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Science of Gender Identity

Saturday, July 25, 2015

Puberty Blockers

I've been deliberating over this post now for a while alongside giving it a lot of thought. It's a topic I have to say I've generally dodged or diverted answering journalist questions because I've not wanted to comment; firstly I'm not a doctor, but nor do I have any personal experience to the topic (which is where I prefer to write from). 

To the point though, puberty blockers and hormone replacement in transgender children / teenagers ... yep a biggie! Firstly yep I'm fully aware there would be a lot of professionals out there with different and greater insight to mine and as always I welcome comments. That said I am also going to give my thoughts now that I've had a little experience and consulted a few different medical opinions over the past few weeks. 

In summary the topic intimidates me, mainly from the point of view of transitioning myself as a fairly OTT health conscious adult and I can assure you to get through all the elements of my transition; particularly the physical, mental and surgical elements (7 surgeries in 3.5 years) I've needed to call on and use EVERY resource (internal and external) available to me and still I'd say I'm not yet back to a '100%' I used to be ... and you think the Tour De France in intense - truly!! Whether I'll ever get back to that past 100% I've given up wondering and instead just see what level of health each day brings ... 

SO that being said, a question that's always stuck with me is that it's all very well and good to be an adult celebrity (or not) transgender individual who confidently walks through such a massive physical and emotional and mental enduring process but WTF is that going to be like for a child who adamantly identifies as this so early in this day in age (from living this I'll never doubt them for one millisecond - it's real and the truth as if you are this you just know, no further explanation required really) ... but is medical progression also problematic in development?

As in it's a pretty major thing to experience an external substance injected into the body designed to halt puberty progress, "delay it" if you will whilst the teen makes sure (at age 16) they definitely want to medically transition (as in that's currently the correct standard practise from the medical practitioners perspective and the Government legality ... hmmm?!?) So at 16 you can begin hormone replacement or put another way; start your puberty experience ... completely over riding a time of body change where A LOAD of development is happening, huge amounts, everywhere! 

With that said, having recently accompanied a young friend of mine on his first visit to a paediatric endocrinologist (thank god they exist!) I'm a little more settled and I still have questions. The point here I think is that early treatment is truly a 'new-ish' thing, and there aren't a load of medical studies yet done to refer to about the affects of all of this, if any! 

But from researching and questioning doctors the way I like to (they love me deep down I'm sure, truly ;)) I can see that it does work and is pretty much okay. The main issue being that the intervention does sway a little from the 'normal range' puberty onset time period so the teen can allude the appearance of looking a different age to their peers as their puberty progresses differently.

There are a few things though that get me questioning what the blocker is actually targeting. There are a few different substances used, the main ones I can see work by suppressing signals from the pituitary gland (used similarly in some cancer treatments) which stops the hormone regulation signals to the ovaries or testes respectively (not just the sex organs directly - which I ignorantly thought was the case). As I say here though, I'm not a doctor, the specialists looking after this process are doing very well and I applaud their abilities to step in and offer this to trans kids as it is needed. 

I am though just questioning questions a little as is shown in these diagrams ... 




The pituitary gland does affect other things as well sex organ hormone production and does suppressing this affect these other developmental areas as well; i.e the adrenal ACTH, thyroid TSH, bone density measures, kidney ADH as well as the sex organ hormone release?

Specialists have commented that bone density mass development catches up within a few years of hormone replacement so it's of no consequence to long term to susceptibility of conditions like osteoporosis. The other elements I've not had comments to yet but I hope to in time and more so I would love to see more medical research reports done to the topic ...  

Which brings me to my question has enough research been done and is this actually physically and physiologically healthy, particularly the element of restricting hormones until the age of 16 when most other kids start their puberty earlier, all for the sake of 'what if they change their mind?'. I'm not convinced, they aren't going to change their mind - truly, this is medical practitioner protection talking! But who knows maybe the odd one or two will, I'm looking forward to seeing that though and being proven wrong. 

Blockers generally start around 10-12 once you get through any legal issues with that -- bless Human Rights Commissions for their work to this point as even this isn't that simple depending on what country you're in. But back to the point the age is dependent on their Tanner stage as to not affect their height growth too much - google that point though, tis another topic that isn't for this post. My personal issue is that 10-16 is a lot of years to be suppressing the above functions (in my opinion as an alternative health practitioner). 

I believe hormone replacement should be available from 14 (as agreed by a child transgender child specialist I read from recently) especially if the teenager is requesting it. They are old enough and I think it is healthier. I do definitely think the legal restriction of access to hormone replacement at 16 should be challenged by medical practitioners and parents respectively. It's too late in my opinion particularly if a trans individual choices later in life to go ahead with the genital realignment surgeries ... they are going to want to be as healthy as humanly possible to avoid any of the (up to 40%) surgical complication rates (more joys to look forward to, truly!). I hope in time with doctor / medical advancements these reduce too, I'm confident they will as they work every day to do so.

In summary with this said mentioned, do I think a trans identified child (even with the new frontier that this is) be denied this process and have to grow into adult-hood before beginning any sort of medical transition -- absolutely not. It's likely they'll self harm themselves before that time, and THAT you will always have my word on. 

There is a duty of care though I believe to more acutely watch body functions during this time; particularly mood, metabolism, thyroid function and bone density development etc etc. It it were my child I would be onto monitoring all of this constantly (without trying to make them a lab rat) and be the normal pain in the butt patient / civilian I always strive to be ;)

Cheers as always for reading! 

Tuesday, April 21, 2015

Arm Update

Yo yo ... so I'd be lying if I said sharing this post didn't spark off a chain reaction of people freaking out around me back when, what can I say, was inspired by Terminator 2 at the time (but saving that story for the novel!) ...


Happy glad to report this update of the fading and shrinking ... in that no one ever notices it and with plans I have over the next year or so, it'll have faded away to nuthin!


To life journeying ... and art ! 

Thursday, November 13, 2014

Parental Decisions

I've been thinking today about children and adults having been one of both now. And I realise I have a whole new load of unanswerables to a fairly simple ideology ...

In summary, still watching Nip Tuck (up to season 4) in my recovery period, and the scenario presented in the episode (bare with!) is that the plastic surgeon and wife have just had a child with a hand deformity (there is a big proper name for it). As you can appreciate Dad surgeon is gung ho motivated to surgically reconstruct his boy's hands so he can be as normal as possible asap to place him in the position of best opportunity for fulfilment and success in life (for e.g. learning how to play catch, family eating time, less bullying etc etc - please take the metaphor here - could be any age experience we look forward to in child rearing that involves hands!). 

The mother on the other hand is concerned about the trauma of surgery that could "manifest itself into later life issues" as per what 'new age' health suggests. The child is too young to be able to express pain verbally. The nanny is a dwarf (love script writers) who has suggested this point of view to the mother, saying the child's instinctive response to the surgery will be to think it's being killed (aka elicit a fight or flight instinctual response). AND of course she's just also started to have romantic feelings for the nanny (reciprocated) and they 'sensually kiss' (bad wife bad wife!). ANYWAY this has obviously led her to an experiential discovery that 'our child needs to be able to find those who will love him for who he is' (she's crushing on the dwarf) - boom *crowd goes wild*!

SO ... when one starts to reflect on one's own life and thinks back, you have child in the early 80's who is trans, most likely scenario ... 'parents do know on some level but deny it as what do you do in the early 80's - aka not today's medical world or consciousness' ... most likely solution "child will surely grow out of it with our parenting support" ... however on deeper level, different thoughts:

Option A: 'father wants it ignored and suppressed because surely child will be strong enough to have it 'not an issue' and will present better as an adult with greater chance of fulfilment and nourishment anyway from success of career, partnerships, friends, normal society acceptance and popularity, money, yadda yadda'

Option B: 'mother possibly thinks a bit deeper, allows the child to express themselves more truthfully seeing it as possibly more healthy and nourishing. It will of course bring challenges and big societal judgemental projection onto the child, but also attract truer people so the bonds will be really real and nurturing. The challenge is real though, if you allow the child to exist as is, it will grow up in a tougher world around it, with less instinctive acceptance and life path opportunity (debate-able but also yeah 'cut the crap' and it's absolutely true based on real life experience of the world around us!). I guess we can hope the world is slowly really changing, I'm not so sure today (maybe that's just me).

So at this point it's safe to say from personal experience, option A does indeed last for a while, well as long as the child has the strength to endure the pain of a life with an element of falseness to them and huge trauma to deal with that's developed alongside. I lasted 34 years, no idea if that's a good or bad measure (but it certainly brings with it a real chance of the child ending their own life, from too much pain of ignoring the issue, no qualms about it as that external nourishment doesn't last - for me anyway).

Option B: being who you are, does indeed attract truer people to you and a realer existence in life that does provide a deeper nourishment and fulfilment. However it also does have it's daily pain and challenges and own niche painful problems, and rejection that you don't get with the life and opportunities you do with option A. It also leads to a painful life existence BUT with the pure freedom and joy that is not be-known to Option A. If you can do this option along with finding a way to attain the perks of Option A I think that wins. Internal integrity and outer materialistic reality which is deemed 'normal' - definitely possible this day in age I think.

So at this point my only conclusion is; when you have a child, can you be a parent where you can forgo the motivation to 'give your child the best you think you can and parent (direct) them to take and deny the parts of life that give them the better opportunity as per what society dictates? or not ... and do you agree or do you just go for option A and hope for the best. I say this as possibly the side effect of doing is that you are magnifying painful experiences either way and also limiting your child a tad in who they are instinctively at their personal best (not yours or their teacher's etc etc). This too however I'm sure will bring a new set of problems. I have no answers.

End mind discussion today! 


Sunday, February 23, 2014

It's Not About The Sex - Pre Sale Order

To purchase your pre-release, AUD $25 copy, of 'It's Not About The Sex 
to be released later this year, including both online view and DVD delivery, please click here








for further information please visit www.itsnotaboutthesex.com

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