In female-bodied young people who have male gender identities, we often encounter them for the first time when they are starting puberty, or they’ve been in puberty for a year or two. These are often young people who have really lived through their childhood as boys. Puberty sometimes comes to them as a great shock to them and they don’t understand what’s happening. Why are they developing an adult female body? It’s very distressing for them. I have a lot of young people where we see an emergence of suicidal thoughts, suicide attempts, depression and anxiety because of the onset of an adult female puberty. These young, people, I’ve experienced, they do a lot of work on their own. There’s a tremendous YouTube community for trans guys. They come in with a lot of knowledge about what it’s going to mean to start taking testosterone. If these young people have been on blockers prior to, ideally, they can be on blockers to suppress their estrogen production, and if they’d been on them early enough, they may not have gotten any breast development or started any menstrual cycle, but that is an exception. That is not the rule. Most often, I see trans-guys who have already been through or are well into a female puberty. And we use testosterone to suppress the estrogen production, and also to masculinize their bodies. These young people need to have laboratory follow-up every three months for the first year that they’re in treatment. They also need the assistance of a mental health professional during the transition time. They need to run through with an experienced therapist about the conversations they are going to have with friends, with family members, with intimate partners about the fact that they’re trans.