maradydd: (Default)
First, the OMGWTFBBQ. Via Pharyngula, the Hastings Center Bioethics Forum, and TIME Magazine: pediatric endocrinologists Maria New and Saroj Nimkarn are advocating prenatal treatment with the glucocorticoid dexamethasone to "reduce behavioral masculinization" of female children.

Yes, you read that right: they want to expose pregnant mothers to one of the most potent, adverse-effect-prone steroids out there in the hopes of molding unborn girls into models of femininity.

I'll give you a few minutes to find where your lower jaw rolled off to and get a glass of water -- throwing up in your mouth a little is bad for your teeth. When you get back, I'll expand a little on the current standards of practice, and then we're going to go over some organic chemistry.

Back now? Great. First, PZ got one important fact wrong: the American Academy of Pediatrics and other noteworthy medical organizations have absolutely not condoned or endorsed this practice. The "consensus" to which PZ refers is an agreement that the study of dexamethasone as a preventative for congenital adrenal hyperplasia due to 21-hydroxylase deficiency should be conducted "via IRB-approved clinical trials through research centers large enough to obtain meaningful data" and with follow-up studies. This is, in my opinion, a reasonable position. CAH gets press because one of its effects can be ambiguous genitalia, sometimes aka "intersex", but its effects on aldosterone (one of the steroids your body produces) can lead to dehydration, hyponatremia, hyperkalemia, metabolic acidosis and death, in infancy. "Ambiguous" is also used, erm, ambiguously; it doesn't only mean "large clitoris", it also includes things like the urethra and vagina opening into a common cavity and causing severe urinary tract problems.

If there is sufficient reason to believe that prenatal dexamethasone can keep children whose genes prevent them from producing 21-hydroxylase alive, or make it possible for them to avoid difficult, expensive and painful surgery to restore urinary function, that is a valid avenue for research conducted under the auspices of an institutional review board. Attempting to tweak girls' personalities to make them more girly is way, way out of bounds, and New and Nimkarn should be censured for even suggesting the idea.

But what I really want to talk about is steroids, and what you, dear reader, do and don't already know about them.

"Steroid" is a really, really broad term. It's as broad as "sugar" or "alcohol". (The categories also overlap, which can be confusing; there are sugar alcohols and steroid alcohols.) When you think of "sugar" you probably think of that grainy white stuff you put in your coffee, and when you think of alcohol you probably think of booze -- but the picture is actually much bigger. All monosaccharides and disaccharides are sugars, including the ribose and deoxyribose that form the backbone of your RNA and DNA. Ethanol is the alcohol we drink, but it's just one of the aliphatic alcohols, which also include isopropanol (rubbing alcohol), methanol (can blind or kill you if you drink it!), xylitol (used to sweeten chewing gum), mannitol (baby laxative), ethylene glycol (antifreeze!), and glycerol (aka glycerin). I won't bore you with all the various non-aliphatic alcohol families, but there are a lot of them. So, also, with steroids.

Steroids are emphatically not just what dumb jocks inject to get really ripped really fast. (Those are certain anabolic steroids.) Just as "alcohol" refers to organic molecules with an -OH bound to a carbon atom and "sugar" refers to a particular type of carbohydrate building block, "steroid" specifically means "molecule with three six-carbon rings and one five-carbon ring in a particular arrangement". (That four-ring core is called a sterane, if you were curious.) And, wow, are there ever a lot of them. Cholesterol is a steroid. So are androgens (including testosterone), estrogens (there's more than one), and progestagens (humans only have the one, progesterone). But unless you're on hormonal birth control, taking estrogen or testosterone replacements, taking progesterone as part of fertility treatment, or otherwise tweaking your own sex hormones, if your doctor prescribes you a "steroid" it is almost certainly going to be one of the corticosteroids.

Dexamethasone is, as I said above, a glucocorticoid -- a member of the family of corticosteroids that can affect immune function. (In the interest of space, I'm going to skip the other family, the mineralocorticoids.) It is, not to put too fine a point on it, the nuclear option of corticosteroids. Long-term use -- which, for glucocorticoids, means more than a week -- causes the adrenal glands to start shutting down; stopping glucocorticoids abruptly after this has happened can cause an Addisonian crisis, which can be fatal. Even long-term use as directed frequently causes Cushing's syndrome, which has a whole raft of nasty symptoms including rapid weight gain, high blood pressure, insulin resistance, severe anxiety, and psychosis. As if that weren't enough already, long-term use also causes osteopenia, a lowering of bone density that is the precursor to osteoporosis.

Given the degree of side effects involved with long-term dexamethasone usage -- and the several weeks of treatment involved in the New and Nimkarn study constitutes "long-term" -- the "behavioral masculinization" paper rolls over from "horrible" to "sheer, unrestrained evil". They are literally advocating putting pregnant women through multiple weeks of chemical torture -- not to save lives, but in pursuit of a behavioral "ideal".

If you think this is anything even remotely resembling right, I invite you to spend a month on dexamethasone -- without medication to mitigate side effects, remember we can't give benzos to pregnant mothers because they might adversely affect the fetus! -- and find out what it does to you. The stretch marks alone -- which look more like "I lost a fight with a cage full of tigers" than "boo, cellulite" -- will last a lifetime; the psychological damage from finding out just how deep your capacity for violence and self-hatred can run may fade, eventually.

All that said, there is one extremely valid prenatal use for dexamethasone. If you're about to give birth to a premature baby younger than 34 weeks, one injection of dexamethasone 24-48 hours prior to birth will help the baby's lungs produce the surfactant which it needs to be able to breathe. (Multiple doses used to be the standard, but -- big surprise -- it turns out that the beneficial effects of multiple doses are no higher, in any statistically significant sense, than of a single dose, and the adverse effects on both mother and fetus with multiple doses are worse.) Consider the difference, though: one injection versus several weeks of dosing, sharp increase in likelihood of survival versus reinforcing social norms. It's like day and night.

What it all comes down to, in the end, is this: be an informed patient. Ask questions. When you're prescribed a medication, the minimum you need to know is:
  1. What exact medication is this? Don't accept a category as an answer. You wouldn't hire a contractor who told you she was going to build your cabinets out of "wood"; you wouldn't hire a florist who told you he would make your anniversary bouquet out of "plants".
  2. How long will you be on it?
  3. What is the intended benefit of taking this medication?
  4. What are the potential or likely adverse effects for the timeframe in which you'll be on it?
  5. (if applicable) What are the potential interactions with any other prescription medications, over-the-counter medications, supplements, herbs, &c you take?

Doctors have a lot of training, and they do learn how to perform risk analysis, but at the end of the day, you are the one who gets to decide whether the potential benefits of any medication are worth the risks involved. You can't know the benefits or the risks unless you know exactly what you're putting in your body. Ask, and don't put up with bullshit non-answers.
maradydd: (bad post!)
Via [ profile] fjm, British government finally apologises for its appalling treatment of Alan Turing and other gay men.

By any sensible definition of sainthood, Alan Turing ought to have been canonised long ago (along with Alonzo Church, Haskell Curry, John Backus, John von Neumann, and a small host of other dead computer scientists, but that's another story for another time). The ability to capture something as powerful and as potentially complex as recursively enumerable computation in an idea as straightforward and easy-to-understand as the Universal Turing Machine is the stuff of legends, and the sheer breadth and depth of innovation that the Von Neumann architecture -- inspired pretty much directly by the Turing machine -- has made possible over the last sixty years is nothing short of miraculous. (Well, apart from the fact that we can trace the developments and where they came from, all the way back to the source, which is not common with miracles in the traditional sense. But I digress.)

No, I'm not asking the British government to fall all over itself in self-flagellation for what it did. Gordon Brown's apology is frank and dodges no bullets, and the lack of weaselling is commendable. I am asking, though, that the government keep in mind, moving forward, that it drove one of the most brilliant minds of his generation or any other to suicide over the crime of being different, and to adjust its policies accordingly.

I do not know, and cannot reasonably predict, what Alan Turing would have made of the rest of his life had he lived it to its natural end. Like all the great hackers, curiosity was forever nipping at his heels, and it could have driven him anywhere. Perhaps he would have pursued his passionate interest in human consciousness, or come up with a formalism for an even stronger computational mechanism -- the kind of thing we've blackboxed as an "oracle" for the last sixty years. Perhaps he would have settled down with a nice boy and taken up gardening. That would have been great too, because hey -- it wouldn't have been a life full of undeserved surveillance and forced chemical castration. People do better things with themselves when they're not under that kind of stress.

No, British government, it does not make it any better when you go from just keeping the queers under surveillance to putting everyone under surveillance.

And for everyone else -- let this serve as a lesson to you. Keep an eye on what your watchmen are doing to the different among you, because you're next. This is how social control works: test your procedures out on an "undesirable" sector of society, because who cares about them anyway, and refine the procedures to the point where they're still useful but are statistically unlikely to provoke much in the way of outrage. If the undesirables later lose their undesirable status, apologise for the ones you killed, and keep on going.
maradydd: (Default)
Worth exactly what you paid for it, so hey, if I piss you off, all you wasted was your time.

Anyway. I recently read some discussion in a trans* community about the following excerpt from an HRC newsletter:
Getting the truth in front of the American public is no small undertaking. Extremist groups are not only attacking equal rights we've already won – they are raising millions to shut down progress on victories yet to come.

Backed by supporters like you, here's how we're making a stand:

* In Maine, preparing to defend marriage equality at the ballot – sure to be a major fight;
* In California, rolling out a massive initiative to organize clergy and religious communities in support of marriage equality;
* In New Hampshire, building grassroots pressure behind the marriage bill now making its way to the governor's desk;
* In New York, working with state groups to organize support for a marriage bill scheduled for a vote in the state Assembly today;
* In Iowa, ensuring elected leaders continue standing strong against the radical right's relentless campaign to overturn the recent court ruling;
* In Connecticut and Vermont, ensuring that marriage equality is protected forever.

Every single one of these efforts is being threatened. The truth is on our side, but we need YOUR support to broadcast it, talk face-to-face with Americans, and win hearts and minds.

The discussion was critical of the fact that transgender rights were not being addressed by the HRC's efforts at all. Now, this is a thing worth being concerned about, because there are some major issues going on in the US with respect to access to health care, access to housing, fair treatment in the workplace, fair treatment by the State Department, &c with respect to trans* persons. As an organisation which deals with sexuality-based discrimination issues, it is reasonable to expect the HRC to engage with trans-rights issues.

The HRC also has a lot of money, and it is tempting to assume that it can take on any goal it wants to. Making this assumption can lead to the conclusion that HRC is therefore deliberately ignoring trans* issues in favour of same-sex marriage. However, I submit that it is flawed reasoning to assume that the HRC's resources are unlimited; in fact they most certainly are limited compared to, say, the aggregate resources of the Republican Party and its supporters. This means that the HRC must pick its battles.

It is presently the case that there is legislation related to gay rights, and in particular to same-sex marriage, being considered in several state legislatures at this time. It is also the case that there are ballot issues and judicial issues related to same-sex marriage coming up that immediate, decisive action -- often in a grassroots fashion, as in the case of making sure people get to the polls in order to vote on important issues, or encourage their friends in areas of important ballot measures to get to the polls -- can make a major difference on.

Now, here is my question. What are some major trans* issues currently in front of the courts or the legislatures that I can have some impact on?

I ask that in all seriousness as a US citizen who maintains a residence in California. Offhand I can think of several government issues that I can affect, in California and in the United States as a whole, some of which have to do with same-sex marriage, some of which have to do with other issues with which I concern myself (e.g., privacy, copyright, open-source biology). For instance, if the petition for a rehearing in Strauss v. Horton is granted, I can write an amicus curiae brief -- a "Friend of the Court" letter. Is there a trans-rights case currently going before a state or federal court that I can research and submit a brief about?

How about a trans-rights referendum in some upcoming municipal, county, or state election? Is there, say, a proposition in San Francisco to require the City and County to cover HRT and SRS for trans* government employees? If so, I could encourage all my San Francisco readers -- and there are a lot of them -- to get out the vote. And they'd do it. That's the kind of people I make friends with. I could do the same for Houston, Austin, Iowa City, Chicago, Washington DC, Seattle, Miami, NYC, Boston, just by speaking up and getting the word out, thanks to my diverse group of friends. I can also write letters and make phone calls to Congresscritters, state and local representatives, and ask people in all sorts of places to do the same and get the word out themselves.

So I ask you, what are some time-critical issues that I can help spread the word about? Because HRC is going to have to focus on things that it can affect immediately, and really, that's the kind of thing I can help with too.

Is there a website I can go to that tracks trans* issues before the courts or legislatures? When I go to GovTrack and search using the keyword "transgender", I get seven results for the current session of Congress, six of which are memorial resolutions of one kind or another, the other of which is the National Hate Crimes Hotline Act of 2009. That's nice, but GovTrack only follows the US Congress, not state issues, and it doesn't do elections or courts. Is there a centralised repository of up-to-the-minute (-day would be fine, actually) breaking trans* political issues? Preferably one where I can send emails to my representatives with a convenient dropdown menu?

And finally, if there aren't any trans* issues before the courts or on the ballots at the moment, I strongly recommend putting some there. The issues exist, but in order to get them the attention they need in order to be addressed, they're going to have to be forced in the spotlight by someone taking a discrimination issue to trial, or by getting a legislator to propose some form of legislation, or by grassroots effort to get a proposition on a ballot somewhere.


maradydd: (Default)

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