…I could have told you that 🤷
Source: https://x.com/BriannaWu/status/1984574165643403370
Not my usual kind of source (Xitter), but I want any centrists out there who ask trans people to “just get along” / compromise with actual hate groups that want them eradicated to know that it doesn’t work.
There is no such thing as a reasonable bigot, by definition.
Then, you don’t value bodily autonomy as much as I do, and will deny it to some of your patients, gatekeeping – no matter what you “think” you are doing.
Does my ethical autonomy count for nothing? Am I really obligated under your worldview to harm my patients by acquiescing to their demands carte blanche?
Even as a medical student, I have had patients die in my care from things I couldn’t do anything about. I had no way to save them because the medicine to fix the problem simply does not exist. As an ER tech, I have had multiple times where the physician running the code called the time of death while I was the one doing compressions on the patient. Most of those were children. I am already haunted by the patients I have lost through no malpractice, negligence, incompetence, or malice of my own. I refuse to intentionally add to my nightmares by doing something that I truly believe would harm my patient, even if it is what they are asking for.
In my worldview, the drugs would not have a gatekeeper. They would in available OTC. You should not have your “ethical autonomy” compromised at all. (And yes, it does count for nothing compared to bodily autonomy.)
If your reason (for not providing the drugs) was only protecting yourself or others from State-backed violence, it could be justified. But, you claimed you would do it because you know better how to manage a patient’s body than themselves.
I think you are severely underestimating how much education is actually required to fully understand how medications work and how they can interact with each other. The internet is full of quack grifters like the “Hims” and “Hers” sites that will give people unregulated compounded semaglutide (that doesn’t undergo actual health inspections) to people that are likely to be seriously harmed by it because they don’t do their due diligence of actually screening for comorbid conditions that could lead to serious health consequences.
I just got home from a shift at the hospital where two medical students, two resident physicians, and an attending physician couldn’t find the information on how to adjust dosing for a couple of medications to prevent dangerous interactions so we had to go ask the pharmacist. She responded with more questions about the patient’s clinical condition so that she could give us appropriate recommendations. If we had gotten that medication combination wrong, our patient could have easily ended up with a pulmonary embolism or a stroke.
Point being: even physicians have to phone a friend to figure out medication safety sometimes and I do not think it’s reasonable to put the responsibility of medication safety on patients who don’t have over a decade of study and training to know what the risks are.
On the other hand, when I’ve worked in emergency departments I’ve seen patients that have been severely harmed by medications that they got on their own. A perfect example was the man that thought he had a rare parasite from a continent he had never been to because Chat GPT told him so and it also told him that the treatment for that parasite is Ivermectin. He went and got the horse paste version from Tractor Supply and turned up in our emergency department with fulminant liver failure because he didn’t know how to do the dose conversion correctly (and didn’t know the safe human dosing anyways).
Your model of “total bodily autonomy” with every medication being OTC would drastically worsen the Darwinian hell caused by medical misinformation. I don’t want to see my patients harmed by dangerous medications even if I wasn’t the one that prescribed it.
I’m all for a person educating themselves before making a decision to ingest some material, but the final decision MUST BE THEIRS, and not someone else’s.
Yes, the decisions are often difficult, and I personally know I’m an idiot with a bias NOT to ingest something. But, I refuse to deny someone else their freedom based my judgements, or even the judgements of “experts”. I think there are a LOT of good reason to, so I will almost universally defer to an expert, but I refuse to DEMAND everyone else make that same decision.
Citation needed. ESPECIALLY around HRT.
Elsewhere in this thread I talked about a couple patients I have actually treated. One was a woman in her 60’s that got mystery doses of estrogen from implanted pellets that now has to take blood thinners for the rest of her life because she got a DVT and pulmonary embolism because of the excessive estrogen. She’s also at much higher risk for uterine and breast cancer too. Another was a man in his 50’s that had to get coronary stents and start a pile of medications to try to mitigate his heart and liver damage from taking the doses of testosterone recommended by body building influencers. I actually care about HIPAA, so I won’t be giving you any more specific information about these cases.
It really isn’t the trans folks I’m worried about when it comes to HRT, but if it’s freely available to trans folks, that means it’s also freely available to cis folks that are more likely to do it wrong and suffer severe consequences.
I am concerned for the population at large, and unfortunately, safety regulations have to account for the lowest common denominator unless you think that uneducated or gullible people deserve to suffer. Prescriptions are a way to make sure that people are getting the medications they need in the appropriate doses for the correct indications. There’s enough trouble with people hurting themselves with the medications that are already OTC. I don’t think more OTCs (HRT or otherwise) are a particularly good fix for the disaster that is American healthcare.
Data is not the plural of anecdote. As has been pointed out elsewhere in the thread, many countries have OTC HRT and do not have significantly higher morbidity or mortality rates associated with those materials. Your experiences, in the form you’ve shared them, are NOT citeable. So, we’re still at “Citation Needed” stage.
I think that uneducated or gullible people deserve full bodily autonomy, even if that means bad results from their choices.
Certainly, educated and sophisticated people can also get bad results from their choices; I see no reason to deny them to anyone else.
There is a difference between safety regulation and paternalism that I think you are failing to parse. As a society, we share a collective responsibility to build safeguards and fail-safes into the structures of our environment for the protection of those among us that need help. Unfettered freedom and rugged individualism with “full bodily autonomy” is a recipe for disaster.
And many of those countries have wildly different healthcare systems and health culture. The American population is so utterly bombarded with misinformation (including from our own government and regulatory bodies now) that I don’t see phenomena or results from other countries as fully applicable to Americans. There are tons of studies about vastly different outcomes of treatments or interventions in other countries (especially Scandinavian countries) that I do not apply to my clinical practice because a lot of those results are heavily confounded by factors that the study doesn’t account for like cultural diet, healthcare access, amelioration of poverty, and genetics that would skew the results into uselessness in America. So, I’d love to get a list of these countries you’re talking about because if they’re civilized countries with accessible healthcare, it’s not even an apples to oranges comparison; more like apples to chunks of concrete.
There is a fundamental right to bodily autonomy that you aren’t valuing.
You can call it whatever you want, if you prevent a person from self-administering any substance, you are violating their human rights.
On top of that, many, many OTC substances are much more lethal than HRT, so the risks of HRT cannot be great enough to justify them not being available OTC.
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