Claims about Lupron made in Matt Walsh's "What is a Woman?" documentary

Rory

Senior Member.
In the 2022 documentary "What is a Woman?" (at around the one hour mark) three people make claims about Lupron (or Leuprorelin/Leuprolide), a "manufactured version of a hormone used to treat prostate cancer, breast cancer, endometriosis, and uterine fibroids" (according to Wikipedia). It is also used to perform "chemical castration of violent sex offenders, as part of transgender hormone therapy, and to block puberty". In the documentary it is mostly referred to as a puberty blocker.

First, professor of paediatrics Michelle Forcier says:

"Puberty blockers are completely reversible and they don't have permanent effects. They are wonderful because we can pause puberty, like if you were listening to music, and then if we stop the blockers puberty goes right back to where it was, like the next note in the song. It just delays that period of time."

Scott Newgent, founder of TReVoices (TRans Rational Educational Voices), disputes this and says:

"You can't [pause puberty and pick it up where you left off]. How many long-term studies do they have on hormone blockers for children? None."

Finally, Dr Miriam Grossman, a child, adolescent, and adult psychiatrist, says:

"I spoke with a mother whose fourteen-year-old daughter was put on blockers. They discovered after two years [she] has osteoporosis. That's something old women get."

So in the documentary there are a variety of claims about Lupron:

1. That it's wonderful, completely reversible and doesn't have permanent effects
2. That there are no long-term studies on its use by children
3. That there is a link to osteoporosis (claim not made explicitly, but the implication is clear)

Researching whether these are true or not seems quite a straightforward task, but in attempting to look at it I find myself agreeing with the words of a Hormones Matter article: "Just reading and trying to understand Lupron’s literature can be dizzying" - studies are often vague, contradictory, apparently dishonest, with a history of bribing, litigation, and suspiciously redacted reports all muddying the waters).

What's clear, however, is that there are many thousands of people who feel they have been irreversibly damaged by Lupron, with many support groups online and plenty of anecdotal tales (such as here, here, here and here) of debilitating and long-term side effects - particularly depression and bone, joint and tooth issues.

For years, Sharissa Derricott, 30, had no idea why her body seemed to be failing. At 21, a surgeon replaced her deteriorated jaw joint. She’s been diagnosed with degenerative disc disease and fibromyalgia, a chronic pain condition. Her teeth are shedding enamel and cracking.

None of it made sense to her until she discovered a community of women online who describe similar symptoms and have one thing in common: All had taken a drug called Lupron.

https://www.pbs.org/newshour/health/women-fear-drug-they-used-to-halt-puberty-led-to-health-problems
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In trying to verify the claim that it's "completely reversible and doesn't have permanent effects" I don't find any long-term studies of its use by children that would be able to confirm that, while the Hayes Technology Review - "considered to be the industry standard in linking treatments with patient outcomes" - rated it D2 - "the lowest rating possible on [their] scale of safety and efficacy" - "based upon insufficient published evidence to assess safety and/or impact on health outcomes or patient management."

There also appears to be good evidence that its use does cause serious musculoskeletal issues, as outlined in a number of personal testimonies as well as in studies:

Women who used Lupron a decade or more ago to delay puberty or grow taller [...] described conditions that usually affect people much later in life. A 20-year-old from South Carolina was diagnosed with osteopenia, a thinning of the bones, while a 25 year-old from Pennsylvania has osteoporosis and a cracked spine. A 26 year-old in Massachusetts needed a total hip replacement. A 25-year-old in Wisconsin, like Derricott, has chronic pain and degenerative disc disease.

https://www.pbs.org/newshour/health/women-fear-drug-they-used-to-halt-puberty-led-to-health-problems
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Endometriosis Safety Update No. 43818 [...] notes that bone density measurements were performed on 32 patients in the follow-up study. Only 11 of the 32 patients experienced a complete recovery. Thus 21 patients did not have a complete recovery and many showed further decreases.

http://www.lupronvictimshub.com/home/GueriguianReport.pdf
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Researchers in Taiwan found “a possible major side effect” when they studied 11 girls who started Lupron around age 8 and continued treatment for about five years. When the women were about 20 they performed bone scans and found that 45 percent had lower-than-average bone density and merited a diagnosis of osteopenia.

Canadian researchers also identified five children who developed the same bone problem within years of taking a puberty-delaying drug. The children each suffered from slippage in the long bone of the leg, near the hip, due to “a lack of adequate sex hormone exposure at a ‘critical period’ of bone formation.”

https://revealnews.org/article/women-say-drug-used-to-halt-puberty-has-ruined-their-lives/
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"[In a survey of over 1,000 users of Lupron] almost 20% reported some degree of osteoporosis, and 16% reported cracking or brittle bones, 42% reported toothaches (9% severe) and 26% had cracking teeth. Osteonecrosis was reported by 3% of the respondents.

https://www.hormonesmatter.com/lupron-side-effects-survey-results-scope-severity-side-effects/
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Lupron's own label (version used between 1991 and 1995) also warned that:

"After 6 months the vertebral trabecular bone density as measured by Quantitative Computer Tomography (QCT) was decreased by an average of 13.5%."

https://www.hormonesmatter.com/they-say-lupron-safe
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In contrast, while reduction in bone density during treatment wasn't disputed, some studies seemed to indicate that musculoskeletal side effects were temporary:

One 2009 study by Italian researchers examining 66 girls found that bone density was significantly lower after treatment, but within about 10 years returned to a level comparable with women who served as study controls. Another German study concluded that there was no harm to bones, even though 7 of 41 women studied, or 17 percent, had osteopenia several years after their treatment ended.

https://revealnews.org/article/women-say-drug-used-to-halt-puberty-has-ruined-their-lives/
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Further complicating matters, however, "many Lupron studies and follow-up studies have been designed using non-QCT bone density scans, and often it is wrist (and not hip or vertebral) scans that are performed" - ie, an alternate and less effective scanning technique such as Dual-energy X-ray absorptiometry (DEXA) may have been used for these studies (current Lupron labels now cite bone density decreases as measured by DEXA, thereby reducing the previous average from 13.5% to 3.2%).

It seems a pretty complex issue. But in a tentative first pass I am of the opinion that:

1. The claim by Michelle Forcier that Lupron is "wonderful, completely reversible and doesn't have permanent effects" doesn't seem to have any evidence to support it, and that the contrary may be true
2. The claim by Scott Newgent that "there are no long-term studies on its use by children" appears to be true
3. The case of osteoporosis and musculoskeletal issues related by Miriam Grossman appears fairly commonplace among users of Lupron, as reported both in personal accounts and studies

There's lots more that could be written but perhaps it would be best to see what other people think and then address what's brought to the table rather than overload with information here.

*​

Finally, in addendum, it's probably worth nothing that Walsh also made the news a few years ago by sharing what NBC called a "viral fake news story" which claimed that Lupron was "linked to thousands of deaths, [according to] FDA data."

This was explained by Professor Joshua Safer as a misunderstanding and/or misrepresentation of data:

“There’s no study here, I think all they did is go into the FDA database and look at reports. The problem with that is you don't even know that those deaths are connected to the agent they are reported to be connected to.”

According to NBC Safer suggested that it was much more likely that the 6,370 deaths (spread over four decades) were in terminally ill cancer patients who were going to die anyway.
 
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deirdre

Senior Member.
about Lupron (or Leuprorelin/Leuprolide)
uh oh. theyre giving kids a ferret/parrot drug? is that better than a horse dewormer?

Article:
Leuprorelin is frequently used in ferrets for the treatment of adrenal disease. Its use has been reported in a ferret with concurrent primary hyperaldosteronism,[64] and one with concurrent diabetes mellitus.[65] It is also used to treat pet parrots suffering from chronic egg laying behavior.[66]
 

deirdre

Senior Member.
I trying to verify the claim that it's "completely reversible and doesn't have permanenet effects" I don't find any long-term studies of its use by children that would be able to confirm that, while the Hayes Technology Review - "considered to be the industry standard in linking treatments with patient outcomes" - rated it D2 - "the lowest rating possible on [their] scale of safety and efficacy" - "based upon insufficient published evidence to assess safety and/or impact on health outcomes or patient management."

NHS who is as woke as woke can get, says
Article:
Puberty blockers (gonadotrophin-releasing hormone analogues) pause the physical changes of puberty, such as breast development or facial hair.

Little is known about the long-term side effects of hormone or puberty blockers in children with gender dysphoria.

Although GIDS advises this is a physically reversible treatment if stopped, it is not known what the psychological effects may be.

It's also not known whether hormone blockers affect the development of the teenage brain or children's bones. Side effects may also include hot flushes, fatigue and mood alterations.


and the Mayo Clinic
Article:
Possible side effects of GnRH analogue treatment include:

Injection site swelling
Weight gain
Hot flashes
Headaches
Use of GnRH analogues might also have long-term effects on:

Growth spurts
Bone growth and density
Future fertility — depending on when pubertal blockers are started
 

Rory

Senior Member.
how do you know its at the one hour mark? where is the documentary?

I have a copy of it. It's available on The Daily Wire website (though I got my copy elsewhere). Trailer here:

Source: https://www.youtube.com/watch?v=42ivIRd9N8E

He's not exactly Lous Theroux or Jon Ronson - but I think he makes some good and interesting points.

your thread op is super confusing.

It's a somewhat confusing and complex issue, it seems. But I have tried to clean it up a bit.

[Michelle Forcier] is in the documentary?

Yep. She does quite a long interview with Matt Walsh about various things and is presented in a number of segments.

th claim [about it being reversible and non-permanent] is in the documentary? if it is, im sure the documentary debunks it , no?

No. It was Scott Newgent who refutes this claim and Miriam Grossman who says she thinks Lupron is dangerous. But it doesn't go into depth about Lupron (it's not the main focus of the documentary).

uh oh. theyre giving kids a ferret/parrot drug?

Well, I get your reference. ;)

But, yeah, it does seem quite a scary "medication" (Forcier for some reason took exception to it being called a "drug", calling it an "exploitive word" and "malignant and harmful").

NHS who is as woke as woke can get, says:

Little is known about the long-term side effects of hormone or puberty blockers in children with gender dysphoria.

Although GIDS advises this is a physically reversible treatment if stopped, it is not known what the psychological effects may be.

Yeah, I also read some physicians (and others) talking about the potentially damaging psychological effects, which it would be hard to argue are "completely reversible".

I didn't include those quotes though as they're not really measured, more opined. Plus, it was long enough as it was.

Thanks for the questions: they help.
 
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Mendel

Senior Member.
theyre giving kids a ferret/parrot drug? is that better than a horse dewormer?
I'm pretty sure that a dosage which is safe for ferrets is reasonably safe for humans.
Especially if that drug has passed phase 3 clinical trials for the intended human use.
 

Mendel

Senior Member.
Although GIDS advises this is a physically reversible treatment if stopped, it is not known what the psychological effects may be.
More on GIDS:
Article:
The Gender Identity Development Service (GIDS) is a highly specialised clinic for young people presenting with difficulties with their gender identity. Our service was established in 1989.

We are commissioned by NHS England who set the service specifications for how we work.

Article:
Hormone treatment

Although hormone blockers and cross-sex hormone treatment are recommended in young people with GD and widely used across the board, it should be noted that the research evidence for the effectiveness of any particular treatment offered is still limited.

A Dutch research programme indicates that a treatment protocol including puberty suppression followed by cross-sex hormones and gender reassignment surgery, leads to improved psychological functioning in a selected group of transgender adolescents, who had persistent GD from childhood, lived in a supportive environment and had no serious co-morbidities. If the young people did not show persistent GD from childhood, live in a supportive environment or if they had serious co-morbidities, assessment was prolonged (de Vries et al 2014). The hormone blocker alone does not seem to alleviate feelings of GD, however, it does have a positive impact on adolescents’ psychological well-being by putting their pubertal development on hold (de Vries et al 2010). The Dutch authors conclude: ‘Clinicians should realize that it is not only early medical intervention that determines this success, but also a comprehensive multidisciplinary approach that attends to the adolescents’ GD as well as their further well-being and a supportive environment’ (de Vries et al 2014). Additionally, having good peer relationships and engaging in social interaction with other transgender people have both been shown to help build resilience and improve psychological well-being (Testa, Jimenez & Rankin, 2014; De Vries et. al., 2015).

Safety concerns

Safety concerns remain regarding the impact of physical interventions. Although puberty suppression, cross-sex hormones and gender reassignment are generally considered safe treatments in the short term, the long-term effects regarding bone health and cardiovascular risks are still unknown (Cohen-Kettenis & Klink, 2015; Klink et al., 2015,).

I haven't identified the referenced studies yet. Klink seems particularly interesting, especially if there are more recent publications.

I believe there's a high suicide risk inherent in untreated gender dysphoria, so (reversible?) osteoporosis as a possible side effect may be a reasonable trade-off.
 

LilWabbit

Senior Member
I believe there's a high suicide risk inherent in untreated gender dysphoria

Any evidence on pre-treatment suicide risk exceeding post-treatment suicide risk to support this belief?

Also, is there any sound science available demonstrating suicide as an inevitability comparable to a biological process resulting in osteoporosis?
 

Ann K

Senior Member.
Matt Walsh's name alone makes me suspicious of the reliability of the information. He describes himself, perhaps tongue in cheek, as a "theocratic fascist", and has long waged war on transgenderism.

Excerpts from his Wikipedia article:

https://en.wikipedia.org/wiki/Matt_Walsh_(political_commentator)

In May 2021, Walsh called doctors who perform gender-reassignment surgeries for transgender youth "plastic surgeons basically acting like Leatherface from The Texas Chain Saw Massacre."[27]

Regarding What is a Woman:
Walsh described the documentary as an "assault on gender ideology".[32]"


"In February 2022, transgender activist Eli Erlick alleged that Walsh had invited dozens of trans people and doctors, including a fourteen-year-old girl, to participate in What is a Woman? under alleged false pretenses.[37][38][39][40] Model Kataluna Enriquez, Fallon Fox, and other transgender public figures corroborated the account, saying that Walsh had created a group called the Gender Unity Project in his efforts.[41][42]"
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~~~~~~~
Anecdote: I first heard the word "osteoporosis" at about the age of eleven, because my same-age friend next door was diagnosed with it after she broke her arm. This was in the 1950s. It's rare in children, but certainly not unheard of.
~~~~~~~
 
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Hevach

Senior Member.
uh oh. theyre giving kids a ferret/parrot drug? is that better than a horse dewormer?

Article:
Leuprorelin is frequently used in ferrets for the treatment of adrenal disease. Its use has been reported in a ferret with concurrent primary hyperaldosteronism,[64] and one with concurrent diabetes mellitus.[65] It is also used to treat pet parrots suffering from chronic egg laying behavior.[66]
There are exceptionally few veterinary drugs that are not adapted from human drugs. The skin shed aids you see for snakes are just derivatives of burn treatments. Even malachite green, used to treat ich in goldfish, used to be used to treat wounds in humans, the stuff in flea drops used to be used in head lice shampoo. Veterinary medicine is mostly just improvisation with human medicine hand-me-downs, there are no pharmaceutical companies producing experimental pills for your dog's arthritis.

The issue with ivermectin was that a horse dose is designed to deliver twice the safe concentration over five times the body mass in half the time compared to a human dose. I'm not sure what the leuprorelin dose per kg is for a ferret, but by virtue of a ferret weighing somewhat less than a horse [citation needed] the math is probably going in the safer direction rather than the more toxic direction.
 

deirdre

Senior Member.
I believe there's a high suicide risk inherent in untreated gender dysphoria, so (reversible?) osteoporosis as a possible side effect may be a reasonable trade-off.

unless it is the psychological interventions mentioned that [perhaps] reduce suicidal feelings:
Article:
The Dutch authors conclude: ‘Clinicians should realize that it is not only early medical intervention that determines this success, but also a comprehensive multidisciplinary approach that attends to the adolescents’ GD as well as their further well-being and a supportive environment’ (de Vries et al 2014). Additionally, having good peer relationships and engaging in social interaction with other transgender people have both been shown to help build resilience and improve psychological well-being (Testa, Jimenez & Rankin, 2014; De Vries et. al., 2015).


We'd have to see if there is data on kids who got suppressors but don't have all those proper psychological supports.
 

deirdre

Senior Member.
The issue with ivermectin was that a horse dose is designed to deliver twice the safe concentration over five times the body mass in half the time compared to a human dose.
i know. i was referring to the Joe Rogan backlash though. his doctor didn't prescribe a horse dose.
 

Rory

Senior Member.
I believe there's a high suicide risk inherent in untreated gender dysphoria, so (reversible?) osteoporosis as a possible side effect may be a reasonable trade-off.

Seconding LilWabbit's question, I'm interested to hear if there's evidence to support that belief.

Matt Walsh's name alone makes me suspicious of the reliability of the information.

Indeed, that's why I felt it necessary to check into the issue, having noticed on two occasions that he was guilty of sharing misinformation. But it seems on this occasion - as on others - he wasn't.
 
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Mendel

Senior Member.
Via https://medicine.yale.edu/childstudy/policy-and-social-innovation/lgbtq-youth/ (I'm quoting from the PDF)(excerpted):
Article:
Biased Science: The Texas and Alabama Measures Criminalizing Medical Treatment for Transgender Children and Adolescents Rely on Inaccurate and Misleading Scientific Claims

In this report, we cite studies that are peer-reviewed, up to date, conducted by respected investigators, and published in high-impact journals that are widely read. This represents the highest-quality evidence available to physicians making treatment decisions in this context.

[...]

A solid body of reliable research has shown that the potential next steps in genderaffirming care for adolescents with gender dysphoria – puberty-blocking medications and hormone therapy – have major mental-health benefits, including higher levels of general wellbeing and significantly decreased levels of suicidality.

Puberty blockers have been shown to decrease suicidality in adulthood and to improve affect and psychosocial functioning as well as social life. Hormone therapy has been shown to reduce suicidality in transgender adolescents when compared to peers with gender dysphoria who did not receive it. Notably, none of the studies has found a worsening of these mental health measures among recipients of genderaffirming care.

Among children and adolescents, patients who present for gender-affirming care at later pubertal stages are more likely to require psychoactive medications and are more likely to have considered or attempted suicide than patients who received gender-affirming care at earlier stages of pubertal development.

[...]

Recent studies suggest that puberty-blocking medication has negligible or small effects on bone development in adolescents, and any negative effects are temporary and reversible. The most recent studies show that puberty-blocking drug therapy either has no effect on bone mineral density (BMD), a proxy measure of bone strength, or is associated with a very small secrease.

Calcium supplementation has been shown to protect patients from bone loss. Critically, any reduction in BMD is recovered when adolescents cease taking puberty-blocking medication, whether or not they continue to gender-affirming hormone therapy.
 

deirdre

Senior Member.

can you dig through and link the studies? because they sound a bit biased, both politically and professionally
Article:
page 2
On April 7, 2022, Governor Kay Ivey of Alabama signed S.B. 184 (the “Alabama Law”), which imposes felony penalties on anyone providing certain medical care to any child, adolescent, or young adult under age 19.3 We are a group of six scientists and one law professor. Among the scientists, three of us are M.D.s., three are PhD’s, and all treat transgender children and adolescents in daily clinical practice.
 

Mendel

Senior Member.
Article:
Gender-affirming hormone therapy: An updated literature review with an eye on the future

Hormonal regimens have changed over time, and older data may be less relevant for today's practice. In recent literature, we have found that even though mental health problems are more prevalent in trans people compared to cisgender people, less psychological difficulties occur, and life satisfaction increases with gender-affirming hormone treatment (GAHT) for those who feel this is a necessity.


Article:
Long-term outcome of early medical intervention

True long-term outcome studies are currently not available but studies within a cohort of young adults at age 22 who were treated in their teens are published. With respect to bone health, it was reported that bone mass was in the normal range but not at pre-treatment level for both transgender men and transgender women. However, only in transgender women, few had T-score < −2.5 [38]. When compared to age-matched peers, young adult transgender women showed greater similarity to cis-women than to cis-men with respect to body shape and body composition [34]. BMI was only slightly higher but the increase of obesity prevalence in trans-gender women was higher compared to cis-women. Thus, a subset of transgender women proved to be more prone for excessive weight gain [39]. In transgender men, body shape and body composition were within reference values for cis-women and cis-men. An earlier Tanner stage at start of treat-ment appeared to be associated with a closer resemblance of body shape to their affirmed sex [34]. The pre-treatment obesity prevalence was already higher compared to the general population, but the increase in prevalence was comparable to cis-men. For both transgender men and women, other cardio-vascular risk factors such as fasting glucose, lipid profile, and blood pressure were similar or more favorable [39]. In addition, the psychological benefits of early medical intervention for young transgender adolescents have been established [30,31]. One year after surgery, the GD was alleviated, psychological functioning had steadily improved, and well-being was similar to or better than same-age young adults from the general population.

It seems to be important to consider how old a study (and its data) is.
 
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Mendel

Senior Member.
can you dig through and link the studies
no, there are too many
88 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):E270-75 (hereinafter, “Klink et al. 2015”); Schagen SEE, Wouters FM, Cohen-Kettenis PT, Gooren LJ, Hannema SE. Bone Development in Transgender Adolescents Treated With GnRH Analogues and Subsequent Gender-Affirming Hormones. J Clin Endocrinol Metab. 2020 Dec 1;105(12): e4252-e4263 (hereinafter, Schagen et al. 2020”); Delemarre-van de Waal HA, Cohen-Kettenis PT. Clinical management of gender identity disorder in adolescents: a protocol on psychological and paediatric endocrinology aspects. Eur J Endocrinol. 2006;155:S131-S137. Studies of children treated for precocious puberty found that BMD was normal at final height attainment. Alessandri SB, Pereira F de A, Villela RA, Antonini SRR, Elias PCL, Martinelli Jr CE, de Castro M, Moreira AC, de Paula FJA. Bone mineral density and body composition in girls with idiopathic central precocious puberty before and after treatment with a onadotropin-releasing hormone agonist. Clinics (Sao Paulo). 2012;67(6):591-96; Antoniazzi F, Zamboni G, Bertoldo F, Lauriola S, Mengarda F, Pietrobelli A, Tato L. Bone mass at final height in precocious puberty after gonadotropin-releasing hormone agonist with and without calcium supplementation. J Clin Endocrinol Metab. 2003 Mar;88(3):1096-1101 (hereinafter, “Antoniazzi et al. (2003)”); Heger S, Partsch CJ, Sippell WG. Long-term outcome after depot gonadotropinreleasing hormone agonist treatment of central precocious puberty: final height, body proportions, body composition, bone mineral density, and reproductive function. J Clin Endocrinol Metab. 1999 Dec;84(12):4583-90; Neely EK, Bachrach LK, Hintz RL, Habiby RL, Slemenda CW, Feezle L, Pescovitz OH. Bone mineral density during treatment of central precocious puberty. J Pediatr. 1995 Nov;127(5):819-22.
Content from External Source
They don't sound biased to me.
 

deirdre

Senior Member.
well my first fact check is worng:

Article:
page 3The AG Opinion falsely implies that puberty blockers and hormones are administered to prepubertal children, when, in fact, the standard medical protocols recommend drug treatments only for adolescents (and not prepubertal children). For purposes of this report, we use the term “adolescent” to refer to a child under the age of majority in whom pubertal development has begun.



Article:
(7) This course of treatment for minors commonly 4 begins with encouraging and assisting the child to socially 5 transition to dressing and presenting as the opposite sex. In 6 the case of prepubertal children, as puberty begins, doctors 7 then administer long-acting GnRH agonist (puberty blockers) 8 that suppress the pubertal development of the child. This use 9 of puberty blockers for gender nonconforming children is 10 experimental and not FDA-approved.
 

Mendel

Senior Member.
well my first fact check is worng:

page 3The AG Opinion falsely implies that puberty blockers and hormones are administered to prepubertal children, when, in fact, the standard medical protocols recommend drug treatments only for adolescents (and not prepubertal children). For purposes of this report, we use the term “adolescent” to refer to a child under the age of majority in whom pubertal development has begun.
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Source: https://medicine.yale.edu/childstudy/policy-and-social-innovation/lgbtq-youth/report%20on%20the%20science%20of%20gender-affirming%20care%20final%20april%2028%202022_437080_54636_v2.pdf
You need to look in the corresponding section further back to find the footnotes.

Yale:
1 Tex. Op. Att’y. Gen. No. KP-0401 (Feb. 18, 2022) (hereinafter, “AG Opinion”).
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found at https://www.texasattorneygeneral.gov/opinions/ken-paxton/kp-0401

The AG Opinion wrongly conflates treatments available to adolescents with those offered
to children.20 In fact, current medical protocols for gender-affirming care do not recommend
either surgery or drug treatments (puberty blockers and hormones) for prepubertal children.

20 AG Opinion, p. 2 (claiming that there is a “novel trend of providing these elective sex changes to minors,” with “sex changes” previously defined to include surgery and drug therapies).
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AG General:

SmartSelect_20220629-182740_Samsung Notes.jpg
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deirdre

Senior Member.
You need to look in the corresponding section further back to find the footnotes.

Yale:
1 Tex. Op. Att’y. Gen. No. KP-0401 (Feb. 18, 2022) (hereinafter, “AG Opinion”).
Content from External Source
found at https://www.texasattorneygeneral.gov/opinions/ken-paxton/kp-0401

The AG Opinion wrongly conflates treatments available to adolescents with those offered
to children.20 In fact, current medical protocols for gender-affirming care do not recommend
either surgery or drug treatments (puberty blockers and hormones) for prepubertal children.

20 AG Opinion, p. 2 (claiming that there is a “novel trend of providing these elective sex changes to minors,” with “sex changes” previously defined to include surgery and drug therapies).
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AG General:

SmartSelect_20220629-182740_Samsung Notes.jpg
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minor children (from your AG snippet) is not the same as prepubertal. am i missing some point you are trying to make?
Article:
(18) MINOR.A person who is under 19 years of age.
 

Mendel

Senior Member.
minor children (from your AG snippet) is not the same as prepubertal. am i missing some point you are trying to make?
Article:
(18) MINOR.A person who is under 19 years of age.
conflates treatments available to adolescents with those offered to children.
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"conflates" means "lump together", the Yale people criticize that Paxton doesn't make clear that his statement does not apply to small children, only to teenagers adolescents.

Because he doesn't explicitly state it, page 3 uses the word "implies". Saying "minors get this" implies all minors do, from age 1 to 17.

If I am informed correctly, surgical procedures are not performed on minors at all.
 
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deirdre

Senior Member.
conflates treatments available to adolescents with those offered
to children.
Content from External Source

"conflates" means "lump together", the Yale people criticize that Paxton doesn't make clear that his statement does not apply to small children, only to teenagers.

Because he doesn't explicitly state it, page 3 uses the word "implies". Saying "minors get this" implies all minors do, from age 1 to 17.

If I am informed correctly, surgical procedures are not performed on minors at all.

well, we will have to agree to disagree (although that opinion was an interesting read i am glad you linked for readers to read)
1656522979820.png

only to teenagers.
puberty can start earlier
Article:
The average age for girls to start puberty is 11, while for boys the average age is 12.

But it's perfectly normal for puberty to begin at any point between the ages of 8 and 13 in girls and 9 and 14 in boys.
 

Ann K

Senior Member.
can you dig through and link the studies? because they sound a bit biased, both politically and professionally
I'm concerned about your own political bias, because you are downplaying the medical findings of medical professionals, while apparently calling the opinions of a non-medical politician in an extremely socially conservative state "very interesting". The former should be the standard for supporting the facts of the matter, should they not? Or am I completely misunderstanding the thrust of your post? And please, try not to throw around the term "woke" as a pejorative.
 

Mendel

Senior Member.
the opinions of a non-medical politician
I wouldn't have brought it up (it's off topic, and I didn't reference it in my initial quote, except for the title of the paper), but that's what deirdre chose to fact-check on, so...
 

deirdre

Senior Member.
I'm concerned about your own political bias
i'm sure you are. But instead of ad homining all over MB, perhaps providing some actual information would be more useful to MB's target audience (ie people who believe the bunk)

you are downplaying the medical findings of medical professionals,
actually i'm questioning them because

1. i see no facts/evidence in Mendel's quote, if you want to blindly believe them that is cool.
2. They work with transgender kids (vs being a neutral, guilt-free medical professional
3. They decided to include politics in their paper, which doesnt seem all that "professional"
4. I have bias towards Yale and what their psychology arm does to children. (not all the doctors are bad, but they have misdiagnosed autism in at least 3 kids i personally know...which caused all sorts of problems for the families and the kids and they negligently pissed off Adam Lanza)

"very interesting"
from a legal standpoint it is very interesting. he lays out some impressive sounding arguments. but, of course, as always the courts will decide.

And please, try not to throw around the term "woke" as a pejorative
please try not to read every thing i utter as "evil" and accuse me of such.
 

deirdre

Senior Member.
because you are downplaying the medical findings of medical professionals,
ps i dont think quoting the NHS and the Mayo Clinic is downplaying findings of medical professionals. Perhaps you meant "you are down playing the [alleged] findings of these particular medical professionals" ?
 

Rory

Senior Member.
If I am informed correctly, surgical procedures are not performed on minors at all.

I guess it depends where you draw the line at "minors". But if it's at 18 then, yes, surgical procedures are performed on minors.

I believe there's a high suicide risk inherent in untreated gender dysphoria, so (reversible?) osteoporosis as a possible side effect may be a reasonable trade-off.

I suppose the questions are:

1. What's the risk of suicide in untreated gender dysphoria?
2. What's the risk of suicide in treated gender dysphoria?
3. What's the risk of irreversible osteoporosis?

It may be the case that these questions don't yet have satisfactory answers. And maybe there are more important questions anyway, such as:

Are people like Michelle Forcier genuinely unaware of the concerns around Lupron or are they promoting and prescribing it with full knowledge of its side effects yet keeping that knowledge to themselves?
 

Ann K

Senior Member.
2. They work with transgender kids (vs being a neutral, guilt-free medical professional.
3. They decided to include politics in their paper, which doesnt seem all that "professional"

Transgender kids need both medical and psychological care. Would you consider it "neutral" to deny that care to a patient? (Texas actually wants to do that as a purely political move, based on the opinions of a non-medical AG, so your point number 3 seems especially misapplied.) And where does the phrase "guilt-free" enter into the matter, please?
 

Rory

Senior Member.
I suppose the questions are:

1. What's the risk of suicide in untreated gender dysphoria?
2. What's the risk of suicide in treated gender dysphoria?

Among the best studies and writings I've looked at on these questions:

A large 2018 study of over 120,000 11-19 year-old ("adolescent") Americans found:

Female to male adolescents reported the highest rate of attempted suicide (50.8%), followed by adolescents who identified as not exclusively male or female (41.8%), male to female adolescents (29.9%), questioning adolescents (27.9%), female adolescents (17.6%), and male adolescents (9.8%).

https://publications.aap.org/pediat...76767/Transgender-Adolescent-Suicide-Behavior
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A 2011 cohort study of 324 gender-reassigned (ie, had surgery) Swedes reported 10 suicides (3.1%) compared with a control group incidence of 5 in 3,240 (0.15%). Suicide attempts were recorded as 9% (GR) and 1.4% (C) respectively:

The overall mortality for sex-reassigned persons was higher during follow-up (adjusted Hazard Ratio 2.8) than for controls of the same birth sex, particularly death from suicide (aHR 19.1). Sex-reassigned persons also had an increased risk for suicide attempts (aHR 4.9) and psychiatric inpatient care (aHR 2.8).

https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0016885
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Then there's the 2019 study of 2,679 Swedes who received a diagnosis of gender incongruence whose conclusions were reported by NBC as follows:

Overall, people in the study with gender incongruence were six times more likely than people in the general population to visit a doctor for mood and anxiety disorders. They were also three times more likely to be prescribed antidepressants, and six times more likely to be hospitalized after a suicide attempt.

But among trans people who had undergone gender-affirming surgery, the longer ago their surgery, the less likely they were to suffer anxiety, depression or suicidal behavior during the study period.

https://www.nbcnews.com/feature/nbc...ng-term-mental-health-benefits-study-n1079911
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The study itself (published in the American Journal of Psychiatry) reported an average of 8% reduction in mental health utilization for each year following surgery and concluded that:

In this first total population study of transgender individuals with a gender incongruence diagnosis, the longitudinal association between gender-affirming surgery and reduced likelihood of mental health treatment lends support to the decision to provide gender-affirming surgeries to transgender individuals who seek them.

https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.2019.19010080
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This study, which was perhaps the first and only study to report such findings, was subsequently challenged and its conclusion shown to be erroneous:

After the study was published, many researchers and scientists alerted the AJP to multiple serious methodological problems that challenged the study’s conclusion. In response, the AJP editor requested an independent statistical review of the data, which led to a reanalysis of the data and an official correction. When gender dysphoric patients who received surgeries were compared to those who did not have surgeries, there was no statistically significant difference in their mental health utilization.

Nine months after the study’s original publication, the AJP stated, “the results [of the reanalysis] demonstrated no advantage of surgery in relation to subsequent mood or anxiety disorder-related health care visits or prescriptions or hospitalizations following suicide attempts.”

https://segm.org/ajp_correction_2020
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Once again it all seems like a bit of a minefield, similar to the questions about Lupron, with studies often biased, erroneous, inconclusive, or lacking sufficient data. Though written 18 years ago, the situation doesn't seem to have changed much since The Guardian wrote this:

[We] asked Birmingham University's Aggressive Research Intelligence Facility (Arif) to assess the findings of more than 100 follow-up studies of post-operative transsexuals. Arif, which conducts reviews of healthcare treatments for the NHS, concludes that none of the studies provides conclusive evidence that gender reassignment is beneficial for patients. It found that most research was poorly designed, which skewed the results in favour of physically changing sex. There was no evaluation of whether other treatments, such as long-term counselling, might help transsexuals, or whether their gender confusion might lessen over time. Arif says the findings of the few studies that have tracked significant numbers of patients over several years were flawed because the researchers lost track of at least half of the participants. The potential complications of hormones and genital surgery, which include deep vein thrombosis and incontinence respectively, have not been thoroughly investigated, either. "There is huge uncertainty over whether changing someone's sex is a good or a bad thing," says Dr Chris Hyde, director of Arif.

https://www.theguardian.com/society/2004/jul/31/health.socialcare
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Also this from The Conversation (2016), who looked at a number of studies to answer the question as to why there was an increased risk of suicide among post-op transgender people when compared with the general population:

Three conclusions spring to mind. First, we still have limited insight into the actual causes of the increased suicide risk in sexual minority groups. Secondly, we need more studies on suicide in transgender people, ideally designed in close collaboration with people with the lived experience of suicidality. Last, we should remember that despite the higher statistical risk, the majority of transgender people do not attempt suicide or die by suicide.

https://theconversation.com/factche...and-a-higher-suicide-risk-after-surgery-55573
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In conclusion, there's not really very much clear in any of this - but if there is a benefit to be derived from gender reassignment in terms of suicide prevention and mental health well-being the evidence for it is either in studies I haven't come across or it's yet to be discovered.
 
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deirdre

Senior Member.
Would you consider it "neutral" to deny that care to a patient?
i didnt say the neutral doctors who dont prescribe Lupron to minors, can't agree with the Yale doctors.

Transgender kids need both medical
but do they? that is what we are discussing in this thread and have not yet determined. perhaps you can provide the studies that prove this for us.

Texas actually wants to do that as a purely political move, based on the opinions of a non-medical AG,
it's Alabama. youre right ken paxton is texas.

and based on the AG opinion they are trying to prevent the law being broken.
based on the opinions of a non-medical AG, so your point number 3 seems especially misapplied
so are you saying medical professionals dont need to be more medically professional than non-medical people? fair enough, though i disagree.
ex they said (linked in post #20):

page 3The AG Opinion falsely implies that puberty blockers and hormones are administered to prepubertal children, when, in fact, the standard medical protocols recommend drug treatments only for adolescents (and not prepubertal children). For purposes of this report, we use the term “adolescent” to refer to a child under the age of majority in whom pubertal development has begun.
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a more medically professional way to say this could be along the lines of:

" It is our opinion that the wording the AG uses, specifically the term "child" vs a more specific "adolescent" could confuse law makers into thinking puberty blockers are given to children pre-puberty. This is not the case, the standard medical protocols recommend drug treatments only for adolescents (and not prepubertal children)"

And where does the phrase "guilt-free" enter into the matter, please?
I don't understand the question.
 
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Rory

Senior Member.
Did you search extensively? how sure are you this was the "only" study?

It could be more extensive. But I may have been overcautious in my "perhaps" and, if pressed, would upgrade it to a "probably" - with an expectation of going "most likely" (or stronger) with further research. :)
 

Rory

Senior Member.
Here's one large scale study (2021, n=27,715) that contradicts that:

In this article, we present the largest study to our knowledge to date on associations between gender-affirming surgeries and mental health outcomes. Our results demonstrate that undergoing gender-affirming surgery is associated with improved past-month severe psychological distress, past-year smoking, and past-year suicidal ideation.

After adjustment for sociodemographic factors and exposure to other types of gender-affirming care, undergoing 1 or more types of gender-affirming surgery was associated with lower past-month psychological distress (adjusted odds ratio [aOR], 0.58; 95% CI, 0.50-0.67; P < .001), past-year smoking (aOR, 0.65; 95% CI, 0.57-0.75; P < .001), and past-year suicidal ideation (aOR, 0.56; 95% CI, 0.50-0.64; P < .001).

https://jamanetwork.com/journals/jamasurgery/article-abstract/2779429
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Those figures interpreted:

Gender-affirming surgeries were associated with a 35% reduction in tobacco smoking, a 42% reduction in psychological distress and a 44% reduction in suicidal ideation when compared with transgender and gender-diverse people who had not had gender-affirming surgery but wanted it.

https://www.hsph.harvard.edu/news/h...its-associated-with-gender-affirming-surgery/
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deirdre

Senior Member.
a 35% reduction in tobacco smoking

oh well that's good!! (sorry for the sarcasm, i cant believe their list is severe psychological distress, suicide and ...smoking)

those numbers seem oddly high to me. would be nice if true, but...
Article:
The study examined data from the 2015 U.S. Transgender Survey, which included nearly 20,000 participants, 38.8% of whom identified as transgender women, 32.5% of whom identified as transgender men, and 26.6% of whom identified as nonbinary. Of the respondents, 12.8% had undergone gender-affirming surgery at least two years prior and 59.2% wanted to undergo surgery but had not done so yet.


@Rory now i need you to look up how many transgenders WANT surgery. because -unless my math is wrong- there are 72% in that that had surgery or want surgery.
 

Rory

Senior Member.
Those certainly are strikingly impressive and encouraging numbers. Hopefully it's not one of those that "skewed the results in favour of physically changing sex."

I do note that Harvard reported "nearly 20,000 participants" while the study writers stated "27,715". And in examining the tables and stats it seems that the numbers involved generally add up to 19,960, though this number isn't stated anywhere in the paper*.

For the explanation it's maybe because they had the "study group" (those who had had surgery at least two years prior to the survey), the "control group" (those who wanted surgery) and then two possibilities for "the rest" (1. neither had nor wanted. or 2. had had in the previous two years).

The first possibility for "the rest" is explained - "We excluded participants who did not report desire for any gender-affirming surgeries" - but I don't see a mention for those who had had surgery in the previous two years*.

There is this though:

1656558488676.png

Which is no surgery + surgery = 19,960 without saying whether it was wanted or not or was within the last two years.

Another possible explanation for at least some of the errant 7,745 responses might be that they were incomplete and deemed unusable. When I work on surveys such as these there's generally a fairly high percentage that fall into that category. But, again, I don't see it explained*.

I also notice that they included a summary of previous studies, including the Swedish one mentioned above that was later amended.

Despite growing demand for and access to gender-affirming surgery, there is a paucity of high-quality evidence regarding its effects on mental health outcomes among TGD people.

Existing evidence on the association between gender-affirming surgeries and mental health outcomes is largely derived from small-sample, cross-sectional, and uncontrolled studies. A 1998 review of the experiences of more than 2,000 TGD people from 79 predominantly uncontrolled follow-up studies demonstrated qualitative improvement in psychosocial outcomes following gender-affirming surgery. Attempts since then to empirically demonstrate mental health benefits from gender-affirming surgery have generated mixed results. A meta-analysis of 1,833 TGD people across 28 studies concluded that studies offered “low-quality evidence” for positive mental health benefits from surgical gender affirmation. The largest existing study on this subject to our knowledge, a total population study including 2,679 people diagnosed as having gender incongruence in Sweden, demonstrated a longitudinal association between gender-affirming surgery and reduced mental health treatment utilization.However, a 2020 published correction of this study demonstrated no mental health benefit from gender-affirming surgery after comparison with a control group of TGD people who had not yet undergone surgery. Mental health effects of gender-affirming surgery thus remain controversial.

https://jamanetwork.com/journals/jamasurgery/article-abstract/2779429
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So in a sense that 2019 study was "perhaps the first and only one" that demonstrated such positive results from a decent sample size - and now this one is. ;)

* I've haven't read it word for word and relied somewhat on ctrl+f, so there's a possibility that there is an explanation for all this somewhere in there.

As for the accuracy of the figures, I guess my first curiosity would be how other possible factors are accounted for - for example, could it be that those who had had surgery also had more money, were naturally more proactive, were more "together", and/or had an increased baseline of mental well-being over those who wanted but hadn't had surgery?

This is probably addressed by them. I'll have a further look tomorrow when I have more time.
 

Mendel

Senior Member.
1. i see no facts/evidence in Mendel's quote, if you want to blindly believe them that is cool.
The Yale study is full of factual statements. The evidence for these statements is referenced in the numerous footnotes (I quoted footnote 88 for you above; it concerns the osteoporosis claim).
2. They work with transgender kids (vs being a neutral, guilt-free medical professional
Being an expert in transgender therapy tends to involve working with transgender kids.
Would you expect someone to be an expert on cancer if they had never actually been involved in treating a cancer patient?

Someone who does not actually work in the field they claim to be expert in have a higher hurdle to pass in establishing their experience and knowledge in this field.
 
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