'Gender affirmative care' is gay conversion therapy: Part 1

How Homophobic Quackery Is Targeting Children

Eli Braille @megawhelmed

I've just been asked by my employer to sign Stonewall's conversion therapy ban petition. Any suggestions? Other than quitting.

Eli, you might point your employers to this piece by Sue Donym, which I’m delighted to republish here after the usual gang of incels kicked her off Medium. Her previous post on autogynophilia can be found here.

It’s long, but important, so I’ve broken it down into three parts.

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What if I told you that conversion therapy still existed? A conversion therapy that targets children who may turn out gay or lesbian. Homosexual. Fruity. Fabulous. Butch. Femme.

This conversion therapy isn’t really that different from the old conversion therapy. It involves torture, medical experiments, and outright quackery. Same shit, different day. It involves the off-label use of powerful cancer drugs, and no one knows the potential long term effects.

This new conversion therapy has a name. It’s supported by the left, criticized by the right. You’ve probably been told that unless these children receive the new conversion therapy, they might kill themselves.

That name of the new conversion therapy is ‘child transition’. ‘Transgender children’.

No one knows the side effects for sure, beyond one: no ‘transgender child’ will be fertile after a complete treatment.

In some cases, they might be dead.

Do not turn off your system. Do not tune out.

Sit your ass down, and pay attention, because as it turns out, homophobia is definitely alive and well in the American medical establishment.

The drugs used for the new conversion therapy are known as Gonadotropin-Releasing Hormone Antagonists/Agonists, known more conveniently as ‘GnRHa’. These drugs bind to the gonadotropin receptors, effectively causing a suppression of sex hormones. In adolescents, this stops the progression of puberty. GnRHa drugs were originally intended to treat terminal prostate cancer patients, but their use has proliferated into a huge variety of off-label uses, including the one we’re focusing on today: as the new conversion therapy.

Supposedly, the use of these drugs allows a transgender young person ‘time’ to decide on their ‘gender identity’.

The issue with this whole ‘allows extra time’ business? Studies show that the ‘decision’ is effectively made by the time these children are put on puberty blockers — their use hugely increases rates of persisting gender dysphoria, and the inevitable outcome is cross-sex hormone therapy. One study on puberty blocker use found that no adolescent withdrew from puberty suppression. Unable to go through an actual, natural, puberty, these children are sterile for life. Almost all are funneled into sex reassignment surgery, a physical castration that complements the prior chemical one.

Neither GnRHa drugs, nor their manufacturers, are new to controversy. Abbot Labs, the parent company to spin-off AbbVie, which currently manufactures Lupron, settled multiple suits over the past decade relating to Medicare fraud and off-label marketing, concerning two drugs — Lupron, and Depakote. The first suit, over the off-label marketing of Lupron, settled for $875 million dollars between TAP Pharmaceuticals, a joint venture between Abbot Laboratories and Takeda Pharmaceutical Co, and the Department of Justice. The venture was dissolved in 2008, with Abbot keeping the rights to Lupron. The DOJ indicted multiple TAP employees for Medicare fraud in 2001, mostly for ripping off the elderly, ripping off Medicare and bribing physicians. Abbot also later settled a suit for off-label marketing Depakote (not a GnRHa) to nursing homes for elderly dementia patients, despite the fact a prior clinical trial had shown it could cause anorexia in those patients. They don’t really have a moral compass. Promoting the new conversion therapy certainly isn’t beyond them. Companies such as Ferring have funded puberty blocker studies.

It’s a big business, after all. Pubertal Suppression in Transgender Youth, a book edited by Courtney Finlayson, an endocrinologist at Lurie Children’s Hospital (whose gender clinic is funded by transgender Republican ideologue Jennifer Pritzker), reveals in its second chapter the business that the new conversion therapy could bring. Pediatric versions of Lupron are far more expensive than the adult versions, often running at twice the price. Lupron Depot is $4800 for a three-month dose, while it’s pediatric version, Lupron Depot-Ped is $9700 for the same dose. A subcutaneous histrelin implant for children is $35,000, compared to an adult implant, which costs $4400. And the costs of using those drugs runs into the hundreds of thousands of dollars, as the book also discusses using the drugs for ‘upwards of seven years’.

Think of the money — $9700 every three months, for up to seven years — that’s $271,600, from one patient. If you had even a hundred children taking these drugs for seven years, that’s $27 million in drug sales.

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The new conversion therapy is not ‘radical queer praxis’. It’s not radical at all. It’s nothing but the establishment adapting to the fact one can no longer be quite so obvious when attempting to ‘cure’ the homosexual.

To support the new conversion therapy, it’s proponents have created a cult-like atmosphere. The proponents of the new conversion therapy make use of garbage statistics to scare people into compliance through emotional blackmail.

And children are the victims.

How? Well, have you seen the side effects of these drugs?

LUPROBLEMS: SIDE EFFECTS AND MORE

Well-documented is the effect GnRHa drugs have on bone density. While there was a well-publicized article in Kaiser Health News on young women who were prescribed the drug for precocious puberty suffering various bone health problems in their late teens and early twenties, the trans movement ignored this. The Pediatric Endocrine Society, which had arch gender priest (and paid AbbVie consultant) Stephen Rosenthal as president at the time, made a media release regarding the FDA investigation following the Kaiser Health News report, declaring that the Pediatric Endocrine Society did not foresee any changes to its prescribing practices.

“On 2/9/17, we issued the following statement: “At this time, we are not aware of any new documented safety concerns with this class of drugs that should change prescribing practices or warrant discontinuation of these medications.”

Since that time, members of our committee, with the assistance of other PES members, have investigated these safety issues further. We have conducted a literature search and contacted the manufacturers of GnRH agonists in the U.S. and pediatric endocrinology colleagues in the US, UK, EU and South America to inquire about any new safety issues. These queries have identified no safety concerns that are not currently reflected in the product labels.

After further review of available information, we do not feel that there is any new safety concern with GnRH agonists that should change our prescribing practices at this time. As always, for any of the medications prescribed by pediatric endocrinologists, we encourage our colleagues to report to the FDA any unexpected adverse events that may be related to use of these medications. In aggregate, these reports serve as a key source of information for FDA inquiries and are critical to identify post-marketing safety issues.

Notably, a past president of the PES, and its current treasurer, Peter A. Lee, ran a 2014 study with AbbVie on Lupron’s use in girls with precocious puberty.

The study tracked girls who used Lupron for six months to treat precocious puberty found it had an ‘acceptable safety profile’. The study did not measure anything to do with the bones of its participants. Notably, it was also funded by AbbVie.

AbbVie Inc participated in the study design, research, data collection, analysis and interpretation, and writing, reviewing, and approval of this publication. All authors had access to the data and participated in the development, review, and approval, and in the decision to submit this for publication.

Disclosure Summary: P.A.L. is on the board of the Pediatric Endocrine Society, is a consultant for and has received payment for the development of educational materials by AbbVie, and consults for and has received clinical research support from NovoNordisk. K.K. is a consultant for Endo Pharmaceuticals and AbbVie, has received grants from Pfizer and AbbVie, has been paid for participating in speaker’s bureaus and educational presentations for AbbVie, and has had travel/accommodations paid for by AbbVie and Endo Pharmaceuticals. N.M. has been a consultant for Ipsen and ViroPharma, and has received grants from AbbVie. T.L.-V. and P.B. are employed by and own stock or options in AbbVie.

How unbiased is that media release, PES? Because I do smell a rat.

Worse: the science disagrees with that study and that press release. Numerous studies have reported bone density problems after the use of Lupron, like this one which found that 56.5% of it’s patients had osteopenia and had significantly lower Vitamin D levels than a control group.

It’s not the only study reporting young women having bone density issues after using it to block puberty. Other studies, like Spontaneous reversibility of bone loss induced by gonadotropin releasing hormone analog treatment have found similar side effects, examining a group of young women using the drug to treat endometriosis, and who used the drug for six months, which found that after six months of GnRHa treatment, lumbar bone mineral density decreased significantly after using the drug for more than six months. This study however reported that many of the women recovered after use. However, the drug was only used for six months — what about the years that the drug is used to block puberty for transgender children? The study concludes disturbingly with this:

“This study does not exclude the possibility that treatment of women who have not yet achieved peak bone mass may compromise bone mineral density.”

Adolescents have not achieved peak bone mass, which on average isn’t attained until one’s early twenties. The authors of this study concede they have no idea on the effects that use of the drug may have on the bone density of children.

There are also the potential effects on cognitive performance. One study on women taking GnRHa’s to treat endometriosis found that many of them suffered memory disruption while taking the drug, which was taken over twenty-four weeks. Nearly half of the women reported moderate to marked impairment compared to ‘community norms’ while taking the drug. The memory problems resolved after discontinuing use of the drug. That was when used for six months — what happens if you use the drug for years on end as an adolescent? After all, at least one study found that use of GnRHas in children going through early puberty (i.e used to block puberty) suffered an average seven to eight point drop in IQ while using the drug.

None of this is specifically about transgender youth. Thankfully, Johanna Olson-Kennedy, a paid AbbVie advisory board member, has also recently completed a study, ‘Physiologic Response to Gender-Affirming Hormones Among Transgender Youth’. This study had 101 initial participants, of whom 59 had follow-up physiologic data collected between 21 and 31 months after initiating hormones. Nearly half the study’s participants dropped out. The study, in it’s abstract states that ‘extensive and frequent laboratory examination in transgender adolescents may be unnecessary’, based on its conclusions.

Of course, there’s a caveat to that — the study admits itonly can say that use of cross-sex hormones in transgender youth is safe over a ‘treatment course of approximately two years’.

But what about after three years of treatment? Four? Fifty? No one prescribing these drugs to children has any idea of what the long-term effects are. I’ll quote from the study here, to illustrate the sheer level of quackery we’re dealing with:

“Over the past seven years, there has been a significant increase in the number of youth presenting for care related to gender dysphoria in gender-specific clinics, and in primary care settings [1, 2, 3]. Gender dysphoria is widely understood as the persistent distress that arises as the result of an incongruence between one’s assigned sex at birth (male or female) and one’s experienced gender (male, female, both, or neither).

The study uses the risk of suicide to convince the reader that this is a needed treatment. Emotional abuse in a scientific article.

Interestingly enough, Olson-Kennedy also says that polycystic ovary syndrome is associated with female-to-male transsexualism. We decided to hunt down the study Olson cited on that factoid.

That study, “Association between polycystic ovary syndrome and female-to-male transsexuality”was done in Japan and examined 69 participants who presented themselves to a Japanese gender clinic. None of them had received any hormone treatment. Most of the patients they saw had a ‘polycystic ovarian morphology’. How many in this study were diagnosed with it?

“On the basis of the Rotterdam 2003 criteria, 40 of the 69 FTM transsexual patients (58.0%) participating in this study were diagnosed as having PCOS.

58%. Fifty-eight per cent.

Want to know the normal incidence rate of polycystic ovary syndrome? Of course, you do. It’s 4–12%.

How does that not establish a causal link between FTM transsexualism and polycystic ovary syndrome? Why not treat the PCOS first, rather than making it worse with a hormone therapy that increases insulin resistance? Could gender dysphoria in these patients simply be a psychological result from PCOS? Why treat the GD instead of the PCOS? If you treated the PCOS, would the GD resolve? Who knows?

Many FTM patients in the clinic, even without PCOS, had showed high insulin resistance. The study also comments that hormone therapy eventually makes ovaries polycystic regardless of whether the patient initially presented with PCOS or not.

In adult humans, hypersecretion of androgens causes the ovary to have a polycystic appearance; moreover, it is known that ovaries removed from FTM transsexual patients after long-term androgen therapy are histopathologically polycystic. These findings thus suggest that FTM transsexualism is frequently associated with PCOS.

And while Olson-Kennedy cited this study and said that FTM hormone therapy is ‘safe’, these scientists disagree:

“Administration of exogenous androgen, the treatment of choice for FTM transsexual patients, causes insulin resistance. Given that insulin resistance is closely related to type 2 diabetes, hypertension, dyslipidacmia and cardiovascular disease, complications associated with PCOS would be expected to represent a significant health risk for FTM transsexual cases.”

The study concludes thus:

“Our findings show that many cases of FTM transsexuality are associated with PCOS and hyperandrogenaemia, which suggests that they are important factors in the pathogenesis of FTM transsexualism. In addition, our findings also suggest that when administering androgen therapy to FTM transsexual patients, it is important that practitioners keep in mind that this treatment worsens insulin resistance.

That doesn’t sound safe.

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There are very few studies on possible long-term effects. We found a 2015 study, “Bone Mass in Young Adulthood Following Gonadotropin-Releasing Hormone Analog Treatment and Cross-Sex Hormone Treatment in Adolescents With Gender Dysphoria”, which followed 34 subjects, both transmen, and transwomen, in a longitudinal study. This study used triptorelin, rather than Lupron, like the original Dutch Protocol study. The subjects were also followed up on after they had a gonadectomy (i.e castration).

The study found this:

Between the start of GnRHa and age 22 years the lumbar areal BMD z score (for natal sex) in transwomen decreased significantly from −0.8 to −1.4 and in transmen there was a trend for decrease from 0.2 to −0.3. This suggests that the BMD was below their pretreatment potential and either attainment of peak bone mass has been delayed or peak bone mass itself is attenuated.”

There are long-term side effects — trans youth possibly don’t attain their actual peak bone mass due to the treatment, meaning they are vulnerable to bone issues later in life, or even during their youth. In this study, GnRHa therapy on its subjects had a duration ranging from half a year to nearly four years, and most of them had been on cross sex hormones for five years or more. How bad was that decrease in bone mineral density?

According to the World Health Organization classification, both groups had individuals that would classify as osteopenic according to their T-score (6).

That’s not great. Actually, that’s really bad.

The researchers also have no real idea of the long-term effects:

“The relevance of these findings with respect to fracture risk is not clear. At present, as for transgender populations who had sex reassignment as adults (16), in adolescents with GD it is unknown whether medical intervention leads to an increased risk of fractures later in life.”

We have no idea what this means for their future.

We don’t know what the long-term effects are in adults, either. There is this review of hormone therapy in transgender adults “Hormone therapy in transgender adults is safe with provider supervision; A review of hormone therapy sequelae for transgender individuals”.

Of course, it uses the words ‘we don’t know the long-term effects’.

“The primary concern among MTF individuals on estrogen therapy is the possibility of developing thrombogenic complications 2, 3, 4, 5, 6, 7. Therefore, educating MTF individuals and their providers for preventative ways to minimize risk of thromboembolic events might be the most important long-term assessment of transgender women in order to minimize the risk of adverse effects of HT. Suggested risk modifications from groups studying VTE among MTF individuals include addressing any hypercholesterolemia, hypertension or smoking use that a patient might have. Hypercoaguable risk factors, including the use of a thrombogenic estrogen, ethinyl estradiol, have been associated with many of the cases of reported VTE, and as such the risk of these adverse events may continue to decline as the usage of this drug diminishes [3]. Other health outcomes for transgender women may include increased triglycerides [48] and decreased sexual desire [65].”

“There are multiple case reports of conditions associated with MTF HT, including the incidence of meningiomas, benign pituitary tumors and prolactinomasalong with the occurrence of autoimmune conditions with a female predominance, such as systemic lupus erythematosus. However, the data are too limited to make any type of conclusion or recommendation.

What about in female-to-male hormone therapy?

Transgender men did not experience the increase in thrombogenic complications that some transgender women reported.

Both transgender men and women experienced an increase in insulin resistance, fasting glucose and changes in body fat redistribution. Adipocyte-derived hormone levels may reflect changes in insulin sensitivity on hormone therapy, as transgender men had decreased adiponectin levels while transgender women had decreased leptin, both associated with insulin resistance

Eventually, the scientists give up and admit: ‘we don’t know the long-term effects’.

“With the exception of a few large-cohort and long-term studies, much of the existing knowledge about the health impact of transgender HT is based on case reports. While these provide clues to effects of transgender HT, there is a strong need for future research of greater cohort size to be undertaken in order to address this critical gap.”

I really hope we do address this critical gap, before it’s too late for some people. Because it’s pretty clear that no one has any idea on the long-term effects of the new conversion therapy.