What do gender transition treatments do?

Female-to-male (FtM) treatments raise testosterone dramatically and suppress estrogen and estrogen receptors. Male-to-female treatments do the opposite. GnRHa “puberty-blocking” treatments suppress estrogen in females and testosterone in males. Testosterone and estrogen are sex hormones. Sex hormones affect the brain:

Sex hormones act throughout the entire brain of both males and females…. Many neural and behavioral functions are affected, including mood, cognitive function, blood pressure regulation, motor coordination, pain, and opioid sensitivity” (McEwen 2016).

Transition treatments have already been shown to alter patients’ brain activity, brain structures, and behavioral proneness. The treatments may be extremely dangerous. Excerpts from many relevant studies are here.

Which drugs are used for female-to-male transition?

Anabolic-androgenic steroids (testosterone drugs) are used, including: Androgel®, Androderm®, Aveed®, Axiron®, Depo-Testosterone®, Delatestryl®,  Testim®, and Testopel® (see Forcier; Idaho; Imborek; Meltzer; Metzger; Tom Waddell Health Center; Unger; Warner). Those are anabolic-androgenic steroid/testosterone drugs (Kersey p. 572).

The FDA has strongly discouraged AAS drug use in young people.

GnRHa drugs (“hormone blockers” or “puberty blockers”) are also used in some cases (see “Lupron”; Millican). GnRHa drugs block estrogen in females. They are used in young girls prior to anabolic-androgenic steroids (testosterone drugs). Sometimes they are given with testosterone drugs in older girls or women.

Are these drug treatments FDA approved?

GnRHa drugs are not FDA-approved for gender transition purposes in females.

AAS/testosterone drugs are not FDA-approved for gender transition purposes. They are not FDA-approved for use in females generally.

How do those drugs affect patients?

Female-to-male drug treatments change gray and white matter brain structures and brain activity. They increase aggression proneness and impair verbal abilities. They may impair memory. They may impair social functioning by suppressing activity in brain areas that help people to understand or predict each other’s thoughts and feelings. They may alter patients’ self-related thinking and own-body perceptions, and sexual behaviors, by affecting brain areas that regulate those things. They may cause patients to engage in risky or anti-social/criminal behaviors. Excerpts from many relevant studies are here.

The drugs may also have many physical health risks, described at 4thwavenow and other sites.

Can they cause autism?

They might trigger autism or autistic-like disorders in females.

Autism has been linked to high testosterone conditions in females, and to low estrogen receptor expression. Female-to-male treatments raise testosterone and suppress estrogen receptor expression, so they create hormonal factors that have been linked to autism in females.

Female-to-male treatments have already been shown to suppress activity in “social” brain areas such as the pSTS. In addition, experiments in females have shown that testosterone drugs impair females’ ability to perform social tasks, such as interpreting other people’s facial expressions. Social impairments in autism are believed to stem from abnormal activity in brain areas that support social behaviors. Hormones are suspected to help cause those abnormal activity patterns.

Excerpts from many relevant studies are here.

Can they cause schizophrenia or other psychiatric disorders?

Schizophrenia, bipolar disorder, attention deficit disorder (ADHD), borderline personality disorder, and posttraumatic stress disorder (PTSD) have all been linked to low estrogen, high testosterone, and/or chronic excess testosterone conditions such as polycystic ovary syndrome (PCOS) in females. This suggests that female-to-male treatments, which raise testosterone and suppress estrogen, may help to cause symptoms of those conditions. The treatments have already been shown to alter brain structures, brain activity, and behavioral tendencies.

Excerpts from many relevant studies are here.

Can they affect brain development in girls and young women?

The National Institute on Drug Abuse stated that “pubertal steroid exposure could produce long-lasting structural changes in certain brain regions.” In fact, female-to-male treatments have been shown to change gray and white matter brain structures even in adults! Researchers have said that anabolic-androgenic steroid drugs, which are used for female-to-male treatments, may damage neural cells permanently. Animal experiments indicate that GnRHa drugs may also affect brain development. Excerpts from many relevant studies are here.

Can they cause dementia, repetitive concussion-type effects or other brain-related problems?

Researchers have indicated that AAS drugs may cause those problems. Excerpts from many relevant studies are here.

High testosterone levels are normal and safe for males, so why are they dangerous for females?

Female-typical testosterone levels are generally safe for females. Male-typical testosterone levels are generally safe for males. However, male-typical levels are not necessarily safe for females.

Females and males can react differently to the same hormones and drugs because they have different bodies, different sex chromosomes in their brains, and other differences that affect response to hormones and drugs. Drug treatments that are safe for males have sometimes been found to be unsafe for females. Women’s health advocates have pleaded for more careful attention to biological sex differences in medical research and practice for these reasons (see Bangasser; Becker; Cahill; Clayton; Davies; Fattore; Freire; Gillies; Hayden; Klein; Li; Loke; McCarthy; McEwen; Ngo; Rodenburg; Sandberg; Soldin; Woodruff; Yang).

Moreover, testosterone levels that are much higher than male-typical levels may be very dangerous for males. That is why the FDA and other agencies have discouraged exess testosterone drug treatments for males (FDA 2016, 2017; “FDA warns”; Fox; National Institute on Drug Abuse 2016, 2017, 2018a, 2018b; 2018c).

Are male-to-female treatments safe?

Starvation is bad for females. That does not mean that obesity is safe for males. Normal hormone levels are generally safe but very high or very low levels may not be.

Female-typical hormone levels are not typical for males and may be very unsafe for males. The transbrainfx site does not focus on this topic, but it is possible that male-to-female treatments are just as dangerous as female-to-male treatments.

Can patients sue for malpractice if they have been given gender transition treatments?

Male or female patients might be able to sue on grounds of medical negligence, medical fraud (concealing and distorting information to induce patients to agree to treatments, and billing for unnecessary treatments), failures to obtain legally sufficient informed consent, etc. See Marchiano and Littman for examples of inappropriate conduct.

If a patient experienced mood swings, aggression, risky behaviors, social difficulties, verbal difficulties, worsening or development of new psychiatric disorders, dementia, neurological disorders or other problems that could be the result of transition drug treatments, then she might have grounds for a lawsuit.

A male or female patient might be able to sue if a doctor or counselor

  • interviewed a patient inappropriately.
  • failed to obtain medical or school records.
  • ignored information from parents.
  • ignored standards of care.
  • provided false information about suicide risks to induce parents to agree to treatments.
  • used undue influence or inappropriate suggestive questioning, social influence or reinforcement techniques to get patients or parents to agree to  treatments.
  • failed to provide appropriate information about the risks of transition treatments.
  • failed to inform patients or parents about the benefits of alternative treatments such as counseling, instead of transition. Many females who experienced dysphoria say that counseling is a helpful alternative to transition.

What if a patient has PCOS or high testosterone?

If a doctor did not investigate, diagnose or treat  underlying physical health problems such as polycystic ovary syndrome (PCOS) properly, then the patient might be able to sue.

PCOS is a chronic excess testosterone disorder that produces problems such as obesity, acne, hair loss on the head, excess body and facial hair, and mood problems. It is often undiagnosed. It is not an “intersex” disorder, but is a common health problem in females. It is typically treated with drugs to lower testosterone, but female-to-male treatments do the opposite.

PCOS and high testosterone are common in females with gender dysphoria (see Auer; Baba; Becerra-Fernández; Bosinski; Futterweit; Mueller) and may cause psychiatric or neurobehavioral problems if not treated properly (see Cesta; Cooney; Dettenborn; Matevosyan; “PCOS”; Pohl; Schwarz; Soleman; Tan; Wooderson; Worsely).

If a doctor provides female-to-male treatments to a patient without bothering to investigate indicators of PCOS or high testosterone, then that may be malpractice. PCOS or high testosterone may help to cause gender dysphoria or desire for transition treatments. Therefore, patients should be treated to see if they still want treatments after their PCOS or high testosterone levels are properly treated.

What if a patient has autism or a psychiatric disorder?

A male or female patient might be able to sue if a doctor did not investigate, diagnose or treat autism, psychiatric disorders or cognitive disorders properly. Those conditions are common in males and females with gender dysphoria (see Becerra-Culqui; Chen; Devor; Jones; Kaltiala-Heino; Leena; Littman; Marchiano; Oswalt; Strang; “Survey”; Vrangalova; Walling).

High-functioning females are especially likely to have  undiagnosed autism or psychiatric disorders (see also Anderson; MacDonald; Russo; Sigler).

Autism and psychiatric disorders may help to cause gender dysphoria or desire for transition treatments. Therefore, patients should be diagnosed and treated. If a doctor jumps to the conclusion that a patient needs transition treatments without exploring the possibility that autism or psychiatric disorders are causing dysphoria, then that may be malpractice.

Why does the FDA allow doctors to provide transition treatments?

The FDA does not regulate drug prescribing or medical practices in general, even if the practices are harmful. Instead, the FDA regulates drug marketing.

After a drug has been reviewed and approved by the FDA for a specific purpose in a specific type of patient, then doctors can legally prescribe that drug for a completely different purpose in a completely different type of patient. This is called off-label drug prescribing. Gender transition treatments are off-label. Off-label prescribing is legal but may constitute malpractice in some cases.

The FDA regulates drug labeling. It could require drug companies to change their drug labels to indicate that gender transition treatment are not FDA-approved uses of drugs and may carry significant risks. The FDA, National Institute on Drug Abuse or other federal or state agencies could create web pages, advertisements, K-12 school presentations, and other ways to inform patients and parents about the risks of transition.

Other federal and state entities, such as state medical licensing boards, do regulate drug prescribing and medical practices. They could and should take steps to curb harmful and unnecessary transition treatments. A list of suggested steps is here.