Tuesday, June 27, 2017

10 Things Your Body Shape Says About You, Gender Identity, Debunked!

7 Sexy Things Women Do That Turn Guys On.Gender Identity, Debunked!

10 Things Men secretly Love about Women, Gender Identity, Debunked!

50 REAL Differences Between Men & Women, Gender Identity, Debunked!

10 Things Guys Will NEVER Say To Girls, Gender Identity, Debunked!

10 Ways Men And Women Think Differently, Gender Identity, Debunked!

How Men and Women Think - FULL DEBATE, Gender Identity, Debunked!

Why Men and Women Think Differently? This Guy Nailed It, Gender Identity, Debunked!

5 Things All Men Want Women To Do More!, Gender Identity, Debunked!

5 Things Women Can Do That Men Can’t!, Gender Identity, Debunked!

31 CONTROVERSIAL DIFFERENCES BETWEEN MEN AND WOMEN, Gender Identity , Debunked

Image result for The Dead will vote

Virginia student heading to prison after registering dead voters for Democrats

Image result for The Dead will vote
A student from James Madison University in Harrisonburg, Virginia, will spend at least 100 days in prison after admitting to registering deceased voters for Democrats during the 2016 presidential election.
Andrew J. Spieles, 21, pleaded guilty Monday in the U.S. District Court of the Western District of Virginia to submitting the names of dead voters to the registrar’s office in Harrisonburg, WTVR-TV reported.

The student was working for Harrisonburg Votes when he committed the crime, according to U.S. Attorney Rick A. Mountcastle. Harrisonburg Votes, whose website has since been deleted, has ties to the Democratic Party.
The political organization was founded by former Harrisonburg Mayor Joe Fitzgerald, a Democratic activist who was in office from 2002 to 2004, according to The Washington Post. Fitzgerald fired Spieles and disavowed his actions once the allegations were made public in August.
“In July 2016, Spieles’ job was to register as many voters as possible and report to Democratic campaign headquarters in Harrisonburg,” a spokesperson for the U.S. attorney’s office told WTVR. “In August 2016, Spieles was directed to combine his registration numbers with those of another individual because their respective territories overlapped.
“After filling out a registration form for a voter,” the spokesperson continued, “Spieles entered the information into a computer system used by the Virginia Democratic Party to track information such as name, age, address, and political affiliation. Every Thursday an employee [or] volunteer hand-delivered the paper copies of the registration forms to the registrar’s office in Harrisonburg.”
But Spieles was caught when one vigilant employee at the registrar’s office recognized one of the names he submitted — it belonged to the deceased father of a Rockingham County judge. The staffer called the police.
That discovery led the registrar’s office to unearth “multiple instances of similarly falsified forms when it reviewed additional registrations,” the U.S. attorney’s office spokesperson explained.
“Some were in the names of deceased individuals while others bore incorrect middle names, birth dates, and social security numbers,” the spokesperson continued. “The registrar’s office learned that the individuals named in these forms had not, in fact, submitted the new voter registrations.”
According to the news report, Spieles later admitted to committing the crime. He explained that he obtained the names, ages, and addresses of individuals from “walk sheets” given to him by the Virginia Democratic Party. From there, he would fabricate birth dates and social security numbers for the falsified voters before registering them.
In total, the JMU student said he created 18 fraudulent voter forms himself and said no one else participated in the crime.
This development is particularly noteworthy given President Donald Trump has often claimed widespread voter fraud is a major problem in the U.S. electoral system.
In May, the president signed an executive order establishing a commission to examine potential voter fraud and voter suppression.
“The commission will review policies and practices that enhance or undermine the American people’s confidence in the integrity of federal elections,” a White House spokesperson said at the time, “including improper registrations, improper voting, fraudulent registrations, fraudulent voting and voting suppression.”
By creating the commission, Trump is making good on a promise he made on Twitter just days after he became president. He vowed to begin “a major investigation” into voter fraud, including the number of deceased people registered to vote.
http://www.theblaze.com/news/2017/06/27/virginia-student-heading-to-prison-after-registering-dead-voters-for-democrats/

Monday, June 26, 2017

Liberals Calling Something ‘Discrimination’ Does Not Make It So, Again, I say Many Time's , The Word " No" Is Not Discrimination’ We Got A Legal Right To Say " No!"

The biggest problem with current sexual orientation and gender identity (SOGI) laws—including “Fairness for All,” which proposes a grand-bargain compromise between SOGI laws and religious liberty—is that they do not appropriately define what counts as discriminatory.

As I explain in a new report for The Heritage Foundation, “How to Think About Sexual Orientation and Gender Identity (SOGI) Policies and Religious Freedom,” these are the laws that are being used to shutter Catholic adoption agencies, fine evangelical bakers, and force business and public facilities to allow men into women’s locker rooms.

The problem is that liberals are calling anything they dislike “discrimination.” But liberals are getting it wrong. To illustrate this, consider several different cases of putative “discrimination.” The law must be nuanced enough to capture the important differences in these cases.

Invidious and Rightly Unlawful Discrimination 
Racially segregated water fountains were one form of discrimination that took race into consideration—in a context where it was completely irrelevant—and then treated blacks as second-class citizens precisely because they were black. The entire point was to classify on the basis of race in order to treat blacks as socially inferior.

As a result, such actions were rightly described as invidious race-based discrimination, and—given the entrenched, widespread, state-facilitated nature of the problem—they were rightly made unlawful.
Likewise, throughout much of American history, girls and women were not afforded educational opportunities equal to those available to boys and men. This form of discrimination took sex into consideration and then treated girls and women poorly precisely because of their sex, barring them from education in certain subjects or at certain levels despite being otherwise qualified.
As with invidious racial discrimination, such treatment took a feature (in this case, sex) into consideration precisely to treat women as less than men. The law rightly deemed such actions invidious sex-based discrimination, and—again, given the entrenched, widespread, and state-facilitated nature of the problem—Title IX of the Education Amendments was enacted to ensure that girls and women received equal educational opportunities.

Appropriate and Rightly Lawful Distinctions That Are Not Classified as Discrimination
When Title IX was enacted in 1972 and its implementing regulations were promulgated in 1975, the law made clear that sex-specific housing, bathrooms, and locker rooms were not unlawful discrimination. Such policies take sex into consideration, but they do not treat women as inferior to men or men as inferior to women. They treat both sexes equally because they take sex into consideration (they “discriminate”—in the nonpejorative sense of “distinguish”—on the basis of sex) precisely in a way that matters: by appreciating the bodily sexual difference of men and women in things such as housing, bathroom, and locker room policy.

Would we really be treating men and women equally in anything but an artificial way if we forced men and women, boys and girls, to undress in front of each other?

Justice Ruth Bader Ginsburg, in her majority opinion for the Supreme Court forcing the Virginia Military Institute to become co-ed, wrote that it “would undoubtedly require alterations necessary to afford members of each sex privacy from the other sex in living arrangements.” Yet we certainly would be treating people unequally if access to intimate facilities were based on factors wholly unrelated to privacy, such as race.
As a result, policymakers did not consider sex-specific intimate facilities as discriminatory in the first place, and laws explicitly reflected that commonsense understanding while rightly declaring racially segregated facilities to be unlawful.

The lesson here is that not all distinctions in fact should be deemed unlawful discrimination.
Not Discriminatory at All 

If sex-specific intimate facilities are an example of lawful, legitimate policies that take sex into consideration, pro-life medical practices are examples of policies that are legitimate and lawful because they do not take sex into consideration at all.

That only women can get pregnant has no bearing whatsoever on the judgment of the conscientious doctor or nurse who refuses to kill the unborn. The insistence of LGBT activists that men actually can become pregnant highlights the point: Pro-life medical personnel refuse to do abortions on pregnant women and “pregnant men” (i.e. women who identify as men).
Thus, we can identify three different types of cases:
  • Cases of invidious discrimination, in which an irrelevant factor is taken into consideration in order to treat people poorly based on that factor, as with racially segregated water fountains;
  • Cases of distinctions without unlawful discrimination, in which a factor is taken into consideration precisely because it is relevant to the underlying policy and people are not treated poorly, as with sex-specific intimate facilities; and
  • Cases with neither distinctions nor discrimination, in which a particular factor simply does not enter into consideration, as with pro-life doctors.
Any proposed policy intended to address the documented needs of people who identify as LGBT must take these categories into account without conflation.

SOGI Discrimination: Real and Imagined
Consider a florist who refused to serve all customers who identify as LGBT simply because they identified as LGBT. That would be a case of invidious discrimination because the mere knowledge that they identify as LGBT should have no impact whatsoever on the act of the florist selling flowers, because there is no rational connection between the two.
Now consider Baronelle Stutzman, the 71-year-old grandmother who served one particular gay costumer for nearly a decade but declined to do the wedding flowers for his same-sex wedding ceremony.
The customer’s sexual orientation did not play any role in Stutzman’s decision. Her belief that marriage is a union of sexually complementary spouses does not spring from any convictions about people who identify as LGBT. When she says she can do wedding flowers only for true weddings, she makes no distinctions based on sexual orientation at all.

This is seen most clearly in the case of Catholic Charities adoption agencies. They decline to place the children entrusted to their care with same-sex couples not because of their sexual orientation, but because of the conviction that children deserve both a mother and a father.

That belief—that men and women are not interchangeable, mothers and fathers are not replaceable, the two best dads in the world cannot make up for a missing mom, and the two best moms in the world cannot make up for a missing dad—has absolutely nothing to do with sexual orientation.
Catholic Charities does not say that people who identify as LGBT cannot love or care for children; it does not take sexual orientation into consideration at all. Its preference for placing children with mothers and fathers is not an instance of discrimination based on sexual orientation—and the law should not say otherwise.

Purported gender identity discrimination presents similar problems. The Washington Post recently reported on a woman who was suing a Catholic hospital for declining to perform a sex reassignment procedure on her that entailed removing her healthy uterus. In that report, the Post captures the conflation of real and imaginary discrimination.

“What the rule says is if you provide a particular service to anybody, you can’t refuse to provide it to anyone,” said Sarah Warbelow, the legal director for the Human Rights Campaign. That means a transgender person who shows up at an emergency room with something as basic as a twisted ankle cannot be denied care, as sometimes happens, Warbelow said. That also means if a doctor provides breast reconstruction surgery or hormone therapy, those services cannot be denied to transgender patients seeking them for gender dysphoria, she said.

The two examples given, however, differ in significant ways. A hospital that refuses to treat the twisted ankles of people who identify as transgender simply because they identify as transgender would be engaging in invidious discrimination, but a hospital that declines to remove the perfectly healthy uterus of a woman who identifies as a man is not engaging in “gender identity” discrimination.

The gender identity of the patient plays no role in the decision-making process: Just as pro-life physicians do not kill unborn babies, regardless of the sex or gender identity of the pregnant person, doctors do not remove healthy uteruses from any patients, regardless of how they identify themselves.

As for the Human Rights Campaign spokesperson’s claim that emergency rooms “sometimes” refuse to treat the twisted ankles of transgender patients, there is no evidence—including on their own website—that it or anything similar in fact happens. Furthermore, insofar as this “sometimes happens,” it seems reasonable to think that the media would focus so much attention on it that the hospital would reverse course within hours. It therefore seems highly unlikely that this alleged problem merits a governmental response.

Need for Policy Shapes the Nature of Policy Response, Definitions, and Protections
My new Heritage report argues that any justified government policy must not penalize valid forms of action and interaction or burden the rights of conscience, religion, and speech. We can see this principle in action.
Because there was such widespread, entrenched systemic and institutional racism throughout American society in the 1960s, for example, and because social and market forces were not sufficient to remedy the problem, it was appropriate for government to respond. That response was properly tailored to meet this need. It defined discrimination to include racially segregated accommodations, places of employment, and housing providers while providing thin religious liberty protections.
Because the justification for antidiscrimination laws based on race was so strong and the need was so great, the law was appropriately broad with limited exemptions.
By contrast, consider laws that address discrimination based on sex. Because the nature of sex and the history of sexism did not represent an exact parallel to racism, the law did not treat them in entirely the same ways. Discrimination was legally defined so as not to include sex-specific intimate facilities, and much broader—and in some cases total—religious liberty exemptions were included. And to this day, sex is not a protected class for federal antidiscrimination law as applied to public accommodations.
In sum, because the justification for laws against sex-based discrimination was weaker than the justification for laws against race-based discrimination, the legal response was more modest: It covered less terrain, defined discrimination more narrowly, and provided greater protection for religious liberty.
Any proposed policies intended to meet the needs of people who identify as LGBT would need to be crafted in a similar manner. Without greater evidence of the justification for specific policy responses—greater documentation of what the needs truly are—it is hard to be specific. In general, however, the need clearly seems weaker than the need for policies designed to deal with discrimination on the basis of race and sex.
A policy response would therefore need to cover less ground, target discrimination more narrowly, define discrimination accurately, and avoid undermining the rights of conscience, religion, and speech. Alas, laws proposed by liberals today do not do this.

Bernie: Obamacare Isn't Working Well, and the GOP Plan Would Kill People, So We Need Socialized Healthcare


 Image result for bernie Sanders is an idiot




Let there be no doubt: The Democratic base's center of political gravity is drifting inexorably to the left, so support for a national single payer healthcare scheme will at some point -- probably sooner than later -- become an ideological litmus test within that party.  Recall California leftists booing and heckling Democratic officials who were unwilling to blindly endorse a proposed Socialized healthcare bill, the price tag for which would double the state's already-bloated budget.  Without any plan to pay for it, and cheered on by the Golden State's leading candidate for governor, Senate Democrats in Sacramento passed the bill -- only to see it sputter and die in the House.  The ruinous fiscal fantasy is stymied for now, but it'll be back.  When it inevitably returns, perhaps California lawmakers should consult with their left-wing counterparts in Vermont, a very liberal state with a small and relatively homogenous population. Vermonters actually approved a single-payer healthcare system seven years ago, and then reality intruded in 2014:
For decades, liberal activists yearned for a European-style, single-payer health system that they argued would lead to more affordable, efficient, and comprehensive medical coverage for all citizens. When Vermont four years ago enacted a landmark bill to establish the nation’s first single-payer health care system, they saw their long-sought dream about to be fulfilled. But reality hit last month. Governor Peter Shumlin released a financial report that showed the cost of the program would nearly double the size of the state’s budget in the first year alone and require large tax increases for residents and businesses. Shumlin, a Democrat and long-time single-payer advocate, said he would not seek funding for the law, effectively tabling the program called Green Mountain Care...The decision not only stunned and angered supporters in Vermont, but also signaled that the dream of universal, government-funded health care in the United States may be near its end...“The idea of single-payer, or a Medicare-for-all type program, has always been a cherished dream for many in the Democratic Party,” said Henry J. Aaron, a senior fellow at the Brookings Institution, a liberal-leaning Washington think tank. “In truth, there had never been a hard, developed plan to implement such a dream. In Vermont, they finally developed a plan, and look what happened.”
Undeterred by this reality check from his own home state, Sen. Bernie Sanders once again pressed for a nationwide government-run healthcare system on Meet the Press yesterday:
"Well let me also say something else when we talk about where we are with health care. Please do not forget that the United States of America today remains the only major country on earth not to guarantee health care to all people as a right. My view is that the Affordable Care Act has problems. Deductibles are too high. Co-payments are too high. We have to address that.  But I also want to say that there is something wrong when we remain the only country not to guarantee health care to all people as a right. I am going to go forward with a Medicare-for-all, single-payer program.  And I think that's the direction long-term that we should be going."
You forgot to mention premiums, too, Senator.  In any case, it's telling that Sanders (while predictably ripping into the Republican healthcare bill), explicitly admits that the "Affordable" Care Act is failing on affordability -- which, we should never forget, was the central premise on which Obamacare was fraudulently marketed to the public.  With Democrats' healthcare experiment falling apart, Sanders is back to touting the need for a fully government-run and -controlled system, noting that the United States is the only major industrialized nation that hasn't embraced that model (declining to mention that some of those countries are moving away from it, amid systemic cost and access problems).  Leftists argue that the demise of exorbitantly-costly single payer dreams, even in states run by committed statists, wouldn't be replicated at the national level.  They cite the federal government's ability to collectively negotiate costs, and to impose and enforce blanket price controls.  Setting aside the fact that these top-down controls would crush medical innovation and inevitably result in government rationing, the notion that single payer is an affordable alternative is preposterous.
A liberal think tank analyzed Sanders' government-run healthcare plan during the campaign and determined that it would cost taxpayers an additional $32 trillion over ten years, meaning that Congress would need to extract more than three trillion dollars every year from the American people to pay for it.  In 2016, Washington spent roughly $3.9 trillion.  Total.  The federal government is already spending hundreds of billions of dollars more than it takes in on an annual basis, pouring more red ink onto the $20 trillion national debt.  The federal government has also handed out unpaid-for promises to the tune of tens of trillions of dollars, stretching into the future.  Absent serious reforms, we are headed to a debt crisis when programs like Medicare and Social Security become insolvent in the coming years.  What Sanders and his fellow travelers want is to take the current level of spending and explode it into the stratosphere, which would mathematically require stunning, economy-crushing and family budget-ruining tax increases on working and middle class Americans.  All to pay for a brand new, enormous program that would effectively massively expand Medicare, which is going broke as it is.

If you like the fiscal insolvency of Medicare, and the level of service provided by the VA -- where another 100 veterans have died awaiting care in Los Angeles -- you'll love single-payer healthcare.  Sanders' party is in denial over the latter reality, and Sanders shocked veterans groups by downplaying gross abuses, corruption and failures at the VA, which grew worse on his watch as chairman on the Senate Veterans Affairs Committee.  He was blinded by his faith in big government.  Hillary Clinton similarly waved away the severity of the VA scandal, attacking Republicans for blowing it out of proportion.  As a reminder, according to the Inspector General, hundreds of thousands of American veterans may have died awaiting appointments and care through the broken federal system, which Republicans have moved to fix.

This is one of the reasons why it's so curious that Sanders and Clinton would lead the charge against the Senate healthcare bill by claiming that it would result in the deaths of thousands (citing a partisan, left-wing advocacy group's analysis).  They both reflexively defended a government program that directly resulted in veterans' premature deaths, wherein bureaucrats manipulated wait list data in order to protect their own taxpayer-funded bonuses.  Similarly, single-payer advocates don't have a leg to stand on when it comes to "people will die" arguments.  Beyond its unaffordability, government-run healthcare results in worse outcomes for its subjects: Far worse delays for doctor appointments and care, significantly worse survival rates for major diseases like cancer, far worse innovation for new life-saving treatments, and lower life expectancy rates (adjusting for fatal gunshot wounds and instant-death car accidents, which do not reflect on the efficacy of a healthcare system).
The plan Democrats created is betraying millions with shattered promises, and is failing apart at the seams.  They're shamelessly demagoguing GOP efforts to fix the mess they made, with the growing Sanders/Warren wing of the party advocating a national system that would result in worse treatment, fewer cures, longer waits for care, and lower survival rates for terrible diseases.  More people would die, sooner.  And Americans would be forced to pay much, much higher taxes for the privilege of living under such a regime.  In other words, to borrow their grotesque demagoguery, Democrats would be insistent on becoming the "death party."  I'll leave you with these correct statements, which expose an uncomfortable truth about Obamacare and cut through the Left's motives-impugning hysteria about the best solutions to these complex policy challenges:

Calf S.J.W On Video Harassing Gay Republican , So Your Telling Me, That Democratic Party Support Gay Right's , But Will Not Defend Gay Republican , Gay Right's? Why?

 Image result for they lost their minds


So Your Telling Me, That Democratic Party Support Gay Right's , but will not defend  Gay Republican , Gay Right's?  Why?

The incident took place in front of WalMart in Fullerton in the heart of the 29th Senate District, which Newman represents. LeTourneau, a long-time left-wing Democratic acivists notorious for his volcanic public outbursts, accused recall organizer Carl DeMaio, a gay Republican activist and former San Diego councilmean, of being a traitor to gays.

“Which one of you a**holes is the gay?,” LeTorneau says in the video. “You f—ing belong to a party that writes our destruction into its platform. How f—ing dare you be in this county. Get your s–t and get out of here. You are a f—ing disgrace to any gay person I know. Piece of sh-t.”
LeTourneau pressed up against the signature table, just a couple of feet from DeMaio, ranting and jabbing his finger while trying to prevent the man and his fellow volunteers from gathering signatures.

LeTourneau took photos of DeMaio and threaten to socially ostracize him:

“I’m gonna make sure everybody in the LGBTQ community knows.”

To which DeMaio replied, “They already know. I publish the San Diego Gay and Lesbian News. They know who I am.”

LeTourneau continued berating the man, barking that he was not authentically gay:

“You do not belong to our community. You also do not belong to the LGBTQ community either.”
A Democratic activist standing nearby came to LeTourneau’s defense, saying he didn’t blame LeTourneau for being angry.

“LeTourneau clearly thinks that if you are gay, you can only be a Democrat which is both arrogant and highly offensive,” DeMaio told the media. “The idea that Californians are sick of paying higher taxes cuts across party lines and sexual orientation.”

OC Daily reached out to OC Democratic Party Chair Fran Sdao for comment on whether this is appropriate behavior from a DPOC officer.

LeTourneau has a knack for courting controversy. Earlier this year, he came under fire to admitting, while addressing the Anaheim City Council, that he had illegally shipped medical marijuana across state lines. He cut his political teeth in ACT-UP’s confrontational, in-your-face school of political action.

The tragic shooting attack on the Republican congressional baseball team by ardent progressive activist James Hodgkinson, in which he severely wounded Rep. Steve Scalise and several other staffers and Capitol police officers, has sparked a national conversation about the toxic political environment created by extreme political rhetoric and actions. This is driven almost exclusively by  progressive-Left activists unable to cope with Donald Trump’s election and responding with over-the-top, over-heated rhetoric about fascism killing our Republic.

Given the apparent desire by political leaders on both sides of the aisle to lower the partisan temperature and pull our politics back from the brink, one has to wonder if it is time for the DPOC to retire LeTourneau’s extreme, attack-dog brand of activism.

Sunday, June 25, 2017

Image result for gay liberal

Gay Liberalism IS A Mental Illness

Image result for gay liberal
Francisco is liberal
Image result for gay liberal

Over the past 10 years, violence has taken the lives of 114 Sacramento teens

The Answer IS liberal social issues. Liberal Care More About There  social issues and so this is what happen, Two IS Also Show , That As Liberal push for a more god less nation is will get worse.


Young people between the ages of 15 and 19 were twice as likely to be killed in Sacramento County as the general population. More teens were killed by gunshot wounds to the head than by any other means, and guns were used to kill teenagers here at a significantly higher rate than the national average.

Here are the 114 teenagers who died violently in Sacramento County since 2007

http://www.sacbee.com/news/investigations/article156699959.html
  • http://www.sacbee.com/news/investigations/article156699959.htmlolence has claimed the lives of 114 teens in Sacramento since 2007, with a higher murder rate than state and national averages for this age group. Nearly all were killed by guns, about 40 percent are unsolved, and all leave families desperately clinging to memories of lost children and dreams of what lives they may have led.
  • murder rate among Sacramento teens since 2007 was much higher than the federal rate and young people here were twice as likely to die of homicide as those in any other age group.

Read more here: http://www.sacbee.com/news/investigations/article156699959.html#storylink=cpy


Read more here: http://www.sacbee.com/news/investigations/article156699959.html#storylink=cpy

Her Name Was Kaitlyn Elizabeth Duffy. She Was A White Senior At Virginia’s Great Bridge High School, And IS Now Dead!

 So Other White Girl Is Dead, When Will This End? All The White being killed it got to end!

Her name was Kaitlyn Elizabeth Duffy. She was a senior at Virginia’s Great Bridge High School, and this summer she would have celebrated her recent graduation.



Known affectionately as “Katie” by friends and family, Duffy was an admired member of the varsity cheerleading team and the swim team. She was also a violinist, National Honor Society inductee, former student council president, and certified lifeguard.

Duffy had recently been accepted to attend Virginia Tech in the fall, as a Harry Bramhall Gilbert Merit Scholarship Award recipient. According to a classmate’s post on Twitter, she had also been voted Great Bridge prom queen.

But Duffy wasn’t here to enjoy this latest in a long line of glowing achievements. She also won’t be among the incoming Virginia Tech freshmen this fall.
http://www.liftable.com/marybeth-bittel/drunk-driver-smashes-car-killing-teen-way-bury-parents-see-flood-1400-line-street/?utm_source=Email&utm_medium=braverafreedomforce&utm_campaign=can&utm_content=2017-06-25

Saturday, June 24, 2017

Gender Identities Vs The Party Of Science

Image result for facepalm


When It Come To Gender Identities, the The Party Of Science, give no proof to GenderIdentities, But Claim to have Science To have Science To Prove 1. "Global Warming",  2."Evolution" 3. " Vaccine" And 4." Pot" ?But No Science, To Prove Gender Identities? Party Of Science, So Again Party Of Science Were The Science,To Prove Gender Identities?  Got To Call out The  Party Of Science To Prove Gender Identities .

3-in-1: A 'transgender' turns back to being a man

My Ex Transgender Testimony #2

My Ex Transgender Testimony #1

Tuesday, June 20, 2017

Effect of Pubertal Suppression on Linear Growth and Body Mass Index; a Two-Year Follow-Up in Girls with Genetic Short Stature and Rapidly Progressive Puberty

 Image result for Pubertal Suppression drug


Objective: Gonadotropin-Releasing Hormone agonists (GnRHa) are used to improve the final adult height in short stature children. There are limited studies which address the potential side effect of these agents: excessive weight gain. We have followed girls with rapidly progressive puberty receiving GnRHa and results were focused on the effect of treatment on final height, weight and body mass index

Methods: Thirty girls between 8.5 and 12 years with short stature and predicted adult height of less than 155 cm were enrolled in the study. All had rapidly progressive puberty. Weight and height measurements were done at the beginning of treatment, 6 and 12 months after starting and 6 and 12 months after the cessation of treatment. Bone age and stages of puberty were estimated at the beginning of treatment, after 12 months of starting and 12 months after the treatment was stopped.
Findings : Predicted adult height (PAH) changes during treatment were not significant. There was no significant difference between final height and weight according to the body mass index (BMI), PAH or bone age.

Conclusion: We conclude that girls with genetic short stature and rapidly progressive puberty will not benefit receiving a one-year course of GnRHa and there is no significant difference between the final height and final weigh among children according to BMI.

Key Words: Short Stature; Puberty; Gonadotropin Releasing Hormone Agonists; Body Mass Index

Introduction

Short stature has always been a serious mind-occupying concern of parents all over the world and different therapeutic approaches are now being used by pediatric endocrinologists[1-5]. Almost 20% of the adult height is achieved during the pubertal growth[6-12]and this might be the reason most parents seek medical help before or in the early stages of puberty of their children in order to do something that can help them achieve a taller stature. Studies have been performed to compare different methods and controversial results are available, but the most prominent feature of all studies, is the need for further evaluation[1-5].

Gonadotropin-Releasing Hormone agonists (GnRHa) are widely used to desensitize the pituitary axis for secreting endogenous GnRH and suppress the progression of puberty[13-18]. As a result, these agents postpone bone maturation and reduce the rate of epiphysiseal maturation due to the lack of steroid sex hormones and help improve the final adult height. Despite extensive research, the best time to start and end the treatment with GnRHa and the positive effect they have on the final height are still not clear.

An important point is the concordance between the clinical pubertal development and the growth spurt[4]. Growth acceleration in girls, generally takes place prior to or during the first year of breast development, the pattern of which has large individual variations. Considering Tanner staging, 40% of girls have their peak growth velocity at breast stage 2 (B2), 30% in B3, 20% in B4 and 10% before any breast development occurs (B1).

The amount of body fat is one other important component of adolescent growth during puberty. It is well known that puberty and growth both are accelerated with common obesity[1].
It is suggested that excessive weight gain might be an unfavorable side effect of the treatment with GnRHa and there are limited studies addressing this issue[4,19-22].

In the present study, we have followed girls with rapidly progressive puberty who received GnRH afor pubertal suppression and results were reviewed focusing on the effect of treatment on their final height, weight and body mass index.

Subjects and Methods

We prospectively followed thirty girls aged between 8.5 and 12 years who referred to the endocrinology clinic due to short stature and had predicted adult height of less than 155 cm. All of our subjects had rapidly progressive puberty (started after the age of 8 yrs) documented by follow-up physical examinations performed in a three-month period before starting any treatments. Subjects enrolled in this study had increasing Tanner’s stage of puberty by at least one point or had presented an additional sign of pebertal progression (e.g. pubic or axillary hair).

Exclusion criteria: any additional condition affecting body mass index (BMI) or puberty onset like deficiency of growth hormone, hypothyroidism or congenital adrenal hyperplasia. 

Treatment with GnRHa (diphereline) was started for all subjects in a dose of 80 mcg/kg every 28 days and continued for 12 months. Weight and height measurements using standard scales, were done at the beginning of treatment, 6 and 12 months after starting the treatment and also 6 and 12 months after the cessation of treatment. Achievement of final height (FH) was defined when the growth rate reached to less than 0.5 cm/year, bone age was more than 15 yrs and bone x-rays showed closed epiphyseal growth plates.

Bone age was assessed according to the left hand x-ray and was estimated for all subjects at the beginning of GnRHa treatment, after 12 months of starting the treatment and 12 months after the treatment was stopped. Stages of puberty were estimated by expert pediatric endocrinologists using the Tanner staging method at the beginning of treatment, 12 months after the start and 12 months after the cessation of treatment. Bayley-Pinneau method was used for calculation of the predicted adult height (PAH). Target height was measured for all subjects and all of the PAHs were less than the target heights.

All data were analyzed using SPSS software version 17. Statistical analyses were performed by Repeated Measurement Test, Student t-Test and Pairwise Comparison (Boneferroni Method). Mann-Whitney Test was also used for comparing data between different groups. P value of less than 0.05 was considered significant for all tests.

Our study was prepared according to the ethical principles of the Helsinki II declaration. The ethics committee in the Department of Medical Ethics, located in Shiraz University of Medical Sciences, approved the study protocol. Written informed consent was provided by all children and their parents.
Findings
Thirty girls aged between 8.5 and 12 years were evaluated and enrolled in the study. All of these girls had their early stages of puberty (breast enlargement) after the age of 8 y (no one had precocious puberty) and all had rapidly progressive puberty confirmed by serial physical examinations during the 3 months before starting the treatment. Patient characteristics are summarized in Table 1. Sexual maturity rate
Table 1
Patient characteristics before starting the treatment
according to Tanner method was estimated for all subjects in each visit and the details shown in Table 1 correspond to the physical examination performed just before starting the treatment. In 76.7% of girls menarche had not occurred but 23.3% had at least one menstrual cycle before treatment.
Height was measured 5 times and the increase in height during treatment was statistically significant (P<0.001) and was evaluated by subtracting the first height measured from all other measurements (Table 2). The rate of Ht increment during treatment was calculated during 4 periods: first 6 m and second 6 m after beginning the treatment, first 6 m and second 6 m after cessation of treatment. Interestingly, the mean of Ht increment was highest during the first 6 m after beginning of treatment (2.9±0.15 cm/6 m) compared to the other three periods which follow respectively: 2.2±0.12, 2.1±0.14 and 2.2±0.18 (P<0.001). Weight was also measured 5 times and the increment was calculated (Table-2) which also showed statistically significant rise during our treatment. BMI was also significantly increased during treatment (P<0.001).
Table 2
Height, Weight and Bone Age during and after treatment
Bone Age assessment is summarized in Table 2

Statistical analysis showed that the mean bone age during treatment had a significant increment (P<0.001). The mean change in bone age was 1.7±0.5 with a minimum increase of 0.5 and a maximum of 3 years.

PAH changes during treatment were not significant and the mean PAH one year after treatment cessation was 152 cm (min 144 and max 161). The mean difference in PAH was 1.49±3.74 with a maximum increase of 7.1 cm.
Pubertal progression ceased after starting treatment in all of our subjects and the Tanner’s staging advanced no more whilst the subjects received the GnRHa.

The average interval between the cessation of the 1 year treatment and menarche in our patients was 14±7.5 months (min 4 and max 28 months). Final height (FH) was measured for all subjects and had an average of 150.2±3.6 (min 144 and max 157 cm). Average of the Final weight (FW) was 42.7±5 (min 35 and max 53 kg). For better understanding of the effect of the treatment and for possibility of comparing among subjects, we defined three groups according to the BMI, PAH, and bone age as follows:

BMI Group: BMI before starting the treatment of below 18 kg/m2 which included 19 of our subjects (63.3%) and the BMI of 18 and above which included 11 subjects (36.7%). Also the BMI one year after the cessation of treatment of below 18 kg/m2 of 13 subjects (43.3%) and the BMI of 18 and above that included 17 (56.7%).

PAH Group: PAH before starting treatment of less than 150 cm which included 12 of our patients (40%) and the PAH of 150 and above which included 18 patients (60%).

Bone age Group: Group 1 were subjects in whom the bone age before starting the treatment was estimated within 1 year of their chronological age and group 2 were those whose bone age was more advanced and had more than 1 year difference with their chronological age. Group 1 included 24 patients (80%) and group 2 consisted only of 6 patients (20 %).

We compared the final height and final weight in these three groups and we concluded that there is no significant difference between these two parameters among different groups. Data are summarized in Table 3.
Table 3
Comparison of Final Height and Final Weight among different groups
BMI calculated before the start of treatment was compared with the BMI one year after the cessation of treatment and 22 (73.3%) of our patients had no change in BMI, in one (3.3%) patient BMI had decreased and in the other 7 (23.3%) BMI had increased. The mean change of BMI was 1.39 kg/m2 ±1.2 (with the most decrease of 0.7 and the maximum increase of 5.18). The reason for the increased BMI is still unclear and requires further investigation. Nevertheless, increased appetite, low physical activity and baseline increased BMI can be predisposing factors.

No correlation was found between BMI and start of menarche after cessation of treatment. Despite the changes in the BMI, we found no correlation between the difference of BMI and the start of menarche. This correlation was checked in both the BMI before starting the treatment and the BMI one year after its cessation and also compared when BMI was classified into two groups of below and above 18 kg/m2 among which the difference was not significant (Table 4).
Table 4
Mean duration of menarche after cessation of treatment compared between different groups of Body Mass Index
We found no significant correlation between the PAH before and after treatment with BMI (P. value of 0.07 and 0.9 respectively).

Discussion

We conclude that girls with genetic short stature and rapidly progressive puberty with relatively early onset, posing them at risk of not attaining their desired adult height, will not benefit receiving a course of one-year treatment with GnRHa.

It is also concluded that BMI can increase significantly but there is no significant difference between the final height and final weight among children with lower or higher BMIs. It means that no advantage exists for girls with lower BMI in gaining taller stature or no disadvantage for obese girls in remaining short despite treatment.

The literature is limited on the final effect of the treatment with GnRHa in children with genetic short stature and rapidly progressive puberty. Studies presenting adult height data after treatment with GnRH agonists alone are few. Carel et al[1] treated 31 girls with idiopathic short stature and onset of puberty around the age of 12 for an average of 1.9 years. They reported disappointing results since adult over pretreatment-predicted height increment was 1±2.3 cm (P<0.02)[9]. They also reported marked decline in growth velocity during treatment and increased height deficit by 0.4 standard deviation score (SDS) on average in these already short girls. Our results also show that the growth velocity was highest during the first 6 m after beginning of treatment and declined thereafter which is supported by the study of Carel et al [1].

Yanovski et al[10] conducted a placebo-controlled randomized study in NIH on a heterogeneous population using GnRHa with a mean duration of treatment of 3.5 years. They showed that adult height SDS increased and the difference was about 4.2 cm. They also stated that their treatment was associated with decreased bone mineral density.

Although the results of these two investigations seem discrepant, but they both indicate that reduced growth rate and reduced bone age progression are two opposite effects of treatment with GnRHa. If the duration of treatment is short, as in the study of Carel et al and the present study, no effect on the final height is seen. Lazar et al[11] also had a similar observation in which short duration of treatment with GnRHa had little or no clinically significant gain in the adult height. But if the duration 
 increases, as in the study of Yanovski et al, the absence of the progression of bone age combined with the slow growth rate, eventually leads to increased adult height. The mean effect has been estimated to be close to 1 cm of height gain per year of treatment.

There are also other approaches to increase adolescent growth, namely: Growth hormone alone, growth hormone in combination with GnRHa, sex steroids (testosterone in particular) and aromatase inhibitors. These have their specific indications and studies have been carried out regarding their efficacy and safety[23-26].

The combination of growth hormone and GnRHa is a popular approach for children born small for gestational age or with a diagnosis of idiopathic short stature. Several encouraging studies have shown variable effects but only in a few of them a relevant control group has been included and adult height data should be measured in future studies[22, 27-29].
Studies addressing the auxological effect of GnRHa in treatment of central precocious puberty have mainly focused on FH outcomes and body weight changes have been ignored to some extent. It is also of note that obesity in childhood is associated with early puberty, and during past two decades, we are witnessing a doubled prevalence of overweight among youth[19-21]. That is why the effect of GnRHa treatment on body weight is now more important. Carel et al[21] have shown that BMI increases during treatment with GnRHa, especially in patients with hypothalamic hamartoma and precocious puberty. Feuillan et al[28] and Boot et al[29] also showed that GnRHa treatment in central precocious puberty increases the percentage of fat mass and BMI SDS for chronological age. On the other hand, reports of Arrigo et al[26] and Lebrethon et al[27] indicate that BMI decreases during these treatments or that the increase in weight is not significantly affected by GnRHa.
In one recent study performed in Shiraz, Iran, on GnRHa treatment for children with idiopathic central precocious puberty, it was shown that these agents do not cause metabolic syndrome after 3 and 6 months of therapy, and they might only induce hyperlipidemia and central obesity[30].
In the present study, it is concluded that BMI is not correlated to the FH or the PAH during treatment with GnRHa in girls with idiopathic short stature and rapidly progressive puberty. We suggest that the result of these therapies is not significantly affected by higher or lower BMIs. Considering many different results in the limited literature available on this issue, further long term studies are required to clearly explain these controversies. We divided our patients to different groups in order to be able to compare them and so was abated the limitation of not having a separate control group.

Conclusion

We conclude that girls with genetic short stature and rapidly progressive puberty, who are at risk of not attaining their desired adult height by the relatively early onset of puberty, will not benefit receiving a course of one-year treatment with GnRHa. It is also concluded that BMI can increase significantly but there is no significant difference between the final height and final weight among children with lower or higher BMIs. It means that no advantage exists for girls with lower BMI in gaining taller stature or no disadvantage for obese girls in remaining short despite treatment.

Authors’ Contribution

Z. Karamizadeh: Concept and design, critical revision of the manuscript.
A. Amirhakimi: Acquisition of data, data analysis, manuscript preparation, and critical revision of the manuscript.
Gh. Amirhakimi: Concept and design, critical revision of the manuscript.
All authors approved the final version of the manuscript.

Acknowledgment

The authors are grateful for data analysis by statistics and epidemiology department, Shiraz University of Medical Sciences.
Conflict of Interest: None

References

1. Carel JC. Can we increase adolescent growth? Eur J Endocrinol . 2004;151(Suppl 3):U101–8. [PubMed]
2. Biro FM, McMahon RP, Striegel-Moore R, et al. Impact of timing of pubertal maturation on growth in black and white female adolescents: The National Heart, Lung, and Blood Institute Growth and Health Study. J Pediatr. 2001;138(5):636–43. [PubMed]
3. Vizmanos B, Marti-Henneberg C, Cliville R, et al. Age of pubertal onset affects the intensity and duration of pubertal growth peak but not final height. Am J Hum Biol. 2001;13(3):409–16. [PubMed]
4. Marshall WA, Tanner JM. Variations in pattern of pubertal changes in girls. Arch Dis Child. 1969;44(235):291–303. [PMC free article] [PubMed]
5. Grumbach MM, Auchus RJ. Estrogen: consequences and implications of human mutations in synthesis and action. J Clin Endocrinol Metab. 1999;84(12):4677–94. [PubMed]
6. van der Eerden BC, Karperien M, Wit JM. Systemic and local regulation of the growth plate. Endocr Rev. 2003;24(6):782–801. [PubMed]
7. Carel JC, Lahlou N, Jaramillo O, et al. Treatment of central precocious puberty by subcutaneous injections of leuprorelin 3-month depot (11.25 mg) J Clin Endocrinol Metab. 25;87(9):4111–6. [PubMed]
8. Carel JC, Lahlou N, Roger M, et al. Precocious puberty and statural growth. Hum Repro Update. 2004;10(2):135–47. [PubMed]
9. Carel JC, Hay F, Coutant R, et al. Gonadotropin releasing hormone agonist treatment of girls with constitutional short stature and normal pubertal development. J Clin Endocrinol Metab. 1996;81(9):3318–22. [PubMed]
10. Yanovski JA, Rose SR, Municchi G, et al. Treatment with a luteinizing hormone-releasing hormone agonist in adolescents with short stature. N Engl J Med. 2003;348(10):908–17. [PubMed]
11. Lazar L, Kauli R, Pertzelan A, et al. Gonadotropin-suppressive therapy in girls with early and fast puberty affects the pace of puberty but not total pubertal growth or final height. J Clin Endocrinol Metab. 2002;87(5):2090–4. [PubMed]
12. Adan L, Chemaitilly W, Trivin C, et al. Factors predicting adult height in girls with idiopathic central precocious puberty: implications for treatment. ClinEndocrinol (Oxf) 2002;56(3):297–302. [PubMed]
13. Antoniazzi F, Cisternino M, Nizzoli G, et al. Final height in girls with central precocious puberty: comparison of two different luteinizing hormone-releasing hormone agonist treatments. Acta Paediatr . 1994;83(10):1052–6. [PubMed]
14. Arrigo T, Cisternino M, Galluzzi F, et al. Analysis of the factors affecting auxological response to GnRH agonist treatment and final height outcome in girls with idiopathic central precocious puberty. Eur J Endocrinol. 1999;141(2):140–4. [PubMed]
15. Bayley N, Pinneau S. Tables for predicting adult height from skeletal age. J Pediatr. 1952;40(4):423–41. [PubMed]
16. Bertelloni S, Baroncelli GI, Sorrentino MC, et al. Effect of central precocious puberty and gonadotropin-releasing hormone analogue treatment on peak bone mass and final height in females. Eur J Pediatr. 1998;157(5):363–7. [PubMed]
17. Bouvattier C, Coste J, Rodrigue D, et al. Lack of effect of GnRH agonists on final height in girls with advanced puberty: a randomized long-term pilot study. J Clin Endocrinol Metab. 1999;84(10):3575–8. [PubMed]
18. Seung Jae Lee, Eun Mi Yang, Ji Yeon Seo, et al. Effects of gonadotropin-releasing hormone agonist therapy on body mass index and height in girls with central precocious puberty. Chonnam Med J. 2012;48(1):27–31. [PMC free article] [PubMed]
19. Dunger DB, Ahmed ML, Ong KK. Effects of obesity on growth and puberty. Best Pract Res Clin Endocrinol Metab. 2005;19(3):375–90. [PubMed]
20. Troiano RP, Flegal KM. Overweight prevalence among youth in the United States: why so many different numbers? . Int J Obes Relat Metab Disord . 1999;3(Suppl 2):S22–7. [PubMed]
21. Carel JC, Roger M, Ispas S, et al. Final height after long-term treatment with triptorelin slow release for central precocious puberty: importance of statural growth after interruption of treatment. French Study Group of Decapeptyl in Precocious Puberty. J Clin Endocrinol Metab. 1999;84(6):1973–8. [PubMed]
22. Pasquino AM, Pucarelli I, Roggini M, et al. Adult height in short normal girls treated with gonadotropin-releasing hormoneanalogs and growth hormone. J Clin Endocrinol Metab. 2000;85(2):619–22. [PubMed]
23. Coste J, Ecosse E, Lesage C, et al. Evaluation of adolescent statural growth in health and disease: reliability of assessment from height measurement series and development of an automated algorithm. Horm Res. 2002;58(3):105–14. [PubMed]
24. Kelly BP, Paterson WF, Donaldson MD. Final height outcome and value of height prediction in boys with constitutional delay in growth and adolescence treated with intramuscular testosterone 125 mg per month for 3 months. Clinical Endocrinology. 2003;58:267–72. [PubMed]
25. Wickman S, Sipila I, Ankarberg-Lindgren C, et al. A specific aromatase inhibitor and potential increase in adult height in boys with delayed puberty: a randomized controlled trial. Lancet. 2001;357(9270):1743–8. [PubMed]
26. Arrigo T, De Luca F, Antoniazzi F, et al. Reduction of baseline body mass index under gonadotropin- suppressive therapy in girls with idiopathic precocious puberty. Eur J Endocrinol. 2004;150(4):533–7. [PubMed]
27. Lebrethon MC, Bourguignon JP. Management of central isosexual precocity: diagnosis, treatment, outcome. Curr Opin Pediatr. 2000;12(4):394–9. [PubMed]
28. Feuillan PP, Jones JV, Barnes K, et al. Reproductive axis after discontinuation of gonadotropin-releasing hormone analog treatment of girls with precocious puberty: long term follow-up comparing girls with hypothalamic hamartoma to those with idiopathic precocious puberty. J Clin Endocrinol Metab. 1999;84(1):44–9. [PubMed]
29. Boot AM, De Muinck Keizer-Schrama S, Pols HA, et al. Bone mineral density and body composition before and during treatment with gonadotropin-releasing hormone agonist in children with central precocious and early puberty. J Clin Endocrinol Metab. 1998;83(2):370–3. [PubMed]
30. Karamizadeh Z, Tabebordbar MR, Saki F, et al. The side effects of Gonadotropin Releasing Hormone Analog (Diphereline) in treatment of idiopathic central precocious puberty. Acta Medica Iran . 2013;51(1):41–6. [PubMed]
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4276584/