Several states1, including Tennessee, have recently enacted prohibitions on transgender treatments for minors, in response to what has been reported as an unprecedented increase over the last decade or so in young people expressing feelings of “gender dysphoria,” i.e. being dissatisfied with the sex they were born as (or “assigned at birth,” in the terminology of gender ideology), and approaching physicians of specialist clinics for medical treatment.
Cosmetic “sex-change” surgery for what used to be called “transsexuals” has been around for decades, but during the 20th Century, scientific understanding of the biochemical basis of human sex differences has advanced considerably. The development of molecular genetics since the early 1980s has allowed for convenient synthesis of many biological products for use as drugs, and made hormonal treatments more available.2
(2D ultrasound of a very close relative 👶🏻, colorized)
At the same time, political activism, which won greater legal recognition of same-sex relationships, has prompted other groups, including “transgendered” individuals, to take up their own cause.
Perhaps the United States’ most recognizable transgender activist, Biden Administration Assistant Secretary of Health Rachael Levine, said in a 2019 interview that “…if I had transitioned when I was younger, then I wouldn't have my children. I can't imagine a life without my children.” Levine, who fathered two children during his previous identity as Richard Levine, understands that one of the most serious potential costs for those undergoing “transgender” treatments and surgeries is sterility.
Even with recent advances in biotechnology, transgender individuals ultimately can only imitate the opposite sex. The structures that make us male and female have been there since before birth, and the chromosomes which determine those structures have been there since conception. Trying to change those facts as late as pre-puberty is simply impossible. Science and surgery cannot remake what years of biological development has made.
In the beginning…
The sex of the initial human embryo, formed from the fusion of the mother’s egg cell and the father’s sperm cell, is determined by the father’s contribution. Since males have a copy of both the X sex chromosome and the Y sex chromosome in all of their cells —when sperm cells are formed, half of the sperm cells receive an X sex chromosome and half of the sperm cells receive a Y sex chromosome. Females have two copies of the X sex chromosome, so the egg cells that are released from the ovaries during each monthly cycle of human fertility will always contain one X chromosome.3
As the embryo implants in the womb and divides and grows into a fetus over the months of pregnancy, sexual differentiation is taking place, led by the part of the developing brain called the hypothalamus, which serves as an interface between the brain and the body's hormonal system, the endocrine system. The hormones produced by the hypothalamus control the release of other hormones by the body's more specialized glands and organs, including the testes in males and the ovaries in females. The hormone produced by the hypothalamus that regulates human sexual development is called gonadotropin-releasing hormone, abbreviated as GnRH4. GnRH doesn’t act on the testes and ovaries directly, but as its name implies, causes the release of other hormones, called gonadotropins, from the pituitary gland, which is located nearby to the hypothalamus in what is evolutionarily the most ancient region of the brain. The gonadotropins5 act on the testes and ovaries, organs which are generically referred to as "gonads," together forming a system known as the “hypothalamus-pituitary-gonadal axis,” which regulates sexual development.
If all goes according to (genetic) plan in embryonic and fetal development, the baby is ready to be born as either a boy or a girl, each with the beginnings of the structures which become reproductively functional after puberty. During the first six months after birth, babies of both sexes undergo a stage known as “mini-puberty” in which the hypothalamus-pituitary-gonadal axis becomes active once again, which is believed to result from being away from the hormonal influence of the mother’s uterine environment. It is hypothesized that this mini-puberty is a continuation of the development of testes and ovaries outside the womb, though less is known for certain about this period of development in girls than in boys.6
Humans are especially weak at birth in comparison to most animals, and it is believed this is due to an evolutionary adaption to accomodate our brain, which continues structural development outside the womb, along with our skulls. We are in effect all born a bit prematurely, so that our big brains and not-yet-fully-formed (and thus more flexible) skulls could fit through our mother's birth canal, once humans began walking upright. So apparently our development of gonads and reproductive structures continues for a while after birth as well. But soon, the hypothalamus-pituitary-gonadal axis goes dormant, and waits years for puberty before starting up again.
“Transitioning” to sterility
“Transgender” treatments recommended for gender dysphoric adolescents, referred to as “gender affirming care,” involve three stages, the first two of which are hormonal treatments. Drugs such as histrelin (trade names Suprelin® LA or Vantas®, manufactured by Endo Pharmaceuticals) and leuprolide (trade name Lupron®, manufactured by Abbvie) both downregulate the pituitary’s production of gonadotropins by supplanting GnRH, and are sometimes referred to in “transgender” treatment regimens as “puberty blockers.”
Given at the onset of normal puberty, around age 11, these drugs were originally approved by the FDA for treatment of children with a genetic disorder known as “central precocious puberty” (CPP), in which the hypothalamus-pituitary-gonadal axis starts up too early, beginning the premature development of adult sexual characteristics in children younger than age 8 or 9. By contrast, use of “puberty blockers” in “transgender” treatment begins at an age when treatment of CPP would be discontinued because physicians treating CPP want their patients to undergo normal puberty, whereas in gender clinic terminology, these drugs are used for "suppression of endogenous puberty," in other words, preventing what would otherwise happen as the child matures into their natural sex.7 As these drugs are not approved by the FDA for this purpose, their use is considered "off label" (which is allowed under U.S. law, based upon the professional judgment of physicians).8
Transgender treatment with “puberty blockers” is considered “reversible,” in the sense that puberty reinitiates when treatment is stopped (just as it does in treating CPP), but there are still clinical concerns for delays in development of bone mass, and in neurological development, from keeping transgender patients in an artificially prolonged pre-pubertal state. One of the concerns in CPP is children developing adult calcification of their growing bones, and thus stunting their eventual adult height. One possible complication for prolonging pre-puberty in “transgender” treatment is osteoporosis, or decalcification of bone, leading to a greater risk of fractures while on the treatment.
The next phase of “transgender” treatment, once the patient’s own hormones are shut down, is supplying cross-sex hormones artificially, inducing hormonal “exogenous puberty” as the opposite sex, but with the same body and body structures created in fetal development all those years ago. According the prevailing published medical standards,9 cross-sex hormone treatment can begin as early as 14-16. Treatment with cross-sex hormones induces irreversible changes in the body, and is intended to help "transgender" individuals resemble the opposite sex.
What happens to the eggs or sperm of individuals exposed to cross-sex hormones during this phase of transgender treatment is uncertain, but it is concerning enough that some patients have made efforts to harvest and freeze their reproductive cells (eggs or sperm) before beginning the treatment, so that they would be available later for in vitro procedures to treat this medically-induced infertility if it occurs. And obviously, surgical modifications to, or removal of the reproductive organs in order to make them resemble the opposite sex will cause irreversible sterility.
Surgical procedures, the last step of “transitioning,” have reportedly been not all that popular, aside from radical double mastectomies which “masculinize” the chest of young “transgender” women. Cross-sex hormone treatment can apparently be sufficient to grow plausible breasts in “transgender” men, but other surgical procedures on the genitals themselves are challenging, and don’t seem to be capable of delivering as promised.10
Victims of “transgender” treatments, known as “detransitioners,” have begun speaking out publicly, and activist demands to compel society to consider “transgender” individuals the same as the sex with which they “identify,” despite requiring medical intervention to even superficially create that “identity,” have led to a political and cultural backlash, which is still …developing.
—end—
(Thanks to @SpiceOfOurLife@social.quodverum.com for the inspiration.)
These states have passed bans on “transgender” treatments for minors: Alabama (2022), Arizona (2022, prohibiting transgender surgery on minors only), Arkansas (2021), Iowa (2023), South Dakota (2023), Tennessee (2023), Utah (2023), Mississippi (2023), Florida (2023), Georgia (2023, prohibiting cross sex hormones and surgeries on minors only) [UPDATE: Kentucky and West Virginia have passed laws banning “transgender” treatments for minors since this article was first published.]
For example, the hormone insulin, production of which is impaired in Type I diabetics, and which regulates sugar metabolism, was previously obtained by extracting it from the pancreas of slaughtered pigs, and caused an immune system reaction due to it not being identical to the human form, but is now produced in the pharmaceutical lab, using the human gene for it, making it identical to the insulin produced by the body.
Always, except for cases of genetic abnormality. Reduction of the number of chromosomes by half during the formation of egg cells and sperm cells ensures that each parent contributes only half of the genetic instructions that go into making their offspring, and that the resulting embryo has the same total number of chromosomes as each parent.
There is also a gonadotropin inhibitory hormone (GnIH) which downregulates the system, which was only discovered in humans in 2009, after the first identified hormone of this type was found in quail in 2000. That such a fundamental discovery was made so recently demonstrates that science and medicine has much yet to learn about these systems.
The gonadotropins produced by the pituitary are known by their names from female physiology, “follicle stimulating hormone” (FSH), and “luteinizing hormone” (LH).
Gender differences in brain development are also attributed in part to the developing brain’s exposure to the burst of testosterone in boy babies during “mini-puberty.” (There is a controversial theory that holds that the symptoms seen in autism-spectrum disorders are due to varying degrees of “hypermasculinization” of the brain —but that’s another story.)
In addition to treating central precocious puberty, these GnRH agonist drugs are also used to treat hormone-sensitive cancers, such as prostate cancer, whose growth is inhibited in the absence of testosterone. They are available in a time-release implant form which lasts up to a year.
Legal, unless you happen to be a physician prescribing “off label” use of unapproved drugs for treating patients during a pandemic.
Sweden’s Karolinska Institute recently curtailed the availability of “transgender” hormone treatment in adolescents, viewing it as an experimental protocol. English translation of Karolinska Institute policy statement.
The World Professional Association for Transgender Health (WPATH), recently published standards which no longer indicate a recommendation as to age for commencing cross-sex hormone treatment.
“Sex-change“ plastic surgery is not officially recommended in the “transgender” medical literature until the age of adulthood (18+ in the U.S.), but non-genital surgery, such as removing the breasts, has clearly been performed on younger girls, some of whom have eventually regretted it, and become “detransitioners.”
Great Dar
Great article ... thank you!