The Hormone Health Crisis | with Endocrinologist William Malone, MD

The Hormone Health Crisis | with Endocrinologist William Malone, MD

this is Benjamin Boyce and welcome to my ongoing series on gender sexuality and transition today's guest is dr. William Malone who is an endocrinologist endocrinologist not to be confused with a rabid hater of Star Wars third episode or sixth episode endure cringe ologist anyways here's William Malone how's your day going so far not too bad you know this this whole topic is a difficult one and I think I think a lot of physicians have some significant frustration and how in particular our medical societies have handled this topic especially in the US and I think that's caused quite a bit of frustration so I think I think you know most most doctors are usually baseline stressed physician burnout is I think at all-time highs but you know this topic in particular is obviously it is a stressful one in and of itself so but the day's going pretty good how's your day going oh it's pretty good I mean I was just going through the report that you sent me on this and you know crank cranking into livelihood but you brought up that it seems like a vicious circle that this topic which would be I guess transsexualism or transgenderism alright it it introduces stress to caregivers medical doctors and therapists which causes them to let alone the patients but it causes the professionals to avoid it leading to less quality of care for the patients and then the people who step in to give the care usually end up being would you say affirmative or only going in one direction yeah now I think that's I think a great great point and that's that's exactly what's happening so if if Doc's don't have an understanding of the topic they will essentially just you're clear of it and they'll direct a patient who is requesting puberty blockers and cross-sex hormones to a so called gender expert who may or may not be an expert now they may just be willing to prescribe cross-sex hormones and and so that doc who has little understanding or may be extremely skeptical of gender affirmation therapy will refer to a doctor who will quote unquote give the patient what they want and and that that obviously yes it has led to the current situation where most Doc's are not speaking out because they don't feel like they have I think the medical knowledge to do so in a competent fashion because you know this so historically you know the number of people who would go on to cross-section hormones and I'll call it feminizing or masculinizing surgery was very small it was maybe one out of 20,000 in the general population one out of 40,000 and you know it was basically considered a an orphan disease condition meaning it's very rare that you you look you'll hardly see it and hardly anyone is specialized in it but with the introduction of puberty blockade in particular and then the new phenomenon of adolescent onset gender dysphoria so I'll call it adolescent or young adult onset gender dysphoria essentially this has exploded into mainstream medicine now and most doctors are completely unprepared to deal with it in the UK it's a little bit different now so Karl Hennigan has come out and he's the editor in chief of the British Medical Journal he came out earlier this year and essentially stated the truth which is gender affirmation therapy is unproven to work and has the risk of significant serious and irreversible side effects and he essentially stated that it is unproven and unsafe to be applied to children and adolescents and then recently the Royal College of General Practitioners that's a group of fifty thousand general practitioners in England in the UK came out recently with a statement essentially stating the same thing which is the truth which is this this approach to treating folks with gender dysphoria this this gender affirmation therapy and in particular and then the application of the medical arm of the Dutch protocol which is puberty blockade at 10 or stage to early puberty followed by cross-sex hormones and then potentially sex reassignment surgery so so that is completely unproven and children and adolescents unstudied unproven very dangerous given the side effects of these hormones and in addition the application of that protocol to because most gender dysphoria resolves so most communities under 20 an say yeah as the peasants and that's what the literature says so regardless of source you know that this is this has been well established back to you probably 1995 and again we're talking so right now about childhood gender dysphoria so 80 to 90% of kids who have gender dysphoria will have resolution of that as they pass through puberty that's not been well studied we don't know the process by which that occurs but we do know through puberty the majority will resolve so if you apply a protocol at puberty blockade so affirmation puberty blocky and cross-sex hormones – every kid who's coming into puberty you essentially are gonna treat many who would have resolution of their gender dysphoria and that's another major obvious problem well what are the the basic effects of the puberty blocker and then going on cross-sex hormones you say that that was dangerous sort they can't be dangerous what are some of the effects of that you know so so puberty blockade essentially the idea is that if you have a gender dysphoria kid you give them puberty blockers it will buy that kids some time to figure out if they want to be treated with cross-sex hormones but puberty blockade and this has been written about fairly extensively in the literature especially the International literature essentially halts the development of that adolescent on multiple levels so physiologically socially perhaps intellectually we don't know so essentially your halting a natural process of development and so after two years of puberty blockade so let's say you start a kid at age 49 period two years later you're essentially still dealing with a 14-year old huh socially that all of their peers have advanced they're having more complex interactions they're going through puberty they're having all of the have they're experiencing all the things that occur during puberty and that process seems to resolve most gender dysphoria and so your halting one criticism here and this is not just my criticism this is the this is what's written in the literature one concern and criticism of this approach is that you are you are halting the process that actually leads to resolution of that is for you now we there are a couple there's one major study about 70 kids who showed and what that shows is that all those kids who were put on puberty blockers went on to cross-sex hormones so people be blockers are sold as a way to decide but if you are halting a child's development how are they supposed to decide and so all of the kids in that study went on to cross-sex hormones and that combination of puberty blockade followed by cross-sex hormones has a high likelihood of causing infertility okay all right so that's one major issue here if you if you initiate puberty blockade early and puberty and then follow that with cross-sex hormones you've essentially induced this state of permanent infertility does that not just fertility but but sexual gratification like the sexual development the ability to have enjoyable yet will contact is diminish yet yeah that's another another concern right because you have essentially immature genitalia okay yep and then there are significant risks of cross-sex hormones so so so you know a a girl who has given testosterone so let's say you know puberty blockade is initiated at age 14 or 13 and then cross-sex hormones initiated at 15 or 16 so within three to six months her voice will deepen permanently and not she'll experience some changes in facial structure so her jaw will increase in size for her brow might change her face will begin to appear more masculine there are changes in skin and hair obviously so testosterone tends to cause body hair growth and reductions in scalp hair growth there are reports and again we don't we don't fully understand what happens here and this is why Carl Hanigan has stated very clearly he said you know this process of puberty blockade and cross-sex hormones is being used and this is his words in a state of profound scientific ignorance so so we don't really we don't know exactly what's gonna happen we have some experience from women who have developed testosterone secreting tumors so if a woman comes in down Italy yes so so endocrinologists are supposed to identify excesses or insufficiencies of hormones and then put those back into normal ranges hmm that's our that's our primary goal that's our primary training so if somebody's insulin levels are too low their blood sugar will be too high they will have diabetes we do things to get their insulin levels back to normal ranges so if if a woman comes in with excess testosterone that this is this is a significant in normal situations this is of significant concern I mean we we start a workup we are we're doing a ton of blood work we're doing imaging we're trying to find this tumor that's making testosterone because it's gonna permanently alter her physical appearance and massively increase her risk of heart disease okay and what does it do to the female genitalia so it'll cause vaginal atrophy and that can lead to in comments so and that that's a significant side effect okay so the you know the vaginal tissue essentially is dependent upon estrogen for its four normal function and sustainability so so there are immediate physical changes and then really long-term a profound increased risk and the chance of heart attack and we do have studies showing that so so a woman taking testosterone has four times the odds of developing a heart attack than a woman who is not and is that because the way in which the female I guess the female grown heart interacts with a new induction of testosterone or is that does it bring it in line does it bring these women in line with the male rates of heart disease it's twice the risk of the male rate okay so it's four so so I want to be careful with this statistical and that terms here so so the correct term the way the study was done it was odds so it was four times the odds of a woman's risk of heart disease and two times the odds of a man's risk so it's higher than both so a woman taking testosterone basically has a higher risk than both categories that probably has to do with a multitude of factors so right every single cell of our body that has a nucleus has either an X X or an X Y chromosome in it and each cell behaves according to its complement of sex chromosomes independently of hormones so it's not like we're all made up of ambivalent cells who will respond simply according to the bath of hormone that you put them in there are sex specific differences this is well known in biology not well known by some people in gender clinic so I found out they think that well if you just put a woman's testosterone level into the male physiologic range that her body will just act as if she's so her risk will just go to male levels but that's not true in addition the way that our DNA expresses itself is also a sex dependent in terms of what genes are turned on and turned off so there's a there's a host of biological differences that some of them are poorly understood but certainly that then it should be no surprise that if you take a male hormone and put it into female physiology at access levels that bad things are going to happen and then the reverse is true as well so so a man who takes estrogen after about five years or so his risk of developing blood clots and strokes is he'll develop so some men taking estrogen will develop blood clots and strokes at two to three times the rate of men not taking test estrogen and women so a significant increased risk of stroke and blood clot we know this just from women who take birth control that is the main main issue with oral contraceptives is is blood clot so so these side-effects should shock no one I mean this this is basic at least for an under chrono just this is basic yeah hormones and biology so you guys endocrinology is being retrofitted to become instead of something that aligns the body with its natural state just to like a kind of a mad scientist we are now employed to change the body's natural state we're now meddling with nature rather than to bring a body back into alignment yeah but only in this one particular condition and that's why there's this cognitive dissonance it's really it's really bizarre so then we have for gender dysphoria correct so in every other aspect of medicine if the if the mind and the body are misaligned so if the mind is is at odds with material reality biological reality or some other reality we do everything we can to get that individual back to foundational reality but in this situation we're essentially changing the body to match the brain but but that paradigm is completely reversed and as it should be in every other aspect of medicine and that's why it makes no sense because it doesn't make any sense it's it's at odds with how we practice medicine and maybe and any other aspect hmm and and that's why some have called this kind of a crisis of you know psychiatry for example because if this principle holds that if the brain and the body are it if the brain is at odds with reality but we reinforce the non reality you know there's there's no field of Psychiatry left we just altered the body to suit the subjective whims of the mind yes which is good business if you're into body modification plastic surgery and I handing out hormones yes it'd be completely cynical and I mean that as a joke but I don't think there's so much joking going on well no I mean I see yes I think there's certainly unfortunately some some of that going on I mean I think yeah and in the United States so in Britain doctors are standing up and coming out and making very firm statements what is happening in the United States in the United States the main medical organizations have endorsed affirmation therapy okay and this was before the wave of adolescent onset gender dysphoria otherwise this is mostly for adults know that so they they endorsed affirmation therapy childhood onset gender dysphoria okay by the way the Dutch national clinic does not promote out doesn't use affirmation therapy at least they don't describe that in the literature and you bring up the Dutch clinic because they're the ones who made the first researches that they're the research that is now the foundation for Africa yes so they're there medical protocol at least okay the puberty blockade followed by cross-sex hormones but they don't they don't use affirmation that so they use there are three different counseling models essentially our approaches to gender dysphoria and I fault the medical societies for not educating physicians about this so affirmation is only one so you have there's a therapeutic there's an accommodative and then affirmation the Dutch do not use affirmation because they understand that affirming a young child's gender confusion or sex confusion right to be more accurate I would say it's a sex confusion reduces the likelihood that that kids gender dysphoria will resolve on its own yeah so they use what's called a modified therapeutic model where they essentially focus on exploring developmental factors that could have led to this state of gender dysphoria which the term gender dysphoria as well as is bizarre but anyway so because no one comes in and complains of their gender usually you know they complained of their characteristic features so I don't like my secondary sexual characteristics I don't like breast development I don't like is it's not I don't like that I like football more than field hockey yeah to use very difficult gender you see what I mean yeah but until this the spate of our OGD rapid onset or adolescent onset which now which I think I'm speculating here but it seems in the cases that I've seen and the people that have spoken to they spend a lot of I'm online and they get this idea in their head that their gender wholesale is wrong yeah relevant aspects yeah I think that might be accurate so we can touch on that but I want to go back to the if you don't mind to the three counseling models just so just to finish that point off in case some people are interested so so the Dutch don't use affirmation because it prevents resolution of gender dysphoria they use a modified therapeutic technique it's called Ken Zucker was using a therapeutic model which is one of the reasons that they came after him because he was essentially trying to help kids resolve their gender dysphoria so they would not have to go through cross-sex hormones and sex reassignment surgery because the long term studies show that in terms of psychological functioning it doesn't help it doesn't work you know suicidality is actually increased there was a Scandinavian studies showing that folks who had undergone sex reassignment surgery had a Toni fold increased risk of completing suicide long term than those who had not versus baseline which is part of the motivation for inducing or introducing puberty blockade to the whole treatment protocol because one of the thoughts was oh maybe the reason these folks are not doing well long term is because they went through puberty and so they look like they're real sex and so they're not able to present themselves as the opposite sex and so if we can block their puberty they'll do better long term completely unproven no long term data to show that that works and in addition because most candidates for it resolves that approach is catching many many kids inappropriately so so doctor was using a therapeutic model and the Dutch use a modified therapeutic accommodative is essentially you don't take one view or the other you don't affirm but you know we also don't try to resolve you essentially hands-off so there are three different models in the United States we have combined affirmation therapy with the Dutch medical protocol so which essentially is ensuring which is the puberty blockade which is essentially ensuring the maximum number of gender dysphoria kids are going to be caught up in to medicalization and so that's another criticism I'm not sure how we got down that really exactly but and and medicalization is a lifelong path unless unless you desist so yes so the assistance is essentially resolution of gender dysphoria and then D transition would be after you've been medicalized stopping cross-sex hormones attempting reversal surgery if possible etc so yes if you go down that pathway and and it's a long term pathway for you yes you are dependent upon medication you're in a sense of award of the medical establishment you are you're a permanent medical patient yes yes you know with in so testosterone injections for example they lost about two to three weeks so if if you're you're essentially your test if you're a woman taking testosterone your testosterone levels of go to zero after about three weeks without an injection so you're completely dependent upon hormones to maintain the state that the hormonal state that you're in I should have one more thing too so so I believe you know the Dutch so this this pathway of medicalization is known to be risky I don't think this is necessarily a surprise but the approach to medicine is a little bit different in Europe that it is cure so in Europe the approach almost is that you can decide to do something that is not good for you if you wish you see that a little bit with assisted suicide for example so okay I have depression and I've tried everything and so I'd like a doctor to basically kill me with medication so so that has been the approach as well and you see in the international literature where okay we know that cross-sex hormones and sex reassignment surgery are dangerous in and of themselves and probably don't improve long term psychological functioning and may in fact worsen it but because this individual wants to choose that road we're going to facilitate that so it's one of kind of personal choice it's quote/unquote a right to access something that is harmful in the United States we we haven't really adopted that approach so much so I think anybody looking at the literature and anyone with any experience prescribing these hormones knows without a doubt that this is a dangerous path and even I would say affirmation supportive practitioners if you really pin them down we'll admit so but they will default to well it's the patient's right to decide how they want to be treated so so there's really two parallel arguments going on one is a medical one and one is you know is it a right to decide in it there are people on both sides it is a is it a right to access a treatment that is harmful to you I guess and there's a cost-benefit analysis that people run through but with the with the political situation and the push towards affirmative therapy or the affirm affirmative model from outside the medical establishment that can guide the patient towards doubling down and very much insisting that the risks are the benefits outweigh the risks yeah I think that's an accurate statement and do you feel in America there is not only are the professionals undereducated with this but there also under pressure to not speak out about this or to just go along is there do you feel that there's pressure or that there's there's risk for people professionally to stand up and to push back against the affirmative model uh yeah I think so yes I think is the answer to both of those I think so I think in the in the general community it's more of an issue lack of understanding of what's occurring lack of familiarity with the literature and and so when that happens what doctors do is they default to guidelines put out by medical organizations and so they'll pick up a document that will sum that it's supposed to in a scientific way putting politics aside summarize the medical literature to help that doctor make a decision about how the best help that patient and that clearly has not happened with The Endocrine Society the American pediatric Association and the Psychological Association Psychological Association as well in this country they have not presented in any scientific or objective fashion the full spectrum of concern about gender affirmation therapy they have gone all in for affirmation to great consequence to negative consequence so so yes it's a lack of information is a failure of our medical societies to actually present objective you know we can't get I'll give you an example here so you know at the main endocrine meetings occasionally we'll have there will be an hour presentation of a point-counterpoint for example of a new diabetes medication today see I have one fellow here and one doctor here so two doctors up there and they they will talk back and forth over the course of an hour with slides and literature and cost-benefit analyses and minutia you cannot even imagine okay and they will pat themselves on the back at how smart they are and and what a great conversation this has been okay yeah and we can't get a point-counterpoint on gender affirmation therapy on puberty bakla blockers we can't we can't get a a public balanced we the yes we can't get any of that it's essentially just a one-sided presentation and so in a room of a thousand endocrinologist I mean these are huge lecture halls you know these meetings happen once a year you'll have a gender affirmation clinician lecturing to a thousand or so endocrinologists telling them essentially confusing them about sex and gender mmm telling them that affirmation is the treatment no mention of the accommodative or therapeutic models do they cast therapy into the do they frame it as conversion therapy do they go that far no okay they just no I just say this this is how this should be treated now okay now yep so it's like by Fiat just somebody right cited this and yeah weird room yeah and a few years ago when they showed up to our main meetings you know we started hearing these lectures you know we looked at each other and said I want what this guy's talking about this this is this makes no scientific sense but you know this was before the adolescent onset gender dysphoria wait well alright I don't know what he's talking about he's certainly not making a lot of sense this does not sound scientific so we're just gonna kind of ignore this for now because it's not directly impacting me but that was a mistake because now it's impacting everybody are you do you perceive that there's a problem for people to even do a presentation on the stuff that you you've been sharing and speaking about can you could you get a slot doing the Tyler point at the endocrine society or at these major societies no it's been asked and it's it's been and there are other kind of academic right so I'm a community and apron ologist I'm a regular one of 5000 endocrinologist in the country so I don't have an academic position that there are academic endocrinologist who would be willing and exceptionally able to tell the truth about the medical literature regarding gender affirmation therapy but that's not been done so far and it's a real it's a real problem so so so that's the second so the first is the doctor don't have the education the medical societies essentially will only allow for conversation after you agree that puberty blockade cross-sex hormones and sex reassignment surgery are the treatment for gender dysphoria that doesn't sound scientific whatsoever that's right that's scientific yeah and that's why this is very difficult right now because we have historically trusted these organizations to provide us with accurate information and and they're not in this situation they are not actively generating debate and it's a real shame and the consequence of that is is is just complete access to provocate and preemie blockers across sex hormones in the community many times being prescribed by practitioners who really have no no business prescribing hormones at all let alone in across such fashion I've heard I've heard from one person at least that Planned Parenthood is now yeah giving access yep so many community clinics in some of these places are stopped by you know different names there's just physician extenders or you know there are nurse practitioners essentially without the expertise training in these fields so and then in terms of something you asked about you know blowback otherwise well you know I think yeah I think there's risk of course to standing up and saying that you don't agree with by standing up and saying the emperor has no clothes there's no data here there's there's there's no proof this works there's lots of proof that it's risky and dangerous there are other treatment modalities yeah there's risk to doing that it's a very emotional topic for most people so it's it adds another element of stress and I think most physicians are opting out of that but this has the potential to basically neuter a generation well I think eventually what's going to happen is the the sheer number of individuals who have been so when you apply an unscientific process or thought process to reality okay you get bad outcomes yeah and that's what's happening so so applying the already controversial Dutch protocol at puberty blockade and cross-sex hormones to adolescent onset gender dysphoria for example okay which we really don't understand at all in terms of duration it looks like many of these predominantly girls but boys as well have autism spectrum conditions very concrete thinking I don't like dresses so therefore I must be a boy Yeah right so treating a young girl like that with testosterone it makes no scientific sense so so when you apply unscientific principles to the real world bad things happen and then eventually those people who have had bad things happen to them start to stand up and say look something bad happened to me look at the consequences of applying this unscientific treatment protocol to real life and eventually the weight of the number of people hurt by this will I believe force some global awareness and and change and reckoning why I guess this you might not have enough data to have a conclusion about this but I have to ask it anyways why are these authoritative institutions how did they get captured by this way of thinking why why are they going in this direction all of a sudden and so strongly yeah that's a good question I mean I could theorize I don't I don't know I don't so this has been written up written about actually you know other psychiatric crazes they're called so essentially the populace led by a few physicians comes to conclude that a somatic treatment for a psychic distress is a good idea and it's almost like it has a life of its own once it gets started and then it basically starts to burn out once everybody realizes it was a horrible mistake and in the meantime you're left with multitudes of people have been harmed and unfortunately after at least what I've read there you know there doesn't appear to be much reckoning it's almost like well well we were just trying to we were just doing the best that we could yeah we were just trying to help yeah but you abandoned scientific principles along the way yeah yeah and on top of that from some of the research that you shared with me this is going to disproportionately affect an already marginalized group namely the homosexuals or bisexuals are the ones who are going to be who end up naturally getting through their gender dysphoria so if if all these let's say lesbian lesbian women and gay men are tracked on to this body modification right it seems like a very weird form of homophobia or like it but a very aggressive regime of stamping out homophobia by modifying the body yeah so you know Debra so has written about that yeah that that's an underlying theme here is that you know kids with so gender non-conforming kids so a girl for example who has preferences for masculine behavior or address etc young and life probability-wise may be same-sex attracted a lesbian later in life so by interrupting pubertal development your your your halting your halting that individuals development the way that it's supposed to go and yes that's been written about as well I mean in Iran for example you know sex reassignment surgery is very popular because homosexuality is illegal so you're not allowed to be same-sex attracted that's it's actually punishable right sometimes by death and so well we'll just fix that quote-unquote with cross sex formula and either masculinizing or feminizing surgery and the reason I use that term is because you can't reassign sex right it's impossible no one is born in the wrong body you know so it's a is essentially a cosmetic intervention for some root psychic distress some psychological distress yeah yeah or sociological I guess punishment or reassignment in the case of a virus yeah yeah just to go back a little bit when you're talking about puberty blockers it just made me think that it seems like people confuse it like you're just holding a kid back in school and you're giving them extra time to development and to develop but it's actually the opposite of doing that you're freezing them in time on yes not just physically but but well I guess the the body is one whole thing so you're not just allowing the brain to proceed while the body weights like the whole thing is stopped that's exactly right and that's one of the major concerns has been raised in the literature by those there was a study done they surveyed clinicians working in gender clinics using puberty blockers and these were the concerns that they raised so even the folks in them doing this are concerned that this is occurring no that's absolutely right and again back to Carl Hanigan right these these drugs are being used puberty blockers are being used the attorney for the British Medical Journal right is someone who should be taken seriously these drugs are being used in the setting of profound scientific ignorance and so if you look at his editorial and then go look at the literature if someone has actually wants to know the truth about this there's no other conclusion to be drawn well Wow so what do you think needs to happen then the professionals need to be better educated and should the I guess the populace needs to be at better educated to about the dangers of this you know maybe some some pushback against the I don't mean this totally negatively but the trans lobby or whoever it is that's really pushing this on a societal level yeah I mean I think the truths has to be told about what's occurring on all of those levels at every level and you know thankfully the rule called Royal College of General Practitioners in the UK just he was last week earlier yeah last week or two weeks ago basically told the truth and said okay you know gender and sex are not the same thing and there's no there's there's no evidence that affirmation therapy works and so we're essentially running an experiment outside of experimental protocols so we're running a giant experiment but that's not how medicine is supposed to work you're supposed to do the experiments first show that the treatment works especially when you're talking about infertility and sexual dysfunction long term and a 4-fold a you know a four times increased risk of heart disease and a to three times increased rate of development of blood clots and and strokes and the data we have now shows a twenty fold increased risk of suicide long term so if we're going to go down that treatment protocol there better be very good evidence that it works and that evidence does not exist and it runs contrary this like I said this entire approach runs contrary to how we practice medicine in every other area if the brain and the body are in conflict we work on the brain we don't work on the body it's really because the brain can change or because messing with the body is more fatal than messing with the brain like what's Regis we have to agree that there is some fundamental reality that we exist and operate in and that we can identify that reality with our senses and measurements and agree upon that reality that X X and X Y cells are different and they respond differently to hormones and so once we agree upon that reality if someone is at odds with that reality we need to help them back to reality not keep them away from reality now how you do that on a social level how do you how do you restore a society back to reality just another clash against the rocks and expend a bunch of lives until they stand up that seems to be what's happening with these crises over and over again so if you look at the opiate crisis right I mean oh here okay here's a non-addictive opiate oh really no and it's not and and how many people had to suffer before that non reality right so you take you take a bad idea put it into reality and you get a bad outcome yeah and so that's that's what's happening and I and I think unfortunately it aches it takes significant suffering for society to wake up to that reality mmm that that's not an optimistic outlook but it seems realistic though yeah I know I'm I I don't I have some optimism more recently because of the world College of General Practitioners the real health organization is going the other route from whatever yep yes so but at least now there's some pushback where on an individual basis individuals who are caught up in this can have a chance now of making a decision at least based on some more factual based information truly or at least more informed consent yeah yeah and what about your role do you speak about this on Twitter and your your Twitter presence really appreciate it and at least in for me and then other people because you're bringing up facts and you're really standing with a lot of people who are bringing up facts do you have any plans to or are there other people in your profession that are you think will converge on doing what you're doing or is there any movement towards like a collective of endocrinologist so I think privately yes brief early oh okay so it's yeah publicly I don't I don't see that yet but I think eventually that will happen like so eventually the the consequences of the application of this bad idea will be so evident that any accept the extreme ideologues will be forced to accept what's happened and do you get referrals from people with gender dysphoria a few so so you brought this up initially most kids now who have gender dysphoria they want puberty blockers and cross-sex hormones and so because I don't do that they're not gonna call anyway okay so they're these kids are presenting to the primary care offices and then the primary care Doc's are confused as to what to do how do i how do I handle this situation do I send up for counseling do I send them to somebody who's gonna put them on puberty blockers my experience up to this date right has been adults with Auto gotta fill yet that was the that was the predominant presentation for adult endocrinologist and then this new adolescent wave most of them are being funneled to so called gender claims so are these gender clinics they just sprouting up I guess to meet the demand and are they what is a gender clinic what is it based on it seems like that's a kind of a gender studies thing it's like it's taking some science and then it's framing it in an ideological so so I think in 2010 there were eight designated gender clinics in this country and now there are more than 50 okay and it's it's what you said essentially meeting this demand for individuals who wish to be treated with cross-sex hormones and so that's what they're offering they're offering affirmation there's no oversight so I don't know exactly the clinical models that are being used in terms of in terms of you know what we're hearing is that more so it's informed consent so you sit down with a brochure here's the testosterone is going to do to you in a in the ways that you think will help you and there's something the other things that might happen it's kind of mentioned in there mmm but it's really not a true informed consent process and I think there's there's a lot more to be said coming about that as well how do you consent a 14 year old to lifelong infertility how do you consent a stress– 17 year old to permanent voice changes increased risk of heart disease and all the other physical changes that that can occur that can be irreversible from testosterone so it's a real problem I mean again under normal circumstances so we've got like two different ways that medicine is being practiced now so gynecologists will not perform elective hysterectomies on women under the age of 25 unless there's some emergent reason and the reason is because they understand that the human brain is not fully mature until at least early 20s maybe mid-twenties and if you've got somebody with an autism spectrum condition or something else that may have caused delay of development they may not be mature to late-20s to make a decision about permanent infertility so that's how regular medicine works and then we have unscientific medicine now where a 14-year olds can but apparently is competent enough to make a decision about lifelong infertility the two can't exists in the same space hmm so the one has to go and move into a little special clinic where they perform you know half off mastectomy is son Valentine's Day and stuff like that yeah y-you saw those those advertisements for a double effect amis right so it's really it's really unbelievable I guess that's the only way to describe it it's it's horrific and and it's thoroughly odd unless you trace it back to some sort of ideological precedent that was set up I think in the Universities with gender theory or some sort of something like that introduced this idea and the idea took weight and took hold or maybe it's so I haven't I haven't dug in too much into the origins of this approach which is a scent which has essentially so counseling as a treatment for gender dysphoria was abandoned back you could say essentially abandoned I think was in the 50s and 60s by three physicians who are considered the founders of transgender treatment guy named think janmani or ammonia and I say his last name Harry Benjamin and Kinsey and if you read about these guys it's it's not a it's not a pleasant read in terms of the types of experiments they were doing on people and but really this this concept of we're gonna treat the body not the mind got started then okay and because it was not affecting many people you know like I said this there's only one of maybe twenty to forty thousand people nobody was really paying much attention and that's why this was able to go on for many years and like I said up until 2010 there were only eight gender clinics in the entire country because it was only after so so if you allow people to go through puberty who have gender dysphoria the majority resolved and so you would only be left with a small percentage who then would have persistent gender dysphoria who would then go on to cross-sex hormones and surgery and you had read Blanchard on he described how cautious they were right live as the opposite sex then do the cross section hormones then do the irreversible surgery but all this is occurring in young adulthood now you can even make a case based on the recent studies of heart disease blood clot and long term suicidality that even that approach should be seriously reconsidered but that approach so that was one out of forty thousand people in general population so so this unscientific miss has been present for a long time it just didn't affect him any people but with the onset of the Pirie blockade and this now adolescent onset gender dysphoria we're in a completely different world and again how do you how do you steer the ship back but I guess you just need to let it happen or speak up as you're doing right now and as other people are doing right now yeah yeah you just basically lay out the facts look here's what's happening here's what the data shows if you're gonna apply a scientific process to this aspect of Medicine we need to apply it to this aspect as well and and then you make your case and from personal experience you know I've talked to you I don't know two dozen physicians at this point kind of in a real sense not just a passing conversation they sat down with them explained the literature now don't take my word for it go research it yourself I've provided you the references go do your job go figure out how best to treat these people and when they do that it's obvious to them that back to Carl Hennigan his his statement is absolutely correct it's unproven and unsafe and and there's really no other conclusion to be drawn from the literature if you take an objective look at it and so that's I think ultimately where this has to go and if we can break through and the main medical meetings I mean it would just take one simple presentation from someone critical of affirmation therapy to dramatically shift practice patterns hmm so you need a a reality blocker regimen yeah we need more reality which is always the case how we need to start wrapping up because I have to take off but I would like to know if you want to tell us how did you get into this field of medicine how did you end up doing this work so so I'm a general under chronologist in the community so the way that this works is you go through Medical School and then you pick a specialty I don't be a surgeon or doing do I want to be a cutter or a talker essentially hmm is really kind of the initial decision that you have to make and I saw the the lifestyle the surgeons are just brutal I mean they were doing incredible work and saving lives but immediately in the immediate sense you know the the stalkers the medicine doctors kind of save lives over the long period of time but yeah so that was the first decision-making point is it's medicine or surgery so I chose medicine and then happened to run into a great endocrinologist where I was training and went through two years of endocrinology so basically what happens is we pass internal medicine boards and then we do two years of additional training and then we have to pass endocrine boards and then at that point we are considered and expected to be and appropriately so experts in all things for moe regardless of the frequency of presentation in the population so diabetes is much more prevalent than a dramatically for example so the achromatic the twice a year right excesses of growth hormone or but we're expected and and rightly so to be experts in all areas of hormonal accesses or deficiency and gender dysphoria included although i would argue it is not that is not a condition of hormonal excess or deficiency this is a a psychosocial yeah this is not an endocrine problem but because the I would say psychiatry and psychology as a whole there are obvious exceptions and we've interviewed exceptions have the front band and yeah they've essentially kind of jumped ship on this condition and and so now the endocrinologist have to step up and say well wait a second you know it's quite easy for a psychologist or a psychiatrist to call the endocrinologist and say oh you got to give this this girl testosterone well they're not going to be the ones called to the bedside two or three years later or four years later or five years later when that individual has had an MI and they're in the intensive care unit you know with their family around them mm-hmm so the prescribers of these drugs have a responsibility to understand the consequences of prescribing and to make sure that there's a clear indication and there is not one in this situation okay um do you do you think that given enough research there might be are there some exceptions to to this then because I've met some pretty amazing people who end up transitioning their sex but that comes with a risk yeah and and the ones that I've spoken to really lay that out and stress yet the yeah that's a conversation I has to be had yeah and and it has to be had based on well I mean it can be had on multiple levels but from my standpoint it's it's a scientific discussion and then a philosophical one perhaps but we have to look at the science and then if we're gonna say that okay the science says it's not safe on unwhole right so we're looking at you know increased risks here percentage-wise etc okay if we're going to a band abandon the approach that we use in every other process well we better have a lot of conversation about why and how that's going to occur and that's how that's how those things need to be figured out scientifically I mean a data long term is just abysmal I mean doctors immediately stop prescribing hormone replacement therapy for postmenopausal women when a study came out showing it was about a most like at fifteen a twenty percent increased risk of breast cancer and heart disease which is significant which yes so seven five one in six right but we're we're talking now about a three hundred percent increased risk of heart disease from testosterone so because of I'm taking it so long yeah so we're looking at a 15 percent risk and that immediately caused almost an immediate cessation of prescriptions for postmenopausal women and there have been some modifications of that it looks like it was that particular formulation etc versus now a three hundred percent increased risk of taking testosterone so that's why I'm saying that we're in a we're in serious disconnect and the only way this is going to be resolved is conversation and that's being suppressed dang that this is really dire episode that thank you for sharing yeah your expertise how complexes is endocrinology just as a comparatively I don't even know if this makes sense as a question I'm just trying to figure out like how complex is the system that you're dealing with so well for those of us who are in it it's it's not that complex but for those who are not in it is it is full of complexity and it takes a while to understand the subtleties of hormonal feedback and how to manipulate those systems to help people achieve better health so yeah it's it's a fairly complex subspecialty have you studied this in relationship to evolutionary biology or how how it kind of propped up itself how it grew over time like just in biology not specifically are there are there studies unlike on that just showing how the mammal constructed itself over time into this complex weird form of juices all interacting with each other yeah well I can give you one example so so metabolically if you burn sugar on the stovetop it turns into like a sticky material you ever seen that yeah you know yeah you know creosote is like if someone as a wood stove they're there they have to clean that pipe of the stove out periodically or else the the byproducts of any carbon-based fuel being burned results in this sticky material and builds up on the stop and and so glucose you know sugar is essentially a carbon-based fuel for us okay reflects fuel we inhale oxygen and then combine that with three different sources of fuel so we've got fats which burn pretty clean proteins which burned dirty which is why we've got kidneys hmm okay so the kidneys clean out the byproducts of protein metabolism the urea the nitrogen and then glucose glucose is its backbone is carbon and so when it burns when you combine glucose with oxygen internally okay which is a metabolic process right we're essentially combustion engine to generate heat okay that process results in the formation of that sticky stuff internally as well and so if you have too much gluten so glucose is a very potent energy source and it would be from an evolutionary standpoint of great advantage to be able to consume carbohydrate but as a consequence of its metabolism not die okay so if your blood sugar is too high and you're developing too much of that sticky stuff build up that sticky stuff bog up small blood vessels and that's what causes the damage of diabetes so the eye is the key piece and the nerves have the smallest blood vessels they get clogged with the byproducts of glucose metabolism if the sugars too high in the blood stream so the body developed a way so that we can consume carbohydrates but immediately store it as an energy source that we can burn later and so we developed the capacity to make insulin which takes glucose out of the blood stores it as fat and when fat burns it's pretty clean I mean think about a candle when it burns down yeah there's you know there's a little by-product but it's a pretty clean burn and so we essentially evolved the ability to consume a high energy source as toxic carbohydrates are toxic but then store that as with the use of insulin as a non toxic fuel and it produces the insulin the pancreas okay yeah and and so diabetes is when you're treating diabetes you're treating the pancreas and why does why does diabetes generally occur what is the so you've got two types of diabetes so so type 1 diabetes is pancreatic failure so in terms of insulin production so digestive Lee you're okay but the pink the autumn the immune system attacks the pancreas and the pancreas is ability to make insulin goes away insulin levels go down and so we have to replace that with injectable insulin type 2 diabetes results from excess body weight it results from essentially an excess of calories so overconsumption of food versus burning of that energy of that food resulting in obesity the pancreas tries really hard to maintain normal blood sugars because glucose is toxic but eventually it burns out and that's what leads to type-2 diabetes so as an endocrinologist essentially got two tasks with type-2 diabetes the first is to normalize blood sugar using diet exercise and medication and sometimes insulin the second task as well is to help the patient understand what led to the obesity what chronic stressor caused the over eating that led to the obesity that then led to the type-2 diabetes so basically okay let's use these medications to help you with your blood sugar but let's also get to the root of the stress why are you why are you overeating what you know the that's another endocrine system that is very interesting so if someone is chronically stressed their stress hormone levels cortisol and adrenaline go up cortisol and adrenaline deplete dopamine levels centrally in the brain so you're not supposed to feel well when you're stressed yeah okay sugar increases dopamine yeah temporarily and it does so in a fashion where the more you get the more you want yeah those dopamine receptors down regulate it's just a classic addiction feedback cycle so so that's the second thing that endocrinology should be helping patients with us understand okay you're chronically stressed what is the reason for that because we need to fix that so that you don't continue your reading yeah so you're doing the accommodative technique which is therapy and and I guess medicalization I guess you could say so it's essentially treating the end result of the condition but also trying to stop it from getting worse by it most of the time the reason people are chronically stressed is they are exceptionally poor at standing up for themselves hmm and and many who have severe obesity as well they have a history of trauma as as young people this has been studied in known as well and so there's there are certain characteristic stress patterns I mean right you've heard that term only the good die young but so doctors know we know that it's usually the really nice people who get sick huh they're susceptible they are too nice they're in a chronic state of stress huh and their cortisol levels this is Mike again this is my theory so so taking this from practice from this is my theory at least just observations of different types of personalities that tend to get sick yeah you know I mean when I went through my rotation you know oncology rotation and the first thing that senior resident said to me he said you know you're gonna notice that it's nice people who get cancer it's the nicest people who get cancer and he was right because they're like bearing the weight of the world or something essentially they're they're in a constant emotional state of appeasement hmm this is my theory on this okay and and many of us now we have counselors embedded in our clinics okay because we know there is a high there's a high rate of depression and anxiety which are essentially result from chronic accesses of stress hormone and really not being able to deal with being susceptible to the stresses of life I'll put it that way well not setting boundaries innocence correct no boundaries putting everybody else first really having a hard time saying no yeah and as a consequence their fight or flight system is cranking out lots of cortisol hmm again this is this is theoretical this is yes you're not just telling everybody to buck up learn how to stand up for yourself and seven hundreds of people right you don't have to be a jerk just yeah just expect the same level of respect that you give everybody else because these these folks will they'll put themselves dead last everybody else is first and this starts at a very young age so these are the these are the sorts of patterns of stress that we see over and over again yeah and you know we can show people like look you're gonna feel better when you set some boundaries you don't feel like you're gonna be at the will of everybody else and you're gonna notice that you're less hungry for food you don't need this sounds pretty amazing because you know the okay I guess the tired criticism of Western medicine is that it just treats everybody as an object but it seems like your discipline at least is moving towards a more holistic understanding of the human being and trying to really service them on on all levels I think I am and there are others who are starting to think this way as well okay it's like okay yeah stress plays a role in probably the onset of illness through disruptions of immune system function and makes it worse once you have an illness and so you know stress management absolutely has to be part of any treatment protocol in my opinion hmm it's just so fascinating to me just as a poet to think that somebody who has a hard time setting boundaries their immune system has a hard time regulating their actual boundaries does it so that that's Nursing way to look at it I mean the the link there the biochemical link is through cortisol so quarters of cortisol is a very potent it's a steroid it's essentially internal prednisone mmm-hmm okay and it's released when we're under stress it's kind of toxic yes it basically the purpose of cortisol is one of the purposes is to raise your blood sugar to feed your muscles so you can fight a flight okay okay so if someone is in a chronic state excuse me chronic state a fighter flight for whatever reason nightshift work abusive relationship past trauma they haven't dealt with just generally being taken advantage of everywhere they go because they don't know how to stand up for themselves there's some studies showing that that that approach to life your limbic system essentially stratifies you in a hierarchy in a social hierarchy so that if you are not standing up to people your fighter flight system is is waiting for this person to come and take your stuff yeah okay just like a monkey troop or a you know a chicken coop essentially so it's a it's an animal based hierarchical system yeah where if you are not holding your ground your fighter flight system gets you ready to be taken advantage of at any point in time your resources your food your mates the whole thing right going back to an evolutionary biology standpoint and so and that creates a constant state of anxiety because the cortisol depletes dopamine levels and in addition cortisol inhibits normal immune system function hmm so so someone who's chronically stressed is going to be getting sick more often let me see that as well I mean you can induce that with over exercise simple so marathon runners if they're if they're running more than 90 minutes per session and there's a certain threshold they all know when they get closer to training their susceptibility to viral infections goes up okay because with the over exercise they put themselves into a chronic state of stress excess cortisol inhibition of immune system mm-hmm so the cortisol knocks down immune system function knocks down dopamine so then we will turn to whatever source of dopamine we turn to and it can be socially acceptable or socially unacceptable yeah to temporarily relieve that feeling of anxiety caused by that dopamine depletion okay serotonin depletion and then at the same time our immune systems dysfunctional and I'm of the thought that some people will be more susceptible to bacterial and viral infections others will be more susceptible to autoimmune disease and others your immune system is the main defense against malignancy all right so if a cell develops it doesn't look like it should our immune system should immediately kill that and it appears that all of us develop cancers continuously through our lifetime yeah and then our immune system just kills them yeah but if your immune system is chronically depleted from excesses of stress hormone you're more likely to get cancer in theory again that hasn't been directly proven but it's really interesting a main and I'll I'll show their peer in a minute the main treatments now being developed for malignancies our immune system based you essentially hyper-charged the immune system so that it will circulate these white blood cells these killer T cells will certainly identify out normal cancer cells and kill them anywhere in the body hmm so you empower the internal editor rather than like shooting laser beams into the person to kill it exactly huh that sounds smart even if it might be tricky to do correctly I mean if you over if you let so the immune system is like a lion a tiger in a cage mm-hmm so if it over activates it can cause a significant problem and like we were saying it can attack the pancreas it can yes organs just to go after great fascinating yes it's what you could talk forever this is great and I'm surprised that you don't go around and give talks at these conferences and especially so I you know I do locally I you know what I desire most is a quiet life in the country yeah and so I I haven't made it a point to put myself out there so I will look up do local talks and everything I just shared with you I will share with patients if if they're under stress and say look you know we've got to get you it gotta give you some skills to deal with that chronic stress and certain ways so yeah well I can't I probably can't get you on Bill Maher but I could boost your profile just a little bit all right thanks so much William for your time this has been an excellent talk I think this is really important a part of the series and I hope that this gets circulated so that scientists and people who are needing this information can can hear it and maybe start spark more conversation along these lines yeah hope so yeah appreciate that yeah well happy insulin I don't know how do endocrinologist say goodbye do you guys have a special hormone handshake or anything if there is okay we'll have a good day okay thanks Benjamin

23 thoughts on “The Hormone Health Crisis | with Endocrinologist William Malone, MD

  • If you think that current treatment methods will change once we see how many people get hurt by unscientific methodology….think again. Look at how many people are on cholesterol lowering medication. Look at how many people are getting diabetes, are obese, and get cancer. All these things have been proven, over 50 years ago, to be treated successfully with diet change (cut out the starch and hydrogenated oils). Yet we are prescribing medication to bring blood levels in line, based on medical studies that show correlation not causation. While ignoring the free treatments which have been PROVEN to work (diet and fasting).

  • All of this because politicians realized that Trans are a voting block a d also a way to appeal to the entire LGBTX community. So they pander to them and don't treat them in any way but to say we will help you do whatever you want. We don't help an anorexic lose weight…we dont give them surgery to help them starve themselves. We don't practice affirmation therapy for pedophiles.

    I beleive the whole thing stems from political power and the left especially is in the habit of buying votes by promising people what they want vs what they need.

  • Does anyone know if BB is getting a lot of abuse about his calm and rational look at this issue. 'Transphobe' etc etc etc.

  • This guy understands nothing to humans sexuality and drives = autogynephilia is a proof you are mentally féminin, all women have it. And they organize their life around this sexual drive, like trans who all have it. All human live around who they are in sexual fantaisies.

    Trans are not born in a body. They own a body. Body is a tool. And when the libido is feminin, the masculin body does not allow to get rid of it. So the tool is lame. Hence we change the tool.

  • He might want to dig a bit more into the research about most obese people experiencing trauma in their life. Some definitely have. It’s likely when dealing with any number of people that at least some have but most? There are multiple factors that contribute

    It’s 4:30 am and I can not recall the doctors name that did the study to save my life right now but the most important thing is it was done in the 1980s & 1990s, during the height of the Recovered Memory Syndrome fraud, & multiple personality (which was a secularized tale of demonic possession in most cases) craze that started the Satanic Panic.

    This is a another instance where quack psycho-therapists, prone to conspiracies and political crusades, destroyed a lot of live.

    RMS therapists that believed in Satanic Ritual Abuse conspiracies tended to be over represented in eating disorder, self harm & gender dysphoria clinics. Many treated the multiple personalities allegedly created by Satanic Ritual Abuse as different genders.

    They also started almost every trauma clinic in the U.S.

    The psycho-therapists involved believed every problem in life was caused by a forgotten sexual trauma in childhood, they blatantly over medicated patients on uppers, downers, psychotropics, experimental doses of heart meds & more to the point of addiction, psychosis, seizures, attempted suicide and death.

    While the patient was under the influence of multiple substances they used suggestion to create false memories of abuse or urged the patient to imagine a family member abused them as a child and then treated that as proof of abuse.

    I’ve found some evidence in the past that the doctor who did the study regarding most obese people experiencing trauma was more than likely on the Satanic Ritual Abuse/Recovered Memory bandwagon years ago. I’d have to search for his name and dig again.

    Much research on trauma & child abuse from the 1970s – early 2000s is horribly tainted by RMS/MPD/DID fraud and SRA conspiracies

  • Is the sticky stuff that damages the blood vessels literally the glucose, it's not a product of respiration.

  • What a fascinating doctor, I could listen to him for hours just about endocrinology. What area by chance does he give those local talks in? Probably not where I am but might as well ask lol

    You done the good by interviewing this doctor Ben. Subscribed.

  • Endocrinologist are the only type of Physician understands The effects of hormones. Unfortunately this is become such a quack industry I worry about these generations of experimental children

  • Actually, the introduction of synthetic hormones for women to control their fertility was the beginning of all this nonsense.

  • Too important of a decision for a child to make! I think they should let them decide as an adult not as a child!

  • This presentation is by far so painfully revealing to us common folk, of the current medical status of our leading teaching institutions!
    Makes me sick! Excellent documentation/ presentation Benjamin! Thank you so much!

  • I agree (cynically) that there is some fraction of the whole medical infrastructure that is pro-transition due to the ongoing financial advantage. (especially to drug manufacturers)
    I also think that there is another fraction that is motivated by something that is hinted at by your comments about infertility and homophobia. (Planned Parenthood comes to mind) To be specific, eugenics. If there was a way to get everybody who has any kind of sexual or gender 'deviance' to sterilize themselves, not just willingly but enthusiastically, even adamantly, it might be possible to eliminate it from the gene pool (assuming there is a genetic cause) which would make certain types of people very happy.

  • It wasn't clear (at least to me) whether the effects of taking puberty blockers was temporary. i.e. if one takes puberty blockers for two years and then stops, does puberty then just continue normally, just later, or is the progress permanently altered?

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