'We don't actually know much' Guardian article on hormone therapy

[JustHereForTheDeletionMessageAgain]

So much to unpack in this Guardian article. I see Devon supplied their own photo, perhaps a guardian one wouldn't be as flattering? https://www.theguardian.com/society/2024/mar/18/science-knowledge-gap-trans-healthcare?CMP=ShareiOSAppp_Other

I found some of this article disturbing. Having seen what "gender surgeons" get up to I'm not sure how much I'd feel able to rely on some of this research.

"Nothing about us without is" sounds good and I can see the value of research done by and about different populations of people taking high doses of hormones but I'd at least want to balance the result of Devon Buchanan's trial with results of work by the other researchers who don't have such a powerful personal interest. For the same reason I wouldn't totally rely on research funded a drug company.

And as for "trans broken arm syndrome" - well, that's ironic. It's as if some people don't know there's a connection between hormones and osteoporosis.

Thank you @JustHereForTheDeletionMessageAgain for the link anyway.

I thought that about the photos 😄In fact they’re all supplied apart from Heinitz and Ahmed.
Yes, there is a lot going on here. I’m also struck by the study linked to ( significantly reducing the risk of depression and suicide), which looked at a not huge test group of 64 people, all waiting for hormone therapy.
I'm no scientist or statistician, but I’m not convinced that this is the most robust study.

“Nothing about us without us” is a slogan taken from the social care sector talking about how services and packages of care should be co designed with the people using the services/care packages

it was not designed to be applied to objective clinical research. I wonder how objective any research can be when tje designers/leaders/researchers are heavily invested in a particular outcome (see Joanna harper!)

I was also struck by the study reported here. https://www.theguardian.com/society/2023/sep/08/fast-access-to-hormone-therapy-in-transgender-adults-lifesaving-study-finds

It seems to say that patients who are depressed and want a particular therapy feel better if they get it quicker than they expected. Not exactly ground-breaking. I'd want to see follow up a few months and years down the line to see if their mental health has improved permanently or whether the underlying issues are still there.

It was a nonsense study. It looked at females accessing testosterone and assessed them after only 3 months. Unsurprisingly the females who accessed testosterone, a hormone known to cause a euphoric effect and a treatment these females had been desperate to get because they were being told they’d be suicidal without it reported less suicidal thoughts just 3 months after they got it.

The females who didn’t get the testosterone they wanted weren’t happy after 3 months🙄.

Of course in the grand scheme of hormone treatments 3 months is absolutely nothing. It’s barely any treatment at all and it has no indication the treatment is actually helping a person’s mental health.

The OP’s article is terrible. You can pick holes in every single part, but the most obvious question to arise is this:

If there’s so much that isn’t known, how can children consent?

Let's apply social theory and social bias to a concept which has greatest value and worth when you remove social bias. Research is all about removing social bias and involvement.

These people are modern eugenicists.

Eugenicists worldwide believed that they could perfect human beings and eliminate 'social ills' through genetics and heredity. They looked to science to provide a solution to their ideological crusade.

Transgender Activists look to science to provide solutions to their ideology. The desired outcome is already predetermined - the desire to pass. No consideration is given to other possibilities. They are just looking for evidence to support this and will suppress anything contrary to this. It is based on grievance culture and a desire to conform to gender stereotypes. That's why everything that doesn't fit is 'transphobic'. It's why the medicalisation of children is particularly important because it props up the legitimacy of the late transitioners beliefs.

It is cultlike for all these reasons too.

Medicine and ideology NEVER mix well precisely because of the conflict between social bias and evidence.

Also.

Where do these fuckers get off saying we don't know X about trans health care, then do what they can to undermine and ruin women's health care which is so behind 'default human' healthcare.

Has anyone seen this study?

https://www.auajournals.org/doi/10.1097/JU.0000000000001971.20

'Abstract

INTRODUCTION AND OBJECTIVE:
Despites rates of comorbid psychologic illness in cases of gender dysphoria being estimated to be 70% greater than the general population, there is a dearth of literature concerning this topic. In this study we aimed to assess rates of psychiatric emergencies before and after gender affirming surgery in a large population-based cohort.

METHODS:
All persons undergoing feminizing (vaginoplasty) and masculinizing (metoidioplasty/ phalloplasty) genital gender affirming surgery were identified in California from 2012-2018 from the Office of Statewide Health Planning and Development datasets using appropriate ICD-9/10 codes. All emergency room and inpatient psychiatric encounters were identified (noting those involving suicide attempts). Rates of these encounters were calculated before and after gender affirming surgery (using date of first operation if staged). On average, patients had a balanced two years of observation before and after their surgery.

RESULTS:
Overall, 869 and 357 patients were identified undergoing vaginoplasty and phalloplasty with 193 (22.2%) and 74 (20.7%) having at least one psychiatric encounter (Table 1). Although the overall proportion of those experiencing a psychiatric encounter was similar between the vaginoplasty and phalloplasty groups, suicide attempts were more common in the vaginoplasty group (4.4% vs. 1.7%, p=0.033). The rate of a psychiatric encounter occurring after surgery if an episode prior surgery occurred was 33.9% and 26.5% for the vaginoplasty and phalloplasty groups. The overall rates of suicide attempts doubled (3.3 vs 1.5%, p=0.017) after vaginoplasty (effect not observed after phalloplasty).
^^
CONCLUSIONS:
Rates of psychiatric emergencies are high both before and after gender affirming surgery. Although both the phalloplasty and vaginoplasty patients have similar overall rates of psychiatric encounters, suicide attempts are more common in the later. In fact, our observed rate of suicide attempts in the phalloplasty group is actually similar to the general population, while the vaginoplasty group's rate is more than double that of the general population. Patients undergoing GAS with a history of prior psychiatric emergences or feminizing transition are at higher risk and should be counseled appropriately.'

'In fact, our observed rate of suicide attempts in the phalloplasty group is actually similar to the general population, while the vaginoplasty group's rate is more than double that of the general population.'

Regarding the above quote, I thought that men (males) had a higher suicide rate than women (females). So the general population rate will be an average. That average will then be higher than the female only rate. As the post phallo rate is that of the general population average, that means that it is higher than the general population female only rate.

It would be interesting to see the male and female suicide rates for California from 2012-2018 to compare the post phalloplasy and post vaginoplasty rates from this study with.

Indeed, in fact if you have a vested interest in your clinical research you usually have to disclose it and then everyone takes your findings with a huge pinch of salt!

Or people who feel so bad about who they are could have talking therapies to help them accept themselves?

It's ALL about the money.

Did Cameron even consider that their kidney issues might be directly connected to taking experimental drugs to do things that their body wasn't born to do.

The more I think about it the more insane and vile I find all of this. Just because science can do things it doesn't mean it should.

Astonishing that people are willing to advocate for the use of such medecines while in the next breath admitting how little is known about potential side effects.

“Regardless of the type of [hormone] therapy and who is using it, we actually surprisingly as a healthcare profession don’t know much,” said Dr Sofia Ahmed of the University of Alberta...

They don't know much about the effects of the drugs they are prescribing, yet they assume that all is fine and carry on doing so. How can that be ethical?

I stopped reading about halfway through, not least because of the "cis gender" word count. The so called study certainly seems to be starting with a lot of assumptions and trying to prove a point, rather than being neutral. As everyone has pointed out, Devon Buchannan has great bias and probably shouldn't be running it.

There are a lot of different reasons why a patient might continue taking a powerful drug even after they've become very ill. Maybe the drug didn't cause the illness, maybe it is harmless or even helpful. Maybe the doctors don't know if the drug is causing the condition or making treatment less effective, so if the patient is keen enough they're willing to take the chance. Maybe the drug originally caused the illness but withdrawing the drug now wont make the illness go away. Maybe the drug is doing some harm but after your body is habituated then taking the drug away is worse than keeping going. Sometimes people stay on cross-sex hormones or a blend of hormones even when they want to detransition because it's the least physically harmful.

Who knows....

The phrase trans-competent jumped out to me. They put the word trans in front of so many things but don't stop to think how that changes meaning. Trans-competent is the opposite of competent...

Self-id as competent. Insist other people treat you as competent regardless of contradictory evidence.

The thing I noticed most about the article was the frequent references to hormones in "cisgender" people, and how those change over the life course - for example, in menopause. There was this line in particular:

"In other words, given levels of sex hormones can undergo a profound shift across an individual’s lifespan, whether cisgender or transgender, understanding their impact could have important implications for everyone’s healthcare."

This feels very much like an attempt to normalise the use of cross-sex hormones and to pretend it's no big deal because, hey, even "cis" people experience hormonal changes and we don't know much about their impact, so it's all fine.

Whereas an alternative perspective might be to think: "Giving predominantly female hormones to men, and male hormones to women, over the course of 30-50 years is a completely new and terrifying experiment and we have absolutely no idea what the consequences might be."

The references to cis are reflective of who (I think) this article is aimed at, i.e. trans people and their sympathisers. While it grates, if it means the parents or friends of a trans-identifying person might have pause for thought, and forward it to their loved one, possible causing them to rethink things, that can only be a good thing.

At least there was mention of effects being irreversible.

There is the quiet "beep...beep...beep" of a ferret starting to reverse and hoping no-one will notice.

Absolutely. Their own research, if conducted properly could show terrible outcomes, cancer, cardiovascular risk, etc etc but they’re so ideologically committed to the idea of the treatment all they’re actually doing is advancing the knowledge of how much or little they’re going to fuck up their bodies, not inform themselves or others - or CHILDREN - as to whether they should or not.

What this article boils down to is: "We need to do Proper Research to tell us whether or not taking fucktons of hormone blockers and cross-sex hormones for years and years is going to fuck up your health."

They might still hope to reverse about children, while still affirming all over adults.

“We start in the understanding that health and disease risks and responses differ between cis men and cis women, but one cannot easily entangle different components of sex or gender – is it due to lifestyle, hormones or genetics?”

That last bit... I know the answer, it's really easy! It has fuck all to do with any medical field whatsoever. Gender isn't a thing. HTH

We start in the understanding that health and disease risks and responses differ between cis men and cis women

That's such a ridiculous statement. It implies that self identified trans people ( ie anyone who claims to have a "gender identity" which is different from their sex) are somehow outside the group of people whose health risks and responses are different by sex. These are sex based, not "cis person based".

These ranges are known to differ between cisgender men and women, but it is unclear what a “healthy” range is for trans men and women taking hormones – a situation doctors have said could put trans patients at risk of receiving the wrong dose of a medication, diseases being missed or even conditions being erroneously diagnosed.

Among those attempting to resolve the issue is Devon Buchanan, a clinical scientist with Synnovis who is running a trial based at King’s College hospital that began in April 2021 and is recruiting 240 trans and non-binary people.

“We know that those ‘normal’ ranges are affected by gender affirming hormone therapy which a lot of trans people take and is very important to them,” she said.

Many previous studies have been small and the results unclear. “We wanted to cover a wide variety of tests and also have a larger sample size so that we could be more sure about the results,” said Buchanan.

This is hugely dangerous. What they’re saying is there are male ranges and female ranges and there should be “trans ranges”. But this is false. If a female on testosterone has a measurement of a particular marker that is outside the normal female range and in the “trans man range”, they likely have pathology. They may well be “normal” for a trans man, but it’s abnormal for a female and therefore causing disease.

“Your level of X is high, which for a woman would be a big concern. But you’re not a woman! For a trans man this level is in our normal range. Nothing to worry about. Off you go.”

It’s so incredibly self defeating to ignore the reality of sex.

I suppose it depends on whether you are thinking of hormones as the cause or the effect of problems. An abnormal hormone level might be causing a problem or it might be the result of a problem. If you are taking loads of cross-sex hormones, you're bound to have unusual levels for your sex, and probably unusual levels compared to the other sex too, so it's not necessarily the result of any other illness. But having the wrong levels of hormones for your physical sex might be causing something to go wrong.

Nobody knows what the "normal" as in "healthy, not causing horrible problems, and not the result of something else being wrong" hormone levels are for people taking hormones in this way. I think there's some knowledge from cancer patients etc getting side effects of hormone treatments, from chemically castrated sex offenders, from athletes taking steroids, and maybe from contraception and HRT - but I don't know how much of that applies to people who are specifically using hormones to feminize or masculinize.

They’re not just talking about hormone levels though. They’re talking any measurement in medicine: hormone levels, other blood levels, blood pressure, anything. And they’re not just talking about ignoring sex differences, they’re talking ignoring normal levels.

For sex based difference take the example of creatinine. Males have higher levels than females. They’re arguing that is a female is on testosterone and has a level that is a) male range or b) a completely different range then either are “normal for trans men” rather than abnormal for females.

For non-sexed based example take liver function. Gamma GT is a marker of liver damage. They’re arguing that if they assess a whole load of males on oestrogen and their gamma GT levels are all higher than normal, then it means it’s “normal” for males on oestrogen to have gamma GT levels at that measurement, not a sign of liver damage.

The flip side is that they could be arguing that exogenous hormones may mask disease. But I can’t think of such a scenario of the top of my head.

The bottom line is there is no “normal” range outside of those for a person’s sex.