Harvard Neuroscientist on Gender Dysphoria, Intersex Co… — Transcript

How did I actually get to researching hormones and brain development and end up with this as a research focus? I didn't have friends. I was shy. I was homeschooled for two years in high school, but that was only after being bullied a lot. Even something like eye contact, the way I'm looking at you now, I used to be really afraid of that. I really only socialized and found joy in online video games. Online video games are mostly males. Oh my boy, the few girls that you'll see there, they get tons of attention. I learned at a pretty early age I can do that. I'd even catfish and like pretend to be someone's girlfriend. Your dad's Bible series resonated a lot with me. He really talks about the depths of those negative experiences. The fundamental question for transgender identity is, is it more similar to sexual orientation, born this way, or is it more similar to anorexia, social contagion? I think the answer is both for different people. That's the oversimplification. The nuance here is that Adam Omore, welcome to my podcast. Thank you, Michela. Blessed to be here. Great. Well, I'm really excited for this. This is going to be interesting. But I think we should jump right in. We were talking. We went out for dinner last night. We're talking about the famous twin study. So can you describe what that is? Dr. John Money was a famous psychologist and sexologist. He was one of the first people to really promote sex change surgery for transgender people and particularly for transgender kids. So this was happening in the 1950s and 60s and beyond, and it was coming off of this blank slate social constructivist view to gender. So we didn't know as much about genetics or how sex hormones influence brain development during critical windows prenatally or the first early signs of sex differentiation. So the theory was in absence of all that and knowing how powerful behaviorism was, how powerful social learning is, that all of these gender stereotypes that we see, and given that so many of them are culturally specific, we don't know if you were to raise a child of one sex completely as the opposite sex, everyone was on board. And even their body, like if you did a sex reassignment surgery, if this genetic male child had a vagina and was raised as a girl all his or her life, then would they identify as a healthy functional woman? And it was an open question, but there was enough of a theory to think that that's very well what will happen. So there have been various cases, but the ideal would be a twin study, like people with the exact same genetics, exact same environment, and you take one and raise them the opposite sex. But everyone knew it would be unethical. So it was pretty much a fluke that this perfect natural experiment came along, a set of twin boys born in Canada. They had a circumcision, and one of the circumcisions was botched, and the boy's penis was destroyed. And because of this, they were referred to all sorts of medical specialists, including John Money. And the theory was this was also based on Freudian psychoanalytic influence. You're thinking about sexual development being critical for healthy psychological development. So this thought of this boy growing up without a penis, he's going to be very insecure in his manhood. He's never going to have a functional sexual life. How's he going to get married? He's going to be depressed. He'd be way better off living as a woman. You know, we can construct a functional vagina. At the time, vaginoplasties had been developed, but it's much harder to construct an artificial penis, especially in a child. So the thought was, here's this perfect natural experiment. So, you know, part of it, I think, was this authentic desire to promote what they thought would be in the child's best interest. But the other part of it that certainly was in the back of John Money's mind is this is the perfect experiment to test my theory. Yeah, that's horrifying. So this child was raised as a girl, Brenda, and her brother Brian was a typical healthy boy. And Brenda was very tomboyish and at early ages, like before eight or so, experienced what we would now call gender dysphoria but didn't really know how to say it other than, I don't feel like other girls. But not just tomboyish. Was the kid told what had happened or did eventually? Eventually, but not at that time, not until he was 14. Wow. So he was tomboyish but not just that, you know, because he was told, well, lots of girls are kind of more rough and tumble. They're into boys' things. But he felt, no, it's not just that. It's like I don't feel like I'm in the right body. And again, without really having the language for that. And he told this to his doctors, but John Money turned out to be quite biased. So in all of the papers that were published at the time in that first decade or two, you hear nothing but a success story of, look, there's twins. He was born a male. Now he's living as a healthy girl, so feminine, you wouldn't believe it. Wears dresses, says he's a girl, everything like that. Wow. But experiencing gender dysphoria and depression and anxiety symptoms the entire time. And then once the puberty age comes along, well, he's not a girl, so he's not going to naturally go through puberty. So there's this critical juncture where you have to start taking estrogen. And they did give him estrogen for a brief time and started growing breasts. And then combined with the depression that she was already experiencing, and you see the pronouns are confusing like I'm already going a bit back and forth between he and she. So this case isn't working. And so she gains a lot of weight in order to hide her breasts because she hates this female figure that the estrogen is developing and just starts to become suicidal. So finally, after all that and the trauma that it causes in this family, the parents tell her, tell him what happened. And he said suddenly it all clicked that I was born a boy. This is why I'm so much like my brother. It's not just that we're opposite sex twins and we share some interests. Like literally, we share all of our genes. I was meant to be a boy. And then you might think, okay, so gender identity is genetically red. And actually, I should finish telling you about this story. So it's not a happy ending. Oh no. So Brenda, after 14 or so, decides to live as a boy, stops taking the estrogen, starts taking testosterone, even gets surgery to construct a penis later, and renames himself David, David Reimer, and continues living as a man for another two decades or so, even gets married and has kids. But tragically, ends in suicide. He struggled with depression his whole life. John Money, the sexologist, while doing these yearly check-ins that he would do with the twins, he'd show them porn, he'd ask them to strip down and do all sorts of weird tests. He was in this mindset that America is so Puritan and that we're so repressive in our attitude towards sex, and we just need to liberate it. So, for example, he thought that homosexuality, which at the time was still in the DSM as a mental disorder, he thought that it was a matter of children not being exposed to healthy sexual role models. So he also encouraged David and Brian's parents to walk around nude and have sex in front of the children. They didn't do that. They drew the line there. But his theory, and when Brenda entered puberty, so she's still a girl before she knew what happened, she thought she was gay. She was attracted to other girls. So that's interesting. Genetically, is there something that sexuality encodes, whether it's you're homosexual or straight? It's completely dissociable from gender identity. So the twin study showed that as well. And John Money, you know, he was willing to admit that part, show that in some cases she's more tomboyish, maybe she's gay, but still she's what we would now call cisgender. It was a success in that regard. But he was so adamant that it must have been because the parents had this unhealthy attitude towards sex. The parents' marriage really was falling apart ever since this botched circumcision ruined their family. So John Money's theory w

lot even something like eye contact the way I'm looking at you now I used to be really afraid of that I really only socialized and found joy on online video games online video games it's mostly males oh my boy the few girls that

you'll see there they get tons of attention I learned at a pretty early age I can do that I'd even catfish and like pretend to be someone's girlfriend your dad's Bible series resonated a lot with me he really talks about the depths

of those negative experiences the fundamental question for transgender identity is is it more similar to sexual orientation born this way or is it more similar to anorexia social contagion I think the answer is both for different people that's the oversimplification the

Nuance here is that Adam omore welcome to my podcast thank you Michela blessed to be here great well I'm really excited for this this is going to be interesting uh but I think we should Jump Right In we were

talking we went out for dinner last night we're talking about the famous twin study so can you describe what that is Dr John money was a famous psychologist and sexologist he was one of the first people to really promote

OTE sex change surgery for transgender people and particularly for transgender kids so this was happening in the 1950s and 60s and Beyond and it was coming off of this blank slatest social constructivist view to gender so we didn't know as much about genetics or

how sex hormones influence brain development during CR critical windows prenatally are the first early signs of sex differentiation so the theory was in absence of all that and knowing how powerful behaviorism was how powerful social learning is that all of these

gender stereotypes that we see and given that so many of them are culturally specific we don't know if you were to raise a child of one sex completely as the opposite sex everything everyone was on board and even their body like if you

did a sex reassignment surgery if this genetic male child had a vagina and was raised as a girl all his or her life then would they identify as a healthy functional woman and it was an open question but there

was enough of a theory to think that that's very well what will happen so there have been various cases but the ideal would be a twin study like PE people with the exact same genetics exact same environment and you take one

and raise them the opposite sex but everyone knew it would be unethical so it was pretty much a fluke that this perfect natural experiment came along a set of twin boys born in Canada they had a circumcision and one of the

circumcisions was botched and the boy's penis was destroyed and because of this they were referred to all sorts of Medical Specialists including John money and the theory was this was also based on Freudian psychoanalytic influence you're thinking about sexual development being

critical for healthy psychological development so this thought of this boy growing up without a penis he's going to be very insecure in his manhood he's never going to have a functional sexual life how's he going to get married he's

going to be depressed uh he'd be way better off living as a woman you know we can construct a functional vagina at the time vaginoplasties had been developed but it's much harder to construct an artificial penis especially in a child

so the thought was here's this perfect natural experiment so you know part of it I think was this authentic desire to promote what they thought would be the CH in the child's best interest but the other part of it that certainly was in

the back of John money's mind is this is the perfect experiment to test my theory yeah that's horrifying so this child was raised as a girl Brenda and her brother Brian was a typical healthy boy and Brenda was very tomboyish and at early

ages like before 8 or so experienced what we would Now call gender dysphoria but didn't really know how to say it other than I don't feel like other girls but not just tomboyish was the kid told what had happened or did eventually

eventually but not at that time not until he was 14 wow so he was tomboyish but not just that you know because he was told well lots of girls are kind of more Rough and Tumble They're into boys

things but he felt no it's not just that it's like I don't feel like I'm in the right body and again without really having the language for that and he told this to his doctors but John money turned out to be quite biased so in all

of the papers that were published at the time in that first decade or two you hear nothing but a su uccess story of look there's twins he was born a male now he's living as a healthy girl so

feminine you wouldn't believe it wears dresses says he's a girl everything like that wow but experiencing gender dysphoria and depression and anxiety symptoms the entire time and then once the puberty age comes along well he's not a girl so he's not going to

naturally go through puberty so there's this critical juncture where you have to start taking estrogen and they did give him estrogen for a brief time and started growing breasts and then combined with the depression that she was already experiencing and you see the

pronouns are confusing like I'm already going a bit back and forth between he and she so this case isn't working and so she gains a lot of weight in order to hide her breasts because she hates this female figure that the estrogen is

developing and just starts to become suicid so finally after all that and the trauma that it causes in this family the parents tell her tell him what happened and he said suddenly it all clicked that I was born a boy this is why I'm so much

like my brother it's not just that we're opposite sex Twins and we share some interests like literally we share all of our genes I was meant to be a boy and then you might think okay so gender identity is genetically

red and actually I should finish telling you about this story so it's not a happy ending oh no so Brenda after 14 or so decides to live as a boy stops taking the estrogen starts taking testosterone even gets surgery to

construct a penis later and renames himself David David Rhymer and continues living as a man for another two decades or so even gets married and has kids but tragically ends in suicide he struggled with depression his whole life John money the

sexologist while doing these yearly check-ins that he would do with the twins he'd show them porn he'd ask them to strip down and do all sorts of weird tests he was in this mindset that America is so Puritan and that we're so

repressive in our attitude towards sex and we just need to liberate it so for example he thought that homosexuality which at the time was still in the DSM as a mental disorder he thought that it was a matter of children not being

exposed to healthy sexual Role Models so he also encouraged David and Brian's parents to walk around nude and have sex in front of the children they didn't do that they drew the line there but his theory and when Brenda entered puberty so she's

still a girl before she knew what happened she thought she was gay she was attracted to other girls so that's interesting genetically is there something that sexuality encodes whether it's you're homosexual or straight it's completely dissociable from gender

identity so the twin study showed that as well and John money you know he was he was willing to admit that part show that in some cases she's more tomboyish maybe she's gay but still she's what we would Now call cisgender it was a

success in that regard but he was so adamant that it must have been because the parents had this unhealthy attitude towards sex the parents marriage really was falling apart ever since this botch circumcision ruined their family so John

money's theory was Brenda's gay not because she was born a boy but because she witnessed this unhealthy marital dynamic yeah of course blame the parents rather than thinking maybe maybe he could be wrong blame the parents yeah right so this makes us think okay now

with modern knowledge of genetics gender identity and maybe sexual orientation it must be genetic and then in grad school I learned about this intersex condition complete Androgen insensitivity syndrome so the most extreme case of this with complete Androgen insensitivity that

means that you can produce androgens like testosterone but the Androgen receptor doesn't work so it's functionally inert so you can have a genetic male with a Y chromosome and I didn't learn this until grad school either the Y chromosome what it really

does the sry Y gene on the Y chromosome produces testes determining factor which is a protein that's used to construct the testes out of undifferentiated gonadal cells so in the first 6 weeks of fetal development the gonads are

sexually undifferentiated and I initially assumed that it was the Y chromosome that coded for development of the penis and other secondary sex characteristics no that's not true it's all Downstream effects of testosterone the only thing the Y chromosome does is

it determines whether you develop testes or an absence of a y chromosome ovaries during that early period of fetal development that's interesting okay so in a genetic male with complete Androgen insensitivity first weeks of fetal development look normal and then they do

produce testes and the testes do produce testosterone but the Androgen receptor doesn't work so it doesn't bind to anything so functionally it's inert and free floating testosterone in males can interact with an enzyme called aromatase so it's aromatized into estrogen and

those low levels of estrogen that are typical in males are enough for the development of female characteristics it's normally inhibited by testosterone but in absence of any testosterone even if you have a y chromosome the baby will develop a

vagina and be assigned female at Birth so that's interesting too because you know people criticize the binary sex idea and say it's a social construct it's assigned at Birth it's an arbitrary physician rating you know obviously it's not arbitrary in 99.9% of cases there's

complete overlap between genetic sex phenotypic sex based on external genitalia hormonal sex but in some of these interex disorders they are dissociable so you can have a genetic male identified female at Birth and then raised as a girl so this is in a way a

more perfect case than the twin study because in the Twin study everyone knew that at least for the first couple weeks or months up to the circumcision this was a boy and even the social constructivist could counter well they

weren't Brenda wasn't really raised as a girl cuz everyone knew in the back of their mind that she's secretly a boy so maybe she's tomboyish because they were treating her different in these unconscious ways yeah but with CIS

they're genetically male they're raised as female they don't even know anything's wrong with them because again perfectly healthy female genitalia so then you might think they're going to live their lives as prepubescent girls because they don't have any testosterone

they're not going to go through male puberty but they don't have ovaries how are they going to go through female puberty but it turns out that low level of estrogen and progesterone that males have is enough for the development of

female secondary sex characteristics wow it just normally is inhibited by testosterone so then these girls will start growing breasts fat will redistribute around the hips other female secondary sex characteristics but they won't ever get their period because they don't have ovaries wow so a girl

with CIS even though they're genetically male here I'm using the term girl and I think that would be appropriate they're going to identify as girls they're even overwhelmingly attracted to men exclusively heterosexual and identify as wom but they are essentially infertile

women and they don't find out until they're 15 16 have never gotten a period they go to the doctor to see what's wrong and they find out that they don't have ovaries they have testes inside their abdomen that never descended

that's crazy what what percentage of population does this hit complete Androgen insensitivity definitely less than one in 10,000 yeah okay okay that's still quite a few that would be shocking if you guys want to purchase this magical supplement see how it shines and

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if you drink cuz it's silly not to there's a money backat guarantee it really works um I hope you're enjoying this episode right so what that tells us is it's not genetics alone it's prenatal hormones during a specific critical

window of brain development that seems to determine gender identity and sexual orientation and there's a couple other intersex disorders that we can use to hone in on that hypothesis further all right so another one is congenital adrenal hyperplasia this is one that

I've published original research on so congenital means present from birth adrenal hyperplasia means overactive adrenal glands so what happens due to a genetic disorder that results in deficiency in an enzyme called 21 hydroxylase which is an enzyme necessary

to synthesize cortisol the adrenals go into overdrive attempting to produce more cortisol and cortisol everyone knows as a stress hormone but it's also necessary in low levels just for basic functioning like metabolism so adrenals go into overdrive they begin

producing other precursor androgens that can be synthesized into cortisol typically but can also be synthesized into testosterone and since their cortisol system doesn't work properly they have excess levels of testosterone and cah can affect both males and females but if it happens to a male well

they'll have more testosterone but it's within the male typical range of variability which is very large and it can be deadly if left untreated but typically it's diagnosed shortly after birth and they're given glucocorticoid supplementation so the real effects

happen in females because then they have male typical levels of prenatal testosterone during this critical window for brain development so there's been Decades of studies of girls with cah and they turn out overwhelmingly to be more tomboyish more interested in rough and

tumble play exhibit boy play preferences and During adult Ood 30 to 40% of them compared to about 1 to 2% in the general population identify as gay or bisexual wow so those two pieces put together CIS and C to me are very strong evidence

that its prenatal sex hormones and particularly Androgen exposure that determine whether in absence of androgens you're going to develop a female phenotype and be attracted to men and in presence of act androgens you're at the very least more likely to be

attracted to women like the girls with cah they're not overwhelmingly gay in fact a majority of them aren't but way more likely to be and then similarly for males most males are attracted to women and yet genetic males without any

testosterone are overwhelmingly attracted to men that's interesting wow that is interesting okay so you know a lot about this there's one more inter keep going keep going okay I should also add cah is the most common and it

affects about one out of every 10,000 births so I think that the other ones being more rare than that add them all up and you're probably looking at less than one in a thousand for all of these severe intersect conditions I should

also add the term intersects some people now say is outdated or offensive the technical term that people like is different in sexual development or dsds I think interex is more straightforward and we're talking to a general audience here so that's an important distinction

to make but five Alpha reductase deficiency so earlier I said it's all testosterone that determines whether you grow a penis and it's testosterone that acts on the brain to produce these psychological sex differences that's the over simplification the Nuance here is that

testosterone interacts with an enzyme called five Alpha reductase and it's converted into dihydrotestosterone DHT and DHT is what actually constructs the penis so with five Alpha reductase deficiency this is another really interesting natural experiment where you can have a genetic

male with typical levels of testosterone and functioning Androgen receptors so testosterone organizes the brain in the male typical way but they don't have any DHT so they're not going to be born with a p and again in absence of that female

typical development is the blank slate default condition so they'll be born with a vagina they'll be identified female at Birth they'll probably be more tomboyish like cah although I don't know of any evidence on that this condition is much rarer and then at puberty this

is where it really gets different because they still have testes and the testes still produce testosterone they have a vagina but the testosterone is what produces other secondary sex characteristics so then you have this girl who's maybe more

tomboyish maybe not but has lived her life identifying as a girl and then suddenly she hits puberty and starts growing a beard starts deepening her voice other male characteristics and this one is really interesting because the other conditions I told you about

the gender dysphoria tends to manifest well with CIS there's not even any dysphoria they're just completely woman they find out they're infertile but other than that they're healthy with cah they're more likely to experience gender dysphoria and that's pretty much a

function of how much prenatal androgens they're exposed to because in the most severe form the testosterone will even masculinize their genitalia so it'll be full-on intersex ambiguous genitalia the clitoris will grow into what looks like a micro penis the labia will grow

outwards and if it's severe enough even fuse into a scrotum but not fully functional you'll also see this with partial Androgen insensitivity so the complete condition is the most straightforward it's also the rarest but if you have partial Androgen

insensitivity with lower than average testosterone it could go anywhere from having say a clinically underdeveloped micropenis to ambiguous genitalia if you have say not enough to grow a functional penis but also way more more than female typical so when people say sex is a

spectrum sex itself is binary but just the forms that your genitals can take during early development do take on this spectrum that's dependent on how much prenatal testosterone or particularly DHT you're exposed to okay so back to five Alpha

reductase without any DHT and with testosterone and with secondary male sex characteristics at puberty it's about a 50/50 shot some of them experience gender dysphoria and want to go on Androgen blockers and continue to live their lives as women they take

estrogen to grow the female characteristics that their body can't naturally produce and go on to live healthy lives as unfertile women and others decide to fully let the testosterone take its course and maybe they can get a phalloplasty to continue

to live their lives as men that's crazy and you said that so so all of that is one in a thousand people you think I would say one in a thousand would be the umbrella stat for any one

of these different disorders and even that is a massive overestimate because cah for example even though it's classified as an intersex condition well for one thing in half of them it happens in males so you're going to experience

the same medical issues with cortisol deficiency but no real issues of sex development and then even of the females who have C it's only ambiguous genitalia and gender dysphoria in the most extreme cases maybe they'll turn out to be gay but

they can still live perfectly healthy lives as women and they are genetically women so that's wild okay so a few questions one why do you know so much about this like what was it about my whole PhD yeah but what what made you

decide to study this was it like rampant talk about gender dysphoria that you grew up around or like why did this interest you specifically it's fascinating you do a lecture on Peterson Academy probably that sounded like a science class was really good yeah that

that was really good but what made you decide to become interested in this thank you Michaela well there's two separate answers there's the Practical how did I actually get to researching hormones and brain development and end up with this as a research focus

and then there's like you said what makes me interested in it because it sounds so Niche right so this actually connects to I think some of the personal interests that we're going to get into like about my upbringing being homeschooled

and growing up with a single mom and spending a lot of time online and having to learn social dynamics in a somewhat unorthodox way but I'll start with the research that's more straightforward so I came into college actually to study

Physics but pretty quickly I switched into cognitive science at first stemming from the physics background I was interested in artificial intelligence and thinking I was going to do something very computer programming I was good at math but I realized pretty early on in

these classes that we know way less about human intelligence how are we going to build artificial intelligence I mean we have succeeded in a way but we also can't really debate on you know what is a woman so to me I as you

mentioned some of this political stuff going on in the background it made me think there were more foundational philosophical questions to be addressed through neuroscience and then my first Neuroscience lab really just by happen stance happened to be focusing on

hormones and brain development and I got to work with cah populations so this was pre-collected data and we were looking at structural brain differences between children with and without chah so the other thing that's interesting about this natural

experiment design you can test two things simultaneously about the hormones so if you see an effect that's present in both males and females with chah but not in typically developing children then it's probably a result of either the cortisol deficiency prenatally or

more likely the glucocorticoid suppl because if you're taking chronic low levels of cortisol you know it's almost like chronic stress exposure which we know impacts the brain hippocampal volume in particular which is the biggest effect that we found but if you

see an effect that's only present in chah females relative to control females then it's probably the prenatal Androgen exposure and you do see both of those you see some effects that are probably glucocorticoid driven present in both sexes and then you see some effects

including the behavioral and psychological ones that are only present in females interesting okay before we get into your background what does what does Cortisol what does what do hyper stressful situations like longterm do to the brain oh this isn't my area of

expertise Robert supulski has a great book on this called why zebras don't get ulcers and the basic idea I guess there's two the first is very low levels of cortisol it has other phys phological functions that are just necessary for

survival but I'm not a physician I couldn't list those out but then in terms of psychological stress response this fight ORF flight response we know that cortisol a spike in the short term is really adaptive so why don't zebras

get ulcers well they'll experience a massive cortisol Spike when they're running away from a lion and then you know they chill out only humans actually primates Saul's done great work on this will experience chronic stress even from social bullying like anything even if

all of your physiological needs are met we have social needs too as social mammals and what does chronic stress do can you reverse it I know I know this isn't your area of expertise but does it shrink your brain it can shrink your

hippocampus which is necessary for forming memories it can impair memory especially if this happens during early development so there's this idea of sensitive or critical windows for brain development a critical is like fully lose it or use it use it

or lose it and you'll see so a lot of these early studies they sound very mad scientist and they kind of are so for whatever reason a lot of the early studies on visual development were done on kittens and you know when you say we're

done in terms of a neuroscience experiment often it ends with the animal being euthanized because you have to dissect its brain so rodents are most commonly used for these invasive Neuroscience studies but cats maybe because they were larger maybe because

they have a longer window of plasticity so plasticity is the term for how malleable your brain is and during specific windows so you'll see that there's sort of this parallel between evolution and ontogeny development within a particular lifespan so the idea

is the earlier a function is like sensory motor brain regions mature the earliest like within the first few months so these scientists what they would do they would blindfold kittens for the first few months of their life and if they did that and they had no

light exposure then they would be permanently blind into adulthood but if you took a kitten who was exposed to normal light and developed normal vision for the first few months and then you blindfold them after the visual cortex

mature and then you blindfold them for years they'll still be able to see when you take it off wow so that's the strongest example I know of for critical period and then psychologists have taken this for language there's also a pretty

strong critical period for language development in the first five or so years of life and then in adolescence in my main area of study there's argument that it's a critical period for higher order cognitive development so this is

things like planning about the future evaluating risks social cognition emotion regulation highle stuff like that but then there's also this term critical versus sensitive so with vision in the first few months if you don't have light exposure no amount of light

exposure later on will help for sensitive period it's more like it's a period of heightened plasticity but it's not all or nothing wow that's crazy okay you might know not know anything about this but I'm going to ask you anyway so

if you put people on something like and this this pertains to me cuz I was on I was on medication throughout my developmental years I've always wondered what that did to my brain and I'm not saying you know that cuz I don't know if

anybody knows that but if you put somebody what's your guess here if you put a kid on something like an SSRI because like my experience was it dampen down I like I took risks when I shouldn't have taken risks and that's

part of my personality but I don't know how much that was influenced by the medication you any thoughts here if you become more of a risk-prone personality type or even more disagreeable because of early serotonin levels I don't know I wonder okay cuz I

like I know I would put myself into risky situations without being scared and I'm sure that that that was blunted from the ssris so I've always just wondered throughout my developmental years if that made me more less risk

averse than I should have been not that I'm like unhappy about it or anything but was like maybe MH so there there is a tie in there about other forms of medication that we give to kids so puberty blockers is the one on the

Forefront of my mind and that's been an active area of research for me recently not working with primary data but just reading animal studies giving them puberty blockers and looking at effects of brain development and whether or not

it's generalizable to humans looking at the limited number of human studies that have been published but there is a meaningful connection there to ssris which is that a lot of people criticize the animal models of puberty blockers or

hormone replacement they'll say it's not generalizable to transgender people or even just to humans because well it's an animal model but most research most things we know about the brain stems from animal research and a lot of these

things especially subcortical structures the more basic the earlier evolved the brain region is the more likely it is to be conserved across mammals and mamalian brains are more similar than they are different they operate on the same neurotransmitters the same hormones same

sensitive periods during phases of life and you'll have these behavioral markers that you'll use to test whether a drug works or not so something like anti-depressants you're not just going to test it on a human right away you

want to have a rodent model for it first but how are you going to measure whether a rodent is depressed or whether it's actually alleviating depression and I don't know the specifics but the basic idea is they have a whole array of

standardized paradigms looking at things like appetite or play Behavior or sex behavior and researchers have coded how a typical animal responds and how a depressed like animal responds or an anxious-like animal responds and generally you'll validate whether an

anti-depressant or an anti-anxiety Med works by looking at the behavior so the interesting thing is in these puberty blocker studies there's some preliminary evidence in rodents and and sheep that they may increase anxiety or depressive like symptoms now we don't know if that

generalizes to humans but based on the psychopharmacology of how anti-depressants and anti-anxiety meds work and just on this general theory that sex hormones are critical for brain development during puberty I'm sure that there's some effect and in fact we do know there's

some effect we just really don't know what it's going to be like if you find a structural brain difference with some it's really straightforward your hoc campus is shrinking you're going to have impaired memory but for a lot of these

especially for cortical networks where it there's enough plasticity that there can be trade-offs so like one one area shrinks another area grows to take its place like in the extreme examples of this you'll see that you know if a child

loses one sensory system at an early enough age other sensory systems will grow and improve to make up for it that's neuroplasticity in action yeah that's really cool that's so that's what happens when somebody goes blind really little right does their hearing actually

improve I don't know if the hearing itself improves I would think yes but at the very least we do know well depending on the type of brain damage if it's literally brain damaged like the area is lesioned and there's tissue that just

simply isn't there anymore then yeah auditory cortex will grow to fill in what used to be visual cortex and presumably that comes with improved function oh wow that's cool if you guys are not filtering your air it is the

easiest thing it's the laziest thing you can do to improve your health I'm so gung-ho about this I literally travel with an air purifier for hotel rooms seriously I've been talking about air purifiers for years but I didn't realize

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air- llarge or select the size you want with code MP for 10% off uh that is linked in the description and in the pinned comment enjoy the rest this episode okay okay let's get into your background a little bit because from

what you told me yesterday and what from what I know about you it's interesting and I think my audience will find it interesting but you grew up in La you had a single mom what was your childhood like I played a lot of video games and

my mom is part-time piano teacher music director at her church we also wanted to talk about spirituality so that may tie in here but basically I didn't have a strong male role model in my life I didn't have friends I was shy I was

homeschooled for 2 years in high school but that was only after being bullied a lot and I was bullied for my weight uh I gained a lot of weight I was 250 lbs when I was 15 years old and didn't have

any friends didn't have any romantic interest I really only socialized and found joy on online video games and it's such a different world and I think this is in a way where the early obsession with sex differences comes in because

online video games it's mostly males and the few girls that you'll see there they get tons of attention often it looks like harassment but on these video games and as a naive kid I was thinking you know there's this term on my favorite

game RuneScape buying GF buying girlfriend so people would literally say that and you know sometimes you'd have someone trade them like they'd have this female character following them around like Entourage they'd give them money or free stuff so I learned at a pretty

early age I can do that I can play as a female character I'd even catfish and like pretend to be someone's girlfriend this might have been as early as 10 years old I don't think I even knew what

it meant other than hey this person's going to give me free stuff so I'd walk around as a female character I'd also go on these online chat rooms like Omegle or kick friends and this was really if I

was lonely and trying to chat with people so often what I'd find is you I'll make a bio about myself I'll post about my interest I'll say I'm I'm 15 years old I want to chat I'd get no

messages and then I make the exact same bio I say I'm a girl I get dozens of messages and a lot of them are probably other Lonely Boys Like Me and we have common interest in video games they're

like it's so cool that you're into video games and you're a chick you're like the perfect bro you know we'd Bond but they they'd fall in love with me often a friendship like that would end because they're like oh my gosh you're the

perfect girl it's just like it's like you're a guy but you're not and often I'd find that I could get more attention if I just put a pretty picture so I'd find random girls on the internet and just post a random photo and pretend to

be that person uh that never backfired hopefully so so I'd also get lots of dickpics and for the most part I just block them the unfortunate part of it all right but you know this was in the early wild west of

the internet at least for teenagers so this is back when you go in Xbox live chat rooms and everyone is cursing up a storm and you're sending like the weirdest porn you can find or Isis beheading videos like all of my video

game friends were really up and so was I so I think part of that had to do with whatever almost unconscious resentment for not having friends or being popular in the real world so it's like you know part of it stemmed into

this early version of perfectionism how can I get the highest level get the best gear you know form a clan and get into a high rank like social status within this virtual world eventually in my late teens it snapped like I could just grind

in real life grind as if it's a video game work on my fitness obsessively calorie count I did all that and succeeded after basically treating it like a video game yeah yeah that was that was wise I think people have to

realize that my dad has talked a lot about you know people who this is mostly people who take drugs or something like that is you have to turn your life into the gamble kind of make it into the game

you have to have like enough going on so you ended up I I want to get into that you ended up losing a bunch of weight young which was very disciplined that's very difficult for people to do especially the way you did it cuz you

just you calorie counted I didn't do it smart though I calorie counted obsessively but I would eat the unhealthy food if it was lower he if it was lower calories I didn't have really any knowledge of Whole Foods or like

what's healthy yeah still that's impressive though how old were you I was 16 when I started I lost 80 lbs in 14 months so I said I used to be 70 lbs heavier I got really skinny first I went

all the way down to 165 and by then you I was still shy and awkward but I did have this fantasy of okay I don't want to just graduate the weird homeschooled kid and never experienced graduation or prom or

anything like that so I wanted to get back into school so senior year I re-enrolled into public school I still didn't make friends I was still really shy but I slowly started coming out of my shellmore and that's when I was 165

lbs and then Senior Year I started working out for the first time so by college I was back up to like 180 lbs and had some muscle less than I have now but like I looked normal and I only

later learned you I graduated high school still without my first kiss but I later learned oh some girls actually had a crush on me then they just spoke to me and I was so awkward that they lost it

but at the beginning it was like hey this is a new kid coming in he's not that badl looking he seems to be smart and then he's practically autistic so you lose the interest there and then I get to college and dating apps are a big

thing so I get on Tinder and it was still the same thing like I started getting a good amount of matches I still had all my friends the ones that lasted were these online friends that I'd never met in person from video games a lot of

them were still overweight and awkward and still never had any success with girls so just the fact that I was now reasonably fit and going to USC which has a very attractive student body and is a pretty social school it also has a

great research department and it's connected with Children's Hospital of Los Angeles so I kind of just steered into the research Direction after I failed to succeed at you know the extroverted party life but online apps were different because

well at first you begin texting and I was familiar with that right not only that but in some ways I think I got more in touch with Mya we can use the union term like my feminine characteristics because I spent so long pretending to be

a girl and you know not wanting to be completely unrealistic I was telling Rob about this Rob Henderson and we use this term authentic catfish he'd be like that's a good title for an article that's a good what's an oxymoron right

so I'd have these one-on-one dates I did reasonably well at scheduling dates because again it's all texting and then they'd meet me first five minutes see how awkward I am find an excuse to leave and I slowly got better through trial

and error but I still didn't know how to interact with people like in class or in a real setting or at parties I didn't even get invited to parties it slowly got better and you know I had my first

few relationships and became more outgoing like even something like eye contact the way I'm looking at you now I used to be really afraid of that and your dad was a big help red pill community in its own way

it was a big help at least in so far as it got me on the stepping stone to reading and listening to better male role models cuz red pill online it's almost like a spin-off of the incel community right it's like the incels

that and I was like that right involuntary celibate graduated high school without a first kiss overweight and then lanky and awkward even after he loses the weight but it slowly got better and the red pill people it there

was a lot of misogyny there it's almost like they adopted this self mind this self-improvement mindset but then simultaneously had this deep insecurity like if it didn't work then it's the girl's fault because and you know they're hyping each other up and some of

it is genuinely positive you know they're saying here's how to count calories here's how to go to the gym here's what you should do look people in the eye give them a firm handshake like all of that stuff really helped me but

and I'm pretty sure it was from there red pill on Reddit that I stumbled across one of your dad's first videos and then I was hooked that also was a major contributor to me switching to cognitive science from physics getting

interested in Psychology and brain development and then PhD in the department he used to work at the rest is history yeah so are you in David bus's lab David bus is at UT Austin and he's an evolutionary psychologist whose

lab are you in I'm in Leah somerville's lab okay and she specializes in adolescent brain development but the puberty and hormones research is also fairly new to our lab we have this NIH grant that we're working on this is all

part of human connectome project which is a massive study there are different wings of it so there's the main human connectone project which is brain development in adults ages 22 to 65 there's a separate cohort looking at brain aging

65 plus there's a infancy and toddler cohort and then there's the development one which we're working on which is 1300 kids ages 5 to 21 and you have different functional MRI measures structural brain activation connectivity and then what I'm working

on specifically is we have saliva hair and maybe blood forthcoming hormones data and puberty measures and linking that to different brain and psychological outcomes of Interest wow that's really interesting you said you said yesterday you had an issue with functional MRIs and

kids so there are some issues that people have known about for a long time one is just that kids move in the scanner and you have to lie really still so you can get motion artifacts that just mess up data but you know you can

you can teach kids to stay still and even if you have to throw out half the data if you get enough kids you're you're going to have enough usable data so that's more just a practical challenge but it can be overcome the

other one is if you're averaging across dozens or hundreds of brains in a study you can get a really precise estimate of on average what brain region is active during a particular task so like I study reward sensitivity so often you'll use a

gambling game Paradigm and basically you're measuring brain activity during the whole game and what you want to do ideally is filter out say wins versus losses because if you're just looking at straight win activity you're not getting just reward response in the brain you're

also getting what is the visual cortex doing when you're looking at the screen you're getting how is the motor cortex preparing to press the button because you have to press the button for the Gam game but if you have win minus loss then

in principle you filter out all of the stuff that's the same in the task across whatever condition and you're isolating what is my brain doing uniquely when I win money compared to when I lose money and there very robustly you'll see

response in the ventral striatum which is known to be the brain region primarily responsible for reward processing and especially in addiction models you'll see this it's part of the mesolimbic mesocortical dopamine system it's dopaminergic testosterone influences vental strial development and

dopamine function and all that's very well established the part that's trickier and this is the part that's troubling for my research if you're looking at group averages either in what part of the brain is responsive or how does it change with age on average you

can get very good estimates of that if you're trying to make individualized predictions you can say you know on average does more testosterone correspond to more vental strium activity and the answer is yes but if you want to make an individualized

prediction does more circulating hormone levels in your blood correspond to more brain blood flow in this one participant so the thing that would actually be translational the answer is no and not only that but sometimes that can be

backwards so think about what the hormone levels that we're measuring first of all it's a single time point so it could be confounded especially if you're measuring it through saliva which most psychology research does because it's cheap and it's easy you know you

don't have to stick a needle in their arm but it's really noisy it can be influenced by the last thing you've eaten how much you slept what your stress levels are a whole host of confounds So ideally you'd want a whole

bunch of samples maybe day to day week to week month to month especially for females because then you can also get uh menstrual cycle fluctuations messing with hormone levels so you want a lot of samples to be able to confidently assess

the estimate but then even if you can do that circulating hormone levels doesn't tell you what the individual genetic response to that is going to be so you could have someone with twice the testosterone as me but functionally it's as if they have less

because their Androgen receptors aren't as sensitive or vice versa can you test that at all or no maybe that's a question for a physician I haven't yeah I haven't heard of anybody's ability to test Androgen receptor sensitivity maybe

we could talk more about testosterone and reward Sensi yeah so this might be a really stupid question but I don't know what I'm talking about here but you said there was a relationship there do do men get like a higher dopamin release in

their reward system because of testosterone or is that not true is that just wrong you can tell me I'm pausing because there's a version of the answer that's yes and a version of the answer that's no okay so we do

know that testosterone influences the structure and function of the vental strium so it's going to make it more reward sensitive now does that mean that it's literally more dopamine or does it just mean it's more sensitive so this

brings up an important distinction in endocrinology research organizational versus activational effects of hormones so organizational refers to these developmental effects anything physiological is developmental so the physical changes that happen during puberty for either sex those are pretty much permanent this is why again for the

puberty blockers debate it's such a big deal because if you are one of these people with innate gender dysphoria and you do want to transition then early intervention is necessary to block development of these opposite sex traits but there's also other questions about

can children consent and we we can get back into that but organizational effects basically are permanent so for the body those are more straightforward for the brain it has to do with again sensitive or critical Windows of brain

development and then activational effects is how is your brain and behavior changing in response to circulating hormone levels so take the testosterone away the reward sensitivity goes away the sex drive goes away and you see those studies both in

experimental animal research where rodents may be castrated or given hormone replacement and you'll see these massive effects or even in human clinical populations like testicular cancer patients if they have to be castrated then you'll see sex drive and

motivation plummets and then they go on testosterone replacement therapy and it comes back and not only that but they can go back on a fraction of once they had and it's enough to reinstate sex drive so it's not the dose response

relationship that most people think of it's not you have 10% more testosterones you're going to have 10% more aggression or sex drive in part because again circulating hormone levels doesn't tell you much about how it's actually bioavailable but then beyond that it's

not a dose response relationship it seems to be more of this threshold effect of you have enough to turn the sexual system on or you don't or same thing with aggression status competition and and if you have unnaturally High

steroid levels then you can also see increased sex drive or aggression but little bit more testosterone isn't going to correspond necessarily to little bit more of those behaviors that's interesting so for women and their reward system do you think the amount of

testosterone they have is enough to turn that on is that how it works or is it just different in women so here's what I think is an open question we know for sure that males are more reward sensitive and more prone to risk-taking

especially during adolescence so wait can we pause so what what exactly is reward sensitive reward sensitive it could be actual response in the brain how much ventral strium activity and how much dopamine release you see it could also

be in one of these gambling game studies like how willing are you to take a risk for potential reward or if you're talking about sex drive reward there have been interesting studies where you'll show participants porn in the

scanner and you can measure physiological arousal you can measure skin conductance in men you can even measure the pressure of their downstairs arousal and those are a bunch of individual differences that may or may not correlate with testosterone levels

but at the very least if you completely eliminated it like with Androgen blockers then that would go away so there's some baseline level and what I'm not sure of the open question here is the female level the Baseline and then

what you do is you say males have more of this therefore they're more likely to take risks but you also see that beginning at puberty women are more anxious and more depressed or at least have a propensity for it we don't know

is this because testosterone inhibits anxiety and there's some animal research to suggest that and even anecdotal experience for people who take testosterone replacement therapy but it also could be that ovarian hormones estrog and progesterone increase anxiety and depression and there are all sorts

of evolutionary theories for this so it makes sense for males to be more reward sensitive and more willing to take risk because one man can in principle impregnate dozens of women so if he can take some major risk for acquiring

status or if he's more aggressive as long as he can fertilize those eggs even if he gets himself killed shortly after even if 90% of people who try get themselves killed it can be a stable reprodu strategy for men and then it

makes sense why women would try to be more cautious especially because women take care of children cross-culturally and have to be more threat sensitive and protective of these vulnerable infants you also see interesting interactions with oxytocin here they call it the mama

bear effect so oxytocin it's known as the love hormone the cuddle hormone but it can increase aggression and what what it really does is it increases the strength of an overall ingroup or outgroup response so if it increases

care towards the ingroup but it also through a chemical cousin of it called vasopress increases aggression towards the outgroup this mama bear aggression that's so interesting I'm going to step away from that a little bit I want to talk about

how how has University been like for you in the political landscape that we're in now I know what it was like for me in 2012 and it was Troublesome for me then uh but you're at Harvard mhm so what

what's it like there politically is it as crazy as it looks in the news definitely not as crazy as in the news but you do see some of those issues so here's the interesting thing I think institutionally there's really as not as

much of a problem with free speech like you do see some examples of professors getting canceled but even if they're canceled what it often looks like is you're disinvited to speak at a conference or something like that and

that's terrible that shouldn't happen like you should encourage disagreement and debate but very rarely are people losing their jobs at least at Harvard it does happen at places you know even Carol hen's story which is the most extreme example that I know of at

Harvard she wasn't officially fired for going on Fox News and talking about the binary reality of sex and talking about her book on test testosterone but socially people just made her life there such hell that she was essentially

forced to leave so that's what you see more of it's almost like bullying or passive aggressive it's like this sense of false common knowledge like in The Emperor's New Clothes story this idea that everyone is thinking that this thing you can't say

even if most people themselves are thinking it and for whatever reason maybe I'm more disagreeable maybe it's because I had a more atypical social upbringing so I'm not as attuned or as willing to follow those sorts of social

norms generally I always speak my mind and I've doubled down on this really ever since I started listening to your dad and exploring my faith more and believing in this foundational logos so now I think whatever the price is for

saying what I believe to be true I'd much rather pay that price than speak falsehood or hold my tongue so that has worked and it's it's very polarizing I'll say that it's made the people who admire and respect me I think

admire me and grow close to me in that way a lot but and it's led to Opportunities like this like being on your podcast but it's also made a bunch of other people think okay that's the controversial guy that's interested in

evolutionary psychology and hormones and sex differences and he's into Jordan Peterson and just stay away he's this bad conservative guy and you know I'm also a diversity fellow at Harvard so this is on the Dei committee which I

applied for this role because I had this sense that those committees despite diversity being in the name were not very diverse so I actually wrote my application basically saying this like I have more conservative unorthodox views I actually called myself Conservative

Christian and I was raised around Christianity my take is more abstract we spoke about this a little bit so I think it's very far from what that term probably rings a bell is like magga Evangelical Republican and I'm quite far

from that but my stance to Dei is even if I was that like there's no reason that shouldn't be welcome like that's genu University that was your essay not in those terms like I didn't say even if I was a magga republican I

should be able to serve on this committee but you know that's that's the spirit that inspired me to apply and the interesting thing you know I have mixed feelings about this because on one hand I'm able to express my opinion and I'm

never going to get in trouble for it because you know it is expressing diversity I'm not making personal attacks I'm literally just saying here's my opinion if you disagree I welcome that like tell me why you disagree let's I find that

stff fun I think some people find it intimidating or they worry are there going to be social or career consequences to this and I think there are like I'm I'm playing a bit of a gamble here I think it's going to work

out for me like I have faith that it'll work out for me but I don't know how it's going to be received crazy crazy okay okay this reminded me I thought this was interesting cuz like I feel like most of

my audience is older than University so they don't know what's going on now how has AI impacted people in University are they using it are professors allowing it can they test for it I think it's left up to each Professor I don't think the

university has an official stance on it so some professors say it's completely banned but then I guess that means they do have to test for it somehow I don't know how the tests go for it but I don't

think most students are using it at least not like it's going to write your essay for you cuz it's it's really bad they really bad it'll make up citations it'll just say things that are completely wrong uh I found that it can

be good for summarizing papers but even if you do that it's like it depends what you want if you want literally a one paragraph High LEL summary and you don't need any Nuance then it's perfect for that as soon as you need Nuance which

you need a lot of and grad school and in research then it's useless yeah okay okay interesting so let's get back into into Faith because you told me yesterday you've done an insane amount of research on religions around the world and

different philosophers so like where are you what what do you believe right now so insane amount of research to me signifies like I'm doing a PhD in it and my gut instinct is this is just like a side personal interest so I couldn't

tell you much about the history of it but personally it stems from I think part growing up exposed to Christianity but then thinking there was no substance to it like learning about Evolution and not having people I could go to and have

critical discussions about it like people who say you know take it literally or leave it so I decided to leave it and it turned into actually this anti-theistic phase in my teenage years but in retrospect I look at that like I

was already depressed I was overweight and resentful and spending all my time online with this bunch of sickos and you know it it's not surprising to me that I had such a pessimistic attitude towards Faith it's it's like the can mindset can

and able that resonated a lot your dad's Bible series resonated a lot with me in college and it was for two reasons the first was because he took a very secular approach to it like he's integrating it with evolutionary psychology rather than

putting it at odds with it and secondly he really talks about the depths of those negative experiences like this resentful envy that one can experience and I experienced this going to USC you know on one hand I went on

scholarship so I applied through questbridge the scholarship for low-income students coming from single mom I wrote my essay about that I wrote about how growing up in poverty with a single mom and I spent most of my time

online that I had to do things like learn how to shave learn how to tie a tie from YouTube tutorials and that it taught me this level of Independence it gave me research skills and how I want to translate that into actual academic

research so that worked out for me but then you know it's like a rich part School the make fun of it nickname for it is University of spoiled children and there were a lot of those so I didn't

fit in part of that was because of my own social difficulties but there's it's I would oscillate between this resentful victim attitude like look at all these people who are coming from wealthy two parent households I don't fit in here

they went to private school they're so much more articulate than me I don't know what I'm doing and then simultaneously thinking like I'm going to one of the best colleges for free and other people across the world like are

starving or can't get an education whatsoever like what right do I have to be a victim and I would go spiral in those States and I think it was just this inherent interest in science and philosophy I couldn't tell you why I had

that so that's a cool thing too it's like it's almost like it was a protective factor for me because I could could have been out causing a bunch of trouble I did that online a little bit like the scamming people on video games

luring was this thing you'd do in RuneScape so like there'd be PVP areas where players could fight each other and if you were a young kid like I was when I first started playing people could trick you into coming there they'd kill

you and take their stuff so then rather learn than learning not to do that I learned to do it to other kids and then I would even justify it as in like well if you're that naive you deserve to have

your stuff taken and that's probably the same attitude that whatever older kid killed me in my first couple years playing the game did so it's like I was morally grasping for something right and trying to justify my own existence and

maybe being more anxious and guilt prone it wasn't just I'm going to get here and exploit as much as possible and then try to get a job and make the most money as possible I think part of that was

engaging with these philosophical ideas pretty early on and it was through game theory that I started to really wrestle with objective morality it was through that as well as this famous girdles incompleteness theorem and the basic idea there is that girdle famous

mathematician proved that any mathematical system you can make it logically coherent with a given set of axioms and you can prove anything within that structure but you have to accept axioms so that's almost like a leap of faith right and I started reflecting

more it was really after listening to The Bible series that even though I called myself such a secular rational empiricist like where did my idea that truth is good come from where did my idea even that the Universe has an

organized structure come from like I realized that I had at the very least metaphysics of physics like I believe there was this set of natural equations that could explain the world and I just took it as a given that that was there

that's kind of a faith-based belief it's obviously evidence-based like you can prove that these laws are out there but then I started to ask is the same thing true for Morality and I think the conclusion that many of these

secular thinkers come to is no like you can make an evolutionary argument for it why cooperation is sometimes adaptive but then you'll come up with all these different exceptions and cultural relativism to it but it was listening to

this Bible series and particular the yian psychology that was in it and connecting that to this idea of archetypes there was a line that your dad had about how Dawkins mimetic Evolution that memes undergo natural selection so like a joke can be modified

to be made funnier and spread more or it can just die that an archetype is something like the most extreme asymptotic destination that a meme converges towards so then there was this thought of there's that and then in Game

Theory there are these equilibria these Optimal Solutions that you can reach and some of them are cooperative and there was just this stitching together with that I also read maps of meaning at this time and what you what did you think of

that did you understand it it took me a while if you know I was listening to the class lectures alongside that it's like dense 500 pages but this was while I was taking the Neuroscience so I was familiar with a lot of the references

and I was getting really into the philosophy so it made like it it literally changed my life hands down so that's why so cool to be doing this oh that's cool that's very cool I started definitely taking a more metaphysical

orientation but trying to string it together like okay so morality is definitely itive of our evolutionary psychology but it's not that it's just subjective and arbitrary there's going to be some almost mathematical laws that guide us in a particular direction and

that's going to be whatever this optimal solution is if you're framing it in a game theory economic way like trying to maximize cooperation or resources but then there's also the narrative organizing part that's talked about in maps of meaning so this idea

that information itself like memes can be operated on in terms of natural selection and that those could co-evolve with Humanity so that our moral intuition can really co-evolve with these evolving morals that are transmitted in stories and then

thinking okay there are Universal patterns in different world mythologies and world religions and those are reflective of our evolution psychology in some deep way so you can still make the case okay it's arbitrary it's a reflection of the human psyche but at

the very least it's not arbitrary it's like deep in our nature and then it's I think our responsibility to figure out what those stories are telling us that was great I feel like that made more sense to me than Dad explaining

maps of meaning just so you know that was good that's a really high con yeah know that that that was really good wow okay so do puberty block blockers if you give them to people when they're like three and

they take them throughout puberty can they ever recover from that like can you go back to a normal brain structure after that do they have research on that okay so puberty blockers were FDA approved in the United States in 1993

and they were approved for precocious puberty which is a medical diagnosis where you're beginning puberty way too early like below age8 or even below age seven and they work they're called G&R agonists gonat tropen releasing hormone this is a

hormone that's produced in the hypothalamus that signals to the pituitary gland to release other hormones that signal to the gonads testes in males to begin producing testosterone or ovaries to produce estrogen in females and what they do at

first I thought that it was going to be an antagonist a blocker right but the cool thing the way the hypothalamus releases G&R it works in a pulsatile fashion so it goes up and down and your brain is expecting a certain Rhythm and

The Agonist it just floods it it's like constant activation we actually don't know whether it's is it that it becomes desensitized so then your brain just no longer responds or is it just the fact that it's constant Activation so it's

not following the rhythmic pattern so then it doesn't work because your brain only responds to that Rhythm we don't know but either way it's an Agonist that essentially shuts off the remaining Cascade and it specifically inhibits gonadal puberal development so there's

adrenal driven pubertal development so this would be like the sex non-specific secondary sex characteristics like body hair acne body odor that stuff still happens if you're given puberty blockers so that's perfect for someone with precocious puberty so you're get you're

going to still go through the early prepubertal development but you're not going to be growing secondary sex characteristics so early like at age six or seven so the drugs work very well for that and then the theory for youth with

gender dysphoria was going to be well you're already experiencing gender dysphoria as a result of your birth assigned sex and magnifying those characteristics is only going to make it worse so the theory here is we block that and it'll at the very least give

you more time to think so they say and decide whether you want to pursue puberty whether the gender dysphoria resolves or not or whether you want to transition and over 90% of kids who are prescribed puberty blockers so if

they're prescribed it's off label it's not illegal but it was originally meant and approved for precocious puberty and it was more theoretic medal propos that well it's it's very intuitive right like if you experience gender dysphoria you want to be the opposite sex these

hormones are the things that give you the opposite sex traits then very well it might reduce your symptoms but also you could imagine a comparison to anorexia like if you're experiencing extreme body dysmorphia and you think you're overweight then maybe weight loss

pills would make your symptoms go down but with anorexia it generally just Spirals and it can become life-threatening so for me that's a really open question and I think people need to be talking about it more I'm not

opposed to the idea that gender dysphoria would resolve and I think that if it's say the annate case like what you see with five Alpha reductase where it could go either way beginning at puberty you start to experience these masculinizing features

and maybe you decide you want to live your life as a man even though you didn't know you were one or maybe you decide you want to block them and continue as a woman I think for those types of people it's probably the right

decision but you also see in recent years the rate of gender dysphoria cases has skyrocketed like more than 10 times the amount of previous decades and also the sex ratio has swapped so historically it's been more males who

transition to be woman and now with Gen Z girls it's mostly females identifying as either non-binary or trans men and they're taking puberty blockers so again puberty blockers if they are harmless when it comes to physiological and reproductive development with one

exception the one exception is bone density and that's because sex steroids fuse the growth plates so the adrenal processes that facilitate height growth spurt those are separate hormones if you block GNR that pathway still continues so this you can see uh in people who

were castrated in Unix there are historical records going back centuries that they often grow to be really tall and lanky because again they have excess growth hormone and there's no gonadal hormones that fuse the growth plate and inhibit that growth hormone signaling oh

wow I had no idea about that right so bone density can be compromised but as long as you have the sex steroids later that will resolve and reproductive function again as long as you go through puberty your birth sex puberty I don't

think there will be any long-term harms to reproduction but two problems there the first is most of them do go on cross- sex hormones and those are more likely to impair fertility and then second well the only thing we know is

that Ence is a sensitive period for brain development that's expectant of certain hormonal inputs and that the hormones are involved in these highlevel cognitive processes like reward sensitivity like social cognition like emotion regulation and that they're somehow related to these massive sex

differences that we see that have health implications like risk- taking in males or anxiety and depression in females at the very least we know that they're going to be influenced and it could be for the better but just this theory that

you're making unpredictable changes and we don't even understand on the individual differences level how it's going to impact anxiety or depression and we do know from limited animal studies that at the very least it impacts cortical development structurally we don't know exactly what

the function would be there's limited evidence that's been contested that it might increase anxiety like behaviors or depressiv like behaviors which would be really ironic and unfortunate because the whole point of it is to decrease these internalizing symptoms yeah okay

so there was just this massive review the Cass review by Dr Hillary Cass it was funded by England's NHS their NIH equivalent and really it it just said that we don't have any highquality longitudinal evidence we can't make any

claims whether these things are good or bad the theory again is intuitive maybe gender dysphoria will resolve but there's all these open questions about why are so many kids so many more kids than before or coming out as trans it

could be because we're more accepting there's less stigma I think that could explain a small part of it but probably not this massive Spike that's seems limited just to gen Z and it doesn't explain sex ratio swap so that's talked

about in the review and then the review gestures at their un unknown effects on brain development and no one's studying that in humans no that's not true there are are a few clinical trials that are be done being done we still don't have

the data and what you really want is longitudinal evidence there are also some animal studies but the open question and the recommendation from the cast review is we shouldn't call this treatment before we know if the benefits outweigh the harms even though there

might be potential benefits especially for these types of intersex conditions where due to genetic abnormalities or due to hormonal imbalances you might stand very well to benefit from it but given the unknowns especially for brain development in typically developing

children this shouldn't be prescribed outside of clinical trials it's a separate question like an ethical question whether to even do the clinical trials whether children can consent to them I don't know if we have time for all that and plus that's more subjective

so I'll leave it at that that's where the evidence stands okay that's not that's like the nerdiest way of saying this was a bad idea that that I've ever heard but okay okay so then delving into that a little bit doesn't it seem

reasonable because there are so many more girls that are interested or or going towards or gender dysphoric or that it's kind of 2024's version of Hysteria like aren't women more impacted by these kind of social disorders like I

know anorexia if you're friends with a bunch of people that have anorexia then you're more likely to get that right there's really good social network analysis on this so yeah anorexia body image disorder cutting suicidality smoking in both

sexes but those former cases especially in girls you definitely see pure influence hysteria I know that there were those historical cases I don't know enough about those but the natural parallel to me so the the other thing I'll say this is such a polarized topic

but I have a pretty optimistic take on it the optimism is that you can tell that everyone wants the well-being of the children top priority right you just have very different ideas of what that looks like for some people they think

the hormones are life-saving and it's what the children need for other people that hormones might destroy the child's life they can't consent they want to protect the children so the good news is everyone wants to protect the children

right like we really care about this and it's really important research and we need highquality longitudinal evidence so that's being done that's a good thing I also think there's this lingering Collective conscience about how we used to treat the same lbgt populations so

homosexuality used to be in the DSM as a mental disorder not only that they used to give hormonal treatments for it it was really chemical castration you know the story of Alan Turing go let's go through it father of

modern computer science he helped crack the Germans cryptography code during World War II helped WI or end it early and built the first modern computer in order to do that he was also gay and he was closeted this whole time while in

the UK it was a criminal offense and he had all these top secret security clearances once it was outed that he was having these secret affairs with men rather than put him in jail he was given this option to go on chemical castration

and made him severely depressed I don't know what he was given exactly it may have been testosterone blockers it probably wasn't just that so it'll eliminate eliminates sex drive but it also eliminates motivation it seems that it made him severely depressed and he

killed himself so we lost a great mind because of that and conversion therapy was a disaster so the fundamental question for transgender identity is is it more similar to sexual orientation born this way or is it more similar to

anorexia social contagion I think the answer is both for different people that's why I really wanted to talk about this famous twin study and the intersex conditions because I do believe firmly that there's an innate biological cause at least in some people probably in

earlier cohorts in most of them that gives them gender dysphoria that makes them really risk their life to go through this transition back when the stigma was way way higher it's still a problem but the fact that used to do it

decades ago and that it used to be mostly males who experienced that that's an interesting research question to me and I think something about the increase rates combined with the sex ratio swap that makes me think it's more likely

that in probably the majority of genz transmen females identifying as men that that is probably not the same biolog iCal innate cause it's probably manifesting late onset during puberty so there's this term late onset or rapid onset gender dysphoria and this is the

social contagion hypothesis it's gotten a whole lot of flack and to be clear there's no data to support it I think it's a very interesting hypothesis and I don't think if it's true that it's true for everyone that's this binary thinking

that I think is the root of this problem it's not going to be a one- siiz fits-all solution H interesting interesting I'm probably in the more of the camp that maybe 1% of the people you see now that

are experiencing gender dysphoria are act actually have a biological route and a real problem I feel like the rest of it might be a social contagion right that's but like I have no data for that that's just what it looks like I think

so it's it's all a real problem and it's all going to have serious psychological side effects that everyone wants to treat whether that's through therapy whether it's wait watchful waiting and its children are going to grow out of it

maybe they're going to turn out to be gay and otherwise completely healthy cisgender I think that's probably the case for some again for some they might benefit from puberty blockers or hormone replacement but again we have no evidence that that actually reduces

negative mental health side effects and there's theoretical reason that maybe it would actually exacerbate them but again we don't have solid evidence of that either yeah okay that makes sense well I'm officially mind blown that was great thank you m yeah thanks very much for

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