 

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     Detransition is estimated to occur in approximately 7–13% of those who initiate a gender transition (Butler et al. 2022 ¹; Boyd et al. 2022 ²; Hall et al. 2021 ³; Olson et al. 2022 ⁴; Turban et al. 2021 ⁵). Vandenbussche’s (2021) international survey⁶ recruited 237 detransitioners who were a mean age of 25 and 92% were AFAB (Assigned Female At Birth). Littman’s (2021) international survey⁷ of 100 detransitioners was composed of 69% AFAB respondents; a majority were sexual minorities, and they were a mean age of 26 when they detransitioned; 61% percent re-identified with their assigned gender at birth. MacKinnon’s (2022) Canadian qualitative study⁸ sampled 28 detransitioners, of whom 64% were AFAB, 71% were between the ages of 20–29, and 61% were non-binary.

     Considering the high statistical prevalence of desisters and detransitioners, of whom in absolute numbers is increasing due to the increased accessibility of gender transitioning treatments, one might assume that there would be greater research on detransition, and the needs of detransitioners and others who desist from transgender treatment. However, at the time of writing, scant scientific, therapeutic, and supportive attention has been paid to this minority of a minority. In fact, pieces in publications such as the International Journal of Transgender Health⁹ refer to desistance disparagingly as a “highly disputed concept”, exploratory therapy that attempts to address co-morbid psychiatric problems as “veiled conversion therapy”, and asserts that research into the aetiology of dysphoria “has no place in a modern depathologized healthcare system” and “[runs] parallel to efforts to prevent or cure transness”.

     What complicates an understanding of desistance and detransition, is the heterogenous character of desisters and detransitioners as a “group”. The very label “detransitioner” is only useful as an umbrella term that signifies a person has reversed their gender transition medically and/or socially—not their current gender identity (some have reclaimed their assigned gender at birth; others have embraced a non-binary gender identity), whether or not they regret having undergone gender transition treatments (gender-fluid, gender-nonconforming, and non-binary detransitioners seem to report a higher satisfaction with having undergone and the ultimate results of their transgender therapy); and whether there were specific aspects of their gender transition that they needed, alongside other treatments that they regret or felt pressured into accepting (e.g. the requirement to have undergone testosterone therapy for at least a year before they were allowed to have a double mastectomy). The highly diverse opinions, experiences, perspectives, and desires of detransitioners, often diametrically opposed, causes further difficulty into research as different groups of detransitioners may be self-selecting depending on the stance or approach of the surveyors. For example, non-binary detransitioners made up a 60.8% majority of those voluntarily surveyed by an openly and all-trans team writing in the Bulletin of Applied Trans Studies ¹⁰. Other detransitioners are highly outspoken against transgender advocacy groups for the de facto assumption that all gender-related body dysmorphia are irrefutable indicators of “transness”, expressing grief that they’ve been irreversibly harmed, and their care has been compromised in order to advance the political interests of one specific group, and the financial interests of private surgeons. Yet others feel uncomfortable with speaking out at all, for fear of their testimonies being exploited to deny others access to gender transition treatments and care.

“Basically, everybody’s cut me out. There’s like four people that I’m still friends with that I still talk to. Most of them, I trigger their dysphoria and invalidate them by existing… I haven’t found community within the [LGBTQ+ community] center, any of those spaces. There isn’t room for detransitioners… When I was emailing [LGBTQ+ community] center, I sent them a [detransition support] booklet that they could put up… [I said:] ‘Here’s the experience of detransitioners and how they deal with the distress around their gender.’ And they stopped replying to me.”

     For the purposes of The MANual, I list below risk factors for detransition for those who would be harmed by and regret masculinisation. Many of these risk factors are reported by Cass (2024) for desistance in an NHS England-commissioned 388-page study, Independent Review of Gender Identity Services for Children and Young People ¹¹, popularly known as the Cass Review. Other factors I have gleaned from anecdotal discussions in various online detrans social media, such as r/detrans; ongoing court cases levied by detransitioners against surgeons and physicians (one of whom mentored my first transgender-focused endocrinologist); and personal conversations with others.

     This list does not mean that having any or even multiple of these risk factors means you should never masculinise in any way. Obviously you can be autistic, abused by your parents, and still benefit from and be happily trans masculine. However, I highly recommend that the following issues be addressed, or at minimum, explored, before undertaking irreversible masculinsation treatments (e.g. feel free to wear men’s clothing as you tackle your eating disorder, but maybe don’t get a double mastectomy until you can go through life without purging and overexercising). Endocrinologists, while well-meaning, are not experts in trauma or family and marriage therapy, which you may need instead of testosterone if you experienced precocious puberty and child sexual abuse, etc.

Risk Factors for Regret

• Precocious puberty
• Sexual abuse as a child or adolescent
• Androphobia (fear of men)
• Gynophobia (fear of women)
• Alexithymia (difficulty understanding one’s own emotions; often co-morbid with autism)
• Eating disorder(s) and associated body dysmorphia
• Other internalising mental health disorders, such as internalising subtypes of Borderline Personality Disorder
• Tokophobia (fear of pregnancy and childbirth)
• Beginning medical transition before the age of 25
• Queer attraction/sexuality combined with internalised homophobia
• Internalised misogyny in AFABs
• Internalised misandry in AMABs
• Family history of abuse
• Family history of autism
• Parents are divorced, unmarried, or remarried post-divorce prior to you reaching the age of 18
• Raised in a single-parent household
• Social alienation from peers in adolescence
• Failure to launch as a young adult; extended NEET status
• Doomscrolling and general screen addiction
• Spending only or fewer than 10 hours a month with friends in-person (a healthy amount of in-person get-togethers with friends is closer to 30 hours a month)
• Unsupported physical disabilities
• Psychiatric issues as a minor aggressively treated with psychotropic drugs
• Lack of exercise
• Aversion and/or disgust to human faces and appearance in others, combined with an attraction to stylised drawings or anthropomorphic figures
• Culture shock: being compelled to abide by gender and other social norms alien to you, especially when you hail from a culture characterised by high levels of individualism, can cause severe gender dysphoria.
  
  Finland to Japan: The case of an MtF I know

       This young person grew up in Finland, a country whose culture does not use gendered pronouns, ranks #1 in civil liberties as of 2025, and is known worldwide for ultra-permissiveness towards children, allowing students to attend school in pyjamas. They participated in a foreign exchange student program and went to Japan, living in a host country with strongly gendered language and carriage (not just pronouns: there are explicitly feminine ways of saying one’s stomach is empty), explicitly gendered and mandatory school uniforms, a high emphasis on communal propriety, and arguably more complex and demanding social rules and norms.

       It was in Japan that they experienced for the first time in their life gender dysphoria, and they confessed that they went out of their way to defy and embarrass their Japanese host family, in public.

       If you’re experiencing gender dysphoria, for the love of gods don’t lash out at your host family. Sort your shit out, at home. For fuck’s sake.

 

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• Have you seen the film Mulan? What do you feel about the ending? Would you be content to return home as a woman after proving yourself, or would you rather live the rest of your life as Shang? (Yes, I said Shang, not Peng.)
• Do you have any particular ambitions or dreams as a man? Can you see the kind of man you want to be?
• Is the image of the man you want to be also the kind of man you want to date? Are you frustrated that you haven’t yet found a partner in life like that, who meets your standards? If so, are you aware that after you transition, you will still be single, and still have to work to find this same kind of man to date?
• Do you see your gender as “seme” or “uke”? If you wish to be a gay man, are your images of gay men’s relations primarily or sorely rooted in straight women’s romantic and erotic fiction? (Yes, I have seen 32-year-old trans mascs seriously proclaim on social media that their gender is “uke”.) If you wish to be a gay man, do you understand that gay men’s relations and cultural histories are not early 2000s manga?
• Do you think life would be easier for you if you were a man? If so, in what ways?
• Conversely: do you think life is harder for you as a woman? If so, in what ways?
• Do you already socialise with others in masculine ways? Did that feel natural to you? How did that make you feel?
• Can you imagine yourself giving to others as a man? Being a male leader in your community, or as a family man?
• How do you feel about cisgender men? Do you admire them and wish to participate in men’s group activities? Or do you feel wary and suspicious of them, assuming hostility, exploitation, and/or dismissal in your interactions with them?
• How would you relate to and interact with cisgender men after masculinisation? For example, would you be eager to participate in freestyle rap competitions, go on team sailing trips, and get up to alcohol-involved camping shenanigans with them if you were offered the opportunity? Or would you rather jump overboard than work the jib with your fellow man?
• If you are attracted to women, have you had any experience with the OFOS scene? How have your relations with women been in general?
• How different would the male version of your current self be? In what ways?
• If you woke up a man the next day, what would you do differently in life?
• Are there any women in your life whom you’re proud of? What makes you proud of them? Who are your female role models, and why?
• Do you have any positive sentiments towards femininity? Do you admire any women who are traditionally feminine, and simply wish you were a masculine admirer? Do you wish you could relate to these women as a man?
• What gets you stoked about manhood?
• Are there any men you admire? What do you admire about them?
• What would you like to bring to the world as a man?
• Are you primarily motivated to transition to give to the world as a man, or are you primarily motivated by a wish to escape painful circumstances, or, as a form of self-defence against a hostile world?
• Are the men and women in your life happy together? What have you learned from them, that you can bring to your own adult relationships?
• Do you have experience with masculinity and femininity in other communities and cultures? How did you feel about those experiences? How has that shaped your relation to your culture and subcultures?
• How much time have you spent affirming yourself as an “egg yet to hatch” or reinforcing confirmation biases via the dopamine hits of social media, versus self-reflection and asking yourself any of these questions above?

 

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What masculinisation options are there?

     Masculinisation is neither a binary switch, nor a singular linear spectrum. As mentioned above, non-binary and non-gender conforming individuals may benefit from deliberately selective and targeted masculinisation treatments and modalities. In particular, microdosing of testosterone, and/or cessation of testosterone treatment after satisfaction of a certain developmental milestone may be ideal for certain individuals. Surgical treatments are not required to pass (I and every straight woman and bachelorette party Downtown who hits on me can attest to this), if one maintains healthy nutrition and exercise whilst on testosterone; others deliberately opt for surgical treatments without testosterone, including explicitly androgynising (read: gender-nonconforming) nipple-grafting procedures.

     I have listed and sorted masculinisation changes according to ease of reversibility, ranging from easily and immediately reversible; to potentially reversible after some time; to unlikely to be reversible without either years of desistance or medical therapy; to permanent and irreversible without surgical (re)intervention (if even possible). This list is not meant to be fully exhaustive, and does not include neurological (and the resultant psychological) changes except for the construction of testosterone receptors; but it should give you an idea of what to expect should you seek testosterone treatment and other means of masculinisation.

These changes can be easily reversed by the patient, or can revert quickly on its own (within a few weeks or months).

• Masculinising make-up
• Head hair styling
• Clothing and accessory choices
• Eyebrow scaping and styling
• Underwear packers
• Chest compression via sports bras
• Chest compression via rash guards
• Voice masculinisation via diaphragm and vocal training
• Performative behaviours, carriage, and language
• Darkening of skin colour, iris colour, and hair colour caused by testosterone
• Vaginal atrophy
• Cessation of menstruation cycle and associated menstrual pains and diarrhoea
• Increased metabolism due to increased basal metabolic needs from masculine muscle mass
• Polycythemia (increased hematocrit and/or hemoglobin concentration in the blood); increased body temperature as a result of thicker blood

 

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These changes may revert on their own, over a long period of time (several months to over a year).

• Voice masculinisation brought on by testosterone; dependant on length of regimen, dosage, and individual
• Light body hair growth
• Light facial hair growth
• Facial fat distribution
• Overall fat distribution
• Thickening of the skin
• Enlargement of the clitoris; dependant on length of regimen, dosage, and individual
• Vaginal atrophy
• Vaginal lubricant pH changes; resultant vaginal flora and scent changes
• Ribcage deformation and decreased chest wall compliance caused by chest binding
• Increased foot musculature and size
• Desensitised, selective olfactory processing (may potentially be immediately reversed by pregnancy)
• Increased muscle mass
• Increased need for hydration due to the requirements of increased muscle mass (yes, that’s why your pee’s gotten darker and orange. Go drink water you thirsty bastard)
• Increased alcohol tolerance, likely due to increased body water in increased muscle mass ¹² (may potentially be immediately reversed by pregnancy)
• Increased libido
• Increased hair and skin oiliness
• Increased risk for incidence non-alcoholic fatty liver disease (NAFLD) due to changes in liver metabolism mediated by oestrogens¹³
• Decreased risk for severe liver disease, also due to the above¹³
• Adrenal gland changes; decreased salt sensitivity, decreased risk of excess sodium-related hypertension¹⁴

 

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These changes may revert on their own after a very long period of time (multiple years), but are unlikely to do so without medical intervention, such as oestrogen treatment, androgen antagonists, and plastic surgery.

• New testosterone receptors constructed in the brain and throughout the body; this is why many post-testosterone therapy changes cannot be reversed without oestrogen treatments.
• Voice masculinisation brought on by testosterone; dependant on length of regimen, dosage, and individual
• Pockmarks caused by cystic acne
• Moderately increased body hair
• Moderately increased facial hair
• Male-pattern receding hairline
• Body odour changes, and changes in skin flora
• Enlargement of the clitoris; dependant on length of regimen, dosage, and individual
• Vaginal lubricant pH changes; vaginal flora changes
• Ribcage deformation and decreased chest wall compliance caused by chest binding

 

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These changes cannot be reversed without medical, typically surgical intervention—if they can be reversed at all. (See the bolded point on loss of clitoral sensitivity.)

• Mastectomy; resultant loss of sensation in affected areas
• Hysterectomy
• Metoidioplasty (clitoral release)
• Scrotoplasty
• Phalloplasty
• Other plastic surgery (e.g. rhinoplasty)
• Loss of sensitivity in the clitoris due to constant friction and drying out, caused by insufficient foreskin coverage post-clitoral enlargement (comparable to circumcision in adults)
• Enlargement of the clitoris; dependant on length of regimen, dosage, and individual
• Narrow pelvic bone and pelvic outlet, if testosterone treatment was initiated prior to full adult ossification
• Humeral geometry and angle, if testosterone treatment was initiated prior to full adult ossification
• Ribcage deformation and decreased chest wall compliance caused by chest binding, if chest binding was initiated prior to full adult ossification
• Facial bone structure, if testosterone treatment was initiated prior to full adult ossification

 

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1. Butler, Gary, Kirpal Adu-Gyamfi, Kerry Clarkson, Ranna El Khairi, Sara Kleczewski, Alice Roberts, Terry Y. Segal, et al. (2022). “Discharge Outcome Analysis of 1089 Transgender Young People Referred to Paediatric Endocrine Clinics in England 2008–2021.” Archives of Disease in Childhood 107 (11): 1018–22. https://doi.org/10.1136/archdischild-2022-324302
2. Boyd, Isabel, Thomas Hackett, and Susan Bewley. (2022). “Care of Transgender Patients: A General Practice Quality Improvement Approach.” Healthcare 10 (1): 121. https://doi.org/10.3390/healthcare10010121
3. Hall, R., L. Mitchell, and J. Sachdeva. (2021). “Access to Care and Frequency of Detransition among a Cohort Discharged by a UK National Adult Gender Identity Clinic: Retrospective Case-Note Review.” BJPsych Open 7 (6). https://doi.org/10.1192/bjo.2021.1022
4. Olson, Kristina R., Lily Durwood, Rachel Horton, Natalie M. Gallagher, and Aaron Devor. (2022). “Gender Identity 5 Years After Social Transition.” Pediatrics 150 (2): e2021056082. https://doi.org/10.1542/peds.2021-056082
5. Turban, Jack L., Stephanie S. Loo, Anthony N. Almazan, and Alex S. Keuroghlian. (2021). “Factors Leading to ‘Detransition’ Among Transgender and Gender Diverse People in the United States: A Mixed-Methods Analysis.” LGBT Health 8 (4): 273–80. https://doi.org/10.1089/lgbt.2020.0437
6. Vandenbussche, Elie. (2022). “Detransition-Related Needs and Support: A Cross-Sectional Online Survey.” Journal of Homosexuality 69 (9): 1602–20. https://doi.org/10.1080/00918369.2021.1919479
7. Littman, Lisa. (2021). “Individuals Treated for Gender Dysphoria with Medical and/or Surgical Transition Who Subsequently Detransitioned: A Survey of 100 Detransitioners.” Archives of Sexual Behavior 50 (8): 3353–69. https://doi.org/10.1007/s10508-021-02163-w
8. MacKinnon, Kinnon R., Hannah Kia, Travis Salway, Florence Ashley, Ashley Lacombe-Duncan, Alex Abramovich, Gabriel Enxuga, and Lori E. Ross. (2022). “Health Care Experiences of Patients Discontinuing or Reversing Prior Gender-Affirming Treatments.” JAMA Network Open 5 (7): e2224717. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2794543
9. Horton, Cal. (2024). “The Cass Review: Cis-supremacy in the UK’s approach to healthcare for trans children.” International Journal of Transgender Health 1–25. https://www.tandfonline.com/doi/full/10.1080/26895269.2024.2328249
10. MacKinnon, Kinnon R., W. Ariel Gould, Florence Ashley, Gabriel Enxuga, Hannah Kia, Lori E. Ross. (2022). “(De)Transphobia: Examining the Socio-Politically Driven Gender Minority Stressors Experienced by People Who Detransitioned.” Bulletin of Applied Transgender Studies 1 (3-4). https://bulletin.appliedtransstudies.org/article/1/3-4/3/
11. Cass, H. (2024). Independent review of gender identity services for children and young people: Final report. https://webarchive.nationalarchives.gov.uk/ukgwa/20250310143642/https://cass.independent-review.uk/
12. Kwo, Paul Y., Vijay A. Ramchandani, Sean O'Connor, Deborah Amann, Lucinda G. Carr, Kumar Sandrasegaran, Kenyon K. Kopecky, Ting-Kai Li. (1998). “Gender differences in alcohol metabolism: Relationship to liver volume and effect of adjusting for body mass.” Gastroenterology 115 (6): 1552-1557. https://www.gastrojournal.org/article/S0016-5085(98)70035-6/fulltext
13. Maggi, Adrianna, Sara Della Torre. (2018). “Sex, metabolism and health.” Molecular Metabolism 15 (pp. 3-7). https://www.sciencedirect.com/science/article/pii/S2212877818300371
14. Baker, Toni. (2023) “Females of all ages, ethnicities have more salt-sensitive hypertension than males.” JAG Wire. https://jagwire.augusta.edu/females-of-all-ages-sexes-have-more-salt-sensitive-hypertension-than-males/

 

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