Let's not fight, but advance higher quality & respectful debates. The collective 'we' (society/ policy makers) & regulated professionals (who shouldn't mark their own homework @WPATH) have choices. These concern, but are not determined solely by, evidence. /1

https://twitter.com/pash22/status/1962386654666068181

Firstly, note the rhetoric of time & physiology becoming something "forced". How so? It's intended to persuade, but throw support, caution & standard tests to the wind. i.e. 'Doing something' is the (uncontrolled or tested) experiment that needs ethical justification. /2

Is it true some female sterilization requests are conditional on trying an IUCD? Outrageous & not just for reasons given below /1 @pash22 @FPH @MeshCampaign @K_IngalaSmith @WHO @RASASC_London @RCObsGyn jme.bmj.com/content/50/10/… Pertinent facts make men & women non-comparable thus obviating need to make this equal rights with men (e.g. small, external, local anaesthetic & highly effective vasectomy vs few other male options). /2 @JME_BMJ @NathanHodson @DrMelDavies @fgodlee @FionaSubotsky @birthrightsorg

1/ Happy 50th birthday Inverse Care Law (1971 Julian Tudor Hart). "In areas with most sickness and death, general practitioners have more work, larger lists, less hospital support, and inherit more clinically ineffective traditions of consultation, than in the healthiest areas; 2/ "... and hospital doctors shoulder heavier case-loads with less staff and equipment, more obsolete buildings, and suffer recurrent crises in the availability of beds and replacement staff. These trends can be summed up as the inverse care law:..."

@AdrianHarrop Dear Adrian, I'm sure you wouldn't wish to encourage reckless prescribing. 1/ As with any drug, the harm:benefit ratio depends on indication, dose, time etc. Insulin is vital in Type 1 diabetes, and can be fatal in the well @AdrianHarrop 2/ There is no comparison with menopause guidance nice.org.uk/guidance/ng23. The menopause is not a disease of oestrogen deficiency (but a kind of withdrawal from one normal level to another), there is a LOT of research. @NICEComms