Health

Over the past year, GPs across the UK have announced they are no longer prescribing the life-saving medical treatment for hundreds of trans patients due to a claimed “lack of expertise” and “lack of support.”

Far Lane Medical Centre – a GP in Sheffield – became the most recent to withdraw its care after writing to patients saying the work is “outside of our expertise.”

Patients of other practices that have ceased care, including a set of GPs in the East Midlands, have said they are “terrified” of the implications and have considered self-medicating if they can’t feasibly access NHS treatment.

In the UK, Gender Identity Clinics (GICs) require that GPs prescribe HRT to trans patients under a shared care agreement since most GICs in the UK do not have the power to prescribe medication.

Under the agreement, GICs or private organisations advise GPs on the prescriptions they give to patients. Without this, trans people are forced to pay hundreds for private care.

Speaking to PinkNews, clinical psychologist and director of CQC-approved private healthcare service Gender Plus, Dr Aidan Kelly, says that the impact of banning HRT prescriptions on patients isn’t being considered by GPs ceasing care, adding that there’s “no nuance to it.”

“There’s no allowing for complexities in people’s individual situations. I don’t think there’s any appreciation for that,” he said. “I don’t think it’s done, perhaps, from a malicious point of view, but I think it’s done from fear.”

[…]

“GPs have expertise in prescribing hormones, they do it for cis people all of the time,” he says. “The only bit where I could see where there’s an argument that there is more particular expertise needed is in the initial assessment and to work out how best to support people.”

No way this could rebound in bad ways…

Republicans for years have tried to legislate their personal beliefs about life beginning at conception. They’ve introduced versions of a bill called the Life at Conception Act 13 times since 2011. These efforts have almost certainly influenced the “conception” language in Trump’s latest executive action.

Dr. Richard Bribiescas, an anthropology professor at Yale University and the president of the Human Biology Association, said the order’s definitions of “sex” and “gender” ignore all kinds of variations that take place in human development.

“Woman/man, boy/girl are gender identities that do not necessarily align with biological characteristics of sex,” he said in an email. “Genders are components of human variation that are influenced by culture, identity, and many other non-biological factors. To illustrate the difference between sex and gender, we can talk about male/female chimpanzees (our closest evolutionary relative) but it would be non-sensical to discuss chimpanzee women, men, boys or girls.”

Trump’s definitions of “female” and “male” are also flawed, said Bribiescas, because he is tying them to something called “anisogamy” in biology, or the observation that females of some species, including humans, tend to produce larger gametes (the reproductive cells that come from germ cells) compared to males.

Anisogamy is not a universal rule in biology, he said. But Trump’s executive order defines females as people belonging to the sex that produces “the large reproductive cell” and males belonging to the sex that produces “the small reproductive cell.”

The size of a person’s gametes is “just one characteristic among many (ie., genetic, hormonal, developmental, physical) that is used to describe sex,” Bribiescas said. “Clearly, this order is not fully informed by current biological science.”

In short:

The Queensland government has announced a review into the evidence for stage one and two hormone therapies for children with gender dysphoria.

While the review is underway, a pause will be placed on new patients under the age of 18 from receiving hormone therapy in the state's health system.

What's next?

Health Minister Tim Nicholls says the pause will remain in effect until the government considers and acts on the outcomes of the review.

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.