#Consultant Reproductive Medicine

[randomriddlee]

guys hear me out imagine house md veterinary hospital au in which:

house got kicked by a cow during his internship and his leg didn’t heal properly which made him use a cane

he was forced to switch to small animal practice, he still hates clients but his fluffy patients love him for some unknown reason

wilson specialises in equine medicine (wilson is basically a horse girl) and because their hospital doesn’t get much calls for horse consults he spends most of his time being annoyed by house

instead of being exposed to hiv cameron gets bit by a rabid 16 year old yorkshire terrier

a lady comes with an obese labrador and chase nearly gets rabid himself

the ducklings are responsible for restraining first and treating patients second

foreman is afraid of small dogs

chase makes fun of him but he’s terrified as well

cameron has four senior sick rescue cats which seem to be immortal

house is addicted to ketamine instead of vicodin

there’s at least one joke about chase’s interest in bdsm and getting bit

wilson always gets a new golden retriever when entering a new marriage, the dogs always stay with his ex-wives

house constantly remarks that he should change his motorcycle for a horse to wilson’s horror

stevie mcqueen was actually brought to the hospital by a rescue for lab animals, house adopted stevie after his treatment was finished

cuddy specialises in animal reproduction and house constantly tries to win the argument by bringing puppies to her office (she folds on occasion)

house nearly does a necropsy on a goat with anthrax

[forthoseinterested]

Sex, gender, & transsexuals

This is an informational post intended to help people better navigate the sometimes-confusing dialogue surrounding sex, gender, and transsexuals. I made it because I find even well-meaning people with progressive attitudes often get basic information about these topics wrong, starting all the way down from fundamental questions like the very meaning of sex and gender—questions and distinctions that practically didn’t exist in public discourse fifteen years ago. This has been accelerated by oversimplifications and misunderstandings that spread on social media faster than any accompanying corrections or clarifications.

About me: It’s often difficult to address this topic in short format because emotions are high and people are understandably defensive, wary about taking a point or correction from somebody whom they aren’t convinced is coming from the right place. This is why I’d like to clarify that I’m a transsexual woman, I’m progressive when it comes to trans acceptance, and I have an overall positive view of the trans community. I’m not trying to sell myself out or throw any other trans people under the bus in order to gain acceptance from people who are typically anti-trans but who might buy that I’m one of the good ones. I don’t usually comment on my identity in the body of these posts, but in this case it may be important to help set the tone and context of why I’m even bothering to write about this, and why I’m making the claims that I’m making. It’s not to argue against transgenderism, or to invalidate anybody. It’s to help you talk about trans people in a way that’s more clear and correct.

I’ll be making some claims about biology. I don’t have any formal background in biology, medicine, or any related field. However, I’m capable of looking up academic texts about the things I’m interested in, and telling you what they say. The biological facts discussed are not complicated or contrived, and the things I claim about biology are not controversial. I am simply reporting to you what the consensus in biology is and has been for a long time. I’ve also consulted with people who do have backgrounds in these areas, to be sure that I’m not sharing anything factually incorrect.

Sex

Sex is a model we’ve come up with to classify organisms by the role they play in sexual reproduction, where sexual reproduction means the fusion of gametes. Gametes are cells that come together to a new organism. With this framing in mind, nearly all species can be interpreted as one of three categories:

asexual, meaning they don’t reproduce sexually at all;

dioecious (die-ee-shiss), meaning they have some kind of male–female distinction;

monoecious (moh-nee-shiss), also known as hermaphroditic, meaning they don’t have a strict male–female organism distinction.

Nearly all individual organisms can then be interpreted as one of four categories:

male or female, the complementary roles in most sexual reproduction;

hermaphrodite, meaning an organism that fulfils both the male and female function, either simultaneously or at different points in its life (there are different sub-types of hermaphrodite);

or asexual, meaning a member of a species that doesn’t have this distinction.

In some species, sexual reproduction is more complicated, and as a result you’d need more than two categories in order to model the roles of its member organisms. This is very rare and limited to things like algae, fungi, slime moulds, and microscopic organisms like ciliates. In many cases there are multiple different types of a thing, and any pair can come together to reproduce so long as they’re not the same time. In some cases, reproduction may require more than two participants, including a group of things coming together like the pieces of Exodia. Though fascinating, keep in mind this is a tiny category of strange exceptions, and that no birds or mammals work anything like this.

If you’re a human, then your body probably has a type of cell called a gamete: either a small gamete (sperm), which your body produces regularly, or a large gamete (egg, or ovum, plural ova), which your body has a finite store of and is slowly releasing throughout your life until depleted. Through sexual intercourse, sperm enters into an ovum, fusing together to create a zygote, the beginning of a new human.

If you’re a sperm-producing human, we’d categorize you as a male, because the way that you’d pass on genetic material to your offspring is through the production of small gametes. If you’re an egg-bearing human, we’d categorize you as a female, because the way that you would pass on genetic material to your offspring is by the production of large gametes. That’s what all this sex business boils down to.

I sometimes hear people say sex is a spectrum, or make the related claim that sex is bimodal. This is erroneous and not what any real scientific sources claim. It likely stems from a mistake about what sex actually refers to. There are various traits that correlate with sex, such as hormone levels, body hair, height, or bone structure, where if you take measures from every person in society, you could end up with what resembles a spectrum with a bimodal distribution. But sex itself is not like this, because none of these traits are sex.

For all intents and purposes, sex in humans is a binary classification, as it’s intended to be. We consider all humans to be one or the other. Even when we’re discussing other species that could have more than two sex designations, sex as a concept deals in discrete categories. If you’re trying to describe something more complex and variable, like the social behaviour of an organism, then sex isn’t the term you’re looking for.

This isn’t my opinion about what sex ought to mean. I don’t care how words are used in the grand scheme of things. I’m very ‘descriptivist’ when it comes to language. I’m just observing how the word is, in fact, used. I consulted many different sources about how sex is used in academia, and what I found is not a divide or debate, but an obvious, overwhelming consensus. I’ll include a few random citations from a variety of sources:

“Sex: either of the two main categories (male and female) into which humans and most other living things are divided on the basis of their reproductive functions” — Oxford dictionary, 2011 “An individual organism’s biological sex relies upon the definition of sex organs (ovaries or testes) and the types of gametes (reproductive cells) they produce — either eggs or sperm. ... Sex is a biological construct, used as a binary descriptor of biological maleness or femaleness.” — The Biology of Sex, by Alex Mills, p.19 (2018). “There is an agreement by convention: individuals producing the smaller of the two gamete types — sperm or pollen — are males, and those producing larger gametes — eggs or ovules — are females.” — The Evolution of Parental Care, 2012.

If your opinion is that the word should be redefined to mean something else, that’s not an invalid opinion to have and somebody could make a prescriptive case for that. However, at the time of writing, that change has yet to happen, so for now, sex means as described above.

What about a sterile person?

Though true in essence, what I wrote about sex above isn’t comprehensive. It’s more of a starting point. If I define a male and female simply as sperm-producing and egg-bearing, respectively, then what about a sterile male who doesn’t produce sperm? You could also ask about a child, or an 80-year-old, or a woman who’s had a hysterectomy, or somebody who’s infertile for any of the other reasons people are infertile sometimes. The point is, what about a person who lacks their primary sexual function?

What is a definition? It’s what a word means, but there’s more to it: what it means for a word to mean something is for that thing to be what real people intend when they use the word. A definition is therefore a functional description of the bounds of the intended referent of the word being defined. This is sometimes a work in process.

If I were making the world’s first dictionary and I had to define the word ‘vehicle’, I might say it’s a thing used to get around, like a bus or car—because when people make that noise out of their mouth, that’s what they have in mind. But what about a bicycle? Is a bicycle a vehicle? I don’t think people consider it one, so we can’t just say it’s a thing used to get around. What if I said it’s a thing used to get around that requires fuel? That might work. But what about a horse? Or a train? Wait, do people consider trains vehicles? I’m actually not true. And then what happens in the future, if people change their mind and now they do consider bicycles vehicles?

Even what feels like a simple concept that we use all the time without having to stop and think about it that much can unfold into something complex if you try and comprehensively define the boundaries of what does and does not qualify. But notice that throughout this process, what we’re doing every step of the way is asking not what should be a vehicle, but what people consider vehicles. That’s the job of a lexicographer, chasing after the ever-changing reality of what real people mean when they say words. Definitions are observed.

Let’s imagine I have a large collection of vehicles. I want to store them all in one of two different warehouses. I label one ‘car storage’ and the other ‘boat storage’. I provide a working definition for both terms: a car is a thing that drives on land, a boat is a thing that floats at sea.

What if I then found a boat that had a big hole in it? It can’t float at sea. So is it no longer a boat? Are we just going to get confused about how to interpret this item and not know where to put it? Does the fact it’s not a boat anymore mean it’s a car?

It’s obviously just a broken boat. It could’ve floated at sea, before something went wrong that prevented it from doing that function. But my first attempt at a definition didn’t take exceptions like this into account. It would be like if I defined swans as white birds before making the discovery that black swans are a thing.

What happens when we stumble upon an exception that a previous definition didn’t account for is that we update our definition to integrate it into our model—or we don’t bother, depending on the necessary specificity of the context in which we’re speaking. For the most part, I could probably still say that boats are things we use to float on water, and it’s not actually going to cause any confusion, because people can do the one-step extrapolation on their own about how to interpret a boat with a big hole in it that doesn’t float anymore. But if I wanted to be precise, I could write into my definition that a boat is a vehicle whose intention, design, or emergent purpose was or is to be propelled across the surface of water, or other water-like liquids without being submerged in said liquid and which is capable of serving as a means of travel for some kind of entity, typically a human, without being submerged in said liquid under normal operating conditions, and which has some kind of mechanism for propulsion other than being pulled along by the motion of the water itself, such as but not limited to oar, engine, or sail. And even this definition isn’t perfect, but it’s more comprehensive than ‘a thing that we use to float at sea’.

If I first say a male is a sperm-producing organism and a female is an ova-bearing organism, most people don’t even bother thinking about the exceptions where a person in actuality fulfils neither function, because they understand that an infertile or immature male would still just be interpreted as a male because they have all the features that would lead to sperm production under normal circumstances or later in their life cycle. But if you really want to rules-lawyer me on this, a male is a human whose design or model is of the sperm-producing variety, while a female is a person whose design or model is of the ova-bearing variety, identified by the presence or absence of sexual development toward ovaries or testes.

When a human is in utero, meaning in the uterus of their mother before they’re born, they have a gland called gonads, which develop into either testicles, which make sperm, or ovaries, which come with a set of undeveloped, dormant ova in the body that are gradually depleted through the ovary’s process selection, maturation, and release, which for the sake of simplicity is sometimes called ova production (though the female body doesn’t produce new ova in the same way the male body produces new sperm).

The question ultimately remains: if this organism were to pass on its genes, would it do so as a male or as a female? And if something were to get in the way of its development and prevent it from reproducing, then the question becomes: what if that hadn’t happened? Then would it have engaged in reproduction as a male or as a female?

Chromosomes

What determines whether your gonads develop into one or the other? This is where most people start talking about chromosomes, which can also be misleading. Your sex is not your chromosomes. Your sex is not defined as, nor does it boil down to, what chromosomes you have. Instead, your chromosomes—really, just one specific chromosome—is the thing that typically causes you to become one sex or the other. There’s a big difference between a causal relationship, where P leads to Q or P gives rise to Q, and an identity relationship, where P is Q, or is defined as Q, or is an alias of Q.

The biology: A chromosome is a thread-like structure made up of DNA and proteins. These come in pairs for some reason, typically 23 pairs, or 46 individual strands, per cell nuclease. Why 23 pairs? I don’t know. Why do you have 10 fingers? Why do you have 26 bones in your foot? It’s just a number. So there’s 23 pairs of these things, and one specific pair, usually shown as the very last, is called your sex chromosomes.

The reason we call them your sex chromosomes is because under normal circumstances, they seem to be what causes, triggers, or induces sexualization. (In this context, ‘sexualization’ means “causing a thing to be distinguishable as male or female”.) The first chromosome in your sex chromosome pair is always what’s called an X, while the other is either also an X, in which case the embryo probably develops into a female, or instead there’s a Y chromosome, which has a special protein called an SRY gene (which literally just stands for “Sex-determining Region Y”), which probably causes the embryo to develop into a male. The reason I say probably is because this isn’t always the case—it’s only normally or typically the case (>99 percent), as opposed to it being so by definition (we don’t need to say triangles “probably” have 3 sides).

Think about a person who has a male reproductive system, who’s born with a penis, their body makes sperm, they can impregnate females—but, they have an XX sex chromosome pair, which is typically female. Is this person male or female? This question has a clear answer: they’re male. This is what I mean when I say your sex isn’t defined as nor does it boil down to your chromosomes. Your chromosomes being female-typical wouldn’t override everything else about you and make you female. This would just be a male with a chromosomal abnormality.

In fact, there’s a condition that causes exactly this, called de la Chappelle syndrome, or XX male syndrome, where a person with female sex chromosomes develops as a male for some reason, likely because they somehow got an SRY gene from somewhere other than a Y chromosome. The human body is so complex, so many things go wrong in our development, and there are so many people in the world to choose from, that strange variations are bound to happen in some number. And the point is, when they do, the final question of what sex a person is has never been their chromosomes. That just correlates with sex.

A comparison: Imagine we figure out some other trait, like being left-handed, or being gay, or having red hair, is caused by a simple gene. Let’s say having red hair is called by having the RH gene. We assume these things are connected because every redhead we test has this gene, and none of the other people have it, so it seems like having this gene is what activates the red hair trait. What happens if tomorrow, we find a natural redhead whom we karyotype they don’t have that gene? We might have an explanation for how this person’s hair is red, and we might not. But what we wouldn’t do is say this person doesn’t really have red hair because they lack the thing that normally causes red hair. Nobody would say the definition of being a redhead is having the gene that causes it. Being a redhead means having red hair. We don’t conflate the thing itself with the thing that causes the thing.

Intersex people

Some people are what we call intersex. This is an unfortunate term that is misleading for some people, because it sounds like it means something that’s between sexes, which suggests that it’s some kind of third sex, or an alternative to male or female. There is a term in biology for an organism that performs both male and female functions: a hermaphrodite. And there’s a term for an organism that’s part of a species that doesn’t have sexual reproduction: an asexual organism. Intersex people are not either of these things.

Intersex people are still considered male or female. The meaning of the term is somebody who has atypical sex characteristics, or as you could put it, they have characteristics that are in between what is typical for males and what is typical for females. An intersex male is a male who has atypical sex characteristics, and vice versa for intersex females.

For example, one of the most common intersex conditions is called Klinefelter syndrome. This is caused by a chromosomal abnormality, where instead of having two sex chromosomes, a person ends up with three, making them not XX or XY but XXY. However, that means they still have an X chromosome, so they develop as males, but they experience various abnormalities, especially during puberty. This person is intersex, but speaking biologically they’re still a male organism. If they were to reproduce, they would do so by passing on their genetic material via the small gamete they produce in their testicles.

In some very rare cases, a person with an intersex condition ends up with an especially atypical combination of traits that could lead a reasonable person to ask if we could justify conceptualizing a third sex designation to catch the exceptions, rare though they may be. Let’s consider some examples:

If a person has complete androgen insensitivity syndrome, or CAIS, their body may begin a process of masculinization as their gonads differentiate into testes, but they won’t descend and instead their body develops a vagina with a mostly female phenotype. However, this person may have XY chromosomes, and lack a uterus. This person would be considered male, but is one of the most atypical males you could possibly come across.

If a person has something called XY gonadal dysgenesis, or Swyer syndrome (s-why-ur), their gonads, insteads of developing into testicles or ovaries, fail to develop one way or the other. Instead they’ll develop female features including a vagina, but they’ll be infertile, never develop ova, and never menstruate. This person has the DNA to become a male, but doesn’t fully do so, and then starts developing as a female, but then doesn’t fully do that either. So what are they? A male, from the sounds of it, because they end up with testicles. But again, this is very far from what you’d expect a male human to be.

If a person has ovotesticular disorder, or a similar condition called mixed gonadal dysgenesis, they may end up with a combination of testicular and ovarian tissue, and may also have ambiguous genitalia (partially a vagina and partially a penis, due to sexualization not completing in a typical way). There has never been a case of a person like this who is capable of both male and female reproductive function, but the classification of such a person is still awkward due to their combination of features, and people both with and without Y chromosomes have been grouped in here, but it’s also such a rare disorder that very little is really known about it.

In cases like these, you may be tempted to say the sex of the person being described should be either both or neither, but we don’t really have those as an option in our model, because humans aren’t an asexual species, and there have never been any known cases of hermaphroditism in humans (it seems to simply not occur in our species). The people with Swyer syndrome or CAIS are males, and it sounds like most cases of people with an ovotesticular disorder were males too, but the most ambiguous case imaginable is still not going to render a ‘both’ or ‘neither’, but a “we don’t know”. If this person were to reproduce, would they do so by passing on small gametes or large gametes? In some cases the answer might end up being that we’re unable to discern how a person would’ve developed if they hadn’t had a developmental abnormality, and as such we’re not sure whether they would’ve been a male or female organism. In principle, it’s the same answer you’d come to if you asked scientists what sex a zygote is the moment after it’s fertilized.

However, for the sake of discussion and understanding, let’s suppose that’s not the case. Suppose instead I agree and say people like this aren’t compatible with a binary model of sex and the solution is to have a third category for people who are especially ambiguous. The result would not be a spectrum, nor sex being bimodal. It would still force a binary for 99.99999 percent of people, but with a tiny third category for some extremely rare exceptions. This would still be discrete options, just three instead of two. In that case, we might call sex a ternary, or trinary, or trinity, rather than a binary—but not a spectrum, and not bimodal.

Sex characteristics and phenotype

Sex itself isn’t the most important quality. Often what actually matters when we look at and interact with other people is not sex itself, but the various things that correlate or arise downstream from sex. These things are called sex characteristics, a term for anything that tends to differ between sexes. This can be broken down further into primary sex characteristics (things like that are directly related to reproduction, like the penis or uterus) and secondary sex characteristics, which are not (e.g. females having larger breasts, males having more facial hair, females having wider hips). This is also how we categorize things like the males of many bird species being more colourful than their females, or male lions having more prominent manes, or a simple difference like female bears being significantly smaller than male ones.

A related term is phenotype, which is often contrasted with genotype. These are general terms that refer to your genes (genotype), and the observable characteristics that result from genes (phenotype). When it comes to the conversation about sex, technically it’s more your phenotype, or rather a specific part of your phenotype (your gonads and their function), that define what your sex is. However, the phenotype of a person also refers to many other features that are not part of your sex. For example, what your face looks like is part of your phenotype.

Gender

By the mid 1900s, beginning in the 60s but remaining on the fringes til gaining more steam in the 90s, writers in various fields converged in wanting to distinguish between the underlying biology of sex and its related characteristics on the one hand, and the way that these biological differences play out socially or in cultures on the other.

We might say, for example, that in a given society, men are expected to pay the bill if he goes to a restaurant with a woman, but is this a sexual difference? Is that part of their sex? No, it’s clearly something else, but something that arises downstream, as a result of their sex. But because we’re pattern-seeking machines, and virtually every person in society is clearly male or female, we tend to form generalizations about these differences. The resulting phenomenon didn’t have a proper name, so they gave one, and the name they chose was gender. This is now largely how the term is used today.

Gender is far from the only instance where we draw a distinction between an underlying, concrete, or base reality, and the more imaginary, conceptual, or abstract idea that our experience of the concrete gives rise to. Consider fathers and fatherhood, leaders and leadership, professions and professionalism. In each case, the concept wouldn’t exist without the underlying reality, but once established, they can be spoken of, thought of, and even exist independently from their origin. A person can exhibit fatherhood without technically being a father. A person can act professionally outside the scope of their job, and so on.

It doesn’t take much for us to recognize patterns, and patterns that affect social organization can create a feedback loop, or compound upon itself, or become self-reinforcing. If all the girls at a school play basketball and all the boys play baseball, that likely influences what sport a new student at the school is going to play, because for various reasons, people like the environments where they feel like they fit in. They’re going to look at the baseball team, look at the basketball team, and the girls are going to go where the girls are and the boys are going to go where the boys are. People self-select for where they feel most welcome, and we have a desire to meet perceived social expectations.

Now think about how that might apply to ancient human tribes. Just the fact women get pregnant and men don’t could alone result in their occupying different social roles, and once that norm is in place, people will select for it. The most socially successful men will be the ones who the boys of the next generation look up to, and vice versa, girls and women. The elders teach the young, the young try to emulate the elders. Once a division like this gets going, it keeps going. Then you realize it’s not just pregnancy. Females are smaller, shorter, weaker, more vulnerable, they have a different psychology, different personalities, they hit puberty earlier, they seem to be more interested in social or interpersonal labour, they occupy roles within family structures. They’re different all over, in so many different ways. There’s no way that any society isn’t going to notice all of these differences and carve out different ideals in their head for what males tend to be like and what females tend to be like, which is essentially all gender is, when half your society clearly fits one pattern and the other half clearly fits the other.

Societies do also differ in their specific gendered ideas. Perhaps in one place wearing earrings is masculine, while in another society they’re feminine. Maybe in one place wearing red is masculine, while in another place wearing red is gender neutral. Maybe 200 years later, it had become a feminine thing. These little details all shift around depending on the time and place, but also overlap in broader themes, because the social development of all these different societies have what are essentially the same starting point: the average biological differences between males and females. It’s like different streams that are branching off from the same riverheader—there’s just some baseline facts that are true in every society, so we’re all forming generalizations and coming up with cultural trends based in similar experiences and observations, even if the more granular things can differ.

History of terms

The discourse about gender originally focused on social roles or gender as a category of association, the idea that some things are for girls and some things are for boys. This led to derivative terms like gender identity, roles, presentation, and more, which can cause confusion because now two people can both say the word ‘gender’ without qualification, and they’re unknowingly talking about different things.

Language like this began appearing in American psychiatric literature in the 1950s, albeit the meaning has shifted since then. The term roles was used at the time to capture the social phenomenon, while the term identity, or core gender identity, was used for the persistent internal or private experience of that social phenomenon. They also talked about sexual identity, i.e. your sexuality, which was another piece of a person’s broader social identity, i.e. the way in which a person is self-aware of how they fit into their society.

Today people use a multitude of terms, like gender performance, gender expression, or gender presentation, to describe the ways in which a person actualizes a certain gender role—any behaviour, attitude, or appearance associated with a person depending on if they’re perceived as a man or woman.

We may then combine this with a description of sex and phenotype to create a thorough report of a person’s place in a given social situation: a person may have a male genotype, a female phenotype, a male gender identity, but attend dinner with their grandparents where they adopt a female gender expression. However, for the vast majority of people this is all unnecessary because these things will align (male genotype, male phenotype, male identity, male expression, or vice versa).

If a person uses the term ‘gender’, it’s their responsibility to ensure the context is understood via some type of qualification; but if no qualification is given, then it becomes your responsibility as a listener to figure out what is actually being spoken of, because ‘gender’ can be the first half of a number of different terms for different concepts, and the truth of a statement about gender can vary depending on what sense of the word is actually under examination.

A great example of this is the statement “gender is a social construct”.

Is gender a social construct?

This phrase has become less commonplace, but in, say, 2013, it was something any person who used the internet regularly heard in someplace or another: gender is a social construct. What does this mean, and why does it matter? The claim gets a lot of mileage for something most people don’t seem able to explain if you ask them, and I’m doubtful of how many people know why it matters either.

”Gender is a social construct” became a progressive canard, something people said out of habit, an utterance whose main purpose was not to convey any specific meaning but to indicate to others which side of the issue I aligned with. It reminds me of a modern joke about how during any meeting at work you can, without even listening or paying attention to the conversation, interject with “it’s all about finding the right balance”, and people will nod in agreement as though you’ve said something meaningful.

And on the other side of the issue, people realized that progressives kept calling things social constructs, and therefore felt obliged to disagree, before they were even sure what they were disagreeing with.

A social construct is anything that is so only because we’ve all agreed that it is. A good example of a social construct is the meaning of words. The fact a rock is hard or sinks into water isn’t a social construct; it’s a truth about the natural world that we observe. But why does the word ‘rock’ refer to this object, or with any given meaning? There is no truth of the universe to that association. We just needed a noise and some symbols to refer to this thing, and ‘rock’ is what we came up with and agreed to. It’s only ‘true’ by convention (or by observation of that which has been agreed to by others).

We could go on to say any other aspect of language is socially constructed, from the words to the spelling and grammar. Another common example is law. What makes something legal or illegal? The universe itself has not given this to us as observable knowledge—the truth is up to us. If every human in the world decided that something was illegal, then it would be. That’s the ‘magic’ of social constructs: the truth is whatever we (as a society) decide it to be. We are the truth makers.

Some other examples: morality, good manners, what year it currently is, when the weekend starts.

Is that the same as it being subjective? It may sound similar, and the two often overlap, but no. A quality being subjective or objective is a matter of whether it’s a property of the object or if it’s something that arises or takes form only via the relationship between object and subject (‘subject’ meaning the outside entity that is observing or otherwise interacting with the object). The most common example of a subjective quality is beauty. What makes a thing beautiful, if not that there is some kind of observer who considers it beautiful? And if nobody considers a thing beautiful, then how can it be said to have beauty? What else does ‘having beauty’ mean? Not all qualities are like this.

A different example that may be more helpful here is the taste of food. Why does honey taste good? I don’t know. It just does. Another person might disagree, however, and say honey tastes terrible. Whether honey tastes good is subjective, because tasting good requires a taster to evaluate it as good-tasting. It’s possible that a space-alien species that visits Earth tomorrow tries honey and to their tongues, it tastes disgusting, and from their perspective we’re all crazy for enjoying it. But the taste of honey isn’t socially constructed, because I don’t only think it’s good because my society has decided that it is, or developed that as a convention and taught me that I’m supposed to like it. My enjoyment of it is independent of any social influence.

(It may be possible for some aesthetic preferences to be like this, not in whole but in part. If a whole society tells itself that a certain thing is supposed to be enjoyable, could they induce an enjoyment for that thing? Possibly. For example, some people argue that how we feel about popular music is socially induced to a degree, and our idea of what music is ‘good’ is going to be different depending on what society we grow up in. There are also some aspects of music theory that seem to be natural and don’t need to be taught or induced. There is probably very interesting discourse to be had on this topic. However, this is clearly not what happened with honey.)

If I were to say gender is socially constructed, what I probably mean by that is to say gender roles entail socially-constructed associations. To wear a perfume that smells like flowers—is this masculine or feminine? It depends on the society. Maybe it’s a unisex thing everybody does. Some aspects of gender as a social phenomenon are socially constructed. There are some qualities that feel as though they get closer to objective observation rather than frivolous cultural fodder like food or clothing, such as the association between men and violence, bravery, physical strength, risk-taking. It’s not beyond imagination that a society could think women are more violent and men are more peaceful, but I don’t think there has ever been such a thing, because it goes pretty directly against the reality created by hormonal differences.

At this point, some people have the intuition that some aspect of our gendered associations, the base or foundation perhaps, are not social constructions but instead an underlying reality that we’re tapping into. This isn’t quite right: a convention that forms based on some kind of observation is still a convention. However, in that world, it would still be so that we socially construct many things atop that foundation, leading to a granted area of agreement where we can say things like which colours are for girls and which colours are for boys is socially constructed. This also indicates that such associations are clearly malleable, because we all know and acknowledge that such associations change over time.

But this is using ‘gender’ to mean gendered associations. What about gender identity? That’s a funny question. What would it even mean for a personal identity to be socially constructed? I assume what a person means by this phrase is that how a person’s identity formed was influenced by social factors. In other words, it’s not actually about socially constructed ideas, but an instance of another long-standing topic of debate within biology and sociology known as nature versus nurture. This means trying to determine the extent to which a given thing is caused by genes (nature) or caused by the conditioning that you experience growing up, interacting with other people or other physical aspects of your environment (nurture). Let’s say we notice girls cry more than boys. Why is that? Is it nature or nurture? It could be something innate, like a hormonal difference, but it could also be that we teach boys growing up that crying isn’t okay, while we don’t discourage it as much in girls, thus creating that difference through nurture? Then again, it could be a combination of both. But if so, then which factor is greater? Is it equal? Is it 20 percent nature and 80 percent nurture? This is the kind of thing people disagree on for many observable differences between people.

Not many things result entirely from nature without any influence by nurture. An example is your blood type, which is unchanging after being genetically determined. Some things result entirely from nurture, like what language you speak. There is no natural language that comes pre-built into your brain. It’s something you learn from other people around you, and if you had been born into a different part of the world, you’d likely know different languages. But many things are influenced by both. When it comes to your personal, core gender identity, is that determined by nature or nurture? It could be influenced by socialization to some extent, but today we believe it’s mostly a matter of nature. However, as recently in time as the 1970s, there were people who supposed core gender identity was determined entirely or nearly entirely by nurture, or, to use the term they used at the time, by rearing.

In the 1960s, a researcher named John Money saw an opportunity to test and hopefully demonstrate this hypothesis when a baby, at an age of 1 year and 10 months, had somehow lost most of its penis in an accident. Money somehow convinced the parents to let Money give the child cross-sex hormone treatments and raise him as a girl. Money thought if you raise a child as a girl, the child will accept that role and go along with it, because in Money’s view core gender identity was determined by socialization, and with this child he hoped to prove it. And for some time, people thought he did, but later Money came to be seen as having lied about the results of the experiment by hiding details of what happened to the boy, yet referring to it as a success story and as proof of how malleable gender identity supposedly was.

In actuality, it went very badly. For one, Money was accused of grossly mistreating this child during his upbringing, until the child eventually rejected what they had been taught and went back to living as a boy by the time he was 14. The experience was traumatizing, not only for the confusion but for the strict treatment the boy endured, along with his twin brother, whom Money also got to work with. He not only saw and worked with both boys naked, but instructed them to pretend to be acting out sex acts with one another, supposedly to enforce to the main boy that he was supposed to be in a woman’s role, which Money claimed was part of how the child would learn their new identity.

Later in his career, John Money went on to say he didn’t think pedophilia was necessarily harmless, writing in 1991, among other instances, that a 10-year-old boy could have a sex relationship with a man in his 30s and that would not be pathological. This coming after his unethical experiment that he lied about, John Money became a controversial figure and is now remembered almost exclusively in a negative light. He passed away in 2006.

I have no interest in trying to rescue Money’s legacy or reputation, which are deservedly negative. However, in the interest of accuracy, I’ll clarify a few things:

John Money wasn’t a pedophile. There’s no evidence that he was one. If he had been a pedophile, it sounds like he was in a position where he could’ve easily sexually abused the children he had access to, yet decades later he had never been accused of that. It seems safe to say he wasn’t one. He did work with naked children, but so do many other medical professionals whom you don’t consider pedophiles. Let’s not overstate our condemnation: Money was a researcher who did some aggressively unethical things in effort to prove himself right. Sadly, this happens sometimes with scientists and other intellectuals, which is why they need oversight and ethics rules.

Decades ago, when you were dealing with a vulnerable group of people who were generally looked down upon, you could get away with a lot more than usual, and far more than now. There is likely a great amount of abuse in the history of study of gender and related topics.

John Money isn’t, like, “the founder of gender theory” or anything like that. Nor is he somebody to whom modern progressives owe their beliefs. John Money’s beliefs were directly at odds with what is believed today, because if children simply accepted whatever gender identity was given to them by their upbringing, then how could trans people exist? The failure of Money’s experiment is, if anything, a confirmation of the modern position. Trans people can’t just be conditioned or willed out of being trans, just like the boy that Money experimented on couldn’t be conditioned out of his being a boy. However, anti-transgender figures to this day love to bring up John Money and talk about him as though his sins discredit modern beliefs about gender or trans people. This is the main reason most people ever even hear about him.

Even if John Money had been the first person to propose every facet of modern beliefs about gender, got all of it correct, and then ran around being a racist pedophile serial killer who loved torture and cannibalism, that would all be irrelevant to the accuracy or inaccuracy of his findings. If Einstein were a bad person, would that make relativity any less true? The type of argument people are making when they attack Money in this way is called a genetic fallacy or fallacy of origins, whereby an idea is evaluated not by its merit, but how we feel about where it came from.

Why does it matter?

I asked this earlier. Let’s get back to it.

At best, the notion gender is a social construct is offered in reply to somebody who’s speaking of gendered associations as though they’re timeless, or something that can or should never change. It can sometimes be useful to point out or remind people of the fact humans are in control of these standards, not the way around, and we know our standards can change and have changed in the past. However, there are also many conversations in which that isn’t a relevant thing to say, and people blurt it out anyway. The message becomes unclear, unless the intention is, as it seems, to say “this thing is a social construct, therefore it doesn’t matter or is unimportant, because it’s just a social construct”.

A more focused response in that context may be to say that our standards are demonstrably malleable. A malleable thing is one we can change or alter over time without breaking. We understand that laws are malleable, and that language is malleable. We understand that fashion changes. So do gendered associations. There’s no reason to bring the language of social construction into the mix. It doesn’t add anything to the discourse, and is often confusing.

Transsexuals

There has always been some disagreement about how precisely to define a transsexual person. A simple description is that a transsexual person is a male who identifies with and wants to live in a way that’s more consistent with females, or a female who identifies with and wants to live in a way that’s more consistent with males, in their respective cultures.

Let’s consider the history of terms:

The term ‘transsexual’ came to English in the 1940s, derived from the equivalent German “transsexualismus”, used in 1923 by German sexologist Magnus Hirschfeld.

‘Gender’, in its modern sense, first emerged in the mid 1900s, but became more popular in the 1970s, and then again in the 2010s.

‘Transgender’ was first used in the 1960s, intended to be an alternate term for the same phenomenon as ‘transsexual’. It was introduced by psychiatrist J. F. Oliven, who said ‘transsexual’ was misleading because it made people think it was describing something sexual in nature, like ‘homosexual’.

‘Cisgender’ first emerged in the 1990s to describe the non-trans population, simply by taking the existing cis- prefix, the opposite of trans- in various contexts.

Magnus Hirschfeld should probably be regarded as one of the great heroes of queer history. In addition to his well-meaning work with transsexuals, he wrote about homosexual love and racism. For his work, he was assaulted and exiled from his country by the Nazis. Their paramilitary groups also destroyed his research facility and burned his library in 1933.

Transsexual vs. transgender

Why are there two different terms that mean roughly the same thing? Today, some trans people reject the transsexual label, and some trans people reject the transgender label. Many other people consider the two synonyms, or view transsexual as the outdated, legacy term for transgender. Other people may consider transsexual to be a subset of transgender, with different meanings. I often shorten it to ‘trans’ in order to sidestep this entire dispute, but it’s interesting enough to review.

The term transsexual came first, and then in the 1960s people started saying transgender, which really caught on by the 80s. Christine Jorgenson, one of the most famous transsexuals, probably the first ‘celebrity’ trans woman in the US, famously rejected the transsexual label, then in vogue, and insisted on being called transgender instead.

She, too, cited her rationale as being that ‘transsexual’ sounded like it meant something to do with her sexuality, so that seems to have been what led to change broadly, as the country was then still divided on its view of homosexuals.

The term transsexual didn’t fully disappear, however. It just became less popular, and then later back into some popularity, like a fashion trend coming full circle.

But the reason, in both cases, was more than a random trend. In the last couple decades, the meaning of transgender was expanded to include more than it originally did, becoming an umbrella term for a set of people that’s mostly transsexuals, but also some other people, who would probably claim to be trans, but not transsexuals. This left transsexual as the obvious choice to communicate that distinction, if you so desire.

This is what I’m signalling when I refer to myself as a transsexual. I’m transgender, but unlike some people, I’m also transsexual. I’m using it as a more specific designation. The people who consider theirselves transgender but not transsexual are, generally speaking, people who say they identify with the other gender, but don’t actually transition their body or identify with the other sex. They might refer to theirselves as nonbinary, agender, or something else. There have been various proposed umbrella terms for these people (an umbrella within the larger transgender umbrella), such as gender-nonconforming, gender-queer, gender-variant, or gender-diverse.

There is sometimes conflict or tension between these two groups (transsexuals and non-transsexual transgender persons). In using a more specific term that communicates which subgroup I’m a part of, my intention is clarity and specificity, not to denounce or exclude anybody else. It’s important to me that society protect the rights of gender-diverse expression. I would never choose to live in a place where a bearded lady doesn’t feel safe in public.

Why are people trans?

The short answer is nobody is sure. It’s one of the many little quirks of nature, like how some people are gay, or left-handed, or psychopaths, or enjoy cilantro, or only have nine fingers. But unlike some of those other things, it’s still a mystery what exact mechanism induces the quality of being trans. There are proposed hypotheses, but the truth of the matter is not yet settled. For now, we can just accept that every new generation of people is going to have some transsexuals in the mix. It’s been estimated to affect roughly one in every 200 to 300 people, or in other words something like 0.3 to 0.5 percent. It could be more or less. (I’d personally argue those early estimates now seem to be slightly too high and the actual figure is more like 0.1 to 0.2 percent, but it’s difficult to know any of this for sure.)

A trans person is born into society with no knowledge they’re trans. They’re raised in a gender-based social order where some people are boys and some people are girls, and depending on which you are, you’re treated differently growing up, and then sorted into different rooms for some reason. At some point, that person may become self-aware and realize they’re a girl but they really wish they could be a boy, or the other way around, and it’s more than just a passing thought; it’s a complex, a kind of obsession, something they can’t easily get over or stop thinking about, because it’s coming from a deep, fundamental part of theirselves. The question then shifts to how they want to navigate that situation.

In a sense, the ‘trans agenda’ is a proposal made by trans people to their community. “I’m not a male. I’m female. I was born female, and I was raised as a girl. However, my intention is to live as a man from now on. I’d like it if you could think of me like a male, treat me the way you treat males, and refer to me using male-coded language.” And think of it the other way around for people born male. Importantly, this doesn’t require disputing any of the facts about biology presented earlier in this document. Trans people don’t have to claim or believe anything about theirselves that isn’t uncontroversially true.

The language that we use for a trans person actualizing their identity is ‘transitioning’—either a female who transitions from living as a woman to instead living as a man, or a male who transitions from living as a man to instead living as a woman. Transsexual women are males living as woman, while transsexual men are females living as men.

Note at this point that it’s become common to use man and woman for gender, but male and female for sex. This isn’t always the case, and hasn’t always been the case, but if we agree on a common distinction like this, it prevents having to clarify each time in the future. As such, I use this distinction in this document and in most of my other writings.

Are trans people mentally ill?

If you’re willing to respect the conclusion of modern psychiatrists, the simple answer is no, it’s not considered a mental illness. It was sort of considered one in the past, when the condition was less well understood. Trans people typically had a lot of distress and confusion, high rates of other disorders, and their insistence on their own identity could be interpreted as some kind of irrational compulsion, so they’d go in to see medical professionals who would say “well something seems to be wrong with this person”, and they tentatively threw us in the “mental disorder of some kind” bucket, where we stayed for a few decades until enough researchers decided to investigate the matter more.

What is a mental illness, or disorder? It’s something that causes significant impairment to your ability to live your life in a normal, healthy, functional way. It’s possible for you to experience a certain symptom but not so severely that it interferes with your ability to, let’s say, have a job, go to school, maintain friends, family, a relationship, etc. If there can be people who lead normal, healthy lives while being trans, then ‘being trans’ is not itself a mental illness.

The belief that trans people are mentally ill—many people seem to think they’re mentally ill by definition—comes from misunderstandings about ‘gender dysphoria’, a term listed in the DSM-5 that people interpret as a renaming of an older term, “gender identity disorder”. If you look up that name change, you’ll find sites claiming it was only renamed to help spare trans people’s feelings, because the term ‘disorder’ was too stigmatizing—not because calling it a disorder was technically inaccurate. The impression people walk away with is that trans people have gender dysphoria, which is essentially still a mental disorder, so it’s fair to just say trans people are mentally ill.

However:

The shift from “gender identity disorder” to “gender dysphoria” was not just a renaming, but also a reconceptualization of what it is we’re even talking about. It shouldn’t even really be thought of as the same disorder under a new name, but a new disorder that better explains similar real cases, rendering the previously conceptualized disorder obsolete. We went from talking about the identity itself and calling that a disorder, to talking about the experience of distress or discomfort that arises from the divergence between a person’s identity and the social expectations they experience in their society.

Being trans doesn’t just mean having gender dysphoria. Gender dysphoria refers to something trans people often experience (distress or discomfort that arises from the incongruity between their identity and the social expectations they face in society), but not something that all trans people experience at all times, and which some trans people no longer actively experience after transitioning (which is why some people refer to transitioning, or the social actualization of gender identity, as the ‘treatment’ for dysphoria).

There’s a colloquial mix-up between gender dysphoria as a general experience versus gender dysphoria as a clinical diagnosis. This is similar to people who say they feel anxiety about something compared with people who have an anxiety disorder. Trans people may describe “feeling dysphoric” or “feeling dysphoria”, but they aren’t really describing having those feelings in a way that is so significant they would be classified as a mental illness. To make that distinction, some people have adopted the more specific term clinical gender dysphoria, while gender dysphoria without qualification can also include a general feeling that doesn’t necessarily rise to the level of a disorder.

Even if trans people were necessarily mentally ill—as in, if ‘being trans’ was considered a mental illness—this likely wouldn’t accomplish anything for the people who are most interested in the distinction. The purpose of claiming trans people are mentally ill is to imply that we should doubt the validity of their identity or experiences. That could make sense if you consider how, in many other cases, people who experience mental illness are likely to exhibit cognitive distortions, which can affect their judgment or reasoning. However, that doesn’t seem to be the case when it comes to gender dysphoria or with identifying as a trans person. The trans people who claim to identify differently from the gender of their sex go on to live as the opposite gender and this does make them happy. There doesn’t seem to be any real mistake in their reasoning or perception of the world.

A similar claim I sometimes see is that if somebody is mentally ill and claims something that isn’t true—e.g. you’re a schizophrenic and you think the government is watching you while you sleep—then we shouldn’t affirm that delusion. The problem (aside from that I’m not certain we should never affirm the delusions of a crazy person—what if that is the right thing to do sometimes?) is that unlike a person who’s hallucinating or experiencing a delusion of causality, trans people don’t claim anything about the world that isn’t factually true. This is itself contentious and leads to the next point.

Are trans people delusional?

The people who dislike transgenderism and don’t want it to be socially accepted sometimes claim that trans people hold a false belief, or deny some aspect of reality, by stubbornly asserting, perceiving, or believing in something that isn’t true. This is called a delusion: a fixed belief that is held without justification and despite the presence of evidence that it’s false. However, if you ask such people to identify the belief that is supposedly false, they immediately run into some problems.

Answer 1: “Trans people think they can change their sex.” This is a misconception that could, charitably, be blamed in part on the language of sex and its derivatives. The term ‘transsexual’ could sound like it means somebody whose sex changes, and transsexual people do get procedures that used to be called “sex change operations” (this term is outdated and no longer commonly used), and take what we still call cross-sex hormones. However, if we set aside these confusing labels and misnomers, trans people don’t believe or assert they’re actually changing their sex. Trans people understand they’re able to change some aspects of their body, but not all aspects, and the amount of change possible with our current level of technology is not enough to justify saying the sex of any person has changed. Trans women haven’t become biological females—a trans woman is a male who has feminized their body to some extent (they undergo feminizing hormone therapy), but they’re still not able to get pregnant or have periods. They don’t have female reproductive function. They can’t pass on their genetic material through large gametes that fuse with the sperm of another person. And vice versa for trans men. There is no real confusion about any of this, except for the confusion that sometimes arises about what language is best to describe this reality.

Answer 2: “Trans women think they’re women.” How can this be a delusion? If somebody says it’s a delusion, they’ve failed to distinguish a factual dispute from a linguistic one. The latter is not categorically able to be a delusion, or even a false belief. As such, there must be a misunderstanding. Let’s ensure we understand the difference.

If I tell you this jar has 23 beans in it, but you disagree and say it only has 20, then we’re having a factual dispute. There is some underlying fact of the matter, and we disagree about what that is. The reality may correspond with one of our claims, but not both, assuming our claims are contradictory. (We could also both be wrong.)

If I tell you there’s an elevator in the lobby, but you’re from Britain so you call it a lift, then we’re having a difference in language. We mean the same object, but we refer to this object using different names. There is no disagreement about the underlying reality we’re both describing.

If I ask you for chips, thinking of potato chips, but you’re from Britain so you come back with what I’d call french fries, there is again a difference in language, but this time of a different nature: we’re using the same name, but we had different objects in mind. So remember, it happens both ways.

A word is just a noise or series of symbols that directs us to a meaning. It’s like a signpost, pointing to a location. The meaning is what matters. There can be interesting discussion about linguistic differences, as in asking why one way of wording something might be better or clearer than another—but linguistic differences can’t be a ‘delusion’, because they aren’t a matter of one’s perception or understanding of reality. In other words, a linguistic difference is not evidence of a factual dispute.

Disagreements about the word ‘woman’ are a matter of people using the same term, but intending two different things. The comparison I often use is if I say there’s a crane in the park, but you look in the park and don’t see a crane, that may sound like a factual dispute at first, but if you realize that I was talking about a crane, the type of bird, and you were looking for a crane, those industrial lifting machines used to move heavy objects around, then we’re actually not having a factual dispute at all. We’re just experiencing a difference of language, but mistaking that for a factual disagreement.

I like to write out the different meanings as though separate entries in a dictionary:

crane noun [ kreyn ] 1: a member of the family Gruidae, tall birds with long legs and a long neck which is extended during flight 2: a machine that uses a hoist and pulley to lift objects, typically during construction or to load and unload freight

This allows us to replay that interaction: I say there’s a crane(1) in the park, but you look and say you don’t see a crane(2) in the park. This time, there’s clearly no conflict between our statements.

Now imagine woman is defined like this:

woman noun [ wo͝omən ] 1: an adult human female 2: an adult human, usually a female, but not necessarily — I’ll expand more on this later

An anti-trans person claims that trans women aren’t women(1), but trans women don’t claim to be women(1). They only claim to be women(2). As such, there is no factual disagreement between the two statements, because the trans woman isn’t claiming to meet the woman(1) criteria.

What is a woman?

Yes, that’s the question the arguments in the previous section are naturally leading to.

The concept of a woman came about to describe the general qualities of females, but now the proposal is that it doesn’t need to be taken so strictly, and it’s possible for a male to become part of what people intend when they say women, provided such males are sufficiently female-like, in some way or another (where precisely that line is drawn varies from person to person, so it’s hard to nail down beyond this).

But why? What’s the point in adopting a less rigid definition of ‘woman’? This is an interesting point in the dialogue that many people never reach, instead getting stuck on one of the points before this. There is a natural shift in meaning that occurs when the intended referent changes, due to the language being pegged to something other than the qualities we actually care about or are meaning to select for. This is especially likely to happen when there are changing circumstances (e.g. the invention of hormone treatment and gender-affirming surgeries that make ‘transsexual women’ more of a realistic phenomenon for the rest of society to experience and integrate into their understanding of the world).

Think about a similar concept: fatherhood. To be a father in the biological sense means to be the male progenitor of another organism. From this point, though, we develop a concept of fatherhood, meaning the way fathers do or should behave in society or the type of relationship or commitment they do or should have to their offspring. It’s then possible for a person to exhibit fatherhood toward a person without actually being their male biological progenitor. The concept derivative is able to exist independent from its concrete foundation.

Now suppose I live in a society where people have only recently started adopting children, as a new practice. I say to a class of children, if you don’t know anything about hunting, you should ask your fathers to teach you, and two of the children raise their hand and say they don’t have fathers—but I learn one of them is being raised by a man who adopted them, and the other is being raised by their mother along with another man whom their mother married after their father died. To clarify, I say that in their case, whenever I say ‘father’, they can just assume I mean those men instead, since for the purpose of what I’m talking about, it’s not actually important for this person to be your biological progenitor. What’s actually important is just that he’s the man who’s committed to raising and taking care of you.

Though imaginary, you can see how in this case, you can see how there’s a divergence between the previous, literal definition of the language being used (father: male biological progenitor), and the idea that I was actually trying to capture, for which I merely used ‘father’ as a shorthand for lack of better term (father: the man who’s raising you). But when an exception arose, I effectively redirected or rerouted that word from one meaning to the other by establishing my intention to the listener. It typically means one thing, but in this context, for you, take it to mean something else.

We may then develop language for this distinction, to be used whenever necessary. In this case: adoptive father vs. biological father. There are some circumstances where I need to specify one or the other, but there are many other cases where the distinction is unimportant and I can just use the unqualified unifying term ‘father’.

This works out especially well in the father example because in many cases the distinction isn’t apparent, i.e. you can’t tell by looking. You’ve probably encountered people in your life whose father was not their biological progenitor and you didn’t notice. In many cases, their children theirselves don’t even notice. This isn’t necessary for the linguistic rerouting, but it helps the transition happen more smoothly.

Now ask the question: Why choose a less rigid definition of father? To some degree the answer is we didn’t directly choose it, so much as it happened, or that it comes about naturally under certain circumstances (a divergence between the intended and previous meaning of a word that’s used as an approximation for some other, more important thing). The advantage conferred is ease or convenience. Instead of calling the adoptive father a father too, I could have always made the clarification “ask your father—or, if you don’t have a father, then any male who is raising you like a father—to help you with this”. But it’s easier and more convenient to establish that “for our purposes here, that person counts as a father, so when I say ‘father’ in this context, he is included”. We could say this person is an honorary father.

This analysis and rationale seems no less applicable to the concept of womanhood. Consider what I said earlier: the trans ‘agenda’ is a person making a proposal to their society to be treated like the sex they’re not. Regardless of your personal attitude toward this phenomenon, the fact by this point is that in many communities, that proposal has been accepted. There are, in fact, biological females who are thought of, spoken of, and generally accepted as women, even by people who know full well they aren’t females. The exact criteria varies, but suffice to say if a male expresses a persistent psychological desire to live as a woman and makes a significant change to their hair, clothing, behaviour, and body to be more female-like, then society at large, at least where I live, will accept this person as a woman, similar to the adoptive father being accepted as a father. I dare say they’re honorary females.

Consider the effect this has on our language: if I tell all the women to go to one place, but my intention is not only for females but also for males who are thought of like females to go to that place, then I could specify that each time—or to make things easier, I could establish that, for my purposes in this context, when I say ‘women’, I mean both females and this special category of males that we treat like females. In this way, the language of ‘woman’ has been redirected or rerouted, to better match what is actually intended when it was first used.

Trans women didn’t need to be considered women. ‘Woman’ is just a word, after all. I could imagine an alternate timeline where this linguistic shift never happened, where trans activists never said “trans women are women” and everybody in society insisted on a strict, unchanging definition for the term. What would be the fate of trans women? A person might ask me if trans women are women, and in that timeline I might reply “no, but we should treat them like women, even though they technically aren’t”. And what difference would that make? Aside from the worlds we use to describe it, not much. And remember, it’s ultimately the treatment of people that is more important than the names we give them. We tend to care about language only because it often affects treatment, or it affects how people think, which affects treatment.

Why didn’t that happen? Because it’s weird and unnatural. It makes more sense that the language we’re most used to would evolve. If I’m at a restaurant with a trans woman and I say to somebody “yeah I’m at the table with that man over there”, pointing to somebody who looks like a female to everybody else, people are going to be confused. And nobody wants trans men who look like males in the female washrooms. Nor does anybody want to have to bother updating the way that we talk about gender in order to integrate these exceptions as clearly as possible. It makes more sense to integrate the exceptions into the language, by shrugging and saying “trans women are women and trans men are men”. It’s the simpler, more natural, more common-sense solution to the dilemma.

Why did trans people become such a popular topic in the 2010s?

To many people this seems like a completely random cultural shift, like society got bored of its previous struggles and went out looking for some shiny new cultural thing to obsess over. That could be true to some extent, in a way that’s less of a cynical conspiracy theory than it sounds, if some popular writers didn’t have much to talk about and started paying more attention to issues they had previously overlooked to fill the attention vacuum—but I also don’t really see anything to suggest that’s the case. The shift was instead a consequence of systemic and institutional changes, some of which were resulted from research and understanding of trans people reaching a critical mass, where the opinion of establishment medical professionals was changed in response to accumulating evidence.

In 2011, a major professional organization dedicated to research and treatment of trans people, known as the Harry Benjamin International Gender Dysphoria Association (est. 1979), or HBIGDA, was renamed to the World Professional Association for Transgender Health, or WPATH. In the following year, it published version 7 of its Standards of Care for the Health of Transgender and Gender Diverse People, often shortened to just the Standards of Care, or the SOC. A major change from the previous version published in 2001, version 7 finally discontinued the Benjamin Scale for diagnosing gender identity disorder. Although progressive for its time, being developed by the well-meaning Harry Benjamin (another hero of queer history) as part of his 1966 book The Transsexual Phenomenon, the Benjamin Scale had become inconsistent with a modern understanding of gender identity, and, out of caution and an attempt to reduce liability for practitioners, it set much higher requirements for diagnosis than we have today. The language and framing about transsexual, transgender, or gender-diverse people was also updated, stressing that such people are not necessarily disordered. This contributed to destigmatization, and led to transitioning being far more accessible for normal trans people.

In 2013, the American Psychiatric Association (the APA) issued their fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, often called the DSM. This update not only replaced gender identity disorder with gender dysphoria, but reframed how we even think about these things, from the identity itself being a disorder and a problem, to instead our goal being to address the anxiety or distress that such people experience, and that being the disorder. Like the WPATH changes, this contributed to destigmatization and helped increase accessibility of care.

The emergence of social media was also a factor to increasing awareness of numerous social issues, including transgender identities, as it allowed emergent dialogue that might’ve not happened otherwise, at least not nearly to the extent extent. In 2005, nobody had a smartphone and there was no such thing as Facebook, Reddit, Twitter, Tumblr, YouTube, Instagram, or TikTok. A mere 7 years later, in 2012, all those websites had become mainstream (except TikTok, which took another 8 years or so). There are still people who don’t recognize how much of a change this was for our culture, because of how it enabled people all throughout society to access information and to connect and engage in conversation about anything they wanted in a pseudonymous manner. This was huge for minority voices, or anybody who would have been marginalized in the previous decades and had difficulty breaking through the more centralized landscape of mainstream legacy media. The amount of discourse that took place focusing on race, gender, and sexuality suddenly exploded. It was a decade of freedom and self-expression that people who grew up before this time rarely had access to.

Then, in and around 2015, there were major breakthroughs in mainstream cultural representation. This is when Caitlyn Jenner came out as transgender, probably the most high-profile person ever to do so. It shocked the world and sparked god knows how many conversations in how many households across America. It was also in 2015 that I am Jazz, a reality television program spotlighting transgender teen Jazz Jennings, debuted on TLC with mainstream support, funding, and attention. Even just these two changes, Jenner and Jennings, effectively taught millions of people what being trans even meant. This language was not even known to most people only a year prior.

There is something very empowering about discovering or developing the language and concepts with which to make sense of the world around you. The random lines become a pattern, the noise becomes music, the mess becomes a system that you can predict and navigate.

If a society goes from nobody knows what trans people are, to that concept being the talk of the town, there’s probably going to be some increase in the number of people who think about it and realize something about theirselves. It’s similar to the way I’ve heard some people talk about mental health patterns, where if you have something like autism or ADHD, but you’ve never heard of those terms before, and you were living back in 1305, you might never know what’s wrong with you.

Some remaining questions

How many genders are there?

This is a question that got a lot of attention 10 years ago, which led to people defiantly claiming there’s only two genders, in opposition to those who would entertain any other answers. Traditionally, gender was an abstraction based on observations about sex, which led to most cultures developing a simple binary understanding of masculinity versus femininity, which is enduringly intuitive for us today. However, there’s no strict rule that prevents us from imagining other categories, if doing so feels useful. We could imagine that space between the two ends as its own category of some kind. We do this with colours, for comparison, when we label that space between red and blue ‘purple’.

The proposal is, at least, that we carve out a middle category called ‘nonbinary’ (this is the name everyone has settled on).

The argument for doing so is that our society has use-cases for such a concept, i.e. very androgynous people who identify and present as something in-between being very masculine or very feminine. However, it seems most discourse about this ends up being about the plausibility of creating such a category rather than whether there’s a social need for it.

There are numerous things to consider:

If it’s not intuitive or doesn’t click for enough people, it may simply never catch on and become socially meaningful. There’s a good chance this is the case for a third gender. After all, dealing with only the concepts of masculine and feminine as a one-dimensional spectrum where the vast majority of people—i.e. something greater than 99 percent—are clearly and apparently one or the other is the norm and has been for centuries. It’s the only real paradigm that most of us are used to. Our language and culture have developed around this being the case.

The idea of somebody who is something other than a man or woman raises immediate questions for the way in which we think about such a person in relation to others, considering we live in a society with a gendered social order. If that person has sex with a man, are they gay or straight? If they use a gendered facility, do they use the men’s or women’s area? I don’t know the answer.

It’s often so that people who self-identify as something other than ‘man’ or ‘woman’ are still seen or interpreted as either men or women by others in society, or in other words as nonbinary males or nonbinary females. This is probably what people would use to base their answers to my previous questions (a man who has sex with a nonbinary male would feel like he’s having gay sex, while a man who has sex with a nonbinary female would not—and people would probably recommend the nonbinary male use the men’s washroom, not the women’s). Unless that nonbinary person is also a transsexual, in which case this flips. In conclusion, a nonbinary person’s internal identity notwithstanding, their social experience tends to be gendered according to their phenotype.

There are some nonbinary people who claim they aren’t “between” masculine and feminine, but off the spectrum entirely. What does that mean? For most people it’s incoherent, comparable to somebody saying “I’m not tall or short, nor am I in between tall and short; I don’t have a height” or “I’m not hot or cold, nor am I in between hot and cold; I don’t have a temperature”. It doesn’t make sense to us, or at least it’s not something whose meaning is easily interpretable for people who don’t already “get it”.

The most I’ve been able to make sense of it is as follows: some people have an inner sense of thinking about theirself as a masculine person and therefore trying to do masculine things. They want to walk in a masculine way, talk in a masculine way, do things that people consider masculine. And they want to avoid doing anything feminine. And vice versa for people who consider theirselves feminine instead.

Imagine if a person said rather than holding one of these two attitudes, they feel no connection or aversion to either side, and just do what they want without consideration for the gendered associations of their choices or behaviour.

The way that I try to relate to this is thinking about possible distinctions between two categories where other people might have a preference but I don’t. Let’s try to come up with a couple examples: do I try to listen to music made in England, or America? I don’t know. I don’t really think about it. Some bands I like are English and some are American. How about when I buy coffee, do I favour beans grown in South America, Africa, or Asia? I don’t know. I think the popular brands where I live are usually grown in Africa, but I’m not sure about that. There could be another aspect, where a person feels some kind of anxiety about being put in a box, made to choose between, and commit to, one thing or another. That could be how a person like this relates to the feeling of dysphoria, if they claim to.

What are the social consequences of any of this? I don’t know. Possibly nothing. It’s like asking what the social consequences are of somebody who claims to be aromantic. They don’t experience romantic feelings at all. What does that mean to you? If you aren’t trying to date them, then maybe nothing, you have no reason to care. But you get to learn a little bit more about how their brain works. When you live in a place where people have a lot of freedom to express what they want, you’ll end up with people who express uncommon feelings, and sometimes they might come up with language to describe those feelings, even if it’s not particularly consequential.

Perhaps confusingly, there are some categories of personal identity that don’t seem to entail or require any particular external performance, and therefore are not necessarily visible to an outside observer. A person who claims to be nonbinary, agender, or some other gender-divergent identity might not seem to be any different from a normal man or woman, except in their self-reported internal feelings.

Overlapping categories

Intersex people are not necessarily trans. There are intersex males who are also trans women, but there are some intersex males who remain men, and similar for intersex females.

Nonbinary and other gender-nonconforming people might also identify as transsexuals if they transition. There are some people who refer to theirselves as nonbinary trans, or trans nonbinary, meaning they transitioned, but after transitioning they consider theirselves nonbinary rather than the opposite sex.

These three categories can all have some overlap, but they’re also distinct enough ideas that people can be one without the other two, or two without being the third.

That’s all for now. Say, does Tumblr have a character limit? This is the longest thing I’ve posted yet, but I have another topic in mind that will end up being even longer when I get around to it.

[demi-shoggoth]

2023 Reading Log pt 16

The last books I read in 2023, and the least books I've read in a year since starting to keep track. But 80 books is still nothing to sneeze at.

76. Pandemonium: A Visual History of Demonology by Ed Simon. This book rules; it’s up there for best books I’ve read in 2023. As the title suggests, the book is primarily concerned with high quality reproductions of art of demons and hell in the Western tradition, organized by era, with accompanying essays discussing the role played by demons in culture and what they symbolize in literature, religion and art. These build to a crescendo, as the last essays are about the modern era as an Age of Moloch, where destructive, unrelenting consumption is the rule of the elite, which articulates feelings that I have had as a demon-obsessed ex-Christian for some time. It also talks about the Cthulhu Mythos as a post-modern demonology, which probably pisses ST Joshi off something fierce, so I give it props for that as well.

76a. A Curious History of Vegetables by Wolf D. Storl. “Curious” is an excellent word to describe this book, as its author is a nut. We’re talking, “consults astrological charts for planting certain vegetables” nut. Although the cover calls him an “ethnobotanist”, Storl is clearly a crank of the highest order—the introduction includes ranting about how vegetables are full of deva spirits, but GMOs are possessed by rakshasas. I was willing to read along for quite a while with this as a book about the magical properties and beliefs about plants—I got about halfway. But by that point, the author’s continual paranoia about using drugs as medicine, claiming that every vegetable is a panacea, and obvious disdain for scientific curiosity or little things like “evidence” got to be too much for me. That’s not me elevating him into a strawman, BTW. He goes into a lengthy rant about “The Shoemaker and the Elves”, talking about how scientists destroy magic with their curiosity and thus ruin the world. Blech.

77. Most Delicious Poison by Noah Whiteman. I’m a sucker for books about poison, and this is a good one. I think I’d still recommend Plants that Kill above this, but this is an excellent follow-up for the reader. This book talks a lot more about the modes of action of particular chemicals, and how chemicals fall into families of molecules that often have related properties. The book is one of those part science/part memoir nonfiction books that seem to have grown in popularity. The author was inspired to write it in part by his father’s death from alcoholism. So definitely go into it with a trigger warning in mind.

77a. Sex in the World of Myth by David Leeming. Abandoned after the Greece/Rome chapter. I abandoned it partially because it lumped Greece and Rome together and talked about their views on sex and sexuality as if they were interchangeable and consistent through the thousands of years of their existences, partially because the author is a Freudian. Life is too short to read books by Freudians. The specific line that made me give up was when the author defined all pornography as violent and exploitative. Blanket statement.

78. Household Horror by Marc Olivier. This is a weird one, even by the standards of “scholarly analyses of horror movies”, in that it looks at the horror movies it covers from the perspective of inanimate objects within them. Sometimes literally—the author discusses The Exorcist through the lens of Regan’s bed being possessed before she is—and sometimes figuratively—what does the exact make and model of the typewriter, and the reams and reams of hand typed text, say about The Shining? It’s witty and engaging, and an interesting way to view and review movies that, for the most part, have received a lot of critical attention already.

79. Quackery: A Brief History of the Worst Ways to Cure Everything by Lydia Kang and Nate Pedersen. This is a re-read; I bought this book shortly after it was released in 2017 and read it then. But, the podcast Behind the Bastards did an episode on radium quackery that used it as a source, and I was still stinging from having started and abandoned two crappy books in as many weeks, so I wanted something of a comfort read. Of course, my version of a “comfort read” involves gross medical malpractice and people poisoning themselves and others. I’m strange. The book is organized into chapters by subject (elements, animal products, vegetable poisons, etc), and is very well illustrated with vintage advertisements, engravings and photographs. There are more in-depth books about just about all of the topics covered here, but this is an excellent survey of the more shameful corners of medical history.

80. Words from Hell by Jess Zafarris. It’s a book on etymology! Namely, the etymology of profanity, slurs, sex, violence, drugs, crime, monsters… It’s a bit of a mixed bag in terms of theme, but is organized well within. A recurring topic is the hidden biases built into the English language, from “sinister” meaning “left-handed” to the classism built into words like “rascal” and “villain”. The author is good about discussing multiple hypotheses for word origins, and about when things are uncertain and unknown. And she’s a sex-positive WLW, which goes a long way towards giving me good feelings towards any book (an example joke: when discussing the shared root word of “vagina” and “vanilla”, she quips “no wonder they’re both so fun to lick”).

[reasoningdaily]

Wrapping his wife in a blanket as she mourned the loss of her pregnancy at 11 weeks, Hope Ngumezi wondered why no obstetrician was coming to see her.

Over the course of six hours on June 11, 2023, Porsha Ngumezi had bled so much in the emergency department at Houston Methodist Sugar Land that she’d needed two transfusions. She was anxious to get home to her young sons, but, according to a nurse’s notes, she was still “passing large clots the size of grapefruit.”

Hope dialed his mother, a former physician, who was unequivocal. “You need a D&C,” she told them, referring to dilation and curettage, a common procedure for first-trimester miscarriages and abortions. If a doctor could remove the remaining tissue from her uterus, the bleeding would end.

But when Dr. Andrew Ryan Davis, the obstetrician on duty, finally arrived, he said it was the hospital���s “routine” to give a drug called misoprostol to help the body pass the tissue, Hope recalled. Hope trusted the doctor. Porsha took the pills, according to records, and the bleeding continued.

Three hours later, her heart stopped.

The 35-year-old’s death was preventable, according to more than a dozen doctors who reviewed a detailed summary of her case for ProPublica. Some said it raises serious questions about how abortion bans are pressuring doctors to diverge from the standard of care and reach for less-effective options that could expose their patients to more risks. Doctors and patients described similar decisions they’ve witnessed across the state.

It was clear Porsha needed an emergency D&C, the medical experts said. She was hemorrhaging and the doctors knew she had a blood-clotting disorder, which put her at greater danger of excessive and prolonged bleeding. “Misoprostol at 11 weeks is not going to work fast enough,” said Dr. Amber Truehart, an OB-GYN at the University of New Mexico Center for Reproductive Health. “The patient will continue to bleed and have a higher risk of going into hemorrhagic shock.” The medical examiner found the cause of death to be hemorrhage.

D&Cs — a staple of maternal health care — can be lifesaving. Doctors insert a straw-like tube into the uterus and gently suction out any remaining pregnancy tissue. Once the uterus is emptied, it can close, usually stopping the bleeding.

But because D&Cs are also used to end pregnancies, the procedure has become tangled up in state legislation that restricts abortions. In Texas, any doctor who violates the strict law risks up to 99 years in prison. Porsha’s is the fifth case ProPublica has reported in which women died after they did not receive a D&C or its second-trimester equivalent, a dilation and evacuation; three of those deaths were in Texas.

ProPublica condensed 200 pages of medical records into a summary of the case in consultation with two maternal-fetal medicine specialists and then reviewed it with more than a dozen experts around the country, including researchers at prestigious universities, OB-GYNs who regularly handle miscarriages, and experts in maternal health.

Texas doctors told ProPublica the law has changed the way their colleagues see the procedure; some no longer consider it a first-line treatment, fearing legal repercussions or dissuaded by the extra legwork required to document the miscarriage and get hospital approval to carry out a D&C. This has occurred, ProPublica found, even in cases like Porsha’s where there isn’t a fetal heartbeat or the circumstances should fall under an exception in the law. Some doctors are transferring those patients to other hospitals, which delays their care, or they’re defaulting to treatments that aren’t the medical standard.

Misoprostol, the medicine given to Porsha, is an effective method to complete low-risk miscarriages but is not recommended when a patient is unstable. The drug is also part of a two-pill regimen for abortions, yet administering it may draw less scrutiny than a D&C because it requires a smaller medical team and because the drug is commonly used to induce labor and treat postpartum hemorrhage. Since 2022, some Texas women who were bleeding heavily while miscarrying have gone public about only receiving medication when they asked for D&Cs. One later passed out in a pool of her own blood.

Doctors and nurses involved in Porsha’s care did not respond to multiple requests for comment.

Several physicians who reviewed the summary of her case pointed out that Davis’ post-mortem notes did not reflect nurses’ documented concerns about Porsha’s “heavy bleeding.” After Porsha died, Davis wrote instead that the nurses and other providers described the bleeding as “minimal,” though no nurses wrote this in the records. ProPublica tried to ask Davis about this discrepancy. He did not respond to emails, texts or calls.

Houston Methodist officials declined to answer a detailed list of questions about Porsha’s treatment. They did not comment when asked whether Davis’ approach was the hospital’s “routine.” A spokesperson said that “each patient’s care is unique to that individual.”

“All Houston Methodist hospitals follow all state laws,” the spokesperson added, “including the abortion law in place in Texas.”

“We Need to See the Doctor”

Hope marveled at the energy Porsha had for their two sons, ages 5 and 3. Whenever she wasn’t working, she was chasing them through the house or dancing with them in the living room. As a finance manager at a charter school system, she was in charge of the household budget. As an engineer for an airline, Hope took them on flights around the world — to Chile, Bali, Guam, Singapore, Argentina.

The two had met at Lamar University in Beaumont, Texas. “When Porsha and I began dating,” Hope said, “I already knew I was going to love her.” She was magnetic and driven, going on to earn an MBA, but she was also gentle with him, always protecting his feelings. Both were raised in big families and they wanted to build one of their own.

When he learned Porsha was pregnant again in the spring of 2023, Hope wished for a girl. Porsha found a new OB-GYN who said she could see her after 11 weeks. Ten weeks in, though, Porsha noticed she was spotting. Over the phone, the obstetrician told her to go to the emergency room if it got worse.

To celebrate the end of the school year, Porsha and Hope took their boys to a water park in Austin, and as they headed back, on June 11, Porsha told Hope that the bleeding was heavier. They decided Hope would stay with the boys at home until a relative could take over; Porsha would drive to the emergency room at Houston Methodist Sugar Land, one of seven community hospitals that are part of the Houston Methodist system.

At 6:30 p.m, three hours after Porsha arrived at the hospital, she saw huge clots in the toilet. “Significant bleeding,” the emergency physician wrote. “I’m starting to feel a lot of pain,” Porsha texted Hope. Around 7:30 p.m., she wrote: “She said I might need surgery if I don’t stop bleeding,” referring to the nurse. At 7:50 p.m., after a nurse changed her second diaper in an hour: “Come now.”

Still, the doctor didn’t mention a D&C at this point, records show. Medical experts told ProPublica that this wait-and-see approach has become more common under abortion bans. Unless there is “overt information indicating that the patient is at significant risk,” hospital administrators have told physicians to simply monitor them, said Dr. Robert Carpenter, a maternal-fetal medicine specialist who works in several hospital systems in Houston. Methodist declined to share its miscarriage protocols with ProPublica or explain how it is guiding doctors under the abortion ban.

As Porsha waited for Hope, a radiologist completed an ultrasound and noted that she had “a pregnancy of unknown location.” The scan detected a “sac-like structure” but no fetus or cardiac activity. This report, combined with her symptoms, indicated she was miscarrying.

But the ultrasound record alone was less definitive from a legal perspective, several doctors explained to ProPublica. Since Porsha had not had a prenatal visit, there was no documentation to prove she was 11 weeks along. On paper, this “pregnancy of unknown location” diagnosis could also suggest that she was only a few weeks into a normally developing pregnancy, when cardiac activity wouldn’t be detected. Texas outlaws abortion from the moment of fertilization; a record showing there is no cardiac activity isn’t enough to give physicians cover to intervene, experts said.

Dr. Gabrielle Taper, who recently worked as an OB-GYN resident in Austin, said that she regularly witnessed delays after ultrasound reports like these. “If it’s a pregnancy of unknown location, if we do something to manage it, is that considered an abortion or not?” she said, adding that this was one of the key problems she encountered. After the abortion ban went into effect, she said, “there was much more hesitation about: When can we intervene, do we have enough evidence to say this is a miscarriage, how long are we going to wait, what will we use to feel definitive?”

Around 8:30 p.m., just after Hope arrived, Porsha passed out. Terrified, he took her head in his hands and tried to bring her back to consciousness. “Babe, look at me,” he told her. “Focus.” Her blood pressure was dipping dangerously low. She had held off on accepting a blood transfusion until he got there. Now, as she came to, she agreed to receive one and then another.

By this point, it was clear that she needed a D&C, more than a dozen OB-GYNs who reviewed her case told ProPublica. She was hemorrhaging, and the standard of care is to vacuum out the residual tissue so the uterus can clamp down, physicians told ProPublica.

“Complete the miscarriage and the bleeding will stop,” said Dr. Lauren Thaxton, an OB-GYN who recently left Texas.

“At every point, it’s kind of shocking,” said Dr. Daniel Grossman, a professor of obstetrics and gynecology at the University of California, San Francisco who reviewed Porsha’s case. “She is having significant blood loss and the physician didn’t move toward aspiration.”

All Porsha talked about was her devastation of losing the pregnancy. She was cold, crying and in extreme pain. She wanted to be at home with her boys. Unsure what to say, Hope leaned his chest over the cot, passing his body heat to her.

At 9:45 p.m., Esmeralda Acosta, a nurse, wrote that Porsha was “continuing to pass large clots the size of grapefruit.” Fifteen minutes later, when the nurse learned Davis planned to send Porsha to a floor with fewer nurses, she “voiced concern” that he wanted to take her out of the emergency room, given her condition, according to medical records.

At 10:20 p.m., seven hours after Porsha arrived, Davis came to see her. Hope remembered what his mother had told him on the phone earlier that night: “She needs a D&C.” The doctor seemed confident about a different approach: misoprostol. If that didn’t work, Hope remembers him saying, they would move on to the procedure.

A pill sounded good to Porsha because the idea of surgery scared her. Davis did not explain that a D&C involved no incisions, just suction, according to Hope, or tell them that it would stop the bleeding faster. The Ngumezis followed his recommendation without question. “I’m thinking, ‘He’s the OB, he’s probably seen this a thousand times, he probably knows what’s right,’” Hope said.

But more than a dozen doctors who reviewed Porsha’s case were concerned by this recommendation. Many said it was dangerous to give misoprostol to a woman who’s bleeding heavily, especially one with a blood clotting disorder. “That’s not what you do,” said Dr. Elliott Main, the former medical director for the California Maternal Quality Care Collaborative and an expert in hemorrhage, after reviewing the case. “She needed to go to the operating room.” Main and others said doctors are obliged to counsel patients on the risks and benefits of all their options, including a D&C.

Performing a D&C, though, attracts more attention from colleagues, creating a higher barrier in a state where abortion is illegal, explained Goulding, the OB-GYN in Houston. Staff are familiar with misoprostol because it’s used for labor, and it only requires a doctor and a nurse to administer it. To do a procedure, on the other hand, a doctor would need to find an operating room, an anesthesiologist and a nursing team. “You have to convince everyone that it is legal and won’t put them at risk,” said Goulding. “Many people may be afraid and misinformed and refuse to participate — even if it’s for a miscarriage.”

Davis moved Porsha to a less-intensive unit, according to records. Hope wondered why they were leaving the emergency room if the nurse seemed so worried. But instead of pushing back, he rubbed Porsha’s arms, trying to comfort her. The hospital was reputable. “Since we were at Methodist, I felt I could trust the doctors.”

On their way to the other ward, Porsha complained of chest pain. She kept remarking on it when they got to the new room. From this point forward, there are no nurse’s notes recording how much she continued to bleed. “My wife says she doesn’t feel right, and last time she said that, she passed out,” Hope told a nurse. Furious, he tried to hold it together so as not to alarm Porsha. “We need to see the doctor,” he insisted.

Her vital signs looked fine. But many physicians told ProPublica that when healthy pregnant patients are hemorrhaging, their bodies can compensate for a long time, until they crash. Any sign of distress, such as chest pain, could be a red flag; the symptom warranted investigation with tests, like an electrocardiogram or X-ray, experts said. To them, Porsha’s case underscored how important it is that doctors be able to intervene before there are signs of a life-threatening emergency.

But Davis didn’t order any tests, according to records.

Around 1:30 a.m., Hope was sitting by Porsha’s bed, his hands on her chest, telling her, “We are going to figure this out.” They were talking about what she might like for breakfast when she began gasping for air.

“Help, I need help!” he shouted to the nurses through the intercom. “She can’t breathe.”

“All She Needed”

Hours later, Hope returned home in a daze. “Is mommy still at the hospital?” one of his sons asked. Hope nodded; he couldn’t find the words to tell the boys they’d lost their mother. He dressed them and drove them to school, like the previous day had been a bad dream. He reached for his phone to call Porsha, as he did every morning that he dropped the kids off. But then he remembered that he couldn’t.

Friends kept reaching out. Most of his family’s network worked in medicine, and after they said how sorry they were, one after another repeated the same message. All she needed was a D&C, said one. They shouldn’t have given her that medication, said another. It’s a simple procedure, the callers continued. We do this all the time in Nigeria.

Since Porsha died, several families in Texas have spoken publicly about similar circumstances. This May, when Ryan Hamilton’s wife was bleeding while miscarrying at 13 weeks, the first doctor they saw at Surepoint Emergency Center Stephenville noted no fetal cardiac activity and ordered misoprostol, according to medical records. When they returned because the bleeding got worse, an emergency doctor on call, Kyle Demler, said he couldn’t do anything considering “the current stance” in Texas, according to Hamilton, who recorded his recollection of the conversation shortly after speaking with Demler. (Neither Surepoint Emergency Center Stephenville nor Demler responded to several requests for comment.)

They drove an hour to another hospital asking for a D&C to stop the bleeding, but there, too, the physician would only prescribe misoprostol, medical records indicate. Back home, Hamilton’s wife continued bleeding until he found her passed out on the bathroom floor. “You don’t think it can really happen like that,” said Hamilton. “It feels like you’re living in some sort of movie, it’s so unbelievable.”

Across Texas, physicians say they blame the law for interfering with medical care. After ProPublica reported last month on two women who died after delays in miscarriage care, 111 OB-GYNs sent a letter to Texas policymakers, saying that “the law does not allow Texas women to get the lifesaving care they need.”

Dr. Austin Dennard, an OB-GYN in Dallas, told ProPublica that if one person on a medical team doubts the doctor’s choice to proceed with a D&C, the physician might back down. “You constantly feel like you have someone looking over your shoulder in a punitive, vigilante type of way.”

The criminal penalties are so chilling that even women with diagnoses included in the law’s exceptions are facing delays and denials. Last year, for example, legislators added an update to the ban for patients diagnosed with previable premature rupture of membranes, in which a patient’s water breaks before a fetus can survive. Doctors can still face prosecution for providing abortions in those cases, but they are offered the chance to justify themselves with what’s called an “affirmative defense,” not unlike a murder suspect arguing self defense. This modest change has not stopped some doctors from transferring those patients instead of treating them; Dr. Allison Gilbert, an OB-GYN in Dallas, said doctors send them to her from other hospitals. “They didn’t feel like other staff members would be comfortable proceeding with the abortion,” she said. “It’s frustrating that places still feel like they can’t act on some of these cases that are clearly emergencies.” Women denied treatment for ectopic pregnancies, another exception in the law, have filed federal complaints.

In response to ProPublica’s questions about Houston Methodist’s guidance on miscarriage management, a spokesperson, Gale Smith, said that the hospital has an ethics committee, which can usually respond within hours to help physicians and patients make “appropriate decisions” in compliance with state laws.

After Porsha died, Davis described in the medical record a patient who looked stable: He was tracking her vital signs, her bleeding was “mild” and she was “said not to be in distress.” He ordered bloodwork “to ensure patient wasn’t having concerning bleeding.” Medical experts who reviewed Porsha’s case couldn’t understand why Davis noted that a nurse and other providers reported “decreasing bleeding” in the emergency department when the record indicated otherwise. “He doesn’t document the heavy bleeding that the nurse clearly documented, including the significant bleeding that prompted the blood transfusion, which is surprising,” Grossman, the UCSF professor, said.

Patients who are miscarrying still don’t know what to expect from Houston Methodist.

This past May, Marlena Stell, a patient with symptoms nearly identical to Porsha’s, arrived at another hospital in the system, Houston Methodist The Woodlands. According to medical records, she, too, was 11 weeks along and bleeding heavily. An ultrasound confirmed there was no fetal heartbeat and indicated the miscarriage wasn’t complete. “I assumed they would do whatever to get the bleeding to stop,” Stell said.

Instead, she bled for hours at the hospital. She wanted a D&C to clear out the rest of the tissue, but the doctor gave her methergine, a medication that’s typically used after childbirth to stop bleeding but that isn’t standard care in the middle of a miscarriage, doctors told ProPublica. "She had heavy bleeding, and she had an ultrasound that's consistent with retained products of conception." said Dr. Jodi Abbott, an associate professor of obstetrics and gynecology at Boston University School of Medicine, who reviewed the records. "The standard of care would be a D&C."

Stell says that instead, she was sent home and told to “let the miscarriage take its course.” She completed her miscarriage later that night, but doctors who reviewed her case, so similar to Porsha’s, said it showed how much of a gamble physicians take when they don’t follow the standard of care. “She got lucky — she could have died,” Abbott said. (Houston Methodist did not respond to a request for comment on Stell’s care.)

It hadn’t occurred to Hope that the laws governing abortion could have any effect on his wife’s miscarriage. Now it’s the only explanation that makes sense to him. “We all know pregnancies can come out beautifully or horribly,” Hope told ProPublica. “Instead of putting laws in place to make pregnancies safer, we created laws that put them back in danger.”

For months, Hope’s youngest son didn’t understand that his mom was gone. Porsha’s long hair had been braided, and anytime the toddler saw a woman with braids from afar, he would take off after her, shouting, “That’s mommy!”

A couple weeks ago, Hope flew to Amsterdam to quiet his mind. It was his first trip without Porsha, but as he walked the city, he didn’t know how to experience it without her. He kept thinking about how she would love the Christmas lights and want to try all the pastries. How she would have teased him when he fell asleep on a boat tour of the canals. “I thought getting away would help,” he wrote in his journal. “But all I’ve done is imagine her beside me.”

[froggy-1988]

Woman's reproductive rights uk

Below the line for those who are uncomfortable

When I was pregnant my consultant was an abortion specialist and she got very nervous finding out my husband was a a journalist because she'd been secretly recorded once by a woman pretending to want an abortion.

To see if she was following the law.

Which she was because the law in the UK is pretty simple.

The law in the UK is that women can only have abortions for health reasons.

Yet, it's an extremely rare circumstance for a woman to be turned down for an abortion - they have to literally state 'I didn't want a girl' or similar as sex based abortions are illigal.

Now, the reason it's rare is because health reasons in the UK law includes mental health of the mother and there is an understanding a woman who ends up having to go through pregnancy and birth when she is not prepared and does not want to is going to cause her anxiety and depression and this is enough of a health reason to qualify for an abortion, or be past the 24 weeks pregnant mark which with free healthcare and walk in clinics in the UK there are plenty of opportunities to determine - I don't think I've been to a dr's without having to take a pregnancy test in the last year.

When put on the news and asked if she thought she'd asked enough questions to determine if a woman had the right to an abortion under these laws my consultant said (not verbatim because my memory is not that good) 'Abortions are not an easy thing for the mind or body to deal with and I trust that every woman who comes to me has already thought about their situation and made their decision and has not woken up one morning and come into my clinic on a whim. They know their situation better than I do , so they are the best to judge."

That consultant later saved my life from a post-birth complication so I'm glad she was not hounded out of medicine - as she said, she respects women's choices but more than that she had a skill that can save lives.

[anyataylorjoys]

I still haven’t moved on from finding out today that there is a tiktok trend of people INGESTING BORAX.

I ended up going down this rabbit hole to find out where people are getting this information and immediately found this:

https://www.lybrate.com/topic/borax-benefits-and-side-effects

These are real doctors from India with masters who work in the states and such, I did a brief bg check on them. What the fuck? This is the only thing I could find that states borax has “health benefits”. But wait... in the fine print at the bottom:

I kept digging for more and found this article by the Jerusalem Post stating the possible origin of this trend. Dr. Rex E. Newnham has been cited by many tiktokers for having written several papers claiming that borax had health benefits but the research showing results is difficult to find. From these papers, a conspiracy has spawned and now people have become convinced Newnham was onto something and was blocked by big pharma so they could continue making billions.

Now here’s some information you mostly will find online when researching borax:

FUN FACT: Borax is actually banned in several countries because it has been suggested that it can cause cancer and multi-organ accumulation of poisoning. Kids have actually died playing with slime activated by borax. (src)

Studies conducted by NLM (National Library of Medicine) on people who consumed borax show “immune cell proliferation and sister chromatid exchange in human chromosomes”.. In other words: “Toxicity of borax may lead to cellular toxicity and genetic defect in human.” (src)

Here’s what I now know based on most research that can be pulled of borax:

-it is not boric acid, it is also NOT boron. boron is only one component of borax. -classified as a mild skin irritant and can even cause chemical burn -banned by FDA as a food additive. -can be used as a component in pesticides, flame retardant, enamel glazes, glass, ceramics, laundry detergent etc. -has potential to disrupt the reproductive system shown in studies of mice and hemorrhagic gastroenteritis in cattle. (src) -like anything else, bad for you in large quantities or in long-term use but this is actually classified as poisonous and there are more studies that show this than anything opposing. -just because it’s natural doesn’t mean it’s safe for consumption

Folks, if you have joint pain, look into MSM supplements or powder for more potency which is an anti-inflammatory agent that the FDA has recognized as generally safe for consumption under 4000 mg/day with little to no known side effects. You should consult with your doctor before taking any supplements realistically but for the love of god, do not consume borax.

[dr-sweta-gupta]

Your Guide to IVF Treatment at Noida's Premier Hospital

Hello and welcome! I'm Dr. Sweta Gupta, and I'm thrilled to share with you the latest insights and information about IVF treatment at our esteemed hospital in Noida. Here at our facility, we are dedicated to providing compassionate care and cutting-edge technology to help couples achieve their dream of parenthood.

About Our Hospital

Located in the heart of Noida, our hospital is renowned for its state-of-the-art infrastructure and world-class facilities. We understand that undergoing fertility treatment can be a deeply personal journey, and our team is committed to supporting you every step of the way.

Meet Dr. Sweta Gupta

As the lead fertility specialist at our hospital, I bring years of experience and a passion for reproductive medicine. My team and I believe in a holistic approach to fertility care, combining advanced medical techniques with personalized attention to address each patient's unique needs.

Comprehensive IVF Services

Our hospital offers a comprehensive range of services to assist you on your fertility journey:

Initial Consultation: A thorough evaluation to understand your medical history and discuss personalized treatment options.

Diagnostic Testing: Advanced diagnostic tests to identify any underlying causes of infertility.

IVF Treatment: Tailored IVF protocols using the latest technology to optimize success rates.

Egg Freezing: Preservation options for women looking to preserve their fertility for the future.

Genetic Testing: Screening options to ensure the health and viability of embryos.

Why Choose Us?

Expertise: Our team comprises skilled fertility specialists, embryologists, and support staff dedicated to your care.

Patient-Centered Care: We prioritize open communication, empathy, and support throughout your treatment journey.

Success Rates: We are proud of our high success rates, which reflect our commitment to excellence in fertility care.

Patient Testimonials

Don't just take our word for it! Read testimonials from our patients who have successfully built their families with our help. Their stories are a testament to our dedication and expertise.

Get Started Today

If you're considering IVF treatment or have questions about your fertility options, we encourage you to schedule a consultation. Our team is here to provide you with the guidance and support you need to make informed decisions about your reproductive health.

Thank you for visiting our blog! Stay tuned for more articles on fertility tips, treatment updates, and patient stories. Remember, at our IVF hospital in Noida, your journey to parenthood is our priority.

For more Information:-

[news4dzhozhar]

Miscarriages in Gaza Have Increased 300% Under Israeli Bombing

**And these deaths aren't included in the running count of Palestinians killed**

At Al-Emirati Hospital in Rafah, a woman identified by Doctors Without Borders as Maha sought a delivery room as she began going into labor, but was denied: “All the delivery rooms were full,” an emergency coordinator working with the humanitarian group recounted in a news release published Wednesday. Maha “knew something wasn’t right,” and that she needed care. But without other options, she returned to her tent. Her newborn son died as she gave birth to him in the bathroom near her tent. “Without this war, she would not have lost her son,” the emergency coordinator wrote.

Shortly after Israel’s bombardment of the Gaza Strip began in October, global health groups raised alarms that there was no longer anywhere safe for pregnant women to give birth. More than three months into the siege, conditions have only worsened, and pregnant and menstruating people are especially at risk. Health care workers report a 300% increase in the miscarriage rate among pregnant people in Gaza since Israel’s attacks began three months ago, Nour Beydoun, CARE’s regional advisor on protection and gender in emergencies, told Jezebel.

The lack of supplies due to Israel’s ongoing blockade has resulted in pregnant women struggling to carry healthy pregnancies; higher risk of infection and death after giving birth or having c-sections; increased infant mortality; and a range of other deadly sexual and reproductive health outcomes. Beydoun told Jezebel that CARE has heard about “significant weight loss” among pregnant women “due to the limited access to food, to proper nutrition,” resulting in “poor personal health and also in poor fetal and newborn health.”

Ammal Awadallah, executive director of the Palestinian Family Planning & Protection Association, told Jezebel that “all pregnant women are now at severe risk of delivering in unsafe conditions, being put in situations where they are giving birth in cars, tents, and shelters.” At health centers, pregnant women are only admitted “when fully dilated and are dismissed within a few hours after giving birth, due to the overcrowded facilities and extremely limited resources.” On top of all this, Beydoun said that many women must make the journey to hospitals or health centers—where they could still be turned away due to lack of capacity—on foot.

Due to limited resources, Awadallah says many c-sections and births “are being performed without basic medical supplies, or anesthesia and without any postnatal care.” Few are able to get or attend appointments with their doctors after giving birth, and many “have no option other than to stay in the overcrowded shelters.” As a result, a lot of “women are being dangerously exposed to infections,” the the risk of maternal mortality is high: “There’s now so much risk of hemorrhaging and infections without the right tools and medicines,” Beydoun said. And the many women forced to undergo emergency c-sections also face cesarean wound infections due to lack of clean medical tools for the procedure.

These conditions are similarly dangerous for newborns, who are “dying from a lack of sterile environment and specialized staff,” Beydoun said.

Of course, this is all assuming that pregnant women are able to be admitted into hospitals at all, where “priority is often not for women going into labor” and beds are rarely available for them, Awadallah said. The conditions at the Al-Emirati field hospital in Rafah demonstrate how overworked hospitals in Gaza have become: Beydoun said the hospital was “initially designed to receive 30 to 40 outpatient consultations from pregnant women on a daily basis—now they handle 300 to 400 cases daily.” The hospital has just one operating room and is “designed to have two to three c-section deliveries per day—now they’re delivering 20 daily.”

In October, it was estimated that at least 50,000 women in Gaza were pregnant. The International Planned Parenthood Federation reported at the time that more women were miscarrying or going into early labor from shock and stress under bombardment. And it’s not yet clear how many of those thousands of pregnant women in Gaza are among the estimated 24,000 Palestinians who have been killed in Israel’s attacks, or among the thousands who remain missing. In its charge of genocide against Israel at the International Court of Justice, South Africa alleges that “two mothers are estimated to be killed every hour in Gaza.” (The Israeli death toll from Hamas attacks on October 7 stands at 1,139. Hamas continues to hold roughly 200 people hostage.)

After months of Israeli bombardment, the health care system in Gaza is “completely collapsing,” Doctors Without Borders warned last month. A CNN investigation published on January 12 found at least 20 of 22 hospitals in northern Gaza had been damaged or destroyed in the first two months of Israel’s war on Gaza, and 14 were directly attacked by Israeli forces. The World Health Organization reported in December that no “functional” hospitals remained in northern Gaza, and only nine out of 36 hospitals in the south were even partially functioning to serve Gaza’s population of 2 million. On Tuesday evening, journalists in Gaza reported that Israeli forces had closed in on and were attacking Nasser Hospital.

Birth complications are just one threat people who menstruate are facing: As the independent Gaza-based journalist Bisan Owda highlighted earlier this month, period supplies are nearly impossible to find. According to Awadallah, few people “can find a pharmacy nearby,” let alone one that still stocks sanitary products. Many are forced to use strips of cloth that they can’t wash due to lack of water, plastic bags in lieu of pads, or, “if they’re lucky enough,” cut-up baby diapers. One hospital worker told Owda that “each day” she encounters “numerous instances of fever directly linked to vaginal yeast infections, arising from inadequate hygiene and the absence of feminine products.” Another told her that the “scarcity of basic products results in more hospital visits, longer hospital stays, and worsened conditions” from infection and disease. Severe water shortages and overcrowded public bathrooms further contribute to “the high number of reproductive and urinary tract infections,” Awadallah said.

On top of that, due to “the suffering, anxiety, and deteriorating psychological status of the women in the [Gaza] Strip,” Awadallah said a large proportion are now “getting their period a number of times during the month” instead of once.

This lack of water and malnutrition as a result of Israel’s blockade have been especially detrimental for nursing mothers: Women are struggling to breastfeed their babies as they aren’t able to produce milk “without having water to drink nor sufficient food to eat,” Awadallah said. In a letter provided by CARE, Alaa, a mother in Gaza, wrote that “no one is eating enough,” and “it is usually the mothers who eat last” in order to feed their children first. “I slept on an empty stomach every night so my children wouldn’t go hungry,” Alaa wrote. Back in October, Al-Aqsa Hospital told the Associated Press that many mothers in Gaza were forced to mix baby formula with contaminated water, “[contributing] to the rise in critical cases” in the hospital’s neonatal ward.

Barriers to basic health care and resources aren’t new for the women and girls of Gaza, Awadallah told Jezebel: “Palestinian women and girls were already living in a severely vulnerable environment, in an area which has been blockaded from essential basic health services and products for more than a decade.” But the crisis has become more dire than ever, and “without a full and immediate ceasefire, and the unimpeded delivery of humanitarian aid across all parts of Gaza, maternal and neonatal deaths will continue to rise.”

[djuvlipen]

Miscarriages in Gaza Have Increased 300% Under Israeli Bombing

At Al-Emirati Hospital in Rafah, a woman identified by Doctors Without Borders as Maha sought a delivery room as she began going into labor, but was denied: “All the delivery rooms were full,” an emergency coordinator working with the humanitarian group recounted in a news release published Wednesday. Maha “knew something wasn’t right,” and that she needed care. But without other options, she returned to her tent. Her newborn son died as she gave birth to him in the bathroom near her tent. “Without this war, she would not have lost her son,” the emergency coordinator wrote.

Shortly after Israel’s bombardment of the Gaza Strip began in October, global health groups raised alarms that there was no longer anywhere safe for pregnant women to give birth. More than three months into the siege, conditions have only worsened, and pregnant and menstruating people are especially at risk. Health care workers report a 300% increase in the miscarriage rate among pregnant people in Gaza since Israel’s attacks began three months ago, Nour Beydoun, CARE’s regional advisor on protection and gender in emergencies, told Jezebel.

The lack of supplies due to Israel’s ongoing blockade has resulted in pregnant women struggling to carry healthy pregnancies; higher risk of infection and death after giving birth or having c-sections; increased infant mortality; and a range of other deadly sexual and reproductive health outcomes. Beydoun told Jezebel that CARE has heard about “significant weight loss” among pregnant women “due to the limited access to food, to proper nutrition,” resulting in “poor personal health and also in poor fetal and newborn health.”

Ammal Awadallah, executive director of the Palestinian Family Planning & Protection Association, told Jezebel that “all pregnant women are now at severe risk of delivering in unsafe conditions, being put in situations where they are giving birth in cars, tents, and shelters.” At health centers, pregnant women are only admitted “when fully dilated and are dismissed within a few hours after giving birth, due to the overcrowded facilities and extremely limited resources.” On top of all this, Beydoun said that many women must make the journey to hospitals or health centers—where they could still be turned away due to lack of capacity—on foot.

Due to limited resources, Awadallah says many c-sections and births “are being performed without basic medical supplies, or anesthesia and without any postnatal care.” Few are able to get or attend appointments with their doctors after giving birth, and many “have no option other than to stay in the overcrowded shelters.” As a result, a lot of “women are being dangerously exposed to infections,” the the risk of maternal mortality is high: “There’s now so much risk of hemorrhaging and infections without the right tools and medicines,” Beydoun said. And the many women forced to undergo emergency c-sections also face cesarean wound infections due to lack of clean medical tools for the procedure.

Of course, this is all assuming that pregnant women are able to be admitted into hospitals at all, where “priority is often not for women going into labor” and beds are rarely available for them, Awadallah said. The conditions at the Al-Emirati field hospital in Rafah demonstrate how overworked hospitals in Gaza have become: Beydoun said the hospital was “initially designed to receive 30 to 40 outpatient consultations from pregnant women on a daily basis—now they handle 300 to 400 cases daily.” The hospital has just one operating room and is “designed to have two to three c-section deliveries per day—now they’re delivering 20 daily.”

In October, it was estimated that at least 50,000 women in Gaza were pregnant. The International Planned Parenthood Federation reported at the time that more women were miscarrying or going into early labor from shock and stress under bombardment. And it’s not yet clear how many of those thousands of pregnant women in Gaza are among the estimated 24,000 Palestinians who have been killed in Israel’s attacks, or among the thousands who remain missing. In its charge of genocide against Israel at the International Court of Justice, South Africa alleges that “two mothers are estimated to be killed every hour in Gaza.” (The Israeli death toll from Hamas attacks on October 7 stands at 1,139. Hamas continues to hold roughly 200 people hostage.)

After months of Israeli bombardment, the health care system in Gaza is “completely collapsing,” Doctors Without Borders warned last month. A CNN investigation published on January 12 found at least 20 of 22 hospitals in northern Gaza had been damaged or destroyed in the first two months of Israel’s war on Gaza, and 14 were directly attacked by Israeli forces. The World Health Organization reported in December that no “functional” hospitals remained in northern Gaza, and only nine out of 36 hospitals in the south were even partially functioning to serve Gaza’s population of 2 million. On Tuesday evening, journalists in Gaza reported that Israeli forces had closed in on and were attacking Nasser Hospital.

Birth complications are just one threat people who menstruate are facing: As the independent Gaza-based journalist Bisan Owda highlighted earlier this month, period supplies are nearly impossible to find. According to Awadallah, few people “can find a pharmacy nearby,” let alone one that still stocks sanitary products. Many are forced to use strips of cloth that they can’t wash due to lack of water, plastic bags in lieu of pads, or, “if they’re lucky enough,” cut-up baby diapers. One hospital worker told Owda that “each day” she encounters “numerous instances of fever directly linked to vaginal yeast infections, arising from inadequate hygiene and the absence of feminine products.” Another told her that the “scarcity of basic products results in more hospital visits, longer hospital stays, and worsened conditions” from infection and disease. Severe water shortages and overcrowded public bathrooms further contribute to “the high number of reproductive and urinary tract infections,” Awadallah said.

On top of that, due to “the suffering, anxiety, and deteriorating psychological status of the women in the [Gaza] Strip,” Awadallah said a large proportion are now “getting their period a number of times during the month” instead of once.

This lack of water and malnutrition as a result of Israel’s blockade have been especially detrimental for nursing mothers: Women are struggling to breastfeed their babies as they aren’t able to produce milk “without having water to drink nor sufficient food to eat,” Awadallah said. In a letter provided by CARE, Alaa, a mother in Gaza, wrote that “no one is eating enough,” and “it is usually the mothers who eat last” in order to feed their children first. “I slept on an empty stomach every night so my children wouldn’t go hungry,” Alaa wrote. Back in October, Al-Aqsa Hospital told the Associated Press that many mothers in Gaza were forced to mix baby formula with contaminated water, “[contributing] to the rise in critical cases” in the hospital’s neonatal ward.

Barriers to basic health care and resources aren’t new for the women and girls of Gaza, Awadallah told Jezebel: “Palestinian women and girls were already living in a severely vulnerable environment, in an area which has been blockaded from essential basic health services and products for more than a decade.” But the crisis has become more dire than ever, and “without a full and immediate ceasefire, and the unimpeded delivery of humanitarian aid across all parts of Gaza, maternal and neonatal deaths will continue to rise.”

[drguptasclinic1]

Unraveling the Enigma: Exploring the Causes of Infertility in Men and Women

Infertility, a condition that affects millions of couples worldwide, can be a source of immense emotional distress and frustration. While there are numerous factors that can contribute to infertility, understanding its underlying causes is essential for effective diagnosis and treatment. In this article, we delve into the multifaceted causes of infertility in both men and women, shedding light on the complex interplay of biological, environmental, and lifestyle factors.

Causes of Infertility in Women

Ovulation Disorders: Irregular or absent ovulation can hinder conception. Conditions such as polycystic ovary syndrome (PCOS), thyroid disorders, and premature ovarian insufficiency (POI) can disrupt the ovulation process.

Fallopian Tube Damage: Blockages or damage to the fallopian tubes can prevent the egg from reaching the uterus for fertilization. Previous pelvic infections, endometriosis, or surgery may contribute to fallopian tube issues.

Uterine Abnormalities: Structural abnormalities in the uterus, such as fibroids or polyps, can interfere with embryo implantation and development, leading to infertility.

Age-related Factors: As women age, the quantity and quality of their eggs decline, making conception more challenging. Advanced maternal age is a significant risk factor for infertility.

Causes of Infertility in Men

Low Sperm Count or Quality: Issues with sperm production, motility, or morphology can impair fertility. Factors such as hormonal imbalances, genetic conditions, and lifestyle choices (e.g., smoking, excessive alcohol consumption) can affect sperm health.

Varicocele: A varicocele, an enlargement of the veins within the scrotum, can lead to decreased sperm production and quality. It is a common reversible cause of male infertility.

Testicular Factors: Conditions such as undescended testicles, testicular trauma, or infections can impact sperm production and function, contributing to infertility.

Ejaculatory Disorders: Disorders affecting the ejaculation process, such as retrograde ejaculation or erectile dysfunction, can hinder the delivery of sperm during intercourse.

Seeking Help from a Male Fertility Doctor

For couples struggling with infertility, consulting a male fertility doctor, also known as a reproductive urologist or andrologist, can provide valuable insights and guidance. These specialists are trained to evaluate and treat male infertility issues, offering diagnostic tests, fertility evaluations, and personalized treatment plans to address underlying causes and improve reproductive outcomes.

Conclusion

Infertility can stem from a myriad of factors affecting both men and women. By understanding the potential causes of infertility and seeking specialized care from a male fertility doctor specialist, couples can embark on a journey towards achieving their dream of parenthood. With advancements in reproductive medicine and personalized treatment approaches, there is hope for overcoming infertility challenges and building a family.

[gynaecologyandaestheticstalks]

Embracing Beauty And Wellness: Dr. Manal Younis, The Gynecologist With A Passion For Aesthetics

In the picturesque town of Clonmel, nestled amidst the serene landscapes of Tipperary, Ireland, Dr. Manal Younis has carved her niche in the field of women's health and aesthetics. With a background as a skilled gynecologist and a profound passion for beauty and wellness, Dr. Younis has taken the world of aesthetics by storm, offering a range of innovative treatments that empower her clients to look and feel their best. Let's delve into the journey of this remarkable medical professional and the aesthetic clinic she proudly owns.

A Gynecologist with a Difference

Initially established herself as a trusted gynecologist, specializing in women's health, obstetrics, and reproductive medicine. Her genuine dedication to the well-being of her patients made her a respected name in the community. She worked tirelessly to support women in every stage of their lives, from prenatal care to menopausal health.

As a gynecologist, Dr. Younis realized the inseparable connection between a woman's health and her self-esteem. This realization inspired her to broaden her horizons and offer aesthetic treatments aimed at enhancing her patients' self-confidence and overall well-being.

Beauty in the Heart of Clonmel

In the heart of Clonmel, Dr. Younis opened her own aesthetic clinic, offering a diverse range of beauty treatments. Her clinic is a sanctuary where her clients can escape from the hustle and bustle of daily life and focus on their personal beauty and wellness journey.

Bum Augmentation

The Clinic offers advanced techniques for bum augmentation, giving clients the opportunity to achieve their desired curves. Whether you're looking to enhance your curves or achieve a more balanced figure, her clinic provides safe and effective treatments that cater to your individual needs.

Anti-Wrinkle Injections

Aging is a natural process, but it doesn't mean we have to accept its signs without a fight. Dr. Younis specializes in anti-wrinkle injections that can turn back the clock, smoothing out fine lines and wrinkles to reveal a more youthful, refreshed appearance. These treatments are minimally invasive and can be tailored to target specific areas of concern.

Botox Clinic

Botox Clinic is a household name when it comes to non-surgical rejuvenation. Her clinic boasts a state-of-the-art Botox facility, where clients can achieve smoother, more youthful skin without the need for surgery. Botox treatments are quick, convenient, and deliver impressive results.

The Personal Touch

What sets her apart is her unwavering commitment to providing personalized care to her clients. She understands that every individual is unique, and her approach to aesthetics reflects this belief. Before any treatment, Dr. Younis takes the time to consult with her clients, listening to their concerns and goals. This personalized approach ensures that every treatment plan is tailored to meet the specific needs and desires of each client.

Ensuring Safety and Satisfaction

We prioritize safety above all else. Her extensive medical background as a gynecologist equips her with a deep understanding of the human body, which is crucial when administering aesthetic treatments. She utilizes the latest, FDA-approved techniques and only the highest quality products to ensure her clients receive safe, effective, and long-lasting results.

Client satisfaction is of paramount importance to Dr. Younis. She and her skilled team are dedicated to delivering results that go beyond expectations. Whether it's a subtle enhancement or a more dramatic transformation, the goal is always the same: to empower clients to feel confident and beautiful in their own skin.

Community Involvement

Beyond her clinic, she is an active and compassionate member of the Clonmel community. She takes pride in giving back and supporting local charities and initiatives that promote health and wellness for women in Tipperary.

Conclusion

Dr. Manal Younis, the accomplished gynecologist turned aesthetics specialist, has brought a touch of glamour and empowerment to the picturesque town of Clonmel, Tipperary, Ireland. Her journey from women's health to aesthetic treatments reflects her unwavering commitment to the well-being of her clients. With a personalized approach, a dedication to safety, and a passion for enhancing natural beauty, Dr. Younis's clinic is a beacon of hope for those seeking to look and feel their best.

In a world where self-confidence is the key to success, Dr. Manal Younis provides a gateway to achieving your aesthetic dreams, all within the serene beauty of Tipperary, Ireland.

[lathifertility]

What is IVF?

In recent decades, advancements in medical science have revolutionized the field of reproductive medicine, providing hope and opportunities for couples struggling with infertility. One such groundbreaking technique is In Vitro Fertilization (IVF). In this blog post, we will delve into the intricacies of IVF treatment, exploring what it is, how it works, and the potential it holds for those seeking to build a family.

What is IVF?

In Vitro Fertilization, commonly known as IVF, is a fertility treatment that involves the fertilization of an egg with sperm outside the human body. The process begins by extracting eggs from a woman's ovaries and fertilizing them with sperm in a laboratory dish. Once fertilization occurs, the resulting embryos are then implanted in the woman's uterus with the hope of establishing a successful pregnancy.

Understanding the IVF Process

Ovulation Induction: The first step in IVF involves stimulating the ovaries to produce multiple eggs. Fertility medications are administered to enhance egg production, monitored through ultrasound and blood tests.

Egg Retrieval: Once the eggs are mature, a minor surgical procedure known as egg retrieval is performed. A thin needle is inserted through the vaginal wall to collect the eggs from the ovaries.

Fertilization: The collected eggs are then combined with sperm in a controlled environment, allowing fertilization to occur. This step is closely monitored to ensure the formation of healthy embryos.

Embryo Culture: The fertilized eggs, now embryos, are cultured and monitored for several days. The healthcare team assesses their quality before selecting the most viable embryos for transfer.

Embryo Transfer: In the final step, one or more selected embryos are transferred into the woman's uterus. This is a relatively simple and painless procedure that aims to establish a successful pregnancy.

Success Rates and Considerations

IVF success rates vary depending on several factors, including the age of the woman, the cause of infertility, and the quality of the embryos. While some individuals achieve pregnancy in the first cycle, others may require multiple attempts. It's essential to approach IVF with realistic expectations and to consult with healthcare professionals to understand individual circumstances.

Challenges and Emotional Aspects

Embarking on an IVF journey can be emotionally challenging for couples. The process involves physical, emotional, and financial commitments, and individuals may experience a range of emotions, from hope and excitement to disappointment and stress. Support from loved ones and mental health professionals can play a crucial role in helping individuals navigate these challenges.

Conclusion

In Vitro Fertilization has emerged as a beacon of hope for many couples facing infertility challenges.

Schedule a Consultation with Dr. Sonal Lathi Today If you are considering IVF treatment, Dr. Sonal Lathi is the perfect choice for you. She is a leading expert in IVF, and she is committed to helping couples achieve their parenthood dreams.

[vitalityvibe]

Boost Your Testosterone Naturally with These Simple Tips

Introduction

Testosterone is a crucial hormone in the human body, playing a significant role in various aspects of health, including muscle growth, bone density, mood, and even libido. However, as we age, our testosterone levels tend to decrease, which can lead to a range of issues. The good news is that there are natural ways to boost your testosterone levels. In this article, we will explore some simple strategies to increase your testosterone levels, and we'll also introduce you to a product called Alpha Tonic that may aid in this process.

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Maintain a Healthy Diet

A balanced and nutritious diet is a fundamental factor in maintaining healthy testosterone levels. Include a variety of foods rich in essential nutrients like zinc, vitamin D, and healthy fats. Zinc, found in foods such as lean meats, nuts, and seeds, is essential for the production of testosterone. Vitamin D, obtained from sunlight and foods like fatty fish and fortified dairy products, is also crucial for healthy hormone levels. Make sure to consume enough healthy fats, such as those in avocados and olive oil, which support hormone production.

Exercise Regularly

Regular physical activity is another key to increasing testosterone levels. Engage in both resistance training and cardiovascular exercises. Lifting weights can stimulate the release of testosterone, and high-intensity interval training (HIIT) can also be beneficial. Aim for at least 150 minutes of moderate-intensity aerobic exercise or 75 minutes of vigorous-intensity aerobic exercise each week.

Get Adequate Sleep

Quality sleep is essential for overall health and maintaining healthy testosterone levels. Aim for 7-9 hours of sleep per night, as it helps your body repair and regenerate. Poor sleep can lead to hormonal imbalances and lower testosterone levels, so prioritize a good night's rest.

Manage Stress

Chronic stress can lead to elevated levels of the stress hormone cortisol, which can suppress testosterone production. Practice stress-reduction techniques such as meditation, deep breathing, or yoga to keep cortisol in check and support healthy testosterone levels.

Maintain a Healthy Weight

Being overweight or obese can contribute to lower testosterone levels. Losing excess body fat through a combination of diet and exercise can help increase your testosterone production. It's important to focus on sustainable and gradual weight loss for the best results.

Stay Hydrated

Drinking enough water is crucial for overall health, and it can also help maintain healthy testosterone levels. Dehydration can lead to an increase in cortisol levels, which can negatively impact your hormones.

Limit Alcohol and Avoid Excessive Drinking

Excessive alcohol consumption can lower testosterone levels. If you choose to consume alcohol, do so in moderation to support healthy hormone balance.

Introducing Alpha Tonic

In addition to these lifestyle changes, there are natural supplements like Alpha Tonic that can aid in boosting testosterone levels. Alpha Tonic is a dietary supplement formulated with a combination of ingredients known for their testosterone-boosting properties. It includes ingredients like fenugreek, ashwagandha, and tribulus terrestris, which have been used for centuries in traditional medicine to support male health and hormonal balance.

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Fenugreek, for example, has been shown to increase testosterone levels while also supporting libido and muscle strength. Ashwagandha is known for its adaptogenic properties, which can help your body manage stress and reduce cortisol levels. Tribulus terrestris has long been used to enhance athletic performance and support male reproductive health.

Before incorporating any dietary supplement into your routine, it's important to consult with a healthcare professional to ensure it's safe and appropriate for your individual needs.

Conclusion

Maintaining healthy testosterone levels is essential for overall well-being and quality of life. By making simple lifestyle changes such as maintaining a healthy diet, exercising regularly, getting enough sleep, managing stress, and staying hydrated, you can naturally increase your testosterone production. Additionally, considering a natural supplement like Alpha Tonic may provide added support in your quest for hormonal balance. Remember that achieving and maintaining healthy testosterone levels is a journey, so be patient and persistent in your efforts to boost your testosterone naturally.

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Best Women Clinics in Boduppa

At maternity Hospitals, The Department of medicine includes a team of skilled gynaecologists, fetal drug consultants, nutritionists, physiotherapists, and trained and knowledgeable nursing workers. Avi Children's Clinics offer comprehensive care starting from pre-natal care to postnatal care.

The giving birth program conjointly includes specialised packages for pregnant ladies like Divine, that gives comprehensive care throughout the physiological condition journey. we tend to conjointly focus extensively on natural giving birth, whereas we tend to square measure knowledgeable in managing LSCS likewise as high risk and complicated pregnancies.

AVI Children’s Clinic will everything in its power to produce its patients with what they really want, quicker recovery & peace of mind, since there's nothing a lot of necessary than the well-being of patients. AVI Children’s Clinic is one of the best children’s clinics in hyderabad, It has dedicated all its resources to providing superlative instrumentation and repair.

Pediatrics is the branch of medicine that deals with the treatment of infants, children, and adolescents, and also the ordinance typically ranges from birth up to eighteen (in some places till completion of teaching, and till age twenty one within the United States). A health professional WHO focuses on this space is thought of as a medical specialist, or pediatrician.Pediatricians concentrate on the care of infants, children, and adolescents. Pediatricians give a variety of services from well-child care, to basic childhood immunizations and sicknesses, to managing complicated medical conditions and chronic disorders.

Obstetrics is that the health science that deals with physiological condition, childbirth, and postnatal amount(including care of the newborn). Avi Clinics is the best women clinics in hyderabad has skilled WHO practices medicine as a health science is that the nurse. The skilled WHO practices medicine as a medical specialty (Obstetrics and Gynaecology) is that the obstetrician-gynecologist.

Orthopedic surgery or medical science (usually spelled orthopedic surgery and orthopaedics) is the branch of surgery involved with conditions involving the system. Orthopedic surgeons use each surgical and medical procedure means that to treat contractor trauma, sports injuries, chronic diseases, infections, tumors, and inborn disorders.

This is a one-stop clinic for consultation, diagnosing and treatment. can you'll you may see either a nurse or doctor WHO will perform any necessary investigations to diagnose your downside, make a case for what might be wrong and give you recommendation and/or treatment. All recommendation and coverings within the clinic square measure utterly confidential.Physical therapy or physiatrics (sometimes abbreviated to PT) may be a healthcare profession primarily involved with the correction of impairments and disabilities and the promotion of quality, useful ability, quality of life and movement potential through examination, evaluation, diagnosing and physical intervention.

Gynaecology or medicine is that the practice managing the health of the feminine fruitful systems (vagina, female internal reproductive organ and ovaries) and also the breasts. Literally, outside drugs, it means that 'the science of women'. Its counterpart is andrology, that deals with medical problems specific to the male genital system. The majority trendy gynaecologists are also obstetricians (see medicine and gynaecology). In several areas, the specialties of medicine and medicine overlap.

Many parts of medical care, together with giving specialist recommendation, prescribing medication, and observation a person’s condition, will be provided on daily care basis. additionally, a good vary of tests and coverings, together with some surgical procedures, will be administered with success in patient clinics or day care units. for instance, cataract surgery on the attention is typically performed on daily care basis. Even some kinds of surgery performed beneath an associate general anesthetic will currently be evaded needing a long hospital stay.