Adolescent Menopause In Autistic Girls: Is This What We Really Want?

The Science – Part 1

Primary Ovarian Insufficiency (POI, aka early menopause) affects approximately 1% of women in their 30s, 0.5% of women in their 20s, and one in ten thousand adolescent girls. This rarity among girls is because irregular or missing menstrual cycles are normal during puberty. Causes include cancer treatments, genetic abnormalities, autoimmune diseases and, sometimes, surgery.

Normally, menopause takes about a decade before full-blown symptoms appear. With POI, onset can be sudden. Symptoms are infertility, hot flashes, dry eyes, night sweats, brittle bones, irritation, vaginal dryness and atrophy, lack of sexual interest, and difficulty concentrating. Treatment usually consists of estrogen therapy which alleviates many symptoms, though it cannot restore lost fertility. No one in her right mind chooses to suffer from POI.

Estrogen activates and regulates the female reproductive cycle. During puberty, it finalizes bone length and density. It governs the expression of secondary sexual characteristics (like breast development, body hair, curves). Estrogen regulates blood flow and circulation, collagen and skin moisture, and cholesterol and blood sugar levels.

In adolescent girls, estrogen controls myelination—“a process in which nerve fibers are enveloped in a fatty white sheath (myelin) that greatly accelerates signaling across the brain,” increasing thought speed by upwards of 100 times. In the female brain, it has “prominent effects on mood and cognitive functioning in domains such as working memory and executive control.”

Image: Teenage girl (edited) by freepik.

The Science – Part 2

Studies show that people on the autism spectrum are six times more likely to claim to be gender-diverse than non-autistic people. The 7th edition (2011) of WPATH’s (World Professional Association for Transgender Health) Standards of Care noted that “The prevalence of autistic spectrum disorders seems to be higher in clinically referred, gender dysphoric children than in the general population….(page 12)”

According to one study, “Data indicate that 82% of transgender individuals have considered killing themselves and 40% have attempted suicide, with suicidality highest among transgender youth.” Upwards of 66% of autistic adults engage in suicidal ideation, and as many as 50% attempt suicide. Coincidence here seems to approach correlation.

The characteristics of girls on the autism spectrum are similar to gender dysphoria’s symptoms. One recent study found that autism is associated with masculinization (higher levels of androgens in the body) and argues that gender dysphoria reflects autism traits that lead to anxiety and questioning one’s sense of self.

One study is clear that gender dysphoria in children is highly comorbid with a broad range of mental health disorders, including depression, anxiety, behavioral disorders, and autism, as well as adverse childhood experiences including physical, sexual, and emotional abuse, neglect, and exposure to domestic violence.

WPATH 7th says (page 12), “In most children, gender dysphoria will disappear before or early in puberty.” (Studies support this.) WPATH’s 8th edition, from late 2022, which overall affirms “gender diversity” as normal for children, weasels around and says it “cannot be predicted” and “terminology evolves” (page 567). WPATH 7th notes that some adolescent gender divergence persists into adulthood, including participants in one study who were given puberty blockers (page 12).

What Is “Gender-Affirming” Care?

The first step in medically “affirming” gender divergence in girls is administering puberty blockers. These are hormones that stop estrogen and progesterone production. However, cyclic surges of high levels of female sex hormones facilitate the maturation of the brain, the internal primary sex characteristics, and the external secondary sexual features. Puberty blockers bring all that to a halt, and early menopause symptoms commonly ensue. They cannot be treated if stopping feminization is the goal.

“Gender-affirming” care for older adolescent girls sometimes includes a full hysterectomy resulting in immediate menopause with its entire constellation of symptoms. If F2M “transition” is the goal, the girls’ symptoms cannot be treated. The internet is largely silent about this, but one self-identified queer F2M transitioner wrote eloquently about her experience (graphic content): “Recovery [from surgery] was mostly a slow descent into the pits of menopause.” I suspect the lack of available information may be because it dis-incentivizes F2M “transition.”

After stopping feminization via puberty blockers or a full hysterectomy, the next step is to administer testosterone to force masculine secondary sexual characteristics. These include a lower voice, increased body and facial hair, acne, and male pattern baldness. Male and female brains are different (see my previous article here). One study noted the “testosterone-related effects on the developing brain may lead to detrimental effects on cortical functions (ie, higher aggression and lower executive function).”

What Does This Mean?

When an adolescent girl claims she is really a boy in the wrong body, these are safe assumptions:

  • She is likely to be on the autism spectrum and experiencing difficulties associated with that condition.
  • She is likely to have engaged in suicidal or self-harm ideation.
  • She is likely suffering from other issues like sexual trauma, anxiety, depression, and eating disorders.
  • She is likely already in the throes of puberty -- physiologically, mentally, socially, and spiritually -- and absolutely miserable.

Puberty blockers will stop bone and breast development, may leave a girl short and stunted for life, and will put a girl into menopause, adding tortuous suffering on top of everything she’s already experiencing with puberty and her teen years.

Stopping estrogen when a girl is at the height of brain elasticity and capacity for learning, means her nerve pathways will not myelinate when they are supposed to, her synaptic processes will not speed up normally for this age, and she will most likely fall behind her peers intellectually. Menopausal brain-fog, inability to focus, and moody irritability are no joke. I could find no studies on the impact of puberty blockers on higher education success among F2M “transitioners.” I imagine, however, that girls who undergo such treatment forego their potential for success in the STEM fields.

What Do We Do?

Everyone is unique. Certain traits are defining and yet have a wide range. Some men are more feminine than others, and some women more masculine.

Parents of gender-dysphoric (GD) girls must be fully informed about the potential permanent impacts of disrupting a girl’s normal maturation. This isn’t just about binding, shaving one’s head, and other severe forms of role-playing the opposite sex. Here are some resources for parents.

A teenage girl saying she’s really a boy in a girl’s body may be subject to social contagion; most teenaged girls are to some extent. However, some girls’ exceptional vulnerability to this particular narrative must be addressed. An autistic girl, even very highly functioning, with masculinized features, even if barely detectable, can feel sorely out of place. Parents must ensure that their GD girls are first treated for any underlying conditions, and their co-morbidities, that lead to dysfunctional self-perception.

A girl may contemplate suicide or self-harm, even if she denies it. This must be dealt with preemptively through therapy, reduction in external and internal sources of anxiety, and medication (if needed).

Adopting a treat-and-see approach will allow girls to mature physically and intellectually. Girls should be encouraged to take on intellectual, physical, and other challenges to maximize their potential when they are growing their fastest. Help them explore the world through widening interests, volunteering, and competitions. Even part-time work will take them outside of themselves.

Boys have an entire childhood to learn to live with testosterone. Girls facing the sudden euphoria and aggression brought on by the drug do not. A girl must be given, and taught to give herself, grace, and space, and time to become as physically and mentally healthy as she can be. If, as she is reaching eighteen, she persists in wanting a gender “transition,” she should be fully informed of the predictable consequences, possible side effects, and life-long medical dependencies she will face, including infertility and a lack of sexual pleasure without recourse to effective amelioration.

And finally, sad teenage girls should not be medicated into menopause.

h/t to Abigail Shrier and her book Irreversible Damage: The Transgender Craze Seducing our Daughters for the introduction to autism as an underlying feature of gender dysphoria in girls.

h/t to Dr. Jordan Peterson for his interview with Dr. Miriam Grossman

Author’s credit - Anony Mee is the nom de blog of a retired public servant.

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