Testosterone & young females: What is known about lifelong effects?

by Kerry Smith, MD

Kerry Smith [a pseudonym], MD, is a board-certified internist in the US who has been practicing since 2004. She is the mother of several children, including a 12-year-old daughter who suddenly developed the notion that she is transgender after being exposed to the idea in her 6th grade classroom. It was this development that led Dr. Smith to research the protocol for medical transition of children. She believes that most physicians are blissfully unaware, as she recently was, of the current standards which aggressively promote unstudied and off-label irreversible medical interventions in children too young to drink, smoke, vote, drive, consent to sex, or even watch an R-rated movie.

Dr. Smith is available to interact in the comments section of her article.


What are the risks of giving testosterone to a female for a lifetime?

As the mother of a girl trying on a trans identity, and as a practicing physician, I need an answer to this question.

I’m not the only one. Every day more of us join this club, as the rate of girls questioning their “gender identity” continues to skyrocket, outstripping boys at a previously unimaginable pace. Surely, those who advocate for the medical interventions known as “transitioning” must have a risk-benefit analysis available for parents and patients, before committing young people to a lifetime of pharmaceutical (and potentially surgical) treatment for a poorly defined psychiatric condition?

As a physician who has sworn to do no harm, that’s what I would have assumed.

As it turns out, the WPATH-inspired standard of care, adopted by the US Endocrine Society, has pushed boldly ahead where no medical society has gone before, promoting radical, irreversible body modifications for adolescents using powerful, off-label hormone regimens in the absence of any longterm data about safety.

They are perfectly open about this choice, stating in the standards:

These recommendations place a high value on avoiding the increasing likelihood of an unsatisfactory physical change when secondary sexual characteristics have become manifest and irreversible, as well as a high value on offering the adolescent the experience of the desired gender. These recommendations place a lower value on avoiding potential harm from early hormone therapy.

I suppose it is considered “transphobic” of parents to persist in the nit-picky demand for actual data about what that “potential harm” might consist of, but so be it. Teenagers have always resisted parental concerns about their risky activities. Last time I checked, that didn’t keep us from trying to stop them from using dangerous drugs. Why should testosterone (a schedule III drug in the same category as Suboxone and ketamine) get a free pass?

Sex hormones have a long and checkered history in the US, having been widely celebrated as the fountain of youth before falling from grace after studies belatedly showed multiple adverse health outcomes. This was most striking when the evidence from huge studies WHI, HERS and HERS II demonstrated that, contrary to what earlier observational studies seemed to show, hormone replacement therapy for postmenopausal women actually increased rather than decreased the risk of heart attack, stroke and cancer.

Testosterone had its day in the sun as well, being prescribed not just for the medical condition of hypogonadism, but gleefully promoted as a panacea for the vitality and wellbeing of aging men, for the supposed diagnosis of “low T.” Recently the serious risks of this approach have been described, including increased heart attack and stroke; the FDA eventually placed a warning on testosterone products, and lawsuits are underway; however the shameless promotion to men continues unabated.

As a physician, my first stop for drug information is usually the evidence-based clinical resource UpToDate, which contains full prescribing information for medications available in the US and Canada including dosing, indications, risks, interactions, and other details. I reviewed the entry on testosterone and found that, to my surprise, there is no mention of any suggested dosing regimens for female to male transsexuals.

In the US, once a drug is FDA approved for one use, it is often used “off-label” for other conditions, which is a generally accepted practice. These common, accepted off-label uses will be listed in resources such as UpToDate along with relevant dosing information and warnings. For example, the entry for modafinil, a stimulant, has dosing information listed for the FDA approved indications of narcolepsy, obstructive sleep apnea, and shift-work sleep disorder, as well as for the off-label indications of ADHD, cancer related fatigue, major depressive disorder, and multiple sclerosis related fatigue.

In contrast, the UpToDate entry for testosterone makes no mention of any approved or off-label use for the treatment of transgenderism or gender dysphoria. The only indication for testosterone in females listed is for the adjuvant treatment of postmenopausal women with metastatic breast cancer.

I then checked the FDA prescribing information for Depo-Testosterone (injection) and Androgel (topical), and found a total lack of any reference to use in females for any purpose whatsoever.

testosterone

Testosterone:  Schedule-III controlled substance. The US FDA doesn’t acknowledge or mention its use, on- or off-label, for FTMs

This absence speaks volumes. While the WPATH Standards of Care would have us believe that “[f]eminizing/masculinizing hormone therapy – the administration of exogenous endocrine agents to induce feminizing or masculinizing changes – is a medically necessary intervention for many transsexual, transgender, and gender nonconforming individuals with gender dysphoria,” the reality is that this treatment is so far out of the mainstream of modern medical standards that it is not yet anywhere reflected in basic prescribing reference materials, even as an off-label use.

Because “transgender medicine” is a new field, there is as yet no meaningful body of data that can definitively answer the question of what risks my daughter might face if she embarks on decades of testosterone injections. Studies promoting this treatment as “safe and effective” are generally limited to a few dozen patients and a year or two of follow up. A review article in the Lancet published in April 2016 touted as providing “an evidence-based overview of the benefits, risks, and effects of testosterone therapy in transgender men” observed that “testosterone decreases HDL cholesterol, increases triglycerides, might increase systolic blood pressure, and might increase the incidence of [type 2] diabetes and metabolic syndrome” but was forced to ultimately conclude that the long term effects are largely unknown due to “a paucity of high-quality data” in this area, a disclaimer found in most articles regarding cross-sex hormone treatment.

The desired effects of testosterone for transgender-identified females are the development of male secondary sex characteristics: hair growth on the face and body, changes in bone structure, increased muscle mass, redistribution/decrease of body fat, deepening of the voice, cessation of menstruation, decreased fertility and clitoral growth are all expected. Of note, even these desired effects may not live up to the hype; clitoral growth can cause pain or numbness and, in some cases, appears to lead to difficulty attaining orgasm; voice changes may not reach the desired pitch, leading some patients to seek out voice deepening surgery; some reports suggest increased muscle mass on a female frame can lead to thoracic outlet syndrome.

Of these effects, the changes to body composition, menstruation and fertility may be reversible (if testosterone is started post-puberty; if administered immediately after puberty blockers, irreversible sterility is the norm). Though testosterone is a known teratogen, there is no shortage of glamorous stories celebrating transmen who manage to conceive and give birth after stopping testosterone. However, changes to voice, bone structure, hair distribution and genitals are usually permanent, even if the hormone is stopped.

Then there are the undesired effects. The most commonly reported one is acne, which is often severe enough to require treatment. Male pattern baldness is also unmasked in those who are genetically predisposed.

More important than cosmetic effects are the changes in markers for cardiovascular disease. Studies tend to show that exogenous testosterone increases LDL (bad cholesterol), lowers HDL (good cholesterol), increases erythrocytes (red blood cells) potentially leading to venous thromboembolism (blood clots) from polycythemia, and increases blood pressure. It has also been shown to increase fluid retention which can contribute to heart failure.

Studies suggest as well that in women (but not men), higher endogenous testosterone levels correlate with insulin resistance and the development of diabetes, and studies suggest that adding testosterone in the form of a drug may increase risk for diabetes.

Even in male patients, studies clearly indicate that testosterone therapy increases the risk of cardiovascular disease including heart attack. One review article notes dryly:

“The effects of testosterone on cardiovascular-related events varied with source of funding. Nevertheless, overall and particularly in trials not funded by the pharmaceutical industry, exogenous testosterone increased the risk of cardiovascular-related events, with corresponding implications for the use of testosterone therapy.” [emphasis added.]

In other words, all studies showed an increase in cardiovascular disease, but this effect was “less prominent” in Big Pharma funded studies. What a surprising coincidence!

Testosterone may cause mood changes. Small studies suggest testosterone treatment in transmen can increase anger, which makes sense, given that abuse of testosterone by bodybuilders is known to sometimes result in “roid rage,” a condition of unchecked anger and aggression. One article reports a case of late onset psychosis associated with testosterone use in a trans-identified female, in whom no other cause could be found.

Testosterone has also been associated with liver damage or tumors, though more often in oral formulations rather than the injectables favored by transgender medicine practitioners. It has been known to impair kidney function. It has been shown to impair mitochondrial function leading to oxidative stress. The list of recommended laboratory tests for monitoring is long.

The effects of testosterone on the ovaries and uterus are not well defined. Early research suggested testosterone administration causes enlarged and cystic ovaries similar to what is seen in polycystic ovary syndrome. While studies in postmenopausal women suggest that testosterone does not stimulate abnormal growth of the endometrium (uterine lining), small studies of young FTM patients suggest that in younger females, testosterone administration does induce proliferative changes in the endometrium, which could theoretically progress to cancer. Cases of ovarian cancer have been noted in females treated with testosterone. These changes to the ovaries and endometrium explain why removal of the uterus and ovaries are often suggested for FTM patients on long term testosterone treatment, though there is no medical consensus on this as there is minimal data.

There is some experience giving testosterone off-label to postmenopausal women for hypoactive sexual desire disorder (HSDD); indeed this treatment is still promoted online and prescribed by some physicians. However, despite promising results for women’s libidos, studies suggest that even low dose testosterone may increase risks for endometrial and breast cancer, and as of yet there is no FDA approval for any form of testosterone for this indication.

So, the state of the art of transgender medicine for a young girl who believes she is a boy is to affirm this belief using hormones and possibly surgery. Current standards promoted by WPATH include puberty suppression using Lupron as young as age 10, followed by cross-sex hormone treatment with testosterone by age 16. It should be noted that in the United States, top gender doctors who see the greatest number of patients often begin cross-sex hormone treatment much earlier (as young as 12 in this recently published study).

We don’t know all the side effects this regimen may produce, but when started before puberty, one effect is certain: permanent sterility.

Aside from that pesky side effect, the expected effects of testosterone treatment include changes in body fat and muscle composition, changes in bone structure, facial/body hair growth and male pattern hair loss, clitoral growth, changes in sexual function, voice deepening, cessation of menstruation, and increased acne.

Likely side effects include adverse changes in cholesterol and blood pressure, leading to increased risk for heart attack and stroke; increased red blood cell mass which increases risks for blood clots; and changes in the ovaries and uterus potentially leading to increased risk of cancer, for which many experts recommend hysterectomy and bilateral salpingo-oophorectomy.

Possible side effects include increased risk of diabetes (another risk factor for heart disease and stroke), possible liver damage, possible kidney damage, risk of mitochondrial damage, and perhaps an increased risk for psychiatric disease.

How significant are these risks? Will they be worth it to a generation of “gender nonconforming” kids as they start their adult lives already committed to a lifetime as chronic medical patients? Will they face premature disability and death?

No one knows. Maybe it will all work out fine. Maybe testosterone really is the fountain of youth, providing strength, energy, vitality and virility to brave young gender outlaws, as they sacrifice their fertility to give birth to their authentic selves with the eager assistance of the medical and pharmaceutical industries.

Maybe.

But medical history is littered with miracle cures gone wrong. Future historians will judge whether the massive increase in girls and young women prescribed testosterone will go down as a triumph of medicine–or an ill-begotten disaster.

 

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64 thoughts on “Testosterone & young females: What is known about lifelong effects?

  1. This is a great overview; thank you very much. I can’t believe it is so hard to get people to listen when I tell them that this is an EXPERIMENTAL treatment and that girls using T are basically lab rats.

    I have raised most of these points (in letters, since this is the only way kid will listen to me) with my would-be FTM. My bottom line on it is simply, “You may choose to roll the dice with your health when you are a self-supporting adult. Every adult gets to do that. But while you are on my watch and I am paying your living and educational expenses, I will not facilitate or pay for medical intervention like this. I love you too much to be the one responsible for the potential bad long-term side effects.”

    That has been my bottom line all along: that the physical risks are extreme, over time, vs the “risk” of having the kid need to find other ways of coping with the dysphoria and the general “don’t wanna be a girl” point of view. (I think the psych risks are not inconsiderable as well, but I don’t think that’s a strong argument for a teen; they all think they know a lot more than their benighted parents about mental health.)

    I don’t know how parents can look at the risks and still get on board — and become activists for the cause. I know they are scared “because suicide” but it seems that in some cases it’s a lot beyond that; it’s something that starts to define the entire family’s life, the need to become social justice warriors in defense of their kid(s) and to tirelessly cheerlead other families with “transkids” to take the same course of action. If you are a parent who wants to ask questions about the health risks you will generally be slapped down with the equivalent of “oh, honey, let the PROFESSIONALS deal with it.”

    Which I would do, if I had an iota of confidence that the professionals were actually dispensing T on the basis of scientific evidence that it is safe and effective over time in the female body. Evidence that, in fact, does not exist. I don’t even know if any of them give enough of a damn to be collecting it.

    Liked by 6 people

    • I think a lot of parents believe that the “treatments” must have been studied and found to be safe, since they are currently the standard of care, endorsed by multiple professional societies including the AMA, American Psychiatric Association, US Endocrine Society, and the American Academy of Pediatrics, to name just a few. Even as a physician I was unaware that these treatments were wholly experimental and based on ideology, not science, until this issue directly affected my family.

      Liked by 6 people

    • My MIT niece’s suicide happened after she began testosterone, so I am keeping a keen eye on reports of side effects. Also, my spouse had prostate cancer last year after a number of years of taking testosterone for low-T, and if there are risks for bio males from being on it for 10 years to bring their levels to normal, how much more risky is it going to be for bio females, whose bodies aren’t supposed to have anywhere near these levels, being on this regimine for decades?

      Liked by 4 people

    • Puzzled, I am on your page. My daughter might hate me for it right now, for not getting onboard with this, but I picture how much she will hate me in years to come if I would let her and it turns out to be a mistake, when her health is ruined, her life messed up. Then she REALLY has a reason to hate me for not protecting her from herself. We are the adults here and have to act like adults, protecting our children from making a colossal mistake.

      Liked by 3 people

  2. Thank you for writing such an honest, common sense article. It seems incomprehensible that doctors are allowed to prescribe any drug ‘off label’ without any safeguards or governance? How can that be?

    Liked by 3 people

    • Because the path to FDA approval for a specific indication is long and costly, once a drug has been approved for one indication it is allowed to be used for other, off-label uses. It’s a way to allow physicians to use clinical judgement and allow patients access to needed medicine without long delays awaiting results of specific studies to gain approval for each new indication. However, just because a drug *can* be prescribed doesn’t mean it *should* be, and physicians are still bound by ethics to follow clinically appropriate standards of care. Unfortunately in this case, a politically motivated body, WPATH, has directly influenced the standards of care which have then been adopted by specialty medical societies. The medical societies probably have good intentions, but in my opinion have failed to demand a reasonable demonstration of safety and necessity for this unprecedented change in treatment of children and young adults.

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      • So when this house of cards falls apart and many teen girls are left in the wake dealing with permanent changes they may no longer desire, will there be any ramifications to the physicians who prescribed the ‘medicine’ or are they covered by the simple act of having had the Informed Consent form signed. Is that their get out of jail card?

        Liked by 4 people

      • They’ll be awol and it’ll be mommy helping the kid pick up the pieces.

        Per usual.

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  3. Thank you for summing up all of the ways that testosterone effects young women. My daughter, who has been taking it for over a year now, has the acne,facial/body hair growth, and even the shape of her face has changed. I don’t know how it is effecting her internal organs and I’m sure she would never tell me. I do know that she’s more aggressive. After letting her drive the car this winter part of the way to her grandmother’s house, I know I won’t do it again because of anger issues. It’s like taking a drug. I’m sure that car accident rates must go up when woman are taking high doses of testosterone.

    I hope that you, as a physician, can get these serious concerns across to your colleagues. Of course, big pharma will push this for the money, but I would hope that doctors with a conscience will soon understand what is at stake here.

    This is pure experimentation on young women and it needs to stop!

    Liked by 7 people

    • I totally agree it is experimentation and needs to stop! I am working on bringing my concerns about this to my local medical society. It boggles the mind how quickly and silently things have progressed on this front. If you aren’t directly impacted by this trend, as a physician, you would not even have heard about it.

      Liked by 4 people

  4. Thank you for writing this. This is nothing short of pure insanity, misogyny of girls and young women and disrespect for the families raising these young people. I have no problem with severely dysphoric individuals seeking hormones and surgeries after they have experienced enough of their life and developed a sense of where they fit in the world. What a shame for those truly struggling that runaway medicine has hijacked the hysteria of youth for their pocketbooks. What a shame for doctors that uphold their ‘first do no harm’ oath to watch their profession stoop to such atrocities.
    I would argue that ‘transgender’ medicine is not so much a new field but rather a reinvention of ‘transsexual’ medicine that was widely debunked when Johns Hopkins shut the doors of their Gender Identity Clinic in 1979 after a study showed that the psychosocial outcomes of patients was not helped with treatment. The field festered and is now being dusted off and polished off as something grand and wonderful and being forced on the youth of today. There is an enormous effort to mainstream this and yet as you mention it is “so far out of the mainstream of modern medical standards that it is not yet anywhere reflected in basic prescribing reference materials, even as an off-label use.” The reason is there is absolutely no science behind any of this!

    Yet a search for studies on the use of testosterone in females brings up these articles:
    https://academic.oup.com/jcem/article/102/7/2349/3098651
    https://www.researchgate.net/publication/292391480_Subcutaneous_Testosterone_An_Effective_Delivery_Mechanism_for_Masculinizing_Young_Transgender_Men

    Yes, let us just ignore the effects of testosterone and see how effectively we can introduce this poison into the bodies of America’s young women. What great idea!

    I have absolutely no idea what these sick doctors are trying to cure. Growing up female? Is that really such a bad thing? The female body is why we are all here on this earth. This is surely a cure gone very very wrong.

    Liked by 7 people

    • I could not agree more that this is in many ways a brutal expression of misogyny. In the old days, “transsexualism” was overwhelmingly a condition seen in natal males. This ROGD phenomenon is disproportionately affecting girls, and it seems clear to me that much of it is a result of the ongoing misogyny in our culture, and young girls perceiving a new escape hatch. How many of us would have taken a pass on growing up female if we’d had the chance? I shudder to imagine.

      Liked by 3 people

      • Misogyny is exactly what it is, pure and simple. The bizarre thing is that it should reach such a fever pitch at the very time when women have more options and more opportunities and greater freedom than women of previous generations ever dreamed of.

        Liked by 2 people

  5. It’s so sad that this is what is happening to our young teenaged girls who think they should have been born as a boy. In my case, I believe my daughter was being rejected socially by all the girl groups at school, again and again. She desperately wanted to fit in anywhere and have a relationship so badly with anyone. She is lonely. She is very artistic and quirky. She is a total activist for any group supporting human injustices, especially against women. She says she hates men yet wants to be one, go figure?!? Making it hard for her to fit in by the peer group standards. I truly believe she tried on being transgender and got alllllll kinds of attention from school mates, male and female, and teachers, and followers on Instagram and tumblr. Her popularity rose, to her liking, and she ain’t coming back to boring old self. She turns 18 in a few months and talks about taking T, top surgery and can’t wait for her voice to deepen! It breaks my heart. I cannot embrace this. She showed no signs ever, growing up she wanted to be a he. Ever. It was at 15 that everything went sideways for her. If you try to say anything like can we push the pause button and ask why are you hiding in this? I am instantly transphobic. We have decided that as long as she is living with us we cannot support taking T or any other therapies for her transitioning. When I drop her to school, I see many transgender girls, not just one or two. It makes me shiver inside. I feel helpless. Am I the only one who notices these young girls are now all of a sudden wanting to be boys? Is this a result of a different kind of bullying? Where one feels safe to abandon their female self in order not to have any inappropriate attention drawn to them from abusive boys? I really don’t know. She played house growing up wanting to be the mom, wanted dolls and dresses. Ran to the girl section in toy stores. I am not convinced this is who she is. I cannot go along with it and her pronouns. I believe 20 years from now we will be watching documentaries about her generation, where they went wrong, the legal cases that will come out of this and people coming forward with terrible life stories to tell. I wish there was something more I could do. Everyday I pray her eyes would be opened to the truth. That she would see the pharmaceutical companies, doctors and therapist only want her money. That she is making herself a slave to them. I pray for push back, however that happens, whatever that looks like. That more and more people would come forward and her generation would stop this nonsense. I’m so glad she is still alive, still lives with us. As long as she breathes, there is hope!

    Liked by 8 people

    • Tapi my story is so like yours, it gave me chills to read it. I am so afraid of the next generation and what they will be like. Are there going to be fewer and fewer children born because our daughters have ruined themselves physically?? What a sad world we live in.

      Liked by 5 people

      • Tapi,
        You described my daughter as well. She has gained recognition and popularity through her social transition. I am guessing she sees those improvements as further evidence she has found her true self. My heart aches literally; I suppose I should have that checked out.

        Liked by 4 people

    • My daughter is also a total social justice enthusiast and socially awkward. I think one of the things being covered over by transactivism talking points is that MOST girls feel “dysphoric” during puberty and adolescence. I sure did! I recommend Lisa Marchiano’s “letter to a teen” published on this blog last month. (https://4thwavenow.com/2018/05/10/the-project-of-a-lifetime-a-therapists-letter-to-a-trans-identified-teen/) I read it to my daughter last night, then printed it out to let her mull it over herself. There are so many healthier ways to deal with adolescent angst than latching on to a false identity. I am holding my breath that my girl can find her way out.

      Liked by 4 people

    • Tapi, your description of your daughter is familiar to many of us on 4thWaveNow.
      It is a terrible feeling to lose your daughter and watch them go off this direction, self-harming with a whole lot of help & much cheerleading.
      The lost girls.

      Liked by 4 people

  6. Great article; thank you. It is impossible to believe what is happening to our young girls. ROGD, never seen before, is damaging the lives of girls/young women who generally seem to fit a profile highly intelligent but quirky; huge social media bingers/addicts, etc. How can it be that the medical and psychiatric spheres shrug off this obvious commonality and push hormones full speed ahead — as the age of girls self-IDing as trans continues to drop? Do you think some of this cavalier attitude is because they are female, and just don’t matter as much? Is our society simply throwing them away because “silly” pre-teen/teen/young adult “girls” are “moody, emotional, melodramatic,” etc., and it’s just not worth taking the time to study ROGD?

    Liked by 4 people

    • Just another quick thought–when I began researching this to understand my daughter, I found many studies and papers going back decades, all on boys. So many hypotheses, so much time spent on this. Then, when suddenly girls are victims, medicine and science hurtle toward affirmation and dangerous, life-altering prescriptions…

      Liked by 5 people

    • I am very cynical and I do think it is because of misogyny and homophobia that this unprecedented “treatment” is going mainstream so fast. Medicine has never been very good at taking the time to look at the ways that diseases affect females specifically, so it’s easy to lump these new ROGD girls in with “childhood gender dysphoria” which was more studied in boys. There is a narrative that says these girls were “always that way” but since being a tomboy isn’t as alarming to parents as being a boy in a princess dress, we didn’t see them. I don’t buy it.

      The kids who are getting trans’ed would, in the past, mostly have grown up to be gay. It’s hard for me to imagine an experimental treatment with the side effect of LIFELONG STERILITY being used so cavalierly with “normal” (straight-acting) kids in this way. This plague is erasing a generation of young lesbians. That is my opinion as a bisexual woman and a feminist, not speaking as a physician.

      Liked by 1 person

  7. Dr. Smith:
    I keep thinking the only thing that will stop this train is law suits. I know you’re not an attorney, but I assume MDs receive some training on how to practice in a way that limits their liability. Do you see legal vulnerabilities in the way transgender medicine is being practiced?
    If doctors get signatures on informed consent forms, does that cover their rears completely?
    If doctors are following the standard of care endorsed by multiple professional societies, does that cover their rears completely?
    Does the fact that this treatment is not yet anywhere reflected in basic prescribing reference materials even as an off-label use leave doctors open to lawsuits?
    I remember reading a news story where the head of a gender clinic was bragging about how his clinic would be the first to do a long term study of the effects of transition treatments. I was outraged. How long had that doctor been prescribing these medications knowing there had been no long term studies?
    My daughter hasn’t done any medical treatments so far, but I swear if she comes to harm because of this, I will do everything in my power to go after these jokers.

    Liked by 4 people

    • I do see legal vulnerabilities. I’m not a lawyer, but we know as physicians we can be sued for any reason or no reason, and I am shocked that these prescribers are not more worried. I think that the official standards of care being supported by so many professional organizations will protect a lot of ordinary physicians, but I assume (and hope) the legal system will allow patients who were harmed to hold to account to those who wrote the standards knowing there is no long term safety data.

      Liked by 2 people

    • You might take a look at the numerous Accutane lawsuits. It was prescribed off- label for acne and caused long term serious side effects and permanent damage to many teens who were given it.

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    • First time commenter – I’ve been reading up on all this gender-critical stuff big-time since a lesbian friend was pilloried for “cotton ceiling-ing” a trans man (she didn’t, of course, she just has a girlfriend she didn’t want to cheat on, and her offers of friendship were clearly mistaken for interest!) I’m not a lawyer but a final year law student. In Australia, consent covers a lot of medical failings, but a doctor must always provide an informed warning regarding any medical treatment, and doctors have been successfully sued for failure to warn of even extremely rare outcomes, for example, a 1 in 14,000 chance of a particular surgical complication – but generally only if that outcome would be considered especially important for that patient to know about (in that specific case, the woman was having a cosmetic procedure on an eye she was already blind in, and the 1 in 14,000 complication she wasn’t warned about, that did develop, meant she lost her sight in the other eye and became totally blind – she won a hefty payout.)

      A patient cannot sue if they were not warned about a complication that did not develop (no harm done) even if they would not have consented, given that warning. Also, a patient cannot sue if they develop a less severe complication, and would not have given consent if they were given a full warning (e.g. if the patient would not have consented to a procedure if they knew total paralysis was a possible outcome, but they develop numbness in their leg which, if the risk was warned about, would not have stopped them going ahead with the surgery, they can’t sue.)

      Doctors can defend themselves by providing evidence that the treatment they provided is accepted and widespread in the Australian medical community (this definition is being narrowed and narrowed – so if 10% of doctors will do something and 90% say no way, the doctor likely still has a defence.) They just have to prove the treatment is not completely irrational, essentially.

      All that said… I definitely see a wave of future lawsuits, especially in the US (I’m a duel citizen and lived there for 10 years) – and not just against doctors but against those well-meaning affirming parents. There is not a lot of medical evidence regarding the long-term health effects of these treatments and, especially with minors, you always have issues of what informed consent means. If a patient successfully argues the doctors/parents moved too fast, missed signs of mental illness, and sent them on the path to transition improperly… there goes your informed consent.

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      • I don’t have a great deal of time for WPATH but if a practitioner is following their guidelines, which, as far as I can see, they, all do, then the room for litigation is extremely limited. WPATH de facto sets the accepted international standards of care; abide by those and your position is very strong.

        There clearly needs to be more research done into what is called ‘Rapid Onset Gender Dysphoria’ or ROGD. This is not, in my opinion, a gender dysphoria at all, but a combination of teenage body dysmorphia and social media addiction, together with some extremely suspect messages coming from educators. Gender is NOT just a ‘social construct’ and you can’t change it because you think it might be cool. Without proper study and the updating of the standards to accommodate new information, many people are going to be harmed.

        You have also to remember that Gender Dysphoria is a real thing and those who genuinely have it should not be obstructed in seeking appropriate treatment. We live in an era when, if such treatment is denied, people will simply access hormones on the black market and go to Thailand for surgery as soon as they are 18 or can afford it. Parents are in the crossfire here — damned if you do and damned if you don’t, since not facilitating transition in a genuinely dysphoric minor might well result in permanent estrangement.

        You cannot put this back in the bag. Trans is here. Within a very few years, the West will be like southeast Asia, where there are trans people everywhere, getting on with life. They’re on television, on every street corner, in every town. There is no return to some halcyon idyll where all boys were boys and all girls were girls. It’s gone and in any case, it was a cultural aberration that caused an admittedly small number of people a great deal of distress. Better, more reliable predictive diagnostic measures have to be found and that requires research.

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  8. Thanks MD Smith for this post.
    I gave the article to my 14 year old ‘transgender’ daugther to read and she was horrified, said she had no clue how bad T is and asked why this is even allowed to take. Good question, I can only guess why, but based on her reaction, I have new hope it’s not to late for her to turn this around.

    Liked by 1 person

      • I hope so too! As a side note, the International Classification of Diseases (ICD-10) does not list a general code for gender dysphoria for teens. The reportable diagnoses for gender dysphoria in adolescence and adulthood is F640, ‘Dual Role of Transvestism’ and ‘Transsexualism’. This code is reported to 3rd party payers (private insurance, Medicare/Medicaid) and of course to the CDC for statistical purposes, leading to incorrect data collection. Every time a PCP or therapist uses ‘Gender Dysphoria’ as the primary diagnosis, children statistically end up as transgender, even if they never take hormones or have surgery. The diagnosis of transsexualism also goes in the childs medical record, there to stay forever.

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  9. I don’t think there is any doubt that this experiment will end in disaster. The fact is that there are two potential causes of Gender Dysphoria (GD). One, HomoSexual Transsexualism (HSTS), is almost always preceded by years of childhood gender non-conformity (GNC), including but not limited to: cross dressing, adopting opposite sex names, persistent behaviours commonly associated with the opposite sex, including toy and play preferences and CRUCIALLY; a persistent and intense desire for romantic and eventually sexual relations with the same sex and a complete rejection of opposite-sex relations. The other, autogynephilia, affects only non-homosexual males and no equivalent in females has yet been described in the literature.

    Female-to-Masculine (FtM) transsexualism is relatively more rare than Male-to-Feminine (MtF). This is confirmed by numerous studies. Further, this remains so in parts of the world where transsexualism is much more visible than in the West, eg southeast Asia. While it is true that reduced social intolerance and the availability of social networks, which replace the personal networks found elsewhere, almost certainly are implicated in a general uptick in MtF HSTS and a reduction of the age of presentation of AGP in the West, there is no way that the model found in southeast Asia predicts the current rise in FtM referrals in the West; further, most of these are appearing with none of the previous history of GNC normally associated with HSTS.

    In addition, the uptick in FtM seems to involve reported body dysmorphia appearing at the same time or even before the GD. While this is often found in AGP males it is extremely rare in HSTS. Taken together these factors strongly suggest that what we are seeing is a new phenomenon, which has been called Rapid Onset Gender Dysphoria. But as yet no proper study has been done, without which, clinicians should proceed with the utmost caution, which is not being shown.

    WPATH has long been an AGP advocacy organisation and its policy objectives are defined by AGP men. These are not well adapted to MtF HSTS and even less so to FtM in any form. WPATH is not a reliable authority on this topic, rather it is a political pressure group.

    Liked by 1 person

    • Interesting comments. I read your blog and have watched your videos. I agree with most of it. Strongly disagree with a few things. But always interesting. And yes postmodernism sucks.

      Like

    • WPATH is NOT a group of objective medical professionals. It’s the Harry Benjamin Fan Club. I just came across a succinct description of their history in this paper:

      Queer Diagnoses: Parallels and Contrasts in the History
      of Homosexuality, Gender Variance, and the Diagnostic
      and Statistical Manual
      Jack Drescher

      Arch Sex Behav
      DOI 10.1007/s10508-009-9531-5

      According to a colleague, ‘‘By 1972, Benjamin had diag-
      nosed, treated, and befriended at least a thousand of the ten
      thousand Americans known to be transsexual. In the process,
      he had come to be regarded not only as the discoverer but also
      as the patron saint of transsexuals’’ (Person, 2008, p. 260).
      Notably, he accomplished this in a private practice setting
      without either university or academic support. In acknowl-
      edgment of Benjamin’s early advocacy for the medical treat-
      ment of transsexualism, in 1979 the newly formed Harry Ben-
      jamin International Gender Dysphoria Association (HBIG-
      DA),47 which would go on to develop standards of care (SOC)
      for treating trans individuals, was named in his honor.48

      ***
      One more time for emphasis:

      “in a private practice setting
      without either university or academic support.” (!!!)

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      • http://web.uvic.ca/~erick123/#HB

        Erick Erikson was a ‘transman’ philanthropist who had a pet leopard and became a drug fugitive… and funded research on homeopathy and transsexualism.

        Erikson funded the first few Harry Benjamin symposia. When that funding stopped, they incorporated as a non-profit and came up with the Standards of Care.

        HBIGDA eventually re-named itself to WPATH.

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  10. Great article – hoping a journalist with a moral compass is able to bring this to the mainstream.

    At the heart of this is whether or not an individual has a lifelong, crippling dysphoria which can only be alleviated by hormone treatment – in which case one could possibly concede that the benefits may outweigh the risks. This pre-supposes an unproven biological model of the condition.

    I very much doubt whether many of the current generation of trans-identifying teenagers and young adults (my autistic daughter included) do indeed have a (supposedly rare) lifelong condition.

    The endocrine society guidelines, summary available here:
    https://academic.oup.com/jcem/article/102/11/3869/4157558

    ends with this telling sentence:

    “Clinicians should avoid harming individuals (via hormone treatment) who have conditions other than gender dysphoria/gender incongruence and who may not benefit from the physical changes associated with this treatment.”

    I would be extremely worried if I were a clinician who did not take extreme care in establishing that the individual they are treating did not have “conditions other than gender dysphoria”.

    Liked by 4 people

    • I think that sentence about avoiding harm is critically important and seems to be overlooked in the excited rush to transition kids. With so many of these dysphoric kids also having ASD, ADHD, depression, anxiety etc. how can these clinicians KNOW that their symptoms are only due to GD and that hormones will help? This is why reasonable people would assume there should naturally be mental health gatekeeping, rather than the simple informed consent model that has sprung up so recently, without anyone realizing until it happens to their family.

      Liked by 2 people

  11. Can I please also ask you to consider seriously the request from Deborah Whipple? Thank you. I am a transwidow in the UK. According to the UK Government’s statistics there are 3 times as many MtF transsexuals with Gender Recognition certificates as FtM. The health problems for males would, presumably, be of similar kinds and degrees of seriousness…. .Or would they?

    Like

    • Yes I will write a summary about the harms of MTF hormones as soon as I can gather the time. The health problems for MTF are well known and include an increased risk of blood clots in particular as well as cardiovascular risks. MTF hormone therapy is considered more risky than FTM hormone therapy, in all the literature I reviewed for this piece. Stay tuned.

      I’m very sorry to hear what happened to your husband. It’s increasingly common, as you know.

      Like

  12. My goal here is not to troll this website or this article or comments.

    I agree that children should not take hormones for transgender treatment. Blockers to prevent formation of secondary sex characteristics may be a good idea though.

    Disparagement of WPATH is out of line. When you are part of a group that is routinely discriminated against and are by definition fighting for legal and social recognition, paucity of evidence/research is to be expected.

    1. Your kind is wrong and should not be allowed
    2. We will not fund research that might affirm you
    3. Lack of research proves your kind is wrong and should not be allowed

    Catch 22 my fellow Americans. Me and my community are trapped therein.

    Like

    • Merrikat, I understand your situation. Nobody is denying anyone their existence. What is being denied is access to objective evidence-based information while parents are held to ransom with the threat of their child’s suicide.

      Liked by 3 people

    • I think it’s perfectly acceptable to discuss a medical organization which makes medical recommendations FOR MINORS which apparently wants parents to take those recommendations on faith.

      Frankly, I can think of no more grounded cause for concern. Adults can make decisions and wave off risks because they’re adults and they have the freedom to take on those risks, even if unknown. As parents, we are on the hook, into the future, if the choices we made were not informed ones. There is no way a parent can consent to something when they don’t know what they’re consenting TO. What WPATH and USPATH are insisting on is actually the exact opposite of informed consent. And, they’re trying to treat children as adults.

      I believe they completely deserve that criticism.

      Liked by 4 people

    • But there is no such thing as “trans.” The whole thing is a fraud, and unfortunately the girls and boys, women and men who are caught up in it don’t realize this. They are like real-life mannequins of the opposite sex, vainly striking poses in their futile masquerade. I’m sorry to be so blunt, but that’s the way it is.

      The supposed “scientific evidence” that anyone is or could be “trans” is grossly over-interpreted, usually omitting mention of far more plausible alternative hypotheses and spinning out the importance of any perceived association. Nor have alternative approaches to the drastic and illusory “transition” ever even been tested! While the literature contains many case reports and case series of psychological approaches to coping with or overcoming gender dysphoria – some of which held promise, despite the use of old-fashioned methods! – there has never been even one comparative study of psychotherapy for alleviating this type of distress. It is a similar situation with drug therapies.

      For that matter, gender dysphoria is made to seem like some unique unicorn of “proof” that human beings of one sex or the other ought to hasten aboard the transwagon so their healthy bodies may be quasi-medically distorted and re-arranged in such a way to facilitate accurate mimicry of opposite sex stereotypes. But gender dysphoria is not really the sacred oracle of transdestiny that is so madly marketed, “untreatable” without “transition.” Gender dysphoria is a variable, non-specific cluster of depression, anxiety, depersonalization and other common conditions, accompanied by an obsessive false belief that one is “essentially” a member of the opposite sex. If someone had identical symptoms but the “insistent, consistent, persistent” false belief were that she or he was really a cat, a clinician would not greet the patient with a bowl of Little Friskies and a saucer of milk. “Affirmative care” would be completely out. A psychotherapeutic approach using cognitive reframing would likely be a leading option. Yet such strategies are never even considered in people claiming to be the opposite sex. They have never been tested.

      It may take some time for patients to feel better in their own skin, or at least develop skills to help them cope with the reality of their sex, but is it better to make them permanent patients for life, sterilizing them, throwing their healthy endocrine systems into chaos, performing drastic surgeries to amputate or mutilate healthy organs? The net outcome of which is that the patient becomes a more or less effective simulacrum of the opposite sex, a masquerader who reifies the phony ideals of “gender” – which we once well understood as the stereotypes of appearance, mannerisms and roles prescribed for each sex.

      It is true that many such patients claim to be quite happy when all has been said and done, and indeed they may be. Testosterone and estrogen may have a mild positive effect on mood. However, there are huge flaws in the methods of most, perhaps even all studies tracking the long-term outcomes of “gender reassignment” patients. These may include follow-up after too short an interval, failure to account for “sunk costs” bias in patient self-report, extremely high losses to follow-up that are blithely explained away as evidence the patients are doing fine, and exceptionally narrow criteria for documenting patient regret. Given the dramatically higher rates of cardiovascular illness, suicide and other premature death seen in post-operative “trans” patients, it’s incredibly dangerous, indeed it verges on criminally insane, to promote and try to popularize an ideology of easy-peasy, low-risk sex-swaps at any age.

      And this is exactly what WPATH does. Which is why I think it’s great to disparage them. No-one changes sex. “Transition” is dress-up, role-play, drastic unnecessary surgery and dangerous drugs for life. WPATH should know better than to do this, though I guess the judgment of many clinicians & researchers may be impaired in all the cultish excitement. It was also like this in the “repressed memories” craze of the ’80s & ’90s.

      I don’t mean to harsh on anyone’s quest for legal and social recognition. We’re all just doing our best to get through this world in a good way, and sometimes we take one path or another based on stories we were told about that path, or even just our hopes for it. I wish everyone well who has fallen into this, but it’s not helpful to pretend it’s all peace, love and crunchy granola. I went quite a ways down the transroad myself, 13 years in that illusion. It seemed pretty good, until one day I was wide awake inside the dream. Then I saw how things really were.

      Liked by 6 people

    • No, sorry, puberty blockers are dangerous – Lupron has a major known side effect, which is severe osteoporosis, so you are advocating for broken bones and spinal problems in otherwise healthy girls with this insanity.

      What’s up with this “your kind” crap? Quit with the victimhood. Trans people have never been as celebrated as they are today. And that is precisely the problem. Your whiny guilt trips make it impossible to call for prudence. Any suggestion that we slow down the trans train is met with gaslighting and threats of suicide.

      Liked by 1 person

  13. I am wondering why insurance companies are paying for these experimental treatments, and perhaps there is a way to alert the industry to the negative consequences of these treatments so that they reconsider paying for it, or at least require more and more evidence from the doctors that the treatment is warranted. It is just too darn easy to receive these drugs and surgeries, when it would cost the insurance industry far less if other less severe treatments such as talk therapy were mandated first.

    Liked by 2 people

    • It’s quite perplexing how this was so rapidly adopted as a covered benefit. Maybe someone with expertise in the insurance industry could delve into the specifics of how this was so rapidly pushed into acceptance? I, too, find this puzzling.

      Liked by 1 person

      • I too would love to hear from malpractice lawyers and/or insurance actuarial types. I hope someone with this expertise reaches out and writes a piece from that perspective.

        Another perspective that would be interesting to hear from would be a skeptical endocrinologist. I live in a small public health jurisdiction; the single endo clinic deals with diabetics and trans (to mixed reviews). The recent UK NHS consultation report seemed to leak a certain reluctance from some physicians about prescribing these hormones. If I was an overbooked endo, I’d be slightly resentful of a group of patients demanding I facilitate an iatrogenic medical condition.

        Like

      • @Leisha Camden, I have read that essay at mercatornet and I think it is very well done. I wish we physicians on the left of the political spectrum were as free to comment on this madness under our own names as those on the right!!

        Like

  14. Anytime I bought up my concerns about the safety of testosterone I was either dismissed or made to feel like I was being irrational for even having those concerns. The gender therapist at leading children’s hospital said “all medicines have side effects”. Well I would like to know what they are! Silly me!! What an overbearing mother I am

    Liked by 5 people

    • It’s true, all medicines DO have side effects. The responsible physician will help the patient and their family carefully weight the risks and benefits of any proposed treatment, including the risks and benefits of no treatment, and taking into account the possibility of future effects not yet known.

      Like

    • Carey Callahan (aka Maria Catt) is interviewed in that article (and in a video). The article does not mention that what got her to start the detransition process was that the testosterone she was taking was destroying her liver. At least, that’s what I remember from one of her early YouTube videos about it.

      Like

  15. This article in The Times (UK) today.

    Apparently boys and young men taking off label testosterone to enhance their bodies is risky:

    “ The steroids are a synthetic version of the male hormone testosterone, used to build muscles. They can be injected or taken as a pill, but can lead to high blood pressure, heart problems, mood swings and
    dependence.”

    https://www.thetimes.co.uk/article/teenage-boys-take-steroids-to-get-love-island-bodies-llt97krbt?shareToken=eb744971f3a5ab7e142dc0b341531861

    Yet for young women it is prescribed without much concern?

    Liked by 1 person

    • The pressure on young men to have the muscles of a 30-year old in their twenties is intense. My son went to Oxford, studied hard and never had time to go to a gym. The minute he started work (with a 1st class Honours in Greek and Latin!) he was off to the gym and drinking a whey protein drink every day. I told him that he would bulk out naturally as he got older. I also teased him that full milk would do the same and cost much less. He looked a bit embarrassed but kept on. He now has the physique which he wants (at 23!) and he is taking it easier. I wanted him to do more social sports – not a gym where you talk to no one. I am still on at him about being socially sporty!
      I loved the comments under the article: “the best way to pull the girls is to have a big brain!” YES… and work on the humour, not the muscles!

      Like

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