There are very few studies on possible long-term effects. We found a 2015 study, “Bone Mass in Young Adulthood Following Gonadotropin-Releasing Hormone Analog Treatment and Cross-Sex Hormone Treatment in Adolescents With Gender Dysphoria”, which followed 34 subjects, both transmen, and transwomen, in a longitudinal study. This study used triptorelin, rather than Lupron, like the original Dutch Protocol study. The subjects were also followed up on after they had a gonadectomy (i.e castration).

The study found this:

Between the start of GnRHa and age 22 years the lumbar areal BMD z score (for natal sex) in transwomen decreased significantly from −0.8 to −1.4 and in transmen there was a trend for decrease from 0.2 to −0.3. This suggests that the BMD was below their pretreatment potential and either attainment of peak bone mass has been delayed or peak bone mass itself is attenuated.”

There are long-term side effects — trans youth possibly don’t attain their actual peak bone mass due to the treatment, meaning they are vulnerable to bone issues later in life, or even during their youth. In this study, GnRHa therapy on its subjects had a duration ranging from half a year to nearly four years, and most of them had been on cross sex hormones for five years or more. How bad was that decrease in bone mineral density?

According to the World Health Organization classification, both groups had individuals that would classify as osteopenic according to their T-score (6).

That’s not great. Actually, that’s really bad.

The researchers also have no real idea of the long-term effects:

“The relevance of these findings with respect to fracture risk is not clear. At present, as for transgender populations who had sex reassignment as adults (16), in adolescents with GD it is unknown whether medical intervention leads to an increased risk of fractures later in life.”

We have no idea what this means for their future.

We don’t know what the long-term effects are in adults, either. There is this review of hormone therapy in transgender adults “Hormone therapy in transgender adults is safe with provider supervision; A review of hormone therapy sequelae for transgender individuals”.

Of course, it uses the words ‘we don’t know the long-term effects’.

“The primary concern among MTF individuals on estrogen therapy is the possibility of developing thrombogenic complications 2, 3, 4, 5, 6, 7. Therefore, educating MTF individuals and their providers for preventative ways to minimize risk of thromboembolic events might be the most important long-term assessment of transgender women in order to minimize the risk of adverse effects of HT. Suggested risk modifications from groups studying VTE among MTF individuals include addressing any hypercholesterolemia, hypertension or smoking use that a patient might have. Hypercoaguable risk factors, including the use of a thrombogenic estrogen, ethinyl estradiol, have been associated with many of the cases of reported VTE, and as such the risk of these adverse events may continue to decline as the usage of this drug diminishes [3]. Other health outcomes for transgender women may include increased triglycerides [48] and decreased sexual desire [65].” “There are multiple case reports of conditions associated with MTF HT, including the incidence of meningiomas, benign pituitary tumors and prolactinomasalong with the occurrence of autoimmune conditions with a female predominance, such as systemic lupus erythematosus. However, the data are too limited to make any type of conclusion or recommendation.

What about in female-to-male hormone therapy?

Transgender men did not experience the increase in thrombogenic complications that some transgender women reported Both transgender men and women experienced an increase in insulin resistance, fasting glucose and changes in body fat redistribution Adipocyte-derived hormone levels may reflect changes in insulin sensitivity on hormone therapy, as transgender men had decreased adiponectin levels while transgender women had decreased leptin, both associated with insulin resistance

Eventually, the scientists give up and admit: ‘we don’t know the long-term effects’.

“With the exception of a few large-cohort and long-term studies, much of the existing knowledge about the health impact of transgender HT is based on case reports. While these provide clues to effects of transgender HT, there is a strong need for future research of greater cohort size to be undertaken in order to address this critical gap.

I really hope we do address this critical gap, before it’s too late for some people. Because it’s pretty clear that no one has any idea on the long-term effects of the new conversion therapy.

THE DUTCH PROTOCOL

The Dutch Protocol studies are the origins of the new conversion therapy. To examine it’s origins, we took a look at “Clinical management of gender identity disorder in adolescents: a protocol on psychological and paediatric endocrinology aspects”, where the Dutch Protocol originated. The Dutch Protocol is used to refer to the ‘protocol’ of giving gender dysphoric children puberty blockers, a course of cross-sex hormones, and then a gonadectomy, or to be blunt, castration.

It’s worth pointing out that this study (and others)was funded by Ferring Pharmaceuticals.

“The authors are very grateful to Ferring Pharmaceuticals for the financial support of studies on the treatment of adolescents with gender identity disorders”

Ferring is a Swiss pharmaceutical company that makes triptorelin, another GnRHa, and the GnRHa used in the Dutch Protocol studies. I am sure that this created no incentives for the study and the prospect of putting adolescents on courses of triptorelin for years at great cost, had nothing to do with the study which was done for the benign reason of saving these vulnerable youth.

Let’s get into the meat of the study now. This is from the introduction.

“Transsexuals are applying for sex reassignment (SR) surgery at increasingly younger ages. Yet clinicians are usually reluctant to start the SR procedure before adulthood. They assume that adolescents are not able to make a sensible decision about something as drastic as SR. They fear that the risk of postoperative regrets will be high and the treatment will have unfavourable physical, psychological or social consequences. Postoperative regret or any other unfavourable result of SR naturally is of serious concern to clinicians. However, the decision of what age to start SR should be a balanced one. There are two main reasons to consider early treatment as appropriate.”

What are these two reasons? Why is it evil to tell adolescents that they shouldn’t irreversibly damage their bodies? Good god.

“One reason for early treatment is that an eventual delay or arrest in emotional, social or intellectual development can be warded off more successfully when the ultimate cause of this arrest has been taken care of. Suffering from gender dysphoria without being able to present socially in the desired social role, and/or to stop the development of secondary sex characteristics usually leads to problems in these areas. Adolescents find it hard to live with a secret. Often have difficulties in connecting socially and romantically with peers while still in the undesired gender role, or the physical developments create an anxiety that limits their capacities to concentrate on other issues.”

Wait a damn minute. All of this, for these scientists, is about the inability to ‘present socially in the desired social role’ and difficulties ‘connecting socially and romantically with peers while still in the undesired gender role’.

That’s not homophobic. Right. Riiight.

“A second reason to start SR early is that the physical treatment outcome following interventions in adulthood is far less satisfactory than when treatment is started at an age at which secondary sex characteristics have not yet been (fully) developed. Looking like a man (woman) when living as a woman (man) creates barriers that are not easy to overcome. This is obviously an enormous and lifelong disadvantage.”

Translation: ‘It makes them look less weird’.

“Furthermore, follow-up studies show that unfavourable postoperative outcome seems to be related to a late rather than an early start of the SR procedure (for a review, see (2)). Age at the time of assessment also emerged as a factor differentiating two groups of male-to-female transsexuals (MFs), one with and one without post-operative regrets (3)”

Translation: ‘Children we indoctrinate don’t detransition’.

What does that even mean? We know that gender dysphoria often desists during puberty. Where did this come from?

“It is conceivable that lowering the age limit increases the incidence of ‘false positives’. However, it most certainly results in high percentages of individuals who more easily pass into the opposite gender role than when treatment commenced well after the development of secondary characteristics. This implies an improvement in the quality of life in these individuals, but may also result in a lower incidence of transsexuals with postoperative regrets or poor postoperative functioning. Clinically, it is known that some patients who were treated in adulthood regret SR because they have never been able to function inconspicuously in the opposite gender role. This holds especially for MFs, because beard growth and voice breaking give so many of them a never disappearing masculine appearance. But, since the number of ‘false positives’ should be kept as small as possible, the diagnostic procedure should be carried out with great care. Until now, no patients who started treatment before 18 years have regretted their choice for SR.”

I love how cavalier the dismissal of ‘false positives’ is. Are you sure that no patients who started transition under 18 have never regretted their choice for sex reassignment?

“Before this is done, significant persons in the adolescents’ life have to be informed about the impending changes. The underlying idea of these requirements is that applicants should have had ample opportunity to appreciate in vivo the familial, interpersonal, educational, and legal consequences of the gender role change. In adolescents, who are referred at very young ages (around 12 years), the RLE usually starts when they are on GnRHa treatment only. However, at this stage the RLE is not a requirement. When, after the age of 16 years, the cross-sex hormone treatment is started, the RLE is required for obvious reasons.”

What does it mean to ‘live in the role of the desired sex’? What’s the ‘role’ of each sex? Why does the paper constantly switch between the words ‘desired sex’ and ‘desire role’. Here it’s not even about sex — it’s about changing gender role. You know, social constructs about the roles of the sexes that are rooted in patriarchal ways of thinking. Those ‘gender roles’ that serve to enforce sexism and homophobia.

The paper goes onto describe the effects of the puberty blockers:

“In both girls and boys, after a short activation of the gonadal axes, GnRHa will bring the patients into a hypogonadotrophic state. In girls, withdrawal of oestrogens may induce a withdrawal bleeding. Cycling is disrupted. In early pubertal boys, the hypogonadotrophic state will block the development of fertility. In olderstaged boys, fertility will regress. Therefore, in older boys, cryopreservation of semen should be discussed prior to the start of the treatment. As a result of the hypogonadal state, MFs can have complaints of fatigue and a decrease of body strength. With respect to growth, the growth spurt will be hampered and fusion of the growth plates delayed. This phenomenon may give the opportunity to manipulate growth. Since females are about 12 cm shorter than males, we may intervene with growth stimulating treatment in order to adjust the female height to an acceptable male height. In contrast, the blocking of the pubertal growth spurt in males is not a problem. During the treatment with oestrogens, the epiphyses will close progressively resulting in what would be a compromised final height for a nontranssexual male, but a quite acceptable height for MF.”

Oh, there we go. That ‘infertility’ word.

The question arises whether patients participating in this protocol may achieve a normal development of bone density, or will end with a decreased bone density, which is associated with a high risk of osteoporosis. During physiologic puberty, carbohydrate and fat metabolisms change. Temporary insulin resistance occurs and an increase in fat mass is seen in pubertal girls. We do not know what the effects of GnRHa treatment alone, or in combination with cross-sex hormones, are on these metabolic aspects.”

Again: yet another group of scientists with no idea of the long-term effects of what they are doing. What they are doing to children. Not that that stops them. Especially once they pass the age of 18, then it’s time for surgery:

“Surgery is not carried out prior to adulthood (18 years of age). The Standards of Care emphasize that the ‘threshold of 18 should be seen as an eligibility criterion and not an indication in itself for active intervention’. If the RLE supported by the cross-sex hormones has not resulted in a satisfactory social role change, if the patient is not satisfied with, or is ambivalent about, the hormonal effects or surgery, the applicant is not referred for surgery. In MFs, female-looking external genitals are created by means of vaginoplasty, clitoroplasty and labiaplasty. In cases of insufficient responsiveness of breast tissue to oestrogen therapy administered for long enough, breast enlargement may also be performed. After surgery, intercourse is possible. Arousal and orgasm are also reported postsurgically, though the percentages differ between studies (13, 14).” “In FMs, a mastectomy is often performed as the first surgery to successfully pass into the desired role. When skin needs to be removed, this will result in fairly visible scar tissue. Considering the still continuing improvements in the field of phalloplasty, some FMs do not want to undergo genital surgery until they have a clear reason for it. They may then choose to have a neoscrotum with a testis prosthesis with or without a metaidoioplasty (this technique transforms the hypertrophic clitoris into a microphallus) or a phalloplasty. Other genital procedures include the removal of the uterus and ovaries. Whether FMs can have sexual intercourse using their neopenis depends on the technique and quality of the phalloplasty. Although some patients, who had a metaidoioplasty, report that they are able to have intercourse, the hypertrophic clitoris usually is too small for coitus. In most cases, the capacity of sexual arousal and orgasm remains intact. When the gonads of the patient are surgically removed, the patient can discontinue the GnRHa treatment, but will continue the cross-sex hormone treatment.”

It talks about castrating young people — many of whom would otherwise be homosexual without this ‘treatment’, in such a cavalier way. I’d be disturbed if I hadn’t waded through sheer oceans of this kind of thing by now.

The paper then describes the first experiences with the ‘protocol’.

“First experiences with the protocol At present, 54 patients are being treated according to this protocol, 30 of whom are FMs. The GnRHa triptorelin (TRP) is administered in a dose of 3.75 mg every 4 weeks intramuscularly or subcutaneously. At the introduction of the treatment, an extra dose is given at 2 weeks. Preliminary results of the first 21 patients (11 FMs, 10 MFs), treated for 2 years or longer, are as follows” “With respect to bone density During GnRHa treatment, bone density remained in the same range. There were no significant changes in bone densities at three locations: lumbar spine, non-dominant hip and total body, during TRP treatment. However, when calculated as a Z-score, there appears to be a significant decrease during this period. During cross-sex hormone treatment, bone density increased significantly in both MFs and FMs, which is associated with an increase in the bone density Z-score. Figure 4 shows the data of bone density in an MF patient during 2 years of TRP treatment, followed by 2 years of combination therapy with cross-sex hormones.”

The use of GnRHas causes decreases in bone density — this we’ve already seen. What happens next?

“The present protocol, developed to ameliorate treatment outcome in adolescent patients with an early onset of GID, appears to be a suitable way to treat such patients. It seems possible to select patients who will profit from early interventions, starting at 12 years with GnRHa and followed at 16 years by cross-sex hormone treatment, provided that the diagnostic procedure is carried out with great care and by an experienced team. Careful diagnosis should focus on the assessment of the GID as well as potential risk factors (e.g. severe co-morbidity). If any risk factors are present, these should be addressed first, before any medical intervention takes place. Since the diagnostic procedure is lengthy, there is ample time for patient, the family and the psychologist or psychiatrist to make the final decision. Making a balanced decision on SR is far more difficult for adolescents, who are denied medical treatment (GnRHa included), because much of their energy will be absorbed by obtaining treatment rather than exploring in an open way whether SR actually is the treatment of choice for their gender problem. By starting with GnRHa their motivation for such exploration enhances and no irreversible changes have taken place if, as a result of the psychotherapeutic interventions, they would decide that SR is not what they need. However, until now, none of the patients who were selected for pubertal suppression has decided to stop taking GnRHa. On the contrary, they are usually very satisfied with the fact that the secondary sex characteristics of their biological sex did not develop further”

Unfortunately, there is no decisions. We already know that once a course of puberty blockers starts, the persistence rates increase dramatically.

“The first clinical data suggest that bone mineral density remains at the same level during treatment, which indicates a decrease in Z-score when compared with reference values. However, when, at the age of 16 years, suppression of puberty is combined with cross-sex hormone treatment, a catch-up for bone accretion is observed, resulting in a decrease and normalization of the bone mineral density Z-score. This medical intervention, therefore, does not seem to harm bone development in the short term, but long term data on peak bone mass should be assessed before a final conclusion can be drawn.”

We don’t know if this has long-term effects. Does anyone have any idea if this causes long-term effects? Anyone? Anywhere? Hello? Is there anyone here? I’m lonely.

They don’t know if this protocol has long-term side effects on the brain.

“During puberty, developmental processes also take place in the brain. In the adult brain, a number of sex differences have been reported. For example, the amount of grey matter is higher in adult females than males in the gyrus cingulatus, the median frontal area and the lobus paracentralis in particular. It is not clear yet how pubertal suppression will influence brain development. From our experience with adolescents, who have been taking GnRHa and are now adults, no gross effects on their functioning are detectable. However, a study on brain development of adolescent transsexuals, who have used GnRHa, will be carried out to detect eventual subtle functional and structural effects.”

This study had no control group. No study using the Dutch Protocol has. We have no idea whether it’s more effective than other treatments for GID.

The Dutch studies don’t have any control group that doesn’t receive intervention — how do we know that their intervention is the most effective treatment? We don’t know the answer to that question, yet these scientists are forging ahead with the puberty blocker path anyway, and casting any form of therapy to help these young people accept their bodies as is, without medical interventions as ‘conversion therapy’ that prevents them being their ‘authentic selves’. There are no control groups. No one has any idea of the long-term effects, bar the fact that one hundred per cent of children that go through this ‘treatment’ will be completely sterile.

You know, castrated.

Oh, and one of the side effects of that castration can be death. A 2014 study, done by same people who designed this ‘treatment’ for trans children, had a participant die from a necrotic vaginoplasty.

“ Nonparticipation (n = 15, 11 transwomen and 4 transmen) was attributable to not being 1 year postsurgical yet (n = 6), refusal (n = 2), failure to return questionnaires (n = 2), being medically not eligible (eg, uncontrolled diabetes, morbid obesity) for surgery (n = 3), dropping out of care (n = 1), and 1 transfemale died after her vaginoplasty owing to a postsurgical necrotizing fasciitis.”

Death is one hell of a side effect, no?

Why is it, that the preferable outcome for these people is a child that faces a lifetime of medicalization, a denial of sexual maturity, and unknown long-term effects on their bones, their brains, their psychology, and possibly even death rather than potentially growing up to be homosexual?

Why is the latter such a bad outcome?

Why?

I’m serious: growing up to be homosexual, not transsexual is the most likely outcome in children and adolescents with GID. This study “A follow-up study of girls with gender identity disorder.” found:

““This study provided information on the natural histories of 25 girls with gender identity disorder (GID). Standardized assessment data in childhood (mean age, 8.88 years; range, 3–12 years) and at follow-up (mean age, 23.24 years; range, 15–36 years) were used to evaluate gender identity and sexual orientation. At the assessment in childhood, 60% of the girls met the Diagnostic and Statistical Manual of Mental Disorders criteria for GID, and 40% were subthreshold for the diagnosis. At follow-up, 3 participants (12%) were judged to have GID or gender dysphoria. Regarding sexual orientation, 8 participants (32%) were classified as bisexual/homosexual in fantasy, and 6 (24%) were classified as bisexual/homosexual in behavior. The remaining participants were classified as either heterosexual or asexual. The rates of GID persistence and bisexual/homosexual sexual orientation were substantially higher than base rates in the general female population derived from epidemiological or survey studies. There was some evidence of a “dosage” effect, with girls who were more cross-sex typed in their childhood behavior more likely to be gender dysphoric at follow-up and more likely to have been classified as bisexual/homosexual in behavior (but not in fantasy).”

Nearly half of the girls who presented with GID turned out to be homosexual.

Here is some more information on how many of them turned out gay, which included two of the still gender dysphoric patients:

39 participants (60%) were classified as exclusively heterosexual, 8 (32%) were classified as bisexual/homosexual, and the remaining 2 (8%) were classified as having no sexual fantasies. Of the 3 participants classified as gender dysphoric, 2 were exclusively homosexual in fantasy (i.e., sexually attracted to members of their own birth sex). The other gender dysphoric participant reported no sexual fantasies and described herself as being “dead sexually.” (Of the 4 participants with a DSD, 3 were classified as exclusively heterosexual in fantasy, and 1 reported no sexual fantasies; 2 were classified as exclusively heterosexual in behavior, and 2 reported no sexual behavior.)”

I mean, how likely is it that all these young women who had GID would turn out gay?

“ Odds ratios were calculated for bisexual/homosexual sexual orientation in fantasy and behavior using prevalence estimates from several major survey studies of sexual orientation in adolescent girls and young women (Dickson, Paul, & Herbison, 2003; Fergusson, Horwood, Ridder, & Beautrais, 2005; McCabe, Hughes, Bostwick, & Boyd, 2005; Narring, Stronski, & Michaud, 2003; Remafedi, Resnick, Blum, & Harris, 1992; Russell & Seif, 2002). From these studies, base rates for bisexual/homosexual sexual orientation in fantasy and behavior were estimated to range from 2.0% to 5.0% in the female general population. The odds of reporting bisexual/homosexual sexual orientation in fantasy in the present sample was 8.9–23.1 times higher, and the odds of reporting bisexual/homosexual sexual orientation in behavior in the present sample was 6.0–15.5 times higher than it is in women in the general population.”

Well, that’s indicative of a link between childhood gender dysphoria and homosexuality. And the study agrees with me:

To our knowledge, the results of the present study represent the first prospective data set that shows that girlhood cross-gender identification is associated with a relatively high rate of bisexual/ homosexual sexual orientation in adolescence and adulthood. Using survey data on sexual orientation in young women as a comparative metric, we estimated that the odds of reporting a bisexual/ homosexual sexual orientation in fantasy was 8.9–23.1 times higher in the present sample and that the odds of reporting a bisexual/homosexual sexual orientation in behavior was 6.7–15.5 times higher.”

Childhood gender non-conformity is also often predictive of a homosexual or bisexual sexual orientation in adulthood. That’s not just me saying that — that’s decades of science. The 1995 Zucker and Bailey studied mentioned in this paper, “Childhood Sex-Typed Behavior and Sexual Orientation: A Conceptual Analysis and Quantitative Review” ,reviewed forty-one studies on both homosexual and heterosexual recollections of gender-non conforming behavior in childhood. While data on women was somewhat lacking, it found an overwhelming amount of evidence that homosexuals recall substantially more childhood cross-sex typed behavior — gender non-conformity in childhood or even GID isn’t predictive of transsexualism in adulthood, it’s predictive of homosexuality in adulthood — and that doesn’t require a lifelong medication regiment.

“This article reviewed research examining the association between childhood sex-typed behavior and sexual orientation. Prospective studies suggest that childhood cross-sex-typed behavior is strongly predictive of adult homosexual orientation for men; analogous studies for women have not been performed. Though methodologically more problematic, retrospective studies are useful in determining how many homosexual individuals displayed cross-sex behavior in childhood. The relatively large body of retrospective studies comparing childhood sex-typed behavior in homosexual and heterosexual men and women was reviewed quantitatively. Effect sizes were large for both men and women, with men’s significantly larger. Future research should elaborate the causes of the association between childhood sex-typed behavior and sexual orientation and identify correlates of within-orientation differences in childhood sex-typed behavior.”

The evidence all agrees: ‘cross-gender behavior’ is strongly predicative of being a flaming homosexual of either sex. Not transsexualism. Unlike retrospective studies, which rely on adult recall of childhood, prospective studies linking childhood gender non-conformity often used children who met the diagnostic criteria of gender dysphoria — and many of those children grew up to be gay or lesbian. They were ‘truly trans’ — and then they grew out of it and instead became homosexuals.

It even says this in the conclusion:

Homosexual individuals recall substantially more childhood cross-sex-typed behavior than do heterosexuals of the same sex. Prospective studies have supported these retrospective findings for men; analogous studies for women remain to be done. Future research should focus on the causes of this association, as well as the causes and consequence of within-orientation variation in sex-typed behavior”

Welcome to the new conversion therapy.