Erin Reed / Anthony Reed II / @ErinInTheMorn / @ErinInTheMorning / @ErinInTheNight / _supernovasky_ / beholderseye / realitybias / AnonymousRabbit - post-op transbian Twitter/TikTok "activist" with bad fashion, giant Reddit tattoo. Former drug dealer with felony. Married to Zooey Simone Zephyr / Zachary Todd Raasch.

[AnOminous]

Strangley, both Tony and Big Al think "well i'm too lazy to walk that far" is a serious argument.

Most of these fat fucks could use a walk.

 

[AirdropShitposts]

View attachment 5249030

If you want it treated like any other medical matter then it's not between doctors and patients except at the very end point, it's between legislators and regulators with minor assistance from industry. "Legislative researcher" and "independent journalist" who can't identify the largest single payer in the market that's also an entity with regulatory authority about whether anything even can come to market in the first place. Does marijuana, to use a popular example, have any medicinal effects? Who knows, the state effectively bans research on Schedule 1 drugs. It wasn't until it was allowed for medical purposes that the studies could even be done to see if it has any useful medical purposes. This is normal in the administrative regulatory state.

Laziness is not a compelling reason for man to be going into the ladies room.

View attachment 5249198

Strangley, both Tony and Big Al think "well i'm too lazy to walk that far" is a serious argument.

He's right, the separate bathrooms for men and women are not truly equal, the women's rooms have no urinals and the men's rooms have no couches and disgusting stuff left all over the floor regularly. ABOLISH SEPERATE BUT EQUAL BATHROOMS!

Apologies for double-posting.

I knew I couldn't keep "low-quality evidence is good, actually" out of my tag line for long.
View attachment 5251846
@ErinInTheMorn, tweet 1687579509862567936 (archive)


The thing about "low" and "very low" quality evidence, as is the case for "treating" gender dysphoria with puberty blockers and cross-sex hormones, is that it means we don't know that they have the beneficial effect that is claimed for them. However, we do know what the side-effects are, or are likely to be: loss of sexual function, sterility, retardation of brain development, prevention of bone density development, osteoporosis, heart problems, stroke, and dementia.

It is up to the proponents of a treatment to show that it is better than some other treatment, or no treatment at all. First do no harm, and all that.

What is this even from? He links to nothing and Google doesn't return on any of the sentences. I think it might be this but not going to pay to find out: https://pubmed.ncbi.nlm.nih.gov/35642738/

It also ignores that there's no testing possible for gender affirming care because there's not even a hypothesis. GRADE actually has measures to allow for what Tony is alleging it can't (see the chart a bit down from the start): https://www.bjanaesthesia.org.uk/article/S0007-0912(19)30643-9/ The problem is that gender affirming care would fail every single one of them. GRADE can't protect you from GIGO or ideological capture.

GRADE doesn't even require RCT's (since that would be stupid), because it's about alternatives not measuring against placebo/nothing, Tony and the cultists allow no alternatives there is only gender affirming care or DEATH. Obviously you can't do a study where 100% of the control group is dead, then it's a mortality study not a medical study. You can pretty clearly do a gender affirming care vs. something like CBT study, this wouldn't be a violation of ethical practices because it's normal in psychology, the problem is that nobody would want to do this because it would fail the criteria for the study: showing that gender affirming care works. (Assuming you could get any trans patient to agree to it rather than immediately doctor shopping and/or buying wet market HRT and accusing the one who put them in the CBT group of trying to murder them.)

The proposition for a ban isn't that it fails some standard, it's that it doesn't improve things, only makes patients worse off and also fails every standard.

 

[glioblastoma multiforme]

Laziness is not a compelling reason for man to be going into the ladies room.

this is another example of Tony's massive male privilege. certain depatmrnts at universities, and certain types of workspaces, that were traditionally extremely male dominated, have very few ladies' toilets compared to mens' - in old buildings you can walk past 5 mens before getting to a ladies. its very frustrating when desperate for a piss but such places aren't rife with women having accidents in the halls.

he is right that a lot of evidence for medical interventions is low quality in comparison to the ideal standard. it depends a bit on the condition, if you have something that will kill you quickly and painfully, you can volunteer to be a human test subject on something that say looks promising in animal models and has a decent theory behind it because its your only hope. for pharmaceutical interventions, there is a fuckton of testing between pre-clnical trials and bringing something to market (except in times of severe crisis a la covid, but almost everyone with relevant skills was working on those problems then so the swiftness was in part due to extrarodinary manpower, and even then many corners were cut). even then, some side effects only become apparent once the drug is on the market.

what tony's totally ignoring is that while there is low quality evidence for troon interventions improving mental health, there is pretty high quality evidence for the masses of health problems they cause. to my knowledge, drugs with known, devastating side effects are typically written off unless there is no other intervention and the alternative to not intervening is a painful death- like chemo. i have no idea how the side effects vs efficacy for targeted problem is balanced but whatever method is used, i don't see how wrong sex hormones and burchery would come out on the right side of that balance.

 

[Geranium]

Tony's thread on evidence quality got quoted by Jack Turban:

@jack_turban, tweet 1687593419487813632 (archive)

Jack Turban MD (@jack_turban) · Aug 4, 2023 · 10:36 PM UTC
Scary buzzword is a good way to describe this
The general public doesn’t have information on what GRADE criteria are or how they work
They’re complicated (much like pediatric gender medicine), and political operatives rely on people not understanding
Most judges see through it

Jack Turban MD (@jack_turban) · Aug 4, 2023 · 10:40 PM UTC
Long story short: anything that doesn’t have RCTs won’t meet a high level GRADE score. But there are areas of medicine where RCTs aren’t possible or advisable, & thus GRADE recognizes many clinical recommendations can be based on lower GRADE evidence scores and still be good recs

Response to Turban from Leor Sapir:

@LeorSapir, tweet 1687786146066030592 (archive)

Leor Sapir (@LeorSapir) · Aug 5, 2023 · 11:22 AM UTC
This is misleading.
1. GRADE has four rankings: high, moderate, low and very low. RCTs do generally produce high quality evidence but can be downgraded. Observational studies are not as reliable as RCTs, but they can still yield "low, "moderate" or even, in some cases, “high” quality evidence.
See explanation in this article by Prof. Gordon Guyatt, who helped develop GRADE.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2364804/#:~:text=Although%20well%20done%20observational%20studies,quality%20evidence%20(see%20box)

2. In gender medicine, research is generally so poor that the quality has consistently been ranked “very low" by systematic reviews using GRADE.
3. Some studies--including Turban's 2020 suicide paper in @aap_peds—are so methodologically weak that European reviews have determined they do not even rise to a level that qualifies for inclusion in a systematic review. See for instance NICE puberty blocker review, p. 75.
4. I’m glad the debate has now shifted from “it’s settled science and anyone who doesn’t agree is a bigot” to “well, why shouldn’t we allow doctors to sterilize kids under a regime of very low quality evidence?”

Leor Sapir (@LeorSapir) · Aug 5, 2023 · 11:36 AM UTC
BTW: GRADE isn’t applied to individual studies but to overall quality of evidence.

Where Sapir refers to Turban's 2020 puberty blockers & suicide paper being excluded from the NICE puberty blockers review, it's because Turban didn't report the data for puberty blockers separate from other interventions. ie, From Turban's paper, you can't tell what was the result of puberty blockers and what was the result of something else.


Edit:

What is this even from? He links to nothing and Google doesn't return on any of the sentences. I think it might be this but not going to pay to find out: https://pubmed.ncbi.nlm.nih.gov/35642738/

Yeah, it's:

Jack Drescher (2023) Informed Consent or Scare Tactics? A Response to Levine et al.’s “Reconsidering Informed Consent for Trans-Identified Children, Adolescents, and Young Adults”, Journal of Sex & Marital Therapy, 49:1, 99-107, DOI: 10.1080/0092623X.2022.2080780

I've attached the PDF.

Also attached is a response by the original authors to Drescher (and others):

Stephen B. Levine, E. Abbruzzese & Julia W. Mason (2023) What Are We Doing to These Children? Response to Drescher, Clayton, and Balon Commentaries on Levine et al., 2022, Journal of Sex & Marital Therapy, 49:1, 115-125, DOI: 10.1080/0092623X.2022.2136117

An excerpt:

Drescher’s commentary … illuminated the mindset of clinicians who are aware of the limitations of the evidence base of youth gender transition, yet actively promote medicalization while eschewing any noninvasive treatment alternatives. Drescher ridiculed the title of our publication … by naming his own commentary “Informed Consent or Scare Tactics?” Having carefully examined his objections to our paper, we, in turn, suggest that Drescher’s commentary would have been better titled “Risks, Schmisks”— as it succinctly summarizes his counterarguments.

 

[glioblastoma multiforme]

so i read through the "What are we doing..." pdf that @Geranium posted. this is my attempt at a precis.

They start by saying that in the Western world, consent to gender transition can no longer be considered informed.

The scientific method is not applied in the field of gender transition research.

There is a rise in unconventional gender identities and the outcomes of inteventions of these are unknown.

They advise throrough discussion with adolescents and their families prior to medicalisation.

The other PDF attached by Geranium is an argument against this paper, and takes a mockng, irreverant, tone described by the author (Drescher) as a parody.

Drescher admits that the body of evidence for medical intervention is low quality, mired with bias and confounding variables.

Medical interventions on youths is based on very low evidence and long term outcomes are unkinown.

It is possible to obtain high quality evidence in conditions suffered in childhood, as evidenced by procress in pediatric oncology.

Drescher falsely claims that medical interventions are not performed on children, and possibly uses a very liberal definition of 'child'

They attribute the rise in gender disphoria in terms of the traditional identity struggles that arise during puberty. Also claims Drescher has conflicts of interest due to his long crusade to remove gender disphoria fom the DSM,

They also respond to Clayton and Balon, but I need to make dinner so not going to summarise that. ts roughly more of the same.

The point of this post is to confirm that Tony's discussions of evidence do not meet the criteria used by serious researchers. The paper is well referenced and clear in its conclusions. Tony's attempts at citing research fall apart the second you start reading it.

 

[Accept Only Substitutes]

what tony's totally ignoring is that while there is low quality evidence for troon interventions improving mental health, there is pretty high quality evidence for the masses of health problems they cause. to my knowledge, drugs with known, devastating side effects are typically written off unless there is no other intervention and the alternative to not intervening is a painful death- like chemo

I'll try not to PL too much, because no1curr, but it's relevant. I recently had cause to start vaginal estrogen treatment. I was reading the insert in the box, because that's where the instructions were.

There's a huge black box on the top of the insert that reads:

WARNING; ENDOMETRIAL CANCER, CARDIOVASCULAR DISORDERS, BREAST CANCER, and PROBABLE DEMENTIA

The insert goes on and on about the risks of oral estrogen. Estrogen alone shows increased risks of DVT and strikes in women taking it over a seven year period.

During 5.2 years of treatment there's an increased risk for dementia among 65+, it's "unknown" if there are similar risks among younger post-menapausal women.

Adding progesterone to the mix also increases risk of DVT and stroke, and adds increased risk of heart attacks and pulmonary embolisms during 5.6 years of treatment in 50-79 year old women.

P&E treatment also again shows increased risk of dementia among 65+ women with only 4 years of treatment and again it's "unknown" if younger women also have that risk.

But wait! There's more!

Estrogen and progesterone also increase the risk of invasive breast cancer and estrogen alone increases the risk of endometrial cancer.

I'm not going to quote the specific numbers they gave, but the risk looks substantial. If anyone is interested I'll write it up, but it's kinda off topic IMO.

This obviously scared the crap out of me. I looked into it more, but the risk seems to be in the hormones getting into the blood stream. Vaginal estrogen doesn’t enter the bloodstream to nearly the same amount as oral estrogen does. Apparently the vagina just absorbs and uses the vast majority of the drug so there's not much left to enter the bloodstream. Many gynecologists question the need for the black box warning (which really does specify oral hormones) given that a huge decades long study of thousands of women apparently don't have the same results.

These are the side effects that women get from estrogen and progesterone. Two hormones that all women are biologically programmed to use in order to stay healthy. Eventually they start to poison even us, what horrors await these poor troons in their old age?

Most of these ailments showed up in less than ten years on these hormones. We've got threads on people who claim to have been taking these hormones for at least six, seven, eight years. Are we going to start seeing more men with breast cancer soon? Early onset dementia? Fatal cardiovascular events? What about in twenty years? What long term affects will these drugs have on men and women? If a child takes estrogen from the ages of 13-23 then quits, will he develop breast cancer or dementia when he's sixty? We just don't know. We have no way to know.

All other aspects aside, these men and women are being experimented on. Obviously there's no such thing as a perfect medical treatment. Every pill you take or procedure you have has risks. A minor abccess you have drained in your family doctor's office can lead to an infection that could result in death. But that's not what I'm talking about here, these hormones aren't given to the majority of women anymore because they are so risky. But it's fine and good actually to give these drugs to people without the biological ability to truly use them? It's unethical at best.

And when it does come out that cross-sex hormones are actually going to ruin everyone's lives? None of them will be able to sue. At least not successfully, it's very hard to win malpractice lawsuits, especially with off-label drug uses. Use at your own risk, ymmv, no refunds no returns. At least that's how I understand it, for the children's sake I hope I'm wrong because they may be degenerate perverts at some point, but the adults in their lives failed them.

Tony and Zac and his ilk? God, I hope one of the troons we have a thread on gets breast cancer or early onset dementia, I don't want fatal cardiovascular events because that's no fun for us.

 

[Not Dr. Evil]

Tony and Zac and his ilk? God, I hope one of the troons we have a thread on gets breast cancer or early onset dementia, I don't want fatal cardiovascular events because that's no fun for us.

This reminds me of several papers I have seen about the growing problem of prostate cancer in troons. So called "real wimmen" like Zack, Tony, and Big Al chop their dicks off and demand to be seen by OBGYN docs while forgetting that they still have their prostate glands.

Prostate cancer in transgender women
Prostate Cancer in Male-to-Female Transgender Individuals : Histopathologic Findings and Association With Gender-affirming Hormonal Therapy
Prostate Cancer in Transgender Women: Incidence, Etiopathogenesis, and Management Challenges

 

[Accept Only Substitutes]

I posted this in the Tranny Sideshows thread. It's far too long to quote, but I had to share it here too.

There was a study on teenagers on hormone therapy released this year. The abstract talks about how the children see an improvement in mental health from the hormones.

This doctor in r/medicine on fucking reddit posted this screed:

When I started my Child and Adolescent Psychiatry training in the 2010s, the diagnosis and treatment of gender dysphoria were rapidly becoming controversial in the field. Doctors and nurses who had spent decades on inpatient adolescent units, usually seeing one gender dysphoric child every 4-5 years, now saw multiple transgender-identifying kids in every inpatient cohort. It was a rare patient list that did not include at least one teenager with pronouns not matching their sex.
Viewpoints about this differed, with every student, resident, fellow, and attending having their own perspective. All of us wanted what was best for patients, and these discussions were always productive and collegial. While I am not naive about how heated this topic can be online, I have only ever had good experiences discussing it with my colleagues. Some of my attendings thought that this was merely a social fad, similar to Multiple Personality Disorder or other trendy diagnoses, like the rise in Tourette's and other tic disorders seen during the early pandemic and widely attributed to social media. Others, including myself early on, thought we were merely seeing psychological education doing what it is supposed to do: patients who would, in earlier decades, not realize they were transgender until middle age were now gaining better psychological insight during their teen years. This was due to a combination of increased tolerance and awareness of transgender people and was a positive good that shouldn't necessarily raise any red flags or undue skepticism.
During my outpatient fellowship year, I began to suspect a combination of both theories could be true, similar to ADHD or autism, where increasing rates of diagnosis likely reflected some combination of better cultural awareness (good) and confirmation bias leading to dubious diagnoses (bad). Confirmation bias is always a problem in psychiatric diagnosis, because almost all psychiatric diagnoses describe symptoms that exist along a spectrum, so almost anyone could meet the DSM5TR criteria for any condition, so long as you ignored the severity of the symptom, and people are often not good at judging the severity of their own symptoms, as they do not know what is "normal" in the broader population.
I considered myself moderate on these issues. Every field of medicine faces a tradeoff between overtreatment and undertreatment, and I shared the worries of some of my more trans-affirming colleagues that many of these kids were at high risk for suicide if not given the treatment they wanted. Even if you attribute the increase in trans-identification among teens to merely a social fad, it was a social fad with real dangers. If an influencer or spiritual guru on social media was convincing teens that evil spirits could reside in their left ring finger, and they needed to amputate this finger or consider suicide, the ethical argument could be made that providing these finger amputations was a medically appropriate trade of morbidity for mortality. "How many regretted hormonal treatments, breast surgeries, or (in our hypothetical) lost ring fingers are worth one life saved from suicide?" is a reasonable question, even if you are skeptical of the underlying diagnosis.
And I was always skeptical of the legitimacy of most teenagers' claims to be transgender, if for no other reason than because gender dysphoria was historically a rare diagnosis, and the symptoms they described could be better explained by other diagnoses. As the old medical proverb says, "when you hear hoofbeats, think horses and not zebras." The DSM5 estimated the prevalence of gender dysphoria in males as a range from 0.005% to 0.014%, and in females as a range of 0.002% to 0.003%, although the newer DSM5TR rightly notes the methodological limitations of such estimates.
Regardless, most of the symptoms these teens described could be explained as identity disturbance (as in borderline personality disorder and some trauma responses), social relationship problems (perhaps due to being on the autism spectrum), body image problems (similar to and sometimes comorbid with eating disorders), rigid thinking about gender roles (perhaps due to OCD or autism), unspecified depression and anxiety, or just gender nonconforming behavior that fell within the normal range of human variation. It seems highly implausible that the entire field of psychiatry had overlooked or missed such high rates of gender dysphoria for so long. Some of my colleagues tried to explain this as being due to the stigma of being transgender, but I do not think it is historically accurate to say that psychiatry as a field has been particularly prudish or hesitant to discuss sex and gender. In 1909 Sigmund Freud published a case report about "Little Hans," which postulated that a 5-year-old boy was secretly fixated on horse penis because of the size of the organ. I do not find it plausible that the next century of psychoanalysis somehow underestimated the true rate of gender dysphoria by multiple orders of magnitude because they were squeamish about the topic. In fact, the concept that young girls secretly wanted a penis was so well known that the term "penis envy" entered common English vocabulary! Of course, the psychoanalytic concept of penis envy is not gender dysphoria per se, but it is adjacent enough to demonstrate the implausibility of the notion that generations of psychoanalysts downplayed or ignored the true rate of gender dysphoria due to personal bigotry or cultural taboo.
Therefore, for most of my career I have been in the odd position of doubting my gender-affirming colleagues, who would say "trans kids know who they are" and talk about saving lives from suicide, but also believing that they were making the best of a difficult situation. In the absence of any hard outcome data, all we had to argue about was theory and priors. I routinely saw adverse outcomes from these treatments, both people who regretted transitioning and those whose dysphoria and depression kept getting worse the more they altered their bodies, but I had to admit this might be selection bias, as presumably the success cases didn't go on to see other psychiatrists. I could be privately skeptical, but without any hard data there was no public argument to make. The gender affirming clinicians claimed that they could correctly identify which kinds of gender dysphoria required aggressive treatment (from DSMIV-TR to DSM5 the diagnosis was changed to emphasize and require identification with the opposite gender, rather than other kinds of gendered distress and nonconformity), and even when they were wrong they were appropriately trading a risk of long term morbidity for short term mortality. There was nothing to be done except wait for the eventual long term outcomes data.
The waiting ended when I read the paper "Psychosocial Functioning in Transgender Youth after 2 Years of Hormones" by Chen et al in the NEJM. This is the second major study of gender affirming hormones (GAH) in modern pediatric populations, after Tordoff 2022, and it concluded "GAH improved appearance congruence and psychosocial functioning." The authors report the outcomes as positive: "appearance congruence, positive affect, and life satisfaction increased, and depression and anxiety symptoms decreased." To a first approximation, this study would seem to support gender affirming care. Some other writers have criticized the unwarranted causal language of the conclusion, as there was no control group and so it would have been more accurate to say "GAH was associated with improvements" rather than "GAH improved," but this is a secondary issue.
The problem with Chen 2023 isn't its methodological limitations. The problem is its methodological strength. Properly interpreted, it is a negative study of outcomes for youth gender medicine, and its methodology is reasonably strong for this purpose (most of the limitations tilt in favor of a positive finding, not a negative one). Despite the authors' conclusions, an in-depth look at the data they collected reveals this as a failed trial. The authors gave 315 teenagers cross-sex hormones, with lifelong implications for reproductive and sexual health, and by their own outcome measures there was no evidence of meaningful clinical benefit.
315 subjects, ages 12-20, were observed for 2 years, completing 5 scales (one each for appearance, depression, and anxiety, and then two components of an NIH battery for positive affect and life satisfaction) every 6 months including at baseline. The participants were recruited at 4 academic sites as part of the Trans Youth Care in United States (TYCUS) study. Despite the paper's abstract claiming positive results, with no exceptions mentioned, the paper itself admits that life satisfaction, anxiety and depression scores did not improve in male-to-female cases. The authors suggest this may be due to the physical appearance of transwomen, writing "estrogen mediated phenotypic changes can take between 2 and 5 years to reach their maximum effect," but this is in tension with the data they just presented, showing that the male-to-female cases improved in appearance congruence significantly. The rating scale they used is reported as an average of a Likert scale (1 for strong disagreement, 3 for neutral, and 5 for strong agreement) for statements like "My physical body represents my gender identity" and so a change from 3 (neutral) to 4 (positive) is a large effect.
If a change from 3 out of 5 to 4 out of 5 is not enough to change someone's anxiety and depression, this is problematic both because the final point on the scale may not make a difference and because it may not be achievable. Other studies using the Transgender Congruence Scale, such as Ascha 2022 ("Top Surgery and Chest Dysphoria Among Transmasculine and Nonbinary Adolescents and Young Adults") show a score of only 3.72 for female-to-male patients 3 months after chest masculinization. (The authors report sums instead of averages, but it is trivial to convert the 33.50 given in Table 2 because we know TCS-AC has 9 items.) The paper that developed this scale, Kozee 2012, administered it to over 300 transgender adults and only 1 item (the first) had a mean over 3.
These numbers raise the possibility that the male-to-female cases in Chen 2023 may already be at their point of maximal improvement on the TCS-AC scale. A 4/5 score for satisfaction with personal appearance may be the best we can hope for in any population. While non-trans people score a 4.89 on this scale (according to Iliadis 2020), that doesn't mean that a similar score is realistically possible for trans people. When a trans person responds to this scale, they are essentially reporting their satisfaction with their appearance, while a non-trans person is answering questions about a construct (gender identity) they probably don't care about, which means you can't make an apples-to-apples comparison of the scores. If this is counter-intuitive to you, consider that a polling question like "Are you satisfied with your knowledge of Japanese?" would result in near-perfect satisfaction scores for those in the general public who have no interest in Japanese (knowledge and desire are matched near zero), but lower scores in students of the Japanese language. Even the best student will probably never reach the 5/5 satisfaction-due-to-apathy of the non-student.
I am frustrated by the authors' decision not to be candid about the negative male-to-female results in the abstract, which is all most people (including news reporters) will be able to read. I have seen gender distressed teenagers with their parents in the psychiatric ER, and many of them are high functioning enough to read and be aware of these studies. While some teens want to transition for personal reasons, regardless of the outcomes data, in much the same way that an Orthodox Jew might want to be circumcised regardless of health benefits, others are in distress and are looking for an evidence-based answer. In the spring of 2023, I had a male-to-female teen in my ER for suicidal ideation, and patient and mother both expressed hopefulness about recently started hormonal treatment, citing news coverage of the paper. This teen had complicated concerns about gender identity, but was explicitly starting hormones to treat depression, and it is unclear whether they would have wanted such treatment without news reporting on Chen 2023.
Moving on to the general results, the authors quantify mental health outcomes as: "positive affect [had an] annual increase on a 100-point scale [of] 0.80 points...life satisfaction [had an] annual increase on a 100-point scale [of] 2.32 points...We observed decreased scores for depression [with an] annual change on a 63-point scale [of] −1.27 points...and decreased [anxiety scores] annual change on a 100-point scale [of] −1.46 points...over a period of 2 years of GAH treatment." These appear to be small effects, but interpreting quantitative results on mental health scales can be tricky, so I will not say that these results are necessarily too small to be clinically meaningful, but because there is no control group these results are small enough to raise concerns about whether GAH outperforms placebo. It is unfortunate that it is not always straightforward to compare depression treatments due to several scales being in common use, but we can see the power of the placebo effect in other clinical trials on depression. In the original clinical trials for Trintellix, a scale called MADRS was used for depression, which is scored out of 60 points, and most enrolled patients had an average depression score from 31-34. Placebo reduced this score by 10.8 to 14.5 points within 8 weeks (see Table 4, page 21 of FDA label). For Auvelity, another newer antidepressant, the placebo group's depression on the same scale fell from 33.2 to 21.1 after 6 weeks (see Figure 3 of page 21 of FDA label).
I won't belabor the point, but anyone familiar with psychiatric research will be aware that placebo effects can be very large, and they occur across multiple diagnoses, including surprising ones like schizophrenia (see Figure 3 of the FDA label for Caplyta). I am genuinely surprised and confused by how minimal this cohort's response to treatment was. Early in my career I thought we were trading the risk of transition regret for great short-term benefit, and I was confused when I noticed how patients given GAH didn't seem to get better. This data confirms my experience is not a fluke. I could go in depth about their anxiety results, which on a hundred-point scale fell by less than 3 points after two years, but this would read nearly identically to the paragraph above.
A more formal analysis of this paper might try to estimate the effects of psychotherapy and subtract them away from the reported benefits of GAH, and an even more sophisticated analysis might try to tease apart the benefits of testosterone for gender dysphoria per se from its more general impact on mood, but I think this is unnecessary given the very small effects reported and the placebo concerns documented above. Putting biological girls on testosterone is conceptually similar to giving men anabolic steroids, and I remain genuinely surprised that it wasn't more beneficial for their mood in the short term. Some men on high doses of male steroids are euphoric to the point of mania.
But my biggest concerns with this paper are in the protocol. This paper was part of TYCUS, the Trans Youth Care in United States study, and the attached protocol document, containing original (2016) and revised (2021) versions explains that acute suicidality was an exclusion criterion for this study (see section 4.6.4). There were two deaths by suicide in this study, and 11 reports of suicidal ideation, out of 315 participants, and these patients showed no evidence of being suicidal when the study began. This raises the possibility of iatrogenic harm. It would be beneficial to have more data on the suicidality of this cohort, but the next problem is that the authors did not report this data, despite collecting it according to their protocol document.
The 5 reported outcome measures in Chen 2023 are only a small fraction of the original data collected. The authors also assessed suicidality, Gender Dysphoria per se (not merely appearance congruence), body esteem and body image (two separate scales), service utilization, resiliency and other measures. This data is missing from the paper. I do not fully understand why the NEJM allowed such a selective reporting of the data, especially regarding the adverse suicide events. A Suicidal Ideation Scale with 8 questions was administered according to both the original and revised protocol. In a political climate where these kinds of treatments are increasingly viewed with hostility and new regulatory burdens, why would authors, who often make media appearances on this topic, hide positive results? It seems far more plausible that they are hiding evidence of harm.
Of course, Chen 2023 is not the only paper ever published on gender medicine, but aside from Tordoff 2022 it is nearly the only paper in modern teens to attempt to measure mental health outcomes. The Ascha 2022 paper on chest masculinization surgery I mentioned above uses as its primary outcome a rating scale called the Chest Dysphoria Measure (CDM), a scale that almost any person without breasts would have a low score on (with the possible exception of the rare woman who specifically wants to have prominent and large breasts that others will notice and comment on in non-sexual contexts), even if they experienced no mental health benefits from the breast removal surgery and regretted it. Only the first item ("I like looking at my chest in the mirror") measures personal satisfaction. Other items, such as "Physical intimacy/sexual activity is difficult because of my chest" may be able to detect harm in a patient who strongly regrets the surgery but is worded in such a way as not to detect actual benefit. They should have left it at "Physical intimacy/sexual activity is difficult" because a person without breasts can't experience dysphoria or functional impairment as a result of having breasts, even if their overall functionality and gender dysphoria are unchanged. Gender dysphoria that is focused on breasts may simply move to hips or waist after the breasts are removed.
Tordoff 2022 was an observational cohort study of 104 teens, with 7 on some kind of hormonal treatment for gender dysphoria at the beginning of the study and 69 being on such treatment by the end. The authors measured depression on the PHQ-9 scale at 3, 6, and 12 months, and reported "60% lower odds of depression and 73% lower odds of suicidality among youths who had initiated PBs or GAHs compared with youths who had not." This paper is widely cited as evidence for GAH, but the problem is that the treatment group did not actually improve. The authors are making a statistical argument that relies on the "no treatment" group getting worse. This would be bad enough by itself, but the deeper problem is that the apparent worsening of the non-GAH group can be explained by dropout effects. There were 35 teens not on GAH at the end of the study, but only 7 completed the final depression scale.
The data in eTable 3 of the supplement is helpful. At the beginning the 7 teens on GAH and the 93 not on GAH have similar scores: 57-59% meeting depression criteria and 43-45% positive for self-harming or suicidal thoughts. There is some evidence of a temporary benefit from GAH at 3 months, when the 43 GAH teens were at 56% and 28% for depression and suicidality respectively, and the 38 non-GAH teens at 76% and 58%. At 6 months the 59 GAH teens and 24 non-GAH teens are both around 56-58% and 42-46% for depression and suicidality. At 12 months there appears to be a stark worsening of the non-GAH group, with 86% meeting both depression and suicidality criteria. However, this is because 6/7 = 86% and there are only 7 subjects reporting data out of the 35 not on GAH from the original 104 subject cohort. The actual depression rate for the GAH group remains stable around 56% throughout the study, and the rate of suicidality actually worsens from Month 3 to Month 12.
We cannot assume that the remaining 7 are representative of the entire untreated 35. I suspect teens dropped out of this study because their gender dysphoria improved in its natural course, as many adolescent symptoms, identities and other concerns do. However, even if you disagree with me on this point, the question you have to ask about the Tordoff study is why these 7 teens would go to a gender clinic for a year and not receive GAH. Whatever the reason was, it makes them non-representative of gender dysphoric teens at a gender clinic.
The short-term effect of GAH is no longer an unanswered question. Its theoretical basis was strong in the absence of data, but like many strong theories it has failed in the face of data. Now that two studies have failed to report meaningful benefit we can no longer say, as we could as recently as 2021, that the short-term benefits are so strong that they outweigh the potential long-term risks inherent in permanent body modification. Some non-trivial number of patients come to regret these body modifications, and we can no longer claim in good faith that there are enormous short term benefits that outweigh this risk. The gender affirming clinicians had two bites at the apple to find the benefit that they claimed would justify these dramatic interventions, and their failure to find it is much greater than I could have imagined two years ago.
I am not unaware of how fraught and politicized this topic has become, but the time has come to admit that we, even the moderates like me, were wrong. When a teenager is distressed by their gender or gendered traits, altering their body with hormones does not help their distress. I suspect, but cannot yet prove, that the gender affirming model is actively harmful, and this is why these gender studies do not have the same methodological problem of large placebo effect size that plagues so much research in psychiatry. When I do in depth chart reviews of suicidal twenty-something trans adults on my inpatient unit, I often see a pattern of a teenager who was uncomfortable with their body, "affirmed" in the belief that they were born in the wrong body (which is an idea that, whether right or wrong, is much harder to cope with than merely accepting that you are a masculine woman, or that you must learn to cope with disliking a specific aspect of your body), and their mental health gets worse and worse the more gender affirming treatments they receive. First, they are uncomfortable being traditionally feminine, then they feel "fake" after a social transition and masculine haircut, then they take testosterone and feel extremely depressed about "being a man with breasts," then they have their breasts removed and feel suicidal about not having a penis. The belief that "there is something wrong with my body" is a cognitive distortion that has been affirmed instead of Socratically questioned with CBT, and the iatrogenic harm can be extreme.
If we say we care about trans kids, that must mean caring about them enough to hold their treatments to the same standard of evidence we use for everything else. No one thinks that the way we "care about Alzheimer's patients" is allowing Biogen to have free rein marketing Aduhelm. The entire edifice of modern medical science is premised on the idea that we cannot assume we are helping people merely because we have good intentions and a good theory. If researchers from Harvard and UCSF could follow over 300 affirmed trans teens for 2 years, measure them with dozens of scales, and publish what they did, then the notion that GAH is helpful should be considered dubious until proven otherwise. Proving a negative is always tricky, but if half a dozen elite researchers scour my house looking for a cat and can't find one, then it is reasonable to conclude no cat exists. And it may no longer reasonable to consider the medicalization of vulnerable teenagers due to a theory that this cat might exist despite our best efforts to find it.
-An ABPN Board Certified Child and Adolescent Psychiatrist
PS - To be clear, I support the civil rights of the trans community, even as I criticize their ideas. I see no more contradiction here than, for example, an atheist supporting religious freedom and being opposed to antisemitism. If an atheist can critique both the teachings and practices of hyper-Orthodox Hasidic Judaism, while being opposed to antisemitism at the same time, I believe that I can criticize the ideas of the trans community ("born in the wrong body") while still supporting their civil rights and opposing transphobia in all forms.

Yes it's long, suck it up. It's worth every word because it proves that everything we've said on this far-right Nazi genocidal forum was right about everything. But with like data and stuff.

They genocided me with ~!~science~!~

I'm frankly amazed that as of ten minutes ago this post was still up on reddit. Archive.ph link | Reddit link

Edit: this completely demolishes the entirety of their philosophy. Tony BTFO. Let's see if anyone outside of doctors pick up on it.

The comments might be worth reading.

 

[InteracialBowelSyndrome]

This reminds me of several papers I have seen about the growing problem of prostate cancer in troons. So called "real wimmen" like Zack, Tony, and Big Al chop their dicks off and demand to be seen by OBGYN docs while forgetting that they still have their prostate glands.

Prostate cancer in transgender women
Prostate Cancer in Male-to-Female Transgender Individuals : Histopathologic Findings and Association With Gender-affirming Hormonal Therapy
Prostate Cancer in Transgender Women: Incidence, Etiopathogenesis, and Management Challenges

That reminds me a joke:

Troon goes to see a doctor. Doctor says "Alright Sir, your test results are-"

Troon yells "IT'S MA'AM!"

Doctor replies "My apoligies Ma'am. You have testicle cancer."

 

[Criticallacitirc]

The comments might be worth reading

There's a surprising amount of people who appear to be in the medical field agreeing with the op & expressing their concerns. I imagine medical professionals on reddit are no where close to being republican/conservatives, so I would say this is a very bad sign for trannies. The tide is definitely turning.

 

[AirdropShitposts]

Also attached is a response by the original authors to Drescher (and others):

Stephen B. Levine, E. Abbruzzese & Julia W. Mason (2023) What Are We Doing to These Children? Response to Drescher, Clayton, and Balon Commentaries on Levine et al., 2022, Journal of Sex & Marital Therapy, 49:1, 115-125, DOI: 10.1080/0092623X.2022.2136117

Sometimes when I read these academic responses (in my field anyway but it's the same everywhere) I wonder if my built-in skepticism is failing or these really are complete devastations of opponents that leave nothing standing and the person couldn't remotely respond to even if they tried. This one includes one of my favorite of the genre that's basically "the guy cited something expecting all of you to believe he knew what it was, we anticipated this and already accounted for it because we actually know what it is and that's the reason we brought it up."

Regardless, most of the symptoms these teens described could be explained as identity disturbance (as in borderline personality disorder and some trauma responses), social relationship problems (perhaps due to being on the autism spectrum), body image problems (similar to and sometimes comorbid with eating disorders), rigid thinking about gender roles (perhaps due to OCD or autism), unspecified depression and anxiety, or just gender nonconforming behavior that fell within the normal range of human variation. It seems highly implausible that the entire field of psychiatry had overlooked or missed such high rates of gender dysphoria for so long. Some of my colleagues tried to explain this as being due to the stigma of being transgender, but I do not think it is historically accurate to say that psychiatry as a field has been particularly prudish or hesitant to discuss sex and gender. In 1909 Sigmund Freud published a case report about "Little Hans," which postulated that a 5-year-old boy was secretly fixated on horse penis because of the size of the organ. I do not find it plausible that the next century of psychoanalysis somehow underestimated the true rate of gender dysphoria by multiple orders of magnitude because they were squeamish about the topic. In fact, the concept that young girls secretly wanted a penis was so well known that the term "penis envy" entered common English vocabulary! Of course, the psychoanalytic concept of penis envy is not gender dysphoria per se, but it is adjacent enough to demonstrate the implausibility of the notion that generations of psychoanalysts downplayed or ignored the true rate of gender dysphoria due to personal bigotry or cultural taboo.

Ah, I see the problem. You accidentally used recorded history and the logic of the theoretical system you're employing to come to a conclusion, that's incorrect, what you're supposed to do is only presentism and that everyone who lived one second before you currently do right now this second was basically smashing rocks together randomly while grunting. Knowing anything about Freud is wrong because he was debunked and highly problematic in the first place, we know better now not because of anything he did that was built upon or improved but because we're inherently morally pure and cleansed the system of his tainted thoughts. That is why we're able to identify the transphobic oppression that permeates all of psychiatric practice and requires trans patients, and only trans patients (defined as anyone who self-declares because only they can know, The Cis can't), to receive the inverse of good well established psychological and psychiatric care practices. Which completely cures them and anything else leads to DEATH which is why this cannot ever be studied skeptically (aka normally aka the scientific method) and to do so is genocide.

 

[Geranium]

I posted this in the Tranny Sideshows thread. It's far too long to quote, but I had to share it here too.

For the curious:

Check out this takedown of a recent study of children on hormones I found linked to on Twitter. I honestly cannot believe it's still up on reddit. I linked to the archive, but here's the Reddit link.

The Chen 2023 Paper Raises Serious Concerns About Pediatric Gender Medicine Outcomes : medicine (archive)

 

[Flamin Park]

@Accept Only Substitutes getting breast cancer is heckin affirming you bigot

 

[Geranium]

@Accept Only Substitutes getting breast cancer is heckin affirming you bigot

Imagine if Tony had to get his "D cup"* moobs amputated because he got breast cancer.

*reference:

in December 2019 [Tony] said they were "C cups and growing, probably gonna be D cups"

---

Edit: I never posted the text of Tony's Reddit post, so here it is for future search-autism. It's archived, but amazingly he hasn't deleted the live version yet.
Are my nipples always going to be small [NSFW] : MtF (archive)

Are my nipples always going to be small [NSFW] (self.MtF)
Posted by ErinInTheMorning at 2019-12-12T15:50:21+00:00

Seriously... I'm more than pleased about my boob growth. C cups and growing, probably gonna be D cups. But my nipples, at 8 months, are still... well, like my old nipples. They're small, they don't really poke out, they aren't really "puffy". They just look like regular old... well, guy nipples.

Does this ever change? How long does it take? I've been so pleased just about everywhere but this one little thing is upsetting me!

 

[Accept Only Substitutes]

For the curious:

The Chen 2023 Paper Raises Serious Concerns About Pediatric Gender Medicine Outcomes : medicine (archive)

Doh. Of course I could have quoted that part. I'm such a retard. Thanks for doing that fren. <3

 

[Not Dr. Evil]

Tony's latest iteration of "everyone who disagrees with me is a Nazi."

Of course Snaggle Tooth is being less than truthful about what happened. There was a gay pride event at some park in Wisconsin that Gays Against Groomers decided to protest. A group of purported neo-nazis (who were probably feds playing dress up) showed up unannounced at the same event. In Tonyland, that can only mean the two groups were in cahoots.

Neo-Nazi group disrupts Wisconsin Pride: “Us or the pedophiles!

 

[Geranium]

Tony's latest iteration of "everyone who disagrees with me is a Nazi."

Tony: "GCs are nazis."
GCs: "We don't support nazis."
Tony: " You wouldn't have to say that if you weren't nazis."

Circular reasoning for a man becoming more physically circular by the day.

Edit, a couple hours later:

@ErinInTheMorn, tweet 1688260032897368064 (archive)

Leor Sapir (@LeorSapir) · Aug 6, 2023 · 3:12 PM UTC
Correcting an earlier version of my post: A recent survey of 3,000 Americans shows that the Democratic position on “gender affirming care” is highly unpopular, supported by a mere 18 percent of moderate voters, 26 percent of all sample. https://www.liberalpatriot.com/p/the-democratic-party-left-vs-the

Erin Reed (@ErinInTheMorn) · Aug 6, 2023 · 6:45 PM UTC
So you realize this poll actually shows only 41% support total bans on youth gender affirming care, and it also shows that of issues that Americans care most about, the poll shows transgender issues almost at the bottom at 4%, right?
Seems they oppose the Republican position.

Really impressive optimism on Tony's part to think that "this poll actually shows only 41% support total bans on youth gender affirming care" counts as a win. Survey tables are here, here's the summary for this question:

States should protect all transgender youth by providing access to puberty blockers and transition surgeries if desired, and allowing them to participate fully in all activities and sports as the gender of their choice	26%
States should protect the rights of transgender adults to live as they want but implement stronger regulations on puberty blockers, transition surgeries, and sports participation for transgender minors	32%
States should ban all gender transition treatments for minors and stop discussion of gender ideology in all public schools	41%

So "ban all gender transition treatments for minors" is clearly the most popular position, and 73% support at least "stronger regulations on puberty blockers, transgender surgeries, and sports participation for transgender minors".

Meanwhile Tony's anti-regulation, laissez-faire position garners only 26% support.

Sample size of 3,000 is larger than most opinion polls, too.

 

[Not Dr. Evil]

So "ban all gender transition treatments for minors" is clearly the most popular position, and 73% support at least "stronger regulations on puberty blockers, transgender surgeries, and sports participation for transgender minors".

Also silly that Tony calls this the "Republican position" when there are moderate Democrats and Independents in the 73rd percentile.

 

[Thomas Eugene Paris]

Sample size of 3,000 is larger than most opinion polls, too.

Am I reading correctly that none of the >3000 respondents indicated that they were "not sure" of their position? I'm no sociologist and would be happy to be corrected, but that seems remarkable to me. I'm not sure what to make of it, honestly.

 

[Geranium]

Am I reading correctly that none of the >3000 respondents indicated that they were "not sure" of their position? I'm no sociologist and would be happy to be corrected, but that seems remarkable to me. I'm not sure what to make of it, honestly.

It seems that there were 4 or 5 people who answered not sure (screenshot trimmed for clarity):

Perhaps this is a result of the question design: stating three positions and asking which is closest to the respondent's view?

Edit: PDF attached for archival purposes.