The generally accepted treatment program for gender dysphoria begins with administering cross-sex hormones to feminize or masculinize appearance and to improve mental health. The trouble is, no scientifically strenuous studies have been done to assure the effectiveness and safety of this practice, and people with gender issues are being harmed.
One of these people is Jamie Shupe, retired Sergeant First Class from the U.S. Army. His story of emotional and physical trauma from cross-sex hormone treatment illustrates the sometimes unforeseen consequences of the still-experimental cross-sex hormone therapy prescribed for gender dysphoria.
In his words: “I am a transgender person that has suffered my entire life from gender dysphoria. In early 2013, I regretfully allowed the medical establishment to not only convince me that I am a female, but also to lead me to believe that I could successfully gain female appearance characteristics by taking high doses of female hormones. My four years of treatments and their side effects were paid for by the military health care system.”
For over four decades, gender experts have recommended cross-sex hormone therapy to treat those patients who feel they should be the other sex, yet rigorous studies of the effects or efficacy of using powerful hormones in this “off-label” way are lacking. Transgender individuals, adult and children, are being experimented upon, with the full involvement and consent of transgender health care providers.
No link shown between Hormone Therapy and Improved Quality Of Life
In 2016, Boston researchers reviewed all published medical studies available in online medical libraries looking for papers that studied the relationship between hormone therapy and changes in psychological functioning and quality of life in transgender individuals over time. They specifically were searching for studies that used the “gold standard” of research — prospective controlled trials.
The results, published in Transgender Health, reveal the paucity of research. The authors shared that not one prospective controlled trial could be found, and therefore a relationship between hormone therapies and improved mental health and quality of life has not been shown.
Shupe says for him, “The treatments failed to improve my mental health symptoms as promised in the informed consent documents.”
Links To Suicide And Depression
However, the relationship between cross-gender hormone use and depression, while not scientifically tested, has been noted.
For men taking female hormones (aka, transgender women, or MTF), depression is a known side-effect. As one study says, “Other associated conditions commonly seen in transgender women include increased risks of depression.”
Shupe found this to be true: “I was hospitalized in the psychiatric ward twice at the VA for depression and emotional instability after estrogen injections destabilized my mental health to the point that I was suicidal.”
For some women taking testosterone (i.e., transgender men, or FTM), testosterone can cause increased irritability, frustration, and anger. There are reports of testosterone destabilizing FTMs with bipolar disorder, schizoaffective disorder, and schizophrenia. The link to depression and suicide has been noted for decades in transgender individuals who take hormones and go on to undergo gender-change surgery.
In 1979, endocrinologist Dr. Ihlenfeld, who had administered cross-sex hormone therapies at a renowned gender clinic to 500 people diagnosed with gender dysphoria over 6 years, warned, “There is too much unhappiness among people who have had the surgery … Too many of them end as suicides.”
In 2004, a UK Guardian article headlined, “Sex Changes are Not Effective Say Researchers,” quoted researchers who reviewed over 100 studies as saying, “There’s still a large number of people who have the surgery but remain traumatized – often to the point of committing suicide.”
Cross-Gender Hormone Use Is Not Well Studied
Study after study concludes that more research is needed in every area about hormone use by transgender men and women.
For example, effectiveness. The use of feminizing cross-gender hormones has not been proven to be effective. A 2016 research article, which overall tends to be favorable toward cross-gender hormone use, says that, “No studies have examined the efficacy of the different formulations [of estrogen] specific to transgender hormone management.” The author also admits: “There are no unanimous recommendations for the use of anti-androgens [for transgender women].”
Then there’s the question of dosage. Determining the right dose in the right form is a matter of trial and error. As guidebooks, such as this one for MTF, clearly states, there is no typical dose: “Clinical protocols for MTF therapy vary greatly. There is no one right hormone combination, type, or dose.”
The transgender-specific guidelines that experts at the World Professional Association for Transgender Health (WPATH) and the Endocrine Society have created are based mostly on clinical experience from experts in the field; not verified by research.
Medical Risks And Complications
More seriously is the issue of medical risk and complications, which vary between testosterone and estrogen.
Testosterone, used to masculinize the appearance of a female to that of a male, can increase the risk of heart disease, stroke, and diabetes. It is not known if testosterone increases the risks of breast cancer, ovarian cancer, or uterine cancer. Most of the studies on hormone therapy track biological men, not women who want to appear as men. Because men’s bodies are different than women’s and the dosages prescribed are different, the results found for biological men are not transferrable to the transgender male population.
The UCSF Center of Excellence for Transgender Health FTM health booklet shares “a few other risks associated with testosterone therapy that you should know about” —
Testosterone can make your blood become too thick…which can cause a stroke, heart attack or other conditions. This can be a particular problem if you are taking a dose that is too high for your body’s metabolism. Your cholesterol could potentially increase when taking testosterone. Your doctor will perform periodic tests of your blood count, cholesterol, kidney functions, and liver functions, and a diabetes screening test…
Estrogen, used by men wanting to feminize to the appearance of a woman, has medical effects and safety concerns for transgender people which are not fully understood. As the UCSF Transgender Care male-to-female health booklet says, “Since there is not a lot of research on the use of estrogen in transwomen, there may be other risks that we won’t know about, especially for those who have used estrogen for many years.”
Jamie Shupe’s Story
Jamie Shupe suffered health complications from his hormone therapy.
He says: “As a result of being prescribed these off-label, high dose hormones, I’ve suffered numerous serious health complications. I’ve been treated in the emergency room twice for vasculitis (inflammation of blood vessels) and cellulitis in my legs because of oral cross-sex hormones. Testing at the Department of Veterans Affairs (VA) hospital also revealed that my kidney function was abnormal despite leading a healthy lifestyle. The attending physician emphatically advised that I stop taking the oral cross-sex hormones, which I did.”
When Jamie went to an LGBT clinic for follow-up care, to his surprise, the clinic doctor harshly criticized the care he received at the VA, both for putting him on oral hormones the year before (because pill form for someone his age can cause problems in the liver), and for stopping the HRT the month before. The clinic doctor said he had a better plan and wrote Jamie a prescription for weekly intramuscular injections of estrogen, to be self-injected into his thighs.
According to Jamie, in a short time the results proved to be disastrous: “By the fifth week of estrogen injections my mood had spiraled out of control. My energy level had also plummeted. I had rapidly deteriorated from a structured daily routine of exercise and working on my website, to a state of complete and utter despair. I had absolutely no ability to concentrate. Suicidal and in the deepest depression of my life, I angrily threw the syringes and vials of estrogen in the trash, swearing to never take hormones again.”
Ashamed and considering suicide, Jamie was admitted into the psychiatric ward at the VA hospital. Despite telling the mental health doctors about the hormone injections and the recent stopping of hormones, they didn’t test his hormone levels, and as Jamie says, “They diagnosed me with multiple psychiatric illnesses and, in an effort to cure me, pumped me full of antidepressants, mood stabilizers and antipsychotic drugs.”
Nearly five months later and back to writing for the first time, Jamie says he counts himself lucky: “I describe myself as lucky because I never had any transgender surgeries that would have rendered my body unable to restore my natural hormones. Today, my hormones are nearly back to natural male levels. Because of the return of my testosterone, my mood is also beginning to stabilize for the first time in months. Some of my concentration has also returned. I’m by no means out of the woods yet and fully recovered.”
President Trump, Do Not Place The Military At Risk
Over the last 40 years, hormone therapies and sex change surgeries have produced high rates of suicides, unhappiness, and for some like Shupe, deep distress that led to medical complications and stopping the therapy. The military is not the place to advance a “politically correct” experiment with cross-gender hormone therapy on troops and veterans. The risks to the individuals and to military readiness are too high.
The military needs to have a psychologically healthy, emotionally sound, physically fit, combat ready fighting force; not individuals who are distracted by the need for hormone injections and gaining access to a sex change clinic at the expense of military fitness, readiness and funds.
Mr. President, stand up for the military and keep your word to stand down on turning the military into a sex change clinic for the gender distressed.
