I know how this sounds: a whole article dedicated to my breasts is a little bit, strange, to say the least. But only recently, have I realised how important they are for trans women - and what they mean. Don't worry (or: unfortunately, for some) I will not be describing my boobs in any detail in this post.
Why do I have boobs?
In February 2020, I started hormone replacement therapy (1), which is a medical treatment used to relieve transgender patients of gender dysphoria (2).
To summarise: hormone replacement therapy (HRT) is a treatment in which naturally produced hormones (testosterone for males, oestrogen for females) are replaced with the hormones of the opposite sex (oestrogen for trans women, testosterone for trans men).
In this article, we will be focusing on the medical transition of trans women, aka, me.
A huge part of hormone replacement therapy for trans women, is fat redistribution (3).
Fat redistribution can be visible in patients at the three month mark of being prescribed cross-sex hormone therapy, however, the extent of these changes vary from person to person due to genetics. The effects of exogenous oestrogen* are supported by anti-androgenic therapy* for better results.
Breast development in trans women has been found to occur predominantly in the first six months, and the rate of growth declines after that (4), furthermore, the mean breast cup size of trans women after one year of HRT was found to be less than a size AAA.
However, there are longer-term studies which suggest that breast development continuous after the one year mark, and larger cup sizes are achievable (5). As previously mentioned, it all depends on the individual and their genetics.
How does HRT cause breast development?
As previously mentioned, cross-sex hormone therapy (aka hormone replacement therapy) replaces testosterone with oestrogen in trans women. When trans women start this treatment, they undergo what some might describe as a 'second puberty'.
Oestrogen is a steroid hormone which helps with the development and maintenance of secondary sex characteristics in women. Initially when oestrogen is introduced into the body, trans women will develop what we typically call "knots", which are small bumps just under the nipple. These nodules are typically painful to the touch, and develop within the first 2-3 weeks of starting HRT. Thankfully, this slight pain is not permanent. Breast tissue then develops after a couple weeks after that - however, please remember that everyone develops at different rates.
Breast cancer in trans women
Not to scare anyone, but yes, when you start HRT your chances of developing breast cancer do rise. Endogenous and exogenous oestrogen rise the risk of breast caner (6), however the risks of breast cancer for trans and cis women are the same - therefore when you start HRT, you are not at any higher risk of breast cancer than any other women (with exception to genetic factors and lifestyle choices.
A trans women's heightened risk of development breast cancer is only due to an increased amount of oestrogen in the body, as more breast tissue means that there is a higher chance of those cells becoming cancerous.
Why are boobs so important?
Secondary sex characteristics are features which develop during puberty in both males and females, they are a key part in subconsciously assigning the gender to individuals.
Breasts are a key secondary sex characteristic for women, which indicate their maturity. They're one of the key features when assigning gender, making them very important for trans women for when they want to be perceived as their preferred gender.
There are many physical changes that HRT brings with it, however, breast development was the main factor which helped trans women relieve some body-uneasiness (5), aka: gender dysphoria. That's why when trans girls gets some breast tissue, it's so important to them.
I have personally fallen in love with my little boobies. They make me feel really confident and happy. I can see real change in how I look, my breasts growing has definitely been the thing I have noticed the most since starting HRT.
My personal thoughts and feeling about my breasts
Something really funny about my breasts is that, they weren't the main thing I was looking forward to when I started medically transitioning (7), however, now I cannot imagine not having them.
The thing is, I know that to be a women, I don't need breasts. Some of the most beautiful women in the world have small breasts. Yes, admittedly boobs can be viewed as very attractive and desirable, however, that was never my goal. I always just wanted to be myself, to be beautiful - and not necessarily to be viewed as 'sexy'.
Breast augmentation
I guess my views about breasts link back to the over-sexualisation of trans women (8), and how trans women are sometimes seen more as sex objects than human beings.
Breast augmentations are procedures which involve inserting silicone implant under the skin to give an appearance of larger breasts. There are many risks associated with this procedure, however, it still remains one of the most popular surgeries (9).
Sometimes I get the impression that trans women think that they owe it to men to be sexy, and hence have large breasts, perhaps even going as far as getting breast implants. Of course, this is not to say that all trans women get breast augmentations simply to please men, however, I am really proud of my 'tits' and they're mine - not anyone else's.
Not having breasts doesn't make you any less of a woman
I thought it was very important to highlight this, especially considering that a lot of trans women will not have as large of breasts as a cis woman - but you are valid, no matter what size breasts you have - or even if you don't have any!
Definitions:
Endogenous (oestrogen): oestrogen which is naturally produced in the body.
Exogenous (oestrogen): oestrogen which are introduced from an external source into the body (synthetic oestrogen).
Anti-androgen therapy: the use of drugs which block the actions of androgens, usually known as testosterone blockers.
References and sources:
(1) Fatz, S. (2020) What is Gender Dysphoria [Online] Available at: https://www.sebrina.net/post/what-is-gender-dysphoria (Accessed: 26-01-21)
(2) Fatz, S. (2020) Transgender Transition Timeline - from Male to Female. [Online] Available at: https://www.sebrina.net/post/transgender-transition-timeline-from-male-to-female (Accessed: 26-01-21)
(3) Unger, CA. (2016) Hormone therapy for transgender patients. Transitional Andrology and Urology, 5(6), pp.877-884
(4) De Blok, CJ. et al. (2017) Breast Development in Transwomen After 1 Year of Cross-Sex Hormone Therapy: Results of a Prospective Multicenter Study. The Journal of Clinical Endocrinology & Metabolism, 103(2), pp.532-538
(5) Fisher, AD. (2016) Cross-Sex Hormone Treatment and Psychobiological Changes in Transsexual Persons: Two-Year Follow-Up Data. The Journal of Clinical Endocrinology & Metabolism, 101(11), pp.4260-4269
(6) Clemons, M. (2001) Estrogen and the Risk of Breast Cancer. Mechanisms of Disease, (344), pp.276-285
(7) Fatz, S. (2020) My Medical Transition [Online] Available at: https://www.sebrina.net/post/my-medical-transition (Accessed: 26-01-21)
(8) Fatz, S. (2020) Over Sexualisation of Transgender Women [Online] Available at: https://www.sebrina.net/post/over-sexualisation-of-transgender-women (Accessed: 26-01-21)
(9) Adams, WP. Mallucci. Patrick. Breast Augmentation. (2012) Plastic and Reconstructive Surgery, 130(4), pp.597e-611e