#what is a clinical research associate

[headspace-hotel]

I forget why, but I was on the Wikipedia page for polycystic ovarian syndrome, and I started researching hirsutism in women, and I learned the following things in this order:

there's a diagnostic criteria used to evaluate how hairy a woman is

This is important because being too hairy is a diagnostic criteria of most disorders that cause hyperandrogenism

Disorders that cause hyperandrogenism can be diagnosed by...measuring how hairy you are (this is the main and most important diagnostic criterion for PCOS)

Disorders that cause hyperandrogenism are important because they are correlated with obesity, infertility, and...being too hairy?

I think to myself, wait, what is a normal range for testosterone in women? I find this article...which set reference ranges for "normal" testosterone levels in women...EXCLUDING WOMEN WITH PCOS?

Quote: "Polycystic ovary syndrome (PCOS) is another notable condition in genetic (XX) females, which is characterized by excessive ovarian production of androgens. This condition is included for comparison with DSD, as the affected females with PCOS are genetic and phenotypic females. The elevated levels of testosterone in these females can lead to hyperandrogenism, a clinical disorder characterized variably by hirsutism, acne, male-pattern balding, metabolic disturbances, impaired ovulation and infertility. PCOS is a common condition, affecting 7%-10% of premenopausal women."

So: the study claims to demonstrate a clear distinction between the normal range of hormone levels in "Healthy" men and "healthy" women...with "healthy" being defined in the study as...having hormones within the "normal" range.......................

So I researched what the clinically established "normal" range for testosterone in women is

THERE ISN'T ONE????

Quote from the above article: "Several different approaches have been used to define endocrine disorders. The statistical approach establishes the lower and the upper limits of hormone concentrations solely on the basis of the statistical distribution of hormone levels in a healthy reference population. As an illustration, hypo- and hypercalcemia have been defined on the basis of the statistical distribution of serum calcium concentrations. Using this approach, androgen deficiency could be defined as the occurrence of serum testosterone levels that are below the 97.5th percentile of testosterone levels in healthy population of young men. A second approach is to use a threshold hormone concentration below or above which there is high risk of developing adverse health outcomes. This approach has been used to define osteoporosis and hypercholesterolemia. However, we do not know with certainty the thresholds of testosterone levels which are associated with adverse health outcomes."

What the fuck?

What the fuck?

It's batshit crazy to make a diagnostic criteria for medical disorders by placing arbitrary cutoffs within 2-5% of either end of a statistical distribution. What the actual fuck?

"The results came back, you have Statistical Outlier Disease." "What treatments are available?" "Well, first, we recommend dietary change. You should probably stop eating so many spiders."

Another article which attempted to do this

Quote: "Subjects with signs of hirsutism or with a personal history of diabetes or hypertension, or a family history of polycystic ovarian syndrome (PCOS) were excluded."

"We're going to figure out the typical range of testosterone levels that occur in women! First, we're going to exclude all the women that are too hairy from the study. I am very good at science."

Anyway I got off topic but there are apparently race-specific diagnostic tools for "hirsutism." That's kinda weird on its own but when I looked more into this in relation to race I found this article that straight-up uses the term "mongoloid"

[nanamiscocksleeve]

Natural Breeding Clinic - Prologue

warnings: MDNI, breeding kinks, general sex, mention of infertility and insemination methods

a/n: It's here. Finally.

Teaser - Prologue - Patient 1

You take a deep breath and sit down in front of the laptop, waiting for the other person to join the call. Never in your life had you heard about such a unique reproductive center but lately, you’d been feeling the pull to start your own family. You’d discussed this with relevant people in your life. Everyone had said if you really wanted a child, then you should go with the options you thought were right for you.

You’d done the research, looking into different doctors and fertility clinics, but this one just stood out. There were testimonials from several happy families, saying their methods, though unconventional, were effective, and the doctors showcased on the website were all incredibly striking, each one handsome in their own way. But it was the success rate that caught your eye. A 98% guaranteed rate that you would be pregnant, and that pregnancy would be healthy. The site didn’t go into too much detail on their method, but the wording caught your eye.

“A natural breeding clinic” they’d called themselves. You’d finally bitten the bullet and called, requesting an information session. The screen suddenly lightens and you focus your attention as an attractive woman with shoulder-length brown hair comes into view. She smiles in a welcoming way before speaking.

“Hello. Am I speaking with Mrs. L/n?” You nod and smile back, trying not to look awkward or uncomfortable. 

“Perfect! My name is Shoko Ieiri, I’m the main coordinating nurse here at Jujutsu Fertility. Thank you for scheduling an information session with us.”

“Yes, of course. I just needed more details before I booked an appointment.”

“Indeed.” Shoko claps her hands together before continuing. “Let me start by telling you a little bit about ourselves. We’ve been around for almost 6 years now. What sets us apart is that we focus more on women’s comfort than most other clinics. And we are sought out by people who are willing to use a sperm donor. We do not perform insemination services with sperm that are not from our own stock.”

“Your own stock? Are you associated with a sperm bank? And screen all the donors yourself?”

“Not a sperm bank in the conventional sense. We have 5 doctors who keep excellent health and their sperm is regularly screened to ensure quality. They are the only stock we allow for insemination.”

You blink to make sure you haven’t misheard. “The…doctors? Are you saying the fertility doctor I’d be meeting with will also be my sperm donor?”

“That is correct.” Shoko nods her head to confirm. “You will be meeting with the doctor of your choosing for at least 5 sessions. They will need to be at least once a week. Some women take the week off and come in 5 days straight.”

“5…sessions?” you ask, confused by the wording.

“Yes. It’s to ensure the insemination process has occurred an optimal number of times.”

“Wait…so…I’m going to be inseminated multiple times? How much downtime do I need in between each insemination?”

“Hardly any. Our method isn’t like a typical clinic. Most women leave feeling very normal and a lot more satisfied than when they came in.”

“Not like a typical clinic? So…you don’t use the catheter method?”

“We use minimal medical equipment in our inseminations.”

“Minimal…so what does the procedure entail?”

Shoko clears her throat and continues. “So it begins with you choosing one of our doctors. We highly recommend spending some time on this part. It’s essential that you feel attraction towards your doctor. Once you make a choice, they will reach out to discuss how your insemination experience can be optimized for you. You will receive a biodata on their sexual profile, their preferred methods of arousal, and other relevant details.”

“I’m sorry, but what?” You are at the edge of your seat wondering if you’ve entered an alternate dimension. Surely, this was all being made up? “Arousal, sexual profile- why would I need all these details? I thought sperm donors only gave information like height, weight, medical history and stuff like that.”

“Why wouldn’t they? You’re choosing to be bred by them. They would have to make sure their patient is satisfied with the experience.”

“Bred?” You bleat the word stupidly.

“Yes. We are a natural breeding clinic. We use the method nature has provided to us to ensure a pregnancy.”

The gears in your brain start turning and something finally clicks.

“Are-are you saying…I would be having sex with my doctor?”

“That is correct.” Shoko smiles gently at you, pleased that you have finally caught on.

“The human body doesn’t necessarily enjoy having medical equipment inserted into it. All that cold plastic, and the mechanical methods of insertion. It puts the body in a state of stress. Not good for implantation. So our doctors will inseminate you through the process of intercourse.”

 Her words fall like a fog around you. You can feel your heart racing, a flush creeping into your cheeks. It was…insane. The doctor of your choosing was essentially going to fuck a baby into you. As your mind starts pulling up the images of their doctors, each one impossibly handsome and striking, you feel a familiar throb starting between your legs. Wetting your lips, you try to talk to continue with the information session.

“I see. And…there are benefits to this?”

“Yes. Intercourse allows the body to relax, releasing happy hormones. In this stress-free state, in addition to the knowledge that your doctor is someone you’re attracted to and trust, the chance of an implantation doubles.”

You gape at Shoko, your mind reeling from all the information.

“And…when you say the insemination process will be optimized for my best experience…?”

“The doctor you choose will ask you extensive questions about your preferences. What turns you on, positions, dislikes, toys. It’s to determine if they will satisfy your breeding experience. If they feel they might not be a good fit, they’ll recommend another one of our doctors.”

You swallow, your mouth going dry. “I see. And…what else do I need to know?”

“We will start by collecting your medical history and run some blood work to make sure your body is ready for an insemination process. Women who have a domestic partner will need to get both a waiver and a consent form signed by their partner that they have been informed what happens for the insemination.”

“Of course. Makes sense.”

“You will be assigned an emotional support companion during this process. It will either be myself or Mr. Ijichi Kiyotaka. We are there to help ease your nerves and ensure you enjoy the process. And all patients must think of a unique safeword to use during the insemination process.”

“Safeword?” you parrot back, still processing.

“Yes. At any point during the process, should you feel uncomfortable, your safeword ensures all actions cease and your doctor will give you some space to breathe and reassess the situation.”

All you can do is nod along. Shoko gives you a look of reassurance. “I can guarantee that most women are pleased with the results. And our doctors are quite skilled in what they do. It’s natural to feel a little shy and embarrassed but at the end of the day, we all share a common goal- a healthy baby.”

Despite your initial shock, you feel some of your trepidation fade away. Shoko continues.

“If you are ok with all of this, I can send you the forms to get the process started. Once those are filled, you can take some time to decide on your doctor. Then we’ll set up a call with them.”

“Thank you.” You make a split-second decision. “Please go ahead and send the forms.”

“Excellent. I’ll send them to the email you put in your inquiry. Was there anything else?”

You shake your head no. “I think I have all I need.”

“Great! I look forward to assisting you again.” Shoko ends the call and you immediately go the the website again to look at the doctors, one of which will end up fathering your child. Such a hard decision. How will you ever make the choice?

@thesunxwentblack @kentocalls @actuallysaiyan

@belle-oftheball34 @jesssicapaniagua

@figmentforms

[chronicandironic]

Three years after their initial bouts with COVID-19, patients who’d once been hospitalized with the virus remained at “significantly elevated” risk of death or worsening health from long COVID complications, according to a paper published May 30 in Nature Medicine.

Even among those whose initial cases didn’t require a hospital stay, the threat of long COVID and several of its associated issues remained real, the researchers found. And cumulatively, at three years, long COVID results in 91 disability-adjusted life years (DALY) per 1,000 people—DALYs being a measure of years lost to poor health or premature death. That is a higher incidence than either heart disease or cancer.

“People are developing new-onset disease as the result of an infection that they had three years ago,” says Dr. Ziyad Al-Aly, a clinical epidemiologist at Washington University in St. Louis and lead author of the study. “It challenges the notion that these viruses are sort of self-contained or that after the acute first phase, they become inconsequential.”

At three years, Al-Aly tells Fortune, the primary complications among those with mild initial COVID cases were found in the neurological, GI, and pulmonary systems. The persistent risk among those who’d been hospitalized, meanwhile, extended to seven organ systems and included severe conditions such as strokes, heart attacks, heart failure, and even Alzheimer’s disease.

[ashleyrowanthewriter]

Porcelain Doll HRT Observation Report

Part I - WTO Foreword

The report is based on studies and observations performed by Dr. Pierre Oupée, Dr. Kotomi Abuki and Dr. Pirkko Osliini. The team studied 25 participants who underwent therapy including Dr. Osliini.

The therapy has been approved by the World Transhumanism Association, but every licensed physician administering the treatment has to report the course of therapy of at least 50% of patients for clarity of data. The therapy is to be submitted for reapproval once reports of at least 1000 patients are collected.

Part II - Recommended Psychological Evaluation

Before undergoing the therapy it is recommended to evaluate the patients psychologically. The evaluation should take three sessions, which should be performed in intervals of 14 days. The process of evaluation prioritises informed consent and letting the patient consider their decision.

The first session is focused on discussing the desired effects with the patient. During the second session the patient is to be explained about the effects of the therapy. During the third session the patient signs the informed consent file after which they can undergo an endocrinological evaluation and get prescribed the medications.

Part III - Required Medications

All medications are available in oral and epidermal form. It is important to note that the exact dosage differs from patient to patient.

Antihomogen (0,5-2 mg/week) - Humanity removal agent. Due to the anthropomorphic nature of the therapy it is important to keep the dosage low unless cross administering multiple therapies.

Antisomatotropin (10-17 mg/week) - Somatotropin halting agent.

Contostropin (13-22 mg/week) - Shrinking hormone. Due to the rate of influence the final dose should be taken when the patient reaches the height of 5-7 cm higher than desired. Further research is advised.

Tsichirone (17,5-32 mg/week) - Porcelanising agent.

Part IV - Course of Therapy

Phase 1 (onset on week 4-8) - Somatotropin in the patient’s body stops influencing it and constopropin causes it to start shrinking.

Phase 2 (onset on week 7-14) - Tsichirone starts turning the patient’s skin into soft porcelain. The effects of constotropine become amplified causing rapid decrease in height. The patient’s hair starts falling out. It is not understood what causes this effect, but it is observed that it doesn’t affect scalp hair. Further research is required.

Phase 3 (onset on week 20-30) - Tsichirone might cause the patient’s body to spontaneously freeze for a short time. The effect first affects small parts of the body such as single fingers to later spread to entire limbs and near the onset of phase 4 even the entire body. The patient’s scalp hair stops growing. It is not understood what causes this effect. Further research is required. The patient’s body hair falls out entirely midway through this phase. Tsichirone causes the patient’s skin to become more brittle. The patient’s hearing becomes more sensitive to high sounds. It is not understood what causes this effect. Further research is required.

Phase 4 (onset on week 40-56) - The patient’s body is completely turned into soft porcelain. While the patient retains muscle control for some time, tsichirone starts causing muscle atrophy and conversion of movable soft porcelain into immovable hard porcelain.

Phase 4A (10 weeks after the onset of phase 4) - The patient has to register in a surgery clinic licensed to perform dollification surgeries.

Phase 5 (onset on week 55-70) - Tsichirone causes complete conversion of soft porcelain into hard porcelain and complete muscle atrophy. The patient loses control over their body. Dollification surgeries become possible. The medication process is deemed completed.

Part V - Course of Surgeries

All the surgeries become possible after the patient reaches phase 5 of therapy. 

Articuplasty involves cutting the patient’s body and shaping new joints out of kintsugine. The joints become integrated with the patient's body after two to three weeks of auxiliary tsichirone therapy after which the patient is to undergo physical rehabilitation. Articuplasty is to be performed on shoulder joints, elbows, wrists, finger joints, hips, knees and ankles. If the patient expresses such desire, articuplasty can also be performed on toe joints, neck and some regions of the torso. The patients are able to use their joints despite muscle atrophy.

Voice box transplantation is not necessary for transition, but if the patient wishes not to undergo it, it is advised they learn sign language. The surgery involves cutting a hole in the body region chosen by the patient, inserting an artificial voice box and sealing the hole using kintsugine. The seal gets healed after one to two weeks of auxiliary tsichirone therapy. Although the voice box can be transplanted to any part of the body that is big enough to store it, it is highly recommended to transplant it into the neck or the torso.

Some patients express a desire for their post-transition forms to possess winding keys. In such cases it is possible for them to undergo winding key transplantation. The transplantation consists of drilling a hole in the patient’s body, constructing a key rail out of kintsugine, inserting the key and sealing the rail. The key becomes integrated into the patient’s body after two to three weeks of auxiliary tsichirone therapy, during which it is absolutely necessary not to touch the key. Touching the key during the auxiliary therapy may result in damage which may render the key unusable or require repeating the surgery. Winding the key seems to have no effect on the patient's physical state. It is however understood to cause feelings of relaxation. Further research is required.

Some patients express a desire for their post-transition forms to possess movable eyelids. In such cases it is possible for them to undergo palpebraplasty. The surgery involves cutting the eyelid rails into the patient’s eye sockets and shaping the eyelids out of kintsugine. The eyelids become integrated with the patient’s body after four to eight days of auxiliary tsichirone therapy. To ensure proper shape of the eyelids they are to be shaped in the closed position.

Part VI - Reversibility

The effects of the therapy are currently understood to be irreversible once the patient’s body enters phase 4 of the transition process. Further research is required.

Part VII - Contraindications

The therapy is not to be administered to patients with calcium deficiency until the deficiency is treated.

To prevent damage to the organism the therapy is not to be administered to patients with brittle bone disease.

Patients with any health conditions causing muscle atrophy are to be thoroughly observed by their physician.

The physician has the right to alter or completely halt therapy if it poses danger to the patient’s life.

Part VIII - WTO Approval

The World Transhumanism Organisation approved the therapy on August 2nd 20XX.

*************

Sorry, but I like the otherkin HRT genre too much. And while it will feel weird to self-insert myself into such a story as a receiver (because it seems my disability prevents me from gender HRT IRL), I thought I could write some lore bits to contribute to the community. It might not even be the only report I decide to write.

Of course, feel free to base your own story on that report. I'd be excited to read it!

[felinefractious]

Ok so before I followed your blog I used to be judgemental of people who bought from breeders. But now I understand why it's fine and good. Here's something I'm wondering now: should I also stop being judgemental of people who buy breeds like Lyoki that have unavoidable health issues that cannot be bred out? I respect your opinion and think you do a good job explaining things, so I would genuinely like to hear your thoughts on this so I can learn more from you. Hope this is ok to ask

You might be asking the wrong person because I’m a hater 😂

But it really depends on the person and the circumstances, in my opinion.

For example we have a client with a Scottish Fold who later found out about the issues tied to the breed, she feels bad and doesn’t intend to get another one after he passes and stays on top of his care even though he isn’t showing any clinical symptoms yet. I don’t judge her, she made a mistake and her cat is lucky to be in the care of someone who knows what to look for and provide necessary care.

But we also have another client with a Scottish Fold who’s less than a year old and already displaying orthopedic issues… and she still got another one. I don’t know if she hasn’t researched the breed or if she has and just doesn’t care… but yeah, I judge her. Irritates the Hell outta me.

Another example is a client with an Exotic which required surgery to open up his nares and displays chronic problems associated with his facial structure… and she still got another one, from the same breeder at that. So yeah, I judge her. She also went out of state to have these cats declawed so an awful person all around.

But you have to be mindful because people often won’t respond well if you accuse them of having an animal or supporting a breed that unavoidably suffers. They love animals and they love their pet so it’s a truth they’ll resist because it contradicts the truth they thought they knew, kind of similar to how outdoor cat owners may dig their heels in because it’s a hard pill to swallow that they were neglecting a pet they loved.

So I don’t recommend going around trying to “educate” owners of these breeds because it’s more lilely to be taken as a personal attack and not be constructive, not to mention that you often don’t know someone’s circumstances.

Maybe they weren’t aware but are now and don’t plan to get another one, or maybe their cats was adopted, or maybe they inherited the cat from a deceased relative, etc.

I do judge the Hell out of breeders of these breeds, though. You’re deliberately producing animals with known issues, that’s not okay and you can take your denial of their poor health and shove it up your ass.

[religion-is-a-mental-illness]

By: Andy L.

Published: Apr 14, 2024

It has now been just little under a week since the publication of the long anticipated NHS independent review of gender identity services for children and young people, the Cass Review.

The review recommends sweeping changes to child services in the NHS, not least the abandonment of what is known as the “affirmation model” and the associated use of puberty blockers and, later, cross-sex hormones. The evidence base could not support the use of such drastic treatments, and this approach was failing to address the complexities of health problems in such children.

Many trans advocacy groups appear to be cautiously welcoming these recommendations. However, there are many who are not and have quickly tried to condemn the review. Within almost hours, “press releases“, tweets and commentaries tried to rubbish the report and included statements that were simply not true. An angry letter from many “academics”, including Andrew Wakefield, has been published. These myths have been subsequently spreading like wildfire.

Here I wish to tackle some of those myths and misrepresentations.

-

Myth 1: 98% of all studies in this area were ignored

Fact

A comprehensive search was performed for all studies addressing the clinical questions under investigation, and over 100 were discovered. All these studies were evaluated for their quality and risk of bias. Only 2% of the studies met the criteria for the highest quality rating, but all high and medium quality (50%+) studies were further analysed to synthesise overall conclusions.

Explanation

The Cass Review aimed to base its recommendations on the comprehensive body of evidence available. While individual studies may demonstrate positive outcomes for the use of puberty blockers and cross-sex hormones in children, the quality of these studies may vary. Therefore, the review sought to assess not only the findings of each study but also the reliability of those findings.

Studies exhibit variability in quality. Quality impacts the reliability of any conclusions that can be drawn. Some may have small sample sizes, while others may involve cohorts that differ from the target patient population. For instance, if a study primarily involves men in their 30s, their experiences may differ significantly from those of teenage girls, who constitute the a primary patient group of interest. Numerous factors can contribute to poor study quality.

Bias is also a big factor. Many people view claims of a biased study as meaning the researchers had ideological or predetermined goals and so might misrepresent their work. That may be true. But that is not what bias means when we evaluate medical trials.

In this case we are interested in statistical bias. This is where the numbers can mislead us in some way. For example, if your study started with lots of patients but many dropped out then statistical bias may creep in as your drop-outs might be the ones with the worst experiences. Your study patients are not on average like all the possible patients.

If then we want to look at a lot papers to find out if a treatment works, we want to be sure that we pay much more attention to those papers that look like they may have less risk of bias or quality issues. The poor quality papers may have positive results that are due to poor study design or execution and not because the treatment works.

The Cass Review team commissioned researchers at York University to search for all relevant papers on childhood use of puberty blockers and cross-sex hormones for treating “gender dysphoria”. The researchers then graded each paper by established methods to determine quality, and then disregarded all low quality papers to help ensure they did not mislead.

The Review states,

The systematic review on interventions to suppress puberty (Taylor et al: Puberty suppression) provides an update to the NICE review (2020a). It identified 50 studies looking at different aspects of gender-related, psychosocial, physiological and cognitive outcomes of puberty suppression. Quality was assessed on a standardised scale. There was one high quality study, 25 moderate quality studies and 24 low quality studies. The low quality studies were excluded from the synthesis of results.

As can be seen, the conclusions that were based on the synthesis of studies only rejected 24 out of 50 studies – less than half. The myth has arisen that the synthesis only included the one high quality study. That is simply untrue.

There were two such literature reviews: the other was for cross-sex hormones. This study found 19 out of 53 studies were low quality and so were not used in synthesis. Only one study was classed as high quality – the rest medium quality and so were used in the analysis.

12 cohort, 9 cross-sectional and 32 pre–post studies were included (n=53). One cohort study was high-quality. Other studies were moderate (n=33) and low-quality (n=19). Synthesis of high and moderate-quality studies showed consistent evidence demonstrating induction of puberty, although with varying feminising/masculinising effects. There was limited evidence regarding gender dysphoria, body satisfaction, psychosocial and cognitive outcomes, and fertility.

Again, it is myth that 98% of studies were discarded. The truth is that over a hundred studies were read and appraised. About half of them were graded to be of too poor quality to reliably include in a synthesis of all the evidence. if you include low quality evidence, your over-all conclusions can be at risk from results that are very unreliable. As they say – GIGO – Garbage In Garbage Out.

Nonetheless, despite analysing the higher quality studies, there was no clear evidence that emerged that puberty blockers and cross-sex hormones were safe and effective. The BMJ editorial summed this up perfectly,

One emerging criticism of the Cass review is that it set the methodological bar too high for research to be included in its analysis and discarded too many studies on the basis of quality. In fact, the reality is different: studies in gender medicine fall woefully short in terms of methodological rigour; the methodological bar for gender medicine studies was set too low, generating research findings that are therefore hard to interpret. The methodological quality of research matters because a drug efficacy study in humans with an inappropriate or no control group is a potential breach of research ethics. Offering treatments without an adequate understanding of benefits and harms is unethical. All of this matters even more when the treatments are not trivial; puberty blockers and hormone therapies are major, life altering interventions. Yet this inconclusive and unacceptable evidence base was used to inform influential clinical guidelines, such as those of the World Professional Association for Transgender Health (WPATH), which themselves were cascaded into the development of subsequent guidelines internationally.

-

Myth 2: Cass recommended no Trans Healthcare for Under 25s

Fact

The Cass Review does not contain any recommendation or suggestion advocating for the withholding of transgender healthcare until the age of 25, nor does it propose a prohibition on individuals transitioning.

Explanation

This myth appears to be a misreading of one of the recommendations.

The Cass Review expressed concerns regarding the necessity for children to transition to adult service provision at the age of 18, a critical phase in their development and potential treatment. Children were deemed particularly vulnerable during this period, facing potential discontinuity of care as they transitioned to other clinics and care providers. Furthermore, the transition made follow-up of patients more challenging.

Cass then says,

Taking account of all the above issues, a follow-through service continuing up to age 25 would remove the need for transition at this vulnerable time and benefit both this younger population and the adult population. This will have the added benefit in the longer-term of also increasing the capacity of adult provision across the country as more gender services are established.

Cass want to set up continuity of service provision by ensure they remain within the same clinical setting and with the same care providers until they are 25. This says nothing about withdrawing any form of treatment that may be appropriate in the adult care pathway. Cass is explicit in saying her report is making no recommendations as to what that care should look like for over 18s.

It looks the myth has arisen from a bizarre misreading of the phrase “remove the need for transition”. Activists appear to think this means that there should be no “gender transition” whereas it is obvious this is referring to “care transition”.

-

Myth 3: Cass is demanding only Double Blind Randomised Controlled Trials be used as evidence in “Trans Healthcare”

Fact

While it is acknowledged that conducting double-blind randomized controlled trials (DBRCT) for puberty blockers in children would present significant ethical and practical challenges, the Cass Review does not advocate solely for the use of DBRCT trials in making treatment recommendations, nor does it mandate that future trials adhere strictly to such protocols. Rather, the review extensively discusses the necessity for appropriate trial designs that are both ethical and practical, emphasizing the importance of maintaining high methodological quality.

Explanation

Cass goes into great detail explaining the nature of clinical evidence and how that can vary in quality depending on the trial design and how it is implemented and analysed. She sets out why Double Blind Randomised Controlled Trials are the ‘gold standard’ as they minimise the risks of confounding factors misleading you and helping to understand cause and effect, for example. (See Explanatory Box 1 in the Report).

Doctors rely on evidence to guide treatment decisions, which can be discussed with patients to facilitate informed choices considering the known benefits and risks of proposed treatments.

Evidence can range from a doctor’s personal experience to more formal sources. For instance, a doctor may draw on their own extensive experience treating patients, known as ‘Expert Opinion.’ While valuable, this method isn’t foolproof, as historical inaccuracies in medical beliefs have shown.

Consulting other doctors’ experiences, especially if documented in published case reports, can offer additional insight. However, these reports have limitations, such as their inability to establish causality between treatment and outcome. For example, if a patient with a bad back improves after swimming, it’s uncertain whether swimming directly caused the improvement or if the back would have healed naturally.

Further up the hierarchy of clinical evidence are papers that examine cohorts of patients, typically involving multiple case studies with statistical analysis. While offering better evidence, they still have potential biases and limitations.

This illustrates the ‘pyramid of clinical evidence,’ which categorises different types of evidence based on their quality and reliability in informing treatment decisions

The above diagram is published in the Cass Review as part of Explanatory Box 1.

We can see from the report and papers that Cass did not insist that only randomised controlled trials were used to assess the evidence. The York team that conducted the analyses chose a method to asses the quality of studies called the Newcastle Ottawa Scale. This is a method best suited for non RCT trials. Cass has selected an assessment method best suited for the nature of the available evidence rather than taken a dogmatic approach on the need for DBRCTs. The results of this method were discussed about countering Myth 1.

Explainer on the Newcastle Ottawa Scale

The Newcastle-Ottawa Scale (NOS) is a tool designed to assess the quality of non-randomized studies, particularly observational studies such as cohort and case-control studies. It provides a structured method for evaluating the risk of bias in these types of studies and has become widely used in systematic reviews and meta-analyses.

The NOS consists of a set of criteria grouped into three main categories: selection of study groups, comparability of groups, and ascertainment of either the exposure or outcome of interest. Each category contains several items, and each item is scored based on predefined criteria. The total score indicates the overall quality of the study, with higher scores indicating lower risk of bias.

This scale is best applied when conducting systematic reviews or meta-analyses that include non-randomized studies. By using the NOS, researchers can objectively assess the quality of each study included in their review, allowing them to weigh the evidence appropriately and draw more reliable conclusions.

One of the strengths of the NOS is its flexibility and simplicity. It provides a standardized framework for evaluating study quality, yet it can be adapted to different study designs and research questions. Additionally, the NOS emphasizes key methodological aspects that are crucial for reducing bias in observational studies, such as appropriate selection of study participants and controlling for confounding factors.

Another advantage of the NOS is its widespread use and acceptance in the research community. Many systematic reviews and meta-analyses rely on the NOS to assess the quality of included studies, making it easier for researchers to compare and interpret findings across different studies.

As for future studies, Cass makes no demand only DBRCTs are conducted. What is highlighted is at the very least that service providers build a research capacity to fill in the evidence gaps.

The national infrastructure should be put in place to manage data collection and audit and this should be used to drive continuous quality improvement and research in an active learning environment.

-

Myth 4: There were less than 10 detransitioners out of 3499 patients in the Cass study.

Fact

Cass was unable to determine the detransition rate. Although the GIDS audit study recorded fewer than 10 detransitioners, clinics declined to provide information to the review that would have enabled linking a child’s treatment to their adult outcome. The low recorded rates must be due in part to insufficient data availability.

Explanation

Cass says, “The percentage of people treated with hormones who subsequently detransition remains unknown due to the lack of long-term follow-up studies, although there is suggestion that numbers are increasing.”

The reported number are going to be low for a number of reasons, as Cass describes:

Estimates of the percentage of individuals who embark on a medical pathway and subsequently have regrets or detransition are hard to determine from GDC clinic data alone. There are several reasons for this:

Damningly, Cass describes the attempt by the review to establish “data linkage’ between records at the childhood gender clinics and adult services to look at longer term detransition and the clinics refused to cooperate with the Independent Review. The report notes the “…attempts to improve the evidence base have been thwarted by a lack of cooperation from the adult gender services”.

We know from other analyses of the data on detransitioning that the quality of data is exceptionally poor and the actual rates of detransition and regret are unknown. This is especially worrying when older data, such as reported in WPATH 7, suggest natural rates of decrease in dysphoria without treatment are very high.

Gender dysphoria during childhood does not inevitably continue into adulthood. Rather, in follow-up studies of prepubertal children (mainly boys) who were referred to clinics for assessment of gender dysphoria, the dysphoria persisted into adulthood for only 6–23% of children.

This suggests that active affirmative treatment may be locking in a trans identity into the majority of children who would otherwise desist with trans ideation and live unmedicated lives.

I shall add more myths as they become spread.

==

It's not so much "myths and misconceptions" as deliberate misinformation. Genderists are scrambling to prop up their faith-based beliefs the same way homeopaths do. Both are fraudulent.

[fatliberation]

I totally understand and can empathize with fat activists when it comes to medical fatphobia. But I do think its important to provide nuance to this topic.

A lot of doctors mention weight loss, particularly for elective surgeries, because it makes the recovery process easier (Particularly with keeping sutures in place) and anesthetic safer.

I feel like its still important to mention those things when advocating for fat folks. Safety is important.

What you're talking about is actually a different topic altogether - the previous ask was not about preparing for surgery, it was about dieting being the only treatment option for anon's chronic pain, which was exacerbating their ed symptoms. Diets have been proven over and over again to be unsustainable (and are the leading predictor of eating disorders). So yeah, I felt that it was an inappropriate prescription informed more by bias than actual data.

(And side note: This study on chronic pain and obesity concluded that weight change was not associated with changes of pain intensity.)

If you want to discuss the risk factor for surgery, sure, I think that's an important thing to know - however, most fat people already know this and are informed by their doctors and surgeons of what the risks are beforehand, so I'm not really concerned about people being uninformed about it.

I'm a fat liberation activist, and what I'm concerned about is bias. I'm concerned that there are so many BMI cutoffs in essential surgeries for fat patients, when weight loss is hardly feasible, that creates a barrier to care that disproportionately affects marginalized people with intersecting identities.

It's also important to know that we have very little data around the outcomes of surgery for fat folks that isn't bariatric weight loss surgery.

A new systematic review by researchers in Sydney, Australia, published in the journal Clinical Obesity, suggests that weight loss diets before elective surgery are ineffective in reducing postoperative complications.

CADTH Health Technology Review Body Mass Index as a Measure of Obesity and Cut-Off for Surgical Eligibility made a similar conclusion:

Most studies either found discrepancies between BMI and other measurements or concluded that there was insufficient evidence to support BMI cut-offs for surgical eligibility. The sources explicitly reporting ethical issues related to the use of BMI as a measure of obesity or cut-off for surgical eligibility described concerns around stigma, bias (particularly for racialized peoples), and the potential to create or exacerbate disparities in health care access.

Nicholas Giori MD, PhD Professor of Orthopedic Surgery at Stanford University, a respected leader in TKA and THA shared his thoughts in Elective Surgery in Adult Patients with Excess Weight: Can Preoperative Dietary Interventions Improve Surgical Outcomes? A Systematic Review:

“Obesity is not reversible for most patients. Outpatient weight reduction programs average only 8% body weight loss [1, 10, 29]. Eight percent of patients denied surgery for high BMI eventually reach the BMI cutoff and have total joint arthroplasty [28]. Without a reliable pathway for weight loss, we shouldn’t categorically withhold an operation that improves pain and function for patients in all BMI classes [3, 14, 16] to avoid a risk that is comparable to other risks we routinely accept.

It is not clear that weight reduction prior to surgery reduces risk. Most studies on this topic involve dramatic weight loss from bariatric surgery and have had mixed results [13, 19, 21, 22, 24, 27]. Moderate non-surgical weight loss has thus-far not been shown to affect risk [12]. Though hard BMI cutoffs are well-intended, currently-used BMI cutoffs nearly have the effect of arbitrarily rationing care without medical justification. This is because BMI does not strongly predict complications. It is troubling that the effects are actually not arbitrary, but disproportionately affect minorities, women and patients in low socioeconomic classes. I believe that the decision to proceed with surgery should be based on traditional shared-decision making between the patient and surgeon. Different patients and different surgeons have different tolerances to risk and reward. Giving patients and surgeons freedom to determine the balance that is right for them is, in my opinion, the right way to proceed.”

I agree with Dr. Giori on this. And I absolutely do not judge anyone who chooses to lose weight prior to a surgery. It's upsetting that it is the only option right now for things like safe anesthesia. Unfortunately, patients with a history of disordered eating (which is a significant percentage of fat people!) are left out of the conversation. There is certainly risk involved in either option and it sucks. I am always open to nuanced discussion, and the one thing I remain firm in is that weight loss is not the answer long-term. We should be looking for other solutions in treating fat patients and studying how to make surgery safer. A lot of this could be solved with more comprehensive training and new medical developments instead of continuously trying to make fat people less fat.

[transmutationisms]

is there actual proof there's a genetic component to alcoholism? I've been searching and most articles I've read seem to agree it accounts for about half of your predisposition. I'm both skeptical and worried I might be going too far in my questioning to the point of denying science

genetic variants play a role in alcoholism. this is a decently readable overview on the topic from 2013. there are a few main points that should be clarified when discussing this.

often when people ask about this, they're thinking of genetic variants that affect a person's psychology, something like an inherited and inescapable 'addictive personality'. this is not really borne out by the research. as the paper above points out, the strongest genetic effects wrt the development of alcoholism are due to genes that change how we metabolise alcohol. having genes that make your alcohol metabolism more physically unpleasant in various ways (for example, you may have heard of so-called 'asian flushing syndrome') generally lowers the chances you will drink lots of alcohol, and thus lowers the chances you will qualify for a dx of alcohol use disorder. it's not a perfect protection; the paper also notes that, for example, businessmen exposed to cultural and economic pressures to drink heavily were more likely to do so even if they carried the normally protective genes. so, these aren't genes that control our behaviour directly or change our personalities; what we're seeing is largely the result of the fact that people like to do things that feel good, and if drinking makes you feel like hell, you are in general less likely to do it a lot.

this paper, and many papers on this topic, also mentions twin studies and adoptee studies to back up the claim that alcoholism is partially genetically determined. keep in mind that these studies are very hard to control for economic confounding factors, because even with adoptees, genetic siblings are also disproportionately likely to be adopted into families of a similar economic class. this is a general sticking point in a lot of genetics research.

many of the genetic variations believed to contribute to alcoholism are identified by studying families with multiple diagnosed alcoholics. this is tricky because it again has a lot of confounding factors; it identifies broad regions of the genome that then have to be broken down into more detailed analyses; and there are causation-correlation questions in this approach. some of the genes identified by these types of studies have replicated; many have not.

genomes and epigenetic variation are just extremely complicated. that doesn't mean the research isn't worthwhile, but understand that these types of questions turn up hundreds or thousands of potentially relevant genes, whose functions are often completely unknown, and which may be up- or down-regulated in ways no one understands. there are a lot of points of uncertainty between asking "do genes influence alcoholism" and generating an actual working list of such genes. i wrote a little about some of the uncertainties associated with epigenetic research here.

alcoholism itself is, like any psychiatric dx, heterogeneous (there are many different ways to qualify for the dx and the judgments inherently include a degree of clinician subjectivity). so, and this is a problem with studying the genetics of any psychiatric dx and many physical ailments as well, we're not really talking about a single clinical or psychological entity, and thus to even say which genetic variations may contribute to developing it is already pretty dubious in its discursive formulation alone.

[star-anise]

So I've been watching this series of videos where a research-focused psychologist goes through Jordan Peterson's work to see which of his ideas and arguments are based on solid empirical evidence. I love it, even though she does mistakenly say his background is in counselling psychology (my field) when he's actually a clinical psychologist.

Anyway, that's got me thinking about Jordan Peterson, and how his response to criticism is, "People have been after me for a long time because I’ve been speaking to disaffected young men — what a terrible thing to do, that is. [...] I thought the marginalized were supposed to have a voice.”

So, here's my theory: Young men of the 21st century have grown up in a culture that is specifically hostile and punitive towards them. However, I think that while girls and women can participate in this culture, it is as much or more the work of boys and men. And I think that the problem with Peterson is that he's not particularly good at helping his audience escape the maze they are trapped in--and he's absolutely opposed to any attempt to dismantle a maze that is actually of fairly recent manufacture.

Case in point: The metrosexual.

The word "metrosexual" was coined in 1994 by Mark Simpson, a gay writer whose settings seem to be perpetually fixed at "critique the shit out of it".

"Metrosexual" describes heterosexual men who might be mistaken as gay, because they are interested in things very common among gay men, including: Caring about whether they're attractive; caring about how their hair is cut and what products they use in it; caring about what clothes they wear; working out to make their bodies look better; frequenting nightclubs. To be "metrosexual" was, in some people's opinions, to be a "man-boy" searching for his "inner girl".

To be metrosexual was, in some ways, to be called someone who looked gay.

The term didn't really catch on until the early 2000s, when media became briefly obsessed with talking about which celebrities were "metrosexual" or not. In that era of hotly divided opinions over the acceptability of homosexuality and queerness, it was implicitly asking, "Who looks gay? Is he gay? Tell me, fellow broadcaster: How gay does this guy look to you?"

(They got to have their cake and eat it too. A liberal audience, desperate to gather as many LGBTQ+ people and allies as possible in their race for 50% acceptance of gay marriage, cherished any signs that people with social clout might be on their side. And a conservative one, watching the same discussion, would heartily enjoy seeing a rogues' gallery of degenerate Hollywood types paraded before them, their every effeminacy pointed out in loving detail.)

Which of course got us: The Retrosexual!

When everybody's helpfully compiling lists of all the things a man can do that look gay or unmanly, dudes who don't want to get the shit kicked out of them by homophobes know all the things not to do!

Therefore, being "manly" became strictly defined by what was off-limits. To be a Real Man meant you shouldn't care about whether you're attractive, or what soap you use, or how your hair is styled. You shouldn't enjoy dancing or get too enthusiastic about music. A Real Man cares about sports and beer and being on top! Dominant!! A WINNER!!!

And, so like, here's a secret: In Anglophone culture, we are very affected by the Puritan legacy that says pleasure is inherently sinful. Vanity and pride--caring about how you look and whether you're attractive--are literal gateways to the Devil. Gluttony, and therefore seeking pleasure at all, is another such. And in Puritan religious theology, women are inherently more sinful. Yes, it goes back to Adam and Eve, and how Eve was tempted into sin first. Long story short, things associated with women became associated with sinfulness, and sinfulness became associated with effeminacy. And for centuries, you haven't even needed to be religious to drink these attitudes from the groundwater.

Okay, that's not the secret, this is the secret: Pleasure is not inherently sinful.

And liking how you look and feeling attractive and paying attention to your sensuality and your emotional life and connecting with art in a real and vulnerable way can feel really good, if you're able to handle it well.

Being raised to be a Real Man in a world where masculinity is perceived to be actively under threat is so uniquely painful, I believe, because every attempt to define yourself as "not gay" means denying yourself one of life's pleasures, and telling yourself you never even wanted it in the first place.

And then those desperate to be Real Men found a way to take some of those things back in what is surely the most painful context possible: They are allowed strictly as tools of your heterosexuality and masculine need for dominance. You are allowed to care about grooming and dancing, etc, purely as a strategy in playing a game called "Getting Girls", where you either score or you don't, where not scoring means you're worthless and unlovable, and scoring is often... strangely unfulfilling and certainly not enough to fill the aching void inside of you.

The mistake both Peterson and his fanbase make is that they get to this point, and then think: The reason I feel so empty inside is... I just haven't gotten enough girls!

Maybe some guys get out of the maze by finding a woman who is allowed to care about things like affection and love and dancing and looking nice, and their connection with her lets them express all the other parts of their souls that didn't fit in the Real Man box, but can come out in roles like Boyfriend or Father.

But humans aren't telepathic, so relationships can only "fix" you so much as you're willing to do the work of nurturing your own soul in a safe environment, so for a lot of men the maze never ends, and sometimes they don't even get the fleeting joys of relationships or sex, since they're so fucked up about them!

At this point, I as a queer woman am like, "Solution's obvious! Dismantle the maze."

And Peterson, who has worked his whole life to achieve the status of Best Maze-Runner in All of Christendom, is clinging to it like, "NO! DOWN, YOU DARK CHAOTIC MOTHER! THIS MAZE GIVES MY LIFE MEANING! THIS MAZE CONNECTS ME TO MY FOREFATHERS! I CANNOT LIVE WITHOUT THIS MAZE!"

At which point, like... what can you do but just leave him there?

At least he's not in my area of specialization. The world would be too unkind if I had to deal with him in any professional capacity. I wish Clinical Psychology all their continued joy of him.

[soaringthroughthegalaxy]

For soft/fluffy/comforting prompt ideas, could you do something with Crosshair and his lady, like she's been struggling with high blood pressure and associated symptoms (headaches especially during stressful moments, pounding heart, short of breath) and she's supposed to be taking it easy while they wait for the medications to come in? Just him being sweet and soft and concerned?

Thank you so much for the request, anon. I hope this hits the spot. Writing Soft!Cross is always a good time.

I’m sending you all my love if you're struggling with this. I fell down a little research rabbit hole, and it doesn’t sound fun at all 😔

Equilibrium

When your body betrays you, there’s no one else in the galaxy you’d rather have at your side.

Pairing: Crosshair x f!reader

Word count: 1.5k

Warnings: reader struggles with high blood pressure and the associated symptoms, Soft!Cross, established relationship, kisses, care and comfort, fluffy sweetness, some playful banter, Cross has some minor negative self-thoughts but we chase those away.

“And another one, kitten.” The slow slink of Crosshair’s voice offered you reassurance, slender fingers drawing soft circles on your thighs as you followed his instructions and took another deep breath.

It was Zhellday night, and you’d been getting ready to head out when the dizziness had started. You’d made it to the edge of the bed, calling out for him as you sat down before you’d had to shut your eyes in a desperate attempt to stop the planet from spinning. The shortness of breath quickly followed, your chest feeling like it was trapped in a vice as your heart pounded. You hated that the most – feeling like you couldn’t breathe.

It broke Crosshair’s heart whenever you went through this. You were so strong and had made it through so much in life, and yet it was your own body that caused you the most grief. “That’s it. You’re doing so well.” He soothed.

“I hate this.” You whine, fingers gripping the bedsheets for dear life as you will away the discomfort.

What he would give to take it away from you or to at least be able to warn you when it was about to happen. Instead, all he could do was watch as the woman he loved the most battled with her own body and be on hand with medication and comfort. His brows furrowed, lips pressing into a line. “I know, I know.” He muttered, giving your thigh a gentle squeeze.

“We’re gonna be late for dinner.” You sigh, frustration bubbling under the surface. Ever since you and Crosshair got your little place in Lower Pabu, you’d visit his siblings for dinner and games night every Zhellday. It was the highlight of your week.

“We don’t need to go,” Crosshair states, though he knows you’ll protest. You should be taking it easy until the doctor at the island’s clinic can determine the underlying cause of your high blood pressure. Although he bit his tongue whenever it came up, Crosshair couldn’t help but wonder if it was from the years of stress – of keeping him and his brothers alive during the war.

You knew you should be resting, but the thought of missing out on life was frustrating. You’d already lost so many years to the war, and for a while, you’d also thought you’d lost Crosshair. But now you could live normally, back with the man you loved. “I want to go.” You state firmly, eyes still closed as you focus on your breathing.

“Stubborn.” Amusement curled around the word, and Crosshair couldn’t hide the smile that tugged at his lips.

Letting out a small huff at the gentle teasing, your heart wasn’t just pounding now from your condition. It didn’t take much for the magnetic force of a man crouching in front of you to make your heart race – and his teasing had always hit the spot. “Pot meet kettle.”

The low rumble of Crosshair’s laugh filled the room, and your chest no longer felt so tight, breaths coming easier as the medication he’d brought you started to work its magic. Slowly, you opened your eyes, Crosshair’s hawkish gaze locked on you.

The splitting pain in your head had you screwing them shut again quickly, dragging in a quick breath as a noise of discomfort slipped from your lips. Everything had been blurry around the edges, which hadn’t helped the dizziness. “Nope. Not good.” You mumble, sighing in frustration.

“You wound me,” Crosshair replied playfully, knowing full well you hadn’t been talking about him, but he’d take some self-deprecation if it made you laugh.

He was dutifully rewarded. The soft sound of your laughter replaced his in the air, and he soaked up the sound like a dying man in the sands of Tatooine. He’d gone without it a whole year, trapped in the Empire’s clutches. He never wanted to be without it - or you - again.

“You’re still the most handsome man I know.” You insist as your laughter subsides, reaching out blindly to cup his face with one of your hands, smoothing your fingers over the angles of his face. In the four months since you’d rescued him from Mount Tantiss – along with Omega and, surprisingly, Tech - he’d started to gain back a little weight. He was still somewhat gaunt, though, cheeks hollow, but you were both taking it day by day. It was all you could do.

Taking one of your hands with his own, Crosshair lifts it, pressing a soft kiss to the back of it, lips lingering for a moment against your delicate skin. As lovely as your compliments were, he was still uncomfortable accepting them, refusing to believe them regardless of how often you said them.

Gentle fingers sought out your wrist, and more circles were rubbed against your pulse point to offer comfort and as a way for Crosshair to monitor your heart rate. It was still too high for his liking.

Pushing up onto his feet, he moved to lay down on the bed, pulling you down next to him. As much as he loved his brothers and sister – their relationship starting to return to how it had been before Order 66 – there was no question in his mind that you came first. He didn’t care if you were both late. His siblings would understand.

Shifting position, you rest your head against Crosshair’s shoulder, hand pressed to his chest, using his heartbeat and the slow rise and fall of his chest to help anchor you. With his arm wrapped around you, holding you close, his fingers brush against your back in light patterns.

You could feel the meds starting to kick in, the dizziness and headache abating as you rested against your love. Still, you kept your eyes shut.

In the comfortable silence, Crosshair could only watch you rest against him, a smile tugging at his lips. Lifting his free hand, he stroked across your cheek, thumb brushing over the little pout of your lips. As you lean into his touch, warmth coils through him.

His gaze lingers on your face, tracing the delicate lines that tell stories of laughter and tears. The weight of the past had not broken you; instead, it had moulded you into someone he admired more with each passing day. “We’ll go when you’re ready.” He murmured, his voice a gentle promise. “No rush.” Crosshair’s fingers continued offering physical reassurance.

“Thank you.” You whisper, grateful for his care. When you’d joined the boys at the start of the war as their liaison with Command, you hadn’t expected to fall so quickly for the snarky sniper.

He hadn’t expected to fall for you, either.

Snuggling a little closer, you let out a slow exhale. “You’re too good to me.”

“I try to be, love,” Crosshair answers quietly, an ache in his chest at your words. Taking care of you was the least he could do after everything that had happened – the heartbreak on your face as he’d levelled his rifle at you as you’d fled Kamino with his brothers would forever haunt him, as would your tears when he’d opted to stay on that blasted platform after Tipoca City had fallen.

Yet you’d still rescued him from Mount Tantiss, careful hands undoing the bindings that had held him down for far too long, concern on your beautiful face as you’d helped him back to the Marauder and to safety.

He didn’t deserve you, no matter how often you told him he was wrong to think that.

“And you succeed.” You reassure him, wanting to pull his mind from any spiralling thoughts. He’d been getting better over the last few months, snippets of his old self shining through, but you knew the marks from his time with the Empire would never entirely be gone.

As your head feels less like it will split apart, you crack open your eyes a sliver, just enough to see Crosshair gazing down at you, the adoration on his face almost stealing your breath. “Hi.” You whisper, pleased that he’s no longer blurry and the planet has stopped spinning.

“Hi yourself.” He replies, lips pressing to your forehead in a gentle kiss.

Humming happily at the contact, you find his gaze again in the semi-darkness of the room. “I think I’m okay now. We should head out.” You decide. There’s a lingering uncomfortableness – you still feel a little off-kilter – but it’s much better than before, and you know it’ll pass soon. Besides, you’ll always find your equilibrium with Crosshair at your side.

Crosshair’s eyes narrow slightly. He doesn’t quite believe you but won’t outwardly call you out on it. “Another few minutes.” He decides, arms tightening around you.

“Cross…” You protest, trying to wiggle away, a smile tugging at your lips, mirrored by his own.

“Shush.” He admonishes playfully, rolling onto his side so he can drag you closer, tucking you against his chest and under his chin.

You can’t help but laugh, your body shaking a little as you burrow closer to him. You can’t deny that it feels cosy and safe. Content, you don’t argue it.

Crosshair’s small smile turns to a grin as he realises he’s won. “There’s my girl.”  

[covid-safer-hotties]

also preserved on our archive

By Korin Miller

Many COVID-19 variants have come and gone since the pandemic began, but some get more buzz than others. Now, there’s another new variant getting attention from the infectious disease community. It’s called XEC, and it’s currently spreading in Europe.

XEC is an Omicron variant that descended from subvariants KS.1.1 and FLiRT variant KP.3.3, according to Scripps Research’s Outbreak.info. XEC has several spike mutations, which is what the virus uses to infect you—and it might be more infectious that previous strains because of it.

So, will the new variant hit the U.S.? What symptoms should be on your radar? Here’s the deal.

Meet the experts: Amy Edwards, MD, associate professor at Case Western Reserve University and director of the Pediatric COVID Recovery Clinic at UH Rainbow Babies and Children’s Hospital; Mark Cameron, PhD, an associate professor in the Department of Population and Quantitative Health Sciences at the Case Western Reserve University School of Medicine. Emily Smith, ScD, MPH, is an epidemiologist and an assistant professor at the George Washington University Milken Institute School of Public Health.

What symptoms should I watch for? XEC is a pretty new variant and, with that, there isn’t a ton of information right now on symptoms people have experienced with it. However, early reports don’t suggest that it causes dramatically different symptoms from other strains of COVID-19.

According to the Centers for Disease Control and Prevention (CDC), symptoms may include:

Fever or chills

Cough

Shortness of breath or difficulty breathing

Sore throat

Congestion or runny nose

New loss of taste or smell

Fatigue

Muscle or body aches

Headache

Nausea or vomiting

Diarrhea

When will the new variant hit the U.S.? While the XEC variant is getting a lot of attention in Europe, it’s already hit the U.S. As of Sept. 3, data show that there have been 23 cases of COVID-19 caused by the XEC variant in the U.S., with three happening in California.

The virus was first detected here on July 14, but hasn’t been detected since Aug. 16. That doesn’t mean it’s no longer here, though. Because so many people do home tests (or don’t test at all) when they have symptoms of COVID-19, it can be tricky to get information on different strains of COVID-19.

Will it become the dominant COVID variant? That’s not clear. As of this second, XEC isn’t even a blip on the CDC’s radar. The CDC’s variant surveillance system shows that KP.3.1.1 is the dominant strain in the U.S., followed by KP.2.3, and LB.1. XEC isn’t even listed on the surveillance.

That doesn’t mean it won’t spread, though.

“Just like JN.1 emerged from BA.2.86 late last year to drive new COVID infections through last fall and winter, XEC may have similar potential,” says Mark Cameron, PhD, an associate professor in the Department of Population and Quantitative Health Sciences at the Case Western Reserve University School of Medicine. “But we need to know more about the XEC variant and perhaps those still to come.”

But lately we’ve seen several variants circulate heavily at the same time, points out Amy Edwards, MD, associate professor at Case Western Reserve University and director of the Pediatric COVID Recovery Clinic at UH Rainbow Babies and Children’s Hospital. “Dominant is a strong word,” she says. “With so many very contagious variants, I think the days of having one dominant variant is gone.”

How can I protect myself? The CDC currently recommends that everyone aged 6 months and up get the updated COVID-19 vaccine, making that a good place to start. “As yet another Omicron family member, being up to date on the latest COVID-19 booster is a protective measure we can take right now,” Cameron says.

"The main thing we can do to slow a new variant or new wave is to get our booster shots this fall," says Emily Smith, ScD, MPH, an epidemiologist and an assistant professor at the George Washington University Milken Institute School of Public Health. "Generally, we find the boosters give us broad protection, even against new variants."

It’s also a good idea to wear a mask in crowded indoor areas when levels of COVID-19 are high in your area, especially if you’re consider high risk for complications of the virus. And, of course, if you develop symptoms of the virus, it’s a good idea to test yourself to see if you have the virus so you can lower the odds you’ll spread it to others.

If you do, in fact, have COVID-19 and are considered high risk for serious complications from the virus, you may want to contact your primary care physician about taking an antiviral medication like Paxlovid.

[itsawritblr]

Breaking Down Cass Review Myths and Misconceptions: What You Need to Know.

An answer when some tranny or handmaiden disputes the review. (long post with lots of facts!)

Via The Quakometer:

It has now been just little under a week since the publication of the long anticipated NHS independent review of gender identity services for children and young people, the Cass Review.

The review recommends sweeping changes to child services in the NHS, not least the abandonment of what is known as the “affirmation model” and the associated use of puberty blockers and, later, cross-sex hormones. The evidence base could not support the use of such drastic treatments, and this approach was failing to address the complexities of health problems in such children.

Many trans advocacy groups appear to be cautiously welcoming these recommendations. However, there are many who are not and have quickly tried to condemn the review. Within almost hours, “press releases“, tweets and commentaries tried to rubbish the report and included statements that were simply not true. An angry letter from many “academics”, including Andrew Wakefield, has been published. These myths have been subsequently spreading like wildfire.

Here I wish to tackle some of those myths and misrepresentations.

Myth 1: 98% of all studies in this area were ignored.

Fact

A comprehensive search was performed for all studies addressing the clinical questions under investigation, and over 100 were discovered. All these studies were evaluated for their quality and risk of bias. Only 2% of the studies met the criteria for the highest quality rating, but all high and medium quality (50%+) studies were further analysed to synthesise overall conclusions.

Explanation.

The Cass Review aimed to base its recommendations on the comprehensive body of evidence available. While individual studies may demonstrate positive outcomes for the use of puberty blockers and cross-sex hormones in children, the quality of these studies may vary. Therefore, the review sought to assess not only the findings of each study but also the reliability of those findings.

Studies exhibit variability in quality. Quality impacts the reliability of any conclusions that can be drawn. Some may have small sample sizes, while others may involve cohorts that differ from the target patient population. For instance, if a study primarily involves men in their 30s, their experiences may differ significantly from those of teenage girls, who constitute the a primary patient group of interest. Numerous factors can contribute to poor study quality.

Bias is also a big factor. Many people view claims of a biased study as meaning the researchers had ideological or predetermined goals and so might misrepresent their work. That may be true. But that is not what bias means when we evaluate medical trials.

In this case we are interested in statistical bias. This is where the numbers can mislead us in some way. For example, if your study started with lots of patients but many dropped out then statistical bias may creep in as your drop-outs might be the ones with the worst experiences. Your study patients are not on average like all the possible patients.

If then we want to look at a lot papers to find out if a treatment works, we want to be sure that we pay much more attention to those papers that look like they may have less risk of bias or quality issues. The poor quality papers may have positive results that are due to poor study design or execution and not because the treatment works.

The Cass Review team commissioned researchers at York University to search for all relevant papers on childhood use of puberty blockers and cross-sex hormones for treating “gender dysphoria”. The researchers then graded each paper by established methods to determine quality, and then disregarded all low quality papers to help ensure they did not mislead.

The Review states,

As can be seen, the conclusions that were based on the synthesis of studies only rejected 24 out of 50 studies – less than half. The myth has arisen that the synthesis only included the one high quality study. That is simply untrue.

There were two such literature reviews: the other was for cross-sex hormones. This study found 19 out of 53 studies were low quality and so were not used in synthesis. Only one study was classed as high quality – the rest medium quality and so were used in the analysis.

Again, it is myth that 98% of studies were discarded. The truth is that over a hundred studies were read and appraised. About half of them were graded to be of too poor quality to reliably include in a synthesis of all the evidence. if you include low quality evidence, your over-all conclusions can be at risk from results that are very unreliable. As they say – GIGO – Garbage In Garbage Out.

Nonetheless, despite analysing the higher quality studies, there was no clear evidence that emerged that puberty blockers and cross-sex hormones were safe and effective. The BMJ editorial summed this up perfectly,

Myth 2: Cass recommended no Trans Healthcare for Under 25s.

Fact

The Cass Review does not contain any recommendation or suggestion advocating for the withholding of transgender healthcare until the age of 25, nor does it propose a prohibition on individuals transitioning.

Explanation

This myth appears to be a misreading of one of the recommendations.

The Cass Review expressed concerns regarding the necessity for children to transition to adult service provision at the age of 18, a critical phase in their development and potential treatment. Children were deemed particularly vulnerable during this period, facing potential discontinuity of care as they transitioned to other clinics and care providers. Furthermore, the transition made follow-up of patients more challenging.

Cass then says,

Cass want to set up continuity of service provision by ensure they remain within the same clinical setting and with the same care providers until they are 25. This says nothing about withdrawing any form of treatment that may be appropriate in the adult care pathway. Cass is explicit in saying her report is making no recommendations as to what that care should look like for over 18s.

It looks the myth has arisen from a bizarre misreading of the phrase “remove the need for transition”. Activists appear to think this means that there should be no “gender transition” whereas it is obvious this is referring to “care transition”.

Myth 3: Cass is demanding only Double Blind Randomised Controlled Trials be used as evidence in “Trans Healthcare”.

Fact

While it is acknowledged that conducting double-blind randomized controlled trials (DBRCT) for puberty blockers in children would present significant ethical and practical challenges, the Cass Review does not advocate solely for the use of DBRCT trials in making treatment recommendations, nor does it mandate that future trials adhere strictly to such protocols. Rather, the review extensively discusses the necessity for appropriate trial designs that are both ethical and practical, emphasizing the importance of maintaining high methodological quality.

Explanation

Cass goes into great detail explaining the nature of clinical evidence and how that can vary in quality depending on the trial design and how it is implemented and analysed. She sets out why Double Blind Randomised Controlled Trials are the ‘gold standard’ as they minimise the risks of confounding factors misleading you and helping to understand cause and effect, for example. (See Explanatory Box 1 in the Report).

Doctors rely on evidence to guide treatment decisions, which can be discussed with patients to facilitate informed choices considering the known benefits and risks of proposed treatments.

Evidence can range from a doctor’s personal experience to more formal sources. For instance, a doctor may draw on their own extensive experience treating patients, known as ‘Expert Opinion.’ While valuable, this method isn’t foolproof, as historical inaccuracies in medical beliefs have shown.

Consulting other doctors’ experiences, especially if documented in published case reports, can offer additional insight. However, these reports have limitations, such as their inability to establish causality between treatment and outcome. For example, if a patient with a bad back improves after swimming, it’s uncertain whether swimming directly caused the improvement or if the back would have healed naturally.

Further up the hierarchy of clinical evidence are papers that examine cohorts of patients, typically involving multiple case studies with statistical analysis. While offering better evidence, they still have potential biases and limitations.

This illustrates the ‘pyramid of clinical evidence,’ which categorises different types of evidence based on their quality and reliability in informing treatment decisions

The above diagram is published in the Cass Review as part of Explanatory Box 1.

We can see from the report and papers that Cass did not insist that only randomised controlled trials were used to assess the evidence. The York team that conducted the analyses chose a method to asses the quality of studies called the Newcastle Ottawa Scale. This is a method best suited for non RCT trials. Cass has selected an assessment method best suited for the nature of the available evidence rather than taken a dogmatic approach on the need for DBRCTs. The results of this method were discussed about countering Myth 1. Explainer on the Newcastle Ottawa Scale

As for future studies, Cass makes no demand only DBRCTs are conducted. What is highlighted is at the very least that service providers build a research capacity to fill in the evidence gaps.

Myth 4: There were less than 10 detransitioners out of 3499 patients in the Cass study.

Fact

Cass was unable to determine the detransition rate. Although the GIDS audit study recorded fewer than 10 detransitioners, clinics declined to provide information to the review that would have enabled linking a child’s treatment to their adult outcome. The low recorded rates must be due in part to insufficient data availability.

Explanation

Cass says, “The percentage of people treated with hormones who subsequently detransition remains unknown due to the lack of long-term follow-up studies, although there is suggestion that numbers are increasing.”

The reported number are going to be low for a number of reasons, as Cass describes:

Damningly, Cass describes the attempt by the review to establish “data linkage’ between records at the childhood gender clinics and adult services to look at longer term detransition and the clinics refused to cooperate with the Independent Review. The report notes the “…attempts to improve the evidence base have been thwarted by a lack of cooperation from the adult gender services”.

We know from other analyses of the data on detransitioning that the quality of data is exceptionally poor and the actual rates of detransition and regret are unknown. This is especially worrying when older data, such as reported in WPATH 7, suggest natural rates of decrease in dysphoria without treatment are very high.

This suggests that active affirmative treatment may be locking in a trans identity into the majority of children who would otherwise desist with trans ideation and live unmedicated lives.

I shall add more myths as they become spread.

[electricbloodflow]

dissociative experiences scale 2

The DES is such a fun diagnostic tool. I've had a couple of therapists and psychiatrists administer it to me. It's an empirically tested scale that gets a feel for tbe magnitude of a person's dissociation.

I score differently depending on alter (they reason what each question means and how frequently it occurs differently) but usually score in the 45 to 65 range. When I was younger my scores were generally in the 60 to 80 range. Progress!?

I used to score high on questions like dissociating so hard you literally see yourself in the third person and you are approached by people you don't recognize who know you, but I very rarely experience that anymore. I keep forgetting about the experience of seeing myself in the third person during dissociative episodes - that was such a severe symptom that I used to occasionally experience.

For anyone interested in taking it, you can take it here. Today, I obtained a 66. I have been unusually stressed lately.

The website has some interesting information on here. In studies, certain mental illnesses were associated with certain scores.

>!Dissociative Experiences Scale Scores

Explained High and Low DES Scores

High levels of dissociation are indicated by scores of 30 or more, scores under 30 indicate low levels. Successful treatment of a dissociative disorder should reduce the DES score when compared to the result before treatment began. Very high scores do not necessarily mean a more severe dissociative disorder is present, this is because the scale measures both normal and pathological dissociation.

Dissociative Identity Disorder and the DES

Only 1% of people with Dissociative Identity Disorder have been found to have a DES score below 30. A very high number of people who score above 30 have been shown to have Posttraumatic Stress Disorder or a dissociative disorder other than Dissociative Identity Disorder.

Clinical Uses of the Dissociative Experiences Scale

If a person scores in the high range (above 30) then the DES questions can be used as the basis for a clinical interview, with the clinician asking the client to describe examples of the experiences they have had for any questions about experiences which occur 20% of the time or more. Alternatively, the Dissociative Disorders Interview Schedule (DDIS) or Structured Clinical Interview for Dissociative Disorders (SCID-D) can be used to reach a diagnosis.

Average DES Scores in research:

General Adult Population 5.4

Anxiety Disorders 7.0

Affective Disorders 9.35

Eating Disorders 15.8

Late Adolescence 16.6

Schizophrenia 15.4

Borderline Personality Disorder 19.2

Posttraumatic Stress Disorder 31

Dissociative Disorder Not Otherwise Specified 36

Dissociative Identity Disorder (MPD) 48!<

[nenelonomh]

skincare practices

skincare refers to the practice of maintaining and improving the health and appearance of your skin. this post is a guide on where to start!

having a routine (starting with simple practices)

cleanser: begin and end your day by washing your face with a gentle, sulphate-free cleanser. even if your skin feels clean, this step removes any impurities.

moisturizer: apply a fragrance-free moisturizer twice a day. hydration is crucial for maintaining a healthy skin barrier.

sunscreen: protect your skin from uv damage by using a mineral- or chemical-based sunscreen with at least spf 30. apply it in the morning.

skin types

there are 5 primary skin types, each with unique characteristics and needs.

normal skin is balanced and not too oily or dry. it's like the goldilocks of skin types! maintain it with a gentle routine. if your skin is generally normal, opt for a lotion. as you age, consider switching to a cream-based moisturizer for added hydration.

dry skin lacks hydration, feels tight, and may have flakiness. opt for richer moisturizers with ingredients like hyaluronic acid and ceramides. for dry skin, skip lotions and go for creams or ointments. these provide more moisture and help preserve water in the skin.

oily skin produces excess oil, especially in the t-zone (forehead, nose, and chin). use lightweight, oil-free products and consider salicylic acid for acne-prone areas. if you’re prone to oiliness, choose a light gel-based moisturizer to avoid clogging pores.

combination skin is a mix of oily and dry areas. focus on balancing - light moisturizers for oily zones and richer ones for dry areas. treat your face as two zones. moisturize the dry areas and skip the oily ones. remember to look for spf 30 or higher for sun protection!

sensitive skin is prone to redness, irritation, and reaction. choose fragrance-free, hypoallergenic products and patch-test any new products.

common skincare mistakes

skipping sunscreen. sunscreen is non-negotiable! protect your skin from uv damage by using spf 30 or higher daily. if you live in a sunny environment, make sure to reapply before you go outside!

not cleansing before bed: properly cleanse your face before sleeping. it removes dirt, makeup, excess oil, and pollution remnants, preventing breakouts and maintaining healthy skin.

sleeping with makeup on. gross! no! remove your makeup before you go to bed to prevent clogged pores and skin irritation.

using too many products. overloading with products can overwhelm your skin, so learn how to simplify your routine. additionally, using products that are not right for your skin may have negative effects - creating more issues instead of solving them.

overusing acne products. be gentle with acne treatments. overuse can lead to dryness and irritation.

using harsh products. avoid aggressive ingredients that strip your skin. opt for gentle formulations.

remember - healthy skin starts with mindful habits.

further reading

understanding skin - skin types and conditions | eucerin

what are skin types? | verywellhealth ↑ this link has a 'determining your skin type' section

how to pick the right moisturizer for your skin | american academy of dermatology association

combination skin care (youtube video) | dr. aanchal md

how to build a skincare routine for beginners | arizona dermatology

skin care: 5 tups for healthy skin | mayo clinic

end notes

thank you for reading! i get a lot of skincare practice asks, so i figured it was about time i had a good response.

as always - if you're troubled by your skin take yourself to see a professional. they are specially trained to help you with your problems. this post will only be able to share with you what i have researched. definitely have a look into some of the 'further reading' links - it's so important to learn about (and determine your skin type).

if you'd like to have a look at more of my skincare posts, check out 'how to reduce acne - and what is acne?' and 'how to properly wash your face'. feel free to send any questions to my ask box!

❤️nene

[religion-is-a-mental-illness]

By: Mary Harrington

Published: Feb 19, 2024

A new study challenges the common assertion that gender-dysphoric youth are at elevated risk of suicide if not treated with “gender affirming” medical interventions. If it’s true, it ought to have a seismic impact on the accepted medical approach to gender-confused youth.

Reported in the BMJ, the study examines data on a Finnish cohort of gender-referred adolescents between 1996 and 2019, and compares their rates of all-cause and suicide mortality against a control group. While suicide rates in the gender-referred group studied were higher than in the control group, the difference was not large: 0.3% versus 0.1%. And — importantly — this difference disappeared when the two groups were controlled for mental health issues severe enough to require specialist psychiatric help.

In other words: while transgender identity does seem to be associated with elevated suicide risk, the link is not very strong. What’s more, the causality may not work the way activists claim.

The association between gender dysphoria and mental illness is well-documented by both providers of “gender-affirming care” and trans advocacy groups and clinical psychology research. But one less well-evidenced claim, based on this association, is that these difficulties are caused not by being transgender, but by the political and social stigma associated with it. Gender dysphoria, we are to understand, is not in itself a mental health issue. What causes mental health issues in transgender youth — up to and including suicide — is the wider world’s rejection of their identity, and of the metaphysical frame of “gender identity” as such.

This is the root of the oft-repeated social media assertion that anyone who demurs about trans identity, however mildly, is complicit in “trans genocide”. The same assertion that invalidating trans youth makes them kill themselves is also behind the rhetorical question routinely used to browbeat parents into consenting to social and medical transition for their gender-confused offspring: “Would you rather have a live daughter or a dead son?”

It’s behind the prohibition on “trans conversion therapy” already in force in several countries, and promised by the Labour Party in England too. Such measures forbid therapists from exploring with their clients whether there is any link between their gender dysphoria and — for example — life trauma or other mental health issues. For logically, if the cause of distress and suicidality in trans people is not being accepted for who they are, any therapist who seeks to explore links between gender dysphoria and other biographic or psychiatric issues is complicit in just this kind of non-acceptance, and is thus not helping but harming their client.

But as the study puts it: “Clinical gender dysphoria does not appear to be predictive of all-cause nor suicide mortality when psychiatric treatment history is accounted for.” Rather, what predicts risk in this population is “psychiatric morbidity”. And contra the activists, transitioning does nothing to reduce it: “medical gender reassignment does not have an impact on suicide risk.”

Every suicide is a tragedy, and leaves grieving loved ones behind. No one wants to be complicit in pushing a young person down that path. So the suggestion that questioning someone’s gender beliefs may have this effect serves as a powerful emotional cudgel. But if the Finnish study is correct, this whole rhetorical, legislative, and medical edifice may be built on sand. If the elevated risk of suicidality in trans youth disappears when you control for other psychiatric difficulties, this suggests strongly that trans youth are not more at risk due to transphobia or invalidation, but due to the well-documented fact that gender dysphoria tends to occur in people who are disturbed and unhappy more generally.

It ought to follow from this that the way to manage suicide risk in trans-identified young people is not to affirm their gender identity and whisk them off for medical interventions, but to watch for and treat psychiatric comorbidities. Ultimately, though, the claims of gender ideology are less scientific than metaphysical. So don’t expect scientific evidence that contradicts its prescriptions to have much impact on trans advocates. Even if “following the science” would make a real difference to suicide risk in gender-dysphoric youth.

==

History will view "gender affirming care" advocates the same way we view lobotomy advocates.

[antimisinfo]

as someone who has maladaptive daydreaming disorder this pisses me off so FUCKING BAD. im too shakey to type much less read this fully but oh my fucking god. oh my god. what the FUCK. how fucking DARE this person take MY DISORDER and twist it to conform to their DISGUSTING ABLEIST BELIEFS?? im reFUCKINGvolted

https://www.tumblr.com/alyssasmaddworld/741046067507904512/theres-this-level-of-dissociation-that-goes-hand?source=share

i- this post is a lot, but i'll try deconstruct each point here.. i'll be focusing on points that i can debate here / can disprove or try to disprove here because otherwise this will be a really long post,, longer than it already is. also i'll be referring to maladaptive daydreaming as MD for simplicity's sake. if i get any information on MD wrong please let me know as i do not have this disorder(?) nor do i know much about it outside of the research done for this post.

the source linked here does say that it is a dissociative disorder and it does say that it might not be caused purely by trauma " Although trauma may be one causal factor, we indicate several other etiological pathways to the development of MD. We discuss associations with related concepts and suggest directions for future research " so there isn't much for me to say here other than the part about plurality, but we'll go more into depth on that below.

this.. the source they used is pluralpedia.. which used the source of a tumblr blog.. so lets get into this. the first source also mentions maladaptive characters / MD characters but it also says that it is not like DID " We discuss and exemplify with clinical vignettes the shared phenomenological characteristics between MD and dissociative phenomena, such as double consciousness, vivid visual imagery, and the creation of internally narrated characters. MD characters can be experienced as somewhat independently-agentic, although unlike dissociative identity disorder (DID), they typically do not take control over the daydreamer’s behavior "

so lets look into MD characters, shall we? the only source i can find on MD characters ((other than the one they linked / tumblr posts)) consider them more of a form/type of daydreaming (experiencing the daydream as yourself or as a character, daydreaming about a character, ect). these characters are not at all similar to alters and the "closest" i found was the foreign character

" For those who heavily engage in maladaptive daydreaming, they often will begin to develop "The Foreign Character" type of maladaptive daydreaming. In this type, you daydream about a central character who you believe is yourself, but who is fundamentally different in almost all respects. " — maladaptivedaydreaming.org

however these are not at all similar to alters which are

"  two or more separate identities called “alters.” They control your behavior at various times. Each alter has its own personal history, traits, likes, and dislikes " — WebMD

the same source on foreign characters also states that " The reality is that for most people, they engage in these kinds of daydreams because they want to daydream about things entirely devoid from themselves and their real world experience. They don't want to daydream about themselves being a doctor or being better looking (to use the prior examples I used), but instead they want to dream about themselves being entirely different people so they can escape from who they really are. ". other than that source there is very little evidence on these characters being separate identities, even then it's important to keep in mind that it is not the same as having a split identity as it only appears during daydreams i would assume and would not be able to control you, how you think, how you behave, ect. ((which the first source literally said,, do endos even read their sources??)) i would also like to add that if these characters feel real and you believe all your daydreams to be real then it might actually be a delusion. there's nothing wrong with having delusions but it is also important to recognise that it's not real and that it does not at all compare to being a system.

the first source they used to claim that having MD is the same as being plural is a pro endo source, it defines being plural as " The most simplified definition of the term plural that includes all people who take the label is “someone who shares the same physical body with other individuals.”  Such a group is sometimes referred to as a system, though many plural groups use different terminology. " which,, again having daydreams are is not the same as having separate identities, so really this source means nothing.. and the second source is.. just insane really. its a study done on the experiences of those with multiple identities. they did two things, one was an online survey that had 200-300 results and then 6 interviews.. which is definitely not enough evidence, since they cannot know if people are lying on those online surveys and 6 people are not enough to make it a reliable source. but lets focus on the part they pointed out, which was:

" Empirical measurement of multiplicity is sparse. The first inventory published in the field was the Plural Self Scale (Altrocchi, 1999), which assesses the structure of the personality. High scores indicate that thoughts and feelings are different through time and situations. The other inventory to assess multiplicity was developed by Carter (2008) and consists of 20 items, such as “Does your handwriting change noticeably at different times?” or “Do you swing suddenly from one mood to another for no apparent reason?.” However, these scales measure the integrity of the self and rely on the assumption that there is a “you” or “I” who is able to self-reflect. Individuals who consider themselves multiple refer to themselves as a group of selves (“we”). Thus, questionnaires that assess the extent of self-integration fail to assess the experience of individuals who claim to have multiple selves who all have different thoughts, feelings, motivations, and levels of complexity. " which-- just isn't much of a criteria other than the questions, of which are "does your handwriting change at different times" and " do you swing from one mood to another with no apparent reason", but it literally says this fails to asses those who claim to be plural-- so i don't see what their point was here really. it just seems like they're saying words for the sake of saying words.

i don't think this person realises what closed culture is.. tulpulmacy is not a form of being plural nor should it be considered that, thoughtforms are usually used purely for meditation or for your spiritual journey, not for fun,, unlike "tupla systems" which are often not even Buddhists, which is the main issue. a closed practise, which is what tulpulmacy is, is a "practice in which you can only take part in their craft if you were specifically born into the practice, or went through an initiation process.". while i'm not 100% sure what exactly they mean with the last part there isn't much for me to say here other than the fact that tulpulmacy is not the same as being plural and we did have a former Buddhist actually talk to us about this here! and while it isn't exactly sourced i feel its still an important read.

i believe they're speaking about the word plural here,, which wasn't made by endos?? the word plural just refers to more then one. unless they mean traumagenic?? which then confuses me because their source doesn't really mention it--

culture is dynamic yes, but some cultures are closed and it's important to understand that-- just because the culture is shifting doesn't mean you can steal closed practises.

"endogenic sphere" makes me shiver but okay, lets talk about this too. there isn't a lot of research on MD, so i cannot say what the direct cause is. "Experts don’t know exactly why maladaptive daydreaming happens. However, they suspect it happens because maladaptive daydreaming can be a coping mechanism for problems like anxiety, depression and other mental health conditions."

no?? what?? as i said above, many times, having MD is not the same as having DID / being a system and also the image only refers to feeling disconnected from the body and sense of identity which is pretty common with dissociation and doesn't exactly prove anything related to endogenic systems..

i- ?? i mean as i said before we don't know what exactly causes MD but i don't believe people chose to do this?? not really??

" maladaptive daydreaming is often compulsive, which means a person feels like they need to do it. Because the need to daydream is similar to an addiction, daydreaming more often can make it a strong habit, so it’s very hard to stop doing it. That’s why seeking mental healthcare for it sooner rather than later is important. "

but all being said, its not a vaild form of plurality because its nothing like having separate identities?? sure when daydreaming you might identify as a different person but you're still you. your overall identity is intact and i'm pretty sure most people with MD do not think their daydreams are real, i believe that would be a delusion instead of a daydream-- and an important separation is these characters would only show up in daydreams i assume, while alters are always there, infact in DID you yourself is an alter but in MD one of you is a person and the other is a character created through daydreams,, which is not comparable to genuine parts / alters. ((also please do not harass the person who made the original post, our post / response is purely meant to educate and correct misinformation and we do not intend for people to go to the op's blog and send them things))