Book Recommendation: So, you think you may be trans... A critical guide to the debate around trans identities for parents, teachers and others involved with caring for children and young people.

News Commentary

Gender Health Query recommends the book by Tim Davies, 'So, you think you may be trans... A critical guide to the debate around trans identities for parents, teachers and others involved with caring for children and young people.

This book covers many of the issues addressed on our website. The book is factual and written with compassion. Some topics include the history of the trans movement, a clear description of gender ideology, and the complex issue regarding gender dysphoric minors and mental health.

Book description:

In the last ten years there has been a meteoric rise in the number of children and young people self-identifying as 'trans' and seeking to transition to the opposite gender. This is a global phenomenon, apparent throughout the English-speaking world, Europe, South America and beyond. In England and Wales, the explosion in referrals to gender identity clinics has resulted in long waiting lists and, in 2022, to the proposal to reconfigure and extend NHS gender identity services for children and young people.
The response to this development encouraged by the World Professional Association for transgender Health and many official medical bodies (and endorsed by trans-activist organisations) is 'affirmative care': accepting what a child says on the basis that only they can know their 'true' gender identity.
There are now dozens of books available providing parents, teachers and other carers with step-by-step guides to facilitating the child or young person's transition. This is not one of them!
In the last few years, increasing numbers of young adults have appeared on on-line platforms expressing 'transition regret' and seeking to de-transition. At the same time, medical authorities in a number of countries - Finland, Sweden, France, England - have rejected affirmative care and adopted a much more cautious approach to treating minors suffering from gender dysphoria.
All of this leaves parents, teachers, residential care workers, etc. in an invidious position. How should they best support a child or young person who tells them that they're trans? Clearly, there are people for whom transition offers the chance to relieve deeply-felt distress about being 'trapped in the wrong body'. But, equally clearly, there are many troubled youngsters caught up in this new social phenomenon who wrongly believe that transitioning offers a quick fix for more deep-seated problems.
This book aims to provide parents, teachers and others with caring responsibilities with the knowledge and understanding they need to feel confident in responding to gender-questioning children and adolescents. It is not a step-by-step route guide, but a guide to the terrain.
The book provides a brief history of transsexuality, suggests why there has been this explosive growth in cases (and why it is adolescent girls who have been the most affected), explores what children and adolescents might mean when they say they're 'trans' and takes an in-depth look at the medical debate around diagnosis, assessment and treatment. In addition, it examines the role of what has been called 'gender ideology' and - in order to contextualise the debate surrounding trans youngsters -provides a commentary on the wider debate surrounding girls' and women's sex-based rights.

TOPIC UPDATES FOR 2023: TOPIC 2 (PART 2) CONSEQUENCES & PERMANENT SIDE-EFFECTS THAT RESULT FROM THE USE OF HORMONE BLOCKERS

ORIGINAL TOPIC POST= 2) CONSEQUENCES & PERMANENT SIDE-EFFECTS THAT RESULT FROM THE USE OF HORMONE BLOCKERS

We are updating our Topics in 2023 with the most recent and relevant information regarding over-medicalized youth and identity confusion due to queer theory/gender ideology. Since the launch of our website in 2019, only more information has come to light validating our view that pediatric transition is dangerous for children and teens. We support honest and open inquiries regarding this topic. Our focus is protecting lesbian, gay, and bisexual youth from harm, and we want the best long-term health outcomes for all youth, regardless of identity or orientation.

More serious health consequences from puberty blockers, cross-sex hormones, and surgeries are coming to light. This information is forcing the trans-activist-captured legacy media to admit there is anything dangerous about the affirmative model protocol.

They Paused Puberty, but Is There a Cost? As more transgender children seek medical care, families confront many unknowns

We are adding a study indicating the pubertal process is very complex regarding brain maturation.

Coming of age in the frontal cortex: The role of puberty in cortical maturation (Delevich et al., 2021)

Medical Ethics

Due to increasing evidence of harm, several republican dominated states are banning pediatric transition. These laws will be challenged, and this will be a legal battle in the United States for a long time. Health Query does not involve itself in legal battles currently. But we believe it is better for medical ethics board reviews to curtail pediatric transition rather than legislatures. Or, in this case, where the state is merely enforcing existing laws.-

https://twitter.com/agandrewbailey/status/1637882764706848773?s=46&t=_nlFr-A1tHVIfNQH-_MaeA

https://threadreaderapp.com/thread/1637882764706848773.html

Given institutions are caving to activist pressure in the internet age; this is not going to happen at the higher levels or in liberal states anytime soon. Liberal states are making themselves "sanctuary states" for “gender affirmative care,” for runaways, parents who want to medicalize their child, or parents in custody disputes.

Sweden, Finland, the UK, and Norway are countries that are now revieing evidence or curtailing the practice.

Damage From Puberty Blockers

Articles about the dangers of giving puberty blockers to kids-

”New report describes dangers of giving Lupron to kids”

“Use of Gonadotropin-Releasing Hormone Analogs in Children: Update by an International Consortium ‘My body is on fire’: Ga. woman blames drug for pain, sues maker” (Krishna et al., 2019):

Lupron was originally Food and Drug Administration (FDA) approved to treat prostate cancer, but it’s now routinely prescribed for other conditions such as endometriosis and “precocious puberty” — i.e., puberty that begins too early (generally considered under age eight for girls, under age nine for boys). Many of these patients have experienced extreme side effects that shattered their health and their lives, including severe joint pain, osteoporosis, compromised immune systems, and mental health issues such as severe depression and even suicidal ideation. The FDA has received 24,000 reports of adverse reactions, about half of which the agency has deemed serious.

”More women come forward with complaints about Lupron side effects” (suicidal thoughts as a side effect which may be of concern when given to troubled tweens and teens)

Conclusive evidence transitioning male tweens permanently destroys their sexual function

Doctors have permanently destroyed the sexual function of all or most males they puberty-blocked in Tanner stage 2. They will likely experience permanent anorgasmia. Below are WPATH members admitting to this. This is likely due to both the child-like state of the genitalia and the impacts on brain wiring when doctors severely interfere with the pubertal process. Marcie Bowers, a trans-identified heterosexual male, is a vaginoplasty surgeon. Bowers performs experimental and complicated surgeries on minors. The surgery is difficult due to the genital stunting induced by the puberty blockers. 

https://twitter.com/DonovanCleckley/status/1521625518394773505?s=20:

Every single child, or adolescent, who was truly blocked at Tanner stage 2 [by age 11] has never experienced orgasm. I mean, it’s really about zero.

Jazz Jennings was a victim of this effect and a botched vaginoplasty that needed 3 revision surgeries. Bower’s admits in the video that this is detrimental to relationships due to Bower’s experience in dealing with victims of female genital mutilation:

The lack of being able to be intimate with a partner is very important.

This is the sexual lobotomization of children at a stage where they are pre-sexual. Gender Health Query believes this is a human rights crime. Children cannot consent to permanently destroyed sexual function before any sexual experiences. There are no serious calls among “affirmative model” advocates to delay puberty blockers to preserve sexual function, only prescriptions for parents to tell their 10-13 year olds to “masturbate more” before the chemical castration process begins, if even that.

More proof of bone density loss

Major bone mass accrual happens in puberty and then is lost as we age. The problems of reducing bone mass accrual in puberty is obvious.

Endocrinologist Will Malone:

https://openstax.org/books/anatomy-and-physiology/pages/6-6-exercise-nutrition-hormones-and-bone-tissue

Jesse Singal posted an interview with Swedish journalist Carolina Jemsby, who has been reporting on the negative fallout from pediatric medical transition in her country and Karolinska hospital specifically. Sweden is curtailing pediatric transition due to damage resulting from it. The journalist states one 15 yr old has such a severely damaged spine the youth can’t stand up for more than 20 minutes without pain. The journalist said there were other recorded injuries from using hormone blockers and that the doctors seemed very motivated to avoid tracking harm and taking it seriously.

”A Swedish Investigative Journalist Talks About The Youth Gender Medicine Scandal She Helped Uncover At One Of The World's Top Hospitals”

Other articles indicating bone loss due to puberty blockers-

”Pubertal Suppression, Bone Mass, and Body Composition in Youth With Gender Dysphoria” (Navabi et al., 2021)

”Revisiting the effect of GnRH analogue treatment on bone mineral density in young adolescents with gender dysphoria” (Biggs, 2021)

”Hormone Agonist Therapy Disrupts Bone Density in Transgender Youth”

”The Effect of Puberty Blockers on the Accrual of Bone Mass- After two years, up to a third of children have abnormally low bone density”

”Evidence review: Gonadotrophin releasing hormone analogues for children and adolescents with gender dysphoria”

”Puberty blockers for gender dysphoria: the science is far from settled” (Malone et al., 2021):

 The Karolinska Institute in Sweden, long considered gold-standard in providing transgender health care, no longer uses puberty blockers;6 nor does Finland promote their use.7 Additionally, a judicial review in the UK found puberty blockers to be an inappropriate option for most children younger than 16 years. 8 We urge The Lancet Child & Adolescent Health to take this opportunity to engage with this issue, rather than publishing, in our opinion, inaccurate and careless Editorials.

”Puberty blockers revealed to be dangerous for minors: study”

”Puberty blockers ‘stunt bone growth of children”’

We cannot verify the validity of the statements on the r/detrans subreddit below. But it provides insight into how this may be impacting young people in the real world.

https://www.reddit.com/r/detrans/comments/mbmm7x/lupron_side_effects/: 

Brain bleeds and vision loss

 ”FDA Updates Safety Labels for Group of GnRH Agonists”:

Some children who have received GnRH therapies have experienced pseudotumor cerebri, which results in elevated spinal fluid pressure in the brain. This can lead to progressive loss of vision.

Puberty blockers use my increase the likelihood of depression

”Puberty blockers do not alleviate negative thoughts in children with gender dysphoria, finds study” (Dyer, 2021)

The Daily Wire is a conservative website that holds anti-LGB views we oppose, but author Christina Buttons is not of those opinions. We must cite these sources due to the widespread denialism that there are severe dangers to the “affirmative model” in legacy media.

”Animal Study Found Puberty Blockers May Cause Depression — Decades After Doctors Began Administering To Children”:

The results found that treatment with leuprolide, the drug used to suppress puberty, had “profound effects” of increased depression in female mice; in male mice, increased stress and a loss of interest in female mice were reported.

From the study ”Behavioral and neurobiological effects of GnRH agonist treatment in mice-potential implications for puberty suppression in transgender individuals” (Anacker et al., 2021):

Our behavioral and neurobiological characterization reveals for the first time that chronic leuprolide treatment, starting after the onset of puberty, exerts sex-specific effects on social preference, despair-like behavior and hyponeophagia, neuroendocrine responses to mild stress, and hyperactivity of the [dentate gyrus], a crucial neurobiological regulator of stress responses in mice.

 And:

In conclusion, we report that chronic leuprolide treatment in mice has profound effects on female behaviors that are commonly interpreted as depression-like, as well as on neural activity in the hippocampus—a brain region crucially involved in stress processing, depression, and cognition,” the discussion section read.

While these mood-related effects are specific to females, leuprolide causes pronounced differences in locomotion and social preference in males and increases neuroendocrine responses to mild stress,” the researchers added.

Back to the Daily Wire news article (emphasis ours):

Dr. Claudia Gennari, an internist and researcher, believes the negative psychiatric outcomes found in this study have huge implications for pediatric gender medicine.

This study was long overdue and should bring pause to clinicians treating children with puberty blockers because it shows sex-specific neuropsychological changes caused by this medication,” Gennari told The Daily Wire.  

This strongly suggests GnRH agonists are not a ‘pause’ button at all and its use can cause negative effects on cognition, behavior, and coping skills,” she added.

Puberty blockers likely increases persistence

Affirmative model advocates have effectively promoted the “true trans” narrative and social and medical transition as healthy and safe to the public because they are heavily invested in the protocol they encourage. For example, one can find very ideological language written in the Dutch study below, indicating most children/teens who go on puberty blockers persist and go on to transition.

”Continuation of gender-affirming hormones in transgender people starting puberty suppression in adolescence: a cohort study in the Netherlands” (van Der Loos et al., 2022) (emphasis ours):

Most participants who started gender-affirming hormones in adolescence continued this treatment into adulthood. The continuation of treatment is reassuring considering the worries that people who started treatment in adolescence might discontinue gender-affirming treatment.

There is no reason to state this is reassuring. The only way to glean the effects of social and medical transition on minors would be to have a control group of youth who are loved and supported but aided in getting through a healthy puberty and, perhaps, young adulthood until maturation at age 25. It is logical to consider that adding chemicals that strongly affect the brains of growing adolescents may affect their identity development and choices. Stating it is “reassuring” almost all go on to transition is purely ideological on their part and inappropriate for science researchers.

This translates to biased reporting in the media and a propagandized public. Journalists rarely asks why almost all kids are going on to transition. This is the case with the NPR article ”Most teens who start puberty suppression continue gender- affirming care, study finds,” a source that should be unbiased. This enables apathy about what appears to be increasing persistence.

This part of the study indicates transitioning minors increases persistence. Or it may mean they were more dysphoric from childhood, and those who “come out” later are at more risk of regret:

People who started hormones as minors had higher continuation rate than people who started as adults 74.4% (66.0%-82.8%) vs 64.4% (56.0%-72.8%).

In this study the females were likelier to abandon hormone treatment than the males, concerning given the explosion in trans identity in females:

Transfeminine individuals had a higher continuation rate than transmasculine individuals 81.0% (72.0%-90.0%) vs 64.4% (56.0%-72.8%).

Case reports of desistance post puberty blockers

This is a relevant thread on the r/detrans Subreddit. Several of the young people desisted or detransitioned after the use of puberty blockers.

Has anyone here been put on puberty blockers? How has that affected you?:

yes, i was on lupron and testosterone for 11 months starting from the month after i turned 14 to right as i was turning 15. my breasts definitely shrunk a lot (below an a cup) but generally returned slowly, although they never were that big to begin with. i’m now almost 16 and i got my period six and a half months after i started detransitioning. in my opinion blockers shouldn’t be used on minors (in gender transition cases.) another note, the endo that prescribed me lupron did a ‘puberty test’ (i believe it’s the tanner scale test?) except rather than just peeking at my clit development, she squeezed and poked my nipples and stared at my clit with nobody else in the room. this was meant to be preparation for puberty blockers but having read up on this procedure afterwards she definitely was going against the rules of it. on the bright side, i did make it out alive and i am doing generally okay now, at least much better than i was. i think that puberty blockers (or t, or a combination) caused me severe dissociation during the time i was taking them as i had very little coherent thought, i feel as if once i started them i just kind of checked out in terms of life. once i went off both my sense of self returned and i have a level head. :)

The evidence for puberty blockers reducing suicide risk is weak to nonexistent.

Despite a strong drive to promote “affirmative care,” and thus puberty blockers, as “lifesaving,” the evidence for this claim is not strong.

”Researchers Found Puberty Blockers And Hormones Didn’t Improve Trans Kids’ Mental Health At Their Clinic. Then They Published A Study Claiming The Opposite”

”Puberty Blockers and Suicidality in Adolescents Suffering from Gender Dysphoria” (Biggs, 2020):

A report regarding GIDS Early Intervention Study (beginning in 2011) found there was no overall improvement in mood or psychological wellbeing using standardized psychological measures

Tavistock’s Experimentation with Puberty Blockers: Scrutinizing the Evidence

Reasons not to sexually lobotomize and sterilize youth

As we have pointed out in the original Topic #2 article, many trans people want sex lives and to have children.

In the Heterodorx podcast by Nina Paley and trans-identified Corinna Cohn, they talk about the sexual orientation of GAMP. Corrina states that males who want to be females who don’t get bottom surgery are in much higher demand than those who have had it. While there is an unfortunate amount of exploitation of trans people by “chasers,” we believe that males who have this sexual orientation, best described as a type of bisexuality, should facilitate healthier relationships with feminine males with less drastic, expensive, and health-damaging surgeries. Minors cannot weigh the cost of “passing better” to invasive and health-damaging and sexuality-damaging medical procedures.

Episode 42: GAMPs, Pr0n, trans, and the Conservation of Evil

There are more stories of lawsuits from people angry they are now sterilized as a requirement for transition proving fertility is of great importance to many. The same thing is happening in Sweden.

”Transgender Germans seek compensation after forced sterilisation”

Random PB studies

We consider the below study to be poor quality.

”Review: Puberty blockers for transgender and gender diverse youth—a critical review of the literature” (Rew et al., 2020)

We have demonstrated there is weak evidence for the “lifesaving care” claim they make in they make in their conclusion. They also include Jack Turban, who does poor quality research. One study has one participant. And they do not clearly state their search criteria.

The below study on delayed puberty due to congenital hypogonadotropic hypogonadism (Kallmann syndrome) may provide some insights into side effects from delaying puberty in youth.

”Psychosexual effects resulting from delayed, incomplete, or absent puberty” (Dwyer, 2020)

Conflicts of interest in puberty blocker studies

From an article in The Post Millennial, ”Maker of puberty blockers funded original study that led to 'gender-affirming care' for minors: Dutch investigative report”:

A Dutch investigative report has revealed that the 2006 study upon which the entire medical experiment of child sex changes is based was funded by a maker of puberty blockers.

 The NRC article, published on Dec 31, takes aim at the treatment approach known as the "Dutch protocol," which involves blocking the puberty of adolescents who are suffering from gender dysphoria and forms the basis for the "gender-affirming care" model adopted by pediatric gender clinics all over the world.

 ”Ook transzorg moet aan medisch-wetenschappelijke standaarden voldoen”

Another article on Ferring Pharmaceuticals’ involvement in Transgendertrend-

“‘They Look Normal’ – The Case For Puberty Blockers”:

I would want to know why a drug company, Ferring, sponsored the crucial Dutch trial into puberty blockers: the 2006 Delemarre-van de Waal and Cohen-Kettenis paper was ‘presented at the 4th Ferring Pharmaceuticals International Paediatric Endocrinology Symposium, Paris (2006)’ and Ferring Pharmaceuticals supported the publication of these proceedings.’

”Short-term outcomes of pubertal suppression in a selected cohort of 12 to 15 year old young people with persistent gender dysphoria in the UK” (Carmichael et al., 2021) Almost all youth put on blockers persisted and went onto cross-sex hormones and there seemed to be no psychological improvements:

Treatment of young people with persistent and severe GD aged 12–15 years with GnRHa was efficacious in suppressing pubertal progression. Anticipated effects of withdrawal of sex hormones on symptoms were common and there were no unexpected adverse events. BMD increased with treatment in the lumbar spine and was stable at the hip, and BMD z-score fell consistent with delay of puberty. Overall participant experience of changes on GnRHa treatment was positive. We identified no changes in psychological function, quality of life or degree of gender dysphoria.

”Thrombosis Risk in Transgender Adolescents Receiving Gender-Affirming Hormone Therapy” (Mullins, 2021)

This study has a very short window of time, so is not particularly relevant for health effects. There are also conflicts of interest because it’s funded by the makers of puberty blocker Leuprorelin.

Sex Hormone effects

Brain effects

While issues such as depression affect cognitive health, the bad news about brain health in trans individuals is likely due to taking large doses of cross-sex hormones, yet they seem unwilling to focus on this question in the below article.

”’Alarming' Data on Early Cognitive Decline in Transgender Adults”

Cross-sex hormones affect the brain structure of males and females. Adults may be desirous of these changes, but adolescents' brains are not fully formed, nor is their understanding of themselves.

”Cross-sex hormones alter grey matter structures” (Holmes, 2016):

Analysis of brain structures revealed volume changes predominantly in MtF individuals, particularly in the hippocampus — a region involved in neurogenesis and neuronal plasticity. Specifically, oestradiol plus anti-androgen treatment reduced hippocampal volume in MtF individuals, which was accompanied by a global increase in ventricular structures. Moreover, reduced plasma levels of progesterone in MtF individuals correlated with reductions in grey matter structures in the right hippocampus and right caudate. "These structural changes are associated with aging and Alzheimer's does this and so does estrogen...

Fertility effects

Fertility concerns of the transgender patient (Cheng et al., 2019)

Testosterone therapy in transgender men can suppress ovulation and alter ovarian histology, while estrogen therapy in transgender women can lead to impaired spermatogenesis and testicular atrophy.

Bone effects

The below study review study ran into major problems due to lack of consistency in study designs but did find trans-identified males may have lower bone mineral density.

”Systematic Review of the Long-Term Effects of Transgender Hormone Therapy on Bone Markers and Bone Mineral Density and Their Potential Effects in Implant Therapy” (Delgado-Ruiz et al., 2019)

A review indicating dysphoric people do want children-

”Desire for children and fertility preservation in transgender and gender-diverse people: A systematic review” (Stolk et al., 2023):

The majority of TGD people expressed a desire for children. Fertility preservation utilization rates were low as there are many barriers to pursue fertility preservation.

Circulatory effects-both sexes

”Hormone therapy for gender dysphoria may raise cardiovascular risks”

”Cardiovascular Disease Risk Factors and Myocardial Infarction in the Transgender Population” (Alzahrani et al., 2019):

Conclusions: The transgender population had a higher reported history of myocardial infarction in comparison to the cisgender population, except for transgender women compared with cisgender men, even after adjusting for cardiovascular risk factors.

”Hormone therapy for gender dysphoria may raise cardiovascular risks”

”Assessing and Addressing Cardiovascular Health in People Who Are Transgender and Gender Diverse”

In addition, the use of gender-affirming hormone therapy may be associated with cardiometabolic changes, but health research in this area remains limited and, at times, contradictory.

The study below shows a decrease in blood pressure for trans-identified males but an increase for trans-identified females.

”Blood Pressure Effects of Gender-Affirming Hormone Therapy in Transgender and Gender-Diverse Adults” (Banks et al., 2021)

Estrogen specific effects

This post is from a parent of a trans-identified person and not a medical review. But it contains some valuable and in depth information in greater detail than covered here.-

”As the debate over transgender care rages on, we know one thing for sure: estrogen is terrible for men”:

Most transgender care providers will mention venous thromboembolism or VTE as the predominant risk from estrogen, but research in the past few years indicates that its effect on the brain is at least as scary.

Giving male tweens and teens puberty blockers and estrogen likely has significant influences on their brain development, including brain volume shrinkage in some areas.

Effects of adult male rat feminization treatments on brain morphology and metabolomic profile (Gómez et al., 2020):

These results reveal, for the first time to our knowledge, that the volumetric decreases observed in trans women under cross-sex hormone treatment can be reproduced in a rat model. Estrogens are more potent drivers of brain changes in male rats than anti-androgen treatment.

The study ”Psychosocial Functioning in Transgender Youth after 2 Years of Hormones” (Chen et al., 2023) showed some improvement with HRT for females, but not males. We fear estrogen in males may be associated with depression.- 

“Increased estrogen level can be associated with depression in males” (Stanikova, et al., 2018)

Posting relevant quotes from ”Health considerations for transgender women and remaining unknowns: a narrative review” (Iwamoto et al., 2019)-

Some dysphoric people will obtain hormones from black market sources. Attempts to outright ban this practice for adults will fuel this phenomenon:

When barriers prevent trans people from obtaining GAHT from a licensed medical provider, they may search for other sources. Previous reports stated that 4.7–24% of TW have obtained hormones from friends,44–46 and 2–70% have purchased them online.47 Anecdotally, some TW who utilize services at the Ghent University Hospital Transgender Infopunt have admitted to using OCPs obtained from their female partners. The use of GAHT obtained from nonmedical sources varies from 23% in a United Kingdom sample of trans people referred to a gender clinic,47 to 26.8% in a community-based questionnaire in people who self-identified as trans in Canada,45 to 48.0% in a Belgian sample of trans sex workers44 and as high as 63% in urban groups of TW in New York City.46 

 Regarding BDNF:

Brain-derived neurotrophic factor (BDNF) is involved in neurogenesis, neuronal maturation and synaptogenesis, influencing brain plasticity. A study of 10 TW from Belgium showed a significant decrease in BDNF levels after 12 months of GAHT (p = 0.014) independent of age, weight, BMI, total fat mass, total lean mass, LH, FSH, oestradiol, testosterone, cortisol, physical activity or smoking.231Therefore, it was concluded that the decreased BDNF in TW after GAHT resulted from the GAHT rather than as a consequence of or risk factor for gender identity.231

This study is concerning given BDNF is important to brain health and function and is relevant to the aging process.

”Cross-sex hormone treatment in male-to-female transsexual persons reduces serum brain-derived neurotrophic factor (BDNF)” (Fuss et al., 2015)

Reduced serum BDNF in MtF thus seems to be a result of hormonal treatment rather than a consequence or risk factor of transsexualism. 

Testosterone specific effects

Genital and pelvic pain are common with testosterone use.

Studies indicate testosterone use in trans-identified females indicates pelvic pain is the norm-

”Pelvic pain and persistent menses in transgender men” (Obedin-Maliver, 2016)

”Pelvic Pain in Transgender People Using Testosterone Therapy” (Zwickl, 2023) :

Results: Among 486 participants (median age = 27 years), 351 (72.42%) reported experiencing pelvic pain following initiation of testosterone therapy, described most commonly as in the suprapubic region and as ‘‘cramping.’’ Median duration of testosterone therapy was 32 months. Persistent menstruation, current or previous history of post-traumatic stress disorder, and experiences of pain with orgasm were associated with higher odds of pelvic pain after testosterone therapy.

 In the same study also 63% reported painful orgasm; 58% pain during penetrative sex, and 31 % pain on touching external genitalia.

Severe clitoral pain is a known side effect of testosterone use in females:

 “I Thought I Was Saving Trans Kids. Now I’m Blowing the Whistle”:

Other girls were disturbed by the effects of testosterone on their clitoris, which enlarges and grows into what looks like a microphallus, or a tiny penis. I counseled one patient whose enlarged clitoris now extended below her vulva, and it chafed and rubbed painfully in her jeans. I advised her to get the kind of compression undergarments worn by biological men who dress to pass as female. At the end of the call I thought to myself, “Wow, we hurt this kid.”

 Thinning of the vaginal wall is another side effect for testosterone use in females. Also from the same article:

How little patients understood what they were getting into was illustrated by a call we received at the center in 2020 from a 17-year-old biological female patient who was on testosterone. She said she was bleeding from the vagina. In less than an hour she had soaked through an extra heavy pad, her jeans, and a towel she had wrapped around her waist. The nurse at the center told her to go to the emergency room right away.

Testosterone significantly alters brain structures. While adult trans-identified females may desire these changes, it points to the fact that when tweens, teens, and young adults take testosterone, they may be altering the way their brain works and their personality significantly. And probably much more so, as brain development is not complete until age 25.

”Testosterone affects language areas of the adult human brain” (Hahn et al., 2016)

”Research shows testosterone changes brain structures in female-to-male transsexuals”

”Testosterone Effects on the Brain in Transgender Men” (Burke et al., 2018)

”The Effects of Testosterone on the Brain of Transgender Men” (Zubiaurre-Elorza et al., 2021)

”Gender-affirming hormonal treatment changes neural processing of emotions in trans men: An fMRI study” (Kiyar et al., 2020)

”Testosterone effects on functional amygdala lateralization: A study in adolescent transgender boys and cisgender boys and girls” (Becking et al., 2019)

Other side effects

”Erythrocytosis in a Large Cohort of Trans Men Using Testosterone: A Long-Term Follow-Up Study on Prevalence, Determinants, and Exposure Years”

Regarding the above study, a doctor wrote a letter to the editor and believed the researchers under reported the risk to females from testosterone induced erythrocytosis for political reasons. This is discussed for the general public in this Breitbart article, a paper with a conservative bias. But it is difficult to get more liberal leaning news sites to discuss risks:

Males and females have different laboratory ranges for hematocrit (red blood cells).
For adult men the range is 38.3 to 48.6 percent.
For adult women the range is 35.5 to 44.9 percent.
High testosterone levels can directly cause high levels of hematocrit.
Females who identify as trans males are given very high doses of testosterone to attempt to bring their testosterone levels into the male range.

“Women who identify as trans males are being given very high, very risky doses of testosterone,” Laidlaw explained to Breitbart News about his concerns. “These high doses lead to high red blood cell counts. High red blood cell counts can lead to heart attacks and death. We believe these risks are being hidden.”

“Males and females have different normal ranges for red blood cell counts,” he elaborated. “We believe that the authors’ use of the male range for females hides a large number of females who will be at risk for heart disease and death.”

 Laidlaw and colleagues, Andre Van Mol, M.D., Quentin Van Meter, M.D., and Jeffrey E Hansen, Ph.D., note results of the 1994 landmark Framingham study which showed “having high red blood cell counts (erythrocytosis) puts females at increased risk of cardiovascular disease, coronary heart disease and death due to both.”

 “Studies of trans males have already shown up to a nearly five fold increased risk of myocardial infarction compared to females not taking testosterone,” the doctors explain at Gender Sanity…

The Swedish study, ”Lack of data hamper a proper toxicological risk assessment of the off-label use of testosterone in women with gender dysphoria” (Svens et al., 2021) summarizes the issues and calls for more research:

And:

Conclusions

Off-label use of testosterone in transmen has some unique characteristics, making it inherently riskier. High dose treatment is life-long and preclinical and clinical safety assessment studies performed for testosterone drugs lack the whole female group data as testosterone use is contraindicated in females due to teratogenicity. In addition, adverse effects related to off-label testosterone use in transmen is under-reported reported and is a possible patient safety risk. The lack of toxicology data would not be accepted for a new drug and the need for a comprehensive risk assessment is urgent.

Impacts on height

One goal of interfering with dysphoric youths’ natural puberty was likely to influence height to be more in line with the cross-sex identification. This area needs more research, but pediatric transition does not appear to achieve this. Puberty blocker use may stunt growth. In an interview with the Swedish journalist Carolina Jemsby, she states that some of the females who were put on puberty blockers were shorter than expected due to osteopenia.

Timing may be relevant because another study indicates they catch up when put on testosterone. T use in females may reverse stunted height due to puberty blockers and slightly increase an average for females. They will still, on average, be short for men and their bones stand a chance of being weaker than normal as the study below indicates.

”Just as Tall on Testosterone; a Neutral to Positive Effect on Adult Height of GnRHa and Testosterone in Trans Boys” (Willemsen, 2023) 

We expect affirmative model doctors to start giving females human growth hormone, despite possible negative impacts. Doctors consider this for short youth as seen in the study below.

”Should Skeletal Maturation Be Manipulated for Extra Height Gain?” (Wit, 2021)

Puberty blockers do not appear to reduce male height. Starting them on puberty blockers earlier may cause them to be taller than they would have been. This negates justification for this practice on such young male children.

”Development of Hip Bone Geometry During Gender-Affirming Hormone Therapy in Transgender Adolescents Resembles That of the Experienced Gender When Pubertal Suspension Is Started in Early Puberty” (van der Loos et al., 2021)

Transgender Adolescents Resembles That of the Experienced Gender When Pubertal Suspension Is Started in Early Puberty (van der Loos et al., 2021):

Why would they be taller if they take puberty blockers early? Perhaps it is due to their influence on growth plates. This is from Australian guidelines, and they should not use the term female to describe biological males in medical literature. It’s purely ideological, confusing, and irresponsible:

Some trans females may also be distressed by linear growth beyond their expected final height due to delayed growth plate closure with oestrogen and testosterone deficiency. 

However, the Dutch clinicians may use this study to justify puberty blocker use early merely because it influences the hip geometry to be closer to the opposite sex:

In both trans women and trans men, participants resembled the reference curve for SPW and ED of the experienced gender but only when GnRHa was started during early puberty. Those who started during mid and late puberty remained within the reference curve of the gender assigned at birth.

Another study indicates they may give them massive doses of estradiol because it slightly reduces height. One can see the results are very small, indicating this process cannot eradicate male genetics.

”Transgender Girls Grow Tall: Adult Height Is Unaffected by GnRH Analogue and Estradiol Treatment” (Boogers et al., 2020):

Results

Growth velocity and bone maturation decreased during GnRHa, but increased during GAHT. Adult height after regular-dose treatment was 180.4 ± 5.6 cm, which was 1.5 cm below PAH at the start GnRHa (95% CI, 0.2 cm to 2.7 cm), and close to target height (–1.1 cm; 95% CI, –2.5 cm to 0.3 cm). Compared to regular-dose treatment, high-dose estradiol and EE reduced adult height by 0.9 cm (95% CI, –0.9 cm to 2.8 cm) and 3.0 cm (95% CI, 0.2 cm to 5.8 cm), respectively.

Growth decelerated during GnRHa and accelerated during GAHT. After regular-dose treatment, adult height was slightly lower than predicted at start of GnRHa, likely due to systematic overestimation of PAH as described in boys from the general population, but not significantly different from target height. High-dose EE resulted in greater reduction of adult height than high-dose estradiol, but this needs to be weighed against possible adverse effects.

How do these hormones affect height? Growth will continue on PBs, but bone maturation slows due to a lack of sex hormones. But growth plate closure is delayed. When testosterone and estrogen are reintroduced, growth velocity increases and leads to bone maturation. If sex hormones are given in high doses (as is the case at gender clinics), it will quickly close growth plate growth. Genetics, human growth hormone (natural and prescribed), puberty blockers, and sex steroids can all influence height. Their interactions are very complicated and influenced by the timing of treatments. But overall, they have not proved this process significantly impacts more desirable height ranges.

Phalloplasty and Metoidioplasty

Both of these procedures (especially phalloplasty) have very high complication rates, with many being severe, even life-threatening. The study below covers some side effects of metoidioplasty, a surgery result that does not function like a male penis but is less risky than phalloplasty.

”Metoidioplasty Risks and Complications”

Stats from 2 studies-

Metoidioplasty: Surgical Options and Outcomes in 813 Cases (Bordas et al., 2021):

Follow-up ranged from 16 to 180 months (mean 94 months). Mean surgery time was 170 minutes and mean hospital stay was 3 days. Length of the neophallus ranged from 4.8 cm to 10.2 cm (mean 5.6 cm). Urethroplasty was complication-free in 89.5% of cases, and ranged between 81% to 90.3% in different groups. Urethral fistula and stricture occured in 8.85% and 1.70% of cases, respectively. Other complications included testicular implant rejection in 2%, testicular displacement in 3.20% and vaginal remnant in 9.60% of cases. From 655 patients who answered the questionnaire, 79% were totally satisfied and 20% mainly satisfied with the result of surgery. All patients reported voiding in standing position and good sexual arousal of the neophallus, without possibility for penetrative intercourse due to small size of the neophallus.

Overview on metoidioplasty: variants of the technique (Bizic et al., 2020):

Complications occurring after metoidioplasty are less frequent than in currently used phalloplasty techniques, ranging from 10 to 47% according to different literature data, and are mostly related to urethral reconstruction [12, 15, 24, 32].

Vaginoplasty

”Fancy a vaginoplasty? Think again” is an article discussing the lack of ethics and high complication rate of vaginoplasty:

I have seen horrific unethical practices by surgeons who lie about their experience and horrific results surgically as a result of that. We are using trans-gender people as guinea pigs and the medical profession allows this to happen,” said one doctor.

Other Surgeries

High complication rate with laryngoplasty-

”Gender-Affirming Laryngoplasty: Complications Relatively Common”

Cardiac/Circulatory Effects

There is not a complete picture in the literature regarding heart attack risk and strokes in people taking cross sex hormones. But evidence suggests there may be significant increased risks. From heart.org:

Previous research shows transgender men were almost 5 times as likely to report having a heart attack compared to cisgender women, those whose personal identity aligns with their sex at birth. Conversely, transgender women were more than 2 1/2 times more likely to have reported a heart attack than cisgender women – yet they did not have a significant increase in heart attack incidence when compared with cisgender men. However, a 2020 analysis found most of the studies examining gender-affirming hormones and blood pressure had sample sizes that were too small to detect statistically significant differences in blood pressure.

And from ”Hormone therapy for gender dysphoria may raise cardiovascular risks”:

The current study is the largest to date examining the cardiovascular risks of gender affirmation therapy in this historically understudied population. Previous research on hormone-modulating medications has primarily focused on younger women using hormone-based birth control or on older women following a hysterectomy or during menopause. In these populations, long-term hormone replacement therapy has been associated with an increased risk of breast cancer, stroke and blood clots…

In the study, people with gender dysphoria who had ever used hormone replacements saw nearly seven times the risk of ischemic stroke (a blockage in a vessel supplying blood to the brain), nearly six times the risk of ST elevation myocardial infarction (the most serious type of heart attack) and nearly five times the risk of pulmonary embolism (a blockage in an artery in the lung), compared with people with gender dysphoria who had never used hormone replacements. Hormone replacement therapy was not associated with any increase in deaths from any cause or with increased rates of atrial fibrillation, diabetes, hypertension, hemorrhagic stroke or heart failure.

Effects regarding reproductive cancers, fertility, and future offspring

Many trans-identified females want a hysterectomy to avoid pregnancy, breakthrough periods, and cancer risks. Little information is available regarding the impacts on fetuses. There are cases of females on T getting pregnant accidentally (sure to have hormonal influences on the fetus) and planning to get pregnant and stop testosterone.

”Endometrial findings among transgender and gender nonbinary people using testosterone at the time of gender-affirming hysterectomy” (Hawkins et al., 2021) indicates testosterone use affects the endometrial lining which may not revert if the female stops the testosterone use. Currently there appears to be no concern among affirmitve care providers regarding how this may impact babies via bith defects. Steroid use is known to cause them.

These researchers assert that “transphobia” contributes to pelvic pain due to testosterone use in the study “P088Uterine cramping and bleeding in transgender and nonbinary individuals on gender-affirming testosterone therapy” (Sobieraj et al, 2022).

Mastectomy & Binding Side Effects

It appears that post-surgical pain is very common for double mastectomies.

From cancer.org:

Studies have shown that between 20% and 30% of women develop symptoms of PMPS after surgery. It's most common after operations that remove tissue in the upper outside portion of the breast or the underarm area.

Phantom breast sensation appears to be a side effect, according to the article ”The phantom breast after mastectomy, the homunculus and the hole in the cortical map.” (Dutta, 2015)

Binding is not safe, especially for the body of a growing adolescent, as demonstrated in the study ”Health impact of chest binding among transgender adults: a community-engaged, cross-sectional study” (Peitzmeier et al., 2015):

Over 97% reported at least one of 28 negative outcomes attributed to binding.

However, many “LGBTQ” youth websites promote, even celebrate the practice.

Extreme Body Modification for any Identity

The medical industry is becoming a service provider for what has turned into a capitalist body modification movement, but it is tax payers and insurance companies (paid for for all who have it) who will cover the expenses.

Outspoken and well-known affirmative model leaders such as Dr. Michelle Telfer are willing to put people on puberty suppression indefinitely for nonbinary identities. This case study involves a youth who identifies as nonbinary and has been on puberty blockers since age 11 and, at age 18, still wanted to be on puberty blockers. Doctors have kept this individual in a child-like, prepubertal state physically and likely mentally.

“Forever young? The ethics of ongoing puberty suppression for non-binary adults” (Notini et al., 2020) (emphasis ours):

Abstract

In this article, we analyse the novel case of Phoenix, a non-binary adult requesting ongoing puberty suppression (OPS) to permanently prevent the development of secondary sex characteristics, as a way of affirming their gender identity. We argue that (1) the aim of OPS is consistent with the proper goals of medicine to promote well-being, and therefore could ethically be offered to non-binary adults in principle; (2) there are additional equity-based reasons to offer OPS to non-binary adults as a group; and (3) the ethical defensibility of facilitating individual requests for OPS from non-binary adults also depends on other relevant considerations, including the balance of potential benefits over harms for that specific patient, and whether the patient’s request is substantially autonomous.

Hormones, particularly estrogen, are critical for bone density. As people enter their thirties, bone density begins to decrease. If kept on puberty blockers, this person will be at risk for weakened bones and fractures. Many other areas of the body require a normal balance of hormones for healthy function, and what are healthy levels are sex-specific.

The later part of the abstract demonstrates that gender medicine is a product provided based on the patient demands. This removes guard rails to protect people from medically assisted self-harm. Failure to adhere to these ethics has led to unnecessary cosmetic surgery by people with body dysmorphic disorder and widespread opiate addiction.

Although the broadly principlist ethical approach we take can be used to analyse other cases of non-binary adults requesting OPS apart from the case we evaluate, we highlight that the outcome will necessarily depend on the individual’s context and values. However, such clinical provision of OPS should ideally be within the context of a properly designed research study with long-term follow-up and open publication of results.

Other studies regarding this subject-

”Partial Gender-Affirming Hormone Treatment in Non-Binary Transgender Individuals in a Referral Center Cohort” (Van Dijken et al., 2021)

”Selective Estrogen Receptor Modulators: A Potential Option For Non-Binary Gender-Affirming Hormonal Care?” (Xu et al., 2012):

Here, we discuss the theoretical use of Selective Estrogen Receptor Modulators (SERMs) for non-binary people assigned male at birth (AMAB) who are seeking an androgynous appearance through partial feminization without breast growth.

Case reports

”Androgen-receptor-positive hepatocellular carcinoma in a transgender teenager taking exogenous testosterone” (Lin et al, 2020)

”Implications for management of ovarian cancer in a transgender man: Impact of androgens and androgen receptor status” (Aubrey et al., 2021)

”Case Report: Invasive Endometrial Cancer in a Trans Man and Risk of Testosterone Therapy” (Jeevananthan et al., 2021)

”Management of Recurrent Deep Vein Thrombosis in a Transgender Woman” (Oguz et al., 2021)

Conclusion

Corinna Cohn, is a trans-identified person who discusses gender and other issues on the Heterodox podcast. This statement provides a good sumation of the longterm risks and challenges that young people who medicalize will face.

GHQ Endorses Affirmation Generation, a Documentary About the Affirmative Model & the Damage it is Doing to Gender Dysphoric Young People.

News Commentary

Transitioning so many gender dysphoric young people is proving to be doing a lot go damage. The new Affirmation Generation documentary, released on Vimeo is a good overview of what is going on with the explosion in trans-identification and the gleeful enthusiasm to medicalize it.

Show notes:
medical ethics
12 experts, 6 detransitioners,
45 medical articles

We are pleased with this documentary. It is respectful and rational. We are grateful to the producers and participants and hope that more people become aware of this medical scandal as more harmed young people come forward.

Update (03/07/23): Trans activists successfully had this video taken down from Vimeo. However, at a later time they reinstated it.

Comment from a Person with Gender Dysphoria Opposing Pediatric Medical Transition

Editorial

A person with gender dysphoria sent in this comment to Gender Health Query. Allana’s comments are posted here with permission:

I am a 63-year-old MTF trans-woman who has not transitioned. I have been in the struggle for decades, my folks had inclinations when I was 5-7 years old but it wasn't until I was 14 in the middle of adolescence did things shift into high gear. My father was a prominent member of the community, an MD, and one would have thought he would understand. He didn't, and he didn't want to know so he disowned me to scare me into stopping this obsession with thinking I was a girl. At the age of 17 when my mother and father split up and she moved away, he agreed to send me to counseling which only lasted a few weeks. The therapist knew absolutely nothing and I realized I would have to go deep into the closet, so I did telling my father that I had been cured. 48 years later and I still struggle but at least I know that it wasn't a passing fancy. I am alarmed at the worldwide uptick in young people coming out, jumping into HRT, and having surgery. Sure I want what is best for our young people, I don't wish this on anyone, the decades of depression, guilt, shame, and pain of not fitting into the "gender" society says I should be. But, it would be a greater loss for even 1 person to wake up at 25 years old, out of the protected environments of schooling and into the workforce saying OMG, what have I done? I can't go back and I can't undo? Nobody wants that or regrets and nobody wants all the negatives I had to endure as a young person. I can honestly say, however, looking back as painful as it was at times, it was the necessary part of growing, being a human, and developing into an adult.

How can someone at age 10-15 going through puberty and all the other changes that non-questioning teens go through, possibly know that what they are doing with hrt and surgeries can be the correct move? Just because some adult says it will remove their pain and heartache, really? What happens down the road when they have to face other life situations that are as tough if not tougher, do they just follow the crowd, jumping to the latest advice on social media? They must ride out the storm at this critical phase of their life so that when they are out of the teenage years, entering the "real" world of work and making their place in society, they will know in their heart of hearts if they are truly trans. Being truly trans is not a fad, it is not a choice, it does not waver and it will be with you as you age so don't be in such a hurry, give your BRAIN a chance to figure this out. If you are truly trans, there will be plenty of time to make physical corrections to your body but then when you do, you will know with almost 100% certainty that it is the best way for you to proceed. It will be an easy decision, it will be based on Your life, your feeling, and situations, it will be your well-informed choice.

Sure, I wish I had been born a female and never had to go through all of this. I experienced tremendous pain, heartache, and illness but through it all, I matured, grew up and became my own person. I have had plenty of opportunities to transition over the years but it was my conscious choice not to for the sake of family, career, and personal goals. I did the best I could with the knowledge and support that we had in those days and yet I didn't go off the deep end, I dealt with one of life’s many storms that we all go through. Society is a lot better equipped and informed than when I was a youngster and the medical professionals know a heck of a lot more but it is always evolving as we continue to learn. So let's embrace that knowledge and use it for the benefit of the whole person, not just some quick fix so the stats look better on a graph that promotes our own agenda...let kids be kids, be there for them, love them and support them. I am not saying abandon them but allow them the dignity to grow at their speed and mature into the human that they were intended to be. Yes, I have many struggles in my life, being trans is just one part. It's on my mind most days and I am still working through it but I have not just survived but led a wonderful, fulfilling life. I am a functioning member of society, a contributor to the lives of many and oh yes, I am still Transgender. Please, let's not rush to judgment at such an early age, help a youngster to find their way but do so with mother nature’s help. The real truth will set you free.

American Journal of Psychiatry Study Purported to Show Benefits of Transgender Medical Transition Made False Claims

The American Journal of Psychiatry published a study from Yale School of Public Health and the Karolinska Institute in Sweden touting the benefits of surgeries for gender dysphoria:

“Reduction in Mental Health Treatment Utilization Among Transgender Individuals After Gender-Affirming Surgeries: A Total Population Study”

Gender identity surgeries include double mastectomy and phalloplasty for FtMs, and vaginoplasty and facial feminization for MtFs. They have now had to issue corrections indicating the study was flawed and shows no benefit.

The study, as others, indicates overall worse mental health and suicide risk for transgender people compared to the general population:

Results:

Compared with the general population, individuals with a gender incongruence diagnosis were about six times as likely to have had a mood and anxiety disorder health care visit, more than three times as likely to have received prescriptions for antidepressants and anxiolytics, and more than six times as likely to have been hospitalized after a suicide attempt. Years since initiating hormone treatment was not significantly related to likelihood of mental health treatment (adjusted odds ratio=1.01, 95% CI=0.98, 1.03). However, increased time since last gender-affirming surgery was associated with reduced mental health treatment (adjusted odds ratio=0.92, 95% CI=0.87, 0.98).

They found no evidence of benefits of hormones alone. They did report a “longitudinal association between gender-affirming surgery and reduced likelihood of mental health treatment.” The positive message about “gender-affirming surgeries” was widely cited by the media. Current media appears eager to promote pro-medical transition stories, even when it involves minors, as any critical commentary about these protocal is lacking in US media. Dr. Pachankis himself claimed in an interview:

No longer can we say that we lack high-quality evidence of the benefits of providing gender-affirming surgeries to transgender individuals who seek them.

However, the study is flawed and the data shows no benefits from these expensive surgeries that may have negative side-effects such as infection, loss of sexual function, and need for repeat vaginiplasty surgeries. After several letters to the editor criticized it, the journal redid the study’s statistical analysis and found the conclusions are wrong.

While the positive claims were reported in the media, some retractions have not been. Gender Health Query is sending out a request to media outlets who repeated the positive claims of this poorly done study whose authors may have been suffering from confirmation bias to correct the record. We are also asking the American Journal of Psychiatry why they continue to display this title prominently. It’s misleading. Notice the positive sounding title remains intact, but there is only a small link at the top mentioning that there are corrections to the article. Sometimes corrections are minor. That is not the case with this study. Does the AJP want to mislead the public? Because that will be the result based on this title. What are the reasons they did not retract the study altogether?

This study had a high quality, very large data set (2,600 transgender individuals diagnosed with gender incongruence between 2005 and 2015 versus all the rest of the Swedish population). It is one of the better data sets used in a study, with many studies on transgenderism being poor quality (ex- survey studies, convenience sampling, lost to follow-ups). It contricits the finding of the Cornell review And this analysis fails to show improvements in the mental health with hormone use and surgeries. That is significant given the huge increase in medicalized minors.

Most studies on outcomes for trans individuals are of poor quality in terms of research standards. Many studies indicate trans people have improved quality of life post-transition. Others indicate that long-term mental health outcomes are not good, calling into question the effectiveness in reducing suicide risk and improving mental health.

A list of “Letters to the Editor” and their response is listed under the published article:

35 Anckarsäter H, Gillberg C: Methodological shortcomings undercut statement in support of gender-affirming surgery. Am J Psychiatry 2020; 177:764–765Abstract, Google Scholar

36 Van Mol A, Laidlaw M, Grossman M, et al.: Gender affirmation surgery conclusion lacks evidence. Am J Psychiatry 2020; 177:765–766Abstract, Google Scholar

37 Curtis D: Study of transgender patients: conclusions are not supported by findings. Am J Psychiatry 2020; 177:766Abstract, Google Scholar

38 Malone W, Roman S: Calling into question whether gender affirming surgery relieves psychological distress. Am J Psychiatry2020; 177:766–767Abstract, Google Scholar

39 Landén M: The effect of gender-affirming treatment on psychiatric morbidity is still undecided. Am J Psychiatry 2020; 177:767–768Abstract, Google Scholar

40 Wold A: Gender corrective surgery promoting mental health in persons with gender dysphoria not supported by data presented in paper. Am J Psychiatry 2020; 177:768Abstract, Google Scholar

41 Ring A, Malone M: Confounding effects on mental health observations after sex reassignment surgery. Am J Psychiatry 2020; 177:768–769Abstract, Google Scholar

42 Bränström R, Pachankis JE: Toward rigorous methodologies for strengthening causal inference in the association between gender-affirming care and transgender individuals’ mental health. Am J Psychiatry 2020; 177:769–772Abstract, Google Scholar

Here is a list of URLs citing this study that now need correction:

https://www.bustle.com/p/affirming-peoples-gender-improves-trans-mental-health-a-study-says-19345160

https://www.madinamerica.com/2019/11/gender-affirming-interventions-reduce-mental-health-issues-study-suggests/

https://www.jwatch.org/na50059/2019/10/11/gender-affirming-surgery-durably-improves-mental-health

https://www.medpagetoday.com/psychiatry/generalpsychiatry/82642

https://www.nydailynews.com/news/national/ny-transgender-gender-affirming-surgery-mental-health-study-20191004-bxvqkg4gj5budinawa3bogp5oa-story.html

Here is a list of journal articles that referenced this study and quotes used:

Sevelius J.M., Gutierrez-Mock L., Zamudio-Haas S., et al. (2020). Research with Marginalized Communities: Challenges to Continuity During the COVID‑19 Pandemic, AIDS and Behavior, Volume 24, 2009–2012. https://doi.org/10.1007/s10461-020-02920-3

> Among our transgender and gender diverse staff and participants, delays in gender-affirming treatment, such as hormone injections and surgeries, due to the shutdown of clinics and delays in "elective" surgeries, can cause serious mental health issues, including depression, anxiety, and suicidality [16].

Wang Y., Pan B., Liu Y., et al. (2020). Health care and mental health challenges for transgender individuals during the COVID-19 pandemic, Lancet Diabetes Endocrinology, Volume 8, Issue 7, 565-565. https://doi.org/10.1016/S2213-8587(20)30182-0

> Besides access to health care, it is also important to highlight mental health issues of transgender individuals. Previous studies showed that gender-affirming surgery was associated with reduced mental health problems.4

Roque R.A. (2020). Transgender pediatric surgical patients—Important perioperative considerations, Pediatric Anesthesia, Volume 30, Issue 5, 520-528. https://doi.org/10.1111/pan.13845

> "Importantly, surgeries for transgender individuals are medically necessary procedures, proven to improve dysphoria, mental health, and quality of life,26, [29]-33 and should not be viewed as elective.14, 15"

Konrad, M., & Kostev, K. (2020). Increased prevalence of depression, anxiety, and adjustment and somatoform disorders in transsexual individuals, Journal of Affective Disorders, Volume 274, 482-485, https://doi.org/10.1016/j.jad.2020.05.074

Aldridge Z., Patel S., Guo B., et al. (2020). Long term effect of gender affirming hormone treatment on depression and anxiety symptoms in transgender people: A prospective cohort study, Andrology, published online 10 August. https://doi.org/10.1111/andr.12884

> "In contrast, Bränström and Pachankis [40] using the Swedish population register showed no significantassociation between the likelihood of accessing mental health treatment and time since initiation of GAHT.

"Flaherty, A.J., Sharma, A., Crosby, D. (2020). Should Gender-Affirming Surgery Be Prioritized During the COVID-19 Pandemic?,  Otolaryngology–Head and Neck Surgery, Published June 30, https://doi.org/10.1177/0194599820939072

> A recent study found significantly reduced risk of mental health treatment in TGNC patients after receiving GAS but not HRT alone.13

Schvey, N.A., Klein, D.A., Pearlman, A.T., Riggs, D.S. (2020), A Descriptive Study of Transgender Active Duty Service Members in the U.S. Military, Transgender Health, first published 19 May 2020, https://doi.org/10.1089/trgh.2019.0044

> The finding that transmales, who were significantly more likely to have taken steps toward gender affirmation, presented with better mental health may provide further evidence supporting the effectiveness of gender-affirming treatments in ameliorating distress and improving quality of life.69,[70]

Surmaitis, R.M., Greenberg, M.R., Ebeling-Koning N.E., et al. (2020). Characteristics of Transgender Patient Cases Managed by a Toxicologist: an Analysis of the Toxicology Investigator's Consortium (ToxIC) Registry: January 2017–June 2019, J Med Tox, Published: 17 June 2020 

> It would be helpful for further study to gather more information on whether patients have undergone surgical procedures or hormonal therapy because it has been shown that rates of suicidality and utilization of mental health services may differ based on transition-related medical interventions [20, 21].

Giraldi A. (2020). Mental health and gender dysphoria – why does it matter? Acta Psychiatrica Scandinavica, Volume 141, Issue 6, 483-485, https://doi.org/10.1111/acps.13182

> Though, some studies indicate that some of the increased risk of mental health problems persist, which may in part be related to internal and external factors (17-19).

References

Bränström, R., Pachankis, J. (2019). Reduction in Mental Health Treatment Utilization Among Transgender Individuals After Gender-Affirming Surgeries: A Total Population Study. American Journal of Psychiatry, 77(8):727-734. doi.org/10.1176/appi.ajp.2019.19010080

Cornell University. (2018, March 26). What does the scholarly research say about the effect of gender transition on transgender well-being? Retrieved from https://whatweknow.inequality.cornell.edu/topics/lgbt-equality/what-does-the-scholarly-research-say-about-the-well-being-of-transgender-people/

Sensitive Topics: Suicide Risk Information Updates

News Commentary

We are updating GHQ with some more studies on the important topic of suicide risk in gender dysphoric minors and adults.

Studies on Trans Mental Health and Suicide Risk

We are adding information about an older study (Kuiper 1988) (no online link available).

• 141 Dutch TS: 36FtM, 105MtF.

• Recruitment through letters and ads.

• Followed up: 11 FtM, 50 MtF.

• 42 lost to follow up.

• No control group.

• Findings: Suicide attempt before treatment FtM 19%, MtF 23.6%. 3 MtF completed suicide since surgery.

• Unemployment: 36% FtM, 60% MtF.

• No association between well-being and phase of treatment .

• 11% were unhappy with treatment.

• “SRS is no panacea” study authors claim.

We are adding some comments about another older study (Lauder 1998) (no online link available):

• They compared MtF (134) vs FtM (99) 1972-1992.

• MtF were older, had a history of marriage, more likely heterosexual.

• FtM had increased cross gender behavior in childhood.

• Mean age of request of surgery=31.

• MtF had increased fetishism.

• Suicide attempt MtF 14.1%, FtM 23.1%

• Mood disorder MtF 7.1%, FtM 12.7%

• Personality Disorder MtF 7.1%, FtM 14.9%

This study indicates that despite medical transition, the females retain higher levels of suicide attempts and personality disorders, consistent with their biological sex, not gender identity, versus males.

Murad et al., 2010 is an older review study. They describe their study as a review of “low quality” evidence due to study designs. What is relevant to our site here is that yes, medical transition shows improvement for a majority of adult transitions. But there is still a significant minority (see QOL data) who may not be helped. This is relevant in regards to minors transitioning medically.

Some findings:

Resolution of gender dysphoria

Pooling across studies shows that after sex reassignment, 80% ofindividuals with GID reported significant improvement in genderdysphoria (95% CI = 68–89%; 8 studies;I2= 82%). Proportion inMF subgroup is 71% (41–93%) and in FM subgroup is 86% (65–98%).

function (95% CI = 60–81%; 15 studies;I2= 78%). This propor-tion in MF subgroup is 63% (45–79%) and in FM subgroup is 80%(68–89%)…

Psychiatric comorbidities

Pooling across studies shows that after sex reassignment, 78%of individuals with GID reported significant improvement in psychiatric symptoms (95% CI = 56–94%; 7 studies;I2= 86%).This proportion in the MF subgroup is 70% (33–96%) and inthe FM subgroup is 84% (73–92%).

Psychiatric comorbidities were fairly prevalent in individuals with GID…

Suicide attempt rates decreased after sex reassignment butstayed higher than the normal population rate…

Quality of life

Pooling across studies shows that after sex reassignment, 80% ofindividuals with GID reported significant improvement in qualityof life (95% CI = 0Æ72–0Æ88; 16 studies;I2= 78%). This proportionin the MF subgroup is 84% (68–95%) and in the FM subgroup is78% (67–87%)…

Satisfaction with sexual function

Pooling across studies shows that after sex reassignment, 72% ofindividuals with GID reported significant improvement in sexual function (95% CI = 60–81%; 15 studies;I2= 78%). This propor-tion in MF subgroup is 63% (45–79%) and in FM subgroup is 80%(68–89%).

A survey (Clark 2014) from New Zealand indicates social contagion in trans identity (1.2% of the respondents are categorized as trans and 2.5% “are not sure”). The study found being a trans-idenitified youth was associated with: a parent not caring, depression, and suicide attempts. 40% had engaged in self injury and 20% made a suicide attempt in the last 12 months. 20% said they were bullied.

(Reisner 2015) is another study on trans youth showing higher rates of mental health problems and suicide risk. Unlike some other studies they didn’t find significant differences based on sex:

Results

The sample (N = 360) had a mean age of 19.6 years (standard deviation, 3.0); 43% white, 33% racial/ethnic minority, and 24% race/ethnicity unknown. Compared with cisgender matched controls, transgender youth had a twofold to threefold increased risk of depression, anxiety disorder, suicidal ideation, suicide attempt, self-harm without lethal intent, and both inpatient and outpatient mental health treatment (all p < .05). No statistically significant differences in mental health outcomes were observed comparing FTM and MTF patients, adjusting for age, race/ethnicity, and hormone use.

Conclusions

Transgender youth were found to have a disparity in negative mental health outcomes compared with cisgender youth, with equally high burden in FTM and MTF patients. Identifying gender identity differences in clinical settings and providing appropriate services and supports are important steps in addressing this disparity.

Tucker et al., 2018 is an odd study that shows a lowering of suicide risk with full surgery and hormone transition but not each one alone where the outcomes may be worse:

Tucker 2018

This study doesn’t reference suicide specifically but shows a much higher percentage of comorbid mental health conditions in trans people. This study is useful because so many studies on the trans population are survey volunteer studies or have huge lost to follow-ups. This study comes from an electronic health record study.

“Mental Health Diagnoses Among Transgender Patients in the Clinical Setting: An All-Payer Electronic Health Record Study:"

(Wanta 2019)

A new study on suicide risk has come out of the Netherlands noting, like others, trans people have an elevated risk of suicide. The study has a 36% lost to follow-up rate, a major issue with many studies on transgender people. Four of the suicides were people who presented to the healthcare system first as children. Females who transition have a 5x risk of suicide compared to other females; men who transition have a 3x risk of suicide compared to other males. The authors focus on absolute risk of suicide and promote a theory that because FtMs have a higher social status than MtFs they have lower rates of suicide. In reality, MtFs are male, and this pattern is actually reflecting biological sex, not gender identity. 

“Trends in Suicide Death Risk in Transgender People: Results From the Amsterdam Cohort of Gender Dysphoria Study (1972-2017):”

Results: Out of 5107 trans women (median age at first visit 28 years, median follow-up time 10 years) and 3156 trans men (median age at first visit 20 years, median follow-up time 5 years), 41 trans women and 8 trans men died by suicide. In trans women, suicide deaths decreased over time, while it did not change in trans men. Of all suicide deaths, 14 people were no longer in treatment, 35 were in treatment in the previous two years. The mean number of suicides in the years 2013-2017 was higher in the trans population compared with the Dutch population.

Conclusions: We observed no increase in suicide death risk over time and even a decrease in suicide death risk in trans women. However, the suicide risk in transgender people is higher than in the general population and seems to occur during every stage of transitioning. It is important to have specific attention for suicide risk in the counseling of this population and in providing suicide prevention programs.

Dr. Progovac reviewed Medicaid data to compare trans populations to people who are not trans.

“Disparities in Suicidality by Gender Identity Among Medicare Beneficiaries:”

Results: Gender minority beneficiaries had higher unadjusted suicidality than non−gender minor- ity beneficiaries in the disabled cohort (18.5% vs 7.1%, p<0.001). Significant suicidality predictors in all 4 groups included the following: age (except in older adult gender minorities), Medicaid eligible- ity, depression or behavioral health conditions, avoidable hospitalizations, and violence victimiza- tion. In age- and mental health−adjusted logistic regression models, gender minorities had higher odds of suicidality than non−gender minority beneficiaries (disabled, OR=1.95, p<0.0001; older adult, OR=2.10, p<0.0001). Disparities were not attenuated after adjusting for Medicaid eligibility, race/ethnicity, or region.

The Royal Children’s Hospital of Melbourne standards of care document claims high rates of mental health problems and suicide risk in the trans population:

A study of the mental health of trans young people living in Australia found very high rates of ever being diagnosed with depression (74.6%), anxiety (72.2%), post-traumatic stress disorder (25.1%),

a personality disorder (20.1%), psychosis (16.2%) or an eating disorder (22.7%). Furthermore 79.7% reported ever self-harming and 48.1% ever attempting suicide.7

“Deficiencies in Scientific Evidence for Medical Management of Gender Dysphoria” is a paper from a Catholic Medical Association and questions the efficacy of medical transition to reduce suicide risk in the long run:

Limitations of the existing transgender literature include general lack of randomized prospective trial design, small sample size, recruitment bias, short study duration, high subject dropout rates, and reliance on “expert” opinion. Existing data reveal significant intervention-associated morbidity and raise serious concern that the primary goal of suicide prevention is not achieved. In addition to substantial moral questions, adherence to established principles of evidence-based medicine necessitates a high degree of caution in accepting gender-affirming medical interventions as a preferred treatment approach. Continued consideration and rigorous investiga- tion of alternate approaches to alleviating suffering in people with gender dysphoria are warranted.

This review study (Surace 2019) of suicide risk in trans-identified youth endorses the affirmative model:

A random-effects meta-analysis was computed for the following outcomes: non-suicidal self-injury (NSSI), suicidal ideation and suicide attempts. Overall, we found a mean prevalence of NSSI of 28.2% (9 studies, 3057 participants, 95% CI 14.8–47.1). A similar prevalence (28%) was found for suicidal ideation (6 studies, 2249 participants, 95% CI 15–46.3), while the prevalence of suicide attempts was 14.8% (5 studies, 1039 participants, 95% CI 7.8–26.3). Subgroup analyses revealed no significant differences according to biological sex. Given the prevalence of suicidal behaviors in gender non-conforming youths, it appears desirable to implement therapeutic and support strategies for this population. Moreover, educational interventions directed to parents, teachers, mental health professionals and general community should be promoted to struggle against stigma and social isolation, factors that may contribute to increasing the risk of suicidal behaviors.

“Understanding the mental health of transgender and nonbinary youth” is a convenience sample and thus not the highest quality study:

Researchers examined responses from a national quantitative cross-sectional survey of more than 25,000 lesbian, gay, bisexual, transgender, queer, and questioning youth, aged between 13 and 24 years, in the US to better understand the mental health of transgender and nonbinary youth. Compared with cisgender lesbian, gay, bisexual, queer, and questioning youth, transgender and nonbinary youth were at increased risk of experiencing depressed mood, seriously considering suicide, and attempting suicide. Within-group analyses highlighted especially heightened risk for negative mental health outcomes among transgender males and nonbinary youth assigned male at birth. Findings point to the need to tackle transgender and nonbinary youth's needs specifically in prevention and intervention programs, and to promote policies that eliminate discrimination and victimization based on sexual orientation or gender identity.

29.7 % of trans and non-binary youth said they had been physically threatened. 82.8” per cent reported a depressive mood, 54.2 per cent had seriously considered suicide, and 28.6 per cent had attempted suicide.

Hughto et al., 2020 shows post medical transition suicide risk is lower than pre transition:

Nearly all participants (98.6%) reported disclosing their gender identity to family or a coworker; 67.4% endorsed recently using hormones, and 31.3% endorsed a gender-affirming medical procedure. In multivariable models, participants were at greater odds of NSSI, contemplating suicide, and attempting suicide before initiating the gender affirmation process compared to after.

A Swedish paper, “ The Evolution of the Diagnosis of Gender Dysphoria” (off line) reviewed data of the trans population in Sweden:

Suicide Mortality

Since 1998, a total of 6,334 persons have been diagnosed with gender dysphoria in Sweden. Of these, a total of 21 men and 18 women (registered sex at birth) have died from suicide. This represents 0.6 percent mortality by suicide among persons with a gender dysphoria diagnosis since 1998.

Studies and Discourse that May be Flawed.

Jack Turban is a pro pediatric transition psychiatry student from Harvard. His studies have received a lot of criticism for confirmation bias. He has produced a new study, “Pubertal Suppression for Transgender Youth and Risk of Suicidal Ideation” that also seems to have problems with confirmation bias. Here are the claimed results about puberty blockers decreasing suicide risk:

RESULTS: Of the sample, 16.9% reported that they ever wanted pubertal suppression as part of their gender-related care. Their mean age was 23.4 years, and 45.2% were assigned male sex at birth. Of them, 2.5% received pubertal suppression. After adjustment for demographic variables and level of family support for gender identity, those who received treatment with pubertal suppression, when compared with those who wanted pubertal suppression but did not receive it, had lower odds of lifetime suicidal ideation (adjusted odds ratio = 0.3; 95% confidence interval = 0.2–0.6).

CONCLUSIONS: This is the first study in which associations between access to pubertal suppression and suicidality are examined. There is a significant inverse association between treatment with pubertal suppression during adolescence and lifetime suicidal ideation among transgender adults who ever wanted this treatment. These results align with past literature, suggesting that pubertal suppression for transgender adolescents who want this treatment is associated with favorable mental health outcomes.

Oxford sociology professor Micheal Biggs published a paper listing a myriad of problems with the study

If one looks more closely at the data, one finds that some of the categories are lower (such as ideation), but the total actual attempts and attempts resulting in need for inpatient care were higher with the group given puberty blockers which calls into question the claim in the conclusion. A suicide attempt requiring hospitalization could be considered more highly motivated:

(Turban 2020)

It also appears the sample of those who reported being given puberty blockers isn’t even reliable. Another commentator pointed out several other issues with the study. This commentator has been analyzing the research regarding the athletic superiority of MtFs, who are being put on girl’s and women’s sports teams, over females:

@boysvswomen

There is also no evidence it was the puberty blockers that affected different measurements on these questions. Younger people would have been more likely to have the option for puberty blockers, and trans acceptance has improved in the the last decade. Better measurements could be due to increasing acceptance. Not the puberty blockers. It is also a survey study and not likely to record the mental health outcomes of transition regretters, which may be a small number but would affect the mental health outcome data.

Malcom Clark is a science journalist and filmmaker. He is critical of this study. He commented in a long Twitter thread about flaws in how studies are presented. The whole thread can be found here, and it is worth reading:

Pediatrician Julia Mason, a Gender Health Query advisory board member, wrote a response regarding health professionals who believe they are saving lives (see article in Medscape) by advocating the gender affirmative model for minors:

What has really struck me in conversations with and observations of doctors providing puberty blockers and cross-gender hormones to gender dysphoric youth is their utter conviction that they are saving lives. 

"Would you rather have a dead daughter, or a live son?" 

Kevin Wang MD says suicide attempts are 9 to 10x higher. 

But when you look at the data, the rates of suicide and self harm are "more similar than different" to the rates of youth referred for other mental health concerns. I'm quoting from @ZUCKERKJ's excellent article from earlier this year.

Study on LGB Youth who are also at risk.

Recently a study was done on suicide risk and LGB youth taken from data from The Trevor project (and LGBT youth organization) and CDC.

“Suicidality Disparities by Sexual Identity Persist from Adolescence into Young Adulthood” shows that bisexuals at higher risk than gay and lesbian youth. This is similar to findings in other studies on bisexuals.

The Trevor Project, “Suicidality Disparities by Sexual Idenity Persist from Adolescence into Young Adulthood”

LGBT media sites like to make statements blaming all mental health problems on bigotry. From Out Magazine:

But, according to experts, these statistics come as a result of a worsening culture of anti-LGBTQ+ legislation and sentiment from political and religious leaders.

The Trevor Project researcher also blames all mental health problems on stigma:

“Here’s what we know: young LGBTQ people are not prone to suicide because of their sexual orientation or gender identity,” Dr. Amy Green, The Trevor Project’s director of research, tells Out. “They are at a higher risk of suicidality because of increased experiences of internalized stigma, discrimination, and rejection from others. No one factor causes an individual to attempt suicide, but the cumulative effect of these stressors can be detrimental to one’s mental wellness and increase the risk for suicidal ideation. According to The Trevor Project's 2019 National Survey on LGBTQ Youth Mental Health, 76 percent of LGBTQ youth felt that the recent political climate impacted their mental health or sense of self.”

While there is little debate bigotry, stigma, and family rejection harm mental health, it would be useful for these researchers to expand their understanding of what is going on rather than narrowly focus on points that validate an LGBT activist narrative. For example, there may be other personality traits involving bisexuals that cause more mental health problems rather than just stigma, as LG youth also deal with stigma bet have better overall mental health. Social media likely has an effect of worsening mental health for LGBT youth as these online spaces fuel paranoia and victim complexes, which may be socially reinforcing and contagious. Mental health is worsening even for female heterosexual teens.

References

Biggs, M. (2020). Puberty Blockers and Suicidality in Adolescents Suffering from Gender Dysphoria. Archives of Sexual Behavior. doi:10.1007/s10508-020-01743-6

Clark, T.C., Lucassen, M.F.G., Bullen, P., Denny, S.J., Fleming, T.M., Robinson, E.M., Rossen, F.V. (2014). The Health and Well-Being of Transgender High School Students: Results From the New Zealand Adolescent Health Survey (Youth'12). Journal of Adolescent Health 55(1), 93-99. doi: 10.1016/j.jadohealth.2013.11.008.

Firth, S. (2019, September 24). AAFP Debates Care for Transgender Youth. Medscape. Retrieved from https://www.medpagetoday.com/meetingcoverage/aafp/82347

Guerrero, D. (2020, February 11). Study: LGBTQ+ Youth are Four Times More Likely to Attempt Suicide. Out. Retrieved from https://www.out.com/health/2020/2/11/study-lgbtq-youth-are-four-times-more-likely-attempt-suicide

Hughto, J.M.W., Gunn, H.A., Rood, B.A., Pantalone, DW. (2020). Social and Medical Gender Affirmation Experiences Are Inversely Associated With Mental Health Problems in a U.S. Non-Probability Sample of Transgender Adults. Archives of Sexual Behavior. doi: 10.1007/s10508-020-01655-5

Hruz, P.W. (2019). Deficiencies in Scientific Evidence for Medical Management of Gender Dysphoria. The Linacre Quarterly. doi.org/10.1177/0024363919873762

Kim, B. (2020, January 28). Jonathan Haidt on Social Media-Driven Anxiety Among Kids. Retrieved from https://drbenkim.com/social-media-anxiety-kids-jonathan-haidt.htm

Murad, M.H., Elamin, M.B., Zumaeta, M.G., Mullan, R.J., Murad, A., Erwin, P.J., Montori, V.M. (2010). Hormonal therapy and sex reassignment: a systematic review and meta-analysis of quality of life and psychosocial outcomes. Clinical Endocrinology 72(2), 214-231. doi.org/10.1111/j.1365-2265.2009.03625.x

Price-Feeney, M., Green, A., Dorison, S. (2020). Understanding the Mental Health of Transgender and Nonbinary Youth. Journal of Adolescent Health 66(6), 684-690. doi.org/10.1016/j.jadohealth.2019.11.314

Progovac et al. (2020). Disparities in Suicidality by Gender Identity Among Medicare Beneficiaries. American Journal of Preventive Medicine 58(6), 789-798. doi.org/10.1016/j.amepre.2020.01.004

Reisner, S.L, et al. (2015). Mental Health of Transgender Youth in Care at an Adolescent Urban Community Health Center: A Matched Retrospective Cohort Study. Journal of Adolescent Health 56(3), 274-279. dio:https://doi.org/10.1016/j.jadohealth.2014.10.264

Ross, D. (2020, January 9). Teenager took his own life at hotel while awaiting autism diagnosis. Teeside Live. Retrieved from https://www.gazettelive.co.uk/news/teesside-news/marton-teenager-took-life-hotel-17532276

Surface, T., Fusar-Poli, L., Vozza, L. Lifetime prevalence of suicidal ideation and suicidal behaviors in gender non-conforming youths: a meta-analysis. European Child & Adolescent Psychiatry. doi.org/10.1007/s00787-020-01508-5

The Trevor Project. (2020, February 6). Suicidality Disparities by Sexual Idenity Persist from Adolescence into Young Adulthood. Retrieved from https://www.thetrevorproject.org/2020/02/06/suicidality-disparities-by-sexual-identity-persist-from-adolescence-into-young-adulthood/

The Royal Children’s Hospital of Melbourne Standards of Care. Retrieved from https://www.rch.org.au/uploadedFiles/Main/Content/adolescent-medicine/australian-standards-of-care-and-treatment-guidelines-for-trans-and-gender-diverse-children-and-adolescents.pdf

Tucker, R.P., Testa, R.J., Simpson, T.L., Shipherd, J.C. Hormone therapy, gender affirmation surgery, and their association with recent suicidal ideation and depression symptoms in transgender veterans. Psychology Medicine 48(14), 2329-2336. doi.org/10.1017/S0033291717003853Pub

Turban, J. L., King, D., Carswell, J. M., & Keuroghlian, A. S. (2020). Pubertal Suppression for Transgender Youth and Risk of Suicidal Ideation. Pediatrics,  Feb;145(2):e20191725. doi:10.1542/peds.2019-1725

Wanta, J.W., Niforatos, J.D., Durbak, E., Viguera, A., Altinay, M. (2019). Mental Health Diagnoses Among Transgender Patients in the Clinical Setting: An All-Payer Electronic Health Record Study. Transgender Health. 4(1). doi.org/10.1089/trgh.2019.0029

Wiepjes, C. M., Heijer, M. den, Bremmer M.A., Nota N. M., Blok C. J. M. de, Coumou, B. J. G., Steensma, T.D. (2020). Trends in Suicide Death Risk in Transgender People: Results From the Amsterdam Cohort of Gender Dysphoria Study (1972-2017). Acta Psychiatry Scandinavia Feb 18 (ahead of print). doi: 10.1111/acps.13164

Wigzell, O. (2020, February). The Evolution of the Diagnosis of Gender Dysphoria. Socialstyrelsen.

Thanks to The Australian and Bernard Lane for Publishing Our Comments About the Affirmative Model

News Commentary

Bernard Lane has been writing articles about transgender issues for The Australian. Those articles can be found listed under his BIO.

Lane included GHQ statements for an article about conversion therapy laws and how these will be used to immediately affirm the significant increases in trans-identified youth:

“Health chiefs can’t ignore ‘global epidemic’ of transgender teens”

Here is the quoted GHQ commentary:

Justine Kreher, from a new US-based LGBT group Gender Health Query worried about overdiagnosis of gender dysphoria and medicalisation of minors, said most LGBT people were not aware of the risks.

“The evidence is strong that early social transition (living as the opposite sex) and use of hormone blockers will lead to the over-medicalisation — or “conversion” — of LGB minors who would have outgrown gender dysphoria with maturation,” she said.

“It’s already happening as known cases are mounting. The question is, how high will the percentage be?”

Gender Health Query’s international board includes trans adult Miranda Yardley and lesbian feminist philosopher Holly Lawford-Smith from the University of Melbourne.

Ms Kreher, also a board member, said LGBT lobbies and progressive media refused to discuss “the reality that for many gender-nonconforming youths, or even adults, there isn’t a clear line between gay and trans”.

“Trans people argue transition as a minor is a human right (but troubled) LGB people would argue the right to mature and accept oneself, without being medically defaced by the psychology and medical profession, is a human right.”

Ms Kreher said activist promotion of medicalised gender change had been “extremely effective in inducing suicide terror in the public”.

“People should take suicide risk seriously, but it is also exaggerated and employed to manipulate people to not care about serious risks to minors who may (grow out of gender dysphoria) with time,” she said.

“These risks include sterilisation, loss of sexual function, impacts on bone and circulatory health, and a reduction in IQ if they take hormone blockers.”

The article included commentary from mental health professionals expressing similar concerns:

The internationally recognised sex researcher, Ray Blanchard, joined online debate about the Queensland bill, tweeting: “Conversion therapy laws are Trojan Horses, ostensibly about banning attempts to change sexual orientation in adults, actually about banning therapy to help gender-dysphoric children and youth become comfortable with their anatomic sex”.

And:

Dr Parry pointed out that many children grew out of gender dysphoria, becoming “more comfortable with birth gender or a same-sex orientation”. Clinicians say this is a reason to be cautious about medical interventions.

Psychologist Dianna Kenny, who treats gender dysphoric youth, told the committee that trans activists “vehemently denied the role of social contagion in the spread of gender dysphoria in young people because it flies in the face of their flawed ideology that children are the experts regarding their own gender identity”.

Dr Kenny, a specialist in developmental psychology and a former professor at Sydney University, said beliefs and attitudes were especially contagious in centralised social networks.

“This network is highly centralised with only one voice — the trans activist lobby — being heard above the desperate cries of terrified parents and horrified academics, doctors, psychologists and psychotherapists.”

She said this social contagion was affecting not just children and adolescents but also medical practitioners, legislators and educators.

The article confirms this is mainly affecting young females:

There were at least 216 patients on controversial puberty blocker drugs (up 108-fold over six years).

The clinic refuses to reveal birth sex data but 94 per cent of the 84 under-18s on opposite-sex hormones were taking testosterone, meaning they were born female.

Thanks to the paper and author for airing our concerns.

References

Lane, B. (2020, February 11) “Health chiefs can’t ignore ‘global epidemic’ of transgender teens.” The Australian. Retrieved from https://www.theaustralian.com.au/nation/health-chiefs-cant-ignore-global-epidemic-of-transgender-teens/news-story/5849a55ba47884befdc9eb72d25d32d7

Comments from Gender Clinicians Who Resigned from Tavistock in UK Support the Need for Gender Health Query

NEWS COMMENTARY

One of the main goals of Gender Health Query is to ensure that gender dysphoric youth are not being over-medicalized. This is in light of the fact minors are being permanently altered and that the demographics of who is seeking treatment has changed rapidly to include many more young females. Unfortunately, a recent newspaper article in the London Times confirms some of our worries.

These concerns are:

• Some youth are not receiving proper mental health support.

• They are not being given time to mature.

• Inappropriate medical transition of LGB youth is a major risk.

• Anti-gay attitudes among parents and youth themselves may be fueling transition.

• Medical procedures will have negative impacts on health.

These concerns are being raised by gender clinicians themselves as “All five have resigned from the Gender Identity Development Service (GIDS) in the past three years as a matter of conscience.”

Some quotes from the article:

“This experimental treatment is being done not only on children, but very vulnerable children, who have experienced mental health difficulties, abuse, family trauma, but sometimes those [other factors] just get whitewashed,” one female clinician said. “If someone was suggesting plastic surgery or any other permanent change we’d be saying, hang on a minute.”

“They believe that physically healthy children are being medicated in response to pressure from transgender lobby groups and parental anxieties.”

So many potentially gay children were being sent down the pathway to change gender, two of the clinicians said there was a dark joke among staff that “there would be no gay people left”.

“It feels like conversion therapy for gay children,” one male clinician said. “I frequently had cases where people started identifying as trans after months of horrendous bullying for being gay,” he told The Times.

Young lesbians considered at the bottom of the heap suddenly found they were really popular when they said they were trans.

Another female clinician said: “We heard a lot of homophobia which we felt nobody was challenging. A lot of the girls would come in and say, ‘I’m not a lesbian. I fell in love with my best girl friend but then I went online and realised I’m not a lesbian, I’m a boy. Phew.’”

Several clinicians suspected that some of the “transgender” adolescents were reacting to homophobia at home.

“For some families, it was easier to say, this is a medical problem, ‘here’s my child, please fix them!’ than dealing with a young, gay kid,” the third female clinician said. At the service’s “family days”, a parent was allegedly heard saying that they did not want their child to have gay friends because they “didn’t want them mixed up in that hedonistic lifestyle”. “It is converting people into heterosexuals,” one of the clinicians said. “We had so many families who would talk about not wanting their daughters to be lesbian.” Young people “repeatedly” confided their own “disgust” that they may be gay, according to the clinician.

“Children’s bodies are being damaged in order to treat societal issues,” she warned. She recalled a case of a 13-year-old child “whose parents were really pressurising us for puberty blockers”. When the clinician refused to refer him, she claims one of the parents, a lawyer, wrote threatening legal letters to the service. The child was eventually referred for blockers.

I list of these consequences can be found here:

She would have nightmares about her years at the Tavistock. “I would talk about it as an ‘atrocity’. I know that sounds quite strong, but it felt as if we were part of something that people would look back on in the future, and ask, what were we thinking? In the future I think there will be lots and lots of de-transitioners who feel their bodies were mutilated as young people and who will ask, why did you let me do this? It is very disturbing.”

All five clinicians expressed concern over how little young people and their families were being told about the impact of hormone treatment on fertility and sexual function as adults. One claimed young people were unable to give “informed consent” because it was regarded as taboo to discuss the impact of medical intervention on later sexual function in such a young cohort.

In what other specialism would physical intervention that leads to permanent change to the body be the first line of treatment for a vulnerable child? Activists will tell you it’s unethical not to intervene. But we know that not everyone with gender dysphoria will go on to identify as trans for the rest of their lives.”

One case has haunted her. “All the pushing was coming from the father to put the kid on puberty blockers. Thinking back on it now, I fear that the father was a paedophile and the child was being abused.” There is no suggestion the service knowingly ignored the case, and the outcome is unknown

These health professionals have differing opinions about the quality of care. The head of the clinic maintains that proper care is taking place and that there is no evidence of harm. Hopefully this assessment will turn out to be correct for the vast majority of children. But some collateral damage is likely inevitable:

The clinic, which is run by the Tavistock and Portman Foundation Trust and whose director is Polly Carmichael, says it is tracking the progress of 44 young people who began puberty blockers in 2011, and that all available evidence is discussed with families. “This is a rapidly developing field and psychosocial and medical professionals are working hard to ensure that we respond to emerging evidence in an appropriate and considered way,” a spokesman said. The growing body of international evidence showed that “thus far, there is little reported evidence of harm,” he added.

And a differing opinion:

The whole service should have been halted when the number of “transgender” cases first exploded, one of the clinicians said. “That’s the point we should have stopped because we didn’t know what we were doing. Are we a service for kids with gender dysphoria, a medical disorder? Or are we a service for ‘transgender kids’?”

One clinician said it was understandable if her former employer was defensive, saying: “If they are getting it wrong, you have to ask, are they making kids infertile by mistake? Because if they are to truly acknowledge [our concerns], then they will have to ask themselves, what the f*** have we done to thousands of children?”

We do not have open comments on the Gender Health Query website. But that doesn’t mean we aren’t interested in what you have to say. If you have a comment, blog post idea, or any other feedback, we would be interested if the information can be supported by science research, an informed opinion, real-world observations, or personal experiences. Please contact us.