“Should I Take Testosterone When I Turn 16?”

A few weeks ago, I received a very thoughtful email from someone who had read my blog. This young person suffers from gender dysphoria and is considering taking testosterone upon turning 16. We agreed together that I would answer the email here on my blog, in public. 

Rumi showing his love for his young disciple Hussam

Dear N,

Thank you for your email, and for trusting me with a piece of your story.

If we were able to speak face to face, I would first be curious about your dysphoria. I would want to know your particular experience of it. A lot of people talk about being anxious, or depressed — or dysphoric — and those terms are so general and subjective that they don’t tell me much. I would want to hear as many details as possible about your dysphoria. What do you experience in your unique body, in your particular life?

You are not present to answer these questions, so I am at a disadvantage as I offer my impressions about what might be going on. But with the little information I do have, I will share that it sounds as though you hate your body. Is that right?

Unfortunately, most female born people hate their bodies at some point in their lives. I don’t know any woman who has an unambivalently positive relationship with her body. Body hatred is often worse in adolescence for a number of reasons, and sadly, it doesn’t usually entirely go away. But it does change and get better. You start appreciating your body more for the things it can do. Hopefully, you develop some compassion for it, and become interested in taking good care of it, because it is the only one you’ll ever have.

I’m going to be forthright and tell you that, in my opinion, it would be better to avoid taking testosterone when you turn sixteen. If you take testosterone now, things will happen that cannot ever be undone – facial hair, a deepened voice, possible male pattern baldness or decreased fertility. On the other hand, if you do not take testosterone now, doing so will always remain an option in the future.

In addition, it’s always a good idea to be prudent about putting substances in our bodies, and to avoid taking medication unless absolutely necessary. The US FDA recently increased warnings about testosterone, pointing out that it carries risks of heart attacks, liver toxicity, and blood clots – and these warnings are for adult, male-bodied people who are taking testosterone for indicated uses. We really have no idea what testosterone does to female bodied people when used long-term, and there are young women who have experienced some pretty unpleasant and potentially dangerous side effects from taking it.

I also think it’s not the best idea for another reason. Taking testosterone would be a pharmacological answer for a question of the soul. You would be attempting to medicate away feelings of dysphoria, and it is my belief that our feelings – even our most painful, awful ones – always have something important to tell us, and are the means by which we engage the most essential questions about ourselves.

Being dysphoric isn’t like having the flu, where there is an identifiable pathogen. It’s a complex inner experience that likely has emotional, physiological, and social aspects. So it makes sense to try and understand where this experience is coming from, what it means to you, and most importantly, what it might want from you.

What would happen if you sat with the discomfort? When you feel as though you cannot stand to see yourself as you are now, what would happen if you just allowed all of those feelings to be there – both the feeling of intense hatred (if that’s the right word) of your body, as well as the intense desire to change it? What if you just allowed yourself to feel those feelings, rather than needing to discharge the tension around them by acting on them?

Sitting with our feelings allows us to be curious about them, rather than assuming right away that we know what they mean. One of my concerns about the way that gender dysphoria is being addressed in a clinical context is that curiosity and exploration are foreclosed. There is no space to wonder about what these feelings might mean, or discover their complexity. Instead, we are encouraged to believe that they mean we are transgender and need to be treated with medical intervention.

I believe that there is probably more for you to know about the dysphoria, anxiety, and other feelings. If you focus too much on making them go away, you won’t have a chance to learn what they want from you. Feelings are a little bit like the ghosts who visit Scrooge on Christmas Eve. We may find them inconvenient and unsettling, and wish that they would go away, or that we could hide under the covers and ignore them. We may wish to minimize their importance or explain them away. But if we allow ourselves to see what it is they want to show us, we grow and are transformed.

Cultivating curiosity, acceptance, and self-compassion helps us be open to the messages that feelings bring. Since you can’t be curious and judgmental at the same time, approaching our inner lives with curiosity helps us turn off the flow of negative, judgmental thoughts that many of us experience. This allows us to welcome these new emotions, and see what there is to learn from them.

Long before psychology existed as a field of inquiry, poets knew about managing emotions. In the 13^th century, the poet and mystic Rumi compared feelings to unruly house guests.

The Guest House

This being human is a guest house.
Every morning a new arrival.

A joy, a depression, a meanness,
some momentary awareness comes
As an unexpected visitor.

Welcome and entertain them all!
Even if they’re a crowd of sorrows,
who violently sweep your house
empty of its furniture,
still treat each guest honorably.
He may be clearing you out
for some new delight.

The dark thought, the shame, the malice,
meet them at the door laughing,
and invite them in.

Be grateful for whoever comes,
because each has been sent
as a guide from beyond.

Our emotional life is a compass, albeit one that is hard to read. Feelings manifest initially as subtle sensations in the body, and it can be difficult to interpret the bodily sensations that first alert us to an emotional reaction. As this article explains, rather than being hard-wired, our emotions are constructed by a complex interplay of factors. Our past experiences and culture teach us how to categorize experiences and the emotional reactions that go along with them. This is important. It means that if our culture tells us that discomfort with our bodies means we have a medicalized condition that needs invasive treatment, that’s how we are likely to interpret those feelings.

Learning about our emotions and the subtle ways they present as embodied feelings is a vital part of psychological and even physical health. Through a deeper, more nuanced understanding of our feelings, we gain valuable perspective on our emotions, and discover a wider range of possible responses to them. Being able to identify our emotions with a greater degree of specificity is known as emotional granularity, and it is associated with better life outcomes in many areas. Understanding our feelings with more specificity helps us manage them better.

It might be helpful to explore your dysphoria in its full nuance and complexity. There are some good resources for working with emotions. Hillary Jacobs Hendel is a psychologist who has some accessible tools for this kind of work on her website.  Eugene Gendlin developed a remarkable technique called focusing that can be easily practiced and is very effective.

Since those around us invariably contribute to the way we construct our emotional experiences, it may be helpful to find peers who are also struggling with alternative ways to manage dysphoria. Here is a subreddit that is just such a group. This blogger is one of many who has had experience dealing with dysphoria. Does it seem ironic that I am sending you to social media for help with this? The sobering reality is that we are all susceptible to influence. Others can influence us to engage in behaviors that are dangerous or maladaptive, such as happens in pro-anorexia communities. But they can also influence us in sustaining healthy adaptive behaviors, such as refraining from drug or alcohol use. Unfortunately, there is no easy way to tell whether our community is supporting us in a destructive versus adaptive behavior. This is yet another reason why we must become adept at reading the subtle cues that help us attune to our instinctual knowing.

Believe it or not, it may also help to read. Poetry and fiction explore emotions and help us imaginally enter another person’s inner landscape. Reading can therefore help us develop a larger emotional vocabulary that in turn helps us understand our feelings with greater nuance and depth.

Reading may help in another way as well. Literature addresses the profound life questions that each of us must come to terms with. Novels, myths, and other stories help us to know our place in the universe. Jungian analyst Marion Woodman has written that “without an understanding of myth, without an understanding of the relationship between destruction and creation, death and rebirth, the individual suffers the mysteries of life as meaningless mayhem alone.” Everyone struggles with issues of meaning, belonging, safety, and self-acceptance. These are not insignificant matters – they go to the very core of what it means to be human. There are no pat or easy answers to these questions, and I am very suspicious of anyone who offers one – especially a commodified, medicalized answer.

Puberty by Edvard Munch

Engaging these questions is our life’s work, and it often begins in a meaningful way in mid-adolescence – exactly where you are now. In our culture, the trials of adolescence are frequently belittled or pathologized – the angsty teen is a trite trope. But the challenges faced on the lonely and often frightening road to adulthood are anything but trivial. It isn’t a coincidence that many of the world’s great novels deal with coming of age, and treat themes of estrangement and existential loneliness. The painting shown here is by Edvard Munch, and it is titled “Puberty.” The dark shadow that looms up behind her adds to the sense of heaviness, alienation and dread that the painting conveys. It seems to me that this painting captures a universal truth about being an adolescent female.

If you were my client, I would encourage you not to make your dysphoria into an enemy, not to see it as something that you must rid yourself of using any means necessary. Our culture teaches us to focus on solutions, but when it comes to matters of soul, such a focus often misses the point. (C. G. Jung wrote that “we don’t so much solve our problems as outgrow them.”) Engaging these difficult feelings is likely an invitation into your own depths, a call to embark on your hero’s journey. The boon that awaits is that of self-knowledge, a more expansive sense of self, and a conviction about the meaning and purpose of your life.

Doing this work will likely not be easy, and there may be pain involved. While I wouldn’t relish watching you suffer, I would try to help you know that suffering is part of being human. It is usually that which initiates us into our very particular story. And it is part of having a rich, meaningful life.

There is a Buddhist tale about a woman who lost her only child. She begged the Buddha to bring him back to life. He told her that before he could do that, she needed to bring him a handful of mustard seed from a home that had not been touched by loss and sorrow. She looked far and wide for such a home, but of course she found none. No life is free from suffering. If society has led you to believe that, if you are suffering, something must be wrong, then it has done you a great disservice. When we meet suffering with an open heart, it transforms us.

I wrote about this elsewhere: “When we can embrace suffering, it becomes soul-making. Our heart expands, our capacity for empathy is enlarged, and our ability to experience beauty and awe increases. Humans understand this instinctively, and this is perhaps why initiation rites the world over often require of the initiate that he or she suffer. Beatings, mutilation, and scarification are common aspects of tribal initiations. Fear and confusion are also often present. Passing through these trials – suffering them – tests the young person, and opens him or her up to the deep meaning of existence.”

All that being said, life is ultimately a mystery, and we are all unique. Your life is your mystery, and you get to unravel it slowly, down the long days that lie before you. It may be that after becoming better acquainted with yourself, by accepting the invitation to know yourself better that is the dysphoria, you eventually come to decide that taking testosterone is the right path for you. When we make decisions after careful discernment in which we have sought and listened to inner guidance, we often feel a sense of clarity and resolution.

In the meantime, I will leave you with the words that Rainer Maria Rilke wrote to a young poet who had sought out his advice.

“Be patient toward all that is unsolved in your heart and try to love the questions themselves, like locked rooms and like books that are now written in a very foreign tongue. Do not now seek the answers, which cannot be given you because you would not be able to live them. And the point is, to live everything. Live the questions now. Perhaps you will then gradually, without noticing it, live along some distant day into the answer.”

Rilke, Rainer Maria, “Letters to a Young Poet.”