As part of its monthly educational event series, “Transformation Tuesdays,” Grand Valley Alternative Breaks (GVAB) hosted an informational event called “LGBTQ in Medicine.” The purpose of these events is to provide students with an opportunity to engage in meaningful conversation about a variety of important topics.

“Each month, we spotlight a different series or a different topic anywhere from environmental to more social topics,” said Katie Henderson, vice president of member engagement for GVAB.

Dr. John T. Duhn, a family doctor who specializes in transgender medicine, was the featured speaker at this event Tuesday, Feb. 28, in the Kirkhof Center. Duhn began seeing transgender patients six years ago, and today he is the transgender provider for about five counties.

“Within our own (LGBTQ) community, we have not been very nice to the transgender community,” Duhn said. This changed in the past few years, though, when the community united in the fight for marriage equality.

Duhn began his presentation by explaining the difference between sex and gender. He said an individual’s sex is assigned at birth and is defined by their anatomy, while gender refers to a person’s attitudes, feelings or behaviors that culture associates with male and female.

“All people have a gender identity,” Duhn said.

Even if a person is agender, or without gender, that is still their identity.

An individual who does not conform to the classic female and male stereotypes would be referred to as gender nonconforming. Gender-fluid relates to a person who does not view themselves as having a fixed gender.

Duhn explained he is considered cisgender, because his gender identity matches his sex assigned at birth. However, gender identity is not the same thing as sexual orientation. 

“I am a cisgender male, but I am also a homosexual male,” Duhn said.

The opposite term of cisgender is transgender. This denotes an individual whose gender identity does not match their anatomy at birth.

“Transgender female is somebody who is going from male to female,” Duhn said. “Of the two, from a medicine standpoint, this is the more complicated (transition). We are all female when we’re created, and over time, at some point, if you’re going to be male, testosterone gets introduced, and then your anatomy gets decided from that. The default setting is female, but you can override that with testosterone.”

In other words, testosterone is more powerful than estrogen.

“If you’re trying to have a woman transition into a man, basically you give them testosterone, and the body already has the machinery to do that,” Duhn said.

For someone transitioning from male to female, testosterone must first be blocked because it prevents the estrogen from doing anything.

“You give them estrogen, but then the body doesn’t have the natural machinery to undo those things,” Duhn said. “Your beard doesn’t just fall off and go away. Your voice is deeper; it doesn’t just become higher pitched.”

Estrogen can be taken orally,topically or can be given through an injection. Testosterone cannot be “eaten” because the liver gets rid of most of it. It must be given through an injection or topically.

Once an individual starts transitioning, some of their development becomes permanent. Once breast tissue is developed, it doesn’t go away, and after a male has been on estrogen for a while, his testicles will decrease in size.

“What a lot of transgender women do before they transition, so they’re still male and still making sperm, is they sperm bank,” Duhn said.

This way, if they decide to have children at some point, they have sperm that was not affected by the estrogen.

For a transgender male, basically just testosterone is prescribed, Duhn said. Within the first year of treatment, the individual’s voice will deepen, and they will grow facial hair. These are changes that cannot be reversed.

“Once you’re on treatment for several years, basically it’s impossible to go back,” Duhn said.

Not every transgender individual will opt to go through surgery, and many will only undergo hormonal transition. Duhn said it is important to think about the individual needs of the patient when coming up with a treatment plan.