#professional primary care physician

[karliahs]

spoke to a new doctor today and he said he'd noticed I'd had a referral for trans healthcare and wanted to make sure they had my correct pronouns/name on the system and I immediately started crying a little

like. not even just the supportive of trans stuff aspect but just the fact that he had looked at my medical records beyond the absolute bare minimum he needed to. and cared about what i preferred, in any context

[vijaykumarpradhan]

Innovations in Mental Health Webinar Secure your spot for the upcoming mental health live webinar to uncover the advanced therapies and integrative approaches in mental health treatment

[nanamiscocksleeve]

Prescription For Pleasure

Warnings: MDNI, sex, masturbation, medical masturbation, use of vibrators, clit play, piv sex, use of latex gloves, oral (fem receiving), some praise, kinda slow burn A/n: I am not normal about this man in any way. Not really proofread. Please do not use my banners without permission.

You’re seated in Zayne’s office, trying not to squirm as he sets up your appointment. Although this was now the third time you were seeing him for this regular inspection, it didn’t alleviate your nerves the slightest. Each month, according to the Hunter’s Association regulations, every hunter needed to be seen by their primary care physician for 3 consecutive days for their health.

And although the association deemed it a necessity, it was an embarrassing requirement according to you. The Hunter’s Association had done a survey and discovered that many of their employees suffered from high levels of stress because they were isolated and lacked much-needed human contact. To combat this, they made it mandatory to get physical contact by a medical professional every month.

But when all the fancy jargon was pushed aside, all the hunters called it the same thing - medical masturbation. It had become wildly popular amongst both men and women hunters, eagerly marking the days on their calendar for when they could come in. When you heard about the rule, you wished the earth would open up and swallow you whole. You had tried talking to Jenna to insist that you were indeed taking care of yourself in that aspect, thanks to your trusted vibrator, but she had shaken her head no. 

“We need documentation. I’m subject to it, and so is everyone else in my order.”  Defeated, you’d walked out of Jenna’s office before remembering another mortifying fact with a jolt. Your primary care physician was Zayne. 

Your childhood friend, your trusted cardiologist, stoic and calm, who remained reserved during your general checkups, was going to be your medical masturbator. You had almost turned yourself into a ball on the floor, tweaked out at the insanity of it all. Although Zayne was your general physician, you had a separate gynecologist, and apart from asking if you’d had your annual PAP smear, Zayne had left that part of your anatomy unquestioned. It didn’t help that you were attracted to him, and sure, if he’d asked you out on a date, you would have been more than happy to let him inspect you all he wanted down there.

But this clinical setting, enforced by your organization was a little too much to bear. Wondering how to tackle this situation, you wander over to Tara who was humming as she made her medical bookings on her phone app. “Isn’t this exciting?” she squeals as she sees you. “God knows the dating pool is thin right now. This is just what I needed!”

Tara’s primary care physician was a woman, and you wondered if that was a pro or a con. On the one hand, dropping your panties for a woman doctor seemed less unnerving than for a man. But if you had a preference for men, would it work against your arousal? You shook your head at your ridiculous musings and focused on talking to Tara. “Are you really that excited about this?”

“You have no idea!” Tara taps her feet as she talks to you. 

“And you’re ok about having a woman stimulate you?” You probe, trying to gauge Tara’s reaction. Tara giggles and lightly pats your shoulder. 

“I don’t know but the idea is kind of hot. I mean, getting it on in a doctor’s office? Besides if I don’t like it, I can change the doctor the next time.”

Her words hit you like a ton of bricks. “You can change your doctor?”

“For this yes, the app gives you an option since it involves showing off a lot of intimate areas. You have to be able to trust your doctor right?”

You logged into the app, finding the little button to request a change in doctors, but for some reason, the page kept refreshing and crashing. With a sigh, you decide to get the worst of it over with and call Zayne, hoping he can make the change for you on his end. His voice is cool and professional when he answers your call.

“Yes?”

“So, you must have heard about…the new regulation?” you had put forth nervously.

“I am aware of it, yes.” 

“Well, for obvious reasons, I would like a different doctor.” 

Zayne smoothly says, “Of course. Patient comfort is always first. Do you have a doctor in mind?”

“Maybe my gynecologist? I tried doing it in the app but it keeps crashing.” There’s a moment of silence and you can hear Zayne’s fingers tapping away at his keyboard before a low hum leaves his end of the line.

“There appears to be a problem.”

“Problem?” you’d parrotted back.

“Yes. Because so many people are booking appointments at the same time, most of the available doctors are already taken. Including your gynecologist.” 

It felt like watching a bird crashing into a window in slow motion, that brief moment of hope that it wouldn’t hit the glass shattering in an instant. “Oh.”

There’s a pause before Zayne delicately says, “I’m sorry but it looks like you will have to make those appointments with me for this month. 3 of them according to the regulation. Hopefully, you can make the change for next month.” His voice sounded slightly apologetic.

“Won’t it be weird given that we know each other personally?” The question had fallen from your lips before you could stop yourself. 

“I promise not to treat you any differently than any of my other patients who are coming in for this inspection. I understand this may be a little unexpected, but I assure you I did a term of gynecology during my internship.”

A tinge of mirth carried over in his voice and you can’t help but make a noise of embarrassment. “Zayne, please!” His laugh was dry but not unkind, and you can’t help but want to hide your face even though he couldn’t see you. 

“Don’t worry too much. But I do advise you to make the appointments soon. My schedule is filling up rapidly.”

With those words, he’d disconnected the call and you were left wondering if an unknown god from another planet had cursed your existence. 

And changing doctors had proven to be more difficult than you’d thought. The entire organization seemed to be having a single thought. They had made appointments in the app almost halfway into the year, essentially blocking you from being able to do anything about your situation. Now on your third month with Zayne, you watch as he checks his notes from your last session, feeling like you want to scamper from the room.

The last two sessions had been incredibly stimulating, your arousal heightened by the fact you were attracted to Zayne. You’d never considered having someone watch as you touched yourself but found that you’d enjoyed it, at least, when it was him. He had remained professional, but you’d avoided him these last two months, save for when you had to get your monthly cardiac profile. He reads his notes from his computer as he prepares for your session. 

“Preferred device for stimulation still a vibrator, with a large, rounded, flexible head?” His eyes remain on his screen and you’re grateful for him giving you this smidgen of privacy. 

“Yes.”

“Preference for the doggystyle position still?” 

Your face burns. “Yes.”

“Still consenting for verbal stimulation?”

You nod your head.

“And still consenting for internal vaginal stimulation?” You make a noise of consent, squeezing your thighs together, your panties uncomfortably chafing against your already swollen pussy. 

“All right, I have everything I need.” He logs off and removes his lab coat, rolling up the sleeves of his shirt, revealing his well-corded arms, and your mouth almost waters at the sight of them. Clearing your throat, you shyly reach into your bag and pull out the vibrator in question, which he takes from you and clamps into a stand, adjusting it over the examination table you’d be on. A bottle of lube awaits on the tray next to the table and you swallow as he finishes the setup. 

“Whenever you’re ready,” he says in that deep voice, and feeling like your fingers are wrapped in thick woolen mittens, you reach behind you to untie the hospital gown you’re wearing, and it falls to the floor with a swoosh, your nipples pebbling under the sudden chill. A small set of sensors were taped to your chest and on the sides of your forehead, essential medical devices to ensure your orgasm was satisfactory. Unperturbed, Zayne gestures to the table and you make your way onto it, letting your feet settle in the stirrups as he settles on a stool between your legs, pulling on latex gloves before gently spreading your folds apart. You stare up at the ceiling as he does his initial checkup.

“Labia look healthy, no signs of trauma or abnormal discharge,” he murmurs, then runs a finger down the edge of the fold that separates your inner and outer lips, causing your core to clench involuntarily. You hold still, knowing very well he saw the action, holding your breath, letting out a little sigh as he lets go. 

“Normal reaction to stimuli, already semi-aroused,” he says, trashing the gloves and making another note on his computer. He glances over at you, leaning back uncertainly on the table. “You may begin.”

You swallow, then carefully turn onto your hands and knees, crawling towards the head of the table, grabbing the bottle of lube and squeezing the viscous liquid onto the head of the vibrator, avoiding eye contact as your breasts sway under the motion, nipples painfully hard from anticipation. You could feel Zayne’s gaze but can’t bring yourself to look up. Even though this was the third time, it hadn’t gotten easier, stripping naked and pleasuring yourself in his office. 

Once the rounded head of the vibrator is slick, you turn, the chill of the lube against your heated membranes causing more blood to flow into your already engorged nub, and run your moist slit across the surface to spread the liquid onto your slickened folds. Your hand fumbles for the little remote control and with a buzz, the vibrator turns on at the lowest setting. You click the button a few more times until it gets to the speed you liked, then fail to hold back a moan as the sensations pleasurably begin to take hold in your clit. 

The first time you had done this, nervousness had made you set the vibrator on the highest possible setting hoping to get a quick orgasm and sprint out of the office. Unfortunately, the sensors relayed this information into Zayne’s medical record that your climax had been unsatisfactory, and you had endured being lectured by him with the medical gown loosely draped on your body, your rear open to the cold office air. 

His tone wasn’t unkind but it hadn’t helped you feel better either. “It helps neither of us if you rush this. The whole purpose of this examination is to ensure you’re relaxing. I know it’s embarrassing but if you fail to have a proper orgasm, I’ll have to make you repeat the process until I get data that says otherwise.”

“The sensors are-”

“The only way to measure anything. Without involving another person anyway.”

His words had left you gobsmacked and your retort had died in your mouth. After that incident, you had learned. Even with the chagrin of having him watch you, you had learned to take your time and let the feelings build, leading to incredibly savory climaxes that made your body squirm from the aftershocks. 

Your hips sway, setting up a rhythm to brush your sensitive slit onto the head, letting it vibrate from cunt to clit, the lube aiding the frictionless sliding and making your core drip. Quiet noises of pleasure leave your throat as help yourself, arching your back and changing the curvature of your ass to maximize the sensations, then when the perfect pattern emerges, you let out a keening sigh, and try to remain still, letting the vibrator work its magic. 

Zayne, who has been quietly observing the computer this entire time, observing the spikes relayed from the sensors, asks, “Have you found your optimal pleasure form?”

“Yes,” you gasp, the timbre of his voice sending an arrow of lust into the deepest parts of your clenching core. You knew what was about to come next. The sound of Zayne’s desk chair moving, followed by the snap of latex gloves as he pulled a fresh pair onto those beautiful hands. He approaches the examination table and takes the bottle of lube you had set aside earlier, a wet squelching noise issuing from it as he squeezes it over his gloved hand, gathering the fluid on his index and middle fingers. He leans over to whisper in your ears; the verbal stimulation has begun.

The humiliating reveal that you had a heavy praise kink had come up during your initial session and despite your insistence that it wasn’t necessary, Zayne, the ever-diligent worker, had made a note in your profile, and he’d been fulfilling it each time. A tickle of hot breath near your ear, before he murmurs, “Are you enjoying yourself?”

The hum of the vibrator in the background coupled with his voice makes your breath catch in your throat. You nod, knowing you didn’t have it in you to form coherent words. 

“That’s a good patient. Good patients listen to their doctors you know. And you’re doing a wonderful job.”

Your hips snap back to push your clit against the rubber pad, letting out a whimper of pleasure, the action pushing your ass up higher, revealing your pathetically drooling cunt, fluttering with the dissatisfaction of being unfilled. 

“Are you ready?” He waits for your consent and you manage a husky, ‘mm hm’.

“Good girl. Take a breath.”

You inhale, trying to relax, then let out an uninhibited moan as Dr. Zayne inserts his middle finger into your needy cunt, the ring of muscles offering no resistance to the probing digit. He gently thrusts a few times, before curling the tip of his finger up into the delicate patch of nerves on your upper wall, the smooth come hither motion awakening a new level of pleasure in your body. Your fingers tighten on the edges of the table, sobbing, trying not to scream at the feelings that threatened to explode from you. He keeps up the gentle assault before asking, “Are you ready for another one?”

“Yes…” your voice comes out shakily, knowing you desired more than just his fingers, but that you would never get to experience it. 

“Perfect. So well behaved, taking exactly what I give you.” Zayne’s sensual voice floods your ear before his index pushes into you, the thickness of both his fingers sending you into overdrive. Your walls clench welcomingly around him, inciting an exciting pull of liquid heat in your abdomen, the muscles tensing in anticipation for the exquisite release you knew was about to occur. 

Feeling your inhibitions abandon you as you are stroked closer to orgasm your self-control slips and his name falls from your lips as he pushes over the edge.

“Zayne…” some partially functioning confine in the back of your brain registers what you had just involuntarily purred, but the spasms rocking your core, those gratifying waves of delight flooding your body made it easier to ignore it as your being is reduced to a pliant mess of pleasure. His fingers ease up as the fluttering in your pussy calms down, your clit pulsating weakly as the final vestiges of pleasure are wrung from your body. 

With a wet noise, his fingers leave your moist hole, the glove coated with your juices and the lubricant. Awareness finally comes crashing around you as you realize what you had uttered in the throes of passion. 

“I…I didn’t…I wasn’t in control…” You try to find a way to explain, to let him know you had very little choice in the matter of sobbing his name as you orgasmed, but everything feels flat, almost on the fine line between explaining and insulting. 

“There’s no need.” Almost as if he’s read your mind, Zayne matter-of-factly redirects the conversation. “It’s not uncommon to blurt out things during climax. Some people swear, and others call out names. It was a very normal reaction considering I was the one in the room with you.”

He throws the gloves in the trash and goes to check the computer, to ensure the sensors had given him the information he needed before starting the second round of the appointment.

“Oh.” You say quietly as he sits at his desk, feeling dejected. Although relieved he wasn’t making a big deal out of it, you can’t help but feel disappointed with his reaction. Shouldn’t a man be flattered when a woman cried out his name when she came? Maybe he really was treating you strictly as a patient. And here you were, pussy exposed and spread after being probed by his dextrous fingers, mooning over him like a high school girl. Perhaps the limit of your relationship with him was in fact, doctor and patient, the childhood friends aspect fading. 

So there was no romance here at all. You had a crush on him, and he was doing his job. Reality sucks. You sniff and suddenly feel cheap, and get out of the doggystyle position and try to find the hospital gown to preserve some of your modesty. Zayne glances over at your sudden movements.

“Are you cold? I can get you a blanket.”

“I’m fine.” You try to sound normal. 

“Your records show that you usually rest about 10 minutes before you are ready for the next round. Do you feel like that will be the case this time too?”

You find the gown and drag it up to your chin, covering your body as you lay back on the table. “Yeah. Actually a little sooner today maybe. I have somewhere to be.”

“You can’t rush these things. Your body will cum when it wants to. A forced orgasm doesn’t promote anything beneficial.”

“Well can we find a way for this to happen quickly and in compliance with the sensors?” You’re trying not to let your frustration show, the pleasantness of your orgasm fading. “I don’t think I have the patience to do two more rounds.”

Zayne listens to you impassively, but those amber eyes flecked with green had an underlying intensity you couldn’t place. “You don’t have the patience to do two more rounds?” He gets up and comes over to you. “You want to just leave then?” He approaches the edge of the table and there’s tension in his jaw. Perplexed, you look at him, his reaction unexpected. 

“No, I’m sorry, I know I can’t leave because of compliance and all that.”

“Compliance,” Zayne mutters under his breath before grasping your chin and forcing you to look at him, a gasp leaving your throat. 

“You’re getting frustrated because you have to do this a few times every month while being supervised? Do you have any idea what I have to do before you come in for these sessions?” His voice is a growl and you clam up, shocked by this aggressive display of expression from him.

“Every month I have to remain professional as you come in, pleasure yourself, and then leave. I have to endure seeing your beautiful body bare in front of me and control all my impulses to touch you, to not overstep my limitations as your doctor. I pleasure myself remembering the noises you make and ensure I’m well spent before coming in to do your appointments. You sit there, acting like it’s hard for you, but do you have any idea what you do to me?”

One of his knees is on the table, and he’s looming over you making you feel like a tiny animal caught in his fury. “It’s torture, to watch you. You’re not like the other patients I see. You never have been. Because with you, I always feel like I’m on the verge of losing control. Do you know how difficult it is to not do things to you that aren’t specified on your medical record? To have my fingers so intimately inside you, feel every little drop of pleasure clenching around my fingers, knowing at the end I can’t have you to myself? To hear you call my name and know that you only see me as your doctor?” 

Your face is a bright shade of red but you can’t look away from his face. His teeth are gritted, and when you dare to glance down, you see the noticeable bulge that has formed between his legs. He follows your glance and clicks his tongue, letting go of your chin. 

“I know I crossed a boundary today. It’s all right. You can go. I’ll reschedule you with another doctor. I know you didn’t want me in the first place.”

Your mind is a blur as you quickly reach out to grab his hand, your heart hammering wildly in your chest. His admission was like a prayer answered, and you weren’t going to meek about this. His breath hitches as he feels you pulling at his hand and gives you a look of uncertainty. Your lips part but the words you want to say refuse to come out. 

“Damn it,” he whispers ferally before his mouth captures yours in a rough kiss. It was wild and demanding, a contrast to the reserved, patient man he usually was. You’re swept up in the feeling of his mouth on yours, the taste of his tongue, and the softness of his lips. When you break apart, his hand cups your cheek, his eyes searching your face.

“This isn’t just because of the session right?” He asks keenly and you realize what he’s asking you. He’d been aching for you before this whole stupid policy came into place. The same way you’d been longing for him. 

“No, it’s not. I had a crush on you back when you became my doctor to check on my heart condition.” A sigh of relief leaves him before he tenderly presses his forehead to yours, and you’re caught up in the sweetness of the moment. 

“I just had to be sure.”

Boldly, you raise your head, delighted when he meets you, pulled back into his kiss, your tongues sliding over each other, your fingers tangling into his hair, scratching the nape of his neck, pulling him closer to you. 

You gasp as he breaks the kiss to drag his tongue down the column of your throat, pressing wet, open-mouthed kisses to the heated flesh, your blood humming in your veins as your eyes flutter closed. He pulls away the gown and pulls your perked nipple into his mouth, and you revel in the jolt of pleasure it brings you, each suckle felt in your clit which had already swollen up again in need. His fingers capture your other nipple, softly tweaking and pulling it and drawing little whines of desire from your throat. 

Your hand finds the junction between his legs and cups the heavy bulge, drawing a groan from him, palming him through his slacks, feeling it grow and tent the fabric under your ministrations. A low guttural sound leaves him and he gets off the table, and you almost protest until you see him dragging the small wheeled stool from earlier towards the table. He settles down on it, looping his arms around the tops of your thighs and pulling you closer to the table's edge until your feet find the stirrups again. 

“Stay open for me darling,” he instructs, his eyes glittering and you shiver as you feel his breath against your swollen folds. You squeak as he pushes your folds apart with his nose, inhaling your scent, his eyes growing dark with lust. “You smell delicious. I always wondered. Had to stop myself from sniffing my gloves after you climaxed. Not professional you know.” 

The musky tang of your pussy fills his senses, and his tongue darts out and dips into your slit, finding the swollen bud and licking it with just the right pressure that makes your toes curl and stars pop into your vision. 

Your hand rests on his head, tugging his beautiful dark locks, his name falling from your lips without barriers. Your hips rock against him, moaning, then let a sob as his lips suction around your clit. His fingers, free from the gloves at last, probe your entrance, scissoring inside to prepare you for what was to come before they curl up into that gummy patch that he knew too well. 

The sensations flood you, and the sheer knowledge of knowing you had Zayne touching you this way, unbound by the usual rules was sending you into a frenzy. Incoherent noises leave your mouth, crying out hotly as he teases the orgasm from you, your body shivering from the intensity. 

He wipes his mouth on the back of his hand and takes in your appearance, so soft and satisfied on his table, a dreamy look in your eyes.

“Are you prepared for the after?” he asks, you nod, more than eager to experience him. A sly smile crosses his face before he reaches over into the little chest of drawers by the table and pulls out a condom. 

“Hospitals have free condoms. It would be impractical to not use one when it’s on hand.” He explains seeing your questioning look and stands to undo his pants. You watch curiously as his cock is finally freed, eyes widening as it faces you, so impressive and veiny, standing proudly with a slight curve in its length. His pubes were neatly trimmed at the base, ebony curls visible behind the shaft. As he starts to roll on the condom, you feel your whole body heating up in anticipation. 

He leans down to kiss you before taking your feet and resting them on his shoulders, his cock at the perfect angle to enter you. As he sinks into your welcoming heat, you let out a sigh of longing, feeling the delicious stretch of muscle as he pushes up inside you, gasping as you feel his full length sheathe itself. As he bottoms out, his eyes close in bliss, hardly daring to believe that after all this time, he is finally getting to fulfill this private dream. 

Each stroke has him brushing against your gspot and kissing your cervix as he paces himself, feeling the primal urge to take you roughly and selfishly calling at his self-control. A growl leaves his throat as you whimper, straining towards him as the both of you struggle to keep a grip on reality. He feels the seductive way your walls clench around him, hears the soft noises you make, sees your face contort in pleasure with every roll of his hips. 

“Oh you feel so good,” he pants hotly, glasses askew, almost at the tip of his nose as he thrusts. “Clenching me so needily. Gonna milk me dry.”

Your response is a shuddering whimper, your back arching greedily to feel all of him, creating the perfect curvature to brush your clit against the base of his erection with each push of his hips. He feels the little bud on his heated skin, your combined fluids dripping onto his shaft, slickening the bundle of nerves with each stroke. 

“Be a good girl and cum on my cock the way you do on my fingers.” Zayne’s voice is husky as he tries to hold on, damned if he came before you. “I know you want to. I can feel the way your walls are spasming. They always do this pattern before you orgasm.”

The fact that he had memorized this knowledge of you was too much and you let go, your voice filling the room as you climax. Zayne’s hips stutter as he feels you around his length, pussy fluttering so him. His pace quickens, the sound of slapping skin becoming more and more urgent, his balls hitting your ass each time as he chases his orgasm. 

A shiver passes through his body as it happens and he buries himself in your warmth. You hum in satisfaction as you feel his cock twitch and pulse inside you as he spills his load. He pants, sweat on his forehead as he bends down to kiss you again, carefully lowering your legs which burn from the stretch as they settle on the stirrups. 

Threading your fingers through his hair, you brush your noses together, smiling shyly at him as he smirks, his eyes closing as he catches his breath.

“Can I see you outside of my office sometime?” he asks and you laugh at the invitation. 

“Are you asking me out on a date after having sex just once?” you tease as he grips the base of the condom and slides out, your pussy feeling the loss keenly. 

“I have been wanting to for a while. I was just wondering if I was misreading the signals. But I think I have a solid answer now.” He helps you sit up and cradles your body against his, idly stroking your skin, before gently removing the sensors off your body. 

“Let’s get dressed,” he murmurs, pressing a kiss to your forehead after a moment of cozy silence, and the both of you hunt down your clothes. As he fixes his tie, Zayne passes by his computer and lets out an amused huff. 

“Something funny?” you ask as you button your blouse.

“The sensors definitely gave enough information to make anyone’s head spin.” You walk over and snort as you see the window, full of sharp spikes. 

“Well, at least I am guaranteed you had a good time.” Zayne’s eyes sparkle mischievously as he pulls you in for another kiss. 

“I’m not changing my doctor,” you reassure him as you pull away. There’s amusement in his gaze when he replies. 

“Oh, definitely not. I think if the Hunter’s Association ever sees this record, they’ll heavily advise you to remain with the same healthcare professional.” 

support banner by @/ cafekitsune @theimmortalbuns @otomegamesforlife @sweets-kozume @actuallysaiyan

[healingtouchmediclinic]

Good general physician near me

Dr. Pratul Priyadarshi is an experienced and one of the most renowned doctors, with an MD in medicine and a gold medalist at that. Along with this, his expertise lies in treating general diseases, Diabetes, Thyroid, Gastric Disorders and serious chest disorders. Dr. Pratul is a renowned diabetologist in Delhi NCR. He practices in Delhi and Faridabad.He is not only an excellent professional but he is good human being as well. He is patient listener, explains all issues in depth and cares for his patient’s health. He is loved and admired by his patients.

[city-world-clinic]

We all need primary care to ensure our health is at its best. But despite accessibility to a good primary care clinic and other health services, it is up to our agency to make use of their care.

[avemapsychmedicalpllc]

In doing so, we can address physical and mental health concerns simultaneously. This approach allows for early detection and intervention of behavioral health problems, improving patient outcomes and reducing healthcare costs.

[financeprincess]

I spent, at a minimum, at least $500-$1,000 a month exclusively on my self improvement. Here is most of what I spend on, in no particular order:

Education (classes, books, courses, certifications, college tuition, seminars, etc.)

Private lessons for languages, musical instruments, sports, etc.

Personal hobbies and passion projects

Crest whitening strips (great when in a pinch), Invisalign, professional whitening, preventative dental care, prescription whitening products from my dentist

Investments such as index funds, REITs, ETFs, CDs, individual stocks, commodities, appreciative luxury items, precious metals & gems, etc.

Organic food, vitamins, supplements, high quality healthcare, therapy, massages, prescriptions (Rx skincare, etc.)

New glasses & contacts (getting some bayonetta glasses from Burberry soon, very excited)

Sports, gym membership + sauna, hot yoga, Pilates, kickboxing, tennis, skiing, dance, etc.

Personal care such as bath/shower products, body care, haircare, skincare, makeup, brightening eye drops, perfume, etc.

Travel, events, concerts, festivals, etc.

Shopping (clothes, accessories, home goods, etc.)

Eating out at restaurants and going to coffee shops

Beauty treatments such as manicures, pedicures, waxes, brow tint & threading, salon blowouts, hair cuts & colors, facials, lash lift & tints, vitamin IVs, etc.

Regular visits to my dermatologist, dentist, psychiatrist, eye doctor, primary care physician, gynecologist, and any other specialists

Semi-regular appointments with a personal trainer, holistic nutritionist, and dietitian

I don't do all of these every single month, but most of these are recurring throughout the year and budgeted accordingly. Eventually I might add in more intense cosmetic work like medspa services, Botox, etc. If you can find a workplace with a great benefits package such as high quality healthcare, an HSA/FSA, health & wellness reimbursements for the gym, disability & life insurance, etc. I would highly recommend it and max out all the benefits you can.

[scientia-rex]

Hey, I just wanted to tell you that I have massive amounts of respect for the work you do, and that you and all medical professionals deserve a hug and a pat on the back and systemic change and reform that allows you to have a healthy work-life balance without being forced to make the choice to compromise patient care or meet your basic needs.

Call your local elected representatives and tell them you want more residency spots that are federally funded so we can train more doctors so we have fewer provider shortages. International medical graduates who WOULD come here to work are being kept out by racism while we know we don't even have enough training slots for everyone who would like to work here. Also, we need lower medical school tuition; this would also allow the salaries for physicians to be lower and would decrease pressure to be in specialties and cities, when the worst shortages tend to be rural primary care. Call your elected reps, pick one thing, say it clearly, tell them you live in their district (and don't lie), and then keep doing that on a regular basis forever.

Also tell them we really, really need reform because United Health Care being allowed to own every step of the healthcare world and profit off of all of it has meant significant decreases in quality of patient care. Vertical integration IS monopoly, and they're killing people every day.

[fadingplaidlibrary]

oh i am EATING THESE UP. PLATE AND TABLE TOO. do you have any harvey hcs surrounding farmer? like how he is with crushes

omg hiiii beloved anon, i'm so glad you're having fun!! just for you my darling, here are some harvey x farmer headcanons <3

a doctor in love

harvey has a reputation as a polite, levelheaded sort of guy. he's very professional, generally calm and collected, and known for his reassuring bedside manner

then he meets the new farmer

you know how they say doctors make the worst patients? no amount of medical training could make this man recognize the symptoms of a crush in himself

our precious, deeply oblivious doctor doesn't realize he has feelings for the farmer for a long time. not when he insists on personally delivering them a handwritten birthday card (with a reminder to schedule an annual checkup). not when he catches himself painting one of his model planes in the farmer's favorite colors. not when he wakes up from an unexpected nap at his desk after a very unusual dream...

every time he runs into the farmer he chokes on his words, and ends up defaulting to some variation of "remember to take care of yourself" no matter how many times he rehearses a normal conversation in his head or in the mirror

naturally, maru is the first to notice that he's scheduled a house call for the new farmer. in-home care is not entirely unheard of in his small local practice, but since when does harvey bring so many extra first aid kits with him on a house call? and wait -- is he wearing cologne?

the first time the farmer passes out in the mines and gets carried to the clinic, harvey struggles to swallow down the panic long enough to stabilize them and send them home. after that, he insists on giving the farmer an emergency pager to carry with them on their mining expeditions

harvey lives a simple life both by choice and by necessity, but he is absolutely a man of refined tastes. he enjoys a nice bottle of aged fruit wine, a perfectly brewed cup of coffee, or a drizzle of truffle oil garnishing his simple meals. it's not long before the farmer becomes his preferred source for all of the very best and freshest fine foods

our good doctor is very careful about maintaining appropriate boundaries with his patients. so when the farmer reassures him that they're still under the care of their primary physicians back in zuzu city (and therefore technically not his patient), harvey secretly breathes a sigh of relief -- and immediately blushes bright pink

harvey was always the shy type in his dating life, but once the farmer makes the first move, our sweet boy falls completely head over heels. i'm talking matching friendship bracelets, a picture of you tucked into his lab coat, boxes of junimo-patterned bandages snuck into your backpack, all of it

the locals couldn't have predicted that their polite, gentlemanly local doctor would become such a swooning hopeless romantic, but it's certainly one of the more amusing improvements the new farmer has made to their little town

maru does wish he'd stop writing "300mg of kissies" into the farmer's chart, though

[cranquis]

Your recent reblog made me sad, but also makes a lot of sense. I've been following you since I was in medical school, and I'm now in my fifth year of specialty training (I am not American). I did occasionally wonder why I've been seeing less of the kind of content you used to put out.

All I can say is - thank you for the work you do. I've seen enough online to get an idea of what you must face on a daily basis. I think I'm lucky that somehow, the doctor-patient relationship overall hasn't deteriorated to such an extent where I live (yet at least), but I definitely understand the frustration and despair of trying to communicate with people who aren't coming into the conversation in good faith.

You've always been a kind of role model for me in terms of your passion for your work and your open sharing about your faith. I guess I just wanted to say that I hope you find hope and joy in your work, even if those you serve aren't wise enough to appreciate what you do for them.

Hi, my colleague! Hey first of all, thank you for your kind words of encouragement and affirmation. Negative med-related interactions (online or in person) anymore just roll off me, but the positive ones still give my heart a thrill! :) And congrats on your continued journey down the medical pathway.

Second, I'm glad your message gives me the chance to clarify for all my long-time Cranquis Pants* that I still do enjoy my work. I have been doing the exact same Urgent Care job in the exact same location (with quite a few staff turnovers) ever since I finished residency 17 years ago! I still enjoy the bulk of my patient interactions, I continue to hone my diagnostic skills, I feel very confident in my procedural skills, I have a reputation in our local medical community as a reliable and thorough physician, and I have a loyal group of patients who routinely nag me to "quit urgent care and become a regular doctor so we can be your primary care patients". My staff likes and respects me (despite my best efforts to ruin that on the daily, with my puns etc); I like my staff and appreciate the hard work they do in the face of the same administrative and societal opposition that I encounter; I am not distressed when little kids freak out during physical exams (and my success rate of turning those frowns upside down with playful interactions and silly sound effects is pretty darn good).

I am blessed with amazing work-life balance, more than the majority of Family Medicine-trained physicians I suspect. I carry no pager, I take no call, I leave my work at home when I go home. I know my schedule months in advance, I have a shift template that gives me plenty of week-long stretches off, and I have my Sabbaths 100% free to attend church and spend time with my family. My pay is decent and my benefits are solid, my debts get paid and I have a roof over my head. My kids and wife are happy to see me come home. Personally, I really have nothing to complain about.

But the bloom is off the rose for my profession as a whole. The politics and trends of the US health care system continues to disenfranchise physicians, devaluing the years and $$ invested in becoming physicians, over-valuing patient satisfaction scores and inexpensive labor and glitzy administrative initiatives and staff rumor mills more than evidence-based, experience-driven clinical medicine. The power structure is upside down, as if doctors ought to be automatically doubted and disdained by pharmacists, insurance companies, administrators, patients, and APCs because of their systematic educational journeys and reliance upon scientific evidence.

And one of the saddest results is watching medical professionals turn on each other. The fragmentation and super-specialization of every aspect of medical care creates artificial "us v. them" scenarios; specialists and primary-care battling over who does the paperwork for pre-op visits and FMLA, ER and Urgent Care arguing about how much workup should be undertaken by the UC when the patient is obviously going to need ER management, primary-care so overwhelmed with insurance-required goals that their patients can never get same-day/soon-day appointments, pharmacies so understaffed that it's easier for them to tell the patients that "the doctor never sent the prescription" when in reality ...

I could go on.

I miss the old days (said the geezer on the internet), when I could enthusiastically support a pre-med student's dreams of getting into medical school and "helping people as a doctor someday." Now I wince at the idealism in a high-schooler's eyes, and try to find a nice way to say "there's more options for helping people than just becoming a doctor... be sure you have your motivations straight, because medicine is not what it was even 10 years ago..."

So hope and joy in my career? Hope for the profession of physicians, I have little. But I make the joy in my practice when I can make it, and I only expect to find joy in my non-medical time with family and hobbies and travel and friends and the lifestyle which my medical career still does make more feasible than otherwise.

*Probably not the term historically assigned to "fans of this blog", back when I posted frequently -- it's been a minute -- but if not, SHOOT that was a missed opportunity.

[krewekreep]

JJK Headcanons: Suit & Tie Edition

Word count: A lot I wrote this on Mobile. (Would love if somebody comments the word count for me lol)

Summary: JJK as Professionals/Corporate Boys + as BFs ((randomly began to rate them on a scale of 10, this post is really for my amusement—I hope you enjoy!!)) (I’ll update this over time to include all male JJK characters and more details, just really a random thought post), #activepost. (Will also likely end up lengthy so)

Hiromi: Lawyer

Of Course Hiromi would continue his work as a public defense attorney. He’s considerate but neurotic. Fair but cautious. And has a strong sense of principles that make his job perfect for him but also perfect for his various neurosis to fester and continue depressing this overwhelmed man.

As a Partner: At the point Hiromi (probably a mid life crisis) really realizes he’d like a relationship he’d be the guy that has everything planned out in his head but fails miserably somehow. He’s so analytical and emotional (his consideration of others not really the expression of emotion) and would end up a worry wart of sorts about being up to par with whatever imaginary standards he’s projected onto you. Less so than reassurance, you’d just be incline to remind him he doesn’t need to go above and beyond or have super grand gestures to be impressive. Likewise he’d want to communicate (maybe too much) once a conflict or issue occurred and I can see him likely being a bit overbearing with “You okay? Are you realllyyy okay??? You sureeee???” Along with literal hour long sit downs after arguments or disagreements. You end up feeling he can get parental but find him a good balance or synergy to your possibly avoidant or passive (I just end up shutting up completely lmao) conflict style. He’d work way too much in the beginning and maybe even have a moment of conflict with you about it but will level out with time as you will be his literal priority and focus. Diligent and upstanding he’s (in my taste) a 7-8/10. (I’d get immediately tired of his work schedule cause I’m “clingy”)

Nanami: Doctor

While Nanami is canonically coded as an overworked salary man I think in another universe he’s the perfect doctor. Similar to Hiromi but a bit more stoic and willing to work pass his limits. He’s the type to really be working triple, quadruple shifts off nothing but caffeine and the smiles of his patients. I think he’d be a pediatrician, dentist, or the perfect primary care physician. I see him being a talented medical student that actually does it for the love of the work. He’s the doctor everyone has the hugest crush on but are too intimidated to speak to—and who is also assumed to obviously be claimed cause who wouldn’t.

As a Partner: Kento would absolutely have the worst schedule. He’s genuinely, (probably neurotically), earnest and diligent. His patients’ care is his only concern and you would end up finding his work reputation as an anti social coworker pretty incongruent to the yeah quiet, sometimes intimidating but overwhelmingly kind and considerate man. Of course you become his “special” patient (whether you meet him as his patient or outside of work) and you begin to cutely annoy him by always being sick and needing to be seen only by him. He’ll honestly at first find it lightly irritating as a distraction but will realize how his shoulders ease and his breath steadies when he calms at your presence. As a man of a few words, and literally hands on as a health practitioner, he will communicate his love with actions and gifts. You’re surprised at work or date out with your friends with flowers and a note. Or he tells you he doesn’t want you inside all day and left his card on the nightstand. “Buy something for me ;).” How he only is ever cute or flirty in texts, and a shy even bubbling big guy who flushes red when you kiss him on the cheek. He’s the guy the upper admin want to promote but then will be even more unavailable so he doesn’t tell you about it. And at a work dinner when his coworker comments on it, lowers his head in shame for keeping it from you. In an argument, whether he feels right or wrong, he just wants you to calm down. Hate to psychoanalyze but Nanami gives the vibe he overprotects because he wasn’t protected and/or saw those he cared about hurt terribly and that those he treasures he’s pained to see disturbed in any way. So no he doesn’t want to see you mad and rightfully so he doesn’t know how to communicate he wants MORE time with you not less…and how he actually found a better job with better pay in another state so… “Y/N? Absolutely I was wrong to hold it from you…but now that I told you my other plans…would you…” (lmao I’m trolling I’m so sorry). Overall if he drops everything for me he’s a 10/10 cause he’s also my first JJK Husbando anyway blep) Strong, big, and SILENT!

Suguru: Political Consultant

Pre & Post Kenjaku Geto would be someone ending up in politics. Everyone wants to save him and give him his little tattoo shop but this man (of course once any incredibly negative event would happen cause he’s very emo coded) would be at think tanks and conferences and Capital Hill. While not sinister he’s a good bit mischievous (and messy). He’d love it for the sheer drama and mess and blackmail. He’d love how easy it would be to orchestrate against his enemies for whatever his “grand ideas” are…in reality he’s the worst (best) type of personality because he would never be “neutral,” he’d simply let it be known his “side” is whichever and whoever advances his desires. And his allegiances WILL change. He’d be the political actor in all those official photos no one really knows and that’s the point. (damn he’s just inspired a Scandal TV Show AU)

As a Partner: Boy…you better be the most apolitical person ever, devious as all hell, or truly ready to be his simp in all regards. This man will be everywhere but home. He WILL miss dates, I’m so sorry! (Even if he was jobless he’d somehow be late or miss a date and nobody can convince me otherwise.) You’d go to truly bewildering events in terms of scope and breadth of wealth, access, and political influence. As an Aquarius (real life shade too I’m sorry again) he’d be so two faced! You’d hear him drag for someone BAD and then upon meeting them realize THEY think he’s their BEST FRIEND. I’m sorry Geto is messy coded to me and you’d have to be down for being a hater at Dawn. (We’d work as friends not lovers cause I wake up and hate.) He’d spoil you monetarily from the beginning so it’s up to you if you accept them even if their very obligatory feeling. Otherwise, I see him being impressed by your ability to challenge him, call him out, or deny him. He TELLS you you’re going to be his date to an event but maybe he was way too flirty with one of his peers and thought you didn’t notice? He’s left outside in his bespoke suit with happy flowers and a sour face. 😂 BUT, he’ll weirdly respect (even possibly turned on.) Depending on how you play it he’ll be the guy who just won’t leave you alone and loves to bother you into a reaction for his amusement—or (if you decide to simp) a guy who’ll definitely see how far you’ll let him go. He’ll flirt with everyone and openly lightly disrespect you cause honestly he’s likely encountered enough simps before. Yet, the fact it’s out of pure emotion and want for him rather than money or prestige will make him feel guilty and he’ll SLOWLY but EVENTUALLY be a good partner holistically. Even to the degree he’ll break “character” upon any disrespect or unsavory comment made towards you. Politically—(I know for me I’d kill him probably) since he’d be a “only here for my own best and vested interests,” maybe you’d think hard on his principles. Maybe you’d confront him about how his “neutrality” is selfish and he should be able to stand on something and stick to it! Then maybe he’ll just simply bring out a laptop you’ve never seen before, type in a few things facing away from you, and show you terrabytes of collected info on everyone across the spectrum…maybe he’d then sit there bored as you scream “REALLY? NO WAY?? NOT HER??? Okay well I felt like he’d do something like tha….OH EWWWWW.” And scoffs to himself thinking “and that’s only what I know won’t make you throw up…” All in all I see TRUST and sincerity being the biggest dealbreaker given (and it’s fair) to feel like he’s fake with you or unsure of his feelings. But…the way he gets in bed and private lets you accept his real feelings for you. He’s a 6/10 because the flirting would KILL ME. And he’s technically my second and half JJK Husbando. Grown him would still be menace regardless of Kenjaku.

Satoru: Sports Manager/Finance

Now Satoru would either be the nepo baby that abandons it all or the nepo baby that reluctantly accepts his role at his family conglomerate. If he gets his way: I see Satoru as a sports manager. He’s a people person, athletic, and would care about the young athletes in the industry. If we convert the students of Jujutsu to athletes I definitely see him being one of the managers representing the most Olympians and medaled performers. He’s hot in his shades and open shirt suits with his iPhone against his ear and his blackberry in his hand texting off a contract or something…(Sports Manager AU coming up :/)

Now if he accepts his role at his family conglomerate he’s the CEO of an old money finance firm. He hates his life and his job and hates his responsibilities. It would be closer to his feelings of burden in the story cause he’s well off and well respected but it’s because he was born to be, so it’ll be a job of obligation. Yet, he’d definitely be a philanthropist and own a charity. He’d hate (but understand) the criticism so he’d just shrug and do the most he can. He’s the type to stay single (or marry a few times) but adopt and of course Megumi, Yuuji, and Nobara are his kids. He does conferences and speaks at events and otherwise is one of those “good” billionaires. (I’d give him a hard time about where his money comes from while telling him what color Birkin I want…cause duality…)

As a Partner: Sports Manager Satoru will not be as free and it’s likely upon cementing a committed relationship you’ll travel with him across the world. I don’t see Satoru being the kind of guy who can do LONG distance or long period of time without physically being near his partner. You’d be the wife without a ring (only for a short time, he’s definitely a “if you’re down I’m down and I love you so let’s get this show on the road” type man. He’s the kind to wait to find the right one but you’ll be a bit annoyed at how many possible “right ones” are floating around in the world. He’ll chuckle sheepishly cause every event lurks an ex somewhere. Whether for a week or a couple years—and you fight seething next to him as you take a long gulp of the alcohol in your glass. How it gets to you beyond jealousy that maybe he’s a lover boy and not retired yet? How you want to never be a numbered ex in an irritatingly lengthy list… “Did you really have to give ALL of them the partner title?” You say as you cross your arms and huff in a pout. Satoru’s the kind to always wanna laugh or kiss conflict away, usually it worked but not now. “Babe…,” he moves closer to you to which you move farther from him. “Babe…? Please?” When he has to get serious and you’re being avoidant or passive then he’s the manager everyone fears for his easy ferocity. Now your held down with no choice but to face his peering blue eyes. “Hey…I know my…past upsets you. I mean…shit it kinda upsets me too.” The scowl on your face makes him shake out of his intensity to clean up the sentence: “No I mean, I wish I knew how to love better…I wasted a lot of time and energy…and other people’s time and energy…so for what’s it worth I’m trying and we are in it for the long haul, kid.” No matter your age, he’ll clock your immaturity cutely. Big spender, pretty obvious. Lover boy, who you’ll have to keep an eye on solely for the women who will try you. You end up being at every game and rumored an athletes partner until Toru gets proper mad (extremely jealous he’s not getting the shipping attention and it’s his partner!) and will pop the question at a championship game or whatever. I see a regular fun but albeit stressful travel induced relationship. But one with a thousand memories and fun. Although (please don’t cut me) Gojo isn’t my type at all I don’t know why—he’s def still a 9/10. I can accept dealing with exes and others if you’re ACTUALLY devoted to ME.

Finance Bro Toru: This will not be an openly happy and likely extravagant or extraverted Satoru. This one would be cold and reclusive. It’s likely you only end up on a date with him because he weirdly keeps seeing you on the metro or at his coffee shop or at his favorite lounge. It’ll be nothing to him but he’ll slowly (likely having nothing better to do and being distant from others) people watch doing his best to not accept he only ever watches you. It becomes his break from pressing matters that don’t matter at all to him. How simple but frenzied you are and how you overapologize for knocking over something. How you debated out loud if it was worth asking the Barista to correct your order, then giving up upon mumbling “Oh everyone is so stressed nowadays it’s fine. I’ll just drink it.” How you bristle thinking the man behind you just laughed at you…but how silly that must be to assume on a random man. How he’ll play with his watch and phone outside the shop waiting on you. How he grows impatient and stomps his foot too used to ordering people around and having folks at his beck and call. He’ll cough loudly as you pass by and since you pay him no mind weirdly jogs to catch up to you. “Uh, hey! Hi…Hello,” this dude is weird what does he want. “I—I,” eh he’s cute but…has a stuttering problem? “Yeah guy? What’s up? My train leaves in ten minutes and I got a thirty minute walk before I even get there.” How he doesn’t know how to keep up and finds you abrasive. “I just wanted to ask if you’d like to eat somewhere with me? NOT right now…of course…aha.” You look over the admittedly stunning obvious investor type with consideration. “I thought you had somewhere to be?” He teases. “Oh I do! But…the event I had to get to in ten minutes started an hour ago…lol. I think they’ve accepted my absence by now.” And the both of you would stand awkwardly for like 3-5 good minutes. “So,” you both speak. “Ah you can go sorry about that,” Toru throws. “Well…where you wanna go eat?” And Boom Satoru’s forgotten the seven meetings for today. At first thinking if anything this beautiful stranger can give me a good day. Then when he realizes he’s a late 20 something with no real social life or sense of fun so now you’re damn near seeing him whenever he can. And he’ll love to sneak off to your shabby apartment where his people won’t think to look. “Toru don’t you have a literal meeting with Wells Fargo?” He’ll sour any time you mention work. “Do I have to go to serve a real purpose or just fill in a seat and say yes to whatever they propose?” Well he ate that tbh. So you let him continue eating his Deli sandwich and watching the Bear. Once he loves you he will not even entertain the debate of leaving you because of his role. If anything he’ll propose (albeit inappropriately) at an elite event for the sole sake of making everyone mad. You want to be sure he’s with you for you and not to prove a point or be a “bad boy” and all he does is call up his best friend Suguru in DC and Shoko in Seattle to tell you about how truly terrible your man was as a youth. If anything you bring him back to the source of his actual personality. So you realize this old geezer is actually a retired trouble maker and is absolutely in love with you and getting you both in “trouble.” Easily one of the biggest spenders but deeply intimate so it’ll go either way. He could just be the guy that buys you exactly what you want when you want or the guy that yeah buys you a Rolex without blinking but makes you open ten boxes from huge to miniature all as a gag as he can’t stop laughing at your disappointment. Upon getting to the Rolex he waits for the scream and jumping into his arms. He’ll be a little shitty pervert once you’re in his arms though. 7/10 only cause I romanticized it ALOT but I hate the Uber wealthy and that lifestyle. Plus he’d be much harder to warm up and likely be someone YOU really want to be with tbh😭 AND he’d likely be a victim of a VERY small worldview so unless you code it like dumb rich man meets the real world he’d be insufferable.

Yuuji: Construction Firm CEO/Estate Broker

Yuuji would do construction. Don’t know why he just seems the type…(actually I watch Selling Sunset). He’s less a real estate agent and more an owner of a large estate development firm. If Yuuji ever would decide a life where every day is suits and ties…he’s gonna forgo the tie and remain open shirt to almost an inappropriate degree…he’ll always get requests for “personal” tours but ruins it getting lost in over explaining permitting and how difficult it was to get city approval for zoning. He has the perfect personality for it as it’s an active, hands-on job that’s still people based but also creative. Yuuji is someone who would need a holistically fulfilling job and I think the energy of real estate development is very him.

As a Partner: Full Blown Unintentional Love Bomber. I hate to say it but Yuuji is absolutely someone to fall and fall WAY too hard. I don’t see him being aggressive or forceful but he will appear wherever you are. He’s a well connected, well respected, wealthy man it’s not weird for him to end up at the parties you end at up either. It’s stranger for you to be there but whether you are in his field or of a professional career, a client or someone who just meets him, Yuuji will be the kind to sweep you off your feet. While it’s likely you won’t always physically be around him or able to—he’s the kind to have you on the phone throughout his work day, all day. “Yeah I mean again it was right for you to tell your boss you can’t do someone elses—DIDNT I SAY A DIFFERENT STYLE OF BACKWASH! Portion of the work? If they know there’s gonna be a big client coming then they should’ve—TODO CALL ABOUT THE PERMITS BEFORE I LOSE MY FUCKING MIND!!! Made sure everyone did their portfolio and presentations…do you need me to call up there? You know I know…”(insert CEO you don’t even know of your company’s Name Here lmao). It would all depend on you if how hard he loves is perfect or off putting. He’d love very publicly but would respect your request for reduced or no PDA. He’d just be so happy he has someone tbh. And someone who wants what he wants in a long term, committed way. He’s a lover boy but only in the sense he wants to truly give his heart to someone and take care of someone else’s. Big spender, big protector, big my girl said I can’t come so *shrugs*, very much a “stop telling me how much something is…numbers annoy me, here” and now you got his black card realness. In conflict he will force you into his arms and make sure you scream, cry, and whatever else ;) it all out. You get annoyed he refuses to argue with you and will literally fall silent. How he tells you everyone gets frustrated but he just can’t get frustrated with you as he leaves you for work with a kiss on the forehead. How you get a heat building in your stomach and suddenly want to shop for kid’s clothes. Upon marriage and/or creating a family Yuuji calls Megumi up to design a couple houses. “A couple houses??? We only need one Yu…” You can’t contain your laughter. “One? That is absolutely not enough. We are going to have two family homes—you decide where. You’re gonna have your own condo when you want time to yourself and—babe you know me…thinking of houses for the babies…” meanwhile nobody is pregnant. But you hold your stomach instinctively for some reason. How fatherly and intense made your initial reaction become: “Sure! I mean…how many houses we thinking…?” You chuckle nervously, to which Yuuji just tells Megumi they’ll speak later and rises from his seat towards you. “I don’t know, but for sure one has to look like me and one has to look like you…so what we gonna do about that? Guess we’ll have to keep em coming till that happens, no?” 10/10 I’m so “one and done” like? I do NOT feel like dating 😂

Megumi: Architect/Engineer

I debated whether he would be an Architect or Engineer but if we ever learn their favorite subjects we’ll know if he’s STEM-brained or more humanities based. Either way he’ll do something that’s still creative but methodical. Like Yuuji he’d need full stimulation from his job and I think of course he’d be Yuuji’s business partner who designs the buildings. Likewise a job with purpose and long lasting impact. He’s definitely about sustainability and would incorporate nature similar to Japanese architects like Sou Fujimoto (utilizes unconventional shapes and literal nature) and Kengo Kuma (utilizes shape and literal environment by means of aesthetic cohesion to the surroundings xyz I had to look it up and simplify it 😭💕).

Otherwise he’s some kind of engineer (I’m more humanities so forgive how bad I summarize). Rather than unfamiliar, I’m moreso unsure of which kind of engineering would suit him “the most” but I find of course he’d likely be an industrial, civil, or architectural engineer. He’d want to be useful and in every sense not waste his time or his energy. Maybe a concentration in environmental engineering specifically just cause I see him having a mindset of sustainability and community.

As a Partner: Openly neurotic and pathological about his work so be ready for that kind of man. Will absolutely get mad if you interrupt him working but knowing it’s a him thing will feel guilty about ghosting you for a week…so will continue to ghost you. You’ll have be angry, sad, or simping enough to endure Megumi. He’s definitely introverted and because of the insular nature of his work will be a human black cat. He’ll want his pets when he wants them, cuddles when he wants them, distance when he wants it, etc. You’ll have be used to or okay with someone who may not talk the entire day. Even if he’s not working, I see Megumi just being someone who can and will revel in peace and silence. If you relate that’s perfect and you’ll be two cats in a burrito blanket. If not, he’ll REALLY have to like you to like your possibly disruptive or hyper active nature. And may not be able to appreciate you until you meet Yuuji and Nobara and others. He’ll realize “Yeah, it’s me” realizing just like with everyone else he grew to care about he has to be open and fair and patient. All of a sudden he chuckles more at your dumb jokes or clumsy nature. As a professional, whether it be conferences or grants or fellowships Megumi will end up sought after and very busy. Likely the weight of academics and infrastructure will be visible in his pronounced dark eyes so it’ll take time for him to break out of accepting being overburdened and overworked but your trips to the beach, your propensity to miss deadlines and laugh it off, the way you went to class or work hung over and had an amazing day…he takes it all in and so maybe he won’t accept or feel pressured to do this or that or work overtime on this or help someone with that…he’ll learn how to “overwork” his own way and once he’s consulting with cities on infrastructural improvements and visiting more schools seeing little kids projects on space and noodle bridges he’ll remember how fun what he does is and will kiss you the most passionate he ever has when he gets home. How his hand rests on your stomach and rubs it lightly. “Meg (his albeit reluctantly accepted nickname) your so flirty tonight?! What’s up with you?” He’ll say nothing as he leans into the crook of your neck and breaths. He doesn’t think he’s a charmer but that’s what makes him all the more dreamy to you. How you never could question his sincerity since he’s the living embodiment of it, so how when he wants you—really wants you…it’s easy to lean into him and let him drift your bodies to your bedroom. Empty introverted all up on you cat boy Megumi: 10/10. The functionality of the relationship is a strong 3/10 because he will not prioritize the relationship for a number of MONTHS. He’s a workaholic introvert who is an engineer…whether graduate student, Ph.D, Instructor, or seasoned professional he’s def gonna be hard to deal with. Likewise you’ll have to be really strict with him about replying to you cause he’ll just…not do it. He’ll answer in his head and hope it gets to you…so once you threaten a breakup if he goes a day ever again without replying to you…he’s incredibly responsive and kicks himself at all the day to day conversation he missed out on…so he’ll make up for it.

Upcoming

Yuuta

Sukuna

Toji

Choso

Haibara

Inumaki

[promptedwordsmith]

LADS MEN REACTION to mc friend-zoning them after leading them on ;)

This was really hard for me to write since I’ve never led anyone on, the second I thought anything like that was happening I immediately set boundaries and didn’t allow any misunderstandings. If this isn’t what you meant, then I apologise!

Ok, so all of them would be extremely respectful about it, but I believe they would have different base emotions:

Rafayel would have betrayal as his, you lead him on made him think he was what you wanted spent so much time with him and acted like it was only a matter of time before you were together. But when you turned around and established him as your friend, his heart shattered, as much as he hates to admit it, he doesn’t think he could have done anything wrong, he only reciprocated the energy he got from you, never anything more than that. So, he feels played with, and can’t help but consider you like the other MCs that abandoned him, because he feels like they set him up just like that, it’s just this time you’re still in his life. He says OK, he will step back, but he doesn’t know what he can do from there, he spends more time in his studio, spends less time with you and the energy just isn’t the same for a long time until he can come to terms with everything.

Xavier would be confused underneath it all. Would apologise and ask if he did something wrong, when he gets confirmation that you never felt the same, he would rethink the entire time he spent with you trying to figure out how he could have interpreted everything another way fully believing he was completely in the wrong and there was no way you could have been leading him on. None of the other MCs did that did they? Questions everything repeatedly and vows that if he gets another chance in the future, he would be more careful and attentive to you to make sure this doesn’t happen again. Feels it’s his duty to always be in control of his emotions so not much would change except his skin ship and proximity which would lessen, otherwise he would still talk to you and partner up with you, but he would be much more cautious.

Zayne would be surprised, he regarded himself as quite intelligent, even emotionally intelligent, so learning you did not feel the same as him he feels he missed a clue. Would take an instantaneous step back, apologising but saying he needed some space to re-evaluate and re-assess his expectations for the relationship. He wouldn’t take too long, a week or so because he is fully aware that he is your primary care physician and that comes first for him whether you are in a relationship with him or not. Your health would always come before his feelings, so he is the epitome of professionalism from there on out. He still sees you outside of work sometimes but nowhere near as often as before and there would always seem to be a line in the sand, one that you could cross if you showed him you wanted him but that would act as a boundary otherwise.

[semiweirdshipper]

I need to write these three narcissistic, dangerous, intelligent A-holes in a fic together with a reader, like, soon.

Geez, just imagine the chaos.

Herman is the reader's primary care physician.

Hannibal is their psychiatrist.

And then Wesker can be their boss or something like that.

The reader is just trying to get by (definitely has suffered some kind of past trauma, possibly has a mental illness or maybe even some kind of disease. I don't know yet, but I'll find a way to make them unique), and they're going by without realizing that these three powerful men have feelings for them.

Imagine Hannibal learning that Wesker has something to do with the reader's stress, and so he goes to seek him out to kill and/or eat him only to discover that Wesker is much more intelligent and dangerous than he thought- and he too also has feelings for the reader. Oh, the irony.

Herman can be a step ahead of both A-hole 1 and 2 by using his professional, sappy charm to woo the reader into a dinner date or a walk in the park or something. (Writing this prince charming of a man is like drinking redbull- He gives me wings, baby!) And maybe one of the other two A-holes show up or do something dramatic to try and ruin their time. Hell, maybe Wesker and Hannibal work together to ruin the damn date, I don't know, but I'm bound to write something stupidly insane.

All three of them want the reader to themselves, but there's competition. What are they gonna do about each other without ultimately ruining the reader's happiness and trust? All three of them are extremely manipulative, so charming the reader is a breeze, but what about when the reader becomes overwhelmed because- hello!- their doctor, boss and psychiatrist are all each asking them on a date! Ahhhhhhh.

Gosh, the things I could do with this concept... I know, I know, I need to stop. I just figured that getting the idea out of my head this way would help me concentrate on updates that are actually important.

Thanks for listening to my goofy rambling, my loves. Maybe this idea could be something that blossoms into a story one of these days. We'll see.

[cellythefloshie]

;; Look At My Face

Summary: Dunn is livid after a high hit leaves him bloodied. You are able to bring him some comfort after a concussion spotter has him removed from the game. Kinks & TW: Hurt/Comfort. Notes: Reader is a medical resident/intern for the Seattle Kraken Organization, this would make her 24+. If this was going to be anything more than a short one-shot I would spend more time researching the NHL concussion protocols so you get a lot of generalization. I am also in no way a medical professional - my knowledge goes as far as basic first aid. AND yes I spent a good 20 minutes studying the different members of NHL medical teams just for 700 words. We're lucky I wanted to keep this shorter. Inspired By: This Gif Set. And the incident from the Ducks vs Seattle games on 2023-03-07. Word Count: 708

The hit from Max Comtois had been high. His shoulder collided with Vince Dunn square in the face and down onto the ice where he lay still until his slow-moving body had lifted itself from the ice. Everyone had seen it. Well, everyone except the officials. The crowd was left roaring in disapproval, and Vince? He was livid. Skating back to the bench, where the trainers waited to get a good look at the damage done, he spewed profanities. He let out a few choice words, coward and fuck among them as he smacked his stick against the boards in protest. It was only then the referees made a call - but the hall wasn’t against Comtois for his high hit. No, it was against Vince for his unsportsmanlike conduct. 

Vince was in the box for a limited time before he was removed from the box, and sent down the tunnel to you and the rest of the medical team that waited for him. The concussion spotter had seen something, and he would have to spend the rest of the game away from the ice. He was still fueled with anger as he trudged down the hallway. He was met by the team’s primary care physician, who sat Vince down and began to go through their set checklist laid out by the NHL’s concussion protocol. 

As a medical resident welcomed onto the team’s medical staff in an intern capacity - one of the NHL’s desperate attempts to assure more women were involved and represented in hockey - you stood by, filled out the needed paperwork and did as you were told. This was a huge learning opportunity for you, and you hoped to one day return to the organization in a physician role - so you refused to do anything to fuck things up. 

“Stay with him,” the physician told you when he completed his list, “if there are any changes page me - and get that cut clean up.”

It was a simple enough task, and you accepted it with a nod. Pulling on a pair of gloves you stepped in front of Vince who sat still half-dressed in his equipment in his stall. He had hoped to return to the game, but you were sure the clock was creeping onto its final minutes. You cleaned him up in silence,  your eyes carefully examining the shallow cut on the bridge of his nose. His visor had cut through the skin on impact, sending blood streaming down his face. 

“You won’t need stitches,” you assured him after a moment, your careful touch wiping the blood away with some gauze and antiseptic. 

“Thanks, Doc,” he muttered his tone calmer than it had been when he had first entered the room - but his look of frustration remained. 

You could see it in the tension of his jaw and in the glassiness of his eyes. Vince looked to be on the verge of tears. Not because he was in pain, but because he was frustrated. The officials had missed another blatant call. Not only was it missed it had sent him back to the locker room, he could miss games because of it. 

It left him sighing in his seat in front of you, his bright eyes blinking slowly to keep even a single tear from falling. Then, came something that surprised you. Vince was leaning in, defeated, and his forehead came to rest against the curves of your waist. You could feel his hot breath washing over you through your team-branded polo, and it was followed by the touch of his hands. They stroked over the breath of one of your thighs, a hand on each side as his arms came to wrap around your leg. It was an innocent thing, an action born from the need for calm, the need for comfort. 

It was a comfort you provided, letting him hold you, and you had even lost yourself in the tender moment as you raised a hand to stroke through the curls of his sweat-drenched hair. The two of you remained there until your phone vibrated against your hip, a silent reminder that he was now cleared to go home. 

[intersexcat-tboy]

Examining Miscalculations and Intersex Definitions Regarding Sax's .018% Claim

The debate surrounding the definition of intersex and their characteristics has been a topic of debate within various professional fields, advocacy organizations, and studies for decades. Amidst this discourse includes a response from Dr. Leonard Sax, who claims to provide a "clinician's standpoint" despite lacking specialized expertise in these conditions, having only served as a primary care physician.

However, his arguments stand in stark contrast to those of Fausto-Sterling, a world-renowned professor of biology and gender studies. Furthermore, they diverge significantly from the consensus among major health associations, medical organizations, intersex rights groups, and human rights organizations.

Leading/Major Health Associations

The definition of intersex is resoundingly clear among leading health associations. The World Health Organization recognizes that intersex individuals are those "born with natural variations in biological or physiological characteristics, including sexual anatomy, reproductive organs, and/or chromosomal patterns that do not fit traditional definitions of male or female." Similarly, the National Institute of Health acknowledges individuals who are "born with, or who develop naturally in puberty, biological sex characteristics that are not typically male or female." The National Health Services emphasizes that intersex "involves genes, hormones, and reproductive organs, including genitals, and a person's physical sex development can differ internally, externally, or both."

Major/Leading Medical Associations

Major medical associations provide crucial insights into the understanding of intersex variations. The The American Medical Association adopts a broader definition, recognizing those with "a congenital condition with inconsistent chromosomal, gonadal, or anatomic sex development." Likewise, the Royal Australasian College of Physicians (PDF - which trains and accredits physicians in Australia and New Zealand) recognizes the significance of "congenital variations in a person's physical, hormonal, or genetic characteristics that do not match strict medical definitions of female or male sex." Additionally, the Center for Disease Control highlights the concept of "variations in physical sex characteristics, including anatomy, hormones, chromosomes, or other traits, that differ from expectations generally associated with male and female bodies." The International Symposium on Disorders of Sex Development notes there to be over 40 conditions

Leading Intersex Rights organizations

Intersex rights organizations, including Intersex Human Rights of Australia and Brújula Intersexual in Mexico, explicitly disagree with Dr. Leonard Sax's narrow definition of intersex individuals. They align themselves with more inclusive perspectives. For instance, Intersex Society of North America (working with) InterACT still use Fausto-Sterling's estimates over a decade later. Intersex Campaign for Equality in the United States also uses Sterling's estimates, believing the figures may even be higher than 2%. Intersex Asia and Intersex Russia both use estimates ranging from 0.5%-1.7%, Russia even including PCOS by name (which would be higher than 1.7%). InterAction from Germany's Intersex Rights suggests a range of 1-2 individuals per 100 births, highlighting how the medical community tries to "keep the frequency as extremely low as possible". Stop Intersex Mutilations from France posits there are over 40 variations and also suggests the prevalence might surpass 1.7%. Additionally, OII Europe presents prevalence estimates of 1:200 and 1.7% in their materials.

These organizations stress that intersex variations encompass a wide spectrum of biological and physiological characteristics beyond chromosomal ambiguity, challenging Sax's limited viewpoint.

Major human rights organizations

unequivocally support intersex individuals. The Office of the High Commissioner for Human Rights emphasizes that intersex individuals are "born with a wide range of natural variations in their sex characteristics that don't fit the typical definition of male or female." Amnesty International notes that intersex encompasses "a wide umbrella of natural variations" (1.7%) and human rights abuses faced by intersex individuals. Human Rights Watch and the Human Rights Campaign underline the broader definition of intersex, acknowledging variations in genitalia, chromosomes, gonads, internal sex organs, hormone production, hormone response, and secondary sex traits, noting 1.7% as a prevalence rate. These human rights organizations underscore the importance of acknowledging intersex variations to ensure the protection of human rights.

Other Medical Orgs

Additional medical organizations like the Société Internationale d'Urologie (PDF) (an international professional organization dedicated to the field of urology), and the National Society of Genetic Counselors (uses 1.7%, says sex is not based on chromosones) adopt definitions that align with broader medical perspectives, they recognize the complexities of intersex conditions and advocate for understanding beyond binary definitions. Furthermore, the Endocrine Society acknowledges CAH to be part of a continuum of disorders, acknowledging the variations in severity.

Examining oversights: Discrepancies in Calculations

What's interesting is that even within Sax's own criteria, defining intersex as when 'the chromosomal sex is inconsistent with phenotypic sex, in which the phenotype is not classifiable as either male or female,' there's an evident inclusion of conditions like 'sex reversals' and ambiguous genitalia. However, Sax overlooks contributors such as mixed gonadal dysgenesis (MGD), as well as Swyer Syndrome and de la Chapelle syndrome, despite the former being the second leading cause of ambiguous genitalia.

Let's do the math

CAH (.0077) + CAIS (.0076) = .0153

+ ovotestes (.0012) + Idiopathic (.0009) = .0174

+ PAIS (.00076) = .01816

Fausto-Sterling includes de la Chapelle syndrome and MGD, although not as separate statistics. MGD is amalgamated with Turner's statistics, and de la Chapelle syndrome is grouped with other sex chromosome variations. However, Sax completely disregards these conditions when he discards several categories from his estimates, effectively throwing out qualifying numbers and ignoring their potential impact on the overall prevalence of intersex conditions.

While newer studies suggest a prevalence of .004 for de la Chappelle, we also have to consider that neither study includes Swyer Syndrome (+.00125), and PAIS is now recognized as at least as common as CAIS, with the latter being less likely to cause ambiguous genitalia at birth, and more likely to be identified in childhood.

The leading causes of ambiguous genitalia are CAH (.0077), PAIS (.00076), MGD (.005) and ovotestes (.0012), which places us just below (.01466) the ambiguous genitalia observed at birth from Mothers And Babies Reports from Australia, if we account for 15% (0.0006) of de la Chapelle births having ambiguous genitalia, it brings ambiguous genitalia at birth to a total of .015% found before.

If he includes CAH, PAIS (since CAIS is often not identified until childhood), ovotestes and idiopathic causes under his definition of intersex, it leaves us with .005% of births with ambiguous genitalia without a possible causing condition. This gap can easily be explained by his exclusion of MGD and de la Chapelle syndrome.

If we count only CAIS (.0076) and CAH (.0077), and the newer study estimate of de la Chapelle (.004), it already surpasses Sax's estimate at .0193.

With the addition of ovotestes (.0012), idiopathic (.0009), MGD (.005) and Sawyer syndrome (.00125) it brings us to .022%. With older estimates of PAIS (.00076), .0234%; with newer ones (.0076), just a bit above .03%, which is over two thirds an increase of Sax's original estimate.

There is overwhelming support for a more comprehensive understanding of intersex variations that emphasizes the importance of respecting a wide range of biological and physiological characteristics beyond mere genital and chromosomal definitions. This approach is essential in safeguarding human rights and ensuring equitable treatment for all individuals

TLDR;;

The collective stance of experts and organizations, spanning from health associations to human rights advocates, sharply contrasts with the limited definition created by Sax. He claims to know other clinicians' thoughts, without any evidence to back it up. As stated previously, he also lacks education and clinical experience on intersex individuals, he is a family doctor.

[religion-is-a-mental-illness]

My name is Dr Jill Simons. I'm a board-certified pediatrician and the executive director for the American College of Pediatricians. Today I'm here alongside my colleagues representing the Coalition of co-signers of the Doctors Protecting Children Declaration. Our coalition consists of physicians together with nurses, behavioral health clinicians, other health professionals, scientists, researchers and public health and policy professionals. And we have serious concerns about the physical and mental health effects of the current protocols promoted for the care of children and adolescents in the United States who express discomfort with their biological sex.

This declaration was authored by the American College of Pediatricians, but really it was developed from the expertise of hundreds of doctors researchers and other healthcare workers and leaders wh, for years have been sounding the alarm on the harmful protocols that continue to be promoted by the medical organizations in the United States. Despite recent revelations from the leaked WPATH Files and the recent release of the final report from the Cass Review, these medical organizations have not changed course.

So, we are calling on these medical organizations of the United States, including the American Academy of Pediatrics, the Endocrine Society, the Pediatric Endocrine Society, the American Medical Association, the American Psychological Association and the American Academy of Child and Adolescent Psychiatry to follow the science and their European colleagues and immediately stop the promotion of social affirmation, puberty blockers, cross-sex hormones and surgeries for children and adolescents who experience distress over their biological sex.

In our declaration, we affirm that sex is a dimorphic, innate trait defined in relation to an organism's biological role in reproduction: male and female this genetic signature is present in every nucleated somatic cell in the body and is not altered by drugs or surgical interventions. Consideration of these innate differences is critical to the practice of good medicine and to the development of sound policy for children and adults alike. Medical decision-making should be based upon an individual's biological sex. It should respect biological reality and the dignity of the person by compassionately addressing the whole person.

We are here defying the claims made by these medical organizations in the US that those of us who are concerned are a minority and that their protocols are consensus. They are not consensus, and we are speaking in a loud unified voice: enough.

[ Full press conference: https://youtu.be/C2tU90XPFlg ]

--

Doctors Protecting Children Declaration

As physicians, together with nurses, psychotherapists and behavioral health clinicians, other health professionals, scientists, researchers, and public health and policy professionals, we have serious concerns about the physical and mental health effects of the current protocols promoted for the care of children and adolescents in the United States who express discomfort with their biological sex.

We affirm:

1. Sex is a dimorphic, innate trait defined in relation to an organism’s biological role in reproduction. In humans, primary sex determination occurs at fertilization and is directed by a complement of sex determining genes on the X and Y chromosomes.  This genetic signature is present in every nucleated somatic cell in the body and is not altered by drugs or surgical interventions

2. Consideration of these innate differences is critical to the practice of good medicine and to the development of sound public policy for children and adults alike.

3. Gender ideology, the view that sex (male and female) is inadequate and that humans need to be further categorized based on an individual’s thoughts and feelings described as “gender identity” or “gender expression”, does not accommodate the reality of these innate sex differences. This leads to the inaccurate view that children can be born in the wrong body. Gender ideology seeks to affirm thoughts, feelings and beliefs, with puberty blockers, hormones, and surgeries that harm healthy bodies, rather than affirm biological reality.

4. Medical decision making should not be based upon an individual’s thoughts and feelings, as in “gender identity” or “gender expression”, but rather should be based upon an individual’s biological sex. Medical decision making should respect biological reality and the dignity of the person by compassionately addressing the whole person.

We recognize:

1. Most children and adolescents whose thoughts and feelings do not align with their biological sex will resolve those mental incongruencies after experiencing the normal developmental process of puberty.

Desistance is the norm without affirmation as documented by Zucker in his article “The Myth of Peristence”. (1) Zucker, KJ. The myth of persistence: Response to “A critical commentary on follow-up studies and ‘desistance’ theories about transgender and gender nonconforming children” by Temple Newhook et al. International Journal of Transgenderism. 2018: 19(2), 231–245. Published online May 29, 2018.http://doi.org/10.1080/15532739.2018.1468293 [1]

In the “largest sample to date of boys clinic-referred for gender dysphoria,” there was a desistance rate of 87.8%. (2) Singh D, Bradley SJ and Zucker KJ. A Follow-Up Study of Boys With Gender Identity Disorder. Front Psychiatry. 2021;12:632784. doi: 10.3389/fpsyt.2021.632784

The pro-affirmation Endocrine Society Guidelines (2017) admit: “…the GD/gender incongruence of a minority of prepubertal children appears to persist in adolescence.” (3) Hembree, W., Cohen-Kettenis PT, Gooren L, et al. Endocrine treatment of gender-dysphoric/gender-incongruent persons: An Endocrine Society clinical practice guideline J Clin Endocrinol Metab. 2017; 102:1–35.

A longitudinal study from the University of Groningen in the Netherlands followed 2772 adolescents (recruited from a psychiatric clinic) from age 11 years through 22 – 26 years. “In early adolescence 11% of participants reported gender non- contentedness. The prevalence decreased with age and was 4% at the last follow-up (around age 26).” Even in this psychiatric patient study group for which interventions were not addressed, but “gender affirmation” is most likely, gender non-contentedness (essentially gender noncongruence) decreased substantially from early adolescence to young adulthood.(4) Rawee P, Rosmalen JGM, Kalverdiijk L and Burke SM. Development of gender non-contentedness during adolescence and early adulthood. Archives of Sexual Behavior. 2024; https://doi.org/10.1007/s10508-024-02817-5

2. Responsible informed consent is not possible in light of extremely limited long-term follow-up studies of interventions, and the immature, often impulsive, nature of the adolescent brain. The adolescent brain’s prefrontal cortex is immature and is limited in its ability to strategize, problem solve and make emotionally laden decisions that have life-long consequences.[2]

3. Sex-trait modification or “Gender affirming” clinics in the United States base their treatments upon the “Standards of Care” developed by the World Professional Association for Transgender Health (WPATH). However, the foundation of WPATH guidelines is demonstrably flawed and pediatric patients can be harmed when subjected to those protocols.

The two Dutch studies that form the foundation for treatment guidelines as documented in the WPATH “Standards of Care” guidelines version 7 (SOC 7) had serious flaws.[3]

These studies did show that the appearance of secondary sex characteristics in adolescents and young adults could be changed by hormonal and surgical interventions, but they failed to demonstrate meaningful long-term improvement in psychological well-being.

Scientific concerns with these studies also include a lack of a control group, small sample sizes, significant numbers of patients lost to follow up, and the elimination of patients who experienced significant mental illness from entering the studies.

It is concerning that the Dutch studies did not address complications and adverse outcome in the adolescent cohort that underwent transition. These complications included new onset diabetes, obesity and one death.[4]

4. There is now sufficient research to further demonstrate the failure of the WPATH, American Academy of Pediatrics and Endocrine Society protocols.

The Cass Review was released on April 10, 2024, as an “independent review of gender identity services for children and young people”. The following points are from Cass’s final report:[5]

Commissioned by the National Health Service (NHS) England, and chaired by Dr. Hilary Cass, the 388-page report utilized systematic reviews, qualitative and quantitative research, as well as focus groups, roundtables and interviews with international clinicians and policy makers.

As part of the evaluation, they reviewed the research on social transition, puberty blockers, and cross-sex hormones.

Social transition

“The systematic review showed no clear evidence that social transition in childhood has any positive or negative mental health outcomes, and relatively weak evidence for any effect in adolescence.

However, those who had socially transitioned at an earlier age and/or prior to being seen in clinic were more likely to proceed to a medical pathway.”

Puberty blockers

“The systematic review undertaken by the University of York found multiple studies demonstrating that puberty blockers exert their intended effect in suppressing puberty, and also that bone density is compromised during puberty suppression. However, no changes in gender dysphoria or body satisfaction were demonstrated [emphasis added].”

“There was insufficient/inconsistent evidence about the effects of puberty suppression on psychological or psychosocial wellbeing, cognitive development, cardio-metabolic risk or fertility.”

“Moreover, given that the vast majority of young people started on puberty blockers proceed from puberty blockers to masculinizing/ feminizing hormones, there is no evidence that puberty blockers buy time to think, and some concern that they may change the trajectory of psychosexual and gender identity development.”

Cross-sex hormones

“The University of York carried out a systematic review of outcomes of masculinising/feminising hormones.” They concluded, “There is a lack of high-quality research assessing the outcomes of hormone interventions in adolescents with gender dysphoria/incongruence, and few studies that undertake long-term follow-up. No conclusions can be drawn about the effect on gender dysphoria, body satisfaction, psychosocial health, cognitive development, or fertility.”

“Uncertainty remains about the outcomes for height/growth, cardio-metabolic and bone health.”

The Cass Review further stated, “Assessing whether a hormone pathway is indicated is challenging. A formal diagnosis of gender dysphoria is frequently cited as a prerequisite for accessing hormone treatment. However, it is not reliably predictive of whether that young person will have longstanding gender incongruence in the future, or whether medical intervention will be the best option for them.”

A 2024 German systematic review on the evidence for use of puberty blockers (PB) and cross-sex hormones (CSH) in minors with gender dysphoria (GD) also found “The available evidence on the use of PB and CSH in minors with GD is very limited and based on only a few studies with small numbers, and these studies have problematic methodology and quality. There also is a lack of adequate and meaningful long-term studies. Current evidence doesn’t suggest that GD symptoms and mental health significantly improve when PB or CSH are used in minors with GD.”[6]  

5. There are serious long-term risks associated with the use of social transition, puberty blockers, masculinizing or feminizing hormones, and surgeries, not the least of which is potential sterility.

Youth who are socially affirmed are more likely to progress to using puberty blockers and cross-sex (masculinizing or feminizing) hormones.

“Social transition is associated with the persistence of gender dysphoria as a child progresses into adolescence.”[7]

“Gender social transition of prepubertal children will increase dramatically the rate of gender dysphoria persistence when compared to follow-up studies of children with gender dysphoria who did not receive this type of psychosocial intervention and, oddly enough, might be characterized as iatrogenic.”[8]

Puberty blockers permanently disrupt physical, cognitive, emotional and social development.

Side effects listed in the Lupron package insert include emotional lability, worsening psychological illness, low bone density, impaired memory, and the rare side-effect of pseudotumor cerebri (brain swelling).[9]

A coalition of physicians and medical organizations from around the world submitted a petition to the Commissioner of the U.S. Food and Drug Administration requesting urgent action be taken to eliminate the off-label use of GnRH (growth hormone) agonists in children.[10]

Testosterone use in females and estrogen use in males are associated with dangerous health risks across the lifespan including, but not limited to, cardiovascular disease, high blood pressure, heart attacks, blood clots, stroke, diabetes, and cancer.[xi],[12]

Genital surgeries affect future fertility and reproduction.

6. A report from Environmental Progress released on March 4, 2024, entitled “The WPATH Files” revealed “widespread medical malpractice on children and vulnerable adults at global transgender healthcare authority.”[13]

“The WPATH Files reveal that the organization does not meet the standards of evidence-based medicine, and members frequently discuss improvising treatments as they go along.”

“Members are fully aware that children and adolescents cannot comprehend the lifelong consequences of ‘gender-affirming care’ and, in some cases due to poor health literacy, neither can their parents.”

In addition, developmentally challenged and mentally ill individuals were being encouraged to “transition”, and treatments were often improvised.

7. Evidence-based medical research now demonstrates there is little to no benefit from any or all suggested “gender affirming” interventions for adolescents experiencing Gender Dysphoria. Social “affirmation”, puberty blockers, masculinizing or feminizing hormones, and surgeries, individually or in combination, do not appear to improve long-term mental health of the adolescents, including suicide risk.[14]

8. Psychotherapy for underlying mental health issues such as depression, anxiety, and autism, as well as prior emotional trauma or abuse should be the first line of treatment for these vulnerable children experiencing discomfort with their biological sex.

9. England, Scotland, Sweden, Denmark, and Finland have all recognized the scientific research demonstrating that the social, hormonal and surgical interventions are not only unhelpful but are harmful. So, these European countries have paused protocols and are instead focusing on evaluating and treating the underlying and preceding mental health concerns.

10. Other medical organizations are adhering to the evidence-based medicine documented in the Cass Review Final Report.

The constitution of the National Health Service in England will be updated to state, “We are defining sex as biological sex.”[15]

The European Society of Child and Adolescent Psychiatry issued a document titled “ESCAP statement on the care for children and adolescents with gender dysphoria: an urgent need for safeguarding clinical, scientific, and ethical standards.”

In this paper, they stated, “The standards of evidence-based medicine must ensure the best and safest possible care for each individual in this highly vulnerable group of children and adolescents. As such, ESCAP calls for healthcare providers not to promote experimental and unnecessarily invasive treatments with unproven psycho-social effects and, therefore, to adhere to the “primum-nil-nocere” (first, do no harm) principle”.[16]

11. Health care professionals around the world are also acknowledging the urgent need to protect children from harmful “gender-affirming” interventions.

In a letter to the British newspaper, The Guardian, sixteen psychologists, some of whom worked at the Tavistock Center for Gender Identity Development Service, acknowledged the role clinical psychologists played in placing children on an “irreversible medical pathway that in most cases was inappropriate.”[17]

In the United States, a group of psychiatrists, physicians and other health care workers wrote an open Letter to the American Psychiatric Association (APA), calling on the APA to explain why it glaringly ignored many scientific developments in gender-related care and to consider its responsibility to promote and protect patients’ safety, mental and physical health.[18]

12. Despite all the above evidence that gender affirming treatments are not only unhelpful, but are harmful, and despite the knowledge that the adolescent brain is immature, professional medical organizations in the United States continue to promote these interventions. Further, they state that legislation to protect children from harmful interventions is dangerous since it interferes with necessary medical care for children and adolescents.

The American Psychological Association states it is the largest association of psychologists worldwide. The organization released a policy statement in February 2024 stating, “The APA opposes state bans on gender-affirming care, which are contrary to the principles of evidence-based healthcare, human rights, and social justice.”[19]

The Endocrine Society responded to the Cass Review by reaffirming their stance. “We stand firm in our support of gender-affirming care…. NHS England’s recent report, the Cass Review, does not contain any new research that would contradict the recommendations made in our Clinical Practice Guideline on gender-affirming care.”[20]

The American Academy of Pediatrics (AAP) Board of Directors in August 2023, voted to reaffirm their 2018 policy statement on gender-affirming care. They did decide to authorize a systematic review but only because they were concerned “about restrictions to access to health care with bans on gender-affirming care in more than 20 states.”[21]

Of note, Dr. Hilary Cass called out the AAP for “holding on to a position that is now demonstrated to be out of date by multiple systematic reviews.”[22]

In Conclusion

Therefore, given the recent research and the revelations of the harmful approach advocated by WPATH and its followers in the United States, we, the undersigned, call upon the medical professional organizations of the United States, including the American Academy of Pediatrics, the  Endocrine Society, the Pediatric Endocrine Society, American Medical Association, the American Psychological Association, and the American Academy of Child and Adolescent Psychiatry to follow the science and their European professional colleagues and immediately stop the promotion of social affirmation, puberty blockers, cross-sex hormones and surgeries for children and adolescents who experience distress over their biological sex.  Instead, these organizations should recommend comprehensive evaluations and therapies aimed at identifying and addressing underlying psychological co-morbidities and neurodiversity that often predispose to and accompany gender dysphoria. We also encourage the physicians who are members of these professional organizations to contact their leadership and urge them to adhere to the evidence-based research now available.