Gender affirming care is not just for trans people, it should be available to everyone. While I can understand the unknown worries with studies only being done on older men, this is a clear sign that research on younger men should be prioritized.
When I was first prescribed my own hormone therapy as a trans woman, it was made quite clear that there was not a large body of research done on the long term effects. Which was an acceptable risk to improve my life drastically. It’s called informed consent, cis men and women deserve the same choice. Just as men do with hair implants or women getting breast implants.
Bodily autonomy should always be the final word. It’s their body, so it’s their choice.
We do indeed treat cisgender men who have low testosterone with testosterone, as endocrinologists do with transgender men. And the treatment goals for both groups are essentially the same widely accepted testosterone ranges that we would expect to find in a large group of healthy cisgender men.
However, there is a big problem of inappropriate testosterone use among young men. Many start taking testosterone taken illegally, elevating their blood levels far above the highest levels a healthy human body can produce, to the point where it is dangerous to their health. This actually causes a feedback loop where the body stops producing its own testosterone, causing levels to crash when they stop taking it. So they start “cycling” with medications used for female infertility, breast cancer, or menopause that have never been tested in men to try to mitigate that, all based on pseudoscientific nonsense theories that circulate widely on the internet. I’ve then gotten several of these patients in my office with crashing testosterone asking me to prescribe HRR, which of course will only extend the problem by continuing to suppress the body’s natural testosterone production.
There is also a big problem of people going to doctors with symptoms that could be caused by 100 different illnesses, who have convinced themselves that only testosterone could be the cause. They go to shady doctors who don’t care enough about the person to investigate the symptoms properly, and then just prescribe testosterone without doing any testing. Or they do some testing, find the testosterone is low, but don’t do any follow-up to figure out why it’s low. Which is frustrating because there are very clear guidelines based on extensive scientific data that are being ignored in exchange for easy money from patients.
While I agree that autonomy is important, I disagree that it should “always be the final word.” What if someone came up to you and said they have decided they need opioids for their pain, but they can’t afford them, so they want you to go rob a pharmacy and give them some? Would you do that in the name of bodily autonomy? Of course not: your bodily autonomy is yours. You can’t expect to go to someone else and ask them to do something they know is unethical, illegal, and/or potentially dangerous in the name of your bodily autonomy.
The guiding principle of medicine is “Do no harm.” Because of this, we as doctors have an ethical and legal obligation to protect patients from harm that we cause. You cannot expect to go to your doctor and ask them to do something they know is unethical, illegal, and/or potentially dangerous in the name of your bodily autonomy.
I’m happy to prescribe testosterone to my patients who need it. But I draw the line at people who want it without needing it, especially if they want dangerously large amounts, because I know the harm this med can cause if not taken correctly. So while that person might very well get testosterone elsewhere if I say no, I personally am not going to be a party to it.
Which is why people should also have safe, reliable options to terminate their lives, when they no longer want to exist. Or is that the bridge too far?
I certainly don’t think so. The right to live as you please should also extend to not live as you please. However just as we should make knowledgeable medical professionals available to those seeking gender or reproductive care, we should do the same seeking of life care.
I get regular blood tests to ensure medication is working as intended, so mental health screening should be applied to those suffering from depression or other mental health issues to ensure that their given adequate alternatives. While still remaining available to those suffering chronic conditions that significantly affect quality of life. I am also a disabled person who live in persistent pain without a clear end date. Who is to say when exactly another person life suffering should be extended purely for the sake of extending life irrespective of the quality?
At the end of the day, bodily autonomy is the ideal but informed consent given by medical professional about risks and alternatives is the method.
I agree with informed consent and bodily autonomy, that seems like a great ethical foundation - but one downside might be in not preventing harm done when people duped by mannosphere social media influencers pushing pseudo-science claims about testosterone ask their doctor for testosterone therapy. The clinical value of hormone therapy for trans individuals is well grounded in empirical research, but testosterone therapy for healthy, young cis-men is not based on clinical benefits.
There clearly needs to be some counter-measure to misinformation about testosterone therapy, this is not like trans healthcare.
There clearly needs to be some counter-measure to misinformation about testosterone therapy, this is not like trans healthcare.
The main hurdle to trans healthcare is simmiliar misinformation spread by those same type of manosphere or evangelical actors. Many will say that trans folk receiving care are simmiliarly brainwashed or misinformed. I don’t see value in a 3rd party saying a patient is receiving care from a doctor for the" wrong" reasons.
Disinformation will always exist, especially among the general public. Which is the exact reason informed consent and a knowledgeable health professional explaining the risks is so important. It’s not our place to say another is misguided in the persuit of reproductive or gender affirming care.
Of course a third party can claim a trans patient is seeking care for the wrong reasons, or that their care is actually harmful, etc. - but we have to remember that we can still parse claims and test them against reality.
Doctors have a moral and legal obligation to practice evidence-based medicine, and they should not take seriously pseudo-science fad treatments that are contrary to the well-being of the patient. It is their place to deny a patient such a treatment.
That said, because transphobia in our society has resulted in gatekeeping and withholding gender-affirming care from trans patients for so long (including my own care!), it is hard for me not to agree with you: the patient should be free to make choices about their body. I believe hormones should be accessible over the counter, without a required prescription.
But again, this rights-based approach and desire for radically free access to hormones has downsides, namely the harm done if there isn’t anything done to mitigate something like this testosterone therapy fad.
I think we agree that one solution is that a doctor can provide informed consent, but I think this is too much responsibility on doctors to combat misinformation campaigns. As a society we are having to come to terms with how destructive misinformation can be, and what needs to be done to combat it. I actually have no idea how to best solve this, even if I can see that it is naive to expect a single visit with a doctor to deprogram an incel from their ideology or adequately protect them from starting a needless and harmful treatment.
Gender affirming care is not just for trans people, it should be available to everyone. While I can understand the unknown worries with studies only being done on older men, this is a clear sign that research on younger men should be prioritized.
When I was first prescribed my own hormone therapy as a trans woman, it was made quite clear that there was not a large body of research done on the long term effects. Which was an acceptable risk to improve my life drastically. It’s called informed consent, cis men and women deserve the same choice. Just as men do with hair implants or women getting breast implants.
Bodily autonomy should always be the final word. It’s their body, so it’s their choice.
As a family doctor, I agree with you somewhat.
We do indeed treat cisgender men who have low testosterone with testosterone, as endocrinologists do with transgender men. And the treatment goals for both groups are essentially the same widely accepted testosterone ranges that we would expect to find in a large group of healthy cisgender men.
However, there is a big problem of inappropriate testosterone use among young men. Many start taking testosterone taken illegally, elevating their blood levels far above the highest levels a healthy human body can produce, to the point where it is dangerous to their health. This actually causes a feedback loop where the body stops producing its own testosterone, causing levels to crash when they stop taking it. So they start “cycling” with medications used for female infertility, breast cancer, or menopause that have never been tested in men to try to mitigate that, all based on pseudoscientific nonsense theories that circulate widely on the internet. I’ve then gotten several of these patients in my office with crashing testosterone asking me to prescribe HRR, which of course will only extend the problem by continuing to suppress the body’s natural testosterone production.
There is also a big problem of people going to doctors with symptoms that could be caused by 100 different illnesses, who have convinced themselves that only testosterone could be the cause. They go to shady doctors who don’t care enough about the person to investigate the symptoms properly, and then just prescribe testosterone without doing any testing. Or they do some testing, find the testosterone is low, but don’t do any follow-up to figure out why it’s low. Which is frustrating because there are very clear guidelines based on extensive scientific data that are being ignored in exchange for easy money from patients.
While I agree that autonomy is important, I disagree that it should “always be the final word.” What if someone came up to you and said they have decided they need opioids for their pain, but they can’t afford them, so they want you to go rob a pharmacy and give them some? Would you do that in the name of bodily autonomy? Of course not: your bodily autonomy is yours. You can’t expect to go to someone else and ask them to do something they know is unethical, illegal, and/or potentially dangerous in the name of your bodily autonomy.
The guiding principle of medicine is “Do no harm.” Because of this, we as doctors have an ethical and legal obligation to protect patients from harm that we cause. You cannot expect to go to your doctor and ask them to do something they know is unethical, illegal, and/or potentially dangerous in the name of your bodily autonomy.
I’m happy to prescribe testosterone to my patients who need it. But I draw the line at people who want it without needing it, especially if they want dangerously large amounts, because I know the harm this med can cause if not taken correctly. So while that person might very well get testosterone elsewhere if I say no, I personally am not going to be a party to it.
Thank you, you are communicating my concerns much better than I am!
Funny how complicated people make this very simple concept
Which is why people should also have safe, reliable options to terminate their lives, when they no longer want to exist. Or is that the bridge too far?
I certainly don’t think so. The right to live as you please should also extend to not live as you please. However just as we should make knowledgeable medical professionals available to those seeking gender or reproductive care, we should do the same seeking of life care.
I get regular blood tests to ensure medication is working as intended, so mental health screening should be applied to those suffering from depression or other mental health issues to ensure that their given adequate alternatives. While still remaining available to those suffering chronic conditions that significantly affect quality of life. I am also a disabled person who live in persistent pain without a clear end date. Who is to say when exactly another person life suffering should be extended purely for the sake of extending life irrespective of the quality?
At the end of the day, bodily autonomy is the ideal but informed consent given by medical professional about risks and alternatives is the method.
They prefer to make it harder on these people…
You wouldn’t want to lose a perfectly exploitable wage slave.
I agree with informed consent and bodily autonomy, that seems like a great ethical foundation - but one downside might be in not preventing harm done when people duped by mannosphere social media influencers pushing pseudo-science claims about testosterone ask their doctor for testosterone therapy. The clinical value of hormone therapy for trans individuals is well grounded in empirical research, but testosterone therapy for healthy, young cis-men is not based on clinical benefits.
There clearly needs to be some counter-measure to misinformation about testosterone therapy, this is not like trans healthcare.
The main hurdle to trans healthcare is simmiliar misinformation spread by those same type of manosphere or evangelical actors. Many will say that trans folk receiving care are simmiliarly brainwashed or misinformed. I don’t see value in a 3rd party saying a patient is receiving care from a doctor for the" wrong" reasons.
Disinformation will always exist, especially among the general public. Which is the exact reason informed consent and a knowledgeable health professional explaining the risks is so important. It’s not our place to say another is misguided in the persuit of reproductive or gender affirming care.
Of course a third party can claim a trans patient is seeking care for the wrong reasons, or that their care is actually harmful, etc. - but we have to remember that we can still parse claims and test them against reality.
Doctors have a moral and legal obligation to practice evidence-based medicine, and they should not take seriously pseudo-science fad treatments that are contrary to the well-being of the patient. It is their place to deny a patient such a treatment.
That said, because transphobia in our society has resulted in gatekeeping and withholding gender-affirming care from trans patients for so long (including my own care!), it is hard for me not to agree with you: the patient should be free to make choices about their body. I believe hormones should be accessible over the counter, without a required prescription.
But again, this rights-based approach and desire for radically free access to hormones has downsides, namely the harm done if there isn’t anything done to mitigate something like this testosterone therapy fad.
I think we agree that one solution is that a doctor can provide informed consent, but I think this is too much responsibility on doctors to combat misinformation campaigns. As a society we are having to come to terms with how destructive misinformation can be, and what needs to be done to combat it. I actually have no idea how to best solve this, even if I can see that it is naive to expect a single visit with a doctor to deprogram an incel from their ideology or adequately protect them from starting a needless and harmful treatment.