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Medical Risks of Gender Affirmative Therapy in light of Rapid Onset Gender Dysphoria

Posted by mlaidlawmd on 28 Aug 2018 at 22:25 GMT

One must view Dr. Littman's study in light of the significant medical harms that occur to children, adolescents, and young adults in the gender affirmative care (GAC) model:

1. Sterility induced by puberty blockade followed by indefinite high dose cross sex hormones and potential gonadectomy [a,b].

2. Documented exceedingly low rates of fertility preservation. [a,b]

3. 5X elevated risk of venous thromboembolic disease for MtF due to estrogen. [c]

4. Elevated risk of myocardial infarction and death due to cardiovascular risk in males and females because of cross sex hormones [c]

5. Permanent sexual dysfunction caused by early puberty blockade followed by cross sex hormones. [d]

6. Impairment of proper bone mineralization caused by puberty blockade with GnRH agonists or similar medications. [e]

7. Impairment of normal pelvic bone development (dependent on estrogen) for females receiving puberty blockers and testosterone. This has negative health implications with risk to mother and baby for future pregnancy and delivery. [f]

8. Hirsutism induced in females by taking supraphysiologic doses of testosterone which will be very difficult to reverse.

9. Gynecomastia induced in males by taking supraphysiologic doses of estrogen will in most cases not be reversible except by surgery.

10. The existence of detransitioners who regret their medicalization under GAC and live with permanent negative health consequences above. [g]

It is therefore imperative that a proper diagnosis be made of the "true trans" person in order to insure that people are not harmed by these very powerful therapies and life altering surgical procedures.

Dr. Littman's article is an essential first step in probing if there is a sociological contagion element for adolescents and young adults choosing gender affirmative therapy. She also identified a high proportion of underlying comorbid psychiatric conditions or neurodevelopmental disabilities which could make them susceptible to contagion and obsessive compulsive thinking and behaviors. In which case a high proportion of these young people may not be "true trans" and will be irreversibly harmed by GAC.

It should be well known that parents will have the best knowledge of a child's medical history until the child is of age to be responsible for their own care and for informed consent.

Physicians caring for adolescents and children depend on parents specifically to obtain a good medical history and to observe the child’s health and behavior. A young person whose judgement and perceptions are altered due to social contagion, psychological factors, high dose hormones, or the need to hide information will be poor historians or even deliberately deceptive in these instances.

For all of these reasons and more, I believe that Dr. Littman's study is of vital importance to the medical and scientific community.

Michael K. Laidlaw, MD
Board certified specialist in Endocrinology, Diabetes, and Metabolism

a. Nahata L, Tishelman AC, Caltabellotta NM, Quinn GP. Low Fertility Preservation Utilization Among Transgender Youth. J Adolesc Health. 2017;61:40-44.

b. Chen D, Simons L, Johnson EK, Lockart BA, Finlayson C. Fertility Preservation for Transgender Adolescents. J Adolesc Health. 2017 Jul;61(1):120-123.

c. Irwig MS. Cardiovascular Health in Transgender People. Rev Endocr Metab Disord. 2018;Aug 3 epub.

d. Laidlaw M. "Gender Dysphoria and Children: An Endocrinologist's Evaluation of I am Jazz". Public Discourse. April 2018.

e. Klink D, Caris M, Heijboer A, van Trotsenburg M, Rotteveel J. Bone mass in young adulthood following gonadotropin-releasing hormone analog treatment and cross-sex hormone treatment in adolescents with gender dysphoria. J Clin Endocrinol Metab. 2015 Feb;100(2):E270-5

f. Huseynov A, Zollikofer CP, Coudyzer W, Gascho D, Kellenberger C, Hinzpeter R, Ponce de León MS. Developmental evidence for obstetric adaptation of the human female pelvis. Proc Natl Acad Sci USA. 2016 May 10;113(19):5227-32.

g. "Experience: I regret transitioning". The Guardian. Feb 2017

No competing interests declared.

RE: Medical Risks of Gender Affirmative Therapy in light of Rapid Onset Gender Dysphoria

dhart922 replied to mlaidlawmd on 30 Aug 2018 at 17:44 GMT

Yet, there is no intervention known to medical science that relieves gender dysphoria. Gender affirmation is proved to reduce levels of stress and anxiety to near normal levels. We do not tell people to reject a therapy that they need because of the side effects.

Competing interests declared: LGBT Advocacy (I write a popular LGBT blog - The Slowly Boiled Frog)

RE: RE: Medical Risks of Gender Affirmative Therapy in light of Rapid Onset Gender Dysphoria

bb replied to dhart922 on 11 Sep 2018 at 17:41 GMT

That's simply not true. Study after study has shown that many -- in fact, the majority -- of cases of childhood dysphoria resolve on their own or with psychiatric therapy.

For some people with chronic, persistent gender dysphoria, transition is the best treatment. For THEM, it works well.

Don't you understand that you can't just apply a treatment meant for the most severe, chronic cases to every single case of dysphoria right off the bat? Especially because it's an EXTREMELY invasive treatment -- it causes massive, irreversible physical changes, which would not be desired and would be deeply distressing in any patient whose condition was resolved on its own or with therapy.

This really is such a simple concept to grasp: don't jump straight to highly invasive irreversible surgery to treat a condition that is likely to go away on its own.

No competing interests declared.

RE: RE: RE: Medical Risks of Gender Affirmative Therapy in light of Rapid Onset Gender Dysphoria

sgarfio replied to bb on 12 Sep 2018 at 19:09 GMT

"Don't you understand that you can't just apply a treatment meant for the most severe, chronic cases to every single case of dysphoria right off the bat?"

Which is why that's not how it's done. Your comment shows a lack of understanding of the process that patients go through when they present with gender dysphoria. The first step is therapy. A therapist's letter is generally required (in the US) for anyone, even an adult, to obtain hormone therapy. Once hormone therapy begins, the patient is regularly monitored. In the small number of cases where the therapeutic diagnosis proves incorrect, the onset of HRT is often where this is discovered, since cross-sex hormone therapy in cisgender people tends to cause great distress. Transgender people, on the other hand, often experience great relief.

Surgery is not something transgender people "jump straight to", and in fact is not even considered for minors. WPATH has the following standards for gender-affirming genital surgeries ( page 60):

1. Persistent, well documented gender dysphoria;
2. Capacity to make a fully informed decision and to consent for treatment;
3. Age of majority in a given country;
4. If significant medical or mental health concerns are present, they must be well controlled.
5. 12 continuous months of hormone therapy as appropriate to the patient’s gender goals (unless
the patient has a medical contraindication or is otherwise unable or unwilling to take
6. 12 continuous months of living in a gender role that is congruent with their gender identity.

They also specify letters of recommendation from not one, but two therapists competent to treat gender issues. Items 1 through 4 also apply to "top surgeries."

It is far from easy to get gender-affirming medical treatment. No one does this on a whim. You don't get through all of this lengthy and involved process without being absolutely certain.

Furthermore, the person you were responding to said nothing about surgeries. They specifically referenced "Gender affirmation" and "therapy." Where is the harm in allowing a child to explore their social gender presentation after they express a desire to be (or an insistence of already being) the opposite gender from what we thought they were? The only possible "harm" comes from unaccepting people in society - like the parents at Maddie Rose's school in Oklahoma who bullied her viciously online and threatened violence against her ( This is why gender affirmation is so incredibly important.

No competing interests declared.