Endocrinologist reveals the disturbing truth about "gender-affirming care" (Dr. Michael Laidlaw)

We just had a great fourth of July in our corner of California, but I couldn't help thinking, you know, what would the founders think about what's happening today? What would they think if someone couldn't define what a woman is or what a man is, or that you could give chemicals they didn't know about hormones to magically transform someone from a boy into an adult woman or a girl into an adult man? Thank you. Again, I was first really took a deep dive into this when this book, if you've heard of it, I Am Jazz, was read to kindergartners in our local school system, and a parent urged me to read it as an endocrinologist, and this is a propaganda book geared towards very young kids, kindergartners, and elementary school, and I found at least a couple of things that were untrue claims in there, that a boy could be born with a girl's brain, that a doctor could somehow diagnose a child as being transgender, and there was a lot of information missing about types of medical harms that can happen with this treatment. So today, I'm going to talk about what is gender dysphoria a little bit, how normal human sexual development works, what is gender affirmative therapy, hormones and such, who are the major promoters, you've heard a lot about that, I'll go through that a little bit, nations and states that have turned away from this care, and about suicide, deaths, and a conclusion. What does all this hinge upon? I think Dr. Grossman covered this well, objective biology versus subjective feelings. So gender identity is an internal feeling of being a boy, a girl, or some variation. Gender dysphoria is a legitimate psychological diagnosis found in the DSM-5, with an extreme discomfort with one's sex and perceived gender, leading to significant distress and impairment of functioning, lasting at least six months. And it's important to know that depending on which study you look at, so long as kids aren't interfered with with hormones, the majority, 50 to 98 percent, will desist or grow out of this by adulthood. Also important to know is that many of these people, as you've heard today, have other coexisting psychological comorbidities, such as anxiety, depression, or autism, or self-harm. Now, as an endocrinologist, I provide hormones to people. Hormones are very powerful medications that alter body and mind. And so if I'm going to give insulin to a patient, I'm going to make sure I have some objective evidence of diabetes. I want glucose results. If I'm going to refer a patient for a thyroid cancer, I want a biopsy to show me for sure that this person needs this treatment. So we're going to radically alter, as I said, people's bodies, kids' bodies, with hormones. How can I prove that this person is transgender? Where do I find the gender identity? Can you do a CAT scan, or an MRI, or chromosome testing, or other testing? And the answer is you cannot. Again, there are only two sexes, in case you missed that earlier. Sperm comes from your father, an egg from your mother, and there are no other gametes out there. There aren't 14,000 other gametes. There's only two to make you and all of us. You can look in chromosomal evidence that's found in all cells with nuclei in your body, an XX for a female, XY for a male, and these cause different processes to occur, and sometimes in a sex-specific way within cells. During normal development, you actually develop your reproductive track in organs around weeks 8 through 12, and so there are primitive tubules. In the beginning, you have some that could become a male and some that could become a female, but what happens is you develop into one or the other, and those other tubules are completely eliminated, which means that you can go down one track or the other, but you cannot cross tracks later. We don't have any medical way of doing that. Again, sex is identified at birth. You can do it as an adult, as a four-year-old. They could look at their little brother or sister and it's not assigned at birth. No one flips a coin or pulls out a lotto ball. This is a male or a female. It's very easy to identify. There are people with disorders of sexual development, which is outside of the scope of this and really not relevant here, but it doesn't make any different sex. It's just a disorder of sex development. I'm going to talk about what I call gender-affirmative therapy, which really has four phases, one or more of the social transition, puberty blockers, cross-sex hormones or opposite-sex hormones, and surgical modifications, which you'll hear more from Dr. Lappard. Doctors and pediatricians and doctors can examine patients and find out what stage of pubertal development they're in by looking at what we call Tanner stages. Tanner 1 is the undeveloped prepubertal person, and Tanner 5 is an adult, fully adult, reproductive organs are present and fully developed. Stages 2 through 4 are various in-between stages of development. It's important to know here for our purposes that around Tanner stage 4, sometimes 3, that's when fertility is established. Now, all of this amazing process is under the control of glands, one being the pituitary, which is a small piece-sized shape organ in your brain. That activates the testicles to make testosterone or the ovaries to make estrogen, and that rolls into place all the processes for developing puberty. Now, sometimes persons can develop conditions where they have problems with this communication and it stops puberty or they may not begin puberty, and this is diagnosed and treated by endocrinologists. But other types of medications, such as Lupron, which you may have heard of, can also chemically interfere with this process and stop puberty. Now, this has legitimate uses in central precocious puberty for very young kids, say they're age 3 or 4, who go through puberty early, but there's no FDA approval and there's no good evidence, as you've seen, for using this for the purpose of gender transition. And as you might imagine, blocking puberty blocks this normal advancement and normal advancement of fertility. So, different side effects of blockade of normal puberty. In the male, you'll stunt penile and testicular growth, which makes future surgeries problematic. Sexual dysfunction, as you might imagine, impairment of erection, orgasm, ejaculation, prevention of sperm production. In both sexes, you'll have disruption of normal brain development, which occurs under the influence of hormones, and disruption of normal bone development. In the female, if you stop puberty at an early stage, as recommended by WPATH and Endocrine Society, Tanner Stage 2, you'll develop an early menopause-like state with blockade of normal breast development, decreased blood flow to vagina and vulva, sexual dysfunction with thinning of vaginal epithelium, vaginal atrophy, anorgasmia, problems with orgasm, and, of course, interferes with menstruation and infertility. And you'll hear more about infertility from Ms. Lal later. You can also read labeling and note that there's many neuropsychiatric effects of puberty blockers right on the labeling. And this is ultimately, for many, a pathway towards sterilization because first you've impaired or perhaps destroyed sex organs with these medications, and then many, particularly from earlier studies, go on to have their testicles or ovaries removed, which is complete sterilization. Now, I just want to talk a little bit about bone development. So, the pubertal phase and up through the 20s is an important time for developing bone and bone density. And so, you can see at the bottom here, kids and adults ages and years and bone density. And you can see a rapid increase in both males and females, you know, from a 10-year-old to late 20 years. What happens with puberty blockers is that relative to their peers, they cannot put down as much bone and end up with a lower bone density than you would otherwise expect. And so, there's this flat lining of bone density, which is important because this can lead to risk of osteoporosis and debilitating fractures when a person is older. Now, taking cross-sex hormones after may mitigate some of these effects. But again, as you'll see, that is not a healthy way to go either. Here is a female who had undergone mastectomy surgery. And you can see evidence of what we call hyperandrogenism or high testosterone levels. You can see the abdominal hair, facial hair. And I just want to show you, and I think this was covered earlier, but the normal female range of testosterone, and females make testosterone as well, is 10 to 45, 10 to 50 in blue there. But in the orange is what they're recommending for this gender transition, some 6 to 100 times higher than normal female levels. And this leads to multiple risks, increased risk of heart attack and death due to cardiovascular disease, high red blood cell counts, potential liver dysfunction, as you heard earlier with Kayla, hypertension, various potential risks for the reproductive tract, ovarian, breast, uterine cancer, some of that still being worked out. Of course, hirsutism or hair growth, deepening of the voice, sexual dysfunction, infertility. This is a controlled substance and it's being used off-label. And this is important because this is data from a paper about the Food and Drug Administration adverse event reporting. And I want to note the similarities to anabolic steroid abuse, in which we've written in a paper actually a comment. So in the adverse event reporting, they found evidence of aggression, anger reported, euphoria, depressed mood, dissociative identity disorder, affect-lability, emotional disorder, antisocial, self-destructive behavior, homicidal ideation, suicidal ideation. And many of these are similar as to what can be found in anabolic steroid abuse. Now let's talk about estrogen. Using estrogen in very high doses, maybe 2 to 40 times higher than the normal estrogen levels of males. This leads to, and Dr. Schwartz has a great paper and company about this, increased risk of, again, heart attack and death due to cardiovascular disease, thromboembolism risk, 2 to 5 times increased risk of blood clots, deadly blood clots, possible stroke risk, high triglycerides. The breast cancer risk in males, and males can get breast cancer, has increased some 22 to 46 times, depending where you look, benign tumors of the brain, prolactinomas, germ cell neoplasms, or other possibilities. Endocrine Society is an otherwise legitimate medical organization. I have been a member since 2006. They do great work except in gender stuff. They wrote guidelines in 2009 and 2017. Nine out of the 10 authors of this 2017 guideline were WPATH or WPATH-affiliated. So I've often been asked, you know, why are medical organizations following, you know, this sort of treatment? And I think it's because WPATH early on in 2009 got involved and recognized, why not use the Hormone Association to legitimize what we're doing? Systematic reviews of evidence have been done, and common themes in looking at this is that limited high-quality evidence for most interventions, primarily low-quality, problems with methodology, small sample sizes, lack of control groups, a lack of long-term follow-up, mental health benefits unproven. And so many nations have turned away from this, including the UK. There's Dr. Hilary Kass you heard about earlier. And we have our own HHS report, which is still under peer review, but in many ways expands on the Kass report and is very extensive and worth a read. I want to talk finally about death in this sort of treatment paradigm, because that's the ultimate thing that physicians are trying to prevent. And now, if you look at back in 2011, a study was published looking at the entire nation of Sweden, general population compared to some 300-plus persons who had gotten hormones and surgeries. And so you can see time in years across the bottom and survival with 100% at the top. And the top two continuous lines are males and females in the general population. And if you look at the dashed lines, that shows what they call trans males and trans females, how their survival dropped off rapidly after 10 years. In fact, there was nearly three times the all-cause mortality rate and 19 times the rate of completed suicide. Now, what about children and young people? This is Dr. Johanna Olson-Kennedy, who you heard about earlier, gender clinician and researcher at Children's Hospital Los Angeles. And here's a quote you've heard what she tells parents. We often ask parents, would you rather have a dead son than a live daughter? Which is quite a claim in a way. It's a question, but it's also a claim that if your kid receives these hormones, they're going to live, though they may be different gender than you had thought. And if not, they will die by suicide, which if true, would be maybe an important way to discuss this. But if not true, it would be seen as, in my opinion, extreme form of coercion. And Jane Robbins is attorney and author. She alerted me early on to a study from the NIH, NIH-funded study. And we looked for more information using FOIA requests to NIH. The title of this now 10-year NIH study is The Impact of Early Medical Treatment on Transgender Youth. There's four sites, academic institutions across the country. And so they were looking at two arms, a puberty blocker arm, starting puberty blockers at a very early age, say eight for girls or nine for boys, and monitoring the effects over two years. And also cross-sex hormones starting at age 13, though that was lowered later. And they were studying mental health, psychological well-being, metabolical and physiologic parameters, bone health, and so forth. Now, we found information on that around 2018. And in 2019, one of my colleagues, Dr. Will Malone, who is also an endocrinologist, and my colleague Hachi Horvath of epidemiology, wrote a letter to the Office of Human Resource Research Protections asking for a moratorium on this study because of all the things I mentioned earlier, which would clearly happen. We stated, we contend that neither children nor their parents can meaningfully consent to permanent infertility or other potentially serious medical harms to treat a non-medical condition. We question whether these parents were fully informed of the health risks or the possibility of tragic regret. We received a reply from NIH basically stating that they would not have a moratorium, that that would only stop the data collection in any ways these parents were informed of what would happen, and they weren't going to do anything about it. Now, in 2023, a study was published in New English Journal of Medicine with the cross-sex hormone outcomes, or at least some of them, of 315 patients who were given this treatment of cross-sex hormones. And the most common adverse event was actually suicidal ideation on 11 participants. And two kids or young people actually died by suicide, which is, I thought, that's what we were trying to prevent with this, weren't we? Now, in medicine, it's been common practice for centuries to do autopsies of patients, especially people with rare or unusual conditions, and compare that with their clinical course during life to advance what we know about different things. For example, adrenal insufficiency is one thing I know about where they had done that. So in the New England Journal, what did you find about these deaths? Well, nothing really. It's just a statistic. Were they males or females? We don't know. What were their ages? We don't know. What were their psychological care leading up to that? What were their diagnoses? Were autopsies performed on the study subjects? If not, why not? What were their testosterone levels, or estrogen, or progesterone, or blood levels? What did the first responders' reports say? None of this is known at this time, so information is being concealed, in my opinion, and so the first participant was enrolled in this study in 2016. We wrote our letter in 2019, and then the New England Journal published this data in 2023, and I was quite surprised because we had been following yearly progress reports and never found, I never saw, that death was mentioned. So it was concealed until our wonderful attorneys in the state of Alabama subpoenaed HHS documents in late 2023 and found out the first death actually occurred way back in 2017, before we had written our letter, and I could not find any information about the second death. Now, someone we do have information about, many of you probably know about, Jallie Martinez and her mom, Abigail Martinez. The only reason we know about her case is because her mom has been very outspoken about it. Jallie had depression. She was referred to for gender transition at Children's Hospital Los Angeles because of a school psychologist who said that she needed gender transition, and she was administered testosterone. Her mother relates that the daughter was taken away by the county and placed into foster care. She committed suicide by train in Los Angeles County at age 19. The mom says around 9 30 p.m. that night, she walked in front of the train tracks, facing a train. She went on her knees, raised her arms up, and just laid on the tracks. So, if you want to find out more information of a case report, you could look in your medical journals, right, and find that. No, but you can do a public record request to Los Angeles County Coroner's Office, which is what I did, and found the record. And I don't want to be graphic here, but you can get a picture of it from here. She was identified as a 19-year-old female. Importantly, she had scars on both arms. This was not from a train collision. These were old healed scars from her history of self-harm, and her body was so badly destroyed that mom wasn't even allowed to see the child afterwards. So, we'd like to prevent that from happening. We'd like to prevent other deaths from happening. We'd like to prevent all of the stories we've heard today of young people being severely injured or mutilated from this treatment. Just to know, this is not standard of care. I skipped over that slide, but Endocrine Society even said it. We don't have the technology to turn girls into boys, boys into girls, so kids may believe it. Medications are being used off-label at high doses without proper FDA risk assessment. Multifold harms are evident or predicted. Proper long-term studies haven't been done. Multiple systematic reviews of evidence have found poor quality of evidence of benefit. Young people have been permanently maimed and killed during the course of these treatments. And finally, the WPATH Standards of Care 8 is an extreme document, presents a grave danger to minors, and should not be followed by any clinician or physician. Thank you.