Comment by floatingatoll | Hacker News Reader

Comment by floatingatoll | Hacker News Reader

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.

Source on the sterility?

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.

>This doctor must lose their medical license for life.

Maybe his freedom for life?

> 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.

>>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

Parent is responding to the sentence they quoted at the top of their comment.

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.

Do you have a source for encouraging the prescription of children to have hormone replacement therapy? All I’ve seen are puberty blockers myself.

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.

Yeah I've taken a lot of estrogen at this point and I was never required to sign anything...

Agree that people who call themselves "men" typically don't sign up for titty skittles.

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 :(

https://www.wpath.org/publications/soc

ps. "Estrogen. Little, Blue, Different."

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.

It's always going to be confusing but I believe "transgender woman" is unambiguously someone assigned male gender at birth who identifies as a woman.

What if a biological male is assigned female gender at birth? Would they be transgender, or just female?

1. When is that going to happen? (Genuinely curious if it does happen)

2. It is really up to the person.

Regarding 1:

https://www.bbc.com/news/magazine-34290981

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.

This is a bit off-topic, but "at birth" is a seriously wrong phrasing - they were assigned that phenotypical gender well before birth.

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.

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.

Simply replacing “men” with “people” in that sentence would work fine.

You could say "people with male/masculine bodies" or you could specify you mean sex rather than gender.

"transgender women pursuing medical transition" or "transgender women pursuing HRT" would both be accurate and non-confusing options in that sentence.

> Would it be offensive to say "a person with an x and y chromosome"?

AMAB is politically neutral and unambiguous.

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.

you're really quite sure that trans women are not offered estrogen?

Trans men are not offered estrogen. Which is what the parent is saying.

trans men are born female who are male. why would you give them estrogen

Exactly

Trans women are offered estrogen, of course. Neither cis nor trans men are normally prescribed estrogen.

what is your point, why would you give estrogen to a straight male or a born female who identifies as male?

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:

https://eje.bioscientifica.com/downloadpdf/journals/eje/181/...

They're offered estradiol, not estrogen.

I think we're agreeing vehemently. But I'm not sure. To be clear, since trans women are women, "men" doesn't refer to trans women.

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.

People on feminizing HRT.

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.

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