Like so many parents of a trans-identified child, I am a nerd who has extensively researched the science and social phenomena of transgenderism. Most recently, I listened to 30 hours of WPATH lectures from their 2022 Montreal conference. The video was released after Daily Caller reporter, Megan Brock, submitted a series of FOIA requests to the institutions where WPATH contributors work. Genspect held a webinar with reporter Brock, but the Daily Caller article was short, sharing only a handful of quotes. Eliza Mondagreen has also reported on this conference. I decided to watch these videos in the hopes of understanding how doctors and mental health professionals justify what they do. I didn’t learn much that would surprise PITT readers, but this internal dialogue provided me with new insights into the madness of this crowd.

As Mondagreen pointed out, WPATH’s gender-affirming members are entirely bought into this ideology. Their standards of “care” are not evidenced-based, and the surgeries they recommend are ghoulish and beyond the realm of medical possibilities. No matter. “Giving people access to gender-affirming care is suicide prevention. Period,” according to Jennifer Slovis, a Kaiser family practitioner. This sentiment was repeated by nearly every speaker. Chris Booth, MD, said that despite the “naysayers,” the evidence shows that gender-affirming care does “a world of good and improves on many parameters” for these individuals. Mind you, this was in 2022, two years after WPATH commissioned a review of the literature that found no benefit from hormonal treatment to trans-identified youth – a study that WPATH suppressed.

The speeches hit all the key trans social justice buzzwords: societal discrimination, health disparities, discomfort, microaggressions, minority stress, trauma-informed, sex assigned at birth, gender identity/expression, authenticity, neurodiverse friendly, bias, check your bias, cis-heteronormativity, privileging the binary, intersectionality, barriers, and embodiment goals. And there were a lot of new terms, including pansexual, polysexual, and skoliosexual. Alex Laungani, a surgeon, began his presentation with an apology for any terms he might get wrong in this quickly evolving field. During the question-and-answer session, people introduced themselves with their profession and their pronouns, which just aren’t necessary for this type of interaction. Lastly, Dan Metzger, an endocrinologist, ended his presentation with a slide displaying, “First do no harm. Doing nothing is harmful”.

Presenters were adamant that ROGD is not a thing and compared its adherents to anti-vaxxers. In response to a question on psychiatric contraindications, Dahl responded, “This is not a thing”. After comparing gender-affirming care to wisdom tooth extraction, he noted that most people get “happier” with gender-affirming care, which he saw as evidence of good mental health.

All you parents who don’t affirm will be pleased to hear Ren Massey, psychologist, complain that kids whose parents aren’t supportive will doubt themselves and slow down the process. Massey is a trans-identified female who seems to regret that he hadn’t transitioned sooner, but he seemed fragile and at times on the verge of tears.  Psychologist Wallace Wong said that he helps parents address their irrational fears and grief, shows them the evidence, and teaches them the terminology. He points to research that 94% of kids who start social transitioning continue as evidence of kids knowing who they are. This same data pointed Dr. Hilary Cass to conclude that even social transitions may be irreversible and urge caution. No one “believes” in detransition, and Massey went as far as to state that most detransitioners retransition.

Scott Leibowitz, psychiatrist, recommended talking to parents differently until they are on board, but he did recommend involving parents unless they were deemed harmful (no indication that the parents have a voice in this determination). Leibowitz stated that puberty blockers are a negotiating tactic when parents are reluctant to transition kids. If the parents are resistant, he addresses their child’s mental health issues before transition, but he believes that transition helps with mental health, so it should go first. Massey had a lot of advice to offer. He tells his patients that there are people with whom you process gender transition and others to whom you announce transition. This last category included Massey’s parents who received an email from him announcing his transition with many helpful links. His guidance on battles not worth fighting hinted at estrangement. Another psychologist had recommendations for building a family of choice that is gender-affirming, ritual farewells for first names at birth, and for the parents he offers role-playing or simulation of a post-suicide ceremony.

Where do these professionals want to take our children? Leibowitz promoted screening for gender for all kids and developing their gender literacy and competence while preventing them from caving into the gender binary. The follow-up discussion said that gender is crystallized in children by the time they are four years old and early transition would help trans kids avoid trauma and minority stress. Another psychiatrist chimed in that cis people also need to come to terms with their gender. In his presentation, John Strang, Director of Gender and Autism at a medical school, noted that he rarely saw individuals with intellectual disabilities seeking to transition, which led him to express concern that this population is underserved. He encouraged psychologists to rehearse with their autistic patients so that these kids can communicate their gender needs and goals to doctors, and he then shared resources directed to autistic kids who are trans-identified.

Listening to all this, I conclude that our kids, some socially awkward or with other mental health co-morbidities and stuck in the house during COVID, didn’t stand a chance.

Next up: the medical doctors.

The medical presentations can be distilled from the opening remarks of Marshall Dahl, endocrinologist, “Not only are the medications off label, the whole field is off label”. The experimentation is an open secret among WPATH members – open to WPATH members but secret to the general public to whom they ply their medicine as evidence-based. Many discussions centered on how to provide hormones and at what dosage, but no one referred to dose-response curves that measure patient responses at different dosages. In reply to a comment from the audience, a doctor suggested running an experiment with 10 patients testing two treatments in two groups to compare results. I did not get the feeling that this experiment would be presented to an institutional review board that approves and monitors biomedical research on human subjects. A doctor noted that blood clots in patients taking estradiol are dose related while dismissing risks from taking estradiol.

That the lack of data has serious consequences for patients is demonstrated in a case in which a trans-identified man who was taking spironolactone off-label as an anti-androgen was reporting lightheadedness. The patient was also taking another medication to treat his high blood pressure. Rather than give the patient two high blood pressure medications (spironolactone is approved to treat high blood pressure), a doctor recommends that the patient obtain an orchiectomy.

Dahl stated that he loves testosterone because it does what it is supposed to do, and the results, such as the deepening of the voice or facial hair, are evident. I understood that estrogen might be less predictable. Joshua Safer, endocrinologist, explained how testosterone and estrogen work with the former dominating such that people with high levels of testosterone won’t develop breasts even with the same level of estrogen. Laungani stated that an orchiectomy is a reasonable approach to avoid anti-androgens. Mind you, this is all an effort to suppress testosterone so that estrogen can have the desired cosmetic effects. One doctor pointed out that there are many non-medical options for desired cosmetic outcomes such as laser hair removal or makeup.

How do these doctors justify giving patients cross-sex hormones without research into potential outcomes?

A doctor from the audience asked about progesterone for a trans-identified male patient who learned about it on the internet. Dahl explained his approach to these questions. He first considers the physiological plausibility and conducts a thought experiment. He knows of a Canadian doctor who gives trans-identified male patients progesterone, which she claims increases breast growth. Dahl thinks the cardiovascular risks are low although he admits that the existing data is only for women and, while he recommended against it in his presentation, he didn’t see the harm in prescribing it even though no one knows how the hormone would work in males. He then went on to joke that he has heard that it makes trans-identified males feel as if they are cycling. The audience laughed.

Source: Slide from Dahl’s presentation at the 2022 WPATH Montreal Conference

They know they are working in a “data-free space”. They discussed one progesterone, cyproterone acetate, and Dahl reported that the Dutch observed meningiomas in young people and that it may cause breast cancer and heart disease. This suggests these doctors should understand the physiological plausibility that cross-sex hormones can have severe side effects.

The manner in which most doctors presented the risks of treatment suggested that any informed consent is undermined by the doctors themselves. They repudiated warnings of the side effects of hormones, such as venous thromboembolism (VTE) or unstable/evolving psychiatric issues, because they had never seen them. In reference to the latter Dahl claimed, “It is not a thing.” Laungani said surgeons worry about VTE and ask patients to stop taking hormones in the weeks before surgery, but endocrinologists are convincing him this is not a risk, so he seemed open to allowing patients to continue with hormones while undergoing surgery and then conducting retrospective studies. Other known risks, such as an elevated breast cancer risk in natal males, are explained away as a condition that should be monitored as in any female. Slovis claimed that hormones are not killing trans people, and she attributed the high death rates among trans individuals to AIDS, suicide, and drug use – all the result of societal discrimination. These doctors even dismissed patient complaints of brain fog and lightheadedness to “reading things on Reddit” because they could not fathom the physiological plausibility of the symptom. Another doctor did not believe that testosterone would make trans-identified females more aggressive and asserted that any self-reported increase in aggression was likely a result of patient anxiety.

Doctors admitted to not addressing tough issues with patients. Metzger reported that he doesn’t conduct genital examinations after putting kids on blockers because he didn’t want them to be uncomfortable. Another doctor won’t mention the body parts the trans-identified client wants to get rid of to avoid discomfort. There were some discussions of fertility preservation, which aligns with what was reported by Mia Hughes.

Laungani presented on transgender surgeries in an anodyne voice with seemingly sincere expressions of concern for those suffering from gender dysphoria. But his manner belied the ghoulish nature of these surgeries and poor outcomes. He gleefully presented complication rates for phalloplasty (40-80%) accompanied by 100% satisfaction rates. He said he was open to nonbinary surgical requests too. In medical discussions, one doctor expressed excitement about uterine transplants. Someone noted that colon cancer risks in trans-identified males with neo-vaginas may be. . . gosh, I don’t even want to imagine what they were saying. And of course, Laungani has performed mastectomies on minors with parental support.

Nevertheless, they clung to the Dutch Study and the belief that they are saving lives. The only discussion of ethics came during a legal panel on how gender-affirming doctors could use medical ethics boards to confront hospital leadership who are reluctant to get on board with transgender care.

One last point, one of the criticisms of Mia Hughes, author of the WPATH Files, was that she reported based only on the leaked materials, which could have been taken out of context. The WPATH Tapes prove that this was not the case.

A century ago, fueled by exciting and idealistic new fake-Science (eugenics), progressives in California began state-sponsored, legal, compulsory eugenic sterilizations. Sterilization ramped up from small beginnings in 1909 to a statewide industry by the 1920s, with many feeder institutions. Other states did the same, but California performed the most by far: 20,108. That's a rate of 13 eugenic sterilizations per 100,000 inhabitants per year. [1] For context, Nazi Germany peaked at a rate of 75-80. So we got that going for us: California's Progressives were only one-sixth of Germany's Nazis! Of course, we kept doing it well into the 1960s.

Decades later, in 2003, Governor Davis finally apologized to California's sterilization victims. Attorney General Lockyer called out by name Gov. Gillett and his own predecessor A.G. Webb, who aggressively advanced eugenic sterilization laws. By 2021 there had been some desultory effort for reparations, though little came of it. The 20th century eugenic era was “a sad and regrettable chapter in the state's history,” and that closed the book. Good thing Californians today are too enlightened to let it happen again. Right?

NOW: Uh, about never doing it again...

Today, fueled by exciting and idealistic new fake-Science (gender theory), California progressives like Attorney General Rob Bonta are aggressively using the power of the state to circumvent informed consent. That has already led, and will continue to lead, directly to the sterilization of thousands of Californians – including children. [2] Minors by definition cannot give informed consent, just ask the Nuremberg lawyers. Bonta doesn't mention eugenics (he'd never come within a million miles of that word) but the result is the same as before: state-approved non-consensual sterilizations. Californians today are so enlightened we are letting it happen again. We’re cheering. And we’re electing leaders like Bonta.

Bonta today is aggressively promoting and expanding policies that three years ago had already outpaced [2] the "sad and regrettable chapter in the state's history that must never be repeated again." By 2020 California had already hit 13 per 100K, and rising. (Actually it’s worse: today California is sterilizing 13 per 100K children; in the 20th century we were sterilizing 13 per 100K of mostly adults.) Are we now shooting for Germany's record?

Bonta parrots the trans activists' claims. He has adopted their language, calling transparency and disclosure “forced outing.” He has adopted their frame, selling his move not as a violation of parental rights and a threat to child safety but as the affirmation of child rights. But ask the parents in Chino Valley:

"I can't believe we're at a point in America where authoritarians in power are fighting this hard to keep sexual secrets about children from their own parents. They are now using the heavy hand of the state to subvert local control and try to strip away the most fundamental parental rights.”

Governor Newsom laughed as he dismissed parent concerns, saying trans-identified kids are so few in number; but the numbers make a liar of him. In mutilating these 21st century kids, California has already hit and exceeded its peak rate of 20th century eugenic sterilizations.

It goes without saying that A.G. Rob Bonta is an ambitious partisan hack. What does need saying is that one day, maybe soon, gender dead-enders like Governor Newsom, Attorney General Bonta, Superintendent Thurmond and State Senator Scott Wiener will be viewed not as heroes but as criminals. Read the room, guys. Things are changing quickly. They need to get on the right side of history, or wind up remembered like their eugenic forebears. The second "sad and regrettable chapter" in California history is right now.

When 2103 comes around – or at the current rate of change, in 2033 – how will GovGPT apologize for what Newsom and Bonta and Thurmond and Wiener are doing today? Smiling and eyes wide open, they are walking right into sterilizing and otherwise harming thousands of young people. They are boasting about tearing down the parental guardrails that everyone agreed were necessary until a hot second ago. Bonta and Thurmond both hope to become the next Governor; they are campaigning on opposing even basic transparency to notify parents of what's going on. SILENCE=VICTORY is their plan. They are criminals, and in a just world they'd face a Nuremberg-style trial for what they're doing right now. CA better save its pennies; someday it'll be paying reparations for what's happening at your school.

Have we entered the farcical stage of civil rights thinking? CA already says "Congratulations, mentally ill Californians: you have the right to refuse your medication!" "Congratulations, homeless Californians: you have the right to live under the bridge!" That worked out great. Now children – our children – are breathlessly told "Congratulations, confused kids of California: you have the right to escape your parents' protection and deal directly with groomers and profiteers in complete privacy!" What could go wrong? No thanks, A.G. Bonta, your plan will work as well as all the others. I shudder to think of what civil rights for children Bonta will discover next: "Congratulations, kiddies, you have the right to age-diverse love! (We don't use the hurtful term 'pedo' any more.)"

Guardrails? Who needs parental guardrails? Given the inherently expanding ambitions of Queer Theory, A.G. Bonta needs to answer, Where does this end? Does it end? This is not alarmist thinking. It's a recurring and fundamental issue. If a child can plan his gender transition with other adults in state-enforced secrecy from parents, why can't he consent to sex with adults? That is the (un)Holy Grail of Queer Theory. Dr. John Money, who coined "gender is just a social construct" and popularized the term "Gender Identity", advocated pedophilia – er, Minor Attraction. He's still celebrated at Alfred Kinsey's Institute – another academic sexologist who was pro-pedophilia and even solicited live "data" from an actual Nazi pedophile, Dr. Fritz von Balluseck. No joke. And, for decades beginning in the 1970s West Berlin's Kentler Project routinely placed homeless children with pedophile men, reasoning they'd make "especially loving foster parents." I bet they did. (Read more on Dr. Money and the Reimer kids and Kentler.) The State of California is careening down a dark road; it needs to respect the most basic guardrail – parental notification – or it will find itself on the wrong side of history yet again. Maybe the wrong side of a defendant's dock.

What can I do? 1: Promote California Eugenics Reparations.

Here's an idea: California is giddy about reparations for slavery – even though California was never a slave state, and all slavery in the US ended 158 years ago. What California does not discuss enough is a far more sensible plan: thorough acknowledgment, education, and reparations for the compulsory eugenic sterilizations the state really did carry out as recently as the 1960s. (Hundreds more improper sterilizations continued in CA from the 1970s until 2014.) That really was state policy, and people directly harmed by it may still be alive; few have been compensated or even stepped forward to accept the 2003 apology. The legacy CA does need to reckon with is its own fervent, world-leading embrace of eugenic sterilizations. (Governor, “being the leader” is not always a good thing.) If we popularize the worthy cause of eugenics reparations from the past, that of course will raise the question, My god how did this happen and could this happen again? – a conversation we’d love to start. “Yes, we're doing it at this very moment. Worse than before! Our leaders are pressing for it.” #CAEugenicsReparations

What can I do? 2: Support our troops.

Long-term, caring Californians need to end several political careers. (Long-long-term, a criminal trial would be nice.) Both Bonta and Thurmond are running for governor; they must not succeed. Wiener’s reach must be curtailed. Newsom says he is not running for president, which guarantees you that he is…

Short-term, both Californians and non-Californians can support and encourage the brave parents who have stood up for children and earned the state's wrath for it. I emailed the six CA school boards that chose sanity, assuring them that they are not alone and hoping that more follow their lead. [3] In five minutes you can do the same. What are you waiting for?

I hadn’t realized the numbers were this bad; California’s 21C leaders have already taken us far down the same dark road we traveled in the 20C. We mumble apologies for the deeds of a century ago but California’s 21C leaders have already equaled and surpassed them – and promise still more. A century ago California's leaders went all-in on trendy pseudoscience, sterilizing thousands of people without consent. Later leaders said they learned their lesson and regretted the error. But today California's leaders are doing it all over again -- and their numbers match or beat anything CA did in the past. California is approaching numbers not seen since Nazi Germany. [2] And it's proud of that fact. It's eagerly signing up for more. In Round 2 it's specifically targeting and luring children to mutilate. The resistance needs every brave voice we can find.

With laws like AB665 (lowering the age of consent to 12 for gender counseling and residential shelter, without parental consent or even notification) California's leaders (Newsom, Bonta, Wiener, Thurmond) have allied with the real-life Child Catchers and Comprachicos. [4][5] (Erin Friday is on the case: “The parents will have no idea what happened to their child. Imagine their fear and anxiety. These parents are criminalized without an accusation, evidence or trial.”) With SB107 (giving CA custody of out-of-state children who come to CA for gender-affirming care, with or without a parent) California's leaders are becoming Child Catchers and Comprachicos. The stuff of nightmares. They seem immune to shame; will they be shamed by the predictable outcome of these laws? Which one, faced with the enormity of repeating California's historic crime, will be the first to say “no more”? My bet is on Thurmond. First, he needs something to differentiate his campaign for governor. Second, in the past Black Californians have been skeptical of LGBTQIA+ adventures. Finally, of the four, Thurmond’s current job involves listening to parents. So let’s give ‘em an earful. (I haven’t found a personal email for Thurmond and the others; can a PITT help me out?)

NOTES

[Note 1] That number – a rate of 13 eugenic sterilizations per 100,000 inhabitants – comes from Professor Lutz Kaelber at the University of Vermont. He calculated it this way: using original source materials like this he reports eugenic sterilizations in blocks of years: 1921-1928, 1928-1933, and so on. During the 8-year period 1933-1941, for example, California performed 14,568-8,504 = 6,064 eugenic sterilizations. That's 758 per year on average. (Across all ages: mostly adults but also some minors.) At the time the population of California was approximately 6 million (or 60 x 100,000). Divide 758 sterilizations per year by 60 and you get about 13 sterilizations per year per 100K residents. Kaelber comments, and you can check this claim too, that that rate of 13 per 100K in CA held fairly constant over three decades. He compares California's peak rate of 13 to Delaware's peak rate of 18 and to Nazi Germany's peak rate of 75-80. So that was our "sad and regrettable chapter" a century ago – and it is sad and regrettable. And we’re doing it again.

[Note 2] Just how many gender-affirming sterilizations are we looking at? Providers don't like to talk about the numbers – surprising, if this care is so good and important – but there’s enough data now to form an estimate. Williams Institute (2022) measures the distribution of trans-identified children. Wright (2023) measures the number of gender-affirming surgeries on children. Reuters (2022) measures the number of children starting blockers and hormones. Taken together we can form a rough estimate of the total number of children being sterilized in California each year. It ain't pretty.

(The estimate is complicated by the fact that today, unlike the eugenic era, not all sterilizations require surgery; for example, hormone treatment in boys by itself impedes testicle growth and sperm production. And vice versa, not all gender-affirming surgeries are sterilizing; a double mastectomy on a girl is horrific but by itself it does not sterilize her. So these numbers will be rough.)

SURGERY BASED ESTIMATES

Wright et al. (2023) count 3,678 “gender-affirming surgeries” (GAS) on children age 13-17 in the US from 2016-2020. They acknowledge "there may be under-capture." (So when someone tells you “that never happens,” you can reply with “yeah, over 3,678 times.”) Over that period they found exponential growth averaging roughly 42% per year. They don't specify the state, only that 45.9% of all surgeries (1,688) were performed "in the west."

The Williams Institute (2022) estimates 300,000 trans-identified kids age 13-17 in the US, of whom 81,700 (27.2%) live in "the western US" and 49,100 (16.4%) live in California.

Put together, we get a rough minimum estimate of 3,678 x 16.4% = 603 total GAS performed on children in CA over 2016-2020. It's probably closer to 1,000 total since these sources imply a surgery rate in the Western US that is elevated 45.9% ÷ 27.2% = 1.7X with respect to the number of trans-identified kids living there. Either way, with the 42% per year average growth rate we expect roughly 220 to 360 of those surgeries to have occurred just in 2020. Assuming continued growth, we'd expect 630 to 1,040 surgeries to occur in 2023 and 900 to 1,490 surgeries to occur in 2024.

Finally, the US Census estimates that California has roughly 2.34M inhabitants age 13-17, so even 300 GAS per year implies a rate of 300 ÷ 23.4 = 13 GAS per 100K among that age group. By 2020 we had tied our own 20th century sterilization record, and still were rising fast.

Here's a key point: not all gender-affirming surgeries are sterilizing. However GAS is one late step in a years-long process that does reduce fertility. The girl who gets a double mastectomy at age 17 may have started growth disruptors (aka "puberty blockers") at 12 and synthetic wrong-sex hormones at 15 – and those have harmed her fertility. Chloe Cole certainly thinks so. Ditto the boy who gets feminizing surgery at 17; if he has been taking castrating drugs since middle school, he never developed in the first place. And he doesn't need surgery to seal the deal; the drugs alone may have reduced or destroyed his ability to ever father children. Even the butchers admit that. So how many of those GAS correspond to a sterilization? Probably most of them.

Gender affirming surgery is horrific but what has changed in a century is that today we don't need surgery to sterilize someone, especially a child. Therefore if we look only at surgeries we undercount the total number of child sterilizations.

DRUG BASED ESTIMATES

Reuters (2022) and Komodo Health measured the number of children starting blockers and hormones. Their analysis, the first of its kind, found that "at least 121,882 children ages 6 to 17 were diagnosed with gender dysphoria in the five years to the end of 2021. More than 42,000 of those children were diagnosed [in 2021], up 70% from 2020. ... The number of children who started on puberty-blockers or hormones totaled 17,683 over the five-year period, rising from 2,394 in 2017 to 5,063 in 2021."

Reuters concedes "reliable national data on how many children receive care for gender dysphoria have long been unavailable." I wonder why. But warning that it's "probably a significant undercount," they report a minimum of 5,063 US children started on puberty-blockers or hormones in 2021. The implied growth rate over the period 2017-2021 is 21% per year. Again, Williams implies that 16.4% of all US trans-identified kids live in CA, making 5,063 x 16.4% = 830 new patients in CA in 2021. Put together, Reuters and Williams imply that in 2023 over 1,227 children in CA started on puberty-blockers or hormones, and in 2024 over 1,480 more will start.

Having started, how many will continue drug therapy until their fertility is permanently harmed? It's hard to say, but if it's even one quarter, then for 2023 we're back to the same surgery-based estimated rate of 13 sterilizations per 100K, equaling California’s 20C eugenic peak. And if it's one half... then we're entering very dark territory, a rate of 26. Nazi Bavaria had a rate of 36.

ECONOMICS BASED ESTIMATES

Another way to estimate the number of patients is to look at clinics. America has 400 pediatric gender clinics. (Activists tried to erase that fact. Again, funny if they’re doing such good and important work...) You can't support hundreds of medical practices and thousands of highly skilled workers without a lot of patients – the economics alone dictate that currently active child gender patients must number ten thousand or more nationwide.

CONCLUSION: In the medical and technological and secrecy climate of 2023 it's harder than it was in 1923 to count the number of sterilizations in California. Back then Californians were proud of what they were doing, eagerly compared themselves against their peers, and worried openly that they were falling behind. Now parents are forced to feel our way through a darkened room – because the groomers and profiteers like secrecy and have set it up that way. But whether we consider surgeries or drugs or economics, we conclude that California today is sterilizing children at a rate that equals or exceeds the maximum rate at which it performed eugenic sterilizations a century ago on all people. Shout that from the rooftops.

[Note 3] The Chino Valley Unified School District bravely led the charge. You can write to their five board members here. (Sonja Shaw sounds like an absolute tigress. PITT should interview her.)

Donald Bridge <don_bridge@chino.k12.ca.us>
Andrew Cruz <andrew_cruz@chino.k12.ca.us>
Jonathan Monroe <jonathan_monroe@chino.k12.ca.us>
James Na <james_na@chino.k12.ca.us>
President Sonja Shaw <sonja_shaw@chino.k12.ca.us>

Subject: Thank you for CVUSD's stand for parent rights

Dear Chino Valley USD trustees,

Thank you for standing up for child safety and parents rights. Your policy, simply to notify parents when a child announces a transgender identity, is both modest and reasonable and wise. How I wish my California school had a policy like yours. I hope you will go further, and I hope that hundreds of CA school districts will follow your lead.

I also hope that Attorney General Bonta and Superintendent Thurmond listen to you and to the voices of CA parents, and end their opposition to your good work. California today is mutilating and sterilizing children at rates that match or exceed the dark days of eugenics in the US. (link to this article)

This CA parent thanks you and wishes you victory in your fight for child safety and parent rights.

Good luck and courage,

My Name, My Town CA

Once you’ve sent your message of support to Chino Valley, copy and paste to support our other troops:

● Chino Valley Unified School District Board of Education: President Sonja Shaw <sonja_shaw@chino.k12.ca.us> , Donald Bridge <don_bridge@chino.k12.ca.us> , Andrew Cruz <andrew_cruz@chino.k12.ca.us> , Jonathan Monroe <jonathan_monroe@chino.k12.ca.us> , James Na <james_na@chino.k12.ca.us>
● Dry Creek Joint Elementary School District: President Scott Otsuka <scottotsuka@dcjesd.us> , Jon Fenske <jonfenske@dcjesd.us> , Jean Pagnone <jeanpagnone@dcjesd.us> , Jason Walker <jasonwalker@dcjesd.us> , Jeff Randall <jeffrandall@dcjesd.us>
● Rocklin Unified School District: President Julie Hupp <jhupp@rocklinusd.org> , Tiffany Saathoff <tsaathoff@rocklinusd.org> , Rachelle Price <rprice@rocklinusd.org> , Dereck Counter <dcounter@rocklinusd.org> , Michelle Sutherland <msutherland@rocklinusd.org>
● Anderson Union High School District (also see https://shastascout.org/anderson-union-parental-notification/): President Joe Gibson <jgibson@auhsd.net> , Butch Schaefer <bschaefer@auhsd.net> , Staci Adams <sadams@auhsd.net> , Jackie LaBarbera <jlabarbera@auhsd.net>
● Temecula Valley Unified School District Board: President Dr Joseph Komrosky <jkomrosky@tvusd.us> , Jennifer Wiersma <jwiersma@tvusd.us> , Danny Gonzalez <dgonzalez@tvusd.us> , Allison Barclay <abarclay@tvusd.us> , Steven Schwartz <sschwartz@tvusd.us>
● Murrieta Valley Unified School District Board: Paul Diffley <pdiffley@murrieta.k12.ca.us> , Linda Lunn <llunn@murrieta.k12.ca.us> , Nicolas Pardue <npardue@murrieta.k12.ca.us> , Julie Vandegrift <jvandegrift@murrieta.k12.ca.us> , Nancy Young <nyoung@murrieta.k12.ca.us> , Superintendent Dr Ward Andrus <wandrus@murrieta.k12.ca.us>

[Note 4] For the 1968 film adaptation of “Chitty Chitty Bang Bang,” Roald Dahl added the character Child Catcher, whom BBC viewers voted “the scariest villain in children’s books” and EW named one of the “50 Most Vile Movie Villains.” In 2023 Child-Catcher is real and, like the fictional character, has government support. They always do. Only with official support could such monstrosities go on.

[Note 5] We've been here before. Progressive 21st century CA is not only repeating Progressive 20C CA policy errors, it seems intent on actualizing ancient nightmares, too. European folklore of the middle ages spoke of the Comprachicos – “child buyers” – nightmarish artisans who abducted healthy children and systematically mutilated them, transforming them over years into something frightening or amusing or both, which they’d sell to a king to be his court jester. Shakespeare knew this legend. Victor Hugo had a big hit with a book about a 17C Comprachico victim; the 1928 film adaptation scared the bejesus out of moviegoers and inspired the ultimate Batman villain “The Joker.” Now every time you see Joker’s twisted grin, think of its deep origins in a bad king and the evil artisans who did his bidding. (Now there's a thought: Disney, want to make another Victor Hugo film? A feel-good story about a disabled hero and heroine?)

We are not alone in our suffering. Our ancestors had the same anxieties about their kids we feel today. They told stories like these to process those feelings and give name to them. Today, CA has returned to the days of mysterious child abductors, for real, calling it “progressive” – but it’s not. It’s medieval and nightmarish. Abducting and secretly mutilating healthy, loved children on the king’s whim – that is not a good look, Gavin. You can dress him in a designer suit and put gel in his hair, but a bad king is still a bad king.

“By the time of birth, the train has left the station. This does not mean it cannot be stopped in its tracks, but it generally cannot be sent back to the station.”

-McCarthy et al

One of the foundational statements of Transgender Ideology, particularly regarding the medicalization of children, is the concept of “the wrong puberty.”  The abbreviated version of this concept is that somehow the brain or soul is sexually mismatched from the body and that medicine can force the two into alignment by altering the body.  A necessary step in this alignment is preventing the damage “caused by the wrong puberty.” In essence this position relies on the belief that up until puberty girls and boys are the same, that physical dimorphism is only due to sexual maturity and that behavioral differences are entirely social  - unless of course they are due to the magic of “gender”.   

Of course, it won’t surprise readers that this belief is rooted in something other than physical evidence.

At the shallowest level boys and girls appear very much the same until girls commence puberty - for instance, the growth charts are nearly identical for young boys and girls, physical secondary sexual characteristics are not as pronounced as they will be, and they seem to hit the same development milestones at roughly the same time.  In comparison to adults, children of both sexes appear to be the same - they have neither breasts nor facial hair, neither wide hips nor developed muscles and they know nothing of sexual drive; however, if one looks more closely girls and boys are quite different. You can convince yourself that boys and girls are the same until puberty only if you ignore the elephant-in-the-pants (genitalia), gloss over subtle but very real physical differences and ascribe all behavioral differences to socialization.

But what is puberty?  In simple terms, it’s a flood of hormones that bring about significant physical and mental changes. We tend to think of puberty as the rise of testosterone in boys and estrogen in girls, but it’s actually a much more complicated shift in the Hypothalamus -Pituitary-Gonadal (HPG) Axis.  This axis includes hormones that you probably didn’t know existed  – such as Lutenizing Hormone (LH) and Follicle Stimulating Hormone (FSH) – but are essential components of the puberty system.  Although both sexes will be exposed to LH and FSH, the timing of the hormones and the levels are significantly different and the developmental effects on males and females are also different.

We don’t need to get into the complete workings of HPG Axis, but do understand that there is far more going on in puberty than just testicles producing testosterone and ovaries producing estrogen.  Modern science is starting to understand how infants are exposed to hormonal surges during gestation and in the days and months immediately after birth.  The gestational exposure isn’t considered a puberty because it is part of the development of a zygote into a recognizable human being.  There is a lot of evidence that boys and girls have quite different gestational paths and interrupting the path prevents normal development.  

Complicating our understanding of hormones in puberty, babies have surges in hormones immediately after birth!  The first months after birth are now considered a “mini-puberty” as it is a distinct period of tremendous hormonal influence.  Yes, that little baby boy is experiencing testosterone levels that may be as high as an adult male! Baby girls undergo a subtler but longer exposure to estrogen.

Let’s take a quick look at some graphs of the levels of critical hormones during development. The first pair of graphs are taken from Becker & Hesse and the second pair of graphs are taken from Bizzarri & Cappa.

These graphs largely tell the same story of mini-puberty but with some interesting details.  Becker & Hesse show three periods of exposure: gestation, mini-puberty and puberty.  Note that boys get doses of testosterone earlier than girls receive estrogen, and the doses of estrogen are significantly lower during mini-puberty and teen puberty than during gestation.  Bizzarri & Cappa demonstrate how boys have a brief (only 12-24 hour long) surge of Lutenizing Hormone before a similar surge of testosterone immediately after birth.  After a brief rest, both LH and testosterone begin a steady rise, marking the commencement of mini-puberty in boys.

Both sets of graphs show far more than just differences in estrogen/estrodial and testosterone.  LH levels are much higher in boys, while FSH has a reversed role and has a stronger presence in girls. Bizzarri & Cappa also show another pair of hormones – AMH & Inhibin B – that are present for boys from late gestation through mini-puberty while girls get only a fraction of these hormones and only months later. For our purposes, these charts serve as a stark reminder that boys and girls are not the same!  Not only are testosterone and estrogen/estradiol not mirror images on an assembly line where we have to decide at X weeks of development to add one or the other, but the sexes develop differently - exposures to testosterone and estrogen are not equal in timing or duration, nor are exposures to other HPG axis hormones equivalent.

Or, starting somewhere around the 10th week of gestation the sexual dimorphism trains have left the station on two very different tracks.

Since teen puberty is so clearly noticeable, why aren’t the physical effects of mini-puberty more obvious? Unlike teen puberty, mini-puberty doesn’t usher in strong. observable physical differences.  Instead the effects may be considered foundational in that the changes prepare the body for the dimorphisms that puberty will bring, and also create cognitive differences which, for obvious reasons, aren’t obvious in a four month old baby. Much of the research interest in mini-puberty has been trying to connect levels of testosterone or estrogen to observable differences - and some of the findings are given below.  This vein of research is helping to understand variations within the sexes.  Basic physical differences between the sexes also exist although these are not tied to differences in gestational exposure or mini-puberty. (Research has been done on animal brains that, for obvious reasons, hasn’t been replicated with humans, and despite the difficulty of measuring behavioral differences in babies the literature of early dichotomy from these hormones is accumulating.)

Let’s look at some potential areas of sexual dimorphism as they relate to mini-puberty:

Gonadal Development - For boys, mini-puberty testosterone levels are correlated with testicle and penis growth.  Further, during mini-puberty a type of cell in the testicle (Sertoli) increases dramatically - these are the cells that will later be critical in spermatogenesis, and thus much of male reproductive health is dependent on developments in mini-puberty.  Girls don’t undergo much, if any, change in sexual organs during mini-puberty, but some results suggest mini-puberty affects mammary gland growth.

Body Composition - Boys experience a negative correlation with mini-puberty hormone levels and weight, at least until the age of six.  Animal research suggests that mini-puberty hormone exposures also program the placement of body fat in later life.  Boys are observed to be longer and heavier than girls at birth and at five months, and they also add more lean mass (muscle and bone) than girls.

Behavior - While many parents are certain that boys and girls have different behaviors, the research is too thin at this time to associate the differences with mini-puberty.  Some studies suggest an effect, but others find none.  For this one, rely on your own anecdotal evidence!

Cognitive Development - It’s very hard to measure early cognitive growth, but there are clear effects of mini-puberty moderating language development skills. Girls develop pre-cursors to language development and show greater base language abilities sooner than boys.

In addition, it’s relatively easy to find measurable physical and behavioral differences in pre-pubescent girls and boys - although these are not proven to be caused by hormonal changes.  Two simple differences are height and bone density.  While girls and boys appear to be the same height, there is a small but significant difference in the mean height that is obscured by the overlapping distributions.  Going inside the body, precise scans of the hip in boys and girls show that the boys in Tanner I or Tanner II stages of puberty have denser bones and thicker bones (essentially the strength of the bones) than girls at the same Tanner level. Indeed, on average Tanner I & II boys have stronger hip bones than older Tanner IV & V girls.  While it is reasonable to conclude that boys’ skeletons are preparing for greater muscle mass. the more important takeaway is that pre-pubescent children have deeply hidden physical dimorphism. The astute reader will also have already reached the conclusion that even a pre-pubescent boy may have a skeleton that is athletically superior to those of older teen girls and young adult women - and puberty blockers can’t change that.

So, what do we now think of the “wrong puberty” idea?  The HPG hormones that define teen puberty actually start within weeks of conception and continue in the first months of life before going dormant until about the age of 8.  This exposure lays down a dimorphic foundation upon which further physical and cognitive development will occur - and that foundation cannot be undone or modified.  Against this backdrop the idea of “wrong puberty” is nonsensical, with teen puberty merely the conclusion of a process that has been proceeding for the child’s entire life.

As the quote states… the train has left the station and it can’t go back. It can only proceed along its path.

Sources:

Becker M, Hesse V. Minipuberty: Why Does it Happen? Hormone Research in Pediatrics. 2020;93(2):76-84. (https://pubmed.ncbi.nlm.nih.gov/32599600/)

Bizzarri C, Cappa M. Ontogeny of Hypothalamus-Pituitary Gonadal Axis and Minipuberty: An Ongoing Debate? Frontiers in Endocrinology (Lausanne). 2020 Apr 7;11:187. (https://pubmed.ncbi.nlm.nih.gov/32318025/)

McCarthy MM, Herold K, Stockman SL. Fast, furious and enduring: Sensitive versus critical periods in sexual differentiation of the brain. Physiology and Behavior. 2018 Apr 1;187:13-19. (https://pubmed.ncbi.nlm.nih.gov/29101011/)

Sayers A, Marcus M, Rubin C, McGeehin MA, Tobias JH. Investigation of sex differences in hip structure in peripubertal children. Journal of Clinical Endocrinology and Metabolism. 2010 Aug;95(8):3876-83.(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2917783/)

And thanks to an expert, a professor in the area of development and hormones who wishes to remain anonymous, for discussing these issues and converting the arcane into the common.

As a parent of a trans identifying kid I frequently find myself arguing with people about the logic of transgender ideology.  One of the frequent lines of argument is the “But what about Intersex people? They prove that sex/gender isn’t a binary” and frequently followed by a version of “There are more intersex people than you think and they need a safe non-binary category.”  And then there are the claims that intersex conditions are as common as people with red hair.

One of the things I’ve learned about people - and statistics - is that most people are very bad at comprehending numbers, especially very small probabilities.  This is why people buy travel insurance and lottery tickets.  Its really hard for people to understand just how uncommon something is when the probability is expressed as “.15 per 100,000”.  So instead of disputing the true rate of intersex, allow me to convert these rates into something that is more easily comprehended - the height of people.

I started with a CDC dataset of administered height measurements of about 57,000 Americans over the age of 18.  The sample is about equally split between men and women and is representative of regions, age, ethnicity etc.  It is also extremely gratifying that the distribution of height is indeed a classic Gaussian Normal Distribution - this is nice because most things in nature are normally distributed and because it validates the statistical extrapolation I’m about to do.

For the statistically uninitiated, the normal distribution is a classic bell curve with some very nice properties.  In this instance, about 95% of people have a height that is between 4’10 and 6’2” (147cm and 187 cm) and we can easily use something called a Z-score to determine the probability of a person having a height above (or below) any particular height.  So you’re 5’10” (~178 cm), that’s 1.08 standard deviations from the mean which means you are taller than just about 86% of the US adult population.  As we move away from the average or middle of the curve the frequency becomes very “thin”, so small increase (or decreases) in height have dramatically different probabilities!  For instance, a person of average height is, by definition, taller than 50% of the population but being just one inch taller makes you taller than just about 60% of the population, an increase of 10%.  Contrast that with the “thin” tail where moving from a height of 6’3” to 6’4” (also a gain of just one inch) moves from being taller than 98.9% to taller than 99.4% , an increase of just .5%. 

Now let’s convert intersex occurrence rates! The pro-gender/sex spectrum community likes the numbers from Sterling et al, which sets the rate of intersex conditions at 1.78% (this seems to be the source of the “common as redheads” idea).  Sax makes a really strong argument that the Sterling numbers grossly overestimate the intersex rate, lowering it from 1.78% to .018%, or about 100 times lower.  Colin Wright has an excellent and approachable article supporting Sax’s position. I’ll leave the discussion of what really constitutes “true intersex” to others and focus just on demonstrating the occurrence rate in a more meaningful way.  What I’ve done is take the “% per 100 live births” and convert it into the % of people who don’t have the condition - which I personally find changes the direction of the perspective to be more useful.  I then take that percentage and find how tall a USA adult would have to be to have the same occurrence rate.1

Looking at the table, what the height roughly represents is that the probability of a person being “Non-XX or Non-XY” is the same as you rolling out of the house and finding a person taller than 6’7.2” (201cm).  As you go down the list of supposedly “common” conditions note how many people you know - or might even see during your day -  who are taller than 6’2.5” (the most common, not at-birth, and not an intersex condition of Late Onset CAH).  The least common condition, Idiopathic, corresponds to a giant 7’1”(~217cm).   The Sax figure for overall intersex conditions corresponds to a height of 6’8” (198cm).  Unless you routinely hang around basketball teams you are very unlikely to see someone this tall! Indeed, over the entire history of the NBA, players average just under 6’6” (198cm) so you would need to find an above-average height basketball player! This also holds for players since 2000, for whom the average height is 6’7”.

For further comparison, I’ve added in some other rare traits of humans: green eyes, heterochromia (different colored eyes), poliosis (patches of gray hair), and the probability of being diagnosed with ALS.2 These numbers are less specific because it just isn’t that life-changing if you have green eyes so the counting isn’t as careful.

Hopefully this height comparison3effectively illustrates how rare these conditions are. But we can stretch the example a bit more: Both really tall and intersex people exist - as do people with green eyes and gray hair patches.  However the presence of really tall (and short!) people doesn’t change the fact that the average US adult is 167cm tall, nor does it change the fact that women have an average height of 5’3” (160cm) and men 5’8.5” (174 cm).  Similarly, the existence of intersex conditions doesn’t change the fact that humans are sexually dimorphic.   

Extending this comparison - an adult’s height is fixed and so the presence of remarkably taller or shorter people really doesn’t have an affect on us.  The fact that there are people who are 7’ tall doesn’t affect our height, our interactions with the world or our interactions with 99.999% of other people.  Similarly, the presence of some people with DSDs of intersex conditions doesn’t affect our understanding of our bodies.  The gender expansive attempts to spin intersex conditions into a sexual spectrum is akin to requiring all of our chairs, cars, doors, showers and clothing fit people who are taller than the rare “average” NBA professional. 

Clearly intersex people and the really tall deserve more than a place in a circus freak show (and shower heads that are mounted high enough) but we also shouldn’t classify either group as “normal” in the sense of being representative of the population.  The next time someone says “But what about Intersex people?” just reply - “Well yeah, but what about the needs of everyone 6’8” and taller? You need to refit your shower, doorways and guest bed to accommodate that person just in case one comes to stay with you” and see what happens.

The author has a teen working through trans identity, is taller than 99.46% of the US population and finds that showers are too short, car seats and plane seats are just wrong and no one seems to care.

This is the conclusion of a 4 part essay on the long term effects of wrong sex hormones on men. For Parts I and 2, please see A Man called Hank, Parts I and II. For more detailed information and research, please visit the author’s substack.

Part III: Medicalization

The affirming literature

At first, I looked at the affirming literature that has been covered so glowingly in the press. There are many (and some of them, which have been reviewed here in PITT, are atrociously awful, claiming things that, even with their flawed methodology, they do not show). So I decided to look at the most recent ones that have been published in the most prestigious of journals. For example, take the New England Journal of Medicine – it doesn’t get more prestigious than that. Early in 2023, the NEJM published “Psychosocial Functioning in Transgender Youth after 2 Years of Hormones.”

We should clarify something about this stream of literature straight away. They are primarily concerned about how the patients feel after the administration of hormones or surgery. They are not concerned about the body’s physiological response to these medical interventions. To take an extreme example, if a drug like cocaine was administered to these patients and they then reported feelings of euphoria, this stream of literature would report this euphoria but not consider the other long-term effects of cocaine on the body and the brain

In two wonderfully detailed posts, Jesse Singal goes through the many problems in the paper. For example, the authors started their research project with eight key variables in their study protocol that they submitted as part of their Institutional Review Board (IRB) approval process. However, six of those eight variables – gender dysphoria, trauma symptoms, self-injury, suicidality, body esteem, and quality of life – exactly the type of variables you want to find out in research on mitigating gender dysphoria – are not reported in their published paper. The authors also changed the hypotheses from when they began their research to what they finally presented in their paper.

To put it in more layperson terms, the authors started looking for evidence for something and, upon not finding any of it, tried to pretend that they were looking for something completely different. As Singal points out, this seems to be a textbook case of HARKing, or “hypothesizing after the results are known.” To quote him once again: “...this missing variables issue does call the entire effort into question, simply because if many of the variables the researchers tracked didn’t improve, or even worsened, the fact that they were able to cherry-pick five that did show some improvement might not mean anything at all. We may be looking at nothing but statistical noise – we just can’t say for sure since the researchers are obscuring so many of their results.”

But the authors did find something, right? After all, all medical research is messy, and surely one cannot expect to be 100% certain about every small thing before administering patently “life-saving” care for severely marginalized people who would otherwise commit suicide?

Well, not so fast. As Singal points out in his second post, with the few variables that do improve, the improvements are often so small (and, in one case, not statistically significant either) that the authors themselves classify them as minimal or small (something the paper does not highlight, but can be found in Table S5 in the supplementary appendix: see the “effect size” column). For example, the average depression score goes from “mid” mild (16.4) to “low” mild (14) (scores between 14-19 are considered mild) after two years of hormone treatment. The effect size, 0.20, is at the borderline of insignificant and small. 1

Such “meh” results are nothing new in the field of gender medicine. There have been several studies of truly dubious quality in this area, many of them relying on self-reported surveys (and even there, the data is often so biased that we have no idea about their validity). And yet, prestigious journals continue to publish studies that sometimes even gender affirmists think are too awful.

However, with variables measured by clinicians, especially in longer studies where the subjects were rigorously followed, the psychological results of medicalization have always been “meh.” For example, when it came to puberty blockers, presenting at the WPATH symposium in 2016 in Amsterdam, Polly Carmichael, the Director of the NHS Gender Identity Development Service (GIDS) clinic, reported no changes in psychological functioning or self-harming thoughts or behaviors or gender dysphoric feelings within the clinic’s patients as part of their long-term study that had begun in 2011 to replicate the success of the “Dutch studies.” (In fact, results of the Dutch studies – with all their caveats – have never been replicated anywhere else.)

The elephant in the room in the NEJM study is the alarmingly high rate of suicide among the study subjects, even after the researchers removed the youths with severe psychiatric problems from participating in the study (and the researchers mention that in the study protocol).

Among the 315 relatively stable patients, who on average were only mildly depressed, and were being cared for by “a multidisciplinary team that includes medical and mental health providers,” two committed suicide over the course of the study. In comparison, the Tavistock GIDS clinic in the NHS, the world’s largest pediatric gender clinic (now slated to be closed in 2023), recorded three suicides between 2016 and 2019-20 among its patients or those on waiting lists. This is the clinic where the overwhelming majority of all children and adolescents with gender dysphoria from the entire UK were referred to. Using numbers from the NHS, the annual suicide rate among clinic-referred transgender adolescents in the UK has been estimated at 13 per 100,000. The numbers from the NEJM study? 317 per 100,000 – that’s over 24 times higher.

One cannot claim that the hormones caused the suicides among the patients in the NEJM sample – I’m not an irresponsible researcher, after all – but with these stratospheric numbers, neither can one claim that the hormones helped the youths reduce their suicidal tendencies! However, that did not stop NPR from doing just that. In a recent news report, NPR specifically cited this research to claim that hormones reduced suicidal ideation and attempts. Just how lazy can journalists get? And do they realize how much harm examples like these can do to journalism?

To summarize, therefore: (1) the authors drop six of the eight vitally important variables that they wanted to explore when they began the study, and do not disclose anything about them; (2) they find minimal improvements in a few others, and (3) there is an alarming rate of suicide even among relatively stable youths who are cared for in some of the top clinics in the country. These results – milquetoast at best and extremely alarming at worst – did not stop the researchers from claiming that there is “robust scientific evidence” for hormone treatment for better mental health outcomes among transgender and nonbinary youth.

At this point, let us pause and note that there is no control group in this study. Advocates for affirmation would have us believe that these medications are so life-saving that preventing the kids from having access to medicalization within a study would be cruel. However, after looking at the alarming rate of suicide (even among the more stable patients, who were regularly looked after in some of the top hospitals in the country), with many critical variables not reported, and with minimal improvements in the remaining variables, one has to ask the question – why not have a control group? What if – as was argued in the Archives of Sexual Behavior in November 2022 – all we are seeing is a perfect storm of placebo (and nocebo) effects, and we have no idea at all as to what happened? (Well, actually, we do, but more of that later.)

I digress. I started to find out what can be expected from the medical interventions for young AMAB (assigned-male-at-birth) trans women like my son. And there, the researchers of the NEJM study are unequivocal about their findings: even among the variables that were finally reported, “depression and anxiety scores decreased…but not among those designated male at birth.”

Screenshot from page 5 of the NEJM study

That’s right. For young men like our son, even those researchers who believe in “full steam ahead with hormones” have nothing optimistic to report. Zip. Nada.

Looking back, that shouldn’t have been much of a surprise to the researchers. After all, they would have been aware of the study (with its famous lead author) that had come out exactly a year back in PLOS One, where the authors claimed that access to hormones during adolescence led to “better mental health outcomes” among transgender adults. However, by dissecting the same data (i.e., the 2015 U.S. Transgender Survey), it was shown that estrogen is associated with nearly double the rate of suicidality for young men. 2

These findings on the psychosocial effects of estrogen on natal males, in turn, replicate what was found from a larger (and longer-lasting) study conducted across three gender clinics in Belgium, Italy, and the Netherlands and published in 2021. Following 873 patients undergoing hormone treatment over three years, researchers found very little change in their mental outlook (if anything, the scores were almost uniformly lower for trans women all along).

But so much for patient surveys on their mental outlook and how they feel. How does the body react physiologically to estrogen? To go back to the cocaine analogy I introduced earlier, we do not willy-nilly administer cocaine to patients just because they feel some initial euphoria (which, in the case of estrogen, is ironically conspicuous by its absence). What do the clinical studies on the effect of estrogen on the brain and the body say

Estrogen and the male brain

While not explicitly focused on transgender issues, the research in the last few years in the areas of endocrinology, neuroendocrinology, and neuroscience have given us a much better understanding of the effect of hormones on the brain. Neuroendocrinology used to be the branch of medicine investigating how the brain controls the endocrine system via the hypothalamus and pituitary gland. It has now evolved into a branch that includes studying how hormones affect many aspects of brain function. Research in this area – much of it occurring in the past decade – has changed the way we think of the effect of estrogen on the male brain.

In 2018, researchers from Germany showed that increased estrogen levels are associated with depression in males. No wonder all the patient survey studies, including the latest in the New England Journal of Medicine, showed no improvement in the psychological outlook among males.

Psychoneuroendocrinology, Volume 87, January 2018

Two years later, in 2020, researchers from Spain discovered why estrogen might act this way by administering pharmacological doses of estradiol in adult male rats. They found that when treated with estrogen, the brains of adult male rats show changes similar to those observed in the brains of trans women. As a result, they could now thoroughly examine what these changes were. (As always, we humans have the rodents to thank for many of our medical advances. Thank you, mighty mouse!)

Highlights from the paper in Hormones and Behavior, Volume 125, September 2020

What are these changes? The authors highlighted them at the beginning of the article. One of the effects of estrogen is to reduce the water content within the glial or “glue” cells called astrocytes and the oligodendrocytes (more on that a bit later) as well as the axons in the brain, thereby reducing the cortical white matter integrity in the brain. This is important because reduced white matter integrity is related to cognitive instability.

By reducing the water content, the estradiol increased the relative concentration of glutamate and glutamine in the brain, an excess of which, as the Cleveland Clinic notes, is associated with such diseases as Parkinson’s, Alzheimer’s, and Huntington’s disease.

Estradiol also decreased the brain cortical volume, which has been shown to be positively associated with general intelligence (in other words, a decreased cortical volume will generally predict a lower level of general intelligence). Recent neuroimaging studies (in 2020) have linked lower cortical volume and thickness in patients with schizophrenia and bipolar disorder.

Evidence from the real world backs up these findings. In 2020, researchers from the Alzheimer's Disease Research Center at the University of Wisconsin School of Medicine and Public Health presented their findings that showed a 37% higher prevalence of subjective cognitive decline, which is an early sign of Alzheimer’s disease, among transgender and gender nonbinary adults in the US.

Let’s go back to those glial cells. In the past few years, there has been a wealth of research on these cells in our brains, and this research indicates that these cells do much more than merely being the “glue” that binds everything in the brain.

“Neurons are not the only brain cells that think,” The Economist, January 23, 2023

We now know that misbehaving glial cells are the culprit behind a range of conditions, from autism to multiple sclerosis to obsessive-compulsive disorder. Astrocytes play a crucial role in memory formation, consolidating relevant short-term memories into long-term ones (I got reminded of the “brain fog” that Hank mentioned he suffers from, as well as what the parents said about their male children who had suddenly become less capable mentally after starting hormone therapy). Disorders in astrocytes are related to a wide range of different neuropathologies. There is evidence that malfunctioning astrocytes contribute to mental illnesses like schizophrenia, mood disorders such as depression and anxiety, drug dependence, mental retardation, and neurodegenerative diseases like Alzheimer’s.

Interestingly, it has been shown that the brains of depressed suicide victims had a markedly lesser volume of astrocytes than healthy brains. So, when estrogen reduces brain cortical volume and increases the relative concentration of glutamate and glutamine, not only do many neuropathologies follow, but the subjects also become depressed and more liable to commit suicide. This is not an overnight process but more akin to a slow-moving train wreck that reaches its climax over the next several decades. Transgender activists would have us believe that suicide among transgender people stems from their marginalization. That is definitely a possibility. However, the research from the past few years provides a more “Occam’s Razor” explanation: after the estrogen treatment, their brains gradually become more susceptible to committing suicide.

In this context, it is interesting to note that among two other marginalized groups – gay men and black men – suicide is not a leading cause of death. Gay men do show higher risks of mortality than strictly heterosexual men; however, that increased risk comes only from HIV: “mortality risk from non–HIV-related causes, including suicide, was not elevated [emphasis mine] among MSM [men who have sex with men].” And, among black males, as a percentage of all deaths, suicide does not figure among the ten leading causes of death. However, it does among non-Hispanic white males. Suicide is one of the leading causes of death among younger black males, but even there, it is significantly more pronounced among younger white males. So, their marginalization does not lead gay or black men to commit suicide – at least when compared to their peers.

Estrogen and cardiovascular system

The hormones have other effects too on the rest of the body. For example, a large-scale study from 2018 among transgender patients in the US showed that, compared to men, the incidence of venous thromboembolism or VTE (or blood clots, which include deep vein thrombosis and pulmonary embolism) among trans women is 50% higher within the first two years of hormone treatment and more than five times higher in follow-ups beyond two years. The incidence of ischemic stroke (when the blood supply to part of the brain is interrupted or reduced, resulting in the brain cells dying within minutes) is 30% higher within the first two years and nearly ten times higher in follow-ups beyond two years. The authors conclude that "[t]hese results… indicate the need for long-term vigilance in identifying vascular side effects of cross-sex estrogen." These results weren’t outliers either – they were replicated by researchers at the Amsterdam clinic in 2019.

Estrogen and the immune system

Adult women are disproportionately more prone to allergies, asthma, and autoimmune diseases than men (growing up, boys have more allergies than girls, but the ratios flip completely after puberty), but the huge spike of synthetic estrogen hormones changes that equation for trans women. For example, one parent I talked to mentioned how their son used to love cats and be the prime caretaker of the family’s cats and is now (after hormones) completely allergic to them. Estrogen skews the body’s immune responses toward allergy and worsens asthma attacks, and its deleterious effects gradually progress to more severe autoimmune diseases.

There are case studies of increased immune-mediated rheumatic diseases (IMRD) such as rheumatoid arthritis (Hank mentioned this as one of the things he suffers from), spondyloarthritis (characterized by low back pain – another of Hank’s ailments), systemic lupus erythematosus (the most common type of lupus, where the body’s immune system attacks its tissues in joints, skin, brain, lungs, kidneys, and blood vessels), systemic sclerosis (this is the same as the scleroderma that Hank mentioned), and vasculitis (where blood vessels – both arteries and veins – are destroyed), as well as the onset of other autoimmune diseases among trans women.

One parent I met recently mentioned how their son suddenly developed Crohn’s disease after starting hormone therapy – already, his daily regimen is up to 8 medications. A 31-year-old male detransitioner mentions developing scoliosis and osteoporosis after hormone therapy, both of which, while not autoimmune diseases themselves, are linked to – as outcomes of – autoimmune diseases.

Our understanding of these diseases (76 of them, by the last count), when the immune systems that are supposed to defend our bodies from diseases but attack us instead, is still evolving. Many of them have no known cure. However, we now know that nearly 80% of the autoimmune sufferers are female, and it is now clear that, with some exceptions, many autoimmune diseases “are driven by estrogen,” specifically by spikes of estrogen in the body. For example, Scientific American noted that “oral contraceptives and hormone-replacement therapy, both of which add estrogen to the body, has been linked to an increased risk for lupus.”

Research has also shown a “strong association” between gender identity disorder and multiple sclerosis in transwomen, indicating “a potential role for low testosterone and/or feminizing hormones on MS risk” among natal males.

Estrogen also decreases insulin sensitivity (also known as increasing insulin resistance among diabetes patients) in trans women, which is a sign that the body is having difficulty metabolizing glucose, and this can indicate wider health problems such as high blood pressure and cholesterol levels.

Each one of the ailments that Hank told me he suffers from appears in these case studies. While our son will never have all the characteristics of a woman, he will nonetheless experience womanhood through its diseases. With so many new diseases to choose from! Add to this list the possibility of retinal detachment that Hank and several of his male-to-female transgender acquaintances suffer from.

We should remind ourselves that the recent research probably vastly undercounts both the incidence of disease and the diseases themselves. Historically, the medical establishment could be least bothered by what was happening to an impoverished, marginalized population that stayed in the shadows and was considered freaks by the general public. There was no money there. When they died, nobody cared, and there was no autopsy or investigation. Any “research” carried out was by a few “doctors” who handed out off-label drugs or performed surgeries away from the spotlight. If these doctors came to know or suspect anything, they had no incentive to publicize those findings to the general public and “out” themselves and kill those revenue streams. There were no gullible journals or conferences to virtue-signal their junk research in. All the while, these people died an early death. And those early deaths are staggering.

Rheumatoid arthritis, Systemic sclerosis, Vasculitis, and Chronic Discoid Lupus Erythematosus

Estrogen and the incidence of cancer among men

Other than the risk of hepatocellular carcinoma or liver cancer that I alluded to earlier, an “ample body of evidence” suggests that “estrogens may play a critical role in predisposing, or even causing, prostate cancer.”

And in 2015, publishing in the Journal of Clinical Oncology, researchers found that “circulating estradiol levels showed a significant association” with the occurrence of breast cancer among men.

I guess we have to be thankful. At least these men do not have ovaries and uteruses. Because women have to deal with those types of cancers – and once again, estrogen is to blame.  

Estrogen and the liver

And while we are dumping on poor estrogen, let us also note that higher doses of estrogen have been associated with several liver-related complications, including “intrahepatic cholestasis, sinusoidal dilatation, peliosis hepatis, hepatic adenomas, hepatocellular carcinoma, hepatic venous thrombosis and an increased risk of gallbladder stones.” Remember Hank’s gallbladder stones? While these ailments were more commonly seen with higher doses of estrogen, they have also been described with low-dose estrogen hormone replacement therapy.

Mortality after hormones

Depression, mental disorders, cardiovascular diseases, autoimmune diseases, and increased suicidal thoughts – it is perhaps no wonder the overall mortality risks of transgender women are so much higher than the general population (this landmark study looked at the mortality risks of transgender people in the Netherlands over five decades, between 1972 and 2018). The deaths were attributed to cardiovascular disease (21%), cancer (32%), HIV-related disease (5%), and suicide (7.5%). Significantly, even though the risks of dying from HIV have decreased over the past few decades (and also, presumably, the stigma against transgender people is lower now than it was fifty years back), the mortality risks did not reduce over time. Once again, these results have been replicated among US transgender patients by researchers at the University of Michigan and Brown University in their research that was published in 2022.

At this point, it is so surreal to see that it is parents like us, coming from fields far removed from biology and medicine, who are taking all their time from their day jobs to go through this research. For many, it has affected our professional and personal lives, not to mention our physical health and well-being.

As for the people who should have been doing this job and acting as gatekeepers – the psychologists, the endocrinologists, the doctors and the nurses, and the entire medical profession – why, they all have resorted to magical thinking and activism and even claiming that “although gender-affirming hormones can cause some irreversible changes,…these effects are primarily cosmetic.”

Shrinking brains, cognitive decline, depression, Alzheimer’s, suicide, cardiovascular diseases, asthma, arthritis, systemic sclerosis, Crohn’s disease, lupus, and other autoimmune diseases – yes, according to the gender “experts,” all these changes from estrogen are “primarily cosmetic!”

Do these people truly not know or understand the research, or are they intentionally misleading the general public? At this point, I don’t know which is worse – a scientific inquiry led by idiots or truly reprehensible human beings. Does the American medical establishment realize how much harm it is doing to its long-term reputation by allowing such idiots and/or charlatans to lead this diabolical charade? And all this for what? Some lazy likes on their Twitter feed? Some feeling of easy virtue? A bit of filthy lucre?

However, we do know one thing: the previous generation of the medical establishment could hide behind “we don’t know,” but that no longer applies to the current generation of doctors and psychologists, especially after we have held the research in front of them.

After Surgery

So, the hormones won’t help my son – psychologically or physically. Rather, they will hasten his cognitive decline and increase his risk of getting into depression. It will also significantly increase his risk for cardiovascular diseases and autoimmune diseases. All of which will drive him to suicide if he hasn’t succumbed to them already. All these developments might nudge him towards surgery, after which he might hope to pass better as a woman.

Unfortunately, the mortality rates are even worse after surgery than they are after hormones – which is ironic since, if the activists are to be believed, the surgeries should have led to a more fulfilling life for a transgender woman in their quest to become their “authentic” self.

One reason behind these deaths? The postoperative complications, which are widespread, right from the very beginning.

In early 2023, researchers unveiled the results from Canada's first vaginoplasty postoperative care clinic. Nearly a quarter of the trans women who were operated on accessed follow-up care in the first three after surgery, and more than half sought care within the first year. More than three-fifths (61.3%) were seen for more than one visit and presented with more than two symptoms or concerns.

The most common patient-reported symptoms during clinical visits included pain (53.8%), dilation concerns (46.3%) (this is because the body, apparently not getting the memo from the mind, identifies the neovagina as a gaping wound, and so it has to be dilated for life, including multiple times daily during the first year: the aftercare regimen from the clinic runs into eight pages!), and surgical site/vaginal bleeding (42.5%). Sexual function concerns were also common (33.8%), with anorgasmia (inability to orgasm) (11.3%) and dyspareunia (painful intercourse) (11.3%) being the most frequent complications. The most common adverse outcomes identified by healthcare providers included hypergranulation (38.8%), urinary dysfunction (18.8%), and wound healing issues (12.5%).

We aren’t done yet. A review of the literature from 2018 on complications of the neovagina in trans women after surgery shows an overall complication rate of 32.5% (i.e., about one in three cases) and a reoperation rate of 21.7% (more than one in five cases) for “non-aesthetic reasons.” Another paper (also from 2018) discusses various neovaginal complications in transwomen: stricture of the neo-urethra, leading to urinary tract infections; scar tissues in the neovagina, causing it to become narrower and shorter; “intravaginal hairballs;” vaginal prolapse (when the top of the vagina weakens and collapses into the vaginal canal) and recto-vaginal fistulas (a tunnel between the vagina and rectum, leading to rectal discharge through the vagina, which could occur even during sex).

It is difficult for anyone to come to terms with these setbacks – especially if they had been promised a life of fulfillment afterward. But those who do talk mention that their life has been a “living hell since then.” Another detransitioner asserts, “This is not rare.”

Many of these complications will remain with the patients for life, affecting their basic day-to-day activities from morning till night (one such account makes for harrowing reading: “managing the trickle of urine from my constricted urethra after going to the toilet, the occasional shooting pain and the despair of my own stupidity”). Is it a surprise if many succumb to these complications – or commit suicide – so early in their lives?

Let’s take a minute now to list what my wife and I can expect to happen with our son (and since the research is ongoing, this is probably an incomplete list):

1. After hormones, there’ll be no change in his psychosocial well-being. There’ll be no change in the overall quality of his life.

2. However, if anything, he will be at a higher risk of suicide.

3. His brain will gradually shrink, leading to depression, and…

4. …over the longer term, he will see the gradual incidence of cognitive decline and neuropathologies like early-onset Alzheimer’s, schizophrenia, loss of memory, and other disorders.

5. He will develop new allergies and possibly asthma. He will become prone to many autoimmune diseases, like rheumatoid arthritis, systemic sclerosis, vasculitis, and lupus. His immune system will attack his joints, skin, brain, lungs, kidneys, and blood vessels.

6. He will be at a heightened risk of cardiovascular diseases, especially after the first couple of years, leading to lifelong medication – and possible heart attacks and emergency visits all his life.

7. If he later opts for an orchiectomy, his sex drive will completely cease, and he won’t have any sexual intimacy for the rest of his life.

8. If he further opts for vaginoplasty, he will have to make repeated and regular visits to the surgery room for many different complications – even for basic functions like urinating, let alone urinary tract infections or recto-vaginal fistulas – for the rest of his life. (And since he is in the US, let’s hope he will have a sympathetic employer to let him keep his job and health insurance despite his many absences. As NPR discovered, the first-time costs can run into six figures, never mind the cost of the lifelong follow-up visits.)

9. And finally, what with all the physical ailments, mental diseases, and the decrease of his mental faculties starting from a very early age, he will have a much higher risk of early death from one or more of these conditions – or he might decide to end it all by committing suicide.

With all these “benefits” of medicalization, who needs to research any pesky problems? But then again, what do I understand about my own son’s health and happiness?

The WPATH Standards of Care Guidelines 8 document states in its abstract that its aim is “...to assist TGD [transgender and gender diverse] people…optimizing their overall physical health, psychological well-being, and self-fulfillment.”

What kind of “physical health, psychological well-being, and self-fulfillment” will our son – or, for that matter, any trans woman – get from hormones and surgery? Is it the superior physical health that comes from shrunken brains and blood clots in the brain, and heart attacks? Or maybe the psychological well-being comes from early Alzheimer’s and schizophrenia, and depression? Or the feeling of self-fulfillment that comes from ending life early from suicide?

So many of Hank’s friends did not have to choose – they got all three.

Part IV – What to expect over the years

I realize the bitter irony in this for my wife and me. As the dangers of medical transitioning become increasingly understood, there is a feeling that “peak trans” is probably over. Mainstream media seem to have caught on to the madness. Professional bodies like the British Medical Association are increasingly direct in stating what we parents have suspected for a while – that GAC (i.e., gender-affirming care) is not evidence-based. The explosive Jamie Reed whistleblower account reiterated a similar madness when she exposed what was happening in The Washington University Transgender Center at St. Louis Children's Hospital (and then Jesse Singal bared the dishonesty of those involved in trying to bring her down). That should put other centers under greater scrutiny as more people see Reed’s brave example to emulate.

The searing account of what happened in the GIDS clinic in Tavistock, the world’s largest pediatric gender clinic (until its announced closure in 2023), a place whose doctors most commonly described as “mad,” is another important pitstop on the road to sanity. Do consider reading the book: you will read what happened in the UK in the 2010s, where the NHS Gender Identity Development Service, under pressure from activist organizations like Mermaids (now under investigation) and under severe strain from the rapid influx of a new generation of adolescent patients who identified themselves with gender dysphoria, gave up their prevalent model of care – one that emphasized extended psychological counseling – in favor of rapid medicalization. Fortunately for the British, sanity seems to be on its way.

Unfortunately, all this good news might come too late to save our son. It isn’t easy to escape the claws of the online activists and narcissists and the “trans-tech” industry that estimates the average transition cost at $150,000 per person. And most tragically, he transitioned after 18—as an “adult.”

In her blog, the ever-thoughtful and recently detransitioned woman, Michelle Alleva, pointed out that in the coming years, those who transitioned as young adults – however vulnerable and misinformed they might have been – will not find any sympathy or support. Young children who medically transitioned before 18 might be seen as innocent victims. However, those who transitioned after 18 – never mind that they were barely adults, with their still-developing brains far from full maturity – will be merely seen as just one more of the mentally ill. As someone recently commented on Twitter, “If you're 18 and think you're the opposite sex, you have a mental illness. If you're 8 and think you're the opposite sex, your mother has a mental illness.”

In the coming years, there will be many people who, back in the day, identified as transgender or non-binary or anything in between and will be reminded of their youth as they look at my son and tell their children, “Thank heavens I stopped before making that mistake!” and beat a hasty retreat from his presence. Our son will be the cautionary tale.

My wife and I stay awake every night, thinking about what will happen to him. Years later, even as he realizes that the medical experiments on him have been a series of colossal mistakes, it will get increasingly difficult to admit that. Especially to an uncaring world that has long moved on. What else will he have left to cling to? Can you imagine how it feels to realize that everything you were told was lies and there is no way to turn back the clock? That all those “brave” statements you made are now seen as hollow remarks made by a callous young person without mental maturity? With all the public outpouring of scorn directed towards him, it would be “really easy to slip into the mindset that everyone hates me, I’m a medical monster, I’m bad and evil, and I deserve this.”

All of us have made our share of stupid statements in our youth. That’s one of the rites of passage to adulthood. But then we are afforded the benefit of time to paper over our youthful misadventures. That is a luxury that will be denied to our child. Every new disease he inherits from this cult, every latest visit to the emergency, and every recoil from people he encounters on the street will remind him of what he has wrought upon himself.

It took Hank forty years to come to grips with his mistakes.

But still, Hank is lucky. Even though, by his admission, he has trouble remembering things and suffers from brain fog, he still retains some of his mental faculties, unlike some of his friends. Unlike some of his other friends, he is still alive to tell the tale at 70… after the kidney stones, the gallbladder stones, the liver stones, the saliva channel stones, the heart attack, the hypertension, the arthritis and the back pain, the asthma and the allergies, the scleroderma, the retinal detachments, the lifelong visits to the VA, and the fistful of medications every day. He has finally managed to look at himself and accept what he saw. His friends, unfortunately, didn’t have that chance.

Hank is also fortunate that he has the VA healthcare system to take care of him when he lands up there with his latest medical episode. Our son won’t have that. Will the doctors and the nurses and the psychologists who are telling our son today that hormones are safe, or the researchers who claim that these medical interventions are “primarily cosmetic,” be there for him to hold his hand and pay his bills when he goes to one clinic after another with his various ailments…with his schizophrenia and depression and anxiety and drug dependence and possibly several neurodegenerative diseases? With his blood clots and his autoimmune diseases? Or when he is in an emergency room because of his latest suicide attempt?

Or will it be left just us – my wife and I, these two old transphobes – like Hank’s (or D’s) hapless mother, trying to find a way to help their adult man-child whom the society has chewed, spat out, and completely forgotten?

My son is trans-identified and his condition and the stress it has caused has torn my family apart. I will never stop advocating for him though, and doing my utmost to shine a light on the medical harms of the gender industry. To this end, I have spent countless hours reading and analyzing all available medical literature and research in this “field of medicine” (for lack of a better term) (see Part I and Part II). Lately, my focus has been on the link between autoimmune diseases and exogenous hormones and/or the blockade of hormones.

This is a topic close to home for me these days. Last year, my son commenced a self-prescribed and dangerous herbal concoction regimen. The dose levels he is taking are toxic. They contain high dose phytoestrogens and a herbal anti-androgen. Within months he started suffering from severe allergies ( 3 bouts of “allergies” lasting a total of 8 months) leading to significant stress and misery.  His recent blood tests indicate alarming shifts in blood levels of Eosinophils, SHBG, monocytes and platelet counts that are risk factors for autoimmune disorder related allergy, liver damage, deep vein thrombosis, and CVD respectively. I decided to try to determine what is happening to his body and, at the same time, to look at other regimens prescribed for gender affirmation.

Here’s the state of research: We know that 80% of autoimmune disease sufferers are women and estrogen spikes are implicated significantly in their autoimmune disorders. At issue for these autoimmune diseases is the estrogen, not the “gender”—so, autoimmune disorders are also linked to both exogenous estrogen in males. Further, Testosterone deprivation in males is also linked to inflammation and chronic disease. 

Despite the obvious risks, there is very limited research on the topic when it comes to gender medicine and it seems clear that patients enter the trans medical establishment with perfectly functioning endocrine systems and leave with induced endocrine disorders that are the supposed cure for their gender confusion—but yet exogenous estrogen is still being prescribed for gender care.

So, how is it possible that consistent, high dose exogenous estradiol given to boys as so-called gender affirmative treatment has escaped scientific research for safety and efficacy?

Simply put, the gender industry is choosing to not put these risks on their radar. And the gender industry is choosing not to conduct autoimmune tests, so they are not collecting any data that would support more research—because they know that these experiments would likely be difficult to justify if the research was there.

So, with the limited data we have, what do we know?

We know that we don’t know or understand the autoimmune effects.

In a recent research paper published on the topic of autoimmune effects of wrong sex hormones, it is clear that we know what we don’t know when it comes to autoimmune conditions and wrong sex hormones.

We know that there are likely autoimmune effects

The alarming immune and infection related research disclosures include several observations based on cause effect studies.  

• Sex hormones impact risk and pathology of autoimmune disease

• Testosterone has been identified to upregulate AutoImmune REsponse (AIRE ) gene, whereas estrogen has been shown to decrease AIRE expression, reducing the efficiency of thymic self-tolerance and increasing incidence of autoimmune diseases. 

• Tregs are immune regulatory cells that are crucial for maintaining the balance between effective immune activation and self-tolerance. Decreased numbers of functional Tregs lead to failed self-tolerance and autoimmunity. The number of Tregs increases in the presence of testosterone in vitro. Increasing Estrogen and Reducing Testosterone is a double whammy for self tolerance and autoimmune disease activation in natal males!

• Estrogen-based gender-affirming therapy may contribute to the development of SLE in genetically susceptible individuals. Anti-nuclear antibodies are considered a hallmark of SLE as they are detectable in over 97% of cases ( so called gender affirming care does not test for ANA or genetic susceptibility, WPATH SOC 8 recently released does not recommend any such testing!)

• Estrogen or the reduction of androgens may increase the risk of Systemic Sclerosis development

• The detection of autoimmune disease in a preclinical stage is important for preventing immune-mediated organ damage. Anti-nuclear antibodies may precede development of autoimmunity; a recent study observed that 31% of trans females were positive for anti-nuclear antibodies, compared with 13% in the  male population. The trans male/female groups consistently reported higher positivity for anti-nuclear antibodies thereby increasing the risk for particularly those on estrogen treatment.

• A hospital-based study investigated the incidence of MS in trans males and trans females, compared with cis males and cis females [Pakpour et al]. Between 1999 and 2011, this study included 1157 trans females and 2390 trans males; with 4.6 million cis males and 3.4 million cis females in the reference cohorts. From their results, trans females had an increased risk of developing MS with a risk ratio of 6.63 compared with females.

• Testosterone may be protective in allergic disease, whereas oestrogen may aggravate allergic diseases, this is what I observed as I tested my son his allergies were so severe because he had knackered his free testosterone levels on a poisonous combination of high dose phytoestrogens and anti-androgenic plant based “supplements”.

• In conclusion, given the immune-activating properties of estrogen, it seems likely that estrogen treatment may induce a lower threshold for immune activation in trans females. Therefore, natal males on estrogen and anti-androgens with a genetic susceptibility may be at an increased risk of developing disorders of immune hyperactivation, such as autoimmunity and allergy.

Epigenetic Cause Effect Study

A recent cause-effect epigenetic study at MCRI Australia is the first major study that systematically tracked changes in DNA methylation in people on wrong sex hormones. Their observations are significant and indicate how autoimmune diseases can be triggered by and sustained to organ damage by wrong sex hormones especially estrogens and anti-androgen “therapy” in healthy males. Their observations and results are startling:

• Identified several thousand differentially methylated CpG sites (DMPs) (Δβ ≥ 0.02, unadjusted p value < 0.05) and several differentially methylated regions (DMRs) in both people undergoing feminizing and masculinizing GAHT, the vast majority of which were progressive changes over time. 

• Highlight the need to broaden the field of ‘sex-specific’ immunity beyond cisgender males and cisgender females, as transgender people on GAHT exhibit a unique molecular profile (as indicated above unknown and risky profile).

• Gene promoters containing GAHT-associated DMPs are enriched for immune system processes, most markedly in genes that lose promoter DNA methylation during feminizing GAHT and genes that gain DNA methylation during masculinizing GAHT. 

• After 6 months and 12 months of feminizing GAHT, transgender women exhibit a significant loss of methylation of Vacuole membrane protein 1 (VMP1). In recent years, this region of VMP1 has been consistently reported as hypomethylated in blood of patients with inflammatory bowel disease (IBD), Crohn’s disease (CD), and ulcerative colitis (UC). 

Systematic Reviews and Case Reports

In the seminal study “Sex Hormones in Acquired Immunity and Autoimmune Disease” on Estrogen on Immune system, V Moulton et al write:  

Estrogens in general are considered immune stimulatory therefore pathogenic in autoimmune diseases. Systemic Lupus  is a prototypical chronic systemic autoimmune disease and can affect any organ in the body. Joints and skin are frequently involved, while complications in vital organs such as kidneys can lead to lupus nephritis and renal failure. Complex interaction of genetics, environmental factors, and hormones lead to the deregulation and aberrant activation of the innate and adaptive immune systems leading to circulating autoantibodies and inflammatory immune cells which eventually lead to destruction of target organs . Historically, studies with gonadectomy/hormone deprivation and hormone supplementation in male and female lupus prone mice have shown a clear association of sex hormones with lupus, where estrogen accelerates or worsens disease and estrogen removal ameliorates disease in females. Male gonad removal increases susceptibility to disease in male mice and androgen supplementation improves disease in female mice. Human studies indicate that female hormones particularly estrogen plays important roles in immune cell generation, homeostasis, and function which impact control of immune responses. Estrogen mediates key effects on B cell physiology and function, which are vital in the pathogenesis of autoimmune diseases like SLE.. most important factors are concentrations and durations of Estrogen exposure.

The main auto immune diseases caused by wrong sex hormones in natal males that have been reported in several studies and anecdotally are: Crohn’s Disease or IBD, Multiple Sclerosis, Systemic Sclerosis, and Systemic Lupus Erythromatosis. These are severe, progressive and unfortunately fatal diseases.

In a study linking Estrogen with IBD, Pierdominici et al indicate that “Crohn disease (CD) and ulcerative colitis (UC) are chronic forms of inflammatory bowel disease (IBD) whose pathogenesis is only poorly understood. Estrogens have a complex role in inflammation and growing evidence suggests that these hormones may impact IBD pathogenesis”. 

Studies of males with low T and high E levels. 

In an alarming study of organ damage at high estrogen levels in males reported through the Medical University of South Carolina (MUSC) found that men with scleroderma and higher levels of estradiol had more severe disease and heart involvement. Those with the Scl-70 autoantibody and higher levels of estradiol had a greater risk of death. In scleroderma, the body makes too much connective tissue. This causes thickening of the skin and internal organs and, ultimately, organ damage. Women are three times more likely, and women in their child-bearing years nine times more likely to have the disease than men. Men, however, have more severe disease progression. Scleroderma develops in women during their child-bearing years, when estrogen levels are at their highest. Hormone replacement therapy trials found that women’s skin thickened during therapy and then returned to normal after completion of treatment. MUSC has previously reported that similar thickening occurred in skin cultures exposed to estradiol. 

ANA markers and SCL-70 autoantibody tests are  not administered in gender affirming “care” and any accelerating organ damage is likely not detected until it is too late. 

The researchers in this study tested estradiol and scleroderma autoantibody levels in banked samples from 83 men aged 50 years and older with diffuse cutaneous systemic sclerosis, a type of scleroderma. They also tested samples from 37 healthy men of a similar age. They then used a variety of statistical approaches and the careful clinical annotations accompanying each sample to determine whether estradiol levels were linked to any of the clinical traits of scleroderma. 

Male patients with diffuse cutaneous scleroderma had significantly higher levels of estradiol (average, 30.6 pg/mL) than both healthy men (average, 12.9 pg/mL) and postmenopausal women with the disease (24.2 pg/mL). Those with higher estradiol levels (average, 43.7 pg/mL) had significantly more heart involvement than those with lower levels (29.4 pg/mL). Finally, for patients with the Scl-70 autoantibody, increasing levels of estradiol in the serum was associated with a significantly greater risk of death.

People of African, Asian, and Native American ancestry are at higher risk for the disease than those of European descent. Those of African ancestry are also at greater risk for systemic sclerosis (SSc, scleroderma) and often develop SLE and SSc earlier in life and experience more severe disease than those of European descent ( self under siege article below).

Finally while the 2019 MUSC study found correlation to high estradiol in organ wall thickening in Systemic Sclerosis in vivo and in vitro cause effect studies,  an earlier 2013 study made a direct link to circulating estrogen and organ wall thickening (Yasuoka et al). They concluded that the profibrotic effect of E2 and the increased circulating levels of E2 and estrone may explain, at least in part, the higher incidence of SSc.

Anecdotally, autoimmune effects are common and merit research

Understandably, the general public is not going to easily slog through the slim cause effect studies that exist. They are dense and technical. However, with the dramatic rise in transgender medicalization, we are rapidly amassing a host of anecdotal studies that, if known to the general public, would be much harder to ignore. Especially noteworthy are the stories are from detransitioners who, after medicalizing, report a host of ailments related to gender care.

One such story is from Isaac,  a brave detransitioner who has been writing about his autoimmune health-related issues that he attributes to his several years on Estrogen in the hopes that he can help spare others the effects of these wrong sex hormones. Isaac recently reported that his chronic health issues stemming from cross sex hormone use have essentially confined him to his home. He has discussed his health issues openly with the physician who prescribed him cross sex hormones without any testing for auto-immune sensitivity, and this physician blames Isaac for insisting on his own “treatment” path.

A random search on twitter of CSH and autoimmune disorders shows innumerable complaints by males on estrogen with many complaining of severe complications. 

These anecdotes indicate that the medical community has failed many such individuals who have not been tested for genetic and autoimmune markers prior to initiation of wrong sex hormones.

It’s time for us to take a real look at the medical risks of wrong sex hormones, including the increased risk for autoimmune conditions. We need to acknowledge the many indications of risks, ban the experimental medications, and begin to collect data in a lab or controlled setting. It’s unconscionable to continue experimenting on humans for the sake of gender identity.

References

Aida-Yasuoka, K., Peoples, C., Yasuoka, H., Hershberger, P., Thiel, K., Cauley, J. A., Medsger, T. A., & Feghali-Bostwick, C. A. (2013, January 10). Estradiol promotes the development of a fibrotic phenotype and is increased in the serum of patients with systemic sclerosis - Arthritis Research & Therapy. BioMed Central. https://doi.org/10.1186/ar4140

Baker Frost, D., Wolf, B., Peoples, C. et al. Estradiol levels are elevated in older men with diffuse cutaneous SSc and are associated with decreased survival. Arthritis Res Ther 21, 85 (2019). https://doi.org/10.1186/s13075-019-1870-6.

Campochiaro C, Host LV, Ong VH, Denton CP. Development of systemic sclerosis in transgender females: a case series and review of the literature. Clin Exp Rheumatol. 2018 Jul-Aug;36 Suppl 113(4):50-52. Epub 2018 Feb 19. PMID: 29465362. https://pubmed.ncbi.nlm.nih.gov/29465362/

Dhindsa S, Champion C, Deol E, et al. Association of Male Hypogonadism With Risk of Hospitalization for COVID-19. JAMA Netw Open. 2022;5(9):e2229747. doi:10.1001/jamanetworkopen.2022.29747, https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2795874

Higher estrogen levels linked to more severe disease in scleroderma. (n.d.). Higher Estrogen Levels Linked to More Severe Disease in Scleroderma | MUSC | Charleston, SC. https://web.musc.edu/about/news-center/2019/06/05/estrogen-levels-scleroderma

Jasuja GK, de Groot A, Quinn EK, Ameli O, Hughto JMW, Dunbar M, Deutsch M, Streed CG Jr, Paasche-Orlow MK, Wolfe HL, Rose AJ. Beyond Gender Identity Disorder Diagnoses Codes: An Examination of Additional Methods to Identify Transgender Individuals in Administrative Databases. Med Care. 2020 Oct;58(10):903-911. doi: 10.1097/MLR.0000000000001362. PMID: 32925416; PMCID: PMC8010422. https://pubmed.ncbi.nlm.nih.gov/32925416/

Koenig, M. (2022, March 31). Raven Alexis dies at 35 after battling Crohn’s disease. Mail Online. https://www.dailymail.co.uk/news/article-10672379/Porn-star-Raven-Alexis-dies-35-battling-Crohns-disease-suffering-infection.html

Leffler J. Potential immunological effects of gender-affirming hormone therapy in transgender people - an unexplored area of research. Ther Adv Endocrinol Metab. 2022 Dec 10;13:20420188221139612. doi: 10.1177/20420188221139612. PMID: 36533187; PMCID: PMC9747891. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9747891/

Media, M. C. (n.d.). Gender-affirming hormone therapy can influence Gene Activity. Murdoch Children's Research Institute. Retrieved February 11, 2023, from https://www.mcri.edu.au/news-stories/gender-affirming-hormone-therapy-can-influence-gene-activity https://www.mcri.edu.au/news-stories/gender-affirming-hormone-therapy-can-influence-gene-activity 

Moulton VR (2018) Sex Hormones in Acquired Immunity and Autoimmune Disease. Front. Immunol. 9:2279. doi: 10.3389/fimmu.2018.02279, https://www.frontiersin.org/articles/10.3389/fimmu.2018.02279/

Pakpoor J, Wotton, C, Schmierer K, Giovannoni G, Goldacre, M. Gender Identity Disorders and Multiple Sclerosis Risk: A National Record-Linkage Study (I5.008). Neurology Apr 2016, 86 (16 Supplement) I5.008; https://n.neurology.org/content/86/16_Supplement/I5.008

Pierdominici M, Maselli A, Varano B, Barbati C, Cesaro P, Spada C, Zullo A, Lorenzetti R, Rosati M, Rainaldi G, Limiti MR, Guidi L, Conti L, Gessani S. Linking estrogen receptor β expression with inflammatory bowel disease activity. Oncotarget. 2015 Dec 1;6(38):40443-51. doi: 10.18632/oncotarget.6217. PMID: 26497217; PMCID: PMC4747344. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4747344/

Schutte MH, Kleemann R, Nota NM, Wiepjes CM, Snabel JM, T'Sjoen G, Thijs A, den Heijer M. The effect of transdermal gender-affirming hormone therapy on markers of inflammation and hemostasis. PLoS One. 2022 Mar 15;17(3):e0261312. doi: 10.1371/journal.pone.0261312. PMID: 35290388; PMCID: PMC8923509. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8923509/

Self under siege. MUSC Health | Charleston SC. (n.d.). April 1, 2016, from https://muschealth.org/health-professionals/progressnotes/2016/spring/features/self-under-siege

Shepherd,Rebecca, Bretherton Ingrid, Pang Ken, Czajko Anna, Kim Bowon, Vlahos Amanda, Zajac Jeffrey D., Saffery Richard, Cheung Ada and Novakovic Boris. 'Gender Affirming Hormone Therapy induces specific DNA methylation changes in blood,' Clinical Epigenetics. DOI: 10.1186/s13148-022-01236-4

White AA, Lin A, Bickendorf X, Cavve BS, Moore JK, Siafarikas A, Strickland DH, Leffler J. Potential immunological effects of gender-affirming hormone therapy in transgender people - an unexplored area of research. Ther Adv Endocrinol Metab. 2022 Dec 10;13:20420188221139612. doi: 10.1177/20420188221139612. PMID: 36533187; PMCID: PMC9747891. https://pubmed.ncbi.nlm.nih.gov/29465362/

Last spring we had a big wake up call with my youngest child, and we realized just how vulnerable she was to the influence of gender ideology, even in elementary school. I discovered PITT while trying to navigate through these experiences, and have spent the last year trying to understand how my kids' imaginations have been captivated to such a great extent. 

But today I’m writing about something different within my family that makes our challenges in gender all the more difficult: My son has Klinefelter syndrome—his genetic karyotype is 47XXY. Most males are 46XY and most females are 46XX. Most people have never heard of Klinefelter syndrome, and this unfamiliarity has created a vacuum where others have seized the opportunity to capitalize on assumptions about what it means to be XXY.

For the past few years as the mom of a boy with XXY, I've been "reading the room" and I've witnessed how others cite my son's genetic condition as "proof" that gender exists on a continuum. It is actually quite offensive how these outsiders have leveraged his genetic condition to further their social cause. I've seen how they could care less about his developmental challenges and health concerns. I wish people would approach his genetic condition with actual curiosity not foregone conclusions about something they know nothing about.

So, here’s my essay on this issue—I hope it adds to the overall conversation.

A while back, National Public Radio ran a story about the skeletal remains of a medieval warrior who, through genetic testing, was discovered to have Klinefelter syndrome, also known as XXY.

My teenage son is XXY, and we are connected with a whole network of people who are quite familiar with the ups and downs of Klinefelter syndrome. A common theme emerged as we discussed our reactions to the NPR story: we felt the story did not accurately represent the realities of life with XXY. Multiple people affected by XXY contacted NPR to request that the story be retracted because of its poor research, misrepresentations, and the story’s speculation that everyone with XXY is “non-binary”. They informed NPR that the story harmed men and boys with XXY through its inaccuracies, and did a great disservice to the XXY community. NPR ignored these requests. 

An estimated 1 in every 650 males is born with an extra X chromosome.

The XXY community finds itself in the middle of the cultural fray, with others constantly pushing an agenda at their expense…an agenda that seeks to prove that people are gender fluid and that more than two sexes exist. 

The reality is a far cry from this magical thinking, that those with chromosomal differences are evidence of a third sex. Those looking for my son (and others like him) to be their poster boys for gender and sex fluidity, or on a spectrum are bound for disappointment, and XXY people have more pressing issues to deal with than gender expression.

What does life look like for those with this condition?

First, XXY people often have developmental issues. When my son was a small child (and before he was diagnosed), he struggled with so many things. He had trouble latching on at the breast, low muscle tone, apraxia of speech, poor memory, inattentive ADD, minor autistic like traits, and tooth decay. We used to wonder why it was so hard for him to formulate the words that were swirling around in his head and to kick a ball smoothly “across the midline” like the other kids. He has suffered from low energy and fatigue his whole life. His hands and feet often shake involuntarily, known as essential tremors. As he grows older he will be more susceptible to diabetes, certain cancers, autoimmune and heart diseases, and osteoporosis.

Around puberty the hallmark symptom of Klinefelter syndrome sets in: hypogonadism, also known as testicular failure. This does not mean my son is not male. It means that, for reasons that researchers still cannot explain, the testicles don’t get the message from the brain to make enough Testosterone. The male body needs testosterone for dozens of proper metabolic, executive, and bodily functions. To treat this deficiency, my son needs to give himself a painful Testosterone injection once a week for his short and long term health.

Despite these medical challenges, my son understands that his condition is specific to males, and that his extra sex chromosome and testicular failure do not make him some sort of hybrid male/female person, nor do they make him neither male nor female—non-binary in the common non-scientific parlance. He is not confused about his sex/gender. Society’s ignorance and mischaracterization of this condition, as promulgated by NPR and activists is inexcusable and we should not be allowing this sort of disinformation. It is directly harmful to my son and others.

The XXY community has its work cut out for itself in terms of raising awareness, raising funds for research, undoing outdated stereotypes, and sharing best practices with one another. But we don't make progress when we are constantly reacting to labels that we didn’t choose. Many XXY guys still hide their condition because outsiders have swept them up in the culture wars, speculating about them and their condition as if they are some sort of curiosity in a carnival act instead of individual human beings with their own concerns. 

People are naturally curious about the “novelty” that is XXY. That’s okay. But using them to prove gender theory is not okay. It's not right to use other people’s health conditions to promote what you wish were true, and the continuous positioning of XXY as an identity issue causes harm to those who are actually living with this medical condition. We need to be focusing instead on the issues that are most central to boys and men born with XXY—namely good medical and dental care, speech and occupational therapies, hormonal support, ongoing research, fertility treatments, and educational and workplace accommodations.

I used to think that we could protect our son by being discreet about his condition. I now think that the best thing we can do for his future is to get out in front of it, to dispel myths, and to actively shape this conversation.

In June 2015, Rachel Dolezal, the president of the Spokane chapter of the National Association for the Advancement of Colored People (NAACP), resigned from her role. Rachel, who identified as a transracial black woman, was contradicted by her biological parents, who said she has German and Czech and “traces of Native American” ancestry. Photos from her childhood showed that Rachel was born white, with blonde hair and blue eyes. According to her brother, she started darkening her skin and perming her hair in 2011. Even today, Rachel continues to self-identify as Black and recently changed her name to Nkechi Amare Diallo, a Nigerian phrase meaning “Gift of God.” A documentary on her on Netflix tells a tragic tale of her life: as the New Yorker states, “a primitive power game between mother and child, one that forecasts calamity.”

The documentary shows that story of Rachel Dolezal is, at its core, a tragedy with psychological origins. To quote the New Yorker again, “Dolezal is a pathological liar, but…she is also a victim…[the] shots often linger on this garrison of delusion, the place where Dolezal’s theories about “racial fluidity,” as she calls it, run wild.” Many parents of this forum will find the entire article instructive.1 However, the sympathy that we might feel for her delusional state does not make her narrative accurate. It does not make her Black.

In light of this “Rachel saga,” here are a few statements that can be said non-controversially.

1. Black people exist in the United States.

2. Black people have been historically marginalized and mistreated. There is no doubt of the suffering that they have gone through during various periods of history. And this marginalization and mistreatment continue to the current day.

3. Therefore, Black people and their voices must be advocated for.

4. However, if a non-Black person claims to be Black because they "self-identify" as Black, we do not jump to affirm them. Not only do we not jump to affirm them, but after such a ruse is discovered, society makes fun of such people on late-night TV, however tragic their origin story might be.

In these four statements above, replace the words Black people with any other historically-marginalized community – for example, the Indigenous people, or gays, or lesbians – and we would say the same thing. Society will not condone someone who starts darkening their skin artificially, appropriates a racial stereotype, and then self-identifies as Black.

The reasons why we don’t condone such acts of “self-identification” are legion and wholly non-controversial. It is unjust to the actual marginalized community. It is also degrading and dehumanizing to assign and appropriate some of their perceived stereotypes.

Furthermore, we end up diluting the very movement of that community when we let anyone self-identify as a member. The Rachel Dolezal saga ended up hurting the people who supported her—the next time the supporters want to advocate for their positions, their detractors will surely bring up this episode.

Similarly, in a world where people just need to self-identify as transgender, there will probably be many bad-faith actors masquerading as members of the community. Their reasons can vary widely. Some organizations might see this as a way to stay relevant—or solvent. After all, it can be difficult to raise money for a cause when there is widespread support among the public and bipartisan support in Congress. And evolve these organizations did – around a new issue that was barely on their radar a couple of decades earlier.

For some other actors, it is a profitable endeavor in this age of social media and online content. Views equal clicks equal advertising revenue; for some influencers, those revenues can be substantial. There is a captive audience waiting for new content that promises to be a balm to all the problems in their lives – and, in fact, gives them legitimacy: there’s nothing wrong with you – you are just a member of a community that has been historically oppressed. All you have to do is free yourself from your “despised flesh” – to use the term from the poem from Carla Kaplan’s book I mentioned earlier – and make yourself congruent with your gender identity.

Other profiteers see a burgeoning business opportunity – in other words, actively court this captive audience because “sex reassignment surgery is gaining popularity among the young transgender population,” while the “improving reimbursement scenario” is expected to drive market growth. If it seems like satire, it isn’t – these are quotes picked up from a report by a market research firm for the healthcare industry.

And it is with this audience that we see a reenactment of the Rachel Dolezal tragedy. These are the victims who, one day, might face the same opprobrium of society. And, like Dolezal, that day, they might not get any sympathy (“so all this time you were a phony?”). The organizations affirming them right now might send a “heartfelt apology” – or, at most, fire their CEO – and move on. A few online actors might get slapped on their wrists. But for the overwhelming majority participating in this tragedy – the young and the impulsive (we already know from neuroimaging studies that the “adolescent brain continues to mature well into the 20s” who have no idea what “long term” means – the long term implications of these treatments will hit home.

And hit home, they will. For unless the human body somehow miraculously changes once we declare ourselves transgender, medical science has established what is going to happen to these young people over the next few decades. That the brain gets affected by an excess of either estrogen or testosterone has been known for some time. After several decades of research, a lot is still unknown about the brain and the effects of the hormones on the brain. However, in what we know, researchers note possible higher risks of Alzheimer’s (because of ventricular enlargement) and schizophrenia (due to higher glutamate levels) for transgender women, as well as other types of psychopathology

In the Alzheimer’s Association International Conference (AAIC) of 2021, it was reported reported that transgender adults report more subjective cognitive decline than cisgender adults and that depression and cognitive disability are higher among transgender and nonbinary adults. (The press release highlighting the study also mentioned that “it is known that transgender adults experience a greater number of health disparities considered risk factors for dementia – including higher cardiovascular disease, depression, diabetes, tobacco/alcohol use, and obesity.”) There is evidence of brain damage in mice cells. Research shows that testosterone therapy in transgender men can suppress ovulation and alter ovarian cell structure, while estrogen in transgender women can lead to reduced sperm production and testicular atrophy. Several studies have pointed to the increased risk of cardiovascular disease, blood clots, ischemic stroke (this is where the blood flow reduces to the brain, and its cells start dying within minutes), and heart attacks.

Among the patients in the Amsterdam cohort (in other words, from the center that started it all; also note the large size of the cohort and the length of time they were followed: 2927 transgender women and 1641 transgender men followed over five decades), “cause-specific mortality in transgender women was high for cardiovascular disease, lung cancer, HIV-related disease, and suicide”; “cause-specific death in transgender men was high for non-natural causes of death”; and “no decreasing trend in mortality risk was observed over the five decades studied.” Another study from Sweden that followed a sample of 324 sex-reassigned patients over 30 years found that such patients “have considerably higher risks for mortality, suicidal behavior, and psychiatric morbidity than the general population.”

In this age of excessive information, it is easy to gloss over all these studies. Sometimes they look like words piled on top of other words. But even then, as one reads the list of increased risk factors in published clinical research – heart attacks, ischemic stroke, lung cancer, brain damage, and other yet-unknown changes to the brain – one cannot but realize: medical transition is not the safe panacea as we have been told. Heck, if it was just fertility issues that could be taken care of by cryopreservation, one might think of that as a side inconvenience. But no, this is so, so much more.

As the parent of a young adult who has identified as a transgender woman for the past year and a half, I could not but experience a sinking feeling in my heart as I went through the Amsterdam clinic study. There is a chart called “Cumulative survival in transgender women and transgender men during follow-up” on page 4. The vertical axis shows the overall survival probability, while the horizontal axis marks the years since the start of hormonal treatment. Even before year 10, the odds of survival have statistically deviated from the general population – and it gets horrifically worse after that. The standardized mortality ratio (i.e., the ratio of the number of deaths observed in a population over a given period to the number that would be expected over the same period if the study population had the same age-specific rates as the standard population) is, on average, twice that of the general population. Stated simply, on average, in the coming years, I have twice the chance of holding a dead child in my hands compared to the general population. My apologies…let me correct the previous sentence and restate my risks. My risk is even higher since I should look at the chart for transgender women, whose odds of survival are significantly worse.

In its latest Standard of Care Version 8 (SOC-8), WPATH mentions that the objective of the document is to provide “clinical guidance to assist TGD people in accessing safe and effective pathways to achieving lasting personal comfort…optimizing their overall physical health, psychological well-being, and self-fulfillment.” As far as physical health goes, all the clinical research mentioned above shows that medical transition makes matters significantly worse. But what about their psychological well-being?

From a psychological point of view, we know that surgeries do not result in better mental outcomes for the patients (this was a retraction from the authors’ earlier claim that they do). A recent paper that was covered extensively in the press looked at the mental health outcomes of youths receiving gender-affirming care and claimed that they were doing better than those who did not. The authors came to this conclusion not because the youths receiving care did better (they didn’t) but because the youths who did not have access to care apparently did much worse. I say “apparently” because it was pointed out that the cohort of children not receiving care decreased from 92 at the beginning of the study to just 6 after twelve months (eTable 3 in the supplement). So, any conclusion from just these six remaining subjects was meaningless: what if the remaining 86 became much better and decided not to take part in the study anymore?

As for the other research on mental health outcomes, the Economist noted succinctly, “though some studies have found short-term improvements in mental health, these disappear in long-term studies.” Several long-term studies confirm this conclusion, for example, a comprehensive 3-year study of 873 transgender men and women published in 2021 (if anything, the study indicated that by the end of the three years, the conditions had worsened for the patients). Another seven-year study from 2019 showed that the “prevalence of mental disorder diagnoses” was more than double for “transgender hospital encounters” (as compared to cisgender patients).

Even if we go by the 2015 survey data that is routinely used by transgender-affirming researchers, its evidence shows that estrogen “is associated with greater suicidality among transgender males [almost twice], and puberty suppression is not associated with better mental health outcomes for either sex.” And the physical harm from puberty blockers is becoming increasingly apparent to the medical community, thanks to the prescription of such drugs to so many children (the lead investigator behind the principal drug, Lupron, whose on-label use is for metastatic prostate cancer, noted the side effects without mincing words: bone loss, cognitive, metabolic and cardiovascular effects, and a leading cause of morbidity among adult men. This is something that has been established after four decades of study). The current crop of doctors in the US does not even seem to know about the dangers of hormonal therapy – as the Economist recently mentioned, “Trans ideology is distorting the training of America’s doctors.”

And over the next few decades, the brunt of this ignorance will be borne by a vulnerable population of children and young adults as they age. As with any medical intervention, the effects are not observed – nor are properly researched – in surveys of patients carried out after a few months (here’s one particularly egregious example: claiming improvement just three months after mastectomies), but only in long-term clinical studies. However, the damage to this vulnerable population will already be done. Remember what happened during the opioid crisis?

This is not to suggest that some of these young people won’t turn out to be transgender. Historically, the population of transgender people in several countries has been estimated at a fraction of a percentage point in several countries. The numbers from Scotland, Belgium, and the Netherlands (home of the Amsterdam clinic) are quite consistent—at around 0.008%. All these studies are based on surveys sent out to general practitioners, psychologists, and surgeons who have treated this population and not on self-identification. To be sure, that is less than one-hundredth of a percentage point. Or, described in another way, if you meet 10 new people a day, it will take about three years and four months to meet a transgender person. Extrapolating these percentages would lead to a small (but non-zero) number of young people whom medical interventions might help—and if by “help” we mean interventions that double the risk of having a dead child in your hands, I am not sure whether most parents would even qualify them as such.

Unlike in the US, while being contentious, the debate in some of the other countries, especially in Western Europe, has been somewhat less politicized. One difference might have been their nationalized healthcare, leading to better data about outcomes. We often know what has happened to a patient as they move through the system across different clinics and providers (it gets a bit more complicated sometimes as the transitioned individuals can change their identification numbers in some countries). In contrast, in the US, we have no idea what happens to a patient if they don’t come back to the clinic where they started treatment, an issue that plagues much of the extant research on transgender care.

Today, as the results from the first wave of young people treated on these drugs start to trickle in, Sweden (where the treatment of the large numbers of gender-dysphoric young people started a few years before the US), along with many countries in Europe, like Finland and France, is urging caution on allowing youth who identify as transgender to transition medically rapidly. The data (and this is clinical data, not from surveys of the patients after a year or so) – even from the past few years – is alarming.

The NHS in the U.K., which has the largest pediatric transgender clinic in the world, decided to close it down recently, citing the shoddy quality of research that promotes medical transition. These were not one-line putdowns in some random blog but a systematic review of the available literature till 2020, with a clear description of their methodology. There are two documents, one looking at the research on the efficacy of puberty blockers and the other looking at the research on the efficacy of gender-affirming hormones. Together, they run into nearly 300 pages, and their recommendations were incorporated into the Cass Report.

And in the midst of all that is happening in these countries, we are expected to believe that the medical establishment in the United States is not motivated by money and is suddenly doing the right thing. Does that not sound even remotely strange?

The mainstream press in the US has often criticized the for-profit US healthcare system – rightfully – in that it has delivered significantly worse care than many of its OECD counterparts. The countries that are urging caution today are among those that deliver superior healthcare to their citizens. These countries have been at the vanguard of transgender rights. The UK had established the largest pediatric transgender clinic in the world. Sweden was the first country in the world to allow transgender people to change their sex in 1972 legally, and trans parenthood in 2019. It started treating the burgeoning population of young patients who identified as transgender several years earlier than in the US. So when these progressive (and, incidentally, often much happier) countries urge caution, should we not look at what they found?

And finally, if these interventions are so safe, how come the drug manufacturers have turned down the opportunity to conduct clinical studies and make their drugs available for on-label use? It should be easy money! Think about it – different doses, different branding, inflated pricing, and limitless possibilities for new revenue! The drugs have already been discovered, and all that is left is to carry out clinical trials. They are apparently completely safe. What’s more, since gender dysphoria causes intense distress, they can expect that most patients will rush for a cure. It’s also a large population to cater to—Pew Research Center found that “about 5.1% of young adults in the U.S. say their gender is different from their sex assigned at birth.”2 That is a large market – enough to make these drugs break into the top 300 prescribed drugs. And finally, insurance companies in most states have to cover it. In an age where we can get prescription medication for restless legs, why this sudden reticence?

Are the judgments from the opioid crisis too recent to ignore? Or is it because these companies are well aware that the drugs in question have severe side effects, including death? Or is it that they severely doubt the population estimates? In other words, do they believe that the population percentages are in line with the estimates from other countries – 0.008% – rather than the 5% estimated from the Pew survey (which would then imply that over 99.8% of these young adults today identifying as transgender are misguided and wrong)?  And in which case would they be staring at huge class action lawsuits with hundreds of thousands of plaintiffs a few years down the line?

***

I have gone on for much longer than I intended when writing this article. So I will conclude here.

This newsletter often preaches to the converted—i.e., to the people who believe that the current transgender care model is fatally flawed. Anything that I have written here would probably not be news to you.

However, to any “mainstream” person – and especially a mainstream news reporter – who might read this article, this appeal is for you. I am not trying to convince you of the shoddy quality of the current research on transgender care – many other articles do that with much greater detail than what I have touched upon. All I am hoping for is this – can there be a debate around the issue where all of us agree that transgender people have a right to advocacy?

And then we can also agree that advocacy and the correct medical care for transgender people are Two. Separate. Issues. An analogy might help here. Cancer patients need advocacy. Because of their ailments, they suffer enormously. They need all the help that they can get. However, regarding their care, we all agree that every patient needs different, personalized care. Once a person has a medical condition and wants medical treatment, medical criteria should apply. The oncologists who treat cancer patients are guided by clinical research conducted over years, not patient surveys about how they feel after a few months. Similarly, when discussing the right medical care for our vulnerable children (as opposed to their civil rights), can we leave the rhetoric of advocacy aside and look at the actual clinical research on the drugs and their effects decades down the line?

In “Why is this happening to my family?” (published on PITT August 9) I mentioned a possible connection between politics and trans-identification. Now I share my old data on the “demand” for trans among youth, plus new data on the “supply” of trans among medical professionals. Data sharpens the question of where this problem came from—and more importantly where the solution will come from. I think the solution can only come from liberal “Blue America,” not from conservative “Red America.” And I make some suggestions about language as our battlefield. 

DEMAND FOR TRANS

From August 9th: “We find a dramatic difference … in rates of ROGD between politically liberal and conservative communities … I know of no studies looking directly at liberalism-conservatism and ROGD/trans-ID, but I put together two data sources and found a strong correlation (R2=0.5) at the US state level between the red-blue partisan lean of a state in 2021 and the percent of youth age 13-17 who are trans-identified in 2022.” Here it is in a graph: Red Wyoming had only 0.56% trans-ID youth while Blue New York state was over five times higher at 3.00%. 

I also conjectured that more granular data would show even higher correlations and more dramatic shifts—given, for instance, the contrast of NY city versus NY state. But more granular data about trans-ID youth is hard to find. 

SUPPLY OF TRANS

What is easy to find is data about the “supply” of trans services: gender clinics. The Human Rights Campaign trumpets 62 pediatric “gender clinics” counting only “comprehensive multidisciplinary programs.” (The Society for Evidence Based Gender Medicine claims that HRC understates the true total, saying it's "over 300". Gender Mapper lists "over 400 in North America".  But we want to err on the side of caution, so I see HRC, a hostile data source, as a sound choice for this study.)

HRC’s list is very specific, which poses the question: how should we tally clinics? I think congressional districts are a good level of granularity. They are all approximately the same population (min 526K, max 994K) so we can directly compare one to another; they are nine times more granular than states (yet not too granular, like ZIP code); and they are easy to assign a political measure, such as CookPVI.

Did you even realize how many “comprehensive” gender-affirming clinics exist across the country? Please share this info far and wide. These Mengele clinics are everywhere. They are where you would expect, and also where you would not expect. 

WHOSE PROBLEM? WHOSE SOLUTION?

Blue America dominates supply. Blue America dominates demand. But it’s not 100%. Does that mean trans is a Blue problem? It doesn’t matter. I am beyond caring whom to blame. What matters is that the solution lies with Blue. Red cannot solve the gender clinic butchery problem alone and is ill equipped to do so. [1] Who would they even talk to? Most Reds would have to travel far even to find a clinic. But for Blues, the answer is clear: talk to the leader of your party. Nancy Pelosi has two clinics in her SF district. Talk to Ayanna Pressley (MA-07) and Shontel Brown (OH-11) and Earl Blumenauer (OR-03), each of whom has three. 

It’s Americans who consider themselves normal old-school liberals but who are shocked by the Radical Gender Theory Cult™ who must do much of the work of taking it down. If not Blue, who? [2]

(And if Red America thinks its children are safe and only Blue kids are at risk, they’re wrong. They’re wrong because Blue America is now actively wooing Red children to come transition (CA SB107) without consent of either real parent. They’re wrong because Red America has its own (smaller) trans-industrial complex. They’re wrong because hundreds of Planned Parenthood clinics push trans hormones to minors. They’re wrong because young people are indoctrinated into the Radical Gender Theory Cult™ relentlessly—in school, online, in media—and where a young mind goes, a young body is likely to follow.)

Reds can’t sit this out, Reds must fight this cult. Blues must fight this cult. We can squabble later, after our children are safe.

—

P.S. Since I am revisiting my previous article, I’ll acknowledge another update to my thinking. In August I examined how Social Identity Threats contribute to ROGD. Fellow commenters on PITT objected that I failed to consider pornography. They’re right. Women from Abigail Shrier to Billie Eilish have described the frightening effect porn has on girls who are exposed to it—now more than ever. I’m starting to understand how porn can push boys into ROGD, too. I hope to write an article exploring the role of porn as a SIT that causes ROGD and trans-ID. 

[1] There are other reasons why Red America is poorly-suited to solving this problem alone. Reds are firmly typecast as the bad guys, 

cast as a mob of bigoted haters who would deny the transgendered their basic human rights. There can be no other explanation for why someone might believe that transgenderism defies both reason and the laws of biology. The liberal mainstream media is chief among the institutions in lock-step with the divisive tactics of identity politics. The demonized, of course, are those of religious faith. Much of the Western world has become secularized and anti-religious, but a strain of strong religious belief still remains in the United States. These adherents to a code of sexual morality that differs from the LGBT sexual liberation agenda, albeit foundational to the Judeo-Christian value system for millennia, are seen as the last bastion of opposition. Consequently, expressions of sincerely held religious belief are attacked as hateful and bigoted. Believers are mocked as unsophisticated rubes and rednecks, desperately clinging to their guns and religion while resisting the inevitable triumph of rational modernity. 

It’s not just that confused kids and gender chop-shops infect Blue areas; it’s primarily on Blues to defeat the Radical Gender Theory Cult™ because the Reds who practice traditional faiths or hold traditional views are demonized into irrelevance. They are demonized by Team Blue. That has to stop. 

[2] The Reds and the Shocked Blues must fight side-by-side. But how? I’m convinced that language is one key battlefield. Don’t adopt the language of your opponents. If you do, you have already lost. In "Gender" is surrender ; Why it is never wise in any battle to use the words of your opponents, gay writer Dennis Noel Kavanagh begins: 

Are you “gender critical”? Do you find yourself debating the existence of “gender identity”? Have you discussed the unprecedented surge in “gender dysphoria”? If you have, you may have unintentionally ceded linguistic territory in a battle principally waged in the sphere of language. 

So, stop talking about gender identity. It's not real. It’s a cult term and a cult concept. I love his conclusion: “We must untether our language from that of our opponents, it is their greatest and most dangerous subterfuge.” Even to engage with it is to be defeated. What we are fighting is a Radical Gender Theory Cult™ and it’s as fake as a Unicorn Cult. 

The ugly truth: Trans medicine is not about fixing a natural condition of being born in the wrong body, as activists would have you believe. And it is certainly not a journey to become one’s true self, which should not require any drugs or surgeries. It doesn’t actually turn a man into a woman, or vice versa, either. The goals are unclear, unarticulated, and undefinable when it comes down to it. What it seems to be, instead, is an uncontrolled chemical experiment on the human brain, sometimes with debilitating cosmetic surgery on the body in tandem.

In this societal experiment, gender dysphoria, which develops in the brain, potentially from rumination on gender roles and dysphoria itself, is reinforced by wrong-sex chemical interventions in the form of hormones. In the manner of a self-fulfilling prophesy, these hormones change and damage neural pathways that affect one’s sense of self—the same pathways that play into eating disorders. They destroy and disrupt brain connections, damage astrocytes (the “glue cells” of the nervous system), and reduce brain mass and volume, with all the resultant impacts on brain function that one might imagine. And, contrary to these same activists’ claims, there is no silver bullet that protects the brain from the devastation that hormones inflict. For males, progesterone does not mitigate the damage that high levels of estrogen have on the male brain.

This article summarizes my continuing research on the topic since Rise of the Trans Medical Taliban, an article with an inflammatory title, but one that I stand behind. Gender medicine is harming people, including kids, teens, and young adults, in the name of a radical, fundamentalist ideology. It has no basis in cause-and-effect scientific or evidence-based medicine, and the horrifying long-term results demonstrate this. Again, parents are filling in the information void, while doctors continue to hide their heads in the sand. And again, I (and other parents I know) have found that the research out there does not support the safety or efficacy of gender medicine. Experimenting on the minds of our children and young people through wrong sex hormones, and experimenting on their bodies through cosmetic surgeries meant to craft facsimiles of the desired opposite sex, can only lead to tragedy and human suffering. And, it already is.

Gender Dysphoria and Changes in the Resting State Networks

It is becoming increasingly evident that Gender Dysphoria is not a case of having an opposite sex gendered brain in your body—a belief with no basis in science or logic. Instead, evidence points to connectivity within the Resting State Networks of the brain to explain why some feel that they are the opposite of their actual sex. Namely, research indicates that, with gender dysphoria, as with anorexia nervosa and other body dysmorphia disorders, there are visible connectivity changes within the Default Mode (DMN) and Salient (SN) Networks, which are believed to be the neurological basis for the sense of self.

In their study of brain morphology and on the possible neurobiological underpinnings of Gender Dysphoria, Savic et al conducted a study of brain differences in individuals that expressed gender dysphoria. What they found is that the brain morphology of gender dysphoric individuals was indistinguishable from their natal sex, once adjusted for homosexuality (interestingly, there were differences noted between homosexual and heterosexual individuals). There were changes, however, in gender dysphoric individuals, not in the brains themselves, but in the neuroplastic connectivity networks responsible for “mediating self–body perception”— showing decreased communication in individuals with dysphoria. Because of these connectivity changes, they noted that they were unable to determine that gender dysphoria is innate, or if instead, it is the result of long-term rumination.

Similar findings have been made in studies of anorexia patients. Similar to the gender dysphoria studies, researchers found that there was weakened functional activity in the DMN, and microstructural abnormalities in fronto-occipital brain structure in patients with anorexia, a disorder that has, at its root, a similar disconnect between the image of self and the body, in this case, body weight and size, rather than gender. These disorders appear to be more similar than activists would have us believe, and both involve a disconnect between biological reality and self that is observable within the brain.

In the case of both gender dysphoria and anorexia, the cause and effect is unclear— did a mental disconnect in the subjects, between “their own body image and perception of self”, potentially due to rumination and social influences (known causal factors for both ailments), subsequently lead “to a weakening of the structural and functional connections in these networks”, or did weakened connections and decreased connectivity create the chasm or dysphoria in the person’s sense of self? More study is needed to address the root causes. However, it is clear that disrupted neural pathways can disrupt the sense of self and lead to a variety of distressing conditions.

However much activists would like to believe that these afflictions are different, the brain says otherwise. The commonalities between Anorexia and Gender Dysphoria patients are so evident, that it is striking that this is continually overlooked by researchers. Equally striking, however, are the very different ways that these two disorders are treated, because the common root cause or symptom is being overlooked. Anorexia is treated through psychological care, whereas gender dysphoria is currently treated through affirmation and medicalization to support the disordered thinking. These divergent treatment protocols are baffling. Physicians and psychologists treating eating disorders never affirm the observably false idea, caused by the disruption in accurate body perception, that the patient is overweight, and it is known that eating disorders can be resolved by following this approach, in combination with supportive medical care. With gender dysphoria, however, the school of thought is to agree with the patient’s observably false perception of self and to undertake medical and psychological treatments that further enhance the dysphoria.

Now, when wrong sex hormones are introduced into these individuals with mental dissociation, neural networks are further disrupted by this chemical intervention. As the study by Clemens shows, males treated with hormones showed decreased connectivity between the left frontoparietal cortex and the left dorsolateral prefrontal cortex. In other words, the hormone interventions decreased communication pathways in unintended ways in the brain. One might say that this has the effect of further deepening the body perception disorder, rather than working to resolve it. Not a desirable effect!

Impacts to Neural Networks and Astrocytes

Wrong sex hormones also damage astrocytes, the “glue cells” of the central nervous system, which are critical to brain function and stability. As Siracusa et al writes, astrocytes are …“a population of cells with distinctive morphological and functional characteristics that differ within specific areas of the brain. Postnatally, astrocyte progenitors migrate to reach their brain area and related properties. They have a regulatory role of brain functions that are implicated in neurogenesis and synaptogenesis, controlling blood–brain barrier permeability and maintaining extracellular homeostasis. Mature astrocytes also express some genes enriched in cell progenitors, suggesting they can retain proliferative potential.”

Simply stated, astrocytes have different properties and roles in brain function depending on where they wind up in the brain. Disorders of these cells, with a variety of brain function and blood-brain barrier and homeostasis-maintaining roles have been linked to a wide range of different neuro pathologies and mental disorders, such as schizophrenia, depression, and mood disorders (Koyama et al, Tarasov et al).

Wrong sex hormones create changes in these astrocytes, which are so critical to brain function. Currently, at the University of Madrid, researchers are using animal models to build a better understanding of the male and female brains subjected to wrong sex hormones. Their recent pioneering work on brain differences at the metabolite level, using magnetic resonance spectroscopy (1H-MRS), have come to several path breaking conclusions about brain morphology changes induced by the exogenous wrong sex hormone Estrogen and Estrogen with Cyprotone Acetate (CA- Anti-Androgen). They found that that exogenous estrogen, alone and with CA, leaches water from astrocytes, harming those cells in the process and causing several downstream effects, including brain volume loss.

In their concluding remarks, Gomez et al indicate that “Brain cortical volume correlated negatively with increased fractional anisotropy values and relative metabolite concentrations. These reveal a reduction in water content in brain cells, mainly in astrocytes but also in neurons and the oligodendrocytes surrounding their axons, as revealed by the increase of fractional anisotropy. Indeed, decreased cortical volume could be associated with neuro-cellular shrinkage, a circumstance that would disrupt the delicate metabolic equilibria among metabolite concentrations within neural cells”.

Astrocytes are Central to the Homeostasis ( Maintaining Stable Equilibrium Between the Different Parts ) of the Central Nervous System

So, wrong sex hormones damage the cellular structure of astrocytes, which are critical to maintaining brain stability and function. And we know that disordered astrocytes are linked to various neuro-pathologies. We also know that wrong sex hormones reduce brain volume, likely due to the disruption of the delicate brain equilibrium. And, further, they decrease connectivity between areas of the brain, likely causing other issues yet to be discovered. Estrogenic shock to a still-developing male brain may explain continued psychopathology and mental health distress in wrong sex hormonally treated youth. It is likely that younger, still developing brains will not have the same resilience to astrocyte toxicity as might the much older males who have historically been the primary customers for wrong sex hormone treatments.

Progesterone is No Defense

Now that the risks of estrogen have been publicly raised for women and for men (transwomen), the common response from activists and gender doctors has been, don’t worry, we use progesterone in combination with estrogen — that is a protective hormone that makes estrogen totally harmless and safe! Progesterone is billed as a panacea in gender medicine for males (transwomen).

There are several issues with this argument. First, the information available is largely inapplicable to a male cohort. It does not hold that because studies have shown that it helps to protect the brain from estrogen in women (at levels used for post-menopausal women) — and so, therefore, it must do the same thing for men taking estrogen as a wrong sex intervention.

Progesterone use in Hormone Replacement Therapy (HRT) has been studied in women in several randomized control trials over the decades, such as the WHI, KEEPs and others. Specifically, these trials were conducting brain morphological studies, and determining if HRT was correlated with an elevated risk of breast cancer.

A study was conducted to determine the impact of hormone therapy on healthy post-menopausal women, using estrogen in combination with micronized progesterone (touted as the best option in a systematic review of progesterone use in women for HRT). This study of 77 women found that, after a 2-month trial, HRT led to an elevated risk of tumor gene expression. Yes, the results were better for micronized progesterone (an altered gene expression profile of 600 genes within the transdermal Estradiol  and oral micronized progesterone arm, versus 2500 genes with equine estrogen medroxyprogesterone). And, of the 225 genes involved in mammary tumor development, 198 were attributable to medroxyprogesterone versus 34 for micronized progesterone. But, are better bad results acceptable? Both had adverse expression of important genes regulating proliferation, apoptosis and tumor inclination in vivo.

For postmenopausal women, there are also health benefits that help to counteract the risks of hormone therapy. In trans-medicine, we are talking about hormone therapy to develop superficial cosmetic features, like breasts (or more factually, gynecomastia in men and boys). There is no health benefit to males, apart from nebulous and disproven claims of improvements to mental health and decreased risk of suicide. In this case, how many tumor gene expressions are an acceptable risk to take after just 2 months of exogenous hormones?

In response to criticism about the inapplicability of studies on women to male cohorts, rather than admitting that conclusions should not be drawn for this reason, instead the researcher, Prior, challenges the critics to show evidence that the addition of progesterone is actually harmful! In other words, her expectation is to ask others to prove to her the converse of their argument, rather than expecting her to actually prove her claims.

Now, activists take these results from studies on women and restate them, ignoring the elevated risks of cancer, to conclude that men can expect full protection from the harmful impacts of exogenous estrogen by using progesterone. One can only assume that this is because they know that no one will bother to read the source materials. Even if we accept that progesterone mitigates any damage from exogenous estrogen, the data’s relevance cannot be extrapolated to draw conclusions about progesterone in males. Firstly, it is irrelevant because they are males with entirely different biology. And, secondly, it is inapplicable because estrogen is given to transwomen at 6 times the level used for hormone therapy in women!

There have also been studies on males undergoing wrong sex hormone therapy, and the results have also been terrible. Iwamoto, Safer et al cited a significantly enhanced breast cancer risk, in addition to increased risk of clots and stroke, with progesterone used concurrently. A total population study conducted in males, including transwomen, in the Netherlands found that, “There was a 46-fold higher incidence of breast cancer in the cohort than in cisgender men (standardised incidence ratio 46.7, 95% confidence interval 27.2 to 75.4). Most tumours were of ductal origin and estrogen and progesterone receptor positive, and 8.3% were human epidermal growth factor 2 (HER2) positive. A striking finding was that in trans women the risk of breast cancer increased in a relatively short time”. This is clearly not a desirable result.

Progesterone also does not improve mental health outcomes, as seen in the large cohort total population study reported by Pachankis et al, where progesterone was also used as a wrong sex hormone treatment and there was no resultant benefit to mental health.

Currently, progesterone in trans medicine (for transwomen) is being analyzed in WPATH SOC 8 with a “systematic review” but unfortunately, as usual, this is being done without the rigor of an actual double blinded randomized control trial, as noted by Iwamoto in a Letter to the Editor. Given the state of exogenous hormone replacement therapy even in women,  any attempt to use progesterone in an adjuvant fashion as wrong sex hormones seems very premature, notwithstanding any “systematic” review by WPATH. 

False conclusions, irrelevant cohorts, ignored studies—there is ample evidence that wrong sex hormone therapy is harmful and that progesterone doesn’t make it all better. So, why are doctors trying to demonstrate the safety and efficacy of progesterone? Because, as Prior notes, patients are demanding it. We cannot but be astonished about the lack of rigor in such public physician discussions about introducing a new and powerful exogenous hormone into the treatment protocol for males because patients are demanding it. And, they are demanding it, in a feat of circular logic, because certain so-called trans-medicine experts are touting it as a panacea. And around we go.

Five decades after the initiation of off label experimental hormone use for gender “transition’ on humans, we have yet to see the results of any randomized control trials, or FDA approved products. This is outrageous.

0.1mg Estradiol Transdermal Patch , FDA Warning

Above is the black box warning, required by the FDA for all products that have safety risks. This is what women prescribed estradiol patches receive, as that is the “on label” use of the drug. However, this disclosure never appears in “informed consent" for wrong sex hormones. In stark contrast, gender patients get puff pieces from gender clinics that downplay the risks and focus on slick marketing promising (or implying) rosy outcomes, full of fulfillment and happiness, in your new body.

In truth, we have no idea what the risks of these hormones are when used in trans medicine. The few studies into the risks and impacts of wrong-sex hormones in males point to very poor outcomes. Progesterone doesn’t make them safe. There is ample evidence that, as individuals ruminate on gender, they strengthen certain neuro networks, while others weaken. It is further known that behavioral substitution effects, instituted by reflection, detection, and conscious substitution, assisted by therapy or nootropics, can cause changes to these networks in more precise ways than can hormones. Instead of the nuanced impacts you can affect through traditional therapy, hormones instead cause broad astrocyte loss and long-term negative effects, not just on the DMN networks, but on the entire brain.

When damage to the brain, including leaching water from astrocytes, disruption to neural pathways and brain communication, reduction in brain volume, and high risk of cancers and neural-pathologies are expected outcomes, we should be hitting the “pause button” on medical transition and wrong-sex hormones, not hitting the “pause button” on children’s natural puberty and maturation process.

It’s abundantly clear that gender doctors have no idea what they are doing when it comes to medical “transition”. With astounding arrogance and an almost religious fervor, they are blindly meddling with the complex, nuanced instrument that is the human brain.

Nowhere does a brain test show up in any of the WPATH or USPATH SOCs, no cognition test, no mood or irritability tests, no serum BDNF levels or 1H- MRS studies in order to understand metabolite concentration changes over the duration of the wrong sex hormone treatment.

Short term euphoria is reported as evidence current treatments are safe and successful, long term impacts are not even measured.  As, Gomez at al noted, with regret, with males on wrong sex hormones, the clinical follow up does not include systematic checking of brain structure and function. This is unacceptable. The only plausible reason for this willful ignorance is that gender doctors assume their treatments are dangerous, unethical and ineffective and are keen to avoid the liability that uncovering the truth will inevitably bring.

Gender medicine is governed by ideologues, not scientists. As a result, parents are in the absurd situation of having to prove why introducing wrong sex hormones into our children’s bodies (an absolutely insane idea) is a bad thing to do, rather than doctors and scientists proving to us that this “gender” medical intervention euphemistically called “transition” is safe and effective in helping our confused children with their societally-induced gender dysphoria.

This is an unconscionable disaster, a scandal of epic proportions, and no credible medical professional should proceed down this path. It’s time for immediate and drastic change. Enough. Doctors and researchers—start doing your jobs.

Sources

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Back in 1992, the “feel bad” movie of the year was called Lorenzo’s Oil. Based on a true story, this film followed the struggles of a couple battling to find a cure for their son’s adrenoleukodystrophy. Desperate for information and ideas, they turn to doctors and scientists who rebuff their efforts: they are told there is no effective treatment, and to prepare for his death. Undaunted, the parents badger the scientists, track down scarce studies, and organize meetings until they discover a potential cure: a special oil. Thanks to the parents’ efforts, this oil extends the life of their son and helps other children with the disease. 

Much as I admire Susan Sarandon’s hair, I never wanted to re-enact this movie. But sometimes life imitates art.

In June 2020, during a dark phase of Covid pandemic, our then 15-year-old son announced to my husband and me that he thought he might be trans. This was not just out of the blue, but out of character. Like any parents, we told our son we loved him, then started to dive deep into the existing research on trans-identified teens. Quickly, we realized that high-quality studies on the topic were thin. The popular “affirmative model” of treatment was based on a protocol developed for people who had had persistent gender dysphoria for years since childhood, not teenagers who suddenly developed it out of the blue. My son seemed to better fit Lisa Littman’s description of “Rapid Onset Gender Dysphoria.” Affirming and reinforcing a false belief that my son was actually a girl inside seemed like a bad idea.

In late 2020, I joined a group of parents of trans-identified teenage sons to offer each other support and share resources. Since then, our group has grown to around 110, with members from Europe, North America, and Australia. As we shared our stories, it became clear that our sons shared significant common characteristics. Many of them were smart and quirky and isolated. Their histories and presentations of gender dysphoria were strikingly similar, too. None of them were gender-non-conforming as children. Many of them were sexually delayed and had suffered a recent social rejection. They all made their big announcements out-of-the-blue as adolescents. 

To get a better sense of these patterns, I developed three surveys to measure how frequently these issues were present in our kids. These surveys were conducted between January and May, 2021 through survey monkey. While this study is not a formal, scientific one, it does gather evidence of some striking patterns within the cohort of male “Rapid Onset Gender Dysphoria” adolescents. Some of the significant findings:

• These boys are extremely bright. In our first survey, 44% percent of our boys were gifted (IQ 130-145, n=32/73), 19% were highly gifted (IQ 145-160, n=19/73), and 15% were profoundly gifted (IQ>160, n=11/73). Our second survey asked for precise IQ numbers, and found the average IQ to be 140 (n=19, range 126-175). This appears to be quite different from the historical childhood-onset cohort. 

• These boys are socially awkward and quirky. There is a high rate of Autism (21%), Autism-like behaviors (29%), and poor social skills (39%).  40% have ADHD. 

• These boys were suffering mental health issues before their trans-identification, and their mental health declined. 73% were suffering anxiety, and 60% were suffering depression in the six months before they announced they thought they were trans. In the six months after announcing, their mental health declined: 86% suffered anxiety, and 77% depression.

• As identified in previous studies, issues of trauma appear to be a factor. Over 20% of the boys have suffered a major trauma such as the death or illness of a parent or sibling. 13% have suffered a major upheaval such as a move. 

• Social contagion appears to be at play. 42% of the boys announced after a close friend announced.

• Internet exposure appears to be a factor. 96% of the boys were exposed to pro-trans websites.

• Sexuality and sexual behavior appear to be a factor. 27% of the boys demonstrate discomfort with their sexuality. 57% percent are possibly gay or bisexual. 80% have never kissed anyone. 

• Around 50% of boys announce within 6 months of first considering they are trans. Another 24% announce within 6-12 months. These boys themselves acknowledge and are aware that this is “Rapid Onset,” and that they did not have these feelings in childhood.

• Trans identification and behavior appear to be loose, inconsistent, and fragmented. Within the boys, though a great majority (85%) have announced to their parents, only 46% have announced to all their siblings, and 24% to their extended family. Female clothing behaviors (at home 32% vs at school/work 27%) generally lag behind female pronoun requests (at home 64% vs at school/work 27%). 

• ROGD can dissipate. 42% of the boys have had period of desistance that last at least 2 weeks, and 7% are presently desisting for 6 or more months. As our support group serves families whose sons are actively claiming trans identity, it suggests that the families who have sons who desist would not be engaged in our group or taking surveys.

 A few additional notes:

• Though we have not measured it through surveys, our families appear to be generally highly-educated and savvy consumers of health care information. Parents include doctors, nurses, researchers, lawyers, and other professionals who read the studies behind the headlines, and then read the footnotes behind the studies. We tend to be skeptics and “free thinkers.” This behavior mimics the high intelligence of our sons.  

• Though politically and religiously diverse, our families tend to be “liberal thinkers” in the traditional sense of the phrase, and particularly inclusive in our general attitudes and behaviors. We have gay couples, and families with gay and trans siblings. We are not bigots.

• Generally, our families follow a “supportive but not affirmative” model. We have offered unconditional love, emotional support, and continued financial support to our sons. No one has shamed or kicked their son out of the house. Some of us agreed to pronoun changes and minor social transitioning. A few of us have sons who are on hormones. However, most of us have consistently communicated that the trans identification does not seem to match our son’s past or present behavior, and have firmly stated our opposition to hormones or surgery. We have self-selected away from “gender clinics” and recognize that we may represent a different type of family or presentation of child than those that go to gender clinics. 

• We have all struggled to find appropriate psychological therapy for our sons. There are very few therapists who will engage in deeper analysis with our sons about their underlying issues, as most just follow a blind “affirmation” model. There are very few therapists who have experience working with profoundly gifted, autistic, anxious, depressed boys with ROGD. Finding one who connects with a son like this is particularly challenging. Most of our families are muddling through with minimal therapeutic support. Many of us have stories of therapists who mislead us about their approach, and our trust in the field is eroding. 

• We are aware of a possible connection between SSRIs and the development of gender dysphoria in some of our sons. We are also aware of a connection between online “sissy porn” and anime porn and the development of gender dysphoria in some of our sons. These topics deserve more attention.

• We suspect that social anxiety and isolation lie at the root of gender dysphoria for many of these boys. High-IQ, autistic, ADHD boys are all social outcasts. Puberty further highlights their differences. We suspect that gender dysphoria and a trans identification may be unhealthy attempts to find a community. 

• Some of our boys struggle with eating disorders, and we suspect there may be a connection between these mental health issues. Some of our boys have undergone a severe mental health crisis. The health community’s knee-jerk diagnosis of gender dysphoria and fast-track to treating it with hormones fails to serve these other sons. Our families need a more thoughtful, nuanced, and flexible model of treatment for our sons.

Research on this topic is severely hobbled by both political and practical reasons. Researchers who have attempted to study this issue have been called transphobic, forced out of their positions, publicly heckled, and had their funding pulled. Practically speaking, there is no way to ethically run a hormone study on trans-identified children (some get hormones, some get placebos, some get none). It is also impossible to run a formal study on children who never present to gender clinics. 

Clearly, a teenager who has had gender dysphoria since childhood is different from a teenager who suddenly developed it at puberty, and it is time the medical field acknowledge this different presentation. This recent cohort of trans-identified boys appears to be smarter, more anxious, more depressed, more sexually delayed, and have higher rates of Autism and ADHD than previous cohorts. We hope this informal study can spur additional research and conversations. Like Lorenzo’s parents, we know there are answers out there – and we won’t stop looking until we find them.

When my son came to me saying he felt he was trans, my first inclination, being a scientist, was to dive into the research. I wanted to understand, from a medical and scientific perspective, what was going on with my son. I figured the science was settled, there were evidence-based studies that I could reference. I thought that I was capable of understanding what my son was going through, if I could just understand the science. As his dad, I was determined to accomplish this, for him and for our family.

It didn’t take long for me to discover, however, that this was simply not going to be possible. I’m now convinced that trans is not based on science. It’s fundamentalist religious ideology disguised as science. And not only that, because the entire field is being represented as science when it is, in fact, a belief system, information about extremely harmful side effects is being suppressed, and research efforts are completely subverted, because the ultimate goal is to support the ideology at all costs.

What’s most despicable about the whole affair is that the science is out there showing that the risk/benefit balance is way off when it comes to transgender medical interventions, but medical professionals and researchers are not looking at the data. Because they don’t want to know. So, it’s left to parents like me to do the heavy lifting and become the experts. This is wrong.

From my own experience with my son, it’s clear to me that these children DO feel deeply that they have issues with their body. That is not in question. I know my young teen son feels deeply that he is a woman, or at least that’s what he tells me. I also know that there are likely other underpinning reasons why he feels this way other than that he is literally a woman trapped in a male body. And, I think he is aware that he is not actually a woman, a situation which causes inherent cognitive dissonance. But through today’s rigid ideological lens, that is the only possibility offered to him from the gurus online and, similarly, there is only one possible treatment - trans medicine. But, actually, the science says that one size cannot fit all. At a time when cancer care is based on genetically modifying individual DNA, transgender medicine is still in medieval age of one size fits all - Puberty Blockers, Cross Sex Hormones, and Surgery. Trans is the medical version of the Taliban.

This one-size-fits-all approach is a recent phenomenon. Even when transgenderism was mainly an adult medical field and quite rare in its presentation at clinics, studies have shown that, depending on the presentation, differential diagnosis led to different treatment pathways to produce the best possible outcome for the patient to relieve their symptoms. And these different options and paths were explored, over extended time periods, with each case. The results showed that action short of full sex reassignment (in a legal and medical sense) sometimes yielded positive results.

There was, for instance, the case of a physician who observed that, as they reduced the patients’ testosterone levels, their desire to identify as the opposite sex completely went away. Medically, this makes perfect sense. The brain is clearly impacted by hormonal changes in the body and that the brain is an endocrine organ. Would it not make sense then, to understand if there is a chemical basis for these feelings that can be addressed, short of “transition”. In other words, what are the impact of hormones on the brain?

There ARE studies available about the impacts of trans-medicalization (specifically wrong sex hormones) on the brain — and the results are not good at all. However, unfortunately, no one has made the effort to translate these studies into plain English. It’s far easier to say all gender identities are valid and hormones are no big deal, then to read a complex scientific paper.

As a scientific minded parent, I think it’s essential that we take the time to do just that—after all our children’s medical and mental health is at stake. Unfortunately, the results from the studies out there show that the effects of so-called transgender medicine are horrible.

Gender ideologues say that taking estrogen “feminizes” the brain. It does no such thing. What it appears to do is change blood flow, reduce the size of the brain, interfere with executive function, cause dangerously high build-ups of glutamate, and lead to early-onset dementia and high risk of stroke.

The summary of the effect of estrogen is as shown below, with associated long term risk factors linked to morphological changes or serum marker changes. In sum, estrogen introduced in male brain leads to high glutamate levels, reduction of the size of the brain, and increase in the size of ventricles. Long term, these studies are revealing that estrogen in males leads to reduction in grey matter and vastly increases the risk of Alzheimer’s Disease and psychopathology. These are serious brain changes with extremely serious long term side effects.

What’s worse, this research has been available to the medical community for decades with the first transgender brain morphology study published in 2006 by HeH Pol et al, and replicated by Zubiaurre-Elorza et al in 2014, Sieger et al, Mueller et al, and several others in subsequent years. In 2020, Gomez et al replicated the morphology studies (hippocampal volume reduction, ventricular volume expansion) in mice models and also showed high glutamate levels in the brain on Estradiol treated male mice. 

Mueller et al, observed in their structural MRI study of persons on wrong sex hormones, that “Ventricular enlargement has not only been associated with grey matter reduction due to aging , but has also been identified as a putative marker for progression of Alzheimer’s Disease or a risk factor for psychopathology. Hulshof Pol  observed a final 3rd ventricle size in transgender women on hormonal therapy that was larger after treatment than the ventricle size observed in both natal men and women. Although the mechanisms and clinical implications of such effects are unknown, they deserve further study given reports of physiological risk with hormonal treatment  and prevalence of psychopathology in transgender persons”.

Kraguljac et al,  observed in their study on the Pathophysiological Mechanisms of Schizophrenia “glutamatergic hyperactivity is hypothesized to be a key pathological feature in schizophrenia. Glutamate neurotransmitter flux, neuronal firing rate, and the blood oxygen level dependent (BOLD) response are tightly coupled, and glutamate plays a role in long-range functional connections. In preclinical studies, excess glutamate has been shown to be associated with disorganized neuronal activity  and may result in increased synapse turnover as well as axonal or glial injury. We also conducted studies to examine the impact of glutamate (excess) on brain structures. In unmedicated chronic schizophrenia patients, we found that higher hippocampal glutamate was associated with lower hippocampal volumes, suggesting that glutamate related excitotoxicity (neurotransmitter excess related increased synapse turnover) might affect brain structure. 

These are all alarming effects on the brain that should be a reason for a pause on experimental therapies with estrogen on males. From a scientific basis, we should not be giving males estrogen. It’s as simple as that. It’s imperative that we prioritize other ways to address gender distress, because introducing wrong sex hormones is not safe.

Medically, exogenous estrogen isn’t safe for males (or for females for long term use). However, it’s not safe or effective for mental health either, it turns out. Apart from these cause-effect studies, several long range studies and transgender mental health surveys show significant mental health challenges in transgender identified persons. Pachankis et al, showed that, in a longitudinal study of over a decade of persons on hormonal or surgical “transition” treatment on data from the entire population with no drop-outs, mental health did not improve with such treatments. So, not only are the risks high, and the brain impacts severe, there is no evidence that they even help the patient with their original issue.

In 2020, ENIGI published a longitudinal study that showed a similar result in a deliberately tracked group over three years. 

A 2021 study presented at AIAC conference showed a substantially higher cognitive decline in transgender identified persons.

The higher cognitive decline (in the 12 months leading to the survey date) was observed at a statistically younger age.  As indicated by a study author in a tweet, the study could not determine whether the persons surveyed were ever on hormones, while agreeing this was an important factor to consider. 

In a 2019 survey of 25,233 transgender identified patients compared to Cisgender patients in a hospital discharge setting, B Hanna et al observed the following alarming statistics:

“The prevalence of mental disorder diagnoses was higher in transgender hospital encounters (77% vs. 37.8%, P < .001). The prevalence of each examined mental disorder diagnosis was significantly higher in transgender hospital encounters. A multivariable analysis demonstrated significantly higher odds of all mental disorder diagnoses (odds ratio [OR] = 7.94; confidence interval [CI], 7.63–8.26; P < .001). Transgender encounters with a mental disorder diagnosis had a higher prevalence of chronic medical co-morbid diagnoses as compared with transgender encounters without mental disorder diagnoses.”

Additionally, in a 2011 longitudinal study by Dhejne et al, over a 13 year period , with no loss to follow up, sexually reassigned males (on hormones and surgery) had psychiatric hospitalization at 2.5X the rate of control males and suicidality at 2X the control. In a study published this month 'Mortality trends over five decades in adult transgender people receiving hormone treatment: a report from the Amsterdam cohort of gender dysphoria’ the author's looked at a total follow-up time of 40,232 person-years for Males on wrong sex hormones. During follow-up, 10·8% transgender women died, which was higher than expected compared with general population men (Standardized Mortality Ratio -SMR 1·8, 95% CI 1·6–2·0) and general population women (SMR 2·8, 2·5–3·1). Cause-specific mortality in the hormone treated cohort was high for suicide, consistent with the Dhejne study . Importantly, No decreasing trend in mortality risk was observed over the five decades studied.

If you glean nothing else from these studies, it is at least clear that the balance of risk versus benefit for these serious medical interventions merits discussion and consideration.

Unfortunately, however, this is not the case. Debate has been stifled; these studies buried. Lacking public debate, it’s been left to parents like me, capable of reading dense scientific papers and studies, to try to interpret the details and make informed decisions. At the most charitable interpretation for this willful disregard of the science, the medical community simply assumes that these medical interventions must be safe, or they wouldn’t be trumpeted in the New York Times and other trusted publications. More likely, medical professionals continue to look the other way to continue to financially benefit from confused kids and young adults, and to avoid future legal liability by remaining in ignorance.

In a recent paper on the research gaps in medicalization of gender confused persons, over a hundred papers were surveyed, however not a single brain cause effect research was included in the study. The study authors simply concluded that hormonal treatments result in a transference of risk to the desired sex. Decades of neuro-imaging studies indicate that if these studies are included there is overwhelming evidence to show that the brain effects such as ventricular expansion are a significant risk factor for cognitive decline.

Even for women, the effects and risks of exogenous estrogen are serious. These effects of exogenous estrogen on ventricular volume expansion has been studied in a cohort of Natal women in the KEEPs study, by Mayo Clinic Researchers. Due to these risk factors and breast cancer risks that have been extensively studied in women due to exogenous estrogen combined with any form of progesterone (including Micronized progesterone),  the non profit USPSTF has recommended against Estrogen and Progesterone HRT for even limited periods of time, for post menopausal women. USPSTF stated in their recommendation that the risks outweigh any benefits. But yet, this is administered readily, for a lifetime’s use, to boys and young men?

The open disregard of scientific evidence of harmful effect of exogenous hormones on the brain, and other organs shows that at least in the US, Transgender medicine is more akin to a fundamentalist religious movement, than to a well debated, questioning, scientific research process. 

Sources:

• Christel JM de Blok, MD

• Chantal M Wiepjes, PhD

• Daan M van Velzen, MD

• Annemieke S Staphorsius, MSc

• Nienke M Nota, PhD

• Louis JG Gooren, PhD

• Baudewijntje PC Kreukels, PhD

• Prof Martin den Heijer, PhD 

• Show less

Published:September 02, 2021DOI:https://doi.org/10.1016/S2213-8587(21)00185-6

PlumX Metrics

Flatt, Jason D et al. “Subjective cognitive decline higher among sexual and gender minorities in the United States, 2015-2018.” Alzheimer's & dementia (New York, N. Y.) vol. 7,1 e12197. 28 Jul. 2021, doi:10.1002/trc2.12197 https://www.alz.org/aaic/releases_2021/transgender-adults-cognition.asp

Fuss J, Hellweg R, Van Caenegem E, Briken P, Stalla GK, T'Sjoen G, Auer MK. Cross-sex hormone treatment in male-to-female transsexual persons reduces serum brain-derived neurotrophic factor (BDNF). Eur Neuropsychopharmacol. 2015 Jan;25(1):95-9. doi: 10.1016/j.euroneuro.2014.11.019. Epub 2014 Dec 4. PMID: 25498415. https://pubmed.ncbi.nlm.nih.gov/25498415/

Gómez Á, Cerdán S, Pérez-Laso C, Ortega E, Pásaro E, Fernández R, Gómez-Gil E, Mora M, Marcos A, Del Cerro MCR, Guillamon A. Effects of adult male rat feminization treatments on brain morphology and metabolomic profile. Hormones and Behavior. 2020 Sep;125:104839. doi: 10.1016/j.yhbeh.2020.104839. Epub 2020 Aug 22. PMID: 32800765. https://pubmed.ncbi.nlm.nih.gov/32800765/

Hanna B, Desai R, Parekh T, et al. Psychiatric disorders in the U.S. transgender population. Annals of Epidemiology. 2019 Nov;39:1-7.e1. DOI: 10.1016/j.annepidem.2019.09.009. PMID: 31679894. https://europepmc.org/article/med/31679894

Hulshoff Pol, H. E., Cohen-Kettenis, P. T., Van Haren, N. E. M., Peper, J. S., Brans, R. G. H., Cahn, W., Schnack, H. G., Gooren, L. J. G., & Kahn, R. S. (2006). Changing your sex changes your brain: Influences of testosterone and estrogen on adult human brain structure. European Journal of Endocrinology, Supplement, 155(1). https://doi.org/10.1530/eje.1.02248

Ihara K, Yoshida H, Jones PB, Hashizume M, Suzuki Y, Ishijima H, Kim HK, Suzuki T, Hachisu M. Serum BDNF levels before and after the development of mood disorders: a case-control study in a population cohort. Transl Psychiatry. 2016 Apr 12;6(4):e782. doi: 10.1038/tp.2016.47. PMID: 27070410; PMCID: PMC4872405. https://pubmed.ncbi.nlm.nih.gov/27070410/

Kantarci K, Tosakulwong N, Lesnick TG, Zuk SM, Lowe VJ, Fields JA, Gunter JL, Senjem ML, Settell ML, Gleason CE, Shuster LT, Bailey KR, Dowling NM, Asthana S, Jack CR Jr, Rocca WA, Miller VM. Brain structure and cognition 3 years after the end of an early menopausal hormone therapy trial. Neurology. 2018 Apr 17;90(16):e1404-e1412. doi: 10.1212/WNL.0000000000005325. Epub 2018 Mar 21. PMID: 29661902; PMCID: PMC5902783. https://pubmed.ncbi.nlm.nih.gov/29661902/

Kraguljac NV, Lahti AC. Neuroimaging as a Window Into the Pathophysiological Mechanisms of Schizophrenia. Front Psychiatry. 2021 Mar 11;12:613764. doi: 10.3389/fpsyt.2021.613764. PMID: 33776813; PMCID: PMC7991588. https://pubmed.ncbi.nlm.nih.gov/33776813/

Kranz GS, Wadsak W, Kaufmann U, Savli M, Baldinger P, Gryglewski G, Haeusler D, Spies M, Mitterhauser M, Kasper S, Lanzenberger R. High-Dose Testosterone Treatment Increases Serotonin Transporter Binding in Transgender People. Biol Psychiatry. 2015 Oct 15;78(8):525-33. doi: 10.1016/j.biopsych.2014.09.010. Epub 2014 Sep 23. PMID: 25497691; PMCID: PMC4585531. https://pubmed.ncbi.nlm.nih.gov/25497691/

THE LANCET DIABETES & ENDOCRINOLOGY: Mortality risk in transgender people twice as high as cisgender people, data spanning five decades suggests https://www.thelancet.com/journals/landia/article/PIIS2213-8587(21)00185-6/fulltext

Lawrence, Anne A. Men Trapped in Men's Bodies: Narratives of Autogynephilic Transsexualism. New York, NY: Springer, 2013. Internet resource, p. 150. https://www.springer.com/gp/book/9781461451815

Matthys, Imke et al. “Positive and Negative Affect Changes during Gender-Affirming Hormonal Treatment: Results from the European Network for the Investigation of Gender Incongruence (ENIGI).” Journal of clinical medicine vol. 10,2 296. 14 Jan. 2021, doi:10.3390/jcm10020296 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7829763/

Mueller SC, Landré L, Wierckx K, T'Sjoen G. A Structural Magnetic Resonance Imaging Study in Transgender Persons on Cross-Sex Hormone Therapy. Neuroendocrinology. 2017;105(2):123-130. doi: 10.1159/000448787. Epub 2016 Aug 5. PMID: 27490457. https://pubmed.ncbi.nlm.nih.gov/27490457/

Mueller SC. Mental Health Treatment Utilization in Transgender Persons: What We Know and What We Don't Know. Am J Psychiatry. 2020 Aug 1;177(8):657-659. doi: 10.1176/appi.ajp.2019.19111151. PMID: 32741290. https://ajp.psychiatryonline.org/doi/epub/10.1176/appi.ajp.2019.19111151

Mueller SC. Mental Health Treatment Utilization in Transgender Persons: What We Know and What We Don't Know. Correction. https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.2020.1778correction

Safer JD. Research gaps in medical treatment of transgender/nonbinary people. J Clin Invest. 2021 Feb 15;131(4):e142029. doi: 10.1172/JCI142029. PMID: 33586675; PMCID: PMC7880308. https://pubmed.ncbi.nlm.nih.gov/33586675/

Seiger R, Hahn A, Hummer A, Kranz GS, Ganger S, Woletz M, Kraus C, Sladky R, Kautzky A, Kasper S, Windischberger C, Lanzenberger R. Subcortical gray matter changes in transgender subjects after long-term cross-sex hormone administration. Psychoneuroendocrinology. 2016 Dec;74:371-379. doi: 10.1016/j.psyneuen.2016.09.028. Epub 2016 Oct 5. PMID: 27744092. https://pubmed.ncbi.nlm.nih.gov/27744092/

Stute P, Wildt L, Neulen J. The impact of micronized progesterone on breast cancer risk: a systematic review. Climacteric. 2018 Apr;21(2):111-122. doi: 10.1080/13697137.2017.1421925. Epub 2018 Jan 31. PMID: 29384406. https://pubmed.ncbi.nlm.nih.gov/29384406/

U. S. Preventive Services Task Force Recommends Against Hormone Therapy for Preventing Chronic Conditions in Postmenopausal Women. For women who have gone through menopause, benefits do not outweigh harms of using hormone therapy to prevent chronic conditions. https://www.uspreventiveservicestaskforce.org/uspstf/sites/default/files/file/supporting_documents/hormone-therapy-finalrs-bulletin.pdf

Zubiaurre-Elorza L, Junque C, Gómez-Gil E, Guillamon A. Effects of cross-sex hormone treatment on cortical thickness in transsexual individuals. J Sex Med. 2014 May;11(5):1248-61. doi: 10.1111/jsm.12491. Epub 2014 Mar 11. PMID: 24617977. https://pubmed.ncbi.nlm.nih.gov/24617977/

Note: The 100 reference article by the head or USPATH does not refer to brain morphology research at all

Some parents have taken it upon themselves to read the research and understand the science and we are very concerned by what we’ve found! Please take the time to read our research…

Gender dysphoria (GD) is the suffering from a mismatch between one’s body and one’s gender identity.  There has been an enormous surge in cases in the past decade, especially among adolescents and young adults with onset starting strongly at or after puberty, a new and different cohort.  Earlier cases were mainly adult or child onset GD.  The science of how to treat GD, a temporary condition for many, is not settled.

Old treatment practice

Until recently, it was understood that if someone had GD you could/would try 

1. “Watchful waiting” (especially if a young person, still developing, brain matures ~26)

   •  ~80% (61% - 98%) with childhood onset [+here] grow out of it; it’s a developmental phase for them.

   • Socially transitioning young people can make gender dysphoria persist (also here).

2. Explorative supportive psychotherapy

   • This is particularly important because other conditions (OCD, autism, [+here], trauma, anxiety, distress[+here]) can cause GD and were in fact often disqualifying for medicalization.

3. Some people have their gender dysphoria persist even after the first two approaches. These adults could undergo an arduous and aggressive intervention (sterilization, body parts removal, lifetime off-label hormones with many significant health risks, including to the heart, also here, blood clots, bones, brain, also here and here, endocrine, immune systems, altered biomarkers, risks not yet fully understood, especially long term). 

   • This medical procedure was extended to younger people with the Dutch Protocol, studies of 55 stringently vetted kids (with many requirements not imposed today). This was an attempt to streamline the first two approaches by attempting to identify, and then medicalize sooner, the small fraction of eventual persisters.  

     • Their mental health outcomes were only evaluated a few years past surgery, not the ~10 years already known necessary to catch many known problems.  

     • Treatment included puberty blockers which have risks to bones, brain (and here, here), heart, fertility effects not known, long term not known.

• The sizeable adolescent onset group is a new phenomenon and not well studied or understood; many have mental issues as well.

• For some individuals, this aggressive medicalization is inappropriate and they eventually no longer want to identify with a gender different from their biological sex (“detransitioners”).  No one knows how many there are, especially given the long average time to regret (~4-10 years), and the evolving prerequisites for starting medicalization (currently almost absent in the US beyond self diagnosis) .

• The evidence supporting these treatments is lacking (and here, here) or of low quality (here, here, here). Studies have not been able to show these treatments improve mental health over time, or that they are safe. Many studies are too short to catch the known problems appearing after 7-10 years or lose participants to follow-up. Many extant studies are flawed, having evidence GRADE of low or very low quality.

There is a lot of support for protecting the people who have gone through this arduous medical treatment from discrimination, and those with this identification.  Absolutely.  Yes. Of course.

A fallacy appears

However, around 2010 there was a change and a false assumption was introduced. This was the (false) claim that having gender dysphoria is innate and unchangeable: if you experience GD you are immutably trans.  Period.  Does not change.  (Even some physicians inaccurately say it's biological.)

There is no evidence for the claim that a given gender identity will persist for all those with gender dysphoria.

Again, it is simply not true that everyone who is dysphoric will be so forever unless they transition.  This is why there has long been the usual route of first trying watchful waiting and/or psychotherapy for co-occurring mental health issues, which will resolve GD for many. There is no known test to determine who might heal from these first two protocols, which is another reason why they have been tried first.  

With this false premise about being immutably trans, again, which is not supported by evidence, the first two treatment steps became labelled unethical conversion therapy.  Now one is told to “affirm”. In spite of having no basis in evidence, this approach was rapidly adopted, and flawed research is quoted to support it, e.g. incorrectly conflating therapy and unethical conversion therapy (and falsely implying ethical psychotherapy is harmful, a non-specialist version of the rebuttal is here), or using flawed research to argue medicalization lowers suicidality. 

This fallacy puts children, adolescents, and young adults at risk. It promotes a harmful unnecessary medicalization of those who would desist with the first two interventions, including the majority of children.  For these young people, the aggressive medicalization and surgery would be a terrible mistake.  Some of these are coming forward now, see r/detrans for an informal “look”.

Keeping the fallacy alive

The false premise of immutable gender identity has been buttressed with untrue claims: that the above first two interventions to heal gender dysphoria cannot succeed and that true detrans people do not exist.  The following inaccuracies facilitate this erroneous presumption: 

• “The desisters aren’t really suffering GD, they are just tomboys”, etc. (there is evidence to the contrary).  There is even a claim that desister studies should be halted (direct rebuttals here and here).

• “Therapy is conversion therapy” (This is a false equivalence, only true if gender identity is immutable, which it isn't).  

• “True detransitioners do not exist, people only detransition or are dissatisfied because of discrimination or lack of funding for treatment” (false).  One spin is here. And the additional untrue statement, that if someone transitions, they are saved from suicide (+here).  This is also, dangerously, told to young people themselves.

These are all false. These are all quoted to support the fallacy that all who feel GD will never stop feeling the distress, unless they transition.  That one treatment fits all.

Again, this claim is not true.

Several professional societies do support the current affirmative approach.  They do not have reliable evidence that supports rapid affirmation.  You can see the low quality GRADE that the Endocrine Society gave for almost all of its supporting evidence, concluded as well in multiple other recent evidence reviews, mentioned above. The AAP policy is based on conflating being gay and being trans, a fallacy, and misquoting the literature.  A formal review of treatment guidelines was released in spring 2021, finding those from WPATH and the Endocrine Society (which concern treatment of gender dysphoria) inadequate.  Note WPATH guidelines are “practice guidelines [...] suggestions or recommendations to improve care that, depending on their sponsor, may be biased.” 

Summary and plea

Some people do heal from gender dysphoria with ethical supportive psychotherapy.  

It is false to say this therapy is the same as (unethical!) conversion therapy for gays. Trans is not the new gay.  One is about sexual orientation and one is about how you see yourself. For the people who heal with therapy, GD is reportedly more like anorexia, something one hopes everyone would want people to heal from.  Explorative supportive psychotherapy used to be the first thing to try, for a good reason.  

One size does not fit all. The urgency to medicalize, without exploration, especially given how many (also here) of these young people have mental issues which are known to cause temporary GD, is not supported by evidence.  Originally a last resort for treating GD under careful supervision, this aggressive, dangerous and experimental medicalization, with irreversible consequences, has been promoted to an “on-demand” commodity.  It is now being marketed directly to vulnerable young people in distress (most of whom would not have even qualified for the few earlier studies) as the only option forward, the way to be “their authentic self.”

Those who try to point out the contraindications of the current rush to medicalization are often falsely accused of a phobia of those who have gone through this painful difficult process. It is not anti-trans to investigate the facts. People are wielding “anti-trans” to make people shut out facts.  Please take a look at the evidence. Again, the science is not settled: it is unknown who will have long term mental health benefits or who will instead be harmed.  The physical toll is enormous and irreversible. If you care about these kids, please become aware of the serious debate in the research community.  

Check out www.segm.org, look at what is being said by experts (books, essays, also podcasts and videos, there are many, one can start here), look at the UK,  Sweden (see Trans Train I, 2, 3). Parents can't speak up.  You can.

Please investigate.

Parents are doing their own research. We’re getting educated, as activists suggested. But, you may be surprised by what we’ve found!

Click here for a table of: Transfacts

What you probably know:

Famous trans people (NY Times spread,”Jazz”, Caitlin Jenner,  Sports Illustrated model), some have difficulties (e.g., Chelsea Manning).  Gender dysphoria (“GD”, mind/body mismatch) is painful.

What you might know:

There’s been an explosive rise in gender dysphoria for ages <25 in last decade: UK, US, Netherlands, Sweden, etc., ~80% are natal girls. Many have stresses (e.g. trauma) and mental health issues; teen suicides are a big concern. 

What you might not know:

It is unknown how to best help gender dysphoria.  

It can go away on its own, it’s a developmental stage for ~80% with early childhood strong onset. For young children, social transitioning can make gender dysphoria persist (also here). It can also go away with ethical, supportive, explorative psychotherapy, since it can be caused by underlying mental health issues (e.g., OCD, autism,[+here], trauma, anxiety, distress (also here). 

There is no definitive“test” to show for whom it will persist, even with trying time/psychotherapy, or when it stabilizes. The new adolescent strong onset group is big, unstudied, and often misinformed. There may be social contagion. Unlike those with childhood onset, it is completely unknown how many adolescent onset people might heal with time/therapy.

Medicalization is aggressive, experimental, and dangerous. It is often irreversible and involves lifetime (FDA off-label) drugs. Medicalization has not been shown to be:

• X Necessary to heal gender dysphoria (time/psychotherapy sometimes succeed). Do not “conflate treatment, in the broadest sense, with physical intervention”

• X Safe:  there are known medical dangers to the heart (also here), bones, brain, endocrine, immune system, and fertility. Also unknown are the long term drug/surgery risks (high mortality is seen).

• X Effective for improving mental health (including suicidality; mental health outcome evidence is low quality evidence ref,ref,ref). Even after transitioning, there is a similar psychopathology to those with mental issues.Research claiming otherwise is flawed (ref,ref, see also suicide risk essays: ref,ref,ref, ref). Some people are in fact harmed and there is an unknown rising number of people trying to undo their medical transitions (detransitioners).  It’s often 4-10 years post medicalization when/if transition fails (here are some reasons/ issues). It’s reportedly painful.

The evidence used to justify medicalization is low quality or low quality certainty: (above and here) because of loss to followup, inappropriate populations, flawed measures, flawed analysis, and studies being too short term (<7-10 years) to catch known problematic outcomes.  Outcomes are not being tracked in spite of huge numbers of young people being treated. (Some MDs report “success” because body/hormones were changed, not because the person’s mental distress was healed!) For the new affirmative model, a young person’s self-diagnosis drives medicalization, rather than expert exploration/therapy.

What you know that isn’t so:

FALSE: “Trans is the new gay” No. Gay is sexual orientation, trans is mind/body mismatch. 

FALSE: “Being transgender is innate, biological, set before birth and therefore doesn’t change, it is merely discovered”  No.  For many, again, gender identity evolves, and there is no definitive test to determine who persists with gender dysphoria.

False corollary: “Trying to heal with counseling is like unethical gay conversion therapy.” No. This fallacy+suicide fallacy below underpins “affirmation” 

False corollary: “The only reason trans people are unhappy is transphobia.” No.  Transitioning doesn’t always help mental health, it mentally/physically harms some, some detransitioners report it was the wrong treatment for their problems.

FALSE: “Kids will suicide if don’t transition, one must help them medically transition to save them.”No. See above.

FALSE: Children/young adults with gender dysphoria get thoughtful careful evidence based healthcare. No. Affirmation is fast, a quick route to drugs (castrates MTF quickly), allows surgery even on minors (breasts are being removed for kids as young as 13)

Why didn’t you know?

Ask Drs. Zucker, Littman, Bell. Psychotherapist James Caspian. You can’t ask parents.
                                             

Now you know. 

Some further information (there are many more resources than this):

www.segm.org, Trans Train I, 2, 3, Gender: A Wider Lens Podcast, Economist articles (Bell, puberty blockers, issues)