Theology in the Raw - 864: Are Puberty Blockers and Cross-Sex Hormones Safe? Dr. Michael Laidlaw

Episode Date: May 6, 2021

Dr. Laidlaw is a board certified Endocrinologist with an MD in Endocrinology from USC. He’s been involved in the conversation surrounding trans* identified teens and the use of puberty blockers and cross-sex hormones (CHT). In this conversation, Michael gives us the the honest facts about what we know and don’t know about short term and long term effects of blockers and CHT. Support Preston Support Preston by going to patreon.com Venmo: @Preston-Sprinkle-1 Connect with Preston Twitter | @PrestonSprinkle Instagram | @preston.sprinkle Youtube | Preston Sprinkle Check out his website prestonsprinkle.com If you enjoy the podcast, be sure to leave a review.

Hello, friends. Welcome back to another episode of Theology in the Raw. I have on the show today, special guest, Dr. Michael Laidlaw, who is an endocrinologist. He has an MD from University of California and has been practicing endocrinology for a number of years and has recently, as in the last several years, become involved with the medical side of certain aspects of the trans conversation. As an endocrinologist, he has a lot of expertise in the area of puberty blockers and cross-sex hormones. And that's exactly what we talk about today. I wanted to have him on the show because Michael is extremely level-headed, fair, balanced, kind. And I think he does a great job giving us what we know and don't know

from an endocrinologist's perspective about using different hormones that your body hasn't naturally produced or using certain puberty blockers to prevent the natural process of puberty from happening. So that is the focus of our conversation. I hope you enjoy it. If you want to support the show, you can go to patreon.com forward slash theology in the raw, become part of the theology in the raw community. And I just want to give a massive shout out to the growing number of you who have been

supporting the show. Our show has really grown in the last, especially several months. It's broken into the top 100 Christian podcasts in the United States, at least. It's even ranking in Great Britain and Canada. And I get listeners from all over the world. So if you're outside the US, thank you for listening to Theology in the Raw and for putting up with my accent and my Americanisms. But thank you so much for those of you who are part of the Theology in the Raw community and are supporting the show. Truly, thank you. It really does keep the show going, and I can't thank you enough for valuing the work that we're doing here at Theology in the Raw enough to financially support us. So again, you can go to patreon.com forward slash theology in

the raw if you want to be part of that community. Okay, without further ado, let's get to know the one and only Dr. Michael Laidlaw. All right, welcome back to another episode of Theology in the Raw. I'm here with my friend, Dr. Michael Laidlaw, who is an endocrinologist and agreed to come on the show to talk about the medical side of a very controversial issue about puberty blockers, cross-sex hormones, especially when it comes to trans-identified teenagers. If you're not aware, I think probably most people listening or watching are very aware, but if you're not aware, this has become a major controversial conversation in the medical field, in just ethical conversations as a whole. So, Michael, is it okay if I call you Michael

instead of doctor? Yeah, Michael's fine. Yeah. Okay. Whatever. Well, thanks so much for being on the show. I really appreciate it. Hey, you're welcome. Good to see you again, Preston. Why don't we, I would love to just briefly, you know, get to know you. Who are you? Tell us about your medical practice. And then how did you get into this conversation about puberty blockers and cross-sex hormones? Sure. Well, I'm just an ordinary endocrinologist. I have a small private practice, Rockland, California. We're kind of east of Sacramento, 15 miles or so. I trained as a medical doctor down at the University of Southern California. I did specialty training in internal medicine

and then endocrinology, primarily adult endocrinology, but we dealt with some teen adolescent issues and there's some pediatric training that goes into it, minimal. But to understand adults, you have to, to some degree, understand what happens as a child, what happens through development and growth all the way from the embryo up to adulthood. So yeah, I completed specialty training down in Southern California, fellowship endocrinology, and was kind of just minding my own business, doing my own thing until in Rockland. And you may recall this story. There's a book and a show called I Am Jazz. And in Rockland, there was a big, you know,

it made national news, I believe. And I first heard about it, I think, on the radio that this I Am Jazz book, a transgender book for kids, was read in the local kindergarten class. And parents were rather upset about why that happened and what was going on. And I've heard different versions of the story, but what it sounds like, it was a kindergarten class. There was a boy who had gender dysphoria, gender dysphoria being this discomfort level, anxiety, different psychological effects that come with believing that your physical body parts don't match who you are inside. So this kindergarten student had this problem. He was a boy. I believe he was a girl. And to introduce the students to it, apparently the teacher took it on her own to read this I Am Jazz book.

What's I Am Jazz? Jazz Jennings is a person who identifies as transgender. Born a boy, has gone at this point through hormones and surgeries to have the physical appearance of a female. And wrote a book to, I guess, introduce young people to what was going on. And I was concerned because I thought, what are kindergartners really going to understand about this? And why is it being pushed so hard and the people on that side would not give up? And there were attorneys involved and things like that to force this book into the school, as far as I saw it. But a parent said to me, hey, you really need to look at this book. Look at it as an endocrinologist. What do you think about it? And I had kind of dismissed it as, well, I don't know. It's just a kid's book. But when I started reading it, I was disturbed by what I read.

What was disturbing about it? At some point in the book, and you can have the book read to you on YouTube. That's why I went to YouTube, listened to it, and I think they've got the words with it. But there was some line to the effect of, the doctor diagnosed me as transgender. And there's a picture of a very young kid there. And I thought to myself, how would a doctor diagnose a person, a kid as transgender? I mean, what is the test that they did? Did they do some sort of scan, MRI scan? Did they do blood tests? Did they do chromosomal testing? What was it exactly to give that doctor such confidence that, oh, yes, you know, this person that needs to go on this trajectory, which we'll describe of hormones and surgery and so forth, to grow up in an adult body that's opposite that they were born with. So that bothered me.

The other thing that bothered me is that there's some line to the effect of, you know, I have a girl brain inside a boy body. And I thought to myself, this sounds very medically, biologically suspect. How would that happen? You know, and like I said, in endocrinology, you know, if you want to understand glands hormones, you have to go way back to the beginning, way back to embryology. You know, how did we develop? way back to the beginning, way back to embryology. You know, how did we develop? You know, in somewhere around eight to 12 weeks when the baby is developing in the womb,

and as you probably know, you don't start out with the heart or brain or fingers or things like that. These things have to develop over time. You start with one cell and they divide and then they're apportioned in different ways into all of our wonderful organs, including our sex organs.

You know, be they ovaries for females, testicles for males, penis, uterus, you know, the whole the whole the whole set are created in a certain way. And without being too technical, there's two different systems of ducts or tubes that will develop into either male organs or female organs. And what happens is if you're, if you have testosterone produced, you're going to become a male, you're going to develop penis, testicles, and so forth. If you're, that comes from these, If you're that comes from these that and other things form the male organs. And the thing is, those tubes, those little tubes that are going to fail could form female organs. They're obliterated. They disappear. They're gone forever. You can't get them back again. You can't later say, well, I really wish I could have grown a uterus. So, you know, I'll activate this system. We can't do it. It's medically impossible. So there's a split, there's a bivocation, there's a divergence around 12 weeks, say,

where you can no longer develop those sex organs of the opposite sex. And we know that testosterone in particular is going to form the male organs. And there are people, and you may have heard of it, like testicular effeminization syndrome, where a person born with testicles, but all of their cells are impervious to the effects of testosterone. So they look and are basically grow up as females because they don't develop a penis. They don't develop sperm and so forth.

So so it's testosterone really that makes this split between males and females. And so I said to myself, going back to the brain issue, well, how could you be born with a girl brain in a boy body? a girl brain in a boy body. You had, obviously, Jazz had testosterone circulating throughout the body because, as you find out from the show, he formed a penis. Okay. Why would those hormones not go into the brain and have their effects on the brain? You know what I'm saying? Does it stop somewhere? Your hormones circulate through your whole body. We know that. So, the effects of hormones are going to be on the brain during development and early development and teen development and so on and so forth. So while there's no particular male or female brain, you can't find organs inside of the brain and say, oh, yeah, that's a male. I can see it on an MRI.

That must be a male brain or female brain. There's things that are suggestive, but there's nothing definitive. It really is just one type of brain. They may develop slightly differently, but there's really one type of brain. So those two big inaccuracies really led me to say there's something seriously wrong with this, and the school board needs to know about this. So let me know if I'm going on too long. No, this is good. A lot of the topics that you probably want to discuss,

because it's really what did it for me. And, you know, this I ended up writing, there was an article got published and people got around about this. I am jazz, but it started as a letter to my school board. I wanted to say, Hey, I'm a local endocrinologist. I know a thing or two about hormones and this sort of thing. I'd like to describe to you, while you may think there's benefit, and there is benefit in helping kids to understand about their bodies and why someone might have gender dysphoria, there's definitely a benefit in making kids comfortable and safe and all. I don't disagree with that a bit, you know. But let's be accurate about the science, A. And B, are you really going to tell kindergartners about

negative effects that can happen later on in life because of hormones and surgeries? You know, are we going to go and I, you know, I went to several board meetings with the parents and I discussed some of these topics and I sent a letter and I hit on some of the things I just said. But, you know, if you really want to go to the ultimate extreme, and this ended up happening to jazz, jazz underwent surgery, as you may or may not know. And there was difficulties even planning the surgery. And how do I know this? Because it's on the I Am Jazz TLC show. You can watch it. I did my homework. I looked at it and I said, there's an issue here because jazz got puberty blockers. So I can talk a little bit about that. You know, what are puberty blockers? Puberty blockers are really powerful hormones that

send a signal to the pituitary, which is a controlling gland in the body. And during adolescent development, it basically initiates and progresses puberty in the body, all the changes that you know for males and females. And so if you give this type of blocking hormone, you can freeze the process in place. Now, what happens there? Well, the organs aren't going to develop. As a male develops, the testicles get larger, the penis elongates, there's differences in color, you know, pubic hair development, the whole thing. That's all frozen. It's stunted. And because of that, the penis length is short compared to an adult male, which makes the surgery very technically difficult. Because normally what they would do is, you know, take a full length male penis and remove the insides and then turn it inside out, you know, and form this, what's supposed to be a

vaginal cavity. You can't do that with a very tiny, you know, puberty blocked one. So what they actually ended up doing, it sounds like, is taking a piece of large intestine and cutting it in such a way and swinging it over to connect to other tissue. And as it made sound, that gets to be a complicated surgery. I think Jazz had to go back once or twice, you know twice for revisions. I did hear about that. I know we're getting really technical here, but this is Theology in a Raw, folks. Sorry. I expect nothing less. No, but these are very live questions.

I want to go back and pick up on the puberty blocker conversation because I just had a conversation recently with somebody who said, look, we know that these have been used before. And this is something I'm sure you've heard a lot. They're perfectly safe. You hit pause. And if you don't want to keep going with cross-sex hormones, you just stop taking blockers. And then you go into puberty again and everything's fine. Like there's no, these are perfectly safe. They're perfectly fine. in and everything's fine. Like there's no, these are perfectly safe. They're perfectly fine. Is that perspective medically verifiable from, from your endocrinology perspective? To me, that's inaccurate. Yeah. And that's another thing that struck me as I was reading about these blockers, because there is a condition you've, you've, I'm sure, heard of called precocious puberty, where let's say a girl who's four or

five starts to undergo to puberty development like they might if they were 11 or 12. And that's usually genetic reason. And so they start to develop much earlier than the average kid. And it can be stopped through these puberty blocking medications. That's a use that's labeled that the FDA has approved and has been determined to be safe. I mean, even that has some controversies, but that's a legitimate use of medication. Real quick, just logically, as somebody who's obviously not a medical anybody, but it seems like using blockers in that sense is addressing an issue that has to do with the actual thing that's being administered. Like, that's right. Yeah. So

yeah, that's one of the points. Yeah, that's, that's, that's perfect. Because that's one of the points that I've made. I mean, there you have a, an abnormal condition, and you're trying to correct it by really blocking puberty till a more normal time and then stopping the medication. And after some period of time, a year, year and a half, two years, puberty, you're expecting it to start again on its own. So you're taking an abnormal process and trying to bring it to a normal timeframe to begin. And what I've been saying with puberty blockers for gender dysphoria is you're taking a normal process of puberty that everyone is destined to go through for the most part. And so you're blocking and you're stopping a normal developmental process and you're actually causing an abnormal condition.

We have a long name for an endocrinology called hypogonadotropic hypogonadism, which means what? It just rolls off the tongue. It just means that the pituitary is not sending the signal to the sex organs to make their either testosterone for males or estrogen for females. That's an actual condition that people can develop, and it's an abnormal condition. And as endocrinologists, we try to treat it. So I'm looking at this and saying, well, why are you causing this condition through medication? It's just something seems wrong with that. So what do we know about, or do we, yeah, what do we know about the possible side effects of puberty blockers? Have there been studies done

on it? Because I know this is fairly a recent way to treat it. So it makes me wonder, like, if it's fairly recent, is it correct to call it experimental? I know that's kind of loaded language and can be – I like to use – I want to use language as neutrally as I can to not kind of inject. But it feels – is it experimental? I'll just say it, and you correct me if I'm wrong. Well, in my opinion, it's experimental. And I mean, I think I'm justified in saying that because it's not FDA approved for this condition. I mean, if you want to get FDA approval, you're going to go through experiments on people and prove that it's safe and prove that it's effective to some degree. And that has not been done for this.

So you could you could call it not FDA approved or not FDA labeled for this condition. So there's been some limited studies recently, and I had a diagram at one point just showing how bone density, what you'd expect during adolescent development is bones get stronger and stronger and tougher, what we call more dense. They're going to elongate. They're going to become stronger. And so that's a very rapid progression because of sex hormones and growth hormone to some degree. And what they showed was that where you'd expect it to rise, rise, rise, rise, it just flatlined. But to me, the way it's written was deceptive. Like, Oh, well, the bone density didn't change. And I'm looking at this thing. Well, it's supposed to change. It's supposed to get

stronger and bigger, but, but you're showing that it's flatlined, which is exactly what you would expect if someone wasn't going through puberty. And now what does that mean? Will the adult develop osteoporosis? Will they have, uh, easier to have fractures as a teenager or young adult that we don't really know, but I would be concerned about that. And that's where, you know, for me being an adult, uh, endocrinologist, I see, uh, adult women and men with osteoporosis. No, that's like a brittle bone condition. It's easy to fracture, you know, and, and as endocrinologists, we try to go through and okay, what was it that led to this? Is it just normal aging? Or did you have some other condition? Did you have hypogonadotropic hypogonadism? Or did you, you know, did you have some other glandular problem that led to this? So when I if I had a patient like this, oh, yeah, I got blockers for four years as a child and had osteoporosis, early osteoporosis.

Assuming this happens in the future, I would say, well, this is probably the reason because you didn't get that jump in bone density that you'd expect at that age. So just to be clear, so if they go on blockers for a few years and then go off blockers, the bone density doesn't improve. Like it doesn't go back to the natural kind of development? That's a very good question. And that's where I would say it's unknown. Okay. I would think that there would be some continued, if they're getting sex hormones, whether it's opposite sex or their own sex, there should be some continued increase in bone density. But there's also something we call peak bone density. That means somewhere around age 30, 25, 30, 35, a person hits their what we call peak bone density. It's about as strong as your bones are going to be. And then it's kind of starts to slow down

earlier. It's possible that they never reach their peak bone density, never gets as strong as it's supposed to be. And the thing about puberty too, there's one other thing about puberty that to me is unknown is we know there's a starting point for puberty and even scientifically there's, there's signals, the pituitary starts telling the sex organs to make, make their hormones. So we know there's a start, but we don't really know, is there an end date to that? other words if you pass a certain period

can you really develop in all the ways you are supposed to and the body is a very complex you know you know wonderfully designed uh object and the sex hormones are just part of it there's also growth hormone growth hormone what does it do well as the name implies, there's growth involved. So what happens if you miss the timing of growth hormone with the sex hormones? What's going to happen? We don't know. There are so many unknowns in this that that I think there's not just not a real good understanding. And now we're just talking about bones. And there's how just not a real good understanding and now we're just talking about bones and there's how about brain development how about you know there's different there's some things that so maybe there's an iq drop maybe i don't know can we talk about brain development so yeah i keep hearing people raise questions about brain development and puberty blockers what's what's

going on there well there's a couple i mean there's a couple aspects there's there's the physical aspect of brain development you know what's actually happening in the neurons and things like that. And I would say that there's related, the social, social development, socialization that goes along with it. But if you want to limit it to say brains and neurons and things like that, there's been different studies. Some have shown that maybe the intelligence quotient, the IQ drops. There have been scientists in Scotland, I believe, Scottish scientists looking at sheep brains. Somehow these hormones like LH, probably FSH, maybe play some role in brain development and spatial knowledge or maybe mapping.

I'm not very familiar with these studies, but I know they've looked into the possibility that sheep could be harmed for whatever reason they're using in agriculture for puberty blockers. So there's a big, big unknown there because we don't really know a lot about the brain when it comes down to it. And we know far less about pubertal development in the brain. when it comes down to it. And we know far less about pubertal development in the brain. So to some degree, the sex organs are changing the brain in important ways to develop into an adult. And when you block puberty, you're blocking the sex hormones and you're blocking some of those processes. We don't know exactly what they are, again, because really the tests haven't been done. But then you get into also the socialization aspect of it. The argument for the puberty blockers is that, well, this person has gender dysphoria. They're very uncomfortable in their body.

Let's say they're a female developing their body and they're very uncomfortable with it, which is a normal part of development. developing their body and they're very uncomfortable with it, which is a normal part of development. The notion is that, well, we'll stop puberty and then that will end the discomfort and everything will be better. But what else was supposed to happen, you know, at that point? You know, you're growing, you're maturing with your peers of the same sex and opposite sex. There are interactions that happen. There is a socialization process that happens, and one would find themselves falling behind the other kids, effectively, developmentally-wise. And what effects does that have long-term on them? Are there times where kids need to be together?

I think to go back, you were talking about the pandemic earlier. It's kind of interesting. And I wonder your perspective, too, that I can see it with kids who have been blocked for a period of time being with their peers that there's a lot of depression and anxiety. Right. And these things going on in effect with puberty blockers, you're doing that chemically. You're kind of chemically refraining them or restraining them from developing along with their peers. And you know, what are the negative effects of that? Some of that we're seeing now, I think. Yeah. Is there a cardiovascular issues too? Or it seems like the theme here is we just don't know the long term effects. But yeah, a lot of it we don't know. Now cardiovascular, I, you know, I can't think offhand with puberty blockers per se. Definitely when you get into what we call cross sex or opposite sex hormones, that comes into play.

Yeah. So. Well, maybe we can transition there. So. Yeah. Well, actually, actually, let me let me try to play the other side for a second, because I know some people say, well, you know, if there's so many ideological assumptions that go into some of these counter arguments. But one of the main ones, right, is they're you know, if you're trans, you're always trans. And if we can get them early and prevent them from going through puberty, then they will be it'll be much easier for them to pass later on. I mean, to take jazz, I am jazz. I mean, look at jazz and you would never, I mean, jazz looks wholly female, right? But if somebody goes through puberty and then tries to transition, they're always going to have a hard time passing. So it does seem like

older trans activists are saying, oh, what I would have given to have not gone through puberty in my biological sex, then I would have been able to pass. I wouldn't have gotten the strange looks or whatever. There's that argument. And then there's also the suicide argument saying, yes, OK, so sure, if you eat bacon, you're taking a health risk. You drive a car, you're taking a health risk. And sure, there's going to be health risk with this.

But as the saying goes, better to have an alive son than a dead daughter or vice versa, because the suicide rate is so high. You can pick both of those kind of counter arguments, but I'd love to hear your thoughts on, yeah. Right. I mean, there's lots of ways of looking at this. I mean, you could look at the desistance rates, which fancy term we use, desistance, excuse me, which is really saying, you know, what young kids with gender dysphoria will eventually kind of grow out of that and decide, well, you know what, I was born a male and I want to stay a male. The desistance rates, depending on which studies you look at, are very high. Some, as much as like 90% of these kids will eventually grow out of it. And some studies say,

well, only 50% of girls or 80% of boys, but whatever, it's, it's a pretty high, it's more than 1% or 10%. So, however, once you introduce puberty blockers, the studies that are out there, they show that at least the initial one that nobody desisted, none of them ended up saying, oh, okay, I was in the right body the whole time, you know, something was wrong. None of them ended up saying oh okay i was in the right body the whole time you know something was wrong none of them did because put it i guess because you can persist in my opinion persist the illusion that you can be the opposite sex because girls and boys you know it's very easy isn't it to just dress a certain different way change the hair haircut uh to make

them look like the opposite sex when they're very young, because there's not much physical differences when they have clothes on that you can tell. But as you said, once they become adults, there's changes to facial features and shoulder width and hips and all of that that are much harder to overcome, like you were saying. So I think that while I understand the argument that, hey, we want people to be comfortable as transgender adults, a significant portion of the young population would actually just grow out of this. And how much harm are you causing them? You know, the other thing I was reading something the other day that the word gender comes from generative or the GEN part. You

probably know more about this than I do, but it's meaning generative or the gen part. You probably know more about the same than I do, but it's meaning generative or productive or, you know, in this case, reproductive. So there are the external aspects of the sex, which we can see, but there are also the very important internal aspects. You cannot produce ovaries in a male who's born a male. You cannot create a uterus there. You know, the generative reproductive functions, we don't, it's not scientifically possible to create those in the person. So while they may grow up as adults, say they started with puberty blockers and be able to pass, if you will, will the inside really believe that they've become the opposite sex when they're missing those reproductive organs and functions, which are really critical and

important for the sexes? And yeah. Sorry, do you hear an echo? I'm hearing an echo on my end. Oh, there it goes. No, it's fine. No, it's my no it's it's a it's a my echo so it's not okay you're fine you sound great um well yeah let's yeah that's

how what about the suicide um argument that sure there's health people that might say okay i agree with everything you're saying but it's still better uh the the the high suicide rate still is a more of a health risk than these possible health risks that you're talking about yeah i um my friend hachi horvath i don't know if you know i know i've yeah yeah he's a he's a he's a great guy and he he actually lived as a female for i think nine nine years or so um but he's brilliant and he's an epidemiologist and he's written quite a lot on this topic. Um, I think, I don't know if it was him, there's something about the myth of trans suicide or, or this idea. It's on, um, it's on, um, oh gosh. Yeah. I read it.

It's a really, uh, the theater, theater of the body. Yeah, I think that's the one. And it's a really lengthy discussion about this very topic from somebody who used to be a trans woman and transition back to male. Yeah, I'd recommend that to everyone who is interested in the topic to read his stuff. And I wouldn't even do well at paraphrasing it. But but effectively, I think the this idea that there's all sorts of kids who are going to commit suicide if they don't get treatment is basically false. And that, in fact, you know, I've had different parents contact me about their children. And one thing I've found is just delaying, trying as much as possible to delay them from starting hormones or surgeries

or giving them reasons to doubt. For one kid, he even just sort of grew out of it. He said, well, I don't really want to do this anymore. So yeah, maybe if you don't support the child or they think there's no other option, maybe depression and anxiety and suicide risk is higher. But if you support them and let them know, in my opinion, as an endocrinologist, let them know about possible harms from hormones, then they might think differently. I, there was a young man I talked to 19 or 20 years old with gender dysphoria, you know, and he said, you know, I've just always felt this desire. I need to cut my penis off, you know. And he was when I spoke to him more, he's very disturbed by things happening in society like, you know, like rape or females getting taken advantage of and all the horrible things you hear on the news to the point where I think he really hated his male sex, which was symbolized in a real way by his

penis, what he wanted to remove. But I spent some time talking to him about, well, these are the harms and things like that. And that's sort of, I don't know that that swayed him. But what I found interesting is, you know, we started talking about kids. It really bothered him to know that kids might be getting puberty blockers or hormones or surgeries. He just thought that was wrong. You know, they need time to develop. And in a sense, I don't think he wanted to be a role model for that sort of thing. He just had a certain psychological issue and there was probably more to it. And he was also an autistic spectrum that, you know, there was something wrong with maleness

and that was his idea to fix it, I guess. Well, I haven't heard it from the male side before, but it's been very well known and well studied that many, and by many, I mean, according to some studies, more than 50% of females who experience gender dysphoria would say that they either during the experience, or maybe later on when they maybe transition or detransition, they would say that I had profound internalized misogyny. I had this really negative view of femaleness. Maybe it's linked to some traumatic episode. Maybe it's just, I was in an environment where femaleness or femininity was seen as lesser than, and I just internalized that.

And again, these are coming from people who are female, who identified as trans or experienced dysphoria. And they said addressing internalized misogyny was connected to some kind of reduction in the dysphoria. Right. So that's interesting because that's the same thing. It's exactly what you're saying, only on the male side. Right, right. Yeah So that's interesting because that's the same thing. It's exactly what you're saying, only on the male side. Yeah, that's interesting. So we have to make a distinction between puberty blockers and then cross-sex hormones. And as you said, according to some studies, I know that I've read that study that 100% of the people that were on blockers ended

up going on cross-sex hormones. So these two are very much, uh, linked. If you do one, there's a really good chance you will end up going on the other. So what do we know about cross-sex, uh, hormones? There's, there's probably more, more known about that, uh, in a sense, because then you're dealing with more adults who've been on cross-sex hormones for a time. Um, you know, if you're talking about, you know, just, I think it helps to, I wish I almost meant to bring a diagram, but think about when, as an endocrinologist, we're dealing with hormones and we're dealing with levels. You know, you go to the lab, you probably get, sometimes you get your lab sheet or you can look online and say, okay, you know, my level is supposed to be here,

but it's over there, or it's supposed to be here and it is here. Thank goodness. You know, and same thing with hormones. You can find normal levels of estrogen or testosterone for males and females. You know, and the main female hormone is estrogen, or we call estradiol, but females are also making some smaller proportion of testosterone, and that's normal. Okay, so to give you an idea of a normal range, let's say it's from five up to 50. So if I were to test a female hormone level and it was 30, I'd say, okay, that's fine. You're not having an issue where you're producing too much. Okay. Now there's a female condition called polycystic ovarian syndrome, which there can be cysts in the

ovaries. It can be irregular menstrual cycles, infertility, but, and this is due to higher levels of testosterone or similar substances in the body. So they might get hair growth on the face where they don't want it. You could get acne, um, masculinizing things can happen to them. Now, if I test that,, maybe her level is 55. Maybe it's 5 over normal or 10 or maybe 50 above normal. Okay. So maybe it's 100, let's say. And that's enough to cause different problems in the body, metabolic problems, glucose problems, lipid problems, cholesterol. Okay.

Now, if you're talking about transitioning female to male, these are going to be much higher. The recommendation is bring it to 300 to a thousand. And if you do the math on that, that can be, depending where you start with 10 to a hundred times above the normal level for that person's body. And that's why when I started looking at this, I'm like, wow, this is incredibly high. If I'm seeing problems with PCOS, just a little bit above normal, what is going to happen when you're going 10, 20 times higher than normal? You're bound to have problems. And that gives you some perspective on the magnitude of the hormone. And so some studies or a review study by Erwig, which I can send to you from 2018,

showed increased risk of cardiovascular mortality from high doses of estrogen testosterone. If you talk about we call thromboembolic disease or blood clots, you might have heard of pulmonary embolism clot in the lung or in the in the leg and so forth. That's a five times increased risk from taking estrogen, estradiol in males. So we know there's risks there. I was just, I think the quote from British Medical Journal, I think it was 46 times increased risk of male breast cancer from estrogen. 46 times. 46 times increase. Now it's, males can get breast cancer. I think it's like 3%. I don't remember the exact number of all breast cancers, but males, even without taking estrogen, can get breast cancer.

But this has gone up 46 times. Wow. So, is it the same from the same level of risk across different of these areas with males taking high doses of estrogen and females testosterone or are females taking testosterone at a higher risk you know i i'm i'm not quite sure because really there hasn't been as many cases it hasn't been going on as long you know if you talk about um sorry the testosterone for females hang on a sec i think there's a big, and I've, what I did is I looked and I said, okay, what is the nearest equivalent that you can find of a female with really high testosterone? And there are some isolated cases where maybe the ovary or some other organ starts making testosterone. It's hard to find. But I thought you can think of a near equivalent of bodybuilding or athletes, female athletes who are using high doses of androgens or testosterone or something similar.

What's happening to their body and what's happening to their minds? You know, one side effect of people taking high doses of androgens is actually euphoria, feeling really great. Yeah. You know, as you might imagine, like, wow, I got all this testosterone. I feel great. You know, and that can be a temporary effect. But another proportion, I think it was 10 or 20 percent, developed psychiatric disturbances, worsening of anxiety, depression, things like that.

So the other aspect beyond the physical is what's happening to people's mental health while they're taking these very high doses of hormones. Going back to the brain, if you've developed a female brain with estrogen, and now you're on these super high doses of testosterone, and males have some understanding of that, you know, going through puberty, what it's like, you have a female body, a female developed brain, what's going to happen? So much of this is unknown, but some of it, I think, can be found looking at, you know, high doses of steroids and androgen abuse. So I want to revisit what you just said about the euphoria, because I have seen in some studies, and also just anecdotally, like, if you talk to somebody who's been on androgens you know female who goes on hormones yeah cross-sex hormones um man you talk to them

six months later a year later year and a half later they're like i'm fixed i'm so happy i feel like i can conquer the world you know it's like yeah of course but you're saying the two three five years after that that's when we're starting to see a lot more than negative, just even mental health or even just, they don't feel that euphoria anymore. Was that fairly accurate to say? I think that's accurate to say. And there's the Swedish study,

can't pronounce the name in Swedish, but it's D-H-E-J-N-E, but you probably know Dujane or Henne. But anyways, which is, in my opinion, a really excellent study, but anyone should look at it and just pull open the graph that shows mortality and how rapidly that's around 10 years. People who have been on hormones and who've had surgeries, they start dying off much faster than the general Swedish population that they're compared to. And some of that's due to suicide. And some of that could be due to cardiovascular

disease or other things. And also, you probably know, I'm sure you know the name Walt Heyer. Yeah. Yeah. Walt's another great guy who also lived as a female for nine or 11 years. He has a really interesting story, and I've talked to him quite a few times and read his books. But when I talked to him, he said, yeah, you know, Mike, I usually people start writing letters to I think it's what's his site? Transgenderregret.com or something like that. I can't remember the exact sexchangeregret.com. Sexchangeregret, yeah. Yeah. So you start writing me emails.

You go, sure enough, it's somewhere, you know, 8 to 12 years that they've been doing great. And all of a sudden, you know, they can't deal with the body that they now have that's been, you know, could be surgically altered, chemically altered. Yeah. Something about this timeframe, many of the people decide I did the wrong thing. I regret what I did. after the surgery or in two years, what you're saying is that's going to yield a real kind of warped, inaccurate perspective. You need to do five, 10, 50, more longitudinal measurements, right? To get a more accurate. Yeah. I think it's really skewed and some of it may be hormones, you know, like we're just talking about. Another, you know, male who took estrogen is like, you know, I've just felt great. I was just floating along and, you know, nothing took estrogen is like you know i just felt great i was just floating along and you know nothing bothered me and people complimented me it was great you know until he didn't take it

for a few days and he kind of he said snapped out of it he's like wow i didn't realize under this sort of cloud or illusion and he ended up detransitioning wow so so yeah we really you know being an endocrinologist i think think we really underestimate the power of hormones in our lives, you know, whether they be physical, which we concentrate on a lot, but also mental. You know, a lot of what I do is treat, obviously treat hormone disorders. If your thyroid levels are really low or really high, you're going to have, you know, major effects that could land you in the hospital. If you're, you know, a male who's got very low testosterone, that you can cause depression, it can cause different mental health effects. And so, and then on the other hand, if you take really high doses, you might feel great for a time, like anything. So extreme caution needs to be, these things need to be handled with extreme caution.

And I just think, especially when we're dealing with kids, I mean, adults can make up their own minds. I mean, they should be aware of what the probable, you know, possible complications are. But when we're dealing with kids who really don't fully understand, what does it mean to have my own child? You know, what is what does it mean to have sexual relations with another person? Which kids on puberty blockers probably will not have. If they go from puberty blockers to cross-sex hormones without developing their organs, they most likely will not have normal sexual relations when they're older and may never be able to form a lasting partnership because of it. Wow. And these are things like, how do you know that when you're

nine? Oh, okay. I want to have a kid. I want to have this and that, you know, you don't want those things when you're nine. Most nine-year-olds aren't thinking long-term anything really. No, they shouldn't be, right? Most 19-year-olds aren't thinking. What about infertility? I've heard that if you're on cross-sex hormones, both for males and females, I think I've heard at least a year and a half or maybe two years that it's almost guaranteed you will be infertile for life. Is that, or what are the facts? I don't think that's as settled. Some people maybe on my side of the, can be convinced of that. I mean, what you can say is if you stop development, uh, prior to, there's a time when a male can produce sperm, um, during puberty and a female

can ovulate. And if you stop development prior to that, and then go to cross-exformant, for sure, they're going to be infertile. Now, the question is, can all that be reversed? There's some, you know, specialists, I think you had Paul, Paul Ruse on your show. Yeah. Paul, Paul's like, no, once you're on it for a certain period of time, maybe he had that a year or two, you know, it's, I don't think you're going to be fertile at that point. And, you know, he, he's a, he's a professor and he knows his stuff. Yeah. I don't think it's been studied enough to know, but I would sure be convinced that there's going to be damage there. And I wouldn't be surprised it's permanent. I mean, I would let a person know that, Hey, this could be permanent damage to your body. Yeah. Is it easy for kids to

get cross sex hormones or blockers? I mean, because I've heard two sides of this. I've heard like they're handing them out on the street corners like candy, not quite, but versus like, oh, it's all conspiracy theory. Nobody under 16 or 18 can even get these. They're well-studied. And we've already kind of covered the well-studied piece, but like, is it something that is easy to get? I know I've heard Planned Parenthood centers are very easy to get. Are people diagnosing kids thoroughly before they get them or what's? Yeah. Well, I mean, it's probably easier to get cross-sex hormones or opposite sex hormones from a place like Planned Parenthood. I don't know if they're doing puberty blockers per se. Some of the things we know about puberty blockers being used on kids,

you know, as young as eight are through studies they've done, like at Children's Hospital Los Angeles. So we know it's being done, or UC San Francisco, we know it's being done. I don't know how widespread it is if you went to, you know, rural Idaho, if someone's giving it, for example, probably not, but it's possible. What about, um, this is going to change the conversation a little bit, but it is related. Uh, the whole trans athlete conversation, um, are from an, I wasn't planning to even ask you this, but I mean, I think this is kind of your area, like from an endocrinology perspective, um, are let's just say biological males. Well, I got two scenarios, a biological male who go, who is on blockers and then cross-sex hormones who never went through male puberty. Are they at any biological advantage over females?

And then also, if they do go through puberty or whatever, but then later on take estrogen and reduce their testosterone, are they at an advantage? Do you have any thoughts? That's interesting. So you're talking about a kid who maybe got puberty blockers, very early puberty. Yeah. And then maybe later took estrogen or thinking about taking estrogen.

You know, probably in that case, I'm just thinking off the top of my head, they would not have the same advantage as, say, an adult male who decides to transition to a female. a female because I think that the effects of testosterone on the heart, lungs, and bones are the key to making, during development, are the key to making the difference. So they may not, and you could argue they could be at some disadvantage even, let's say boys who got puberty blockers because of the blockage of bone development, probably muscle development, things like that. They may be at some disadvantage. I've also heard, again, this is, so a male gets, during prenatal development, gets a wash of testosterone eight to 10 weeks, I think. And that's where, you know, forms early stages of genitalia.

And then I heard at like eight months months another wash kind of towards the end of their prenatal development and then i thought i read somewhere and again i hate you know you and i we read a lot of studies and we don't always take notes and i don't have anything in front of me but i thought i remember seeing hearing that after shortly after birth they, the body gives another kind of push of testosterone so that a biological male, even before puberty, has had some level. I think it's probably minor, but some level of effect on their body with testosterone. Does any of that verify or do you know? Yeah, there are some. Yeah, I don't remember.

After birth, it can be very high levels of testosterone in males. I don't remember female differences. But it's such a short period of time. I don't know how much of a difference that wouldn't. Okay. But, well, okay. So what about, what about a male who has gone through puberty? They've developed as a male, then later on they take estrogen, testosterone reductors or whatever, if that's a thing. Right. Yeah. Yeah. I, again, I'm, and I'm not an expert on this topic, but, uh, you know, they're, they're going to have an increase in heart size. The

male who's gone through puberty, um, lung capacity, muscle size that, that aren't diminished by, well, they're diminished to some degree. And I don't remember the percent is like 10 or 20% or something of what they were before. Not enough to change their body to the equivalent female level of performance. I don't think so. I haven't studied this in depth, but my opinion is no. Okay. Well, yeah. Sorry to put you on the spot with that. Let's go ahead and change to let's to – how much time do you have? Okay, we just got a few more minutes.

So I asked a question on Twitter for people to send in their questions. So if you didn't get that, if you're not on Twitter, sorry, folks, that you didn't get to ask your question. But let me go down here, and we can do these – let's do these fairly quick. We've already covered some of these. What evidence do we have that the application of these treatments yields improved mental health? So referring to puberty blockers and cross-sex hormones, what evidence do we have that they improve mental health? I think we have.

Yeah. I mean, even just this week, it was, uh, one of my colleagues, Quentin Van Meter sent me something journal of endocrine society where they were kind of making a splash of, Hey, we did a review of all these studies and guess what? This improves mental health and such. And then when you look closer at it, they even admit in their paper, well, these were all low quality studies. And some of the studies weren't included. The Swedish study I referred to, the Brandstrom study that initially came out in American Journal of Psychology saying, hey, guess what? Surgeries, you know, improve outcomes for anxiety and depression, things like that.

And a bunch of us wrote letters and say, well, no, there's a lot of problems with what you've done. And they ended up retracting that. So a lot of things that are out there and make headlines, you have to dig in deeper and find out. Usually the studies are not very well done or don't have a lot of patience in it. And especially with kids, we just don't know a lot. Yeah, I read that Brandstrom study and I read you and several other people, your critiques. Yeah, they're pretty scathing. Brandstrom study, and I read you and several other people, your critiques. Yeah. They're pretty scathing.

I was like, man. And then to the point to where they retracted the article or at least significantly corrected it. Their conclusion, yeah, they retracted it. And it's great that they listened to the criticism, you know, and that people are out there saying, hey, let's take another look at this. And all of science should be like that. And all of science should be like that. Our next question, can he, you, can you let us know some prescription medicine names to reactivate the brains of those who want to prescribe puberty blockers? I'm not sure I understand the question. If that doesn't immediately make sense to you.

I'm not quite sure. But, you know, the other thing about puberty blockers is that, as I was saying, you know, let's say a kid decides, well, I don't want to be on this anymore. It could take a year. It could take a year and a half for the signals to restart. And maybe it's delayed indefinitely. We don't really know. There's no like on-off switch where, okay, you take this medicine to turn it off and we'll take this other medicine to turn it back on again. There really doesn't exist that sort of mechanism. So you have to wait for the body to sort of naturally play itself out after that.

All right. What do you think about bills like the one in Arkansas blocking these treatments in the name of child safety? I'm assuming they're referring to puberty blockers, not necessarily cross-sex hormones. Yeah. I was involved in one of the first bills in South Dakota that ultimately failed, sadly, to help block these sort of treatments for kids. And I think to me, one of the main things that has to do with consent and informed consent, like we were talking about earlier, does a child have the maturity to

know what's going to happen to their body, not only, you know, their heart, their lungs, and so forth, but can they comprehend really what it means to have a reproductive life when they're older, or normal sexual function, and I would argue that they don't, and that therefore all of these treatments should be delayed to adulthood, so I think what they're doing in Arkansas is very, very brave and very necessary. And hopefully other states will follow. I'm sure it'll be challenged all the way up to the Supreme Court. And so people really need to get educated in the public about the different sort of harms and problems, but especially kids, you know, kids who can't really comprehend what they want when they're 35, 40, you know, 50

or 25. That's the main crux of the issue. Adults is different, but we're looking at kids, we're talking about, can they really comprehend what's going to happen to them? All right. One more question. This one's kind of broad and it covers some of the stuff we talked to. Actually, no, we haven't actually talked about this specific issue. But what parts of the issue of gender dysphoria and blockers has broad agreement among most experts and which are more controversial, even if some of the controversial ideas you might agree with? Like is there a kind of broad agreement across endocrinologists on much of what you've said or is it so politicized that it's hard hard to even answer the question? Yeah, no, you hit it on the head. It's very politicized. I think the problem is when you get into these organizations, you have a small group of people who are coming up with papers and dictates from above that get pushed out to the public,

including most physicians, where most of us didn't have any input for it. So, you know, something might look like a broad consensus. Well, it was published and all these other groups are, you know, the American Pediatrics Society or AAP agrees with it, but who is actually agreeing with it? Maybe a handful of people in one organization, a handful in the other, and the rest of us who are out practicing doing our jobs, we may not agree with that at all. So there's a difference between what's coming out from academia and the organizations and say, like the real doctors on the ground out there, many of them who are probably afraid to talk about this subject. So yeah, there's the political aspect. There's the

climate of, you know, creating fear in doctors for, for speaking out against it. Cause they don't want to be labeled, you know, transphobic or whatever it is. But I'm just talking about biology and health, you know, in kids when they grow up, that's how I look at it. I'm not, I'm not aiming at any particular group. I just want to say, Hey, let's, let's really think about this. These are powerful hormones. What are we doing? I don't care that the organization said it. Isn't it up to us to question authority and think these things through? I think it is. It's incumbent on us, physicians and healthcare people, to really think carefully about this and not simply go along with the crowd because it's, you know, because we're afraid. Yeah, that's good. Michael, we're at an hour here. So thank you so much for your time. I'd hate to send me your bill, how much I owe you for an hour. But no, I really, really do appreciate it. And I just love the way you're able to talk about this

with, you know, just a really fair open-minded kind a very level-headed kind of perspective so thank you for that I know it's a lot of people are gonna benefit from this oh great okay thanks a lot Preston good to see you thank you Thank you.