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azeene · 1 year

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✨✨✨ - - - - - #lounge #loungeunderwear #mondays #unfold #unfoldapp #mightdelete #selfie #discoverunder5k #microblog #azeene #purple #loungelingerie #discoverunder100k #ootd #ootdshare https://www.instagram.com/p/Ck71KWGo0x8/?igshid=NGJjMDIxMWI=

#lounge #loungeunderwear #mondays #unfold #unfoldapp #mightdelete #selfie #discoverunder5k #microblog #azeene #purple #loungelingerie #discoverunder100k #ootd #ootdshare

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bitterkarella · 8 months

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Midnight Pals: The Fourth Estate

[mysterious circle of robed figures] JK Rowling: hello children Rowling: today we retire jesssse ssssingal Jesse Singal: but mommy! Rowling: he is a ssspent force Rowling no one can take him ssseriousssly anymore Singal: but mommy--!

Singal: mommy no! I'm still relevant! give me another chance mommy! Rowling: you've had your moment jesssse Rowling: but the transsss know your game now and now they won't talk to you Rowling: plusss all thossse sssibilantsss in your name are jussst really hard to pronounce

Rowling: tonight i pressent to you Rowling: the NEW jessse ssingal Rowling: fassster, ssstronger, more efficient Rowling: over TWICE the concern trolling capabilitiess Rowling: i call her Rowling: Azeen Ghorayshi All: [polite clapping]

Azeen Ghorayshi: so i know that jamie reed was exposed as a lying crank months ago Ghorayshi: but what my article supposes is Ghorayshi: what if she wasn't?

Ghorayshi: listen, i'm a journalist Ghorayshi: i follow the story wherever it goes Ghorayshi: and if the story turns out to be that Jamie Reed is a weirdo loon, then I guess I just have to write a story about how she's got valid concerns Ghorayshi: that's the 4th estate, baby

Ghorayshi: listen, if i have to betray the trust of 100 vulnerable families to launder the reputation of one lying crank Ghorayshi: i mean, that's just my duty as a journalist Ghorayshi: also why does everyone keep sending me that one onion article

Ghorayshi: And that's how I became your humble narrator Ghorayshi: To be living so easy and free Ghorayshi: Expect you think that I should be haunted Ghorayshi: But it never really bothers me

Singal: ooo you think you're so great!! i was here first Ghorayshi: get lost kid you're yesterday's news Ghorayshi: now if you'll excuse me Ghorayshi: some of us crackerjack newshounds have trans youth to endanger

Singal: [looking under a rock] hello? hello? Singal: are there any trans youth down there who will still talk to me Singal: p-please Singal: i need the appearance of balance!! Singal: anyone?

#midnight pals #the midnight society #midnight society #jk rowling #jesse singal #azeen ghorayshi

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maaarine · 4 months

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Scientists Pinpoint Cause of Severe Morning Sickness (Azeen Ghorayshi, The New York Times, Dec 13 2023)

"More than two-thirds of pregnant women experience nausea and vomiting during the first trimester.

And roughly 2 percent of women are hospitalized for a condition called hyperemesis gravidarum, which causes relentless vomiting and nausea throughout the entire pregnancy.

The condition can lead to malnutrition, weight loss and dehydration.

It also increases the risk of preterm birth, pre-eclampsia and blood clots, threatening the life of the mother and the fetus.

Perhaps because nausea and vomiting are so common in pregnancy, doctors often overlook hyperemesis, dismissing its severe symptoms as psychological, even though it is the leading cause of hospitalization during early pregnancy, experts said.

Although celebrities like Kate Middleton and Amy Schumer have raised the condition’s profile in recent years by sharing their experiences, it remains understudied.

“I’ve been working on this for 20 years and yet there are still reports of women dying from this and women being mistreated,” said Dr. Marlena Fejzo, a geneticist at the University of Southern California Keck School of Medicine and a co-author of the new study.

She knows the pain of the condition firsthand.

During her second pregnancy, in 1999, Dr. Fejzo was unable to eat or drink without vomiting.

She rapidly lost weight, becoming too weak to stand or walk.

Her doctor was dismissive, suggesting she was exaggerating her symptoms to get attention.

She was eventually hospitalized, and miscarried at 15 weeks. (…)

The researchers found that women experiencing hyperemesis had significantly higher GDF15 levels during pregnancy than did those who had no symptoms.

But the hormone’s effect seems to depend on the woman’s sensitivity and exposure to the hormone before pregnancy.

The researchers found, for example, that women in Sri Lanka with a rare blood disorder causing chronically high levels of GDF15 rarely experienced nausea or vomiting in pregnancy.

“It completely obliterated all the nausea. They pretty much have next to zero symptoms in their pregnancies,” said Dr. Stephen O’Rahilly, an endocrinologist at Cambridge who led the research.

Dr. O’Rahilly hypothesized that prolonged exposure to GDF15 before pregnancy could have a protective effect, making women less sensitive to the sharp surge in the hormone caused by the developing fetus. (…)

The new study is powerful because it offers genetic proof of a causal relationship between GDF15 and the disease, said Dr. Rachel Freathy, who is a geneticist at the University of Exeter and was not involved in the study.

That will help the condition gain greater recognition, she said.

“There is kind of an assumption made by many people that women should just be able to cope with this,” Dr. Freathy said.

With this biological explanation, she said, “there will be more belief that this is a real thing rather than something in somebody’s head.”"

#article #weaker sex #health

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his-heart-hymns · 4 months

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Mun tu shudam tu mun shudi

mun tu shudam tu jaan shudi

Taakas na guyad baad azeen

mun deegaram tu deegri

I have become you, and you me,

I am the body, you soul;

So that no one can say hereafter,

That you are someone, and me someone else.

-Ameer Khusrau,Sufi saint

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maihonhassan · 3 months

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Mun tu shudam tu mun shudi,

Mun tun shudam tu jaan shudi.

Taakas na goyad baad azeen.

Mun deegaram tu deegari.

“I have become you, and you me ‏i am the body, you soul ‏so that no one can say hereafter ‏that you are someone, and me someone else.”

— Hazrat Amir Khusro

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vague-humanoid · 8 months

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probablyasocialecologist · 8 months

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The New York Times has taken a lot of heat recently for its coverage of transgender issues. More than 370 current and former Times contributors signed an open letter detailing how the Times has covered trans issues with “an eerily familiar mix of pseudoscience and euphemistic, charged language.” The contributors emphasized the Times’ coverage of adolescent gender-affirming care, and detailed how its articles are being cited in court by states seeking to ban these treatments. Though the Times’ immediate response was underwhelming, critics had hoped that the paper might take their criticisms to heart in future coverage. That hope was dashed when the Times doubled down with a nearly 6,000-word story about the unsubstantiated claims made by former Washington University in St. Louis gender clinic employee Jamie Reed. The piece by Azeen Ghorayshi, headlined “How a Small Gender Clinic Landed in a Political Storm” (8/23/23), serves as a greatest-hits album of all of the Times’ problematic coverage on adolescent gender-affirming care, filled with familiar tropes and tactics the paper of record has used to distort the issue.

#new york times #transgender #lgbt #puberty blockers #detransition

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desiblr-gapshap · 11 months

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Man tu shudam, tu man shudi

(I have become you, you have become me)

Man tan shudan, tu jaan shudi

(I have become the body, you have become the soul)

Takas na goyad baad azeen

(so from now on nobody can say)

Man deegaram, tu deegari

(that I am someone, you are someone else)

- Amir Khosro.

Love, pyar, mohabbat, prem, ishq, Amore... there are many words to describe only one feeling... Which connects two hearts without any visible string. Dreamy right.

What is love? How does it feel to be in love? How love shapes you as a person?

Only in two ways we can find the answers of these questions, either we fall in love or listen to someone who is in love.

They say love knows no bounds. That is indeed true, we have seen it around us.

I love how people who are in love describe their love. They connect their love with moon, stars, reason to live. People cross limits in love. love is selfless, love seeks future but does not need it. Love is devoting yourself to that one person. We write romantic poetries on their lovers, how they love or want be loved.

Biggest example for this on tumblr is @the-sound-ofrain how he moulds his feelings into words, to define his heart throbbing poem can't be called beautiful poems. His magic of words is beyond our imagination. His poems should be a considered a great example for "This is what you feel when you are in love."

Yes, you're on point... Tonight's theme is love, ishq, mohabbat, prem, pyar whatever you call it in your language, if you are in love you will see that one face only. like i saw chai and chai is-

Your habbit of including chai in every single topic is going to be your end on gapshap. *says titli while pulling chai's ear*

Okay okay I will stop now *laughs nervously*

If you all have read our previous interviews you may know that this lit interview always starts with a rapid fire round.

So here it is... Tell our audience who are in search of great blogs about you.

What your blog is about?

How did you join tumblr?

What made you create such an amazing and one of the best poety blog?

Do you like being a part of desiblr and why?

Basically kundali dena zara apne blog ki. **till then let me finish my chai because does not matter how much you love her, you won't be able to win against my love for chai ** (feeling proud)

Momo be respectful with our guest and don't speak nonsense come here with me or this will be your last interview **says titli and dragging her to the side for a lecture.**

So guys keep your eyes on tonight's star and enjoy till I survive her taunts. I will see you soon. **Chai accepting her fate and ready for lecture.**

#gapshap start🎊#interview of apollo 🎊

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azeene · 2 years

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Hey! 🤓🙋🏽‍♀️✨ - - - - - #moreprogress #progress #gym #gymmotivation #selfie #puregym #puregymsunderland #nikepro #nikewomen #nikewoman #notsponsored #discoverunder100k #discoverunder #microblog #discoverunder5k #memyselfandi #azeene #unfold #unfoldapp #primark #feltcute (at PureGym Sunderland) https://www.instagram.com/p/CkOZlrrIUBF/?igshid=NGJjMDIxMWI=

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bumblee-stumblee · 2 years

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kIds ArEnT gEtTiNg SuRgErY! yOuR'e FeAr MoNgErInG.

If you're able to, please read the Twitter thread.(Jesse's)

>the article is paywalled

More Trans Teens Are Choosing ‘Top Surgery’

Small studies suggest that breast removal surgery improves transgender teenagers’ well-being, but data is sparse. Some state leaders oppose such procedures for minors.

Dr. Sidhbh Gallagher’s unusual embrace of social media platforms like TikTok has made her one of the most visible surgeons in her field.

Azeen Ghorayshi

By Azeen Ghorayshi

Sept. 26, 2022

Updated 8:36 p.m. ET

Michael, 17, arrived in the sleek white waiting room of his plastic surgeon’s office in Miami for a moment he had long anticipated: removing the bandages to see his newly flat chest.

After years of squeezing into compression undershirts to conceal his breasts, the teenager was overcome with relief that morning last December. Wearing an unbuttoned shirt, he posed for photos with his mother and the surgeon, Dr. Sidhbh Gallagher, happy to share his bare chest with the doctor’s large following on social media.

“It just felt right — like I’d never had breasts in the first place,” Michael said. “It was a ‘Yes, finally’ kind of moment.”

Michael is part of a very small but growing group of transgender adolescents who have had top surgery, or breast removal, to better align their bodies with their experience of gender. Most of these teenagers have also taken testosterone and changed their name, pronouns or clothing style.

Few groups of young people have received as much attention. Republican elected officials across the United States are seeking to ban all so-called gender-affirming care for minors, turning an intensely personal medical decision into a political maelstrom with significant consequences for transgender adolescents and their families.

Gender-related surgeries, in particular, have been thrust into the spotlight. Arizona and Alabama passed laws this year making it illegal for doctors to perform gender-related surgeries on transgender patients under 18. Conservative commentators with large followings on social media have recently targeted children’s hospitals that offer gender surgeries, leading to online harassment and bomb threats.

Genital surgeries in adolescents are exceedingly rare, surgeons said, but top surgeries are becoming more common. And while major medical groups have condemned the bans on gender-related care for adolescents, the surgeries have presented challenges for them.

Michael is part of a very small but growing group of transgender adolescents who have had top surgery to better align their bodies with their experience of gender.Credit...Eva Marie Uzcategui for The New York Times

Much research has shown that as adults, transgender men generally benefit from top surgery: It relieves body-related distress, increases sexual satisfaction and improves overall quality of life. A few small studies of transgender adolescents suggest similar benefits in the short term.

But some clinicians have pointed to the rising demand and the turmoil of adolescent development as reasons for doctors to slow down before offering irreversible procedures. Although medical experts believe the likelihood to be small, some patients come to regret their surgeries.

The World Professional Association for Transgender Health, an international group of gender experts who write best practices for the field, had been planning for months to set new age minimums for most gender-related surgeries, including endorsing top surgery for adolescents age 15 and up. Although the guidelines are not binding, they provide a standard for doctors across the world. But this month, the group abruptly withdrew the proposals, a shift reflecting both political pressures and a lack of consensus in the medical community.

There are no official statistics on how many minors receive top surgeries each year in the United States. The New York Times surveyed leading pediatric gender clinics across the country: Eleven clinics said they carried out a total of 203 procedures on minors in 2021, and many reported long waiting lists. Another nine clinics declined to respond, and six said that they referred patients to surgeons in private practice.

Dr. Gallagher, whose unusual embrace of platforms like TikTok has made her one of the most visible gender-affirming surgeons in the country, said she performed 13 top surgeries on minors last year, up from a handful a few years ago. One hospital, Kaiser Permanente Oakland, carried out 70 top surgeries in 2019 on teenagers age 13 to 18, up from five in 2013, according to researchers who led a recent study.

“I can’t honestly think of another field where the volume has exploded like that,” said Dr. Karen Yokoo, a retired plastic surgeon at the hospital.

Experts said that adolescent top surgeries were less frequent than cosmetic breast procedures performed on teenagers who were not transgender. Around 3,200 girls age 13 to 19 received cosmetic breast implants in 2020, according to surveys of members of the American Society of Plastic Surgeons, and another 4,700 teenagers had breast reductions.

An evolving field

Dr. Gallagher’s office in Miami.Credit...Eva Marie Uzcategui for The New York Times

In the past decade, the number of people who identify as transgender has grown significantly, especially among young Americans. Around 700,000 people under 25 identified as transgender in 2020, according to the Williams Institute, a research center at the University of California, Los Angeles, nearly double the estimate in 2017.

On Being Transgender in America

In Montana: Transgender people born in the state will no longer be able to change the sex listed on their birth certificate under a new rule that is among the most restrictive in the country.

Generational Shift: The number of young people who identify as transgender in the United States has nearly doubled in recent years, according to a new report.

The Battle Over Gender Therapy: More teenagers than ever are seeking transitions, but the medical community is deeply divided about why — and what to do to help them.

Elite Sports: Although the number of top transgender athletes is small, the disagreements are profound, cutting to the core of the debate around gender identity and biological sex.

Gender clinics in Western Europe, Canada and the United States have reported that a majority of their adolescent patients were seeking to transition from female to male.

Because breasts are highly visible, they can make transitioning difficult and cause intense distress for these teenagers, fueling the demand for top surgeries. Small studies have shown that many transgender adolescents report significant discomfort related to their breasts, including difficulty showering, sleeping and dating. As the population of these adolescents has grown, top surgery has been offered at younger ages.

Another notable change: More nonbinary teenagers are seeking top surgeries, said Dr. Angela Goepferd, the medical director of the Gender Health Program at the Children’s Minnesota hospital, who is nonbinary. (The program does not perform operations but refers patients to independent surgeons.) These adolescents may want flatter chests but not other masculine features brought on by testosterone, like a deeper voice or facial hair.

After many months of deliberations over its new guidelines, the World Professional Association for Transgender Health initially decided to endorse top surgeries for adolescents 15 and up, part of a suite of changes that would have made gender treatments available to children at younger ages. But the organization backtracked this month, after some major medical groups it had hoped would support the new guidelines bristled at the new age minimums, according to Dr. Marci Bowers, a gynecologic and reconstructive surgeon and the president of WPATH, who is transgender.

“We needed consensus,” Dr. Bowers said. “I just think we need more strength for our argument and a better political climate, frankly, in order to propose this at a younger age.”

Instead, the guidelines kept the previous recommendations, published a decade ago, allowing surgeries for minors on a case-by-case basis.

Because teenagers in most states must be 18 before they can provide medical consent, surgeons require parental consent and approval letters from mental health care providers. The two- to four-hour procedure costs anywhere from $9,000 to $17,000, depending on facility and anesthesia fees. The procedure is often not covered by insurance until patients turn 18.

As demand has grown, Dr. Gallagher, the surgeon in Miami, has built a thriving top surgery specialty. The doctor frequently posts photos, FAQs and memes on Facebook, Instagram and TikTok, proudly flouting professional mores in favor of connecting with hundreds of thousands of followers.

Her feeds often fill with photos tagged #NipRevealFriday, highlighting patients like Michael whose bandages were just removed. On her office windowsill sits a framed nameplate with one of her best-known catchphrases on TikTok: “Yeet the Teet,” slang for removing breasts.

Dr. Gallagher said she performed top surgeries on about 40 patients a month, and roughly one or two of them are under 18. Younger patients are usually at least 15, though she has operated on one 13-year-old and one 14-year-old, she said, both of whom had extreme distress about their chests.

The surgeon said that most of her patients, teenagers and adults alike, found her on TikTok. Her online presence has drawn sharp criticism from right-wing media, as well as from some parents and doctors who say she uses the platform to market to children.

“She goes to the beat of her own drum,” Dr. Bowers said. “For a lot of us, that’s troubling.”

Dr. Gallagher said she doubted she had the influence her critics ascribe to her. “Most of the time I’m just trying to deliver educational content,” she said.

‘Comfortable in my own skin’

Michael and his mother, Annie. He learned more about top surgery through Dr. Gallagher’s TikTok page.Credit...Eva Marie Uzcategui for The New York Times

When Michael first saw Dr. Gallagher’s TikTok page last summer, he was immediately intrigued. (Michael and others in this article asked to be identified by first or middle names because they were concerned about their privacy.) He liked the photos of her patients, observing that their scars had healed well, and liked that she seemed to be an ally of the transgender community.

Michael’s mother, Annie, had gradually come around to the idea of surgery after years of watching him suffer, she said.

Since hitting puberty at age 10, Michael said he felt a gnawing discomfort about his breasts. By the time he was 12, he wore hooded sweatshirts every day in their Miami suburb.

In eighth grade, after he had several severe panic attacks at school, Michael said he started seeing a therapist, who encouraged him to talk about his body issues. He experimented with small ways to appear more masculine, such as tucking his long curly hair into a beanie and wearing boys’ clothes.

“It was the first thing I ever did to try and make myself more comfortable in my own skin,” Michael said.

He came out to his parents as a transgender boy when he was 14. A year later, at the start of the pandemic, he started weekly testosterone injections while doing remote school. He got into strength-training and his voice dropped, a second puberty he relished but was grateful to undergo privately.

Michael started in-person school feeling “10 times happier,” he said, but his chest still tormented him. Testosterone and exercise had shrunk his breast tissue, making it easier to conceal with a binder. But the garment could restrict his breathing and give him panic attacks. He began seeing a psychiatrist, who prescribed antidepressants.

When Michael was 17, Annie said, she decided that waiting another year for surgery would put him in too much pain. Because her insurance covered the procedure only for adults, she took out a loan to help pay for it.

Michael’s psychiatrist initially wrote a letter signing off on the surgery. But he later revoked it, putting the surgery in limbo, Annie said. After Michael started a higher dose of antidepressants, the psychiatrist endorsed the surgery as planned.

Now, nine months after the operation, Michael is in his senior year of high school. He said he is focused on the parts of his life that have little to do with his gender: doing theater tech at school, seeing friends, painting and applying to college.

He also feels less pressure to prove his masculinity than before, he said. He’s growing out his hair and uses he, she and they pronouns. In June, he took his girlfriend to the prom, wearing a brown suit and a pearl necklace.

Weighing the risks

Jamie, a college student in Maryland, began identifying as a transgender boy in the eighth grade, but has since returned to identifying as a woman. Credit...Cheriss May for The New York Times

In 2018, doctors at the pediatric gender clinic at Children’s Hospital Los Angeles published a study of 136 transgender patients ages 13 to 25, half of whom had undergone top surgery. Adolescents who had not undergone the procedure reported significantly more distress because of their chests.

Roughly one-third of those who underwent surgery reported ongoing loss of nipple sensation. Only one patient expressed occasional feelings of regret, when imagining wanting to breastfeed a future child.

“There’s very few things in the world that have a zero percent regret rate. And chest surgery, clinically, I’ve experienced that,” said Dr. Johanna Olson-Kennedy, the lead author of the study and medical director of the clinic in Los Angeles, which began offering surgeries in 2019.

But the study had caveats: Most patients were surveyed less than two years after their surgeries, and nearly 30 percent could not be contacted or declined to participate.

Few researchers have looked at so-called detransitioners, people who have discontinued or reversed gender treatments. In July, a study of 28 such adults described a wide array of experiences, with some feeling intense regret and others having a more fluid gender identity.

Because so few studies have looked at detransitioning, many doctors are asking young patients and their parents to provide consent without acknowledging the unknowns, said Kinnon MacKinnon of York University in Toronto, the researcher who led the study, who is transgender.

“I know personally many, many, many trans men that have benefited and are happy with their medical transition and their top surgery. I would put myself in that category,” Dr. MacKinnon said. “But just as a researcher, I do feel like there are questions that are deserving of answers and have implications for clinical care.”

Jamie, a 24-year-old college student in Maryland, was raised as a girl and began identifying as a transgender boy in the eighth grade. After being sexually assaulted in her junior year of high school and then dropping out, she said, she started taking testosterone. Three months later, just after she turned 18, she underwent top surgery at a private practice in Massachusetts.

For the next few years, Jamie said, she thrived. Testosterone made her feel energetic, and her anxiety dissipated. She went back to school and got certified as an emergency medical technician.

But when she was 21, her father, who was dying of Alzheimer’s, no longer recognized her. She fixated on her wide hips, which she worried stood out next to her facial hair and deep voice. After a date where she had sex with a straight man, she said, she realized she had made a mistake.

“I realized I lost something about myself that I could have loved, I could have enjoyed, I could have used to feed children,” Jamie said. She said she grieved for months and contemplated suicide.

This spring, after a year of fighting her insurance company to cover the procedure, she had surgery to reconstruct her breasts. She never told her original surgeon that she had changed her mind, partly because she also blamed herself. Sometimes, she said, “I still don’t like being a woman.”

Many surgeons say that they rarely hear about patients with regret. But it’s unclear how many, like Jamie, never inform them.

Dr. Gallagher of Miami said that she follows up with patients for up to a year. “I can say this honestly: I don’t know of a single case of regret,” Dr. Gallagher said in May, adding that regret was much more common with cosmetic procedures.

But one of her former top surgery patients, Grace Lidinsky-Smith, has been vocal about her detransition on social media and in news reports.

“I slowly came to terms with the fact that it had been a mistake born out of a mental health crisis,” Ms. Lidinsky-Smith, 28, said in an interview.

She had top surgery when she was 23. About 16 months later, Ms. Lidinsky-Smith said she called and emailed her medical providers, including Dr. Gallagher’s office, to tell them she had detransitioned.

When asked about Ms. Lidinsky-Smith’s case, Dr. Gallagher amended her stance, recalling that years ago a former patient left a voice mail message expressing regret over a surgery.

“At the time, we wondered, Is it a hoax?” Dr. Gallagher said.

Chilling effect

A clinic for transgender children in Dallas, Texas, stopped accepting new patients for hormone therapy and gender affirming care under pressure from the Gov. Greg Abbott’s office. Credit...Shelby Tauber for The New York Times

Republican politicians in states across the country are pushing to ban all gender-affirming care for adolescents, focusing much of their rhetoric on surgeries.

In Florida, where the medical board is considering such a ban for minors, Gov. Ron DeSantis has argued that surgeons should be sued for “disfiguring” children. In Texas, where parents of transgender children have been investigated for child abuse, Gov. Greg Abbott has called genital surgeries in adolescents “genital mutilation.”

Dr. Bowers, the president of WPATH, said that politicians should not be involved in personal medical decisions. “They just don’t understand this care, so they just want to shut it down,” Dr. Bowers said. “That is a very dangerous precedent.”

Although most of the new state actions against gender care for minors are tied up in litigation, they have had a chilling effect.

Earlier this year, a Dallas children’s hospital shut down the only pediatric gender clinic in Texas, citing political pressure from the governor’s office. This month, a woman was arrested on charges of making a false bomb threat to Boston Children’s Hospital after it was targeted online for its pediatric gender program. Dr. Gallagher has also received threats online and said she might hire security guards for her office.

Other clinics have dropped scheduled procedures. William, 14, who has identified as a boy since he was a young child, was supposed to see a plastic surgeon in Plano, Texas, for top surgery in May. But the surgeon canceled the appointment in March because the medical center’s malpractice insurer stopped covering top surgeries for minors.

In August, William and his family flew to California, paying $10,000 more to get the procedure out of state.

Two weeks later, William started ninth grade as just another boy in school. He looks forward to swimming with his shirt off and going to class without wearing a binder.

“It’s like something was unburied,” William said. “My chest was just covering what was always there.”

#radblr #radfem #feminist #radfems #feminism #trans #radfems please interact #gender critical #transgender #radical feminist

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religion-is-a-mental-illness · 8 months

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By: Leor Sapir

Published: Aug 25, 2023

The New York Times has published a new investigative report on the pediatric gender clinic at Washington University in St. Louis, home of case-manager-turned-whistleblower Jamie Reed. Last February, Reed alleged in The Free Press that her former clinic was harming adolescents with invasive and unnecessary treatments. “What’s happening to children,” she said, “is medically and morally appalling.”

Reed tried to raise her concerns with her superiors at Washington University but was shut down. She decided to file a sworn affidavit about the medical abuses she witnessed with the Missouri attorney general, an action that triggered a multiagency investigation that remains ongoing.

The Times’s article represents the first attempt by a major left-of-center newspaper to corroborate Reed’s claims. The author, Azeen Ghorayshi, says that “some of Ms. Reed’s claims could not be confirmed” and that “at least one of her claims included factual inaccuracies.” On the whole, however, Ghorayshi corroborates much of what Reed has said about her former clinic. Most important is the clinic’s disregard for clear “red flags.” Adolescents with serious mental health problems were prescribed puberty blockers or cross-sex hormones when they should have received mental health support.

Ghorayshi and the Times deserve credit for a well-researched article. Ghorayshi does a good job allowing different sides in the controversy to be heard. Her discussion of the medical research, though not the focus of her article, is refreshingly honest and accurate. Considering the pressure exerted on the Times and its reporters by transgender advocacy organizations like GLAAD to toe the ideological line, it takes courage to write a piece as rigorous and as thoughtful as this one.

And yet, the article has problems. Two in particular stand out. The first concerns the question of satisfaction and regret, and the second involves the role of mental-health interventions in pediatric gender medicine.

If the reader comes away from the Times piece feeling ambivalent about the St. Louis clinic, that is because Ghorayshi contrasts Reed’s allegations of wrongdoing with stories of families who say they are satisfied with the treatment their children received there. “It’s clear the St. Louis clinic benefited many adolescents,” says Ghorayshi.

But is it?

As a matter of principle, it is wrong to use satisfaction and regret as the benchmark for judging whether pediatric sex trait modification (PSTM) is a medically necessary and ethical practice. If medicine is to retain its authoritative role in human affairs, patient satisfaction alone cannot determine when interventions are medically necessary. Self-reported satisfaction is how we judge cosmetic procedures, not medically necessary ones. The role of the doctor is to heal, not please. Pleasing, though not unimportant, is secondary and subordinate to healing. Bitter pills are coated with sugar to make pleasing to patients, but it doesn’t follow that sugar is good for you or that doctors should encourage patients to eat it to their heart’s desire. Failure to distinguish the pleasant from the good can result in serious iatrogenic harm. More broadly, it can corrupt medicine and reduce it to mere consumerism.

Ghorayshi is right to take interest in the satisfaction of patients and families who attended the St. Louis clinic. But to leave it at that and to imply that patient satisfaction is a valid counterargument to Reed’s allegations is to miss the far deeper and more significant ethical issues involved. Worse, it’s to take a side in that ethical debate without presenting the competing arguments in a serious way.

I’ve written in the past about the vital importance of providing readers with context about the satisfaction/regret question, especially when it comes to how we think about the St. Louis clinic. If journalists contribute to the public’s (misguided) belief that short-term satisfaction of distressed teenagers with drugs and surgeries is ultimately what matters, they should at least mention that the validity of this framing is itself a key part, if not the heart, of the scientific and medical debate over PSTM.

Research in gender medicine has found no necessary relationship between subjective satisfaction and more objective measurements of mental health and psychosocial functioning. One of the first follow-up papers on gender medicine published by Dutch clinicians in 1988, right around the time they began experimenting with hormonal interventions in adolescents, reflected on the question of subjective versus objective measurements of improvement. The paper acknowledged “a trend” in existing research on adult transsexuals at the time: “the subjective well-being of the transsexuals has increased, whereas an ‘improvement’ in their actual life situation is not always observed.”

A 2020 study by Finnish gender clinicians in the Nordic Journal of Psychiatry did look at more objective outcome measures. To assess whether hormonal interventions are beneficial, the authors used “proxies for adolescent development” including “age-appropriate living arrangements, peer relationships, school/work participation, romantic involvement, competence in managing everyday matters and need for psychiatric treatment.” The researchers found that patients “who did well in terms of psychiatric symptoms and functioning before cross-sex hormones mainly did well during real-life. Those who had psychiatric treatment needs or problems in school, peer relationships and managing everyday matters outside of home continued to have problems during real-life.” Thus, “Medical gender reassignment is not enough to improve functioning and relieve psychiatric comorbidities among adolescents with gender dysphoria.” Presumably, most of the patients were satisfied with their treatment.

The pivot in PSTM research from objective to subjective metrics may reflect an exasperation of the field with trying to find good, causal evidence of improvement in mental health and psychosocial functioning. It may also reflect the true but rarely acknowledged purpose of sex-trait modification, which is to achieve “embodiment goals,” i.e., desired cosmetic outcomes.

Let’s assume, however, that satisfaction/regret is the appropriate benchmark for evaluating the ethics of PSTM. What does the empirical literature tell us about satisfaction and regret from hormonal or surgical interventions? “The number of people who detransition or discontinue gender treatments is not precisely known,” Ghorayshi observes. “Small studies with differing definitions and methodologies have found rates ranging from 2 to 30 percent.”

Ghorayshi is correct. Given the poor quality of research in this field, we do not currently know the true rates of satisfaction and regret among adults who transitioned as adults. Still less do we know about regret and satisfaction in those who transitioned as adolescents. Another problem with relying on satisfaction—especially when, as is often the case in this field of research, follow-up happens mere months after procedures—is that it may be confounded by placebo and Hawthorne effects. (The latter term refers to “the phenomenon where clinical trial patients’ improvements may occur because they are being observed and given special attention.”) Rigorous long-term data, which is more important than short-term data when it comes to adolescent decisions, will take at least another decade to collect and analyze.

Also missing from the Times piece is any serious treatment of the question of harms. Ghorayshi implies that detransitioners were harmed, but in her sworn affidavit Reed documents several instances of harm suffered by patients receiving gender-transitioning care that go unmentioned in the Times piece. These include a teenage girl who experienced bleeding vaginal lacerations following testosterone injections (a known side-effect) and another girl whose clitoris got so large from taking the androgenizing hormone that it painfully chafed against her underwear when she walked.

After conducting an internal investigation, in which it never bothered to interview Reed, Washington University reported that it did not find evidence of any “adverse physical reactions” among those treated at the gender clinic. Not a single case.

Considering how hard this is to believe, it would have been appropriate for Ghorayshi to probe deeper into this matter. Medical treatment decisions by their very nature require balancing benefits against harms. At a time when Americans need to hear the truth about what is known and not yet sufficiently studied about the side effects of these powerful drugs, Ghorayshi’s piece comes across as somewhat sanitized. Ghorayshi mentions 18 patients and families who say that they had “overwhelmingly positive” experiences at the St. Louis clinic, one patient—Alex—who discontinued testosterone after “realiz[ing] she was nonbinary,” and a file compiled by Reed and her coworker that documented 16 instances of detransition. What do these numbers tell us? The answer: close to nothing. The St. Louis clinic apparently had 613 patients who were medicalized during the relevant timeframe (Ghorayshi mentions 598, a number she takes from Washington University’s internal investigation, but Reed’s documents show otherwise). Since we don’t know the fate of the other patients, it’s impossible to draw any conclusions about the overall rates of regret or satisfaction. But again, whether most patients at the St. Louis clinic are satisfied or not is no rebuttal to Reed’s allegations. Using subjective satisfaction as the sole metric is reasonable for cosmetic procedures, but not for “medically necessary” ones.

This brings us to the second problem in the article. “The turmoil in St. Louis,” Ghorayshi writes, “underscores one of the most challenging questions in gender care for young people today: How much psychological screening should adolescents receive before they begin gender treatments?”

The key word here is “before.”

Ghorayshi’s question seems to suggest that the debate between Europe and the U.S. is over how much mental-health screening and counseling to offer adolescents before putting them on a medical track. In truth, the European countries have adopted an approach that emphasizes, for most gender dysphoric adolescents, mental health support instead of hormones.

Though she notes the divergence in medical policy in Europe versus the U.S., Ghorayshi doesn’t fully explain the nature of this divergence and understates its extent. True, Europe hasn’t banned hormonal interventions altogether. But if the restrictions now in place in Finland, Sweden, and Denmark (the situation in the U.K. is more complicated) were implemented in U.S. clinics, the majority of American teenagers now being put on the medical track would receive only mental-health support. In Denmark, for instance, the rate of intake-to-medicalization at the country’s centralized gender clinic was 65 percent in 2018. After restrictions were imposed, the rate fell to 6 percent in 2022.

Ghorayshi mentions a Washington Post op-ed from 2021 by two psychologists, Laura Edwards-Leeper and Erica Anderson, who support the early medical-intervention model albeit with guardrails. According to Ghorayshi, Edwards-Leeper and Anderson “warned that American gender clinics were prescribing hormones to some children who needed mental health support first” (my emphasis). But what Edwards-Leeper and Anderson actually argue in their op-ed is that comprehensive mental-health assessment is needed to figure out whether medicalization is appropriate—a subtle but crucial difference. Such assessment is necessary for differential diagnosis and avoidance of unnecessary and potentially harmful medicalization.

Thus, it’s not just that patients referred to the St. Louis clinic were not receiving “mental health support first.” If judged by Scandinavian standards, which are far more in line with the principles of evidence-based medicine, many or most patients at the St. Louis clinics were likely being given drugs they should not have been prescribed at all. While some may believe that current restrictions in Europe are about “trying everything again from scratch,” an equally plausible explanation is that this is the first step in a bigger retrenchment that will result in firm age restrictions. Time will tell.

Ghorayshi calls Republican laws “draconian,” but the truth is that these laws reflect a view of the underlying medical research and a policy stance much closer to those of European health authorities than those held by Democrats and U.S. medical associations. Condemning Republican laws while implying that the European changes are consistent with evidence-based medicine is, to put it mildly, puzzling.

Related to this is an impression Ghorayshi gives that a root cause (or even the root cause) of dysfunction at the St. Louis clinic was the sharp surge in the number of teenagers, many with serious psychological problems. The subtitle of the article itself says that the clinic “was overwhelmed by new patients and struggled to provide them with mental health care.” The article’s first sentence describes a clinic “buckling under an unrelenting surge in demand.” Ghorayshi later mentions the U.K.’s Tavistock clinic, where long wait times created pressures on clinicians to “affirm” and refer for hormonal treatments rather than do careful mental-health assessments.

But long wait times were only one of the problems identified by physician Hilary Cass in her investigation of the U.K. Gender Identity Development Service (GIDS). The other, and arguably more important problem, was the existence of “an affirmative approach” that “originated in the USA.” GIDS clinicians, Cass wrote, “feel under pressure to adopt an unquestioning affirmative approach [that is] at odds with the standard process of clinical assessment and diagnosis that they have been trained to undertake in all other clinical encounters.” Ghorayshi mentions this pressure on the clinicians but makes it seem as though it were somehow caused by the growing waitlists.

While Ghorayshi acknowledges the “affirming” model as part of the problem, she does not grapple with the true nature of that problem: the infiltration into medicine of a novel set of ideas, including that children have an innate and infallibly knowable “gender identity” and that “a child’s sense of reality” is the “navigational beacon to orient treatment around.” Ghorayshi’s use of terms like “transgender children” and “8-year-old transgender daughter,” though probably intended as a show of respect, implies that kids can know that they have a permanent transgender identity. Current research does not support this belief. Common sense and millennia of experience contradict it. The U.S. Endocrine Society itself says: “With current knowledge, we cannot predict the psychosexual outcome for any specific child.”

It is odd that in the short section of Ghorayshi’s article where she directly discusses the affirmative approach, the patients’ stories she tells all have happy endings. Indeed, she writes: “It’s clear the St. Louis clinic benefited many adolescents.” European health authorities have said the opposite: the current affirmative approach is a major cause of unsafe practices.

Moreover, the surface similarities between the St. Louis clinic and the Tavistock clinic obscure the more significant differences. As Hannah Barnes discusses in her book on Tavistock, GIDS was founded on a strong ethos of psychotherapy rather than medicalization. The story of Tavistock’s collapse is largely one of institutional mission creep: the founding ethos of 1989 was gradually replaced with a new understanding of the role of mental-health clinicians as rubber-stampers for experimental drugs.

In contrast, U.S. pediatric gender clinics were founded well after the Dutch started their experiment with puberty blockers and, it can reasonably be argued, for the purpose of offering these drugs. Endocrinologist Norman Spack, the founder of the first clinic in Boston, would later recall “salivating” at the prospect of using puberty blockers for children entering adolescence. In contrast with the Tavistock clinic, which referred patients to nearby hospitals for endocrine consultations, American gender clinics regularly employ endocrinologists like St. Louis’s Christopher Lewis, who, Ghorayshi notes, has prescribed hormones to patients after only a single visit. As the old saying goes, if you’re a hammer, every problem is a nail.

Given these important differences in the founding purpose, personnel composition, and sense of mission in American versus English clinics, it makes little sense to imply that the rush to medicalize at St. Louis was due to inadequate staffing of mental-health professionals. The surge in referrals may have been an aggravating factor, but it is not the root cause. The true root cause is the new ideology of gender and the mountain of subpar research that has been created to justify early intervention.

Ghorayshi and the Times deserve much credit for a report that is more thorough and balanced than many that we’ve seen from the newspaper of record in recent years on this issue. They are operating in a political environment in which even mere skepticism of PSTM is seen by some as complicity in “genocide.” They are challenging the received wisdom of their own political tribe, which is never easy.

On the other hand, the Times itself has promoted the narrative that PSTM is “medically necessary” and “life-saving,” and that criticism of it reeks of ignorance and bigotry. The trek back to impartiality and devotion to truth-telling will be long and arduous, but it begins with articles like Ghorayshi’s on Reed and the St. Louis clinic.

#Leor Sapir #gender ideology #queer theory #genderwang #medical scandal #medical malpractice #religion is a mental illness #medical transition

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dark-academia-quotes · 2 years

Text

"Farsi Couplet:

Mun tu shudam tu mun shudi,mun tun shudam tu jaan shudi

Taakas na guyad baad azeen, mun deegaram tu deegari

English Translation:

I have become you, and you me,

I am the body, you soul;

So that no one can say hereafter,

That you are someone, and me someone else."