Thread by @_oatc_

@LisaTMullin @MsYekaterina @lisaquestions @ZJemptv @Mermaids_Gender @JulieRei @GenderGP 1/ That is much better, but not good enough (see⬇️). Also reform in the current SOC was thwarted by Endocrine Society guidelines based on the previous one (agonists not before 12, or hormones before 16) so endos maintained there had been no reform. That must not happen again.

@LisaTMullin @MsYekaterina @lisaquestions @ZJemptv @Mermaids_Gender @JulieRei @GenderGP 2/ The ideal for trans girls is to have #PubertyWithPeers. With male Tanner2🖼️ being on average a year later than female🖼️, & a further delay for a period on agonists, that will not happen in many cases. What is the justification for that? Doubts about the patient's gender?

@LisaTMullin @MsYekaterina @lisaquestions @ZJemptv @Mermaids_Gender @JulieRei @GenderGP 3/ If there are no doubts📽️ (& diagnosis of suitability for agonists seem almost 100% accurate currently) going straight to hormones when peers are commencing female puberty, pre-Tanner2, eliminates the need to ever use agonists or blockers, & has huge…

@LisaTMullin @MsYekaterina @lisaquestions @ZJemptv @Mermaids_Gender @JulieRei @GenderGP 4/…developmental/social & psychological advantages📽️. The Aussie guidelines discuss some of those in the context of not delaying use of hormones, but don't go far enough, & neither explain, or provide evidential references in justification

@LisaTMullin @MsYekaterina @lisaquestions @ZJemptv @Mermaids_Gender @JulieRei @GenderGP 5/ This is not new. Kids in many countries have been DIYing using the Pill for decades now - hence so many very feminine trans women in Thailand. The Head of UCSF's CTE, Dr Deutsch, advocates it📽️ in US federal HHS webcasts

@LisaTMullin @MsYekaterina @lisaquestions @ZJemptv @Mermaids_Gender @JulieRei @GenderGP 6/ Another issue is the oestrogen protocol🖼️. 1mg (over the 1st 6-12mnths) is not sufficient for feminisation (the chart🖼️ misleadingly assumes full dosage), & likely not enough for mental health, including the memory facilities needed for crucial schooling. And progesterone is…

@LisaTMullin @MsYekaterina @lisaquestions @ZJemptv @Mermaids_Gender @JulieRei @GenderGP 7/…essential for normal breast growth - wth oestrogen alone mammary tissue will be severely limited🖼️, & likely lumpy - as well as nipple development. In those susceptible to depression or anxiety, lack of the P metabolite allopregnanolone is associated with increased problems.

@LisaTMullin @MsYekaterina @lisaquestions @ZJemptv @Mermaids_Gender @JulieRei @GenderGP 8/ Therefore Progesterone EUPhar (rather than substances only designed to mimic ovarian/uterine effects of the human hormone & which have different effects elsewhere, including not metabolising in the same manner) should be included weeks after significant estrogen is commenced

@LisaTMullin @MsYekaterina @lisaquestions @ZJemptv @Mermaids_Gender @JulieRei @GenderGP 9/ Finally the Australian guidelines' endorsement of withholding genital surgery "until adult"🖼️ are as spurious as that in the current WPATH SOC, whilst denying affirmation, & for those girls most physically dysphoric any ability to have sexual release - such girls, alienated…

@LisaTMullin @MsYekaterina @lisaquestions @ZJemptv @Mermaids_Gender @JulieRei @GenderGP 10/…from their intrusive genitalia from infancy, often nauseated by them, are denied a well-proven surgical solution for years later than necessitated by surgical considerations📽️, for what reason? That surgeon's attitudes vary; don't all doctors'?…

@LisaTMullin @MsYekaterina @lisaquestions @ZJemptv @Mermaids_Gender @JulieRei @GenderGP 11/…Denied because surgery has risks, & needs complex consideration? We don't deny kids other essential surgery; are they saying they don't understand the urgent need?(📽️ 16yo Kim Petras, on having had surgery in 🇩🇪 in 2009) Do they expect to understand, without being a…

@LisaTMullin @MsYekaterina @lisaquestions @ZJemptv @Mermaids_Gender @JulieRei @GenderGP 12/…girl born with male genitalia? Denied because there are few cases? Trans children are rare anyway, the SOC has restricted access, but researchers have not documented the actual cases. Several had SRS at 16/17⬇️…
dailymail.co.uk/news/article-2…

@LisaTMullin @MsYekaterina @lisaquestions @ZJemptv @Mermaids_Gender @JulieRei @GenderGP 13/…by the best surgeons in Thailand, with zero regrets, until a gay activist persuaded the military junta that these were all gay boys who need to be delayed until after they were old enough to get to like gay sex - 💯 true, & not a good excuse for restriction elsewhere. One…

@LisaTMullin @MsYekaterina @lisaquestions @ZJemptv @Mermaids_Gender @JulieRei @GenderGP 14/…must refer⬆️ to 4/ & Anne Dohrenwend describing the necessity of going thru developmental stages at the right time, in the right order; if a 16yo is ready, as Kim Petras' doctors witnessed in court, delay is harmful. The best interests of the patient must be paramount.

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FYI @michelle_telfer @carmencpace, with thanks for the huge advances in your Guidelines.

@LisaTMullin @MsYekaterina @lisaquestions @ZJemptv @Mermaids_Gender @JulieRei @GenderGP cc @threadreaderapp unroll please