Health

The Trump administration cruelly and abruptly stopped the distribution of live-saving antiretroviral drugs to almost 26 million people worldwide. The program, the President’s Emergency Plan for AIDS Relief—PEPFAR—is the global health program started by Republican president George W. Bush in 2003. He celebrated the 20 year anniversary in 2023 at his presidential library.

[…]

Without the drugs for any length of time, HIV will replicate inside the bodies of these HIV-infected people in poor countries across Africa, Asia and elsewhere, who have been living and thriving, as HIV has thankfully become a manageable illness because of the drugs. HIV will be able to transmit from them to others—transmission is suppressed while taking the drugs—and more powerful strains could emerge.

And they will develop full-blown AIDS, suffer immensely, and die.

It’s as simple as that.

Let’s be clear, for Trump this is eugenics, killing off the non-white people in the “shithole” countries who he surely believes we shouldn’t be spending money on.

Trump has promoted eugenics—spouting off about “good genes” and “bad genes” in talking about immigrants he wants to deport who he says are “poisoning the blood” of Americans—and, according to his own nephew, said disabled people should “just die” in the context of his nephew’s own son.

Wow. This is mindblowing.

For some transgender people, hormone replacement therapy (HRT) is “an ontological necessity for a livable life” (Fondén, 2020, p. 29). Some trans people engage in do-it-yourself (DIY) HRT (aka “DIYers”) because of care barriers, including medication costs, difficulty accessing healthcare providers, and mistrust in professionalized medical systems. Although DIY HRT is often framed as highly risky, we analyzed in-depth interviews with 36 U.S. DIYers to understand how they themselves perceived their goals, challenges, and risk mitigation using the Liberatory Harm Reduction and lay expertise frameworks. Participants emphasized experiences of transphobia within medical spaces. In contrast, participants characterized DIY HRT as a community-driven, accessible, and empowering practice. Through self-organized online forums and mutual aid, DIYers constructed adaptive health-promoting practices that challenge biomedical conceptualizations of risk and affirm trans agency.

I emphatically reject the author's opinion that "it’s not ridiculous to suggest, for example, that a randomized trial of puberty blockers would be a good idea." (Why not a randomised trial of ambulances? We'll send half of emergency callers an Uber instead.) But he's certainly thorough, and excepts like this are astounding.

The Cass review was an interesting juxtaposition. Some of the scientific arguments were very reasonable, and the York team generally did a decent job with the systematic reviews that informed the document. However, the review itself often positioned bizarre theories about gender dysphoria alongside data and evidence. I’ve recounted quite a few examples of this during my pieces, but I thought I’d share one more that I found recently:

“Research commentators recommend more investigation into consumption of online pornography and gender dysphoria is needed. Some researchers (Nadrowski, 2023) suggest that exploration with gender-questioning youth should include consideration of their engagement with pornographic content.” (Cass review, page 110)

This paragraph suggests that porn can potentially turn children trans. If you look up the reference, it is to this opinion piece from a psychiatrist. The paper itself contains no data connecting gender dysphoria to pornography, but basically argues that teen girls may view porn and become so disgusted with being women that they choose to instead become men. The paper also notes that “Girls affected by autism might be at higher risk because of their reduced mentalization capacities.”, although it does not provide any evidence that this is true.

The author of this opinion piece is a psychiatric trainee who lists their affiliation as Therapy First. Therapy First is an explicitly anti-medication group which campaigns to prevent children from being given hormones or puberty blockers for gender dysphoria - instead, they recommend psychotherapy as the first and in many cases only option. This is not evidence. It’s barely even an opinion. There is no reasonable excuse for the Cass review having included such a completely bizarre and unsubstantiated theory, especially without noting that it is entirely unsupported by even the most vague of evidence.

Seriously: would you test the effectiveness of chemotherapy by giving a control group of cancer sufferers saline water? I mean, assuming you're not a raving lunatic who insists that cancer is a fashionable lifestyle choice spread by social contagion on TikTok?

The absence of RCTs studying the impact of gender-affirming care on the mental health and well-being of transgender adolescents does not imply that these interventions are insufficiently supported by evidence. Although RCTs are considered high-quality evidence because of their ability to control for unmeasured confounders, the impossibility of masking which participants receive gender-affirming interventions and the differential impact of unmasking on adherence, withdrawal, response bias, and generalizability compromises the value of RCTs for adolescent gender-affirming care. RCTs are methodologically inappropriate for studying the relationship between gender-affirming interventions and mental health. These methodological considerations compound the serious ethical concerns raised by RCTs in adolescent transgender healthcare. Given the limitations of RCTs, complementary and well-designed observational studies offer more reliable scientific evidence than RCTs and should be considered of sufficient quality to guide clinical practice and policymaking. Adolescent trans healthcare is on solid footing.

a periodic reminder that these places exist:

• https://genderdysphoria.fyi/
• https://diyhrt.wiki/
• https://diyhrt.info/
• https://hrtcafe.net/
• https://transharmreduction.org/
• https://transfemscience.org/
• https://gtrr.artemislena.eu/
• https://diyhrt.market/transfem-hrt-guide
• https://www.reddit.com/r/estrogel/wiki/

and places like these:

• https://diyhrt.market/
• https://www.unitedpharmacies-uk.md

and some country specific things (please recommend more):

• https://genderkit.org.uk/

feel free to boost, and reply with other useful links for #trans people

Assuming a lot more people will need this info soon.

⚠️ DISCLAIMER: THIS WEBSITE IS FOR INFORMATIONAL PURPOSES ONLY AND DOES NOT PROVIDE PROFESSIONAL MEDICAL ADVICE.

Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition or treatment and before undertaking a new health care regimen.

This website intends to teach transgender people how to safely perform DIY Hormone Replacement Therapy. Share the site with those who need it, but not to transphobes: use common sense!

Whether it's due to cost, familial issues, or a myriad of other reasons, for many trans people HRT is inaccessible. If you or someone you know fit into this category, this site is designed to help.

Every time a farm worker is infected with H5N1, it’s like a game of Russian Roulette for the rest of us. The virus is making trillions of copies of itself, and many of them carry random mutations. If any of those copies carry mutations that allow it to achieve human-to-human transmission, it will likely be passed on to a contact- or contacts- of that worker. You’ve just witnessed the potential birth of a new pandemic.

So basically, you really, really don’t want this thing- this Spillover Event- to happen even a single time. Every time you do, you’re potentially gambling with 8 billion people’s futures. The Biden Administration has allowed it to happen 61 times in less than a year. And instead of treating it like an emergency, which they almost certainly would’ve before COVID, the USDA, FDA, CDC and White House keep treating their Russian Roulette “wins” like permission to play another round.

Like most of the conclusions the White House appears to have drawn about public health, this betrays a poor understanding of statistics. When you win a round of Russian Roulette, it doesn’t mean you’re “good” at Russian Roulette, or that the game is easy, or that you’re on a hot streak, although gamblers believe these sorts of things about gambling all the time. It just means you got lucky. It shouldn’t be taken as an invitation to go around again.

Where Hong Kong, Finland, Spain and many other governments took immediate and drastic action to avoid spillovers, the US has watched the virus spread and worsen, looking the other way as infections among farmers crop up. Through negligence and incompetence, the US government is creating the conditions for another global pandemic, despite having had months to avert it entirely. 

The French Society of Pediatric Endocrinology and Diabetology (SFEDP) recently commissioned its own version of the Cass Review, and this study reached almost the exact opposite conclusions of Cass […]

Upon reading both the Cass Review and the SFEDP Review, what immediately jumps out is the very different tone of each—Cass takes a tone that feels skeptical to the point of excess, offering mysteriously curt phrasing, statements rife with implications of harm or conspiracy by mainstream providers, and an overall sense of invalidation. By contrast, the SFEDP Review reads like a scientific paper—its language is straightforward and sterile, and there is none of the innuendo of Cass. Reading both side by side feels almost like traveling from a land of paranoia and conspiracy into levelheaded reality.

These basic differences in language imply very different approaches to working with trans minors—gender-affirming vs gender-critical.

[…]

Perhaps nowhere is the difference between the Cass Review and the SFEDP Review more clear than here: Cass bemoans the lack of good evidence and recommends generating it, whereas SFEDP declares that it is ready to follow the science by supporting minors in their transition. One cannot help but suspect that even if further research is conducted, in another 20 years another Cass will come along and demand another round of research into trans youth.

A typically incandescently brilliant barnstormer from Abigail.

There is a clash going on in Britain between two fundamentally irreconcilable ideologies.

The NHS, DHSC, and many other official institutions like courts view transition as a response to a medical problem they call ‘gender dysphoria’ or ‘gender incongruence.’ From this starting point it seems appropriate that trans people have to get permission to transition: transness is a medical matter with inherent risks that ought to be controlled by “specialists.” Sometimes those specialists delay or deny permission, but that’s just part of the job. It also makes sense to ask which treatments are “most effective at treating dysphoria” and explore alternative treatments through trials, reviews, consultations, etc. I call this view ‘Pathologization.’

According to Pathologization, past treatments like electric shocks simply failed to alleviate patients’ dysphoria. These days we have more effective methods, and one day we might discover a cheap way of treating it without transition- a silver bullet conversion therapy. Doctors and managers will determine when and whether adjustments to the system are needed. Ideally they’ll engage with trans people in “stakeholder groups” but if those groups don’t get what they want that’s not a dealbreaker. Patients who suffer or die waiting are unfortunate but hey, the NHS can’t save everyone.

On the other hand, the view of an increasing number- especially young people and trans people ourselves- is that transition is a bit like pregnancy. It’s a process that may require professional assistance to bring to the happiest possible conclusion (whether completion or termination), and for this reason it is appropriate and necessary that the NHS is involved. But whether, how, and when to do it should be up to you. From this starting point there should be as few obstacles as possible: the role of doctors and managers is to facilitate and advise but never delay or deny. Prompt, reliable access to transition is a civil rights matter.

[…]

It is vital to realise that organisations can embody an ideology even if nobody working in them believes it. I think sometimes when people hear “Organisation X is institutionally discriminatory” they interpret that as “The leaders of Organisation X are bad people.” For example;

“The Metropolitan police are institutionally racist.”

“I’ve met some police officers and they’re lovely!”

This is a mistake. To say that an organisation is institutionally discriminatory makes no comment on the character of its employees, merely the pattern of its outputs. Not everyone who controls trans healthcare is a frothing bigot; again, I have no animosity towards Colonel Korn or his colleagues. My issue is with the outputs of the system they manage.

We looked at the latest research from around the world to understand what knowledge was being used to inform the care of children and young people with gender dysphoria by looking for research published in the scientific literature between 2019 and 2023. This work builds on a previous report we provided to NSW Health summarising the research published between 2000 and 2019.

We found 82 research studies published since 2019. This represents a rapid growth in research in this field. Various methods of varying quality were used to gather information in these studies. While we found that there hasn’t been a significant increase in the use of gold-standard methods (such as, randomised controlled trials (RCTs)) in this emerging field of research, we were still able to draw out meaningful insights into the effectiveness and risks of gender dysphoria treatments. The research we found provides a good starting point for discussing critical issues with patients, caregivers, and healthcare providers, including deciding where to invest in future research.

NSW Health will use this review’s findings to guide various projects designed to gather more information from experts and people with lived experiences, with the aim of providing safe and effective psychological and medical treatment services for young people with gender dysphoria.