Nearly eight thousand endocrinologists from all over the world met in New Orleans for 5 days and speakers at each session were drawn from well known, highly published researchers and clinicians working on the topics they discussed.
If you pay your money, you can attend and even as a wee little humble country endocrinologist, you can go up to the microphone and ask your question of the giant on the stage.
My first question was prompted by the comment from the professor who was discussing weight loss diets which included intervals of severely restricted caloric intake, alternating with less severe restrictions. She began by saying that she was from Wisconsin where 65% of the population is obese, so she had no chance to find human beings who were willing to severely calorie restrict for her studies, so she studied mostly rats.
I rose to point out that she had on her campus a cohort of young men who had engaged in severe calorie restriction from roughly age seven for 6 months of each year until they were 22 and they were spending 4 years on her campus: The wrestlers.
She blinked like a deer in the headlights and asked the other doctors on the stage what I had said. "The wrestling team," one of them explained. "Oh," she said, clearly having no idea what I was talking about and that was her entire interest in the proposition.
I have long thought the caloric privation of this group of human beings ought to be studied systematically. There is a theory that diabetics who are intensively controlled with weight reduction and sugar control, if only for a year or two will have a "legacy" effect lasting many years. If this is true, what happens to the young men who have been rigidly controlling their weight and diet? Do they have a legacy effect after they finish their wrestling careers?
No interest in that on the part of the scientists.
Another professor talked about adrenal nodules which have been called "Non functioning" for decades, meaning they do not over produce any of the hormones made by the adrenal gland. They have been thought to be inert, just sort of like calluses, a lump in the bread dough. But this professor showed a slide demonstrating these nodules make the usual array of adrenal hormones, just none in excess. I asked whether we should not drop the term "non functioning" since they clearly did function, just not excessively. Again, the professor seemed stunned. But we've always called them non functioning adenomas.
But the best was the testosterone lectures. The professor went through the very common problem of young men who "abused" testosterone, usually "gym rats" who take industrial doses of testosterone they get illicitly at the gym, but when their supplier runs out, they often stop their injections and allow their blood levels to fall to very low levels. It takes a while for the testicles, which have shut down while a tidal wave of exogenous testosterone from the bottle has been washing through, to restart and to fire up endogenous production. During that recovery period, the man can go to his primary care nurse and ask for a testosterone level, which is temporarily low, and then they get referred to the endocrinologist so they can get prescriptions for testosterone to inject.
Of course, this game is easy to recognize: The patient comes in looking like Arnold Schwartzenager, his testes often small and atrophic, complaining of "low T." The professor described a variety of lab studies to confirm all this, and much discussion ensued about who to deal with these drug abusers.
These men are in some ways like anorexia nervosa patients, who look in the mirror and no matter how thin they are the anorectics see a fat person; the same is true for the testosterone abusers; no matter how muscular and bulky they get, they see themselves as under muscled. Doctors from other countries described how they treat these patients in clinics alongside psychiatrists.
Then I visited the talk by the doctor from Mt. Sinai Hospital (NYC) who talked about how he replaces testosterone in his patients who are female to male transgenders and how he relentlessly increases the dose of testosterone, raising their blood levels to "levels we see in androgen abusers" but this is necessary to achieve the goals of facial hair growth, voice deepening, muscle development.
After the session, I emailed the professor who had spoken about "androgen abusers" and asked whether he would agree that the folks treating transgenders were not also "androgen abusers," both the doctors and the patients.
He replied that this was using testosterone for "gender affirming" goals and only if the patients were attempting to become overly muscular would he think of this as androgen abuse.
The fact is, political/value thinking has driven the approach to "transgender medicine." The suicide rate among transgender patients has remained between 25 and 30% for 30 years.
If we embarked on any other sort of therapy for patients which was attended by a 30% mortality rate, would we be permitted to persist?
The transgender clinic folks say transgenders commit suicide because they are so abused by an intolerant society.
But is it not also possible transgender commit suicide at such astonishing rates because the underlying disorder is itself, a severe psychiatric disease? Are we actually helping these folks by giving them what they ask for?
It is also remarkable how wide the range of therapy: Some female to males do not want voice changes but just to "seem more masculine" and so they are given just a little testosterone. Others receive super doses if that's what they want. Some receive testosterone but continue to have vaginal intercourse, and need contraception so they don't get pregnant.
When discussing placing IUD's in these patients, one of the treating physicians remarked the whole procedure of placing the IUD was very traumatic for the patient, presumably because it was a reminder of their underlying anatomy--in a patient who is having vaginal intercourse!
Much was made of the idea that we all ought to be careful to elicit what "pronoun" the patient prefers to refer to himself/herself with. Females to males often want to be referred to as "him." This should be scrupulously complied with.
Some "binary" patients (those who identify with both or neither gender) want to be referred to as "they."
My mind is clearly too inflexible to accommodate all this. It all struck me as the inmates in charge of the asylum. And that is just what the transgender clinic folks would object to: We are not superior to these patients and it is patronizing to even question whether we should not give them anything they wish.
Which means, of course, we have to give the transgender all the testosterone he desires but we refuse this to the male who wants to "abuse" testosterone to get the effect of increased muscle mass.
If you pay your money, you can attend and even as a wee little humble country endocrinologist, you can go up to the microphone and ask your question of the giant on the stage.
My first question was prompted by the comment from the professor who was discussing weight loss diets which included intervals of severely restricted caloric intake, alternating with less severe restrictions. She began by saying that she was from Wisconsin where 65% of the population is obese, so she had no chance to find human beings who were willing to severely calorie restrict for her studies, so she studied mostly rats.
I rose to point out that she had on her campus a cohort of young men who had engaged in severe calorie restriction from roughly age seven for 6 months of each year until they were 22 and they were spending 4 years on her campus: The wrestlers.
She blinked like a deer in the headlights and asked the other doctors on the stage what I had said. "The wrestling team," one of them explained. "Oh," she said, clearly having no idea what I was talking about and that was her entire interest in the proposition.
I have long thought the caloric privation of this group of human beings ought to be studied systematically. There is a theory that diabetics who are intensively controlled with weight reduction and sugar control, if only for a year or two will have a "legacy" effect lasting many years. If this is true, what happens to the young men who have been rigidly controlling their weight and diet? Do they have a legacy effect after they finish their wrestling careers?
No interest in that on the part of the scientists.
Another professor talked about adrenal nodules which have been called "Non functioning" for decades, meaning they do not over produce any of the hormones made by the adrenal gland. They have been thought to be inert, just sort of like calluses, a lump in the bread dough. But this professor showed a slide demonstrating these nodules make the usual array of adrenal hormones, just none in excess. I asked whether we should not drop the term "non functioning" since they clearly did function, just not excessively. Again, the professor seemed stunned. But we've always called them non functioning adenomas.
But the best was the testosterone lectures. The professor went through the very common problem of young men who "abused" testosterone, usually "gym rats" who take industrial doses of testosterone they get illicitly at the gym, but when their supplier runs out, they often stop their injections and allow their blood levels to fall to very low levels. It takes a while for the testicles, which have shut down while a tidal wave of exogenous testosterone from the bottle has been washing through, to restart and to fire up endogenous production. During that recovery period, the man can go to his primary care nurse and ask for a testosterone level, which is temporarily low, and then they get referred to the endocrinologist so they can get prescriptions for testosterone to inject.
Of course, this game is easy to recognize: The patient comes in looking like Arnold Schwartzenager, his testes often small and atrophic, complaining of "low T." The professor described a variety of lab studies to confirm all this, and much discussion ensued about who to deal with these drug abusers.
These men are in some ways like anorexia nervosa patients, who look in the mirror and no matter how thin they are the anorectics see a fat person; the same is true for the testosterone abusers; no matter how muscular and bulky they get, they see themselves as under muscled. Doctors from other countries described how they treat these patients in clinics alongside psychiatrists.
Then I visited the talk by the doctor from Mt. Sinai Hospital (NYC) who talked about how he replaces testosterone in his patients who are female to male transgenders and how he relentlessly increases the dose of testosterone, raising their blood levels to "levels we see in androgen abusers" but this is necessary to achieve the goals of facial hair growth, voice deepening, muscle development.
After the session, I emailed the professor who had spoken about "androgen abusers" and asked whether he would agree that the folks treating transgenders were not also "androgen abusers," both the doctors and the patients.
He replied that this was using testosterone for "gender affirming" goals and only if the patients were attempting to become overly muscular would he think of this as androgen abuse.
The fact is, political/value thinking has driven the approach to "transgender medicine." The suicide rate among transgender patients has remained between 25 and 30% for 30 years.
If we embarked on any other sort of therapy for patients which was attended by a 30% mortality rate, would we be permitted to persist?
The transgender clinic folks say transgenders commit suicide because they are so abused by an intolerant society.
But is it not also possible transgender commit suicide at such astonishing rates because the underlying disorder is itself, a severe psychiatric disease? Are we actually helping these folks by giving them what they ask for?
It is also remarkable how wide the range of therapy: Some female to males do not want voice changes but just to "seem more masculine" and so they are given just a little testosterone. Others receive super doses if that's what they want. Some receive testosterone but continue to have vaginal intercourse, and need contraception so they don't get pregnant.
When discussing placing IUD's in these patients, one of the treating physicians remarked the whole procedure of placing the IUD was very traumatic for the patient, presumably because it was a reminder of their underlying anatomy--in a patient who is having vaginal intercourse!
Much was made of the idea that we all ought to be careful to elicit what "pronoun" the patient prefers to refer to himself/herself with. Females to males often want to be referred to as "him." This should be scrupulously complied with.
Some "binary" patients (those who identify with both or neither gender) want to be referred to as "they."
My mind is clearly too inflexible to accommodate all this. It all struck me as the inmates in charge of the asylum. And that is just what the transgender clinic folks would object to: We are not superior to these patients and it is patronizing to even question whether we should not give them anything they wish.
Which means, of course, we have to give the transgender all the testosterone he desires but we refuse this to the male who wants to "abuse" testosterone to get the effect of increased muscle mass.
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