Hormone hoax

We are not being told the truth about gender medicine

Photo by Jakayla Toney on Unsplash

Medicalised gender change for young people has been promoted as “life saving”, but these hormonal interventions can lead to infertility, cutting off life at its very source. And although it’s true that the adolescents in gender clinics come from a vulnerable minority, it’s not the “trans kids” celebrated by so much media coverage. Swedish author and journalist Kajsa Ekis Ekman explains in this extract from her book On the Meaning of Sex, published by Spinifex Press — Bernard Lane

Kajsa Ekman

While the effect of puberty blockers can be reversible when stopped in time, this is not the case when testosterone or estrogen are prescribed immediately after. This sequence is highly likely to lead to life-long infertility. Since sexual maturity is never reached, the body cannot produce egg cells or sperm. One US study of young people prescribed puberty blockers found that none of the participants had taken up options to preserve fertility. 

Endocrinologists are well aware of this — even hormone evangelists like Norman P. Spack who founded America’s first children’s gender clinic at Boston Children’s Hospital in 2007. He claims infertility is a price worth paying:

“When young people halt their puberty before their bodies have developed, and then take cross-hormones for a few years, they’ll probably be infertile. You have to explain to the patients that if they go ahead, they may not be able to have children. When you’re talking to a 12-year-old, that’s a heavy-duty conversation. Does a kid that age really think about fertility? But if you don’t start treatment, they will always have trouble fitting in. And my patients always remind me that what’s most important to them is their identity.”

Consequently, children who first access gender clinics aged ten to 12 and are informed it is completely harmless to hit the pause button on puberty while they explore their identity, are highly likely to begin a journey down a path leading to infertility. Rather than being a chance to stop and catch one’s breath, this supposedly innocuous break from puberty is in fact a fast forwarding to sterilisation.

Sterilisation of trans people is often referred to as a crime of the past, but is in fact occurring as we speak, with sterilisation not of adults but of children and teenagers. How can a ten-year-old possibly make an informed decision about a procedure whose implication is life-long infertility?  

This significant decrease in fertility following use of puberty blockers and hormone treatment has opened up a new market for endocrinologists: IVF for trans people. Several US clinics already offer young women the option of freezing their egg cells prior to commencing testosterone treatment. Once they feel ready to have children, the same clinics provide embryo transplants using surrogates.

It is not only childbirth which is denied to individuals on puberty blockers and hormone treatment. Sexual function and pleasure can both potentially be seriously damaged, too. A boy prescribed puberty blockers at 11 followed by hormones will retain the penis of an 11-year-old for the rest of his life, should he wish to keep it. Many teenagers report their libido disappears completely after these interventions. What happens to these teenagers as adults? Five to ten years later, it is not uncommon to find them at fertility clinics.

In late 2020, I interviewed a physician in the IVF sector who reported having noticed the effects in his field of treatment for gender dysphoria over the course of the previous year. One of his patients was a woman in her 20s who had been unable to conceive. Tests revealed her ovaries contained a higher than expected proportion of connective tissue including several small cysts. Blood tests showed ovarian activity was extremely low and it was unlikely that she would ever be able to conceive. On hearing this, the woman broke down and disclosed she had been treated with puberty blockers and testosterone as a teen at the Anova clinic of Stockholm’s Karolinska University Hospital. She had subsequently decided to return to living as a woman and had been informed by the clinic that the treatment she had undergone would not result in any risks to her fertility.

The physician asked Avona about their follow-up procedures for patients and was told they undertook no long-term tracing at all. “It is completely illogical,” he said. “A drug with equally drastic side effects would not be prescribed without long-term follow-up of patients under any other circumstances. Gynaecology and oncology departments remain in contact with their patients for five to ten years post-treatment. It cannot be claimed that the treatment is harmless when no attempts are made to ascertain whether this is the case.”

The list of adverse effects continues. When it comes to long-term estrogen treatment of men who identify as women, they are five times more likely to suffer from cardiovascular disease. A Danish study of all individuals who had undergone sex change treatment in Denmark between 1978 and 2010 corroborated this, finding an increase in cardiovascular disease. In addition, 9.6 per cent of the participants had died at an average age of 53.5 years. Other common complications of estrogen therapy include depression, anxiety, mood swings and insomnia, which are experienced by more than one in ten users. Swedish trans woman Vanessa Lopez reports:

“I have plenty of regrets. My health has deteriorated, I’ve got brittle bones and my doctor said I’ve got the body of a 93 year old. I’ve got back pain and they still don’t know how the drugs affect your heart. I’m on medication for the rest of my life.”

Upon discovering that the hormone could aggravate mental health issues, the mother of a boy with depression prescribed estrogen by the Anova clinic decided to confront the clinic and record the phone conversation. Anova director Cecilia Dhejne and psychologist Annika Johansson are heard minimising the risks:

Cecilia Dhejne: No, generally speaking estrogen doesn’t cause depression.

Parent: But it is a common side effect?

CD: No.

Parent (consulting medication information leaflet): Estradot, common side effects may occur in one in ten users, so that’s like ten per cent: depression, anxiety, mood swings, insomnia. This is off the [Swedish database of medicines FASS].

CD: Mmh. But Estradot is a medicine and it’s what we prescribe, which we both use in a lot of cases, especially for menopause, over long periods of time.

Annika Johansson: There are a number of issues to explore in more depth. And how one assesses well-being, I mean in treatment of gender dysphoria compared to the slightly raised risk from estrogen and I mean, gender dysphoria itself is really depressing, not being able to express yourself the way you want, or experiencing that constant body dysphoria and so on. So if you can get some kind of respite from that then you could feel better once the gender dysphoria is treated.

Parent: But what about these side effects on the medicine information leaflet for Estradot — the depression and that? Don’t they apply to people with XY chromosomes?

CD: Yes, well, it doesn’t really matter whether one has XY or XX chromosomes, but among endocrinologists and gynaecologists prescribing this medication there isn’t any clinical evidence of significant numbers of patients getting depression.

The clinic managers thus deny the very risks which are so well-documented they appear on the medication information leaflet. Parents who ask about such risks are also fobbed off with statements about “new ground being broken” and, should they disagree with hormone prescription for their child, that the child is a suicide risk.

Behind the trans mask

At first glance, one might think that the patients of youth trans clinics only have one thing in common: that they are trans. However, several studies show a much more complex picture. The vast majority of young people seeking treatment at trans clinics are homosexual or have one or several neuropsychiatric diagnoses. Most come from a highly educated family background and 41 per cent previously identified as gay or bisexual. Almost two-thirds of girls in a British study had previously been diagnosed with a psychiatric or neuropsychiatric illness.

Anorexia is especially common, as are ADHD, depression and trauma. The figures are nearly identical in other countries: 60 per cent of patients at transgender clinics in Sweden and Norway suffer from complex mental health needs. Similarly, a US study found 44 per cent of girls aged three to 12 diagnosed with gender dysphoria who did not undergo hormone treatment turned out to be lesbian or bisexual in their teens. 

A 2011 Dutch study followed up 77 children referred to a gender dysphoria clinic when they were aged eight and obtained similar results: the majority later turned out to be gay or bisexual. This was overwhelmingly true for boys [with early-onset dysphoria], 46 per cent of whom no longer had gender dysphoria in their teens. Around half of the participants later identified as gay and, of those whose gender dysphoria persisted, all were in gay or bisexual relationships. The Dutch researchers were obliged to draw conclusions in complete contradiction of their previous work:

“Most children with gender dysphoria will not remain gender dysphoric after puberty. Children with persistent [gender identity disorder] are characterized by more extreme gender dysphoria in childhood than children with desisting [or self-correcting] gender dysphoria. With regard to sexual orientation, the most likely outcome of childhood [gender identity disorder] is homosexuality or bisexuality.”

‘Feminine’ boys

Several of the male participants had been taken to the clinic due to  feminine behaviour in childhood. Investigations into their gender identity consisted of parents being questioned regarding their children’s play habits and their gender role behaviour patterns. The children were observed at play and required to respond to questions like “Do you think it’s better to be a boy or a girl?” Forty-four boys were identified as ‘feminine’. The study showed that only one of the boys treated continued to identify as a girl, while the others (who never underwent gender reassignment) proved to be gay or bisexual. “Of these 44 feminine boys, only one youth was gender dysphoric at the age of 18” meaning “80% of the feminine boys were either homosexual or bisexual.”

The studies mentioned were all conducted prior to the tremendous increase in teen gender dysphoria. A fundamental flaw is that around 30 per cent of participants [in follow-up studies of childhood-onset dysphoria] did not respond to follow-up questionnaires. Therefore, it is impossible to state with any certainty how each and every former patient felt and why. Yet one thing is clear: it is above all gay children and teenagers who are taken to gender reassignment clinics. Through injections and later surgery, they are made to resemble members of the opposite sex — in other words, made to look heterosexual. The boy who behaves ‘effeminately’ and is taken to a clinic at age eight, is made into a ‘girl’ and probably sterilised in the process. Here are the words of a mother of an 11-year-old boy:

“We gave him the idea. He liked wearing dresses and then we read in the paper that one could be born in the wrong body. We thought we were helping him. We didn’t understand that it would lead to this. We confused being feminine with being a girl.”

Pressure can also be exerted by schools and wider society, as experienced by the parents of an American primary school pupil who loved princess dresses, swords, pokemon and his long blond hair. They received a phone call from the school’s principal in which they were informed that “Sam needed to choose one gender or the other, because kids could be mean. He could either jettison his pink Crocs and cut his hair or socially transition and come to school as a girl.”

Society appears provoked in particular by boys behaving ‘effeminately’. While girls who play with boys are often considered strong and independent, there is apparently something unsettling about unmasculine boys.

Advocates of gender reassignment in children often liken their campaign to the struggle for gay rights, since this provides a ready-made narrative about an oppressed sexual minority fighting for recognition. As the narrative goes, the oppressed minority meets resistance from conservative and religious groups, but tolerance eventually triumphs and society at large understands all people must be accepted as they are.

Fifty years of struggle by the gay rights movement has paved the way and trans people are thus merely the next group in line expected to tread the same path. What gay people went through in the past, the reasoning goes, trans people are going through now. This is merely history repeating itself. With the discourse thus presented, the crux becomes about being on the ‘right side’ of history — and there is no doubt what that entails: upholding everyone’s right to ‘be themselves’.

The analogy between gay and trans has been successfully ingrained into our collective consciousness. Remember the gay rights struggle? This is exactly the same! Questioning hormone treatment for children is thus equated with opposition to Pride marches and marriage equality.

However, whereas the gay rights movement fought for the right to be oneself against pathologisation and medicalisation, transactivists now struggle in favour of medicalisation — most often of the very same gay people. Thus, what is being portrayed as one and the same struggle is in many instances in fact the polar opposite. When three-year-old Jazz Jennings’ parents, who took him to a doctor because he liked wearing dresses, were told he ought to start hormone treatment soon and later have his penis removed, he was not being ‘accepted as he is’. Rather, he was being labelled as flawed on the basis that a boy should not wear dresses.

Thus feminine, possibly gay, boys are being transformed into heterosexual girls. Gender incongruence is currently considered a medical condition in need of treatment. ‘Feminine’ young boys who like wearing dresses, experimenting with different hairstyles, putting on dance performances at home and do not take an interest in football are being sterilised. 

Girls who are uninterested in cosmetics, like football and fixing cars and sit with their legs uncrossed are, in turn, being rendered infertile. Is this not in reality a form of gay ‘conversion therapy’ where medical practitioners diagnose gay and lesbian people as deviant and reassign them as heterosexual — the price being sterilisation? What if history really is repeating itself, only the other way around, with the activists of the past doing a 180 degree turn? What if lazy thinking, guilt-by-association and intense lobbying has made the gay rights movement fight against — gay people themselves?

This is an edited extract from a new book ‘On the Meaning of Sex: Thoughts About the New Definition of Woman’ ($A39.95, Spinifex Press) by Kajsa Ekis Ekman, with translation from the Swedish by Kristina Mäki