This doctor must lose their medical license for life. At best they are wildly incompetent, at worst they are maliciously inflicting harm upon a teen for personal or political reasons.
Giving estrogen to men usually causes irreversible sterility for life. The doctor would have known this. The pharmacist would have known this. That they chose to proceed with the risk of sterilizing a boy without notifying his parents implies horrific things about the doctor's view of the lack of humanity of their patient.
Edit:
I added "the risk of" to the previous paragraph, as elsethread notes that the sterility outcome usually requires much longer dosing intervals. Noted, but if I remember correctly, men pursuing a change in gender are expected to sign their name or initial in the box at least ten times in a row in order to receive their prescription — once for each side effect, due to the severity and permanence of those side effects. Both doctor and pharmacist had a professional duty to review those severe side effects with the patient and their legal guardian.
Afaik all that happens is that estrogen inhibits the pituitary, which will temporarily shut down testosterone and sperm production. But with patience or sufficient antiestrogens, those can be restarted. (Testicular atrophy is another factor, but that takes much longer to occur is also reversible)
Which isn't to say that estrogen is harmless. Without proper therapy, the hormonal shutdown can take many months to undo itself, and gynecomastia can usually only be resolved by surgery.
> men pursuing a change in gender are expected to sign their name or initial in the box at least ten times in a row in order to receive their prescription
This is not true, at least not anywhere I've gotten Estradiol.
Also, while I'm sure you intended to be respectful with your comment, most people getting this treatment see themselves as women who are changing their bodies to match their gender, not as men who are changing their gender.
How should one phrase that sentence without it becoming completely confusing?
Would it be offensive to say "a person with an x and y chromosome"?
Even though gender is only a social construct... for some reason, taking estrogen will have totally different effects on a person, depending on that gender.
That's part of the reason that "biological male" isn't a highly informative/technically-precise term, but assuming you mean something like Swyer syndrome, there isn't really a reason to worry about estrogen making them infertile, so in context using the phrase "transgender women" would have been clear regardless.
I think, since the assignment is typically done by a medical professional (at least for recording a birth certificate), the assumption is that the gender is either a quickly fixed clerical error or reflective of a phenotype that presents as sufficiently male/female to convince a professional.
"Convincing a professional" is a reasonable proxy for biological sex, given that the cases that would fool a medical professional are in many (most?) cases sufficiently ambiguous that a reasonable person could take either side for what the biological sex is.
They would continue to be male, forever. "Female" is a sex, not merely a gender identity.
At birth, nobody is "assigning" genders to you, they are attempting to observe your sex from primary sex characteristics. If they see vulva, they are observing a female; if they see penis/scrotum, they are observing a male.
While there are edge cases, it is generally pretty simple.
In social science the word “gender” is used to refer to the social construction of male and female in order to distinguish it from “sex” which is the physiological makeup of ones body.
Physiological sex can be further broken down into ones Anatomical sex, ones chromosomal sex and ones hormonal sex.
However it is possible to have anatomically male genitalia and XX chromosomes as well as all other combinations. To ignore this is to ignore biology.
> Your gender is the ability to become pregnant or to impregnate someone
No, that's reproductive function. Which is closely related to (but different from) biological sex, and not particularly closely related to gender.
> What's socially constructed is how your gender is presented
No, gender presentation (and gender identity, which is related to but different from presentation) is not a social construct, though it is influenced by gender, which is.
> or implied because of said society.
If you mean “ascribed by” instead of “implied because of”, that's what gender, distinct from gender identity, gender presentation, sex, reproductive function, etc., refers to. So, aside from not understanding the terminology, you seem to correctly understand that it is a social construct.
I'm a bit confused how gender presentation can be not a social construct but gender itself can be a social construct. It seems to me that gender presentation depends on gender.
>Depending on the basis on which gender is acribed, it could well be the other way around.
How is it possible to have a concept of gender presentation without having a concept of gender? The definition of gender presentation to me seems to rely on the fact that there's a thing gender. Whereas you could imagine a world where gender exists but no gender presentation exists. Therefore I believe gender does not depend on gender presentation.
That's a decent, if slightly confused, defense/description of the view of gender and sex prescribed by Critical Gender Theory, however, despite its academic sounding terminology and many PhDs, critical gender theory remains unscientific hokem.
1. It's not Critical Gender Theory, though Critical Gender Theory uses broadly similar definitions for the subset of those things which it thinks are worthy of discussion, it's just the fairly common language to distinguish the innate physical (sex broadly, reproductive function for the particular subset you raised), internal self image (gender identity), externally ascribed status (gender), and behavior (gender presentation), and neutral as to material as opposed to conceptual relationships. CGT is opinionated about the material relationships, holding (as I understand it, but CGT isn't something I've more than casually encountered) that gender presentation is socially learned behavior produced by social gender ideas and other aspects of personal social context, gender identity (which CGT doesn’t, IIRC, talk much about directly, but recognizes insofar as it recognizes that people have a social identity related to the social construct of gender) as a product of gender presentation and social gender stereotypes (reversing a common progressive view that gender identity is a fundamental, immutable or nearly so, aspect of identity amd that gender presentation is an expression of identity, to which social gender images may play a part.)
2. It (my post, not Critical Gender Theory) is not supposed to be scientific; it's pretty much all definition of terms, which precedes the ability to even discuss observations of facts, which in turn precedes the ability to discuss hypothesized generalizations from observed facts and empirical tests of those generalizations.
It's important to remember that essentially all human concepts are socially constructed on some level. Even basic ones like 'fish' (is a dolphin a fish? Many cultures would say yes, but modern taxonomy classifies them differently), 'fruit' (is a tomato a fruit?), 'river' (is this a river or a canal?), so it would be truly remarkable to find out that the concepts 'male' and 'female' correspond to objective physical reality - they would be unique among human words!
So no, you don't require CGT to make a distinction between biological sex and the fuzzy notions of 'woman' and 'man'.
To give some examples: is a person with XY chromosomes but Androgen insensitivity (testicles, but a purely female phenotype, including all anatomy, such as a uterus) Male or Female? Purely biologically, obviously male (small, mobile gametes). Would you send this person to male prison? Would they be able to inherit the title of King in medieval society? Should they be encouraged to dress as a man, because that is their biological sex? Should they not be allowed to a gynecologist, since gynecologists are only for women?
Similarly, let's say you have a person with XX chromosomes born with a typical female phenotype, but who has undergone bottom surgery and testosterone therapy, so they now have no breasts, hair on their chest, a penis and apparent testicles. Is this person female? Biologically, yes - they have (or had) large, immobile gametes. Would women feel comfortable if such a person were to undress in a female locker room? Should an advertising company seek to target tampon ads to this person, since they are biologically female? Should they be allowed as a contestant in a Miss America pageant?
The discussion of how malleable the relationship between sex and gender is, and CGT does make arguments in that area that are arguable. But it is not arguable in any way that the concepts 'man' and 'woman' are much fuzzier than biological sex, that they are socially constructed, like all other natural language words and concepts.
I am going by Blackless‘s research. Even if that figure is wrong Klinefelter syndrome occurs at rate 1-2 per thousand which means that your estimate of one in ten thousand is way out.
You can thank genetic "abnormalities" in part for evolution. Many genetic variations, even those that cause disease, have been later found to give evolutionary advantages. Sickle cell comes to mind.
There is no "normal state of being" and it's dehumanizing to talk that way about people who are simply different from you. Nature is bizarre if you open your eyes and humans as social animals spend a huge amount of effort to appear normal.
Of course I can say. Many people have five fingers and some have fewer and some have more. The second sentence of the Wikipedia article on fingers agrees with me. [1] What was so difficult about that that you thought it would be some kind of gotcha?
> Your view makes it impossible to distinguish anything from anything else. It's just intellectually a dead end if you take it seriously with any consistency.
I think I've already demonstrated that you're wrong, but feel free to provide concrete examples of where my view does what you claim.
> Don't be so open minded your brain falls out.
Please avoid this type of language. It's not welcome on HN.
The poster above is being down voted because they are not using the proper terms. What they are talking about is called sex, with gender explicitly being the socially constructed notion usually based on biological sex.
Further, they are using a bad definition of biological sex anyway, as 'people who can impregnate' and 'people who can give birth' is limiting (many cis men can't impregnate for various reasons, and no cis woman can give birth after a certain age, or before a certain age).
The rest of your own comment is low-effort claims with no connection to the topic at hand.
However he is exactly wrong. Check the dictionary “ either of the two sexes (male and female), especially when considered with reference to social and cultural differences rather than biological ones”. Gender is the term used when talking about the social construction.
It seems to vary wildly; I have heard horror stories about having to go through multiple visits and sign multiple consent forms. Some of this is due to WPATH SoC v7 (released 2011), which meant well but has resulted in overly-burdensome consent requirements that especially harm those who cannot afford it. As I understand it, SoC v8 intends to lessen those consent requirements, but it still hasn't been released yet :(
I consciously chose "men" both to parallel the construction of the headline "Boy", with the specific intention of having the sentence hit home for those HN readers who see themselves as "men", while quietly tapping into a certain sexist bias ^1 I've observed in both American medical practices.
Under normal circumstances, I would agree with your point, and I would likely have selected either "transwomen" or "bio-males" in this scenario. Both are exclusionary for various reasons ^2^3, and when making my selection I came to realize that all possible phrases I could use here would result in some sort of HN reply thread about the word or phrase chosen.
Technically, the most correct phrasing for the sentiment I was expressing clocks in at 26 words: "People seeking estradiol treatment for body dysphoria who are perceived as 'men' by their prescribing doctor, regardless of their self-identified gender or their physical sex characteristics". However, that itself would have resulted in a reply thread about shorter ways I could have expressed that, and encouraged a discussion about weakening the accuracy of transgender representation for the convenience of others. That would do more harm than good to transgender acceptance at this point in time than I could accept.
In the end, I considered it most productive for the guaranteed-to-occur HN tangent about my choice of phrasing here to focus on how the word "men" in transgender treatment contexts is insufficiently representative, rather than to focus on how the most-correct phrase is overly representative.
In review of the replies, I am content with the results of my choice. Many users are realizing that there is no simple wording to express this concept, and that every possible choice has issues. It will slightly improve empathy and understanding of transgender representation issues. I feel this choice of wording has been successful.
^1 Doctors are more likely to seek informed consent for procedures affecting reproductive systems (including E2/T dosing) from those they perceive as "men", regardless of the person's actual 'sex' or self-identified gender, especially when the side effects would affect virility in a fertile male.
^2 Genders that are not "women" are permitted to treat body dysphoria by increasing their estradiol levels, too.
^3 Short for "biological males", which excludes people who are not simple 'XY males', such as hermaphrodites, that for whatever reason choose to treat body dysphoria with estradiol.
This comment should not be downvoted. HN have the smart people but does not have a basic knowledge how to be respectful and 'debating' about gender and biology.
>>most people getting this treatment see themselves as women who are changing their bodies to match their gender, not as men who are changing their gender.
I am assuming you have some sort of source showing that this person has the desire to transition? If not I am unclear why this fact matters in the context of this story of what appears to be a doctor forcing medication on a patient against both their and their guardians desire or consent
The higher-order reason that it's relevant is that there's something of a moral panic going on about medical therapy for transgender youth. While this particular case (assuming that the news story is accurate, of course) seems like an entirely unjustified prescription that's also entirely irrelevant to any medical gender transition, there is absolutely a push to try to get doctors to be unable to prescribe estrogen or testosterone for children under any circumstances, and most of the people pushing this seem to have trouble using standard/well-accepted terms for transgender people. So, it's a reason to take the claim about estrogen's side effects with a grain of salt, in much the same way that you'd be at least slightly skeptical of claims about Linux from someone who insists on spelling it "LINUX" - it's a sign that they might be getting their information, in turn, from an unreliable source.
There's a case where an NHS gender clinic at Tavistock Centre is being sued by a former patient who was given both puberty blockers and testosterone at age 16. You can find reports from both mainstream media (like the BBC) and places like LifeSiteNews.
To be clear, by "children" I mean minors past the age of puberty, not, like, 5-year-olds.
I'm sure you intended to be respectful with your comment, but why are women changing their bodies to match their gender superior to men changing their bodies to match their gender?
Nobody said anything about "superior". Men changing their bodies to match their gender are generally not prescribed estrogen, so it doesn't make sense to reference them in the context of people being prescribed estrogen, that's all.
Aplogies, I assumed you were calling trans women starting estrogen therapy 'men'.
The whole thread started because the OP was using the word 'men' to refer to people who are just starting estrogen therapy specifically, not hormone-replacement therapy in general. The person you initially replied to was pointing out that trans women prefer to be called (trans) women at that point, not 'men seeking a gender change'.
You seem to have assumed that they were putting trans men at a disadvantage, but the discussion was never about trans men. It was always about the proper terms to use for someone who is seeking estrogen, whether they should be talked about as 'men seeking to change their gender' or 'women seeking to align their sex with their gender'.
Unfortunately, from your earlier reply, I assumed that you were insisting on the use of 'men' in this case, and I wanted to point out why I believe 'trans women' is more correct. I realize I was wrong in my assumption.
In people who are not seeking estradiol treatment for body dysphoria, prescribing estradiol can still be a viable treatment for issues other than body dysphoria where, due to genetic or other issues, raising their circulating estradiol (E2) blood levels results in a medically positive outcome. In one paper on this topic, two such medical conditions are hypogonadism and prostate cancer:
> Prior to that, Ouchi said, his client felt compelled to take the pills because he feared that disobeying Wang would have a detrimental effect on his pending criminal case.
Makes you wonder what all kind of shady medical shit is done in jails and prisons.
> Makes you wonder what all kind of shady medical shit is done in jails and prisons.
I've personally watched guards ignore diabetic patients in crisis, and heard them tell arrested, but not yet convicted, people to not declare any medical condition that they need medications for while in custody, because the cops didn't want to drive the arrested persons to the hospital and keep them under observation while they're prescribed the medication they need.
If you don't declare any medical conditions during the intake process, and then you have a medical crisis while in custody because you don't have the medication you need to manage your condition, they aren't liable, and good luck convincing the cops to take you to a doctor.
I've heard from case workers that the medical staff in prisons delight in purposely not treating, under-treating, or mistreating prisoners' medical conditions. They just throw anti-psychotics at people because those medications keep the prisoners sedated and compliant, despite the fact that APs have serious side-effects that can be permanent and disabling.
I friend and neighbour of mine, on completing their nurses training, went to work at the local prison.
The medical care they dispensed there was far above what the prisoners received out side. And we have a good general medical system.
The guards may well have been sadistic when away from medical personnel, I cannot say.
There are all sorts of problems of all sorts of different sorts - and if it bleeds it leads - but given that I despair at the reports I keep getting from the USA. ARe things realy getting that bad?
It's always been this bad, it's just that people who weren't given a voice now have some new means to be heard and are actually being listened to instead of having their experiences discounted and discarded.
So the point is that youth protection scandals involving experimenting with medication on unwilling children are rare anywhere ? (even with the youth protection officials getting paid for it)
Ok let's check. Did youth protection do medical experiments on unwilling patients (and by that we mean that BOTH the child and the parent were not asked for permission, and very often not informed at all):
US: aside from this incident, there have been many others [3], including youth protection services specifically [5]
Netherlands: yep (and the officials got paid by Janssens Pharmaceutica) [1]
Belgium: yes [2]
Germany/Austria: jawohl [4]
And if you consider untried psychological treatments as medical experiments as well, and they can certainly have extreme negative consequence, then we should perhaps just say that every kid in youth protection gets experimented on, as this is very close to the truth.
If you think this is the worst they did, you should not Google "aversion therapy LGBTQ youth protection". That was a psychological "treatment" for not being straight that included torture, on purpose. Note that they still treat unwilling children for not being straight. Google "Gender identity disorder treatments" for example. What any sane person would call torture is still being used (ABA, for example).
And let's not forget what ritalin, official treatment for a whole range of (often misdiagnosed) conditions given to children. It is often compared to cocaine, for good reason.
Nobody can be trusted with power over other people's children. Certainly not psychiatrists, who have a LONG history of abuse centuries old, with essentially constant scandals continuing even today.
I apologize. Would it have been better if I had added that I am an American who lives in America? I don't see a comment delete option. Would you delete it for me, please?
If you post nationalistic flamebait like this, or other flamebait this egregious, to HN again, we will ban you.
Also, please don't routinely create accounts. This is also in the site guidelines. You needn't use your real name, of course, but for HN to be a community, users need some identity for other users to relate to. Otherwise we may as well have no usernames and no community, and that would be a different kind of forum. https://hn.algolia.com/?sort=byDate&dateRange=all&type=comme...
None of this very new, but a lot of the reporting is. America locks up an astounding number of people; at any given point about half a percent of the US population is in jail, with a total of ~2.8% of the adult population being somewhere in the correctional system pipeline.
One simply cannot build a prison system capable of processing a percent of your population without the ability to either whole heartedly endorse, or at least ignore some pretty shocking abuses. A society that cared more about the rights and dignity of prisoners would not build such a system in the first place.
For comparison Canada currently imprisons 139 people per 100,000 residents, America currently imprisons 655. Germany is at 71, France is an 97, the Netherlands is at 63. America is literally incarcerating people at 4.7x the rate of its northern neighbor, and at 9-10X the rate for similarly rich EU countries.
But as a mildly funny anecdote to break the seriousness; Liechtenstein's prisoner stats have a funny detail -- Total prison population: 12.
> that I despair at the reports I keep getting from the USA. ARe things realy getting that bad?
The US press is pretty good at finding the bad reports. So count them - then count the population, and realize that, while even 1 case is too many, as a percentage, this kind of horrible stuff is very rare.
Indeed. There was a pediatric cardiac surgeon in Winnipeg whose incompetence lead to the deaths of 12 children.[1] It got to the point that other physicians wouldn't even admit cardiac patients to keep them away from this doctor. Massive failures at every point in the system. Last I heard he's working at UCLA now.
There are bad actors everywhere. We don't condemn the Canadian healthcare system because of people like this guy.
I googled the name of the malpracticing surgeon, and found a LinkedIn profile for a surgeon who works at UCLA has the same name as the surgeon in Winnipeg, but the other details don't match. I think these are two different people.
I have seen a cop order a medic to give sedative to a human that was being choked by said cops for more than 10 minutes (he was basically already dead when they injected him). Search for Tony Timpa on Youtube if you want to see the video. And they were joking while killing him. And last but not least, they all kept their jobs. All humans can be bastards.
> And last but not least, they all kept their jobs
Police unions are some of the most powerful organizations. Not being able to fire bad actors is one of the worst parts of unions. I've never understood why there hasn't been a movement to reform them. Their coworkers get stuck with them too and bringing the whole unit down.
Instead we're always sold some nostalgic narrative of past golden eras of unions. Glossing over all the warts and cruft built up over time. We're long overdue for modernized unions.
It is more that their definition of bad actor is different. Cops that break rank and complain and testify are fired or demoted. Cops that do that stuff are promoted.
Even the nostalgic narrative of the past golden era of unions is, from what I've seen, mostly a creation of propaganda.
The gains unions won for their members were worse than zero-sum, because they merely redistributed from profit (shareholder income) to worker income, while resulting in collective bargaining agreements that reduced the flexibility of the labor market.
The violence they were involved in was almost universally started by them, as illegal action that violated the employer's right to their property, and replacement worker's right to work at their site, was their main source of leverage.
> “Estrogen is not a treatment for ODD. I can’t be more emphatic about that,” McGough said. “You won’t find a reference anywhere that supports the use of estrogen for ODD.”
Well certainly the doctor got this theory from someplace. They believed this young man would be better behaved if he had less testosterone and more estrogen, and went ahead with a treatment against scientific evidence (and ethics quite frankly).
So where did the doctor get this theory? Let's ask ourselves that question, and follow up with this question: what other theories are medical and science professionals getting that aren't science based?
Probably many, but that's not really the problem. We want people to be developing and appropriately testing theories. What we don't want is:
* Treating people against their will outside of specific extreme circumstances which this was not one of
* Coercing vulnerable populations into treatment
* Concealing treatment plans from guardians
* Treating in a manner that is not in line with evidence based practice
* Treating in a manner that is not designed to advance the patient's well-being but is instead designed to pacify the patient for another person's convenience
* Running what amount to illegal clinical trials that have not been validated for medical and ethical soundness, safety, and legitimacy by a medical oversight board
* Insurance fraud (I don't know how payments work in correctional facilities, but generally speaking there is zero probability this treatment plan would result in reimbursement from an insurer. I would naively assume they lied about what they were doing for reimbursement)
As a healthcare practitioner, behavior like this makes me sick. The legal system should open up on this guy with all they've got.
There is no "theory". This is a sickening attempt at using a farcical medical diagnosis to ruin the entire life of a prisoner, even worse, a youth prisoner. History is littered with examples of lobotomies and chemical pacifiers being used to control "oppositional defiant" prisoners.
A doctor with medical credentials would know far better than anyone else, the foundational and fundamental damage done to someone with induced gender dysphoria, the practical effect of giving an ordinary man estrogen. This is psychopathic behaviour that has become all too routine in our national prison complex.
Your unspoken assumption is that "treatment" was a primary goal at all. Here, I would consider if "treatment" is instead the weapon of choice used in service of the actual goal: to brutalize one person so severely that it causes others to sit silently in fear, rather than stand up and speak out.
"This boy was super aggressive towards me, a doctor! so I must punish him for that transgression against me, a doctor! and ensure that I make an example of him! I have just the thing, I'll humiliate him by making him into a girl! I'll lose my license, but it's worth it because I'll be remembered forever as the boogeyman in every juvey in the country!"
> and went ahead with a treatment against scientific evidence
Despite a lack of scientific evidence not against. Don't think this has been tested and disproved in a scientific manner. And for ethical reasons probably won't be.
A relationship between male hormones and aggressive behavior while sometimes questioned is generally well supported. Yes that's not ODD but one can easily see the train of thought here.
What the doctor did is obviously very unethical and wrong (if the story is true)
But it certainly doesn't seem like a random out-of-nowhere idea to me.
Seems equally likely to me that the doctor was unethically treating based off own untested hunches as it is that it was a purely sadistic action.
> A relationship between male hormones and aggressive behavior while sometimes questioned is generally well supported.
That a relationship exist is well supported. The cause and effect, as per more modern research, however is one that more recent (ie > last 30 years) has found to be quite different than previous assumptions.
Throw in a random number of test subjects in a room, observe aggressiveness, and then measure testosterone and you get a clear pattern. Now change the test by first measuring the testosterone and then observe aggressiveness, and the data is all over the place.
The part that more modern research is questioning is not that the relationship does not exist, but rather in what direction the arrow points. Can behavior effect hormone secretion? More and more data seem to support that very theory.
That high testosterone levels are a poor predictor of aggressiveness but almost universally present in violent criminals doesn't tell us much.
That behavior affects hormones, again, is interesting but doesn't tell us much.
What we're really discussing here is whether significantly cutting off testosterone would reduce aggressive behavior over time. That the relationship between testosterone levels and aggression isn't perfect is a nuisance.
For example reducing testosterone would reduce bodily strength significantly. Would that reduce aggression? Perhaps. Reducing testosterone is sometimes shown to increase empathy. Could empathy help reduce aggression? Perhaps.
You could then argue that it's "not testosterone" and one should refrain from physical exercise and attend psychological empathy training to get the same effect. Logically it's a valid argument but practically speaking it misses the point.
The data we have from chemical castration of sex offenders is very solid. There are people criticizing it saying that something else is at play[0]. But nonetheless it's very effective in practice.
The data from animal experiments is strong too. There's definitely a profound change in behavior. Again, it's sometimes called into question over some oddly specific behaviors but it seems rather uninteresting to me.
In your later comment you mention some experiments from a long time ago on violent criminals but I have a hard time finding anything that isn't about sex offenders or animals. So I'd appreciate a link.
As far as theoretical arguments against it go, I'd say the strongest is that high levels are simply a proxy for some irreversible virilization that happened earlier in life. Which would much better explain why both criminal male and females are relatively high T.
[0] say that people who accept the treatment are naturally predisposed to have lower recidivism
If you want to do the work I can recommend a book called The Trouble With Testosterone that takes a meta perspective on the different research on the topic. It is a fun evening/day going through it cited studies.
> The data we have from chemical castration of sex offenders is very solid
The data show same result for female chemical castration of sex offenders. Usually the study goes something like this: a self selected set of child sex offenders volunteer for chemical castration, and later they report a diminished desire for sex. The problem with linking this to aggression is on several layers. It self selected for individuals that want to reduce their desire for sex. It is self reported. And it is about diminished desire for sex.
Will reducing bodily strength cause a reduction in aggressiveness? If we leave the topic of sex offenders and look at aggressiveness as a whole, bodily strength might very well effect social status and thus fit the challenge hypothesis. Crippling a high social status individual and they will likely spend less energy on defending their status, through the result is going to vary depending on the culture.
The empathy studies are interesting (the book above list a few of those). According to one such study, giving men increased testosterone does not decrease their ability to read emotion in an eye test, but giving it to women does reduce their ability. Again this show a repeating pattern of those studies where within normal range, high or low testosterone levels can not predict behavior. You need to give people testosterone so that they are outside human levels to get any significant effect, and then the result is often minor unless taken to a very extreme level.
> As far as theoretical arguments against it go, I'd say the strongest is that high levels are simply a proxy for some irreversible virilization that happened earlier in life. Which would much better explain why both criminal male and females are relatively high T.
What is your source for that? Criminals have higer rate of violence, and if violence causes testosterone secretion, then the higher level can be explain by the increase violence. male-male competition in prison is also likely a bit more intense than outside which would also explain a higher level of testosterone.
> The data show same result for female chemical castration of sex offenders
As expected. Why would it not work in females? You'll be easily getting these levels to a very "unnatural" level below the low end for both males and females.
The studies aren't just on self reported feelings. You're looking at reductions in recidivism exceeding 50%. Yes some studies show a much smaller reduction, but AFAIK every study does show some improvement. Sure as I noted myself it could be self-selection as some argue, but nonetheless there isn't a study out there outright disproving it. There are a few countries where it's mandatory but not sure if there's any data from these.
When you've got studies showing efficacy, to disprove them you'd want something of higher rigor. Say a proper RCT. If one says self selection taints the result then you want a study that controls for that.
Again I'm absolutely not opposed to the notion that there's some cultural/societal feedback loop involved. I'm just arguing that administering strong blockers MAY help with many issues relating to aggressiveness. And that these arguments on just how linear or predictable the relationship is are interesting but not that relevant to disproving the practical efficacy of such a treatment.
I fully agree that one shouldn't demonize the hormone itself and anyone who has high levels. That's what that line of research tells me as far as I'm concerned.
> What is your source for that?
Regardless of what causes violence we have a huge undeniable discrepancy between males and females. If we go with the explanation that violent behavior bumps T up that goes nowhere in explaining the enormous sex difference. Don't remember the exact ratio off top of my head by it's definitely somewhere around 1 to 10 so not buying a purely societal explanation. And if you look at the extremes, say serial killers or very brutal forms of murder it grows even wider apart.
So it would seem logical to me that in these violent high T females either the T does matter or it doesn't but is an indication of virilization earlier in life.
As to the claim that testosterone levels would be a proxy for earlier virilization - for example digit ratios are believed to be an indicator of virilization in utero and studies do show that they correlate with adulthood T levels[0]. Pretty sure there are studies relating it to criminality too.
Personally my hunch is that it's a bit of both. Say if we put everyone on these drugs I'd imagine overall violent crime would drop but males would still be vastly outnumber females.
Just because castration can have an effect on recidivism for some forms of sex offenders (and please point towards a source because it does make the discussion more worth having), it does not mean it have an effect on say axe murderers.
Gun control may also have an effect on recidivism for gang related violence involving military weapons, but is unlikely to effect child sex rapists. Not everyone that work for once set of criminals work for an other set of criminals, nor are recidivism and aggressiveness the same thing.
And there are studies where violent criminals of the non-sex offending nature were given testosterone reducing drugs. It did not work.
> Regardless of what causes violence we have a huge undeniable discrepancy between males and females
That kind of research are plenty in gender research. Men are X more likely to be math professors, having a job, and a number of other gender stereotypical aspect. There is a lot of culture involved and it very hard to separate culture from biology.
But even considering what we know about biology, aggression and crime are not the same and female on female aggression tend to be different than male on male aggression. Culturally we tend to ignore the former and focus on the later.
And finally, there is some evidence that in many cultures male aggression get rewarded with social status, and in the challenge hypothesis, that would link aggression with testosterone through culture. Game theory experiment has demonstrated that testosterone can influence players to be more or less aggressive in an economic game depending on the design of the rules. If aggression is rewarded with maintaining status then injecting players with testosterone increase aggression. If the game is changed and it is cooperation that is rewarded, players with raised testosterone play more cooperative. All cited in that above book.
Quoting from Heim & Hursch (1979): "Of 102 sex offenders, only three castrates (2.9%) relapsed into sex offenses. However, in only 41 cases was the period of observation long (5-10 years). Therefore, there was a maximum of 7% recidivism during this observation period. The recidivism incidence before castration was as follows: Of 102 subjects, 59 (58%) had relapsed."
2.9%/7% vs 58% (this one is on surgical on chemical)
Fedoroff, J.P., Wisner-Carlson, R., Dean, S., & Berlin, F.S. (1992): "All patients received equivalent amounts of group psychotherapy. Of these, 17/46 (37%) relapsed. The rate of relapse among subjects receiving treatment with medroxy-progesterone acetate (MPA) was 4 out of 27 subjects (15%) whereas the rate of relapse among subjects not receiving MPA was 13/19 (68%) "[1]
15% vs 68%
And since you bring up math professors, there's actually a study showing a single dose of testosterone improved spatial cognition in females [2].
Again I'm not opposed to cultural angles. I don't doubt that culture makes small innate differences look much bigger. But that's more philosophical/anthropological, it doesn't tell us much on whether a drug would or wouldn't work at scale. We could go on and deconstruct every psychiatric drug this way.
Yes, surgical and chemical castration undoubtedly reduce sexual interest, sexual performance, and have likely a impact on sex offenders. Removing estrogen and testosterone seems to have an effect on sex offenders recidivism, although it does not work on everyone.
This does not mean estrogen causes aggression. It mean estrogen is as a sex hormone, and sex hormones are connected to behavior which is relevant for recidivism.
> I don't doubt that culture makes small innate differences look much bigger. But that's more philosophical/anthropological, it doesn't tell us much on whether a drug would or wouldn't work at scale.
Understanding biology is needed in order to understand whether a drug would or wouldn't work at scale. Take Oxytocin as an example. A great hormone that makes mothers bond with their child. It has shown to improve prosocial, operate like an anti-depressant, improves trust, make people more generous, and even improve wound healing. It have been considered for use in everything from medicine to vitamin supplements.
More modern research however find that there is a problem. It improves prosocial behavior for the in-group but it also create anti-social behavior towards the out-group. It increases trust with the in-group, and causes fear with the out-group. It make women increase parental behavior and at the same time increase racist behavior, and it makes perfect sense. It a hormone that is connected to the goal of sexual reproduction. It increase behavior that benefit offspring during the first years and it strengthen the bond between mother and the child nearest blood-relatives so that the child has the best likelihood to survive. It also protect the child against non-related individuals who is an increase risk of being a threat.
Understanding what a hormone actually do is critical to understand its medical effect.
Yes, because they tried that in the past on violent criminals back in the less ethical days. They also tried cutting out the Amygdala and nearby parts of the brain.
The result was not great for either. The more aggressive an individual were the smaller the effect is. Testosterone also get secreted by other areas of the body so you also need to add suppressive drugs for that. Biggest effect was measured by chemically removing testosterone for women as they have the smallest amount to begin with. Going from above average testosterone in men to below average gave no results. Castrating the most violent criminal, usually against their will, has some studies showing minor results while others no results.
There is something called the challenge hypothesis. The theory is that testosterone acts as a modulating effect for managing social status. When an individual suddenly gain status the body reacts by secreting testosterone. Testosterone in turn regulate how much energy an individual will spend on behavior to retain that status. For animals that gain and maintain status by exclusively aggression, this then correlate nicely with testosterone. Reducing a male dogs testosterone would reduce the amount of effort they will spend to defend their status against other male dogs, and since dogs are very territorial, there is ample of opportunities where such behavior occurs. However for very aggressive dogs the effect will be much smaller, so its not a solution in those cases and the solution instead tend to be euthanasia.
Social status for humans is massively more complex, and the relation to violent crime even more so.
If you post like this here again we will ban you. Adding a nationalistic flamewar to what is already a gender flamewar is either arson or criminal negligence.
Not to defend the doctor, but common sense? Sex hormones obviously have a huge effect on behavior, and anyone who has interacted with both men and women can see these effects. I'll refer you to the following study to answer your question about "non-science based theories and treatments": https://www.bmj.com/content/363/bmj.k5094
Not that I think "oppositional defiant disorder" is even a sound classification to begin with, but the lawyer's assertion that estrogen is not an accepted or common treatment for males with ODD is spot on. This was done solely with the intent to harm, by offending a deep and fundamental aspect of the person in question.
However “Common sense” is often wrong. That is why you can’t treat people based on whatever hunch you have. Also you would hope that common sense and basic medial ethics would make you avoid violating the Nuremberg code.
In the US, the criminal justice system is not concerned primarily with reforming criminals or deterring future crimes. It’s concerned mostly with making the lives of people convicted or accused of crimes (many of whom are innocent or otherwise had extenuating circumstances) absolutely miserable, retribution taken to the extreme (tangentially, I’m not against retribution in principle, but don’t think it should always be the only reason to punish someone). And any sort of “non-compliance” while retribution is being exacted leads to the misery being dialed up. Is there any civilized country other than the US where long prison terms in sadistic conditions is considered “normal”?
Retribution should not be a part of any justice system. As retribution is not justice.
Restitution, Rehabilitation and isolation should be the 3 goals of a true justice system.
Victims should have a path to restitution when possible (some crimes this is not)
Criminals should have a path to rehabilitation when possible (some crimes this is not)
For when the other 2 fail, Isolation is the final step, isolation means we isolate people that have been proven to be a danger to others and do not have the ability to be rehabilitated.
Retribution is just unethical, it makes the population of a system of retribution to be no better than the criminals they are abusing.
Support for retribution is a visceral reaction but holds no value or place if the goal is justice.
Retribution is perhaps the most intuitive — and the most questionable — aim of punishment in the criminal law. Quite contrary to the idea of rehabilitation and distinct from the utilitarian purposes of restraint and deterrence, the purpose of retribution is actively to injure criminal offenders, ideally in proportion with their injuries to society, and so expiate them of guilt.
Why Is Retribution Used?
The impulse to do harm to someone who does harm to you is older than human society, older than the human race itself (go to the zoo and watch the monkey cage for a demonstration.) It's also one of the most powerful human impulses — so powerful that at times it can overwhelm all else. One of the hallmarks of civilization is to relinquish the personal right to act on this impulse, and transfer responsibility for retribution to some governing body that acts, presumably, on behalf of society entire. When society executes retribution on criminals by means of fines, incarceration or death, these punishments are a social expression of the personal vengeance the criminal's victims feel, rationally confined (it is hoped) to what is best for society as a whole.
Of course there are more sophisticated ways of thinking about retribution, and it's a good idea to be familiar with them since a judge (and that other kind of judge, the criminal law professor) is unlikely to accept "because it's a natural impulse" as justification for retribution in punishment. And with good reason.
Is Retribution Ethical?
While "it's natural" tends not to carry much weight in the criminal law, "it's morally right" can. Moral feelings and convictions are considered, even by the criminal law, to be some of the most powerful and binding expressions of our humanity. In binding criminal trial juries to restrict guilty verdicts to situations of the highest certainty, "beyond a reasonable doubt" is also often described as "to a moral certainty." It is to their moral feelings of what is truly right that jury members are asked to look before delivering a verdict. It's perhaps not too much of a stretch, then, to argue that it's morally right to make criminals suffer as their victims have suffered, if that's the way one's moral certainty points.
No matter what one's moral feelings are about inflicting deliberate harm on a human being, the majority of the U.S. citizenry still holds that it's right to exact retribution on criminal offenders, sometimes even to the point of death. This is almost certainly true of the majority of victims, and their loved ones, for whom equanimity becomes more and more difficult depending on the severity of the crime. What rape victim does not wish to see her attacker suffer? What parent does not hate the one who killed their child? The outrage that would result from leaving these passions for revenge unsatisfied might be seen as a dramatic failure of the entire criminal justice system. It's a good argument for retributive justice, then, that in this world public vengeance is necessary in order to avoid the chaos ensuing from individuals taking revenge into their own hands. And, until the moral certainty of a majority of society points towards compassion rather than revenge, this is the form the criminal law must take.
>>the purpose of retribution is actively to injure criminal offenders, ideally in proportion with their injuries to society
Eye for an Eye leaves everyone blind.
Further I have always taken issue with the concept of "injury to society", I am an individualist so to me society is just a bunch of individuals working under voluntary cooperation
Criminals injure an individual not society, thus any restitution is owed to individuals not society at large
>>The impulse to do harm to someone who does harm to you is older than human society, older than the human race itself
Granted however the entire purpose of civilization, especially western civilization is to become greater than are base instincts, to allow reason and logic to rule over emotion.
Civilization to me is not a conduit to "relinquish the personal right to act on this impulse, and transfer responsibility for retribution to some governing body" as no one has a personal right to act in retribution, and since no one has that right they have no ability to transfer that right to the governing body.
The only ethical use of force is in defense, imitation of force is always unethical
Fines should be in service to restitution, including a "pain and suffering" fine which is often viewed today as "punishment" but in reality is restitution for the victim(s).
The problem is we have removed the concept of restitution from the criminal system and leave it to the domain of civil law almost exclusively with a few exceptions (normally property crimes)
Incarceration should be about rehabilitation and/or removal from society as a defense not retribution. The Prison system should be humane, where inmates would not be physically abused by other inmates or guards, not be subjected to systematic physical or psychological abuse, should be provided basic nutrition, and health care, etc
This can not be said to be true for the US prison system today
It should also be a place to get mental health treatments, and even learn new skills or other methods to return as a productive member of society
>> the majority of the U.S. citizenry still holds that it's right to exact retribution on criminal offenders
This highlights why I will never support a direct democracy. Mob rule almost always the worst outcome
>>This is almost certainly true of the majority of victims
Which is why we separate victims from being judge and jury, emotional responses are not good for civilization
>>What rape victim does not wish to see her attacker suffer? What parent does not hate the one who killed their child?
Many, it is not uncommon for victims to want to see their attacker isolate, not not be able to hurt them or anyone else again. I believe it would be uncommon for victims to advocate torture, abuse or suffering. People that maintain this desire past a grieving or shock period psychologically are probably not far removed from the criminals they are waiting to abuse.
>>until the moral certainty of a majority of society points towards compassion rather than revenge, this is the form the criminal law must take.
No, I neither agree that the majority of society points to aggression nor agree that even if it did then that is the form society must take. As I said before mob rule is almost never the correct outcome. If you look back in history you will see all kinds of atrocities committed due to statements like the one you just made "Well the people demand it so we must do X".
The concept of human rights and equality demands we reject retribution as the basis of criminal justice
You have made a series of claims, but not given any reasons to back them up. What theory of ethics/justice are you invoking, when you claim that retribution/deterrence is unethical and should not be a goal of our justice system. If a billionaire is found guilty of pedophilia, and offers to build for himself a lifetime "prison" that is really a 5-star resort, should he be allowed to do so? According to your argument, the answer is yes, as long as he is equally isolated.
Mainly Zero-Aggression principle, under which the only ethical use of force is for defense of either yourself or others, and only to the extent eliminate the aggressive force being applied.
>>If a billionaire is found guilty of pedophilia, and offers to build for himself a lifetime "prison" that is really a 5-star resort, should he be allowed to do so?
That is a strawman and a red herring all in one. No a person should not be allowed to build their own guided cage, however the prison s/he is sent to should be humane, where s/he would not be physically abused by other inmates or guards, not be subjected to physical or psychological abuse, should be provided basic nutrition, and health care, etc
This can not be said to be true for the US prison system today
Further the system I advocate for would provide for massive amounts of restitution for the victim(s) of this billionaire, unlike the system of today which holds the criminal has a "debt to society" but not necessarily their victims where any restitution would be secondary to the retribution offered to society as "payment" for this debt
I advocate for victim restitution being the primary goal, and hold that society is owed nothing in the equation.
This once a person is isolated from society and can not harm anyone, continued abuse or violence is unethical, "punishment" in captivity is unethical.
>> If a billionaire is found guilty of pedophilia, and offers to build for himself a lifetime "prison" that is really a 5-star resort, should he be allowed to do so?
> That is a strawman and a red herring all in one. No a person should not be allowed to build their own guided cage
This is a direct implication of what you're proposing. The fact that you don't like the implication, doesn't make it a strawman.
You stated that the only goals of the criminal justice system should be rehabilitation, restitution and isolation. Allowing a billionaire pedophile to sequester themselves in a self-funded 5-star resort, is consistent with all of your stated goals, while still being minimally aggressive, and maximizing their welfare. If you find this objectionable, you need to revise your earlier claim.
Luckily I did not say that. Retribution and deterrence are very different concepts and objectives. However, most retributive actions also happen to have a deterrent effect. Ie, sending someone to prison as retribution, will also have a deterrent effect on other would-be criminals. This is an empirically verifiable claim with many supporting studies that you can find via a quick google search.
Retribution is needed to prevent vigilante justice and to cause fear to potential criminals. Remember the story of the drunk driver who killed several people in a crash [0]? He was "punished" by going to a club med like rehab facility where he was taught about the wrongs of his actions by horse back riding. Imagine if all drunk drivers were punished that way?
I am not familiar with the case you are speaking of, and often times people over state what happens in minimum security facilities
also I see you one of many that confuse rehabilitation with giving people a slap on the hand, or "club med" type of facilities.
Retribution is in no way needed to prevent Vigilantism (Vigilantism is never justified or justice). Actual justice, and restitution prevents that just fine.
Rehabilitation has many aspects, and in the case of addiction it would include a medical and psychological treatment for that addiction
There has never been any study that shows tossing a person in a prison with no treatment does anything to solve the underlying issue which just leads to recidivism, in the case of a drunk driver, it is likely they they were caught many many times leading up to their imprisonment, this highlights the failure of the retribution system and where a rehabilitation system would achieve a better outcome
Added source of the case to the OP. And yes, retribution is designed to prevent vigilantism. As that is psychology I can't really give a better source than [0]. Obviously retribution is not meant to go by itself, but along with rehabilitation.
And you believe we should not treat minors different than Adults? this is another area where i disagree with many, as I 100% disagree with this modern trend of prosecuting teens as adults
Why? Do you lack the understanding of how the human mind develops?
I am curious also, do you support the trend of digging up 30 year old comments from peoples past and holding them to account for them, aka Cancel Culture?
I am wondering is this mentality is linked
I am a firm believer in second chances, automatic expungement of criminal records, and various other things that do not hang past mistakes over peoples head for the rest of their lives
One of those is having a separate system for juvenile's as when understand impulse control does not really form in humans until around 20-23 years of age.
I would like science to inform our justice system, not lizard brain emotions for revenge
Something doesn't add up with this story and I suspect it's going to come out in the lawsuit.
If the doctor REALLY did want to lower testosterone levels in the 16 year old, there's a slew of medications that would have been more effective (Spiro, Lupron, Bica, etc). That amount of Estradiol isn't going to do much to lower T levels.
It's possible the doctor knows something the parents of the kid don't. You don't treat the symptom (high T levels) you treat the disease (the behavior disorder). It's possible there is something about the boy's medical history that made it seem like this treatment would work better for his body chemistry, perhaps.
This reads like the plot of a dystopian young adult sci-fi novel. Children who resist authority being diagnosed with a "behavioural disorder" and being forcibly given hormones by an evil doctor. Yet apparently this is the reality of modern society.
Don’t confuse this with normal or common treatment
What are these normal treatments? Pharmaceuticals like Ritalin and Adderall? Asking because I don’t know not that I’m taking this anywhere, but when people talk about behavioral control of children acting out of line with some kind of “norm”, I’m uneducated as to what the norm is or what the status quo for this is.
What I do know (via anecdotes of having sister who works in childhood behavioral science), medicating kids was for a long time the norm and is being harshly critiqued and challenge more recently, but I admit not really bothering to look into this much further.
> medicating kids was for a long time the norm and is being harshly critiqued and challenge more recently
My mom bought into this stuff in the 1990s and I never had proper treatment as a child. Only until I was an adult and saw a doctor myself was I properly diagnosed. The medication was a life-saver in my 20s.
As much as pro-pharma stuff is being pushed behind closed doors there's also tons of pseudoscience "appeals to nature" fallacies [1] being pushed in all public channels, where all chemicals are treated with suspicion. I wish there was more of a balance in the media, because this anti-pharma narrative is everywhere now.
I'm not surprised this manifested into anti-vaxxers. Anyone saying that medication as a solution is still treated with reverence in popular discourse is deceiving themselves. Doctors have all heard the stories by now too.
But that also doesn't mean doctors haven't played a big role in this, including those who massively over-prescribed painkillers, benzos, and antidepressants in the last few decades - which have help distract from all the real positive benefits they provide.
You might already be aware, but it is possible to reclaim most of what was lost via the principle of tissue expansion. It’s called foreskin restoration and allows you to regrow basically everything except the frenulum/ridged band.
It’s time-consuming and takes awhile to learn how to tug properly, and in a certain sense can be psychologically painful to go through, but the results I’ve personally seen so far have been very encouraging.
Off topic, but I have always felt like something was taken from me re: my circumsion as a child.
Do you have any resources or guides you recommend on restoration? I've looked in to manual tugging and some of the stretching devices. The devices don't seem practical to wear around discreetly on a day to day basis, and I haven't gotten manual technique to show results yet.
Careful with your wishes. The school doesn't like strange students. Depends in what country you live, but in the country I live it's solved with money, send the kid to a private school and the school will swallow everything as long as you pay.
Its funny you cite the novel whereas the author, psychedelic guru Ken Kesey, based the book off his real life experience working as a nurses aid in a psychiatric ward while simultaneously being part of a CIA program testing hallucinogens.
For those unfamiliar with the back story of the novel, Kesey conceived the plot and characters while tripping on peyote while at work in the ward...his revelation being the patients were the sane ones and the workers enforcing the rules where insane, which was a metaphor for the modern dystopia he lived in. Times Magazine described it as: "a roar of protest against middlebrow society's Rules and the invisible Rulers who enforce them."
Reminds me of that time Berlin decided to deliberately house orphan children with convicted pedophiles, positing that the “attention” of the older male would be good for them.
> Berlin decided to deliberately house orphan children with convicted pedophiles, positing that the “attention” of the older male would be good for them.
Perpahps who was behind the board that made this decision was a group of (infiltrated) pedophiles
A small but not trivial portion of the public immediately lapses into a near-rage at anything that appears to be an authority figure. People seem to grow out of it.
Maybe it's PTSD from poor interactions with past authorities, maybe it's some kind of pack hierarchy hold over, who knows-- but it appears to be a pretty widespread phenomena.
It doesn't stop being real just because the description could also be abused to dismiss someone who has a legitimate complaint about a particular authority.
The claim that "it's a real thing" doesn't mean anything other than that some people exhibit certain behaviors that some other people decided to group together, give them a name, and put it in DSM-5. None of this refute GP's claim that "that's what they call mouthy rebels these days".
A small but not trivial portion of the public immediately lapses into a near-rage at anything that appears to be an authority figure. People seem to grow out of it.
With the Internet, they now all get together and organize extremist groups. Before the Internet, they had trouble achieving a critical mass. This seems to be more of a middle aged thing than something people grow out of.
It sounds quite Orwellian. I fondly remember being written up almost literally a hundred times throughout school for "willful disobedience" and being sent to the "behavior modification center" as punishment.
Like many behaviours, it can range from "personality trait" to "disorder", with a lot of grey area in between. I'm not hugely in favour of quickly applying the "disorder" label based on my personal experience of being stamped with such things which, in my opinion, are merely "personality traits" which were labelled "disorders" by well-intentioned but overly zealous mental health professionals, but that doesn't mean they don't exist in some people.
That's exactly what I was thinking. I really refuse to believe that he couldn't just be diagnosed with something else, assuming there was really a problem to begin with. This whole case is incredibly concerning. I'd wonder if this is the first time.
no, that's what they usually call young 'psychopaths' that act out, aka 'sociopaths'... there is a high correlation between the two, but no psychologist wants to label a kid as a sociopath...
I had one, in class (5th or 6th grade), and I remember the experience was eye opening. Teachers had to spend a copius amount of energy just to keep him in check.... his behavior would oscillate between funny/to scary dangerous within minutes.
at some point he got in trouble for trying to put the classroom on fire (see how fast do the desks lit/catch fire).... and got trouble again for trying to do the same to his neighbors. He eventually got removed (and I assumed ended up in juvenile correction facility).
Normally this label is not given to kids that have run of the mill problems (aka ADD/ADHD), but only for serious cases.
Psychopathy and sociopathy are two markedly different disorders, despite sharing some common symptoms. It would be prudent the difference between the two before assuming an authoritative stance on APD.
> no, that's what they usually call young 'psychopaths' that act out, aka 'sociopaths'...
That would be "conduct disorder" actually, something rather more severe than just ODD. If a kid shows a pattern of behaving in blatantly antisocial ways that demonstrate a severe lack of empathy for others, that's pretty much it. Setting stuff on fire is actually a tell-tale sign, as is willful animal cruelty.
The Wikipedia page for that is something to behold, reading it you get the distinct impression that someone has succeeded in convincing the psychiatric profession to make an entire stage of human development into a disorder.
In this thread could we have people preface their comments with the intent they're assuming of the doctor? It seems to be a split between "the doctor was using an non-indicated treatment { in an attempt at gender-bending | for unknown reasons }", and the discussion is a disaster because everyone is talking past each other.
Tangential is yesterday's JRE podcast with Abigail Shrier[0] who's a journalist for the Wall Street Journal.
The interview discusses her new book's findings about hormone therapy given specifically to teenage girls through the means of "informed consent", which led to terrible developmental and reproductive damage that was in most cases irreversible.
A little, but not always enough to be a problem.
I took 4x the does he was on for a year without any change in liver function markers. Some transfem people take 1-4x his does for life.
As someone who recently had surgery for gynecomastia that I've had since puberty, I feel sorry for the kid and hope the breast tissue will naturally resolve.
The event is confusing for several reasons - not only are testosterone levels not linked to ODD, even if they were, there are drugs that can gently reduce testosterone production. Estrogen isn't one of them.
One thing not addressed here is that the surge of estrogen during puberty is what causes your long bones to fuse at the ends and you stop growing. It is possible that this young man's growth may have been permanently capped by this irresponsible behavior.
There is a hypothesis, “nominative determinism”, that posits that people tend to gravitate toward professions that “match” their names. I don’t fully buy it, but it’s an interesting idea that has at least some evidence to support it.
Given that nobody seems to be able to account for his decision, it seems like maybe he should be in prison.
If somebody assaults my testicles and renders me infertile, that is an extremely serious crime; this doctor may well have done the equivalent (along with completely destroying the boy mentally) with the stroke of a pen.
The good news (for this boy) is that 13 days of hormone therapy are unlikely to cause any permanent changes. Infertility/sterility is usually only expected after years of HRT - and even then, often returns if HRT is ceased.
Ouchi said the boy, now 17, was released in April and will require surgery to treat the physical issues he developed as a result of the estrogen treatment.
...
The boy’s father said the hormone therapy has had a long-term effect on his son, who now scares easily and has become antisocial.“He’s like a different person. He just wants to be in his room, and he don’t come out for nothing, all day in his room,” the father said. “He was never like that.”
> The boy’s father said the hormone therapy has had a long-term effect on his son, who now scares easily and has become antisocial. “He’s like a different person. He just wants to be in his room, and he don’t come out for nothing, all day in his room,” the father said. “He was never like that.”
How could one possibly discern this from the effects of going through juvie in general. I'd certainly feel betrayed by society, regardless of what meds I was given.
An adolescent boy grows breasts and then wants to stay in his room all day. It could well be all about body shame, trying to protect himself from social trauma. The rate of suicide among people who transition on purpose is so extremely high. What must it be among people who are transitioned by force.
Giving someone the wrong hormones is one way to induce gender dysphoria in non-trans people, so suicide rate there should be similar to that of trans people with unmanaged gender dysphoria.
Suicide rates among people who transition are generally correlated with minority stress [1,2], not transition itself: "The myth that transition leads to SITBs continues to be
used to deny transgender health care access and legislative rights, despite a lack of empirical support for this position and repeated research debunking it." (SITB= suicidal thoughts and behaviors) [3]
>“He’s like a different person. He just wants to be in his room, and he don’t come out for nothing, all day in his room,” the father said. “He was never like that.”
What I am about to say is in no way a defense of the doctor or his actions. What percentage of parents would say this exact same thing about their teenage children? It is perfectly normal behavior and I'm not sure there is anything to link it to the unnecessary hormones forced on the unfortunate kid.
> 13 days of hormone therapy are unlikely to cause sterility.
Yes, it's possible he won't end up sterilized by this. However:
The breast growth triggered in men by medical doses of estrogen is not reversible and requires surgery to correct. There will be social ramifications for life. There may be other (non-virility) physical ramifications for life.
2mg of E2 for only 13 days and he needs surgery? Sounds very much like something a lawyer would say. At most a few mm of development/widening of the areola with the start of development under. Not noticeable unless you are actually measuring them weekly. It is common enough that a someone will have to go off HRT after only a few weeks and anything underlying breast development will undo itself, but not the areola. But full blown gynecomastia that is irreversible? That takes a lot longer.
Perhaps he was already overweight, high fat percentage (which results in high e2 in males) and some gynecomastia already?
Further I would be willing to bet that he was swallowing all 2mg at once and not taking the pills sublingually or buccally split across the day.
It is up to the lawyers to decide and maybe he had better breast development than any trans woman I know, but everything in my experience tells me that noticeable gynecomastia takes longer than 13 days on e2.
I agree that there is likely a much more nuanced truth here than is conveyed by the news article, and I hope that we never gain access to the boy's medical records to clarify further.
My lay understanding is that the absolute levels of testosterone and estrogen are much less important for men than their relative levels.
I actually had blood drawn a couple of weeks ago to check for this very thing. I’m male, and while my testosterone levels are in the median range, my estrogen levels are very high relatively speaking. I’m operating under the assumption that it’s caused by recent weight gain - thanks, quarantine - so I’m working to lose that weight and will check it again.
Interestingly, there don’t seem to be many accepted options for reducing estrogen levels. My PCP suggested broccoli seed extract, but made it clear that it wasn’t a well-supported or accepted treatment. The most reliable treatment is a change of lifestyle.
You are correct in that such a low dose for a short period of time is unlikely to have major problems, but HRT is not a risk-free treatment. It increases risk of heart disease, stroke, blood clots and more.
In studies of post-menopausal cis women, that's correct, extended use is associated with those things. (Also, I think some of those were done with Premarin, which is no longer widely used?)
There has been unfortunately few studies done on transgender people or on young people. (I welcome any links to studies you have!)
Came here ready to be horrified at the gender paranoia living under the surface of HN, was actually surprised with how reasonable everyone was. Except this comment.
None of those symptoms (infertility, "complete mental destruction" or, heh, "assault on the testicles") are alleged here. He got an inappropriate drug, possibly punitively. And that's horrifying enough without painting figurative spectres of the unimaginable cruelty of... emasculation?
If a coach was doping teen athletes with test without their knowledge or coercing them in to it, hell even misleading them to do it, I'm pretty sure I would expect jail time, assault charges etc. And you would probably be in favour as well. But because attacking this feels like an attack on your political narrative you feel the need to spin it inside of it and downplay this.
And don't even try the "this is a medical professional" - the kid got gyno and this is not an approved procedure - it's exactly the same as the coach doping kids.
I think I'd support jail time for this abuse, FWIW (to be fair I've only read the one article). I'm reacting to the gendered reasoning among the poster above. It's bad because it's an unnecessary medical process used (apparently) as a punishment, not because it stole his manhood or whatever.
I'm fine if you're super upset. But if you're MORE upset because of the gendering interaction, that's wrong. The poster above clearly was.
It depends on the motivation, if it was ideologically motivated I would be outraged at the ideology that lead to it and people justifying it, just like I would be outraged at state of high school sports that lead to a coach doing this and people defending that.
But I sort of agree, there is no proof this is ideological (in fact it sounds just as likely that the doctor was experimenting), the other guy is spinning it his way as well - I think you can say that without the need to defend/downplay the action.
Ah, this strikes right at the core of the primary differences underlying American society today.
I don’t care at all what the doctor’s motivations were - I only care about their actions. In this case, those actions were taken without consent and had a significant negative impact on the patient. Whether they “meant well” or either of us agree with their motivation is completely irrelevant to me.
I understand that others see it differently, and that’s fine. My observation is that this disconnect is almost always always unstated and caused a ton of misunderstandings.
> (in fact it sounds just as likely that the doctor was experimenting)
I can think of another prison "doctor" who's known for "experimenting" on unwilling victims. Claiming to be doing experiments, yet without any hint of scientific rigor.
If the claims made in the article are true, this guy belongs in prison no matter his excuse. Whether or not an ideological motivation can be proven or ruled out is completely irrelevant.
I should have put "experimenting" in quotes - just saying there is no evidence this is based on gender ideology so insinuating it is also spinning this in to ideological terms.
> you're MORE upset because of the gendering interaction, that's wrong.
I strongly disagree.
This isn’t about gender as a social construct. This is about a licensed medical professional causing significant changes to a person’s body without their consent.
Completely irrespective of how an individual perceives their own gender, that perception is a core part of who they are. So yes - I am absolutely more upset about this because of the “gendering interaction”. I would be equally upset if this person saw themselves as asexual or androgynous and was administered sex hormones without their consent.
It's not "paranoia" if the subject of the gender-bending either a) was not aware or b) was being held in a state funded institution and otherwise had no intention of "transitioning" to the opposite gender...
You did not read the complete details of the case (or frankly, even read the comment you're replying to). The dose was large enough to give him gynecomastia, which the other inmates bullied him for, and for which he will require surgery. His father reports that his son's personality is completely different, he is now a total shut-in.
> He got an inappropriate drug
He was injected† with non-indicated (as in, there is no literature on this rogue prescription) contradictory sex hormones during adolescence and under duress; I don't know why you're downplaying this, I hope it's just because you don't know what this means.
> infertility
Infertility is a common outcome of sex hormone therapies.
> ...the unimaginable cruelty of... emasculation?
If suppressing gender dysphoric people is wrong, how can it be moral to medically intervene to deprive an adolescent of the normal functioning of his body, and an already solidified gender identity? Using non-indicated medical interventions to emasculate or defeminate somebody who is already secure is a form of extreme cruelty, from basically any moral frame, yes.
† Correction from helpful reply: not injected, taken as pills. I got the "injection" thing from this thread, had thought it was pills before.
Appears to be pills, not injection. So far they aren't reporting infertility, only gynecomastia. It's certainly possible to have the latter without the former.
Can you enlighten me as to what you think my agenda is? For myself, I'm pretty sure I posted that comment so people who might otherwise like to frequent HN doesn't get the idea that the median poster here is a transphobe. Obviously I might be wrong about that, but someone needs to put in the effort.
> He was injected with non-indicated contradictory sex hormones during adolescence and under duress; I don't know why you're downplaying this
I'm not downplaying this at all. It's you who are boosting your interpretation because of "assault on the testicles", "mental destruction", "sex hormone", and other things that tell me what you're really upset about is his masculinity and not his well being.
No, I don't think this is any worse than had he gotten an equivalently dangerous drug (say, fentanyl for sedation, which has also been alleged in juvenile detention facilities IIRC). And I'm point out the fact that you do is... unseemly.
This is worse precisely because of the reasons transphobia is bad. This poor boy has been forced - by a medical professional, no less - into a place on the gender plane that is different to the one that he identifies as. The psychological effects of that are horrifying, and the physiological effects are potentially permanent.
There's nothing wrong with being trans and going through HRT so long as you do it with full and knowing consent. You do that because you feel deeply dysphoric about the gap between the body you've been forced into and your true identity, but it's not without cost. To force both the cost and dysphoria onto someone is, again, truly abhorrent.
>This poor boy has been forced - by a medical professional, no less - into a place on the gender plane that is different to the one that he identifies as.
Where are you getting this intent from? I don't see anything in the article to suggest this was the doctor's goal.
It may well not have been the objective, but that was the rather unsurprising result. Depraved indifference; behaviour that can lead to criminal liability.
Are you actually suggesting him losing his masculinity by forced medication of an unnecessary drug is not in itself an issue? What's the problem with masculinity, exactly, and why is it so bad that drugs should be given to children to remove it?
> It's you who are boosting your interpretation because of "assault on the testicles", "mental destruction", "sex hormone", and other things that tell me
The "assault on testicles" thing was not even part of my description of the boy's condition, it was part of my hypothetical of a crime with potentially equivalent (or probably less severe) outcomes. And for your information, sex hormones are a basic and widely-accepted concept; just because some people are afraid to call them that in the English-language publications of some corrupt institutions in the last five to ten years doesn't mean they went away. Go ahead and tell any trans person on HRT that sex hormones aren't a thing; if they believe you, they'll be horrified, if they know how wrong you are, they may be too flabbergasted to even begin to tell you.
> ...what you're really upset about is his masculinity and not his well being.
I think that you ought to do some introspection as to why you consider those things not to be related. I suspect you are concerned about some people's security in their gender identity, but you seem to want desperately to paint it as a minor thing that they seem to have treated this boy's gender identity (and sexual function) as a disposable lab material; maybe you personally place no value on masculinity, but that's not for you to decide on this boy's behalf.
> ...an equivalently dangerous drug (say, fentanyl for sedation, which has also been alleged in juvenile detention facilities IIRC)
fentanyl is generally safe, the safest opioid AFAIK, and its effects wear off in seconds or minutes (which is why it is often administered through slow-release patches or lollipops).
One is medically approved, while the other sounds to be like some experiment/retribution that someone did to a minor. Do you really not see the difference here?
> “Estrogen is not a treatment for ODD. I can’t be more emphatic about that,” McGough said. “You won’t find a reference anywhere that supports the use of estrogen for ODD.”
For what it's worth, I've personally witnessed esketamine make major improvements to treatment resistant depression after a single treatment when nothing else is working worth a damn. So it's pretty clear to me that it is a real treatment with good cause for using it.
Now, it didn't work in our case because of underlying psychosis, which also means it's dangerous as heck and needs to be used carefully, but in terms of effect size, someone can go from rating their depression as 10 out of 10 down to zero in one treatment.
So I wouldn't be hasty to discard it, just careful to use it on the right people and maybe I'd figure out some way to deal with the psychosis so that those who might otherwise get excluded could have the benefits too.
Internet comment forums are sure a weird social dynamic. It feels like your talking with a group of friends, but also, we're all strangers meeting for the first time.
So cracking a sarcastic joke, a thing that really only works if you know your audience and your audience knows you, feels safe, but obviously doesn't work very well.
i disagree. we have treatments that have been shown to be helpful for a given disease. its not perfect but giving out random cocktails is not the norm. estrogen is not a treatment for that disease, which is why this is a headline and that action (as far as I can tell) is heinous.
well, the main issue is that people usually opt for estrogen/ketamine therapy voluntarily and for specific problems those therapies are supposed to address (estrogen for gender reassignment, ketamine for chronic depression), neither of which seems to be the case here.
Yes, this is horrible and no, from a utilitarian perspective this does not make sense. You are basically argueing for chemical castration. This is exactly the kind of medicalization attitude which is very dangerous. The correct way isn't pumping our youth full with hormones or other chemicals, but giving them sufficient therapy and care and by ensuring that their environment in jail accommodates for a safe return into society, instead of turning juvinele youth into professional criminals and joining prison gangs.
Just to be abundantly clear I think this is a terrible idea. But I'd like to see it dispassionately debated on its merits. One could make the argument that "sufficient therapy" is reminiscent of the "no true Scotsman" fallacy. I do not know of any methods that can reliably work with the most violent of offenders. Chemical castration is evil, but so is life imprisonment. Which is lesser? Does it matter if it were a choice?
Why would you favor chemical alterations instead of simply changing the laws so this large portion of the population doesn't feel ostracized?
I'm not sure the current trend of labeling a lot of things as deficiencies is healthy for society. ADD, ODD, all that stuff should not be "treated" as much as it is today. Society should shape around how people are and not vice-versa.
We're at a point where having testosterone is starting to be seen as a problem which could be remediated by chemical castration for some people, and this is truly disturbing.
The system is working rather well because an innocent kid has been hurt? What kind of system is that? That's a cruel and horrible 'system' and needs to be completely rethought.
The fact that a child fell victim to this kind of calculated medical misconduct in the first place is pretty clear evidence that the system is not "working as intended".
How often does stuff like this happen, but we don't hear about it? Jails and prisons are human rights black holes.
If a prescription like this goes through the entire system and is given to a minor for nearly two weeks - there's definitely a problem there.
I know that there's a lot of systems out there that will automatically flag for "suspicious" or mistaken prescriptions, whenever medicine that is not associated with any diagnoses is prescribed. Surely a basic thing to do in a case like this would be to forward it to another doctor to double-check.
I know several trans women who have had trouble getting their estrogen prescriptions covered by insurance, even with medical diagnoses. Because they've got a system in place that says "Hey, why are you giving estrogen to somebody legally male? That doesn't seem right."
The system isn't working when innocent people get hurt. If that is the 'system' then the 'system' needs to be torn down and rebuilt. It's the same issue with deregulation
> It’s not like you can know which doctors are the bad apples before malpractice like this.
I really doubt this is true. This is defeatist and assumes that there is no possibility to improvement anywhere that would reduce patient harm by malpractice. I'm sure that's not true.
One would hope not, but there's e.g. a BBS Newsnight report among other sources that says the diagnosis and treatment protocols aren't as rigorous as they could be.
>>On-Topic: Anything that good hackers would find interesting. That includes more than hacking and startups. If you had to reduce it to a sentence, the answer might be: anything that gratifies one's intellectual curiosity.
Definitely not. I'm a passionate biohacker (normal people get shocked with how many different pills I self-prescribe) and trans admirer (yet I actually believe forcing people this way is an atrocity, they can only choose for themselves). What I actually hate, however, is political correctness (people who take "inappropriate" humor seriously and actually get or pretend offended - that's whom we should treat with hormones! ;-).
I’ll take your word for it. But I have certainly seen transitioning (which involves estrogen when the transition is mtf) referred to as biohacking in a way I don’t have to pretend to be offended by.
Please don't start up tedious flamewar tropes here.
If there's to be a substantive conversation about a story like the OP, it needs to stay rooted in specifics, not slide off into tired talking points and angry arguments.
More men generally die annually from breast cancer[1] than testicular cancer[2]. The reason men's rights movements are mocked is because of comments like this that equate any possible problem men have as been on equal footing with all the problems that women have.
Testicular cancer is a bad example, but it looks like from some quick googling in USA ~42k women die each year from breast cancer while ~33k men die from prostate cancer. Overall "cancer mortality is higher among men than women (196.8 per 100,000 men and 139.6 per 100,000 women)"[1] Significantly higher. Men on average live 5 less years than women.
Cancer research funding relative to annual deaths[2] shows breast cancer far "overfunded" relative to everything else. Government breast cancer research funding looks generally double prostate cancer research funding[3]
You can debate the above points or how exactly funding should be allocated, but if your response is to justify mocking any concerns, perhaps you are not really assessing the evidence in good faith.
A woman that uses the pill as birth control consumes 0.00365 gram of estrogen a year. At a consumption price of the pill for $300 a gram of estradiol is thus worth $82,191.79. Compare that to $44 for a gram of gold and you wonder if big Pharma is ready for disruption?
Estradiol is about $7 for 30 1mg pills, so more like $233 per gram. Source: goodrx.com / I'm a trans woman.
(edit) - and just to reflect on what happened to this child, in addition to the physical changes & social problems, this "treatment" would have surely induced gender dysphoria, which any trans person can tell you is awful as hell.
You’re not factoring in labor, packaging, pharmacy profit, pharmacist wages, insurance company profit. If you think you can do it cheaper, then go for it
When Florida is importing drugs from Canada instead of buying them domestically then its pretty self-evident that it can be done for cheaper.
Not sure if this is an earnest defense of the state of healthcare costs in the US but you'd have to be deluded if you think that the rampant profit-seeking in the US for healthcare is merely the cost of doing business.
Estradiol is a generic drug and generic drugs tends to be cheaper in the US than Canada[1] and the EU. The US generic drug market is incredibly competitive.
It's brand name drugs that are cheaper in other countries.
I presume you're talking about pharmacy profit and insurance company profit. "universal healthcare" just means everyone's covered. It doesn't mean everything's owned & operated by the government. That means there can still be private insurance companies and pharmacies, both making a profit.
I would assume they are referring to most of the current suggestions for universal healthcare in the US, which follow a centralised model where a central body could collectively negotiate for drug prices (as the NHS does here in the UK, very effectively).
>which follow a centralised model where a central body could collectively negotiate for drug prices
That's orthogonal to universal healthcare or even a single payer system. There's nothing preventing you from having the whole country be represented collectively, but still have private insurers, like in germany. https://www.commonwealthfund.org/blog/2019/how-drug-prices-a...
Sure, that's true. It's not exactly uncommon to conflate a term with the most common/likely implementations known though, which is what I assumed happened here. It is true that universal healthcare could solve those problems, even if it doesn't have to.
It's important, because using the wrong/imprecise terminology muddles the conversation, and allowing it to go uncorrected normalizes it. When it comes to something like politics, all this will lead to is more polarization.
> was diagnosed with oppositional defiant disorder, or ODD, two days after he was arrested and housed at Eastlake Juvenile Hall in June 2019, the lawsuit said. Medical records reviewed by The Times show that the teen’s testosterone levels were “slightly high” when the doctor who diagnosed him prescribed daily doses of estrogen
This is sickening, not so much for the drugging but the 'oppositional defiant disorder' interpretation. Knuckle under, kid.
However, simply on a factual basis (I assume the story was based on an established practice anyway), I remember as a kid reading a story in 1001 nights where some male child was castrated to stop him being bolshy. They do that to animals for the same reason and with the same effect. There's precedent.
Castration reduces testorone. Estrogen does not reduce testorone as far as I know. Which is why transgender women take both estrogen and testorone blockers. If the doctor had prescribed a testorone blocker you might have a point about precedent.
Giving estrogen to men usually causes irreversible sterility for life. The doctor would have known this. The pharmacist would have known this. That they chose to proceed with the risk of sterilizing a boy without notifying his parents implies horrific things about the doctor's view of the lack of humanity of their patient.
Edit:
I added "the risk of" to the previous paragraph, as elsethread notes that the sterility outcome usually requires much longer dosing intervals. Noted, but if I remember correctly, men pursuing a change in gender are expected to sign their name or initial in the box at least ten times in a row in order to receive their prescription — once for each side effect, due to the severity and permanence of those side effects. Both doctor and pharmacist had a professional duty to review those severe side effects with the patient and their legal guardian.