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Can a doctor tell if a person has had a sex change just by looking at them? most people see a strong woman with high cheek bones and strong hands and they assume that that person has had a sex change why do certain women have high cheek bones and strong

2 doctor answers4 doctors weighed in
Dr. Eva Hersh
Family Medicine 35 years experience
Hello : Hello in houston- you’re right, people do make assumptions, and they shouldn’t. Sometimes the woman with the big hands and roman nose is transgender, and sometimes she is…a genetic woman with big hands and a roman nose. And the short guy with small hands and delicate features usually is just a short guy with delicate features that he inherited from his short, delicate-featured parents. Why is it anyone else’s business, anyway? Why do you care what they think? There is a strong inherited (genetic, blood line, family) component to appearance. There is also a strong hormonal component. Picture twins, a boy and girl. Same age, similar genes, although not identical genes — identical twins are always he same sex. When the twins are young, if their hair and clothes are similar, it’s hard to tell which one is male and which one is female. Now imagine them at ages 10, 20, 30, up to age 80. They start to look more different from each other in their teens, and this becomes more and more apparent as they age, until about age 60, when they begin to look more alike again. What’s going on? It’s hormones. In their early teens, the boy’s testicles start producing testosterone and the girl’s ovaries make estrogen. The estrogen adds a layer of fat under the skin, making the girl’s facial features seem softer and the bones and veins in her hands and feet less visible. The boy’s testosterone has much more dramatic effects. Everyone knows that testosterone causes voice deepening and growth of facial and body hair. However, you might not know that testosterone also triggers the growth of facial cartilage. This is why, over the years, men develop larger chins, noses, and ears, and develop more prominent eyebrow ridges. If you think about the shape of a skull, you can see that most of the face is cartilage. The nose and ears have almost no structural bones at all. The hormonal effect on cartilage is what makes a man’s face look masculine. You can see from this why it is so much easier for transwomen to “pass” if they transition young, in their teens or twenties. Before age 30-35, there have usually been only mild testosterone effects on facial cartilage and appearance. When transwomen transition at older ages, especially after age 45, many cannot “pass” well without facial feminization surgery. In this type of plastic surgery, cartilage is removed from the brow ridge, nose, chin, and adam’s apple, resulting in a more feminine appearing face and neck. Because very few insurance plans cover any type of transgender surgery, many transwomen — if they can afford any surgery at all — have to choose between genital and facial surgery. The older a transwoman is, the likelier it is that facial surgery is more critical to her successful transition than genital surgery. Now the last part: why is it anyone else’s business, anyway? Why do you care what they think? Gender is the first thing most people feel they need to know when they encounter another person. If they are not certain of the other person’s gender, many people become anxious and agitated, and can become violent. That is why transpeople have to care if others notice, and what they may be thinking. If you are transgender, passing well is not just a matter of self-esteem; it’s also a safety issue. If you are not transgender, and you notice someone around you whom you think may be transgender or any sort of gender-different, keep an extra eye out for that person’s safety. Even if they are just a genetic woman with strong features or a man with small hands, those small differences can compromise their safety. Dr. Eva eva hersh is chief medical officer at chase brexton health services. Send your comments and questions to her by email at editor@ baltimoreoutloud.Com, or by surface mail to eva hersh md, chase brexton health services, 1001 cathedral st., baltimore, md 21201.
Dr. Ana Adelstein
Clinical Psychology 27 years experience
Cheering!
Sep 13, 2013
Dr. Ana Adelstein
Clinical Psychology 27 years experience
Cheering!
Sep 13, 2013
Dr. Randolph Wong
Plastic Surgery 46 years experience
Usually: The size of the hands and the "carrying angle" of the elbows are the least likely to change with gender reassignment surgery patients. Much of the head and neck, breast and body, and genital parts can be transformed well, although one can usually find some evidence of scars if you know where to look.

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Last updated Oct 3, 2016

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