Thanks for your thoughtful response.

Interesting theory re: exogenous hormones, I'm curious if any studies have attempted to moderate the negative effects of estrogen therapy in ciswomen using hormones derived from the patient akin to CAR-T therapy (or if this is theoretically useful/possible).

Gonadectomy removes the source of the hormones, no? The mechanisms discussed in the paper seem to be associated with the direct effects of suppressed levels of cis hormones, not some tertiary effect of whatever medication. So it seems gonadectomy would only exacerbate the same effects hormone suppressors may cause.

Re: "HRT just switches brains to the other configuration" seems to be a general trend but is a bit of a dangerous oversimplification. When discussing MtF changes in the MRI section they write "These changes are several times the magnitude of the average age-related changes observed in cisgender adults." And it is certainly not a mirror image, many of the effects HRT has for MtFs and FtMs are not 1-to-1 or even present in their counterparts.

I absolutely agree that GD can take a mental and physical toll on the mind and body, I'm just trying to figure out how that effect compares to HRT.

Again, thanks for the thoughtful discussion.