...I could have told you that ๐คท
Source: https://x.com/BriannaWu/status/1984574165643403370
Not my usual kind of source (Xitter), but I want any centrists out there who ask trans people to "just get along" / compromise with actual hate groups that want them eradicated to know that it doesn't work.
There is no such thing as a reasonable bigot, by definition.
Me over here with actually somewhat radical positions.
All HRT should be available OTC. (Yes, including T.)
A parent denying a child access to puberty blockers should be required to pay reparations if the child continues to identify as trans into adulthood.
Require unisex bathrooms for any business larger than a bananna stand.
I'm going to push back on OTC HRT because of the health risks. Supraphysiologic estrogen and testosterone can both have lethal side effects, so correct dosing and monitoring for health complications are essential components of trans healthcare.
Both are already OTC in most of the world, specifically most developing countries.
More importantly, you are applying an insane and bad-faith standard when assessing medication. ANY medication can have lethal side effects. Down a bottle full of Tylenol and you'll condemn yourself to a slow agonizing death of liver failure. Yet you can buy that shit at gas stations.
You answered the wrong question. You asked, "can HRT be dangerous?" Any rational person trying to form an unbiased opinion about it would ask, "is HRT of comparable risk to existing OTC medications?"
In countries besides America, Tylenol comes in blister packs of maybe 20 total pills per package in a lower dose than the American variation. The drug and marketing regulations here are not a good example and I think a lot of medications that are currently OTC need to be much more closely regulated or have things like the inconvenient packaging and MUCH better warnings on them for patient safety.
That being said, poorly managed (or un-managed) HRT has more potential for significant harm than most OTC medications. There are many complications that can come from exogenous hormone treatment for both trans and cis patients, and the risks need to be adequately assessed and managed. Estrogen significantly increases the risk of blood clots and strokes, and Testosterone drastically increases the risk of heart attack and organ failure if not dosed appropriately.
In no way do I intend to restrict trans healthcare, but most medications on the market in America need to be much more closely regulated than they are now because of the risks of harms that can vastly outweigh the benefits, especially when not dosed or monitored accurately.
You're spreading anti trans FUD. The risks are extremely modest. The risks you cite, like heart attack risk on T, are just from moving an FTM person from a female to make heart attack profile. Men have a greater risk of heart attack than women do. Having a male hormone profile gives you male health risks. But people like you like to spread fear by citing this as an effect of HRT.
You're portraying hrt as this crazy substance, but we're talking bioidentical hormones here. They are the same exact molecules that are produced naturally.
You are shamelessly spreading anti trans propaganda. Or take estrogen for example. Trans women raise their E levels to the 100-300 range, the normal female E range. Yet cis women, when pregnant, experience E levels 10-20 times those levels. The human body can handle very high levels of estrogen quite well. You can take 10x the recommended E dose and still be extremely unlikely to have any adverse effects from it.
Show me one single person that has died from the misuse of modern bioidentical hormones. Find me one. Because hrt is absolutely far safer than almost every otc medication out there. You can literally take 10x the recommended doses. That's how safe it is. It's safe because we're talking the exact same molecules that are made by the body.
There's a reason diy is so common among the trans community. Even most doctors are comically ignorant and repeat long disproven myths like the ones you repeat here.
HRT is extremely safe when dosed appropriately. As I said in another comment, I'm less worried about trans folks getting the HRT wrong than cis people taking a bunch of extra hormones because some influencer convinced them that more estrogen or more testosterone will fix all their health problems. Making something OTC makes it available to everyone, not just the people that need it. Trans people need HRT, cis people very rarely do.
And yet, other countries where HRT is OTC don't have an epidemic of cis kids dead from taking T and E. Your concern is purely hypothetical. Meanwhile we have real world data showing the risks of OTC HRT are minimal. And even cis people taking it have very low risks, comparable to other otc medications.
Social media leads people to do all sorts of stupid things. We don't ban bleach because someone might try and drink it to cure covid.
It isn't the cis kids I worry about. It's the menopausal woman in the emergency department with a DVT and PE from the estrogen she got online on the advice of her chiropractor. It's the man in his 50's that thought testosterone would fix his lost libido and fatigue that now has to get coronary artery stents because he got his dosing recommendations from body building influencers.
It's the real patients I have seen and treated that concern me when these hormones aren't even that freely available. It's not a hypothetical for me, it's real people that have suffered real harm even if they didn't die from it.
You can get lethal effects from nicotine, alcohol, bleach, ammonia, and many, many combinations of chemicals that are available with, at most, age verification.
I'm all for people educating themselves as much as they want, from whatever sources they trust, but bodily autonomy DEMANDS someone be able to direct their own medication, including gender affirming medication. Doctor-as-gatekeeper is, IMO, not as good a model as Doctor-as-confidant-and-educator.
As a soon-to-be physician that has sought training in trans healthcare, I do not see my role as gatekeeper, but the role of educator includes teaching about and monitoring for the risks and complications that can come from HRT. Estrogen and Testosterone are both powerful and potentially dangerous hormones and I do not want to see my trans patients dying from strokes or heart attacks that could have been prevented with more careful dosing of their HRT.
No one imagines they are the bad guy. But, if a patient asks for a drug and you deny it to them, you are being a gatekeeper. I imagine you are only doing this for "good reasons", but you are still violating their bodily autonomy.
To be clear: I am not saying this about HRT specifically because, most of the time, HRT is safe when dosed appropriately.
That being said, if I think a medication is going to be dangerous, harmful, or lethal to a patient and I prescribe it anyways, I am legally and morally liable for any harm that comes to them from that medication. I have had conversations with patients about weight loss drugs that they really want, but that would be extremely dangerous based on other comorbid conditions like heart problems or pancreas issues. If a patient asks me for something that I think is unsafe, I engage them in a discussion about why they want that medication, the risks and benefits of it, and possible alternatives that could be safer. If a patient is dead-set on getting a medication that is very likely to harm them, I'm not going to write that prescription because if the worst happened, their blood is on my hands.
It is very uncommon that physicians refuse to prescribe something that a patient is asking for specifically. The much more common situation ends up being that the physician can write the prescription, but insurance won't pay for it. There are obviously some physicians out there that refuse to prescribe things like birth control based on their personal beliefs, but they are obligated to refer that patient to a provider that will give them the prescription.
Then, you don't value bodily autonomy as much as I do, and will deny it to some of your patients, gatekeeping -- no matter what you "think" you are doing.
Does my ethical autonomy count for nothing? Am I really obligated under your worldview to harm my patients by acquiescing to their demands carte blanche?
Even as a medical student, I have had patients die in my care from things I couldn't do anything about. I had no way to save them because the medicine to fix the problem simply does not exist. As an ER tech, I have had multiple times where the physician running the code called the time of death while I was the one doing compressions on the patient. Most of those were children. I am already haunted by the patients I have lost through no malpractice, negligence, incompetence, or malice of my own. I refuse to intentionally add to my nightmares by doing something that I truly believe would harm my patient, even if it is what they are asking for.
In my worldview, the drugs would not have a gatekeeper. They would in available OTC. You should not have your "ethical autonomy" compromised at all. (And yes, it does count for nothing compared to bodily autonomy.)
If your reason (for not providing the drugs) was only protecting yourself or others from State-backed violence, it could be justified. But, you claimed you would do it because you know better how to manage a patient's body than themselves.
DIY saved my life. I purchased bloodtests and monitored my own treatment. But it would have been a lot safer had I not needed to order estrogen online from a foreign supplier.
I am very glad that you were able to get your own care and didn't have any bad outcomes. On the other hand, I've had cis-female patients go to naturopaths or chiropractors to get estrogen and/or testosterone pellets for peri-menopause symptoms and they had no idea what the risks were. In the emergency department, I've had cis-female patients on estrogen replacement therapy that was not well managed show up with DVTs. Cis-male patients on supraphysiologic testosterone are at risk for several different kinds of organ failure along with a drastically increased risk of heart attacks.
I don't think that trans patients are terribly likely to harm themselves with DIY HRT, but having hormones available OTC is going to lead to a lot of cis people getting sick or getting killed by taking extra hormones to try to fix their problems because scammers and quacks have convinced them that hormones will magically fix all of their problems.
I don't believe parents should be able to make any permanent decisions about a child's body.
This includes hormones, tattoos, genital mutilation of any kind, plastic surgery, piercings.
Children cannot provide consent for anything.
You're right - which is why puberty blockers should be required by law for all children until they're 18 and can decide for themselves which puberty is right for them.
I agree parents should not force kids to have piercings. However trans health is a healthcare issue, like other health conditions. There is a problem that is causing suffering. In healthcare, we typically rely on parents as guardians to give legal consent, but kids also have to give their "assent" which carries crucial moral weight in the situation. While kids might not have the capacity to give fully informed consent, they can give assent based on their best understanding.
We apply this to things like cancer treatment, corrective plastic surgery, counselling, and mental health medication for kids. Some of these can be even more permanent and life-altering than hormone blockers for kids (we don't allow bottom surgery for kids).
This is why transcare, like most healthcare for kids, should involve a team of healthcare professionals, guardians, and crucially the child themselves in patient-centered decision-making.
Do bad decisions happen? Yes. Are there misguided professionals, guardians, and kid patients? Yes. But this kind of care as standard is far better than parents deciding, or kids being left alone to figure it out themselves, or worse, policy-makers, who don't give a shit about evidence-based healthcare, deciding no trans kids get care. That's right, banning transcare is also making a decision for people with the consequence that trans kids continue to experience profound suffering without care.
Good thing puberty blockers are reversible.
But you don't actually care about that do you? You'll just move the goalposts.
Unfortunately doing nothing is still a choice. And things aren't better just because they are natural.
It is morally abominable to believe that it is better for 100 trans kids to go through the Hell on Earth of the wrong puberty than for one cis kid to mistakenly go on puberty blockers or HRT. It shows that you fundamentally believe the life of 1 cis person to be worth the lives of 100 trans people. You do not believe in the equal moral value of every human life. You fundamentally, in your heart of hearts, believe trans people to be subhuman, because you do not place the value of their pain anywhere near that of cis people.
I think that ratio is an important one in this debate. Is it actually around 1% (of those reporting dysphoria ) that decide it was a mistake post puberty?
Also sorry if dysphoria is the wrong word.
HRT has a success rate over 90%, measured as more than 90% of people who go on HRT report an improvement in their quality of life compared to before HRT. Of that other roughly 10%, the majority report reasons outside of regret for stopping HRT. Things like: medical complications, financial reasons, loss of jobs or housing due to being visibly trans, loss of friends and family due to being trans, assault or rape, etc., and most report that they would start HRT again as soon as possible. Only a small portion of that 10% say that they regret taking HRT and that it was a mistake.
So is it literally 1%? I don't know, but it's certainly less than 10%, which gives HRT one of the highest success rates in the field of medicine. By comparison, antidepressants have a success rate somewhere around 36% and knee replacement surgery hovers a little over 50%.
The biggest regrets reported by those who take HRT are that they didn't start sooner, and/or being forced through an unwanted puberty with permanent life-altering effects as a child - which is why puberty blockers are a critical component of trans healthcare. Puberty blockers have been in use for young girls since the 80s for what's known as "precocious puberty" - when a girl starts puberty at a very young age, usually around 8 but can be as young as 4. Nobody cared when it was cis girls taking them so that they would start puberty at a normal age. But when trans people started taking them to avoid permanent, life-altering changes until they're old enough to consent to whether or not they want to go on HRT, puberty blockers suddenly became this untested drug being forced upon young boys by nefarious outside forces in the public eye.
Do you feel the same about all life saving medicine as you do about trans health care?
Sorry kid, we can't remove your appendix. Kids can't give consent and I can't give it as your parent. So, I guess you'll die.
Children don't consent to being brought into existence and yet we constantly do so. They can't consent, as one reply pointed out, to medical care either.
Children can't consent to being refused anything that they ask for either.
And even if the denial is on the basis of "their own good" they'll grow to rightfully resent being denied things if it has a significant impact on them into adulthood and rightfully fucking hate their parents for it. Gender transitioning is one such thing.
Children are not ours to own and control and we owe them for dragging them into existence to critically think about their long term well being not just blindly applying some truism to every decision you make about their lives under your care.