DES - transgenderism and birth defects

Washington Post
The Washington Post reports that "DES was the biggest nostrum in quackery since snake oil . . . the medical community looked the other way. They didn't want to admit the mistake they made."

The DES debacle demonstrates the harm caused by the medical community when it fails to abide by the precautionary principle--"First, do no harm." Prescribing drugs without definitive evidence of their safety is irresponsible. The DES case should serve as a lesson: it's adverse effects are long-lasting, indeed they affect the health of women who took the drug during pregnancy, their daughters, and, it turns out, they affect the health of their sons and grandchildren.

The daughters of mothers who took DES "suffered malformed reproductive organs, which would later lead to increased infertility, tubal pregnancies and miscarriage, effectively robbing many of the chance to bear their own children." Furthermore, "Exposure to the drug also harmed male children, who face an increased risk for epididymal cysts -- non-cancerous growths on the testicles -- and varicose veins on the testicles."

Today, public officials--including the FDA and NIMH--and the medical community are similarly complicit in their failure to protect children and fetuses from the hazards posed by mind altering drugs. SSRI antidepressants are being prescribed recklessly to pregnant women and millions of previously healthy children.

The DES case demonstrates the tragic consequences of prescribing drugs whose benefits are not proven, but whose early adverse effects can be detected, and whose future long-lasting adverse effects on the developing brain and nervous system can be foreseen. FDA's failure to protect children and unborn fetuses is irresponsible.
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Center for Disease Control
Diethylstilbestrol (DES) is a drug once prescribed during pregnancy to prevent miscarriages or premature deliveries. In the U.S. an estimated 5 to 10 million persons were exposed to DES from 1938 to 1971, including pregnant women prescribed DES and their children. In 1971, the Food and Drug Administration (FDA) advised physicians to stop prescribing DES because it was linked to a rare vaginal cancer.

After more than 30 years of research, there are confirmed health risks associated with DES exposure. However, not all exposed individuals will experience DES-related health problems. Whether you know for sure or suspect you were exposed to DES, you can use CDC's DES Update to learn more about DES exposure and what you can do about it.

CDC - FOR MORE INFORMATION



What is DES?

Diethylstilbestrol (DES) is a synthetic estrogen that was developed to supplement a woman's natural estrogen production. First prescribed by physicians in 1938 for women who experienced miscarriages or premature deliveries, DES was originally considered effective and safe for both the pregnant woman and the developing baby.

In the United States, an estimated 5-10 million persons were exposed to DES during 1938-1971, including women who were prescribed DES while pregnant and the female and male children born of these pregnancies. In 1971, the Food and Drug Administration (FDA) issued a Drug Bulletin advising physicians to stop prescribing DES to pregnant women because it was linked to a rare vaginal cancer in female offspring.

More than 30 years of research have confirmed that health risks are associated with DES exposure. However, not all exposed persons will experience DES-related health problems. CDC's DES Update has more information about the health risks associated with DES exposure.
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Scientific Physical 
Proof Of Transsexualism
Transsexualism and sex changes through Chemistry Articles 


Pubertal blockade safe for pediatric patients with gender identity disorder


Pubertal blockade can safely be initiated in pediatric patients who experience gender identity disorder, according to researchers at the Canadian Pediatric Endocrine Group 2012 Meeting. With exposure to hormones such as estrogen or testosterone later in their adolescence, these patients will experience normal metabolic processes.
“If kids are persisting at puberty [about the need to be the other gender], they will almost always persist,” said Daniel Metzger, MD, FRCPC, a pediatric endocrinologist at BC Children’s Hospital in Vancouver, British Columbia, Canada, and a clinical professor, division of endocrinology in the department of pediatrics, University of British Columbia in Vancouver.
Metzger spoke about the endocrine management of transgender youth and said pediatric patients who experience gender identity disorder require watchful management to reduce the risks for suicidality, depression, drug use and eating disorders, which are often secondary to gender identity disorder.
“These issues are frequently dealt with if patients can get on the road to transition,” Metzger said, noting that parental support is key in making the transition smooth.
Patients will undergo counseling and therapy if they express a desire to transition from male to female or female to male to ensure they are serious about their desire, he said.
“The effect of the puberty-blocking drugs is reversible,” Metzger said. “If they change their mind, they would come off the (puberty-blocking) drugs and enter puberty.”

American Psychiatric Association Calls for Improved Access to Transition Related Care


Even though transition-related medical procedures are medically necessary for many transgender and gender variant patients, they are often denied the care they need simply because of who they are. Today the American Psychiatric Association (APA) is calling for the elimination of barriers to access for transgender people.
According to the APA, the relentless discrimination transgender people face in virtually every aspect of life – from the workplace to adoption rights to public accommodations – makes it all the more important to ensure transgender individuals have access to high quality health care. In doing so, the APA joins other leading organizations like the American Medical Association and the American Psychological Association in pushing back against the harmful rhetoric that can too often drive discrimination.
The move also reflects the growing momentum within both the business and medical communities to provide more affordable, higher-quality access to care. For example, HRC’s Corporate Equality Index now rates companies on whether or not their health insurance options cover transition-related care. The business community has responded: in the very first year this criterion was added, the number of companies offering fully inclusive health benefits jumped from 85 to 206, a 144 percent increase.
HRC’s Healthcare Equality Index highlights this need for access to culturally competent healthcare for transgender people as well. The HEI helps medical facilities ensure they have the knowledge, skills, and resources to care well for their LGBT patients and their families. It also offers patients access to important resources, like finding a LGBT-friendly healthcare provider or having conversations about gender identity or sexual orientation with a doctor.
Learn more from the APA on both access to care for transgender patients, and the discrimination they too often face.
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What is Too Much Liposuction?

Excessive amounts of surgical trauma can be regarded as toxic to patients. Increasing doses of liposuction-induced surgical trauma produce increasing risks of toxicity in the form of surgical complications. It is not possible to precisely identify the threshold for dangerous amounts of liposuction. However, one can be certain that removing 6 to 9 liters of fat on one day is many times more dangerous than removing 2 to 3 liters of fat on each of three separate surgeries spaced at least one month apart.

Liposuction of 5% of the body's subcutaneous surface area is obviously safer than liposuction of 40% of the body surface area. Cosmetic surgery is not emergency surgery, liposuction patients should not be exposed unnecessary risks of excessive liposuction on a single day.

Excessive liposuction is not safe. This patient had too much liposuction on a single day resulting in gross irregularities of the skin. The goal of liposuction should not be to remove the maximum amount of fat, but rather to achieve the best cosmetic results. Mega liposuction is never necessary and often it is dangerous.
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Primary Care Protocol for Transgender Patient Care

This is an excellent document with links to many areas needed by transgender patients
www.transhealth.ucsf.edu

LINK TO: 
Primary Care Protocol for Transgender Patient Care


The Top 10 Things Trans People Should Know About the New Standards of Care

WPATH standard of care
The Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People by the World Professional Association for Transgender Health (WPATH-SOC) are the most widespread SOC used by professionals working with transsexual, transgender, or gender variant people.
The latest revision was released September 25th, 2011. 
WIKIPEDIA ARTICLE

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The World Professional Association for Transgender Health (WPATH)
today (September 25th, 2011)released a newly-revised seventh edition of its Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People. 

The revised Standards of Care are a critical resource for providers, healthcare consumers, and advocates, and are a step forward in ensuring that transgender and gender non-conforming people receive high quality care individualized for their needs.
Significant features of the new edition include:
  • Recognition that gender nonconformity in and of itself is not a disorder.
  • Strong affirmation that attempts to change a person’s gender identity through “reparative” therapy are ineffective and unethical.
  • Strong affirmation that transition-related treatments such as hormone therapy and surgery are medically necessary for many individuals and should be covered by insurance.
  • Continued emphasis on the individual nature of transition-related care and the flexibility of treatment guidelines.
  • Additional guidance on the treatment of adolescents and children, including guidelines for puberty-delaying treatment.
  • Near elimination of the “real-life experience” requirement as a prerequisite criteria for medical transition in adults, with the exception of some genital surgeries.
  • Discussion of a wider range of treatment options, including voice and communication therapy.
  • Discussion of the preventive care needs of transgender people.
  • Clarification that the Standards of Care should be applied in their entirety to those who are incarcerated or otherwise living in an institutionalized setting.
  • A call for health professionals to advocate not only for their patients – for example by helping them obtain updated identity documents – but also for larger policy and legal reform promoting tolerance and equality.
The revised Standards of Care represent a step forward in ensuring that all transgender and gender nonconforming people have access to high-quality, respectful care responsive to their individual needs.

Transgender woman denied mammogram wins battle with health insurance company



Beth Scott was shocked when her insurance company denied coverage for her routine mammogram.
She soon figured out why.
Aetna, Scott’s health insurance carrier, stated that the procedure fell under her policy’s exclusion for treatments “related to changing sex.”
Scott, a 44-year-old transgender woman from New Jersey, had developed breasts after undergoing hormone therapy.
Her physician had advised her to seek the breast cancer check.
After exhausting her appeals process, she enlisted the help of the Transgender Legal Defense & Education Fund for help in her reimbursement.
Scott, who eventually won the fight and received an apology from Aetna, is just the latest person to struggle against the institutional medical discrimination that transgender people face.
Due to exclusionary clauses in certain insurance plans, not only are people denied coverage for the medical procedured needed to undergo the gender change, they are denied ordinary care.
These clauses make it impossible to receive coverage for any procedure that could conceivably be linked to their transgender status.
“I’ve heard of transgendered people being denied coverage for blood tests,” said Noah Lewis, a lawyer for the TLDEF in New York. “I heard a story about a transgender woman who was denied coverage for a broken arm after the insurance company determines the injury occured while playing on a all-female baseball team.”
Transgender women and men are often denied routine gynecological care and medically necessary surgeries, including fibroid removal and hysterectomies, said Lewis.
Scott’s victory was a personal win, but could also help others in her situation.

Healthy People 2020 Webinar: Transgender Health by Health & Human Services

This is a group of videos provided by the Dept of Health and Human Services. The Department of Health and Human Services (HHS) is the United States government's principal agency for protecting the health of all Americans and providing essential human services, especially for those who are least able to help themselves.
 LINK TO: Healthy People 2020 Webinar: Transgender Health

Prenatal Exposure to Diethylstilbestrol (DES) in Males and Gender-Related Disorders

For many years, researchers and public health specialists have been assessing the human health impact of prenatal exposure to the estrogenic anti-miscarriage drug, diethylstilbestrol (commonly known as DES or "stilbestrol"). The scope of adverse effects in females exposed to DES (often called "DES daughters") has been more substantially documented than the effects in males ("DES sons").

This paper contributes three areas of important research on DES exposure in males:
(1) an overview of published literature discussing the confirmed and suspected adverse effects of prenatal exposure in DES sons;
(2) preliminary results from a 5-year online study of DES sons involving 500 individuals with confirmed (60% of sample) and suspected prenatal DES exposure;
(3) documentation of the presence of gender identity disorders and male-to-female transsexualism reported by more than 100 participants in the study.

During the 1970s and 1980s an increased amount of public and scientific attention was paid to the health and medical problems of individuals whose mothers were prescribed diethylstilbestrol (DES). A potent synthetic nonsteroidal estrogen, DES was first developed in 1938 and initially became available in the U.S. for treating a range of gynecologic conditions in 1941 (Apfel and Fisher, 1984). A few years later its approval by the FDA was broadened to include treatment of pregnant women for the purpose of preventing miscarriages. Though its efficacy had long been questioned by some in the medical community (Bambigboye and Morris, 2003; Dieckmann, 1953), DES remained popular with doctors until discovery in the early 1970s of an apparent association between prenatal exposure to DES and a rare form of vaginal cancer in females whose mothers used DES (Heinonen, 1973; Herbst and Bern, 1981). Subsequent research confirmed the transplacental mechanism of DES transmission (Maydl, et al., 1983) and classified DES as a carcinogen and teratogen (Mittendorf, 1995) as well as a mutagen (Roy and Liehr, 1999; Stopper et al., 2005).

While DES usage with pregnant women was banned by the FDA in 1971, the drug continued to be used in several European countries into the early 1980s (Schrager and Potter, 2004). DES remained a popular option for treatment of advanced prostate cancer in aging males due to its ability to inhibit luteinizing hormone secretion by the pituitary and thus inhibit testosterone secretion (Scherr and Pitts, 2003; Whitesel, 2003), despite reports that adverse effects from this treatment could include feminization in males (B. C. Cancer Agency, 2005). Through the 1970s DES was also prescribed as an estrogen supplement for treatment of male-to-female transsexuals (Kwan, 1985; Ober, 1976).

It has been estimated that as many as four to five million American women were prescribed DES during pregnancy. Estimates of the numbers of "DES daughters" and "DES sons" born in the U.S. are between one million and three million of each (Edelman, 1986). Hundreds of thousands of DES sons and daughters were also born in Canada, Europe and Australia between the 1940s and 1980s. Efforts to determine exact numbers of prenatally exposed individuals, and the dosage and exposure patterns, particularly during the years of prime DES popularity, 1947-55 in the U.S., have been largely unsuccessful (Duke, et al., 2000; Heinonen, 1973). Because DES proved popular as a growth-stimulant in the cattle industry (Raun and Preston, 2002) for more than forty years (McLachlan, 2001), many consumers have also been exposed to unknown amounts of DES as it entered the food chain through beef consumption.

Among the most significant findings from this study is the high prevalence of individuals with confirmed or strongly suspected prenatal DES exposure who self-identify as male-to-female transsexual or transgender, and individuals who have reported experiencing difficulties with gender dysphoria.

In this study, more than 150 individuals with confirmed or suspected prenatal DES exposure reported moderate to severe feelings of gender dysphoria across the lifespan. For most, these feelings had apparently been present since early childhood. The prevalence of a significant number of self-identified male-to-female transsexuals and transgendered individuals as well as some individuals who identify as intersex, androgynous, gay or bisexual males has inspired fresh investigation of historic theories about a possible biological/endocrine basis for psychosexual development in humans, including sexual orientation, core gender identity, and sexual identity (Benjamin, 1973; Cohen-Kettenis and Gooren, 1999; Diamond, 1965, 1996; Michel et al, 2001; Swaab, 2004).

This study’s findings provide fresh evidence of psychiatric disturbances among individuals exposed to DES. It is hopeful that future research on human health effects of exposure to endocrine disrupting chemicals (i.e., assessing neurotoxicity) can include psychiatric disturbances such as major depression, anxiety disorders, eating disorders, and psychoses as potential endpoints for analysis of the long-term effects from prenatal exposure. Additional questions may be explored as to whether psychiatric conditions such as increased depression and/or anxiety disorders in DES sons have a foundation in primary endocrine system disorders.

Endocrine system disorders such as hypogonadotropic hypogonadism in DES sons have been among the more common reported adverse health effects in this research study. Although the prevalence of endocrine system disorders among DES sons has not been discussed in any of the existing published epidemiological research on DES-exposed populations, both the Endocrine Society and the American Association of Clinical Endocrinologists (2002) have recognized prenatal DES exposure as a risk factor for endocrine disorders including hypogonadism. This study confirms that this issue needs further attention in future studies of DES sons.

Relative infrequency of reported cancer among the DES sons in this research is consistent with most existing long-term studies demonstrating limited cancer prevalence in males with prenatal DES exposure. While the rate of total cancer occurrence among members of the DES Sons International Network is uncertain, numerous efforts have been made to generate discussion about cancer risks and in particular, to encourage dialogue regarding testicular cancer experiences. Approximately seven members of the network between the study years of 1999 and 2004 indicated some past or present experience with testicular cancer. It appears that overall cancer outcomes among network members have been low, a finding consistent with research by Strohsnitter et al. (2001).

Based on the findings in this study, research into the human health effects of exposure to endocrine disrupting chemicals needs to focus on additional behavioral toxic endpoints besides those historically investigated.
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Diethylstilbestrol a 5-Year Study: Gender Dysphoria, Transsexualism

During the 1970s and 1980s an increasing amount of public and scientific attention was paid to the health and medical problems of women and men whose mothers and grandmothers took diethylstilbestrol (DES) for prevention of miscarriage. A potent estrogenic chemical, DES was first developed in 1938 and initially became available in the U.S. for treating a range of gynecologic conditions in 1941 (Apfel and Fisher, 1984). A few years later its approval by the FDA was broadened to include treatment of pregnant women for the purpose of preventing miscarriages (spontaneous abortions). Though its efficacy had long been doubted by some in the medical community (Bambigboye and Morris, 2003; Dieckmann, 1953; Edelman, 1986), DES remained popular until publication of research in the early 1970s identifying an apparent association between prenatal exposure to DES and a rare form of vaginal cancer in females (commonly called “DES daughters”) whose mothers used DES (Giusti, Iwamato, and Hatch, 1995; Heinonen, 1973; Herbst and Bern, 1981).

It is estimated that as many as five to ten million Americans received DES during pregnancy or were exposed to the drug in utero between the late 1940s and early 1970s (Giusti, Iwamoto, and Hatch, 1995). The numbers of male offspring exposed in utero to DES (“DES sons”) have been estimated at between one and three million in the U.S. (Laitman, Jonler, and Messing, 1997) and similar estimates exist for the numbers of American females exposed in utero (Edelman, 1986). Hundreds of thousands of DES sons and daughters were also born in Canada, Europe and Australia during a similar period.

Compared with the history of research on the range of health effects of DES daughters, there are relatively few published medical research studies conducted with DES sons. And yet, the finding that prenatal DES exposure also led to detrimental effects for a number of exposed males has existed since the 1970s (Andonian and Kessler, 1979; Bibbo et al., 1977; Gill et al., 1979; Gill, et al., 1988; Laitman et al., 1997). These effects include a variety of structural abnormalities of the reproductive system such as epididymal (benign) cysts, hypoplastic testes or undescended testes (chryptorchidism), microphallus or underdeveloped penis which may be associated with an intersex condition, and hypospadias (opening of the penis is on the underside rather than at the end). Although DES exposure has been suspected as a possible source of male infertility and testicular cancer (Giusti, Iwamato, and Hatch, 1995, it is still uncertain whether prenatal DES exposure has led to increased risk of infertility (Wilcox et al., 1995) or increased rates of testicular cancer as well as other types of cancer in males (Strohsnitter, et al. 2001).
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