[taraharris]

It's telling that there isn't a single mention of surgery in the study or the interview.

Facial feminization surgery (FFS) exists but is extremely rare in Finland. After puberty, hormones alone can't change bone and cartilage structure, nor can they make vocalization congruent. Only surgery can do that.

Comparing what life was like before I had FFS+VFS, and I remember the way people treated me. After puberty locked in my bones, expecting life to be easy with hormone therapy alone simply wasn't realistic socially. Most people were incredibly judgemental. Life is a lot easier when people can't instantly spot you as something they see as abnormal.

[lostmsu]

> see as abnormal

I see a lot of "abnormal" things daily, but only the results of people's own decisions attract attention.

[EA-3167]

I think you have a point, and of course no one study is going to be perfect. At the same time though one of the major strengths of this study is that it looked at large numbers of both MtF and FtM patients, and the results seem consistent, with both MtF and FtM sharing similar outcomes. If FFS was the key variable that was being ignored then you'd expect to see a stark difference between those populations.

The mean ages of participants also trended young, mostly still in their teens, which means that quite a few of the participants were receiving treatment before or during early puberty.