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[I have posted this letter from my advice column over here, because Medium doesn’t let me hold new commenters’ comments for moderation, and I would rather not subject the letter writer to the unfiltered vitriol of the entire Internet on this subject. Comments will be moderated closely and misbehavior will be particularly likely to result in a ban. Please be compassionate to the real person who is in a very bad situation.]
[content warning for description of attraction to children]

I’m a trans woman and started HRT three months ago. For the most part the experience has been immensely positive, and has rescued me from bad depression, but there’s one (possible) big downside: it might be causing me to be (non-exclusively) sexually attracted to pre-teen girls; the feelings seem to correlate in intensity with level of estrogenisation. I expect this to go away and not stay (it’s only been a couple of weeks I’ve been fully feeling it), but I’m still anxious about the possibility.

What should I do if this turns out to be real? Is it responsible for me to continue HRT knowing it has this effect? Should I seek out therapy for this, and if so how? Do you know any healthy ways of managing such desires, or deal with stigma? How will I be able to find adult partners who won’t hate me? I am very anti-contact/anti-csem and don’t think I’m at serious risk of offending; I have been badly hurt multiple times by previous interactions with the mental health profession as a child and as an adult, which makes me nervous about seeing a therapist for this, but am open to the idea.

(Also, to forestall the question: I don’t think this is pOCD. I do have other distressing intrusive thoughts, but I don’t feel panicky now at the thought I might commit/have committed/be committing sexual violation, and I don’t think pOCD makes you moan and roll your eyes back in ecstasy at the thought of making out with a kid.)

This is definitely not an effect I’ve ever heard of anyone having with estrogen, and it seems unusual. However, it doesn’t seem implausible to me that this is an effect for you: testosterone and estrogen both typically lead to changes in people’s experience of their sexuality, and you drew the worst fucking hand. 

I am not a doctor and am not qualified to diagnose anyone with POCD, especially through a letter; I encourage you to consider the possibility that you have it carefully, but will proceed under the assumption that you are attracted to preteen girls.

You mention that you don’t think you’re at risk of harming a child. In fact, the same thing is true of many people in your situation! The research suggests that pedophilia and child molestation are, while linked, distinct. (Wikipedia has a good summary.) Somewhere between a quarter and half of all child molesters are pedophiliac. It is difficult to know how many pedophiles molest children, because non-offending pedophiles are typically closeted, but most experts believe a large proportion of pedophiles never hurt a child. 

You mention seeking out therapy, and that’s a lot of people’s first piece of advice for people struggling with pedophilia. Unfortunately, despite years of research, no one has to my knowledge come up with a reliable way of treating paraphilias. In fact, sex offender treatment programs sometimes increase recidivism rates. Our best treatment strategy is medication that reduces libido.

What is worse, seeking therapy is going to be very difficult. All therapists are mandated reporters, which means that if they suspect you are abusing a child they must report it to the authorities. Therapists typically vary wildly in their interpretation of these rules, and it’s difficult to know how a therapist will interpret it until you open up to them — and potentially face serious consequences. I don’t mean this to discourage you from seeking therapy, but simply as a note of caution. 

However, you don’t actually need a therapist. You will need someone who can listen to you, a source of nonjudgmental support, affirmation, and acceptance and of advice and even criticism when necessary. A therapist can provide that, but so can a friend or family member or (if you’re religious) a religious leader. (You can check the list of mandated reporters in your state here.)

I would suggest talking to at most two or three people: you don’t want your secret getting out any further than you need for support. Choose people who are trustworthy and keep secrets. Select someone you feel comfortable around. Find someone who is calm, doesn’t freak out, and is willing to hear you out about things. 

Unfortunately, many people do not have a friend that trustworthy and have to seek other options. I don’t know anyone with experience in these groups, but this website seems to link to a lot of support groups for non-offending minor-attracted people; perhaps one of them will help you?

Seeking support is an important first step for anyone in your shoes. The other steps you should take depend a lot on your personal experience of your attraction to preteens. Whether or not to continue taking estrogen is a personal decision. You can continue to take estrogen and manage your feelings on your own. You can choose to go off estrogen (and explain to those who ask that you can’t take estrogen for medical reasons), if you find yourself struggling with temptation or if the costs of experiencing this attraction aren’t worth it for you. 

You can also choose to remain on estrogen and add a libido-lowering medication: the easiest ones to obtain, which have the fewest side effects, are SSRIs. You can get SSRIs by telling your primary care physician that you have depression; the screening is usually minimal, although it may help to look up the symptoms of depression ahead of time. The website Roman sells sertraline (an SSRI) legally, online, and with minimal fuss as a treatment for premature ejaculation, if making a doctor’s visit is too difficult. Even if your first choice of SSRI doesn’t work, you can keep trying. Different SSRIs have different effects, and an increased dose or a different SSRI may be exactly what you need to make your sexuality more manageable. (As a second-line option for people assigned male at birth, the research suggests antiandrogens, but presumably you are already on those.)  

Some people suggest that pedophiles avoid all contact with children or being alone with children. Again, I think this is a personal decision. It is important to remain scrupulously nonsexual in your interactions with preteen girls, and if you can’t do this you must avoid them. But people attracted to adults are often attracted to people that they must remain scrupulously nonsexual with, and most of the time we do not implement the Pence Rule. You will have to talk with your support people and figure out what a reasonable set of boundaries is for you.  

However, if you have a crush on a preteen girl — and particularly if you’re starting to think she has a crush on you, or she’s flirting with you — it is important to distance yourself. Avoid being alone together, giving gifts, cuddling, and other “plausibly deniable” flirtatious or romantic behavior. Make a list of the many reasons to avoid feeding your crush (suitably redacted if you’re afraid of snoops). Consider drawing your attention to the flaws of your crush and making a deliberate effort to notice all the things that would be bad about it. 

Because you can’t distance yourself from your own child, I would advise against having children if you have not already; if you do have children, this is a strong point in favor of SSRIs or going off estrogen. 

Think carefully about whether you use written or drawn pornography involving preteen girls. (Of course, you should not use child porn created through raping actual children.) For some people, porn is an outlet for desires they cannot ethically put into practice. For others, it reinforces and strengthens their paraphilia. Reflect on which of these is truest for you. Similarly, consider whether ageplay is a satisfying expression of your fantasies for you, strengthens them, or simply does nothing. 

Finding a romantic partner may be difficult. You do not have to disclose your attractions and, in a more casual/secondary relationship, I wouldn’t; the stigma is too harsh. When looking for a primary partner, you might consider bringing up the topic of pedophilia early on in the relationship, perhaps on the third or fourth date (or equivalent). You can ask in a sort of general way how they feel about sex offender registries, treatment for pedophiles, or lolicon; you can also discuss how they feel about keeping secrets. If there’s a positive result, you can come out to them. This will be risky, particularly if they decide to tell your friends! But it’s best not to have a long relationship with someone who, while personally tolerant, does not want to commit to someone with attractions like yours — that way just leads to heartbreak.

In having pedophiliac attractions, you are in one of the unluckiest positions a person can be in. It seems like you’re taking a good approach to it: you need to accept your sexuality as it is — unchangeable — while taking steps to avoid harming children. I want to say that this is an unfair burden which has been placed on you, and that it is a brave and admirable thing to exist with this stigmatized trait without harming others. 

Good luck!