Numbers removed, but this weight graph from the start of my illness in 2017 to 2023 shocked me. Alternating between anorexia, anorexia purging type, bulimia, etc over the years.
can literally spot when I was in mental health crisis just by looking at it. It’s an interesting visual to see what I’ve put my poor body through over the years, it’s so unsustainable and harmful.

Good day fellow people,
i could need some perspective, support and if necessary, a slap back to reality on my recent bloodwork as well as on previous blood work results.
Some background on recent stats / data: - 28 years old, male, soon 29 - 5,9ft (appr. 175cm) - 165pd (appr. 75kg) - BF 12-15% (see picture, was taken 4 days after current bloodwork in July 2023) - Strength Training since appr. 8 years: Bench: 220x5, Squat 280x5, Deadlift 340x5 with good technique, atg no belt etc. all weights in pounds.
Some background on personal life: - Anorexia Nervosa from age 13/14 to 16 with lowest weight of 95pd (approx. 42Kg) bloodwork at that time showed low lewels of TSH (0,87) which led the general physician to prescribe artifical T4. Sadly, no testosterone values were obtained. - from 16 to 20 normal weight of approx. 130pd (60Kg) to 150pd (70Kg) - no real puberty happened, looked like 15 until at least 22years of age. - strength training since 20years old, ultra slow progress (might have done too much sports in general) - During the whole documentation process and bloodwork history i kept BF below 20% and trained 3-4 times per Week (5x5 mostly). At around 2019 i took eating healthy really serious again.
Bloodwork related information (see also graphs "History" for most relevant bloodwork): - At around 2017 /18 first girlfriend, sex drive etc. was not good, progress in gym slow, decided to check other values (Testosterone / Estradiol) on my own, i do this to this day every half year or so. - September 2018: Tried 3mg MK2886 (Ostarine) for one month, felt better, but ended the experiment soon. Testosterone was 2 ng/dl after this month. OF COURSE MY YOUNG AND DESPERATE ASS DID NOT TAKE THE INITIAL TESTOSTERONE VALUE (could beat me up for this...). - October 2018: Began to use Clomid at 12,5mg for PCT and because i have read, that this would be a reversible try-out Option for raising testosterone. Felt not so good on clomid, nausea and mild anxiety, but decided to give it a try. - May 2019: Bloodwork again, still on clomid 12,5mg a day: Testosterone at 3,9ng/dl. Even if i could say that i felt a little bit better with clomid, the nausea was absolutely overwhelming at this point and i switched to enclomiphene at 10mg/day. - September 2019: Testosterone at 3,1 ng/dl, not feeling too good, but at least no overwhelming nausea. Still decided to switch back to clomid 12,5mg a day. - January 2020: On clomid 12,5mg a day since last bloodwork, Testosterone comes back at 2,3ng / dl. Kind of desperate now, not feeling to good. - In accordance with new general phyisican artifical T4 was dropped at 2020 due to my suggestion, that the initial reason for prescribing it was a misjudgement no alteration in mood, weight etc. but significant rise of TSH, which is now "stable" slightly above the reference range of my GPs reference range. I Feel no different and would not like to go back to use artificial T4 if not necessary. - July 2020: no artifical T4 in the system, no other components as well. Testosterone comes back at 2,36 ng/dl. Decided to drop 10 pounds for summer and began eating really healthy. - October 2020: Diet was good, looked nice, but felt not good. Testosterone comes back at 4,9ng/dl, but i feel no different.
- Since then testosterone hovers at around 4,6 to 5,1 ng/dl with the latest bloodwork coming back at 3,5ng/dl and estradiol nearly undetectable (see other values and timeline in the graphs). I dietet for 3 Months with appr. 2700 kcals/day and achieved the look from the picture in the mountains (taken 4 days after the bloodwork). Looks ok, but i do not feel in the slightest way how i look.
I am not sure, what the reason for me not feeling well is. Is it psychological (i am in therapy since a long time and have discussed this issue also with the therapist with the result, that my problem is kind of an hen and egg problem), is it the Testosterone (and in latest Bloodwork the Estradiol), is it the thyroid? My guess is, that it is not a single value / single solution thing. My symptoms are, that i do not FEEL strong, or driven or in any measurable way "manly" and able to rest in myself. Most of the time i feel nervous and not ready to begin life.
At the moment, i feel desperate to find a solution, since i do not feel well at the moment and did not feel well since what feels like an eternity.
If any of you can give a recommendation on how to interpret especially the latest bloodwork in conjunction with the history of bloodwork (graphs) i would be very thankful. Especially the reason for the crashed E2 would be interesting (could it be diet? Even with 2700kcal / day?).
The idea of going on a testosterone replacement therapy lurks in my head since forever, but i am really hesitant for three reasons: - I do not know, if it will fix my problems (of course not all problems, but sexual and drive problems to begin with would be nice. also beeing able to concentrate on stuff would help alot) - The "try and see if it fixes the problem" mindset can include placebo-effects, but comes with the cost of the possibility to crash my endocrine system once and for all. I regret my mid-teens and the anorexia in terms of having never experienced normal puberty and kind of think that this part of my life potentially lead to an imbalanced endocrine system, which works now kind of ok, and i am hesitant to drive it even further in the ground. - I fear, that i become dependant on the testosterone, not in terms of an medical necessity, but an drug addiction.
If you have read so far, thank you very much, kind stranger on the internet :)

This is a direct follow-up to my previous post, so if you'd like more background info please read that! https://www.reddit.com/transgenderUK/comments/rf3ct4/please_give_feedback_on_the_new_wpath_standards/
Since then, WPATH extended the feedback period a month. It now closes Sunday, January 16th, at 11:59 PM GMT. This is our last week to make a difference before the feedback period closes and the final guidelines are released. Please share to all other trans people & trans-friendly doctors you know. Discord, twitter, facebook, other subreddits, etc. are all effective ways to get the word out.
My previous post was a bit rushed, since there was barely any notice of the guidelines coming out, only a two-week comment period, and quite a lot of material to get through to craft my post. So unfortunately at the time, I wasn't able to provide Suggested Feedback for each of the sections with major issues. Fortunately, the extension of the December 16 guideline has allowed me to write some! I've tried to make it as comprehensive and detailed as possible, backed up with scientific sources and relevant links. You can copy/paste my suggested feedback to WPATH (but change the wording a little in case they screen out identical feedback submissions,) or use portions of it & add your own commentary, or just wing it on your own!
Click the large chapter name links to go to the feedback form for each relevant chapter! (Alternatively, you can go to https://www.wpath.org/soc8 & click the button to arrive at the full chapter list PDF with links to the feedback pages. Should look like this: https://i.imgur.com/PDRHFAo.png)Paste each section of feedback (e.g. "Statement 3") in the corresponding feedback text box for that section & chapter. For example, submit feedback for Adolescent Chapter Statement 3 in this text box: https://i.imgur.com/RFSdt3G.png
________________________________________________________________________________________________________

Suggested Feedback by Chapter & Statement:

Adolescent Chapter:

Introduction:
There are two major errors within this introductory section. First, Lisa Littman’s debunked “Rapid Onset Gender Dysphoria” study is uncritically cited, only qualified by stating that there were “significant methodological challenges” with the study. There is no mention of the more recent study by Bauer et al in the Journal of Pediatrics which comprehensively debunked the junk science of “ROGD,” nor of the two peer-reviewed research articles by Arjee Restar & Florence Ashley which exposed the shoddy, unacceptably flawed methodology of Littman’s study.
Second, later on in the paragraph, it is stated that “the phenomenon of social influence on gender is salient,” citing a methodologically flawed, barely relevant recent study of detransitioners as the only evidence. This study was conducted by the co-founder (Vandenbussche) of a small online organization called “Post Trans,” which works with major anti-trans hate groups such as “Transgender Trend.” The participants of the study were recruited from the “Post Trans” website, from unnamed “private Facebook groups,” and from the extremely transphobic Reddit forum “r / Detrans.” Crucially, even with the major selection errors with the sampling methods, the study does not (nor was it designed to) say anything near what it is cited to support in this chapter. Neither was the study limited to detransitioners who had transitioned in adolescence. The only mention whatsoever of “social influence” throughout the entire study was in the discussion of “Reasons for Detransitioning,” a multi-selection survey of the 237 participants: none of the graphed 12 most common responses included anything related to social influence, though a negligible amount of participants (either one or several) out of 237 included “realization of being pressured to transition by social surroundings” as an additional reason, alongside many other additional reasons listed. This post-hoc statement about transition by a negligible percentage of self-selected detransitioners – a group that itself is a negligible percentage of all people (and adolescents in particular) who transition - does not constitute any evidence whatsoever of wide-scale social influence or contagion as a salient factor of gender identity formation in any segment of trans adolescents.
The following three sources relevant to this section should be added to the bibliography and in-text citations:
Bauer et al (2021,) “Do Clinical Data from Transgender Adolescents Support the Phenomenon of “Rapid Onset Gender Dysphoria”?” https://www.jpeds.com/article/S0022-3476(21)01085-4/fulltext
Restar (2019,) “Methodological Critique of Littman’s (2018) Parental-Respondents Accounts of “Rapid-Onset Gender Dysphoria” https://link.springer.com/article/10.1007/s10508-019-1453-2
Ashley (2020,) “A critical commentary on ‘rapid-onset gender dysphoria’” https://journals.sagepub.com/doi/abs/10.1177/0038026120934693
Statement 3:
Of all the sections within the chapter, this is the most egregious. It carries on a long, extremely harmful tradition of forcing extensive gatekeeping on trans people prior to any gender-affirming healthcare interventions. The time a therapist takes to force a “comprehensive assessment” on their patients can vary widely: from weeks, to months, to years. In this time, the patients are deprived of their bodily autonomy, and their body will unfortunately continue on the wrong physical trajectory, inflicting extreme dysphoria. This is a particularly salient point with adolescents, where intervention is very time-sensitive: most are undergoing puberty, which entails major, unwanted changes to their bodies which are difficult or impossible to reverse later. In this chapter, it is repeatedly mentioned that the 2014 de Vries study only included adolescents who had been subject to “comprehensive assessments.” Yet in recent months, two much larger American studes (Green et al, 2021 & Turban et al, 2022) have been published about the same topic in the Journal of Adolescent Health & PLOS ONE, respectively. In America, many gender clinicians do not require “comprehensive assessments” or gatekeeping disguised as "therapy" for adolescents prior to gender-affirming care. Yet regardless, the same sorts of positive results as in the de Vries study were found in both newer studies. Additionally, there is neither evidence nor rationale presented in this chapter for why “comprehensive assessment” is posited as the key issue which determines whether or not gender-affirming healthcare is in an adolescent’s best interests, other than the fact that “comprehensive assessments” were used in the de Vries study.
Forcing trans patients of all ages to jump through hoops to access care has generated additional difficulties besides the direct harm caused to the patient via loss of agency and increased dysphoria – it also ruptures the relationship between the patient and the therapist (turning it adversarial,) causes patients to lie in order to access the care they desperately need, and results in many patients justifiably turning to other sources to access the healthcare they cannot get through so-called “legitimate” means. The patient (whether adolescent or adult) - not the therapist – is best positioned to determine their own identity, gender-affirming healthcare needs, and status as transgender.
The gatekeeping recommended by this chapter also has an indirect but very significant additional negative consequence for all trans adolescents: long waitlists. When trans adolescents are subjected to mandatory long-term assessments prior to the initiation of gender-affirming healthcare, this causes far fewer adolescents to be seen, and none to be seen in a timely manner. This is particularly true in countries with public healthcare systems which are underfunded by the government. For example, the British GIDS (Gender Identity Development Service) - which has policies of extensive gatekeeping for any and all trans adolescents to receive medical care – by their own admission currently has waitlists in excess of three years between the time an adolescent is referred to their service and the time they get a first appointment. https://gids.nhs.uk/how-long-wait-first-appointment-gids
Finally, this section advocates for even further gatekeeping (“extended assessment”) of autistic trans adolescents compared to those who are neurotypical. This goes directly contrary to their well-being, and establishes a different, more difficult standard for them to access the same care as their neurotypical counterparts. Contrary to the assumptions made in this chapter, autistic adolescents are every bit as capable of knowing their gender identity, having a long-term, stable gender identity, and consenting to gender-affirming healthcare. They should not be punished for their neurotype with additional unwanted gatekeeping.
The following sources relevant to this section should be added to the bibliography and in-text citations:
Green et al (2021,) “Association of Gender-Affirming Hormone Therapy With Depression, Thoughts of Suicide, and Attempted Suicide Among Transgender and Nonbinary Youth” https://www.jahonline.org/article/S1054-139X(21)00568-1/fulltext
Turban et al (2022,) "Access to gender-affirming hormones during adolescence and mental health outcomes among transgender adults" https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0261039
Statement 5:
One very concerning practice endorsed in this section is “therapeutic exploration” with the goal of uncovering “potential factors driving a young person’s experience and report of gender incongruence.” In recent years, this practice (more frequently phrased as “gender exploratory therapy,” but with an identical meaning) has become a phrase used as a front for conversion therapy, both by conversion therapists themselves and by transphobic hate groups which support them. Here are some of many examples of this: https://genderexploratory.com/ https://gender-a-wider-lens.captivate.fm/episode/24-behind-the-curtain-getting-started-in-gender-exploratory-therapy http://gdworkinggroup.org/2018/11/12/how-i-work-with-rogd-teens/ https://www.genderdysphoriaalliance.com/treatment https://link.springer.com/article/10.1007/s10508-020-01844-2 https://twitter.com/genspect/status/1463818733068054529 https://twitter.com/genspect/status/1424276402782801920 The end goal of this “exploratory therapy” is very often for the adolescent to desist in their trans identity or to detransition. At best, it serves as an irrelevant delaying tactic. Even in the best-case scenario, forcing the adolescent through unwanted “exploration” of the so-called “underlying causes” of their dysphoria prior to the initiation of gender-affirming healthcare is extremely unhelpful: it both presupposes a fluid identity where frequently there is none, and presupposes the unsupported hypotheses of social contagion, trauma, sexual orientation, and/or different neurotypes as causes of gender dysphoria and trans identity. It does nothing to help actually move the trans adolescent forward in their transition or in advancing their well-being. It is entirely equivalent to the past focus on rooting out the supposed “underlying causes” of homosexuality (usually posited as similar to the supposed “underlying causes” of trans identity,) rather than simply accepting a person as gay, lesbian, or bisexual and helping them deal with challenges they face.
Unsurprisingly, the transphobic clinician Laura Edwards-Leeper leaned heavily into endorsing “gender exploratory therapy” in her recent fearmongering article in the Washington Post calling for gatekeeping of up to “several years” prior to the commencement of gender-affirmative healthcare for trans adolescents: https://www.washingtonpost.com/outlook/2021/11/24/trans-kids-therapy-psychologist/
Statement 11:
This section legitimizes the fully unfounded “concerns” of transphobic parents regarding alleged social contagion & perceived “very recent and/or sudden self-awareness of gender diversity.” This gives undue credence to the debunked junk science of “Rapid Onset Gender Dysphoria.” It also ignores the fact that often, the only thing that is “recent and/or sudden” is the surprise of the parents, rather than the duration that their child has experienced gender dysphoria.
Statement 12:
The main problem with this section is contained in subsection 12B: the requirement that “several years” of “well-documented gender incongruity” be present prior to any initiation of gender-affirming hormones. Gender dysphoria & trans identity can develop at a wide range of ages, and forcing a trans patient who doesn’t present with the standard narrative of dysphoria since very early childhood to wait “several years” in order to access gender-affirming hormones is unconscionable, and leads to increased dysphoria, mental distress, and in cases where puberty blockers have not been initiated, undesired & irreversible physical changes. Trans patients whose identities & dysphoria emerged more recently are no less trans – and require no more gatekeeping – than those whose identities emerged very early in life. Rather than forcing unneeded, unwanted years of therapy on these patients, a much better approach is to accept trans adolescents at their word & to proceed with a timely initiation of gender-affirming hormones. Additionally, the mandatory minimum requirement of “several years” is a direct step backwards from the SOC 7 guidelines, which for all its many serious faults, provides a more flexible framework on this very specific issue.
Overall Chapter:
This chapter has serious problems throughout: it legitimizes debunked, entirely unevidenced junk science like “Rapid Onset Gender Dysphoria” and the false hypothesis of “social contagion,” subjects autistic trans adolescents to a different, more restrictive standard to access gender-affirming healthcare compared to neurotypicals, and denies the fundamental right of bodily autonomy to all trans adolescents in favor of long-term gatekeeping. Restricting trans adolescents’ rights to agency over their bodies through prolonged gatekeeping, excessive “assessments,” and requiring several years of proof of gender dysphoria is reprehensible and profoundly harmful – just as has been shown in adults. In addition, the entire chapter caters to the tiny percentage of patients who will eventually detransition due to a change in gender identity or political views, at the direct expense of trans adolescents needing medical care.
Additionally, Laura Edwards-Leeper should have no place on this committee – even if one ignores the abhorrent Washington Post article she recently wrote, her transphobia - particularly concerning trans adolescents - is clear. She has repeatedly endorsed and espoused transphobic rhetoric on Twitter, and has openly supported a hate group. Specifically, she referred to trans girls as “boys” https://i.imgur.com/AN1qvFK.png while endorsing the transphobic talking point that trans men transition to “opt out of womanhood,” falsely linked gender dysphoria with viewing porn https://i.imgur.com/ijdDrWC.png, and endorsed the transphobic lie that trans identity is comparable to anorexia https://i.imgur.com/PPAtknk.png. Most egregiously, she has given money and support to an anti-transgender hate group (Genspect) which advocates banning gender-affirming healthcare for all minors, and which has multiple conversion therapists (Sasha Ayad, Az Hakeem, Roberto D’Angelo) listed as “advisors.” https://i.imgur.com/rWebdya.png.
All of these actions and statements are completely unacceptable for any member of WPATH, let alone one who sits on influential SOC revision committees for chapters on trans adolescents and children.
________________________________________________________________________________________________________

Child Chapter:

Statement 14:
The so-called “risks” of social transition (“locking in” an individual to a gender expression even on the rare chance they want to detransition in the future) for pre-adolescent children are exaggerated, speculative & hypothetical. Given the proven benefits of social transition for trans children, evidenced by a wide range of studies cited later in this section, Statement 14 must take a much stronger stance in support of social transition in all cases where the child requests it. The current language prioritizes the speculated convenience for potential rare future detransitioners over the immediate and long-term well-being of trans kids seeking to socially transition.
Overall Chapter:
While the proposed new chapter is better by leaps and bounds than that of the SOC 7, there are two pressing issues which must be addressed: first, the overblown, hypothetical “risks” of social transition proposed in Statement 14. Not only are these supposed risks unevidenced, their inclusion in the SOC gives ammunition to anti-transgender groups, and to unsupportive parents who wish to block their trans children from socially transitioning. The second issue is the inclusion of Laura Edwards-Leeper within the revision committee for this chapter. Edwards-Leeper has made multiple statements denying the fact that trans children exist (while endorsing openly transphobic views) https://i.imgur.com/CPBRI38.png https://i.imgur.com/OWPogbO.png. She has also given money and support to an anti-transgender hate group (Genspect) which advocates for banning trans healthcare for all minors, and has multiple conversion therapists (Sasha Ayad, Az Hakeem, Roberto D’Angelo) listed as “advisors.” https://i.imgur.com/rWebdya.png. Edwards-Leeper's transphobia and monetary support for a transphobic hate group should utterly disqualify her from having any say whatsoever in establishing the new Standards of Care for trans youth.
________________________________________________________________________________________________________

Intersex Chapter:

Introduction:
The very first sentence claims that sex is binary. Not only is this false on its face, it ignores and erases the intersex people the chapter is meant to be about. It also provides fuel for fallacious anti-trans talking points.
Statement 9:
The statement including “parental distress” regarding the genitals of intersex people as a factor in the decision as to whether or not perform surgery on nonconsenting infants or young children is reprehensible. The feelings of the parents as to their child’s genitals are irrelevant. It is the child’s body at stake, not that of their parents, so only issues related to the autonomy & well-being of the child should be considered. It must be made clear that the priority is the bodily autonomy of intersex people, not the comfort of their parents.
Further down, the phrase “gender ideologies” is used: this is a well-known transphobic dogwhistle, and it has no place in this chapter or any other. Later in the paragraph, studies referencing surveys of Intersex adults are cited to support the claim that the majority of Intersex adults support non-medically-necessary surgeries done to Intersex people congenitally or in young childhood. Yet this is irrelevant. The opinions of others should have no bearing on bodily autonomy being stripped from the infants & young children in question. Additionally, this ignores the very sizable group of Intersex adults who were harmed by these surgeries and who campaign for the bodily autonomy of Intersex people. Intersex people must be able to make their own decisions about their own bodies, rather than having that decision made for them before they are able to either assent or consent.

This is a direct follow-up to my previous post, so if you'd like more background info please read that! https://www.reddit.com/transgenderUK/comments/rf3ct4/please_give_feedback_on_the_new_wpath_standards/
Since then, WPATH extended the feedback period a month. It now closes Sunday, January 16th, at 11:59 PM GMT. This is our last week to make a difference before the feedback period closes and the final guidelines are released. Please share to all other trans people & trans-friendly doctors you know. Discord, twitter, facebook, other subreddits, etc. are all effective ways to get the word out.
My previous post was a bit rushed, since there was barely any notice of the guidelines coming out, only a two-week comment period, and quite a lot of material to get through to craft my post. So unfortunately at the time, I wasn't able to provide Suggested Feedback for each of the sections with major issues. Fortunately, the extension of the December 16 guideline has allowed me to write some! I've tried to make it as comprehensive and detailed as possible, backed up with scientific sources and relevant links. You can copy/paste my suggested feedback to WPATH (but change the wording a little in case they screen out identical feedback submissions,) or use portions of it & add your own commentary, or just wing it on your own!
Click the large chapter name links to go to the feedback form for each relevant chapter! (Alternatively, you can go to https://www.wpath.org/soc8 & click the button to arrive at the full chapter list PDF with links to the feedback pages. Should look like this: https://i.imgur.com/PDRHFAo.png)Paste each section of feedback (e.g. "Statement 3") in the corresponding feedback text box for that section & chapter. For example, submit feedback for Adolescent Chapter Statement 3 in this text box: https://i.imgur.com/RFSdt3G.png
________________________________________________________________________________________________________

Suggested Feedback by Chapter & Statement:

Adolescent Chapter:

Introduction:
There are two major errors within this introductory section. First, Lisa Littman’s debunked “Rapid Onset Gender Dysphoria” study is uncritically cited, only qualified by stating that there were “significant methodological challenges” with the study. There is no mention of the more recent study by Bauer et al in the Journal of Pediatrics which comprehensively debunked the junk science of “ROGD,” nor of the two peer-reviewed research articles by Arjee Restar & Florence Ashley which exposed the shoddy, unacceptably flawed methodology of Littman’s study.
Second, later on in the paragraph, it is stated that “the phenomenon of social influence on gender is salient,” citing a methodologically flawed, barely relevant recent study of detransitioners as the only evidence. This study was conducted by the co-founder (Vandenbussche) of a small online organization called “Post Trans,” which works with major anti-trans hate groups such as “Transgender Trend.” The participants of the study were recruited from the “Post Trans” website, from unnamed “private Facebook groups,” and from the extremely transphobic Reddit forum “r / Detrans.” Crucially, even with the major selection errors with the sampling methods, the study does not (nor was it designed to) say anything near what it is cited to support in this chapter. Neither was the study limited to detransitioners who had transitioned in adolescence. The only mention whatsoever of “social influence” throughout the entire study was in the discussion of “Reasons for Detransitioning,” a multi-selection survey of the 237 participants: none of the graphed 12 most common responses included anything related to social influence, though a negligible amount of participants (either one or several) out of 237 included “realization of being pressured to transition by social surroundings” as an additional reason, alongside many other additional reasons listed. This post-hoc statement about transition by a negligible percentage of self-selected detransitioners – a group that itself is a negligible percentage of all people (and adolescents in particular) who transition - does not constitute any evidence whatsoever of wide-scale social influence or contagion as a salient factor of gender identity formation in any segment of trans adolescents.
The following three sources relevant to this section should be added to the bibliography and in-text citations:
Bauer et al (2021,) “Do Clinical Data from Transgender Adolescents Support the Phenomenon of “Rapid Onset Gender Dysphoria”?” https://www.jpeds.com/article/S0022-3476(21)01085-4/fulltext
Restar (2019,) “Methodological Critique of Littman’s (2018) Parental-Respondents Accounts of “Rapid-Onset Gender Dysphoria” https://link.springer.com/article/10.1007/s10508-019-1453-2
Ashley (2020,) “A critical commentary on ‘rapid-onset gender dysphoria’” https://journals.sagepub.com/doi/abs/10.1177/0038026120934693
Statement 3:
Of all the sections within the chapter, this is the most egregious. It carries on a long, extremely harmful tradition of forcing extensive gatekeeping on trans people prior to any gender-affirming healthcare interventions. The time a therapist takes to force a “comprehensive assessment” on their patients can vary widely: from weeks, to months, to years. In this time, the patients are deprived of their bodily autonomy, and their body will unfortunately continue on the wrong physical trajectory, inflicting extreme dysphoria. This is a particularly salient point with adolescents, where intervention is very time-sensitive: most are undergoing puberty, which entails major, unwanted changes to their bodies which are difficult or impossible to reverse later. In this chapter, it is repeatedly mentioned that the 2014 de Vries study only included adolescents who had been subject to “comprehensive assessments.” Yet in recent months, two much larger American studes (Green et al, 2021 & Turban et al, 2022) have been published about the same topic in the Journal of Adolescent Health & PLOS ONE, respectively. In America, many gender clinicians do not require “comprehensive assessments” or gatekeeping disguised as "therapy" for adolescents prior to gender-affirming care. Yet regardless, the same sorts of positive results as in the de Vries study were found in both newer studies. Additionally, there is neither evidence nor rationale presented in this chapter for why “comprehensive assessment” is posited as the key issue which determines whether or not gender-affirming healthcare is in an adolescent’s best interests, other than the fact that “comprehensive assessments” were used in the de Vries study.
Forcing trans patients of all ages to jump through hoops to access care has generated additional difficulties besides the direct harm caused to the patient via loss of agency and increased dysphoria – it also ruptures the relationship between the patient and the therapist (turning it adversarial,) causes patients to lie in order to access the care they desperately need, and results in many patients justifiably turning to other sources to access the healthcare they cannot get through so-called “legitimate” means. The patient (whether adolescent or adult) - not the therapist – is best positioned to determine their own identity, gender-affirming healthcare needs, and status as transgender.
The gatekeeping recommended by this chapter also has an indirect but very significant additional negative consequence for all trans adolescents: long waitlists. When trans adolescents are subjected to mandatory long-term assessments prior to the initiation of gender-affirming healthcare, this causes far fewer adolescents to be seen, and none to be seen in a timely manner. This is particularly true in countries with public healthcare systems which are underfunded by the government. For example, the British GIDS (Gender Identity Development Service) - which has policies of extensive gatekeeping for any and all trans adolescents to receive medical care – by their own admission currently has waitlists in excess of three years between the time an adolescent is referred to their service and the time they get a first appointment. https://gids.nhs.uk/how-long-wait-first-appointment-gids
Finally, this section advocates for even further gatekeeping (“extended assessment”) of autistic trans adolescents compared to those who are neurotypical. This goes directly contrary to their well-being, and establishes a different, more difficult standard for them to access the same care as their neurotypical counterparts. Contrary to the assumptions made in this chapter, autistic adolescents are every bit as capable of knowing their gender identity, having a long-term, stable gender identity, and consenting to gender-affirming healthcare. They should not be punished for their neurotype with additional unwanted gatekeeping.
The following sources relevant to this section should be added to the bibliography and in-text citations:
Green et al (2021,) “Association of Gender-Affirming Hormone Therapy With Depression, Thoughts of Suicide, and Attempted Suicide Among Transgender and Nonbinary Youth” https://www.jahonline.org/article/S1054-139X(21)00568-1/fulltext
Turban et al (2022,) "Access to gender-affirming hormones during adolescence and mental health outcomes among transgender adults" https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0261039
Statement 5:
One very concerning practice endorsed in this section is “therapeutic exploration” with the goal of uncovering “potential factors driving a young person’s experience and report of gender incongruence.” In recent years, this practice (more frequently phrased as “gender exploratory therapy,” but with an identical meaning) has become a phrase used as a front for conversion therapy, both by conversion therapists themselves and by transphobic hate groups which support them. Here are some of many examples of this: https://genderexploratory.com/ https://gender-a-wider-lens.captivate.fm/episode/24-behind-the-curtain-getting-started-in-gender-exploratory-therapy http://gdworkinggroup.org/2018/11/12/how-i-work-with-rogd-teens/ https://www.genderdysphoriaalliance.com/treatment https://link.springer.com/article/10.1007/s10508-020-01844-2 https://twitter.com/genspect/status/1463818733068054529 https://twitter.com/genspect/status/1424276402782801920 The end goal of this “exploratory therapy” is very often for the adolescent to desist in their trans identity or to detransition. At best, it serves as an irrelevant delaying tactic. Even in the best-case scenario, forcing the adolescent through unwanted “exploration” of the so-called “underlying causes” of their dysphoria prior to the initiation of gender-affirming healthcare is extremely unhelpful: it both presupposes a fluid identity where frequently there is none, and presupposes the unsupported hypotheses of social contagion, trauma, sexual orientation, and/or different neurotypes as causes of gender dysphoria and trans identity. It does nothing to help actually move the trans adolescent forward in their transition or in advancing their well-being. It is entirely equivalent to the past focus on rooting out the supposed “underlying causes” of homosexuality (usually posited as similar to the supposed “underlying causes” of trans identity,) rather than simply accepting a person as gay, lesbian, or bisexual and helping them deal with challenges they face.
Unsurprisingly, the transphobic clinician Laura Edwards-Leeper leaned heavily into endorsing “gender exploratory therapy” in her recent fearmongering article in the Washington Post calling for gatekeeping of up to “several years” prior to the commencement of gender-affirmative healthcare for trans adolescents: https://www.washingtonpost.com/outlook/2021/11/24/trans-kids-therapy-psychologist/
Statement 11:
This section legitimizes the fully unfounded “concerns” of transphobic parents regarding alleged social contagion & perceived “very recent and/or sudden self-awareness of gender diversity.” This gives undue credence to the debunked junk science of “Rapid Onset Gender Dysphoria.” It also ignores the fact that often, the only thing that is “recent and/or sudden” is the surprise of the parents, rather than the duration that their child has experienced gender dysphoria.
Statement 12:
The main problem with this section is contained in subsection 12B: the requirement that “several years” of “well-documented gender incongruity” be present prior to any initiation of gender-affirming hormones. Gender dysphoria & trans identity can develop at a wide range of ages, and forcing a trans patient who doesn’t present with the standard narrative of dysphoria since very early childhood to wait “several years” in order to access gender-affirming hormones is unconscionable, and leads to increased dysphoria, mental distress, and in cases where puberty blockers have not been initiated, undesired & irreversible physical changes. Trans patients whose identities & dysphoria emerged more recently are no less trans – and require no more gatekeeping – than those whose identities emerged very early in life. Rather than forcing unneeded, unwanted years of therapy on these patients, a much better approach is to accept trans adolescents at their word & to proceed with a timely initiation of gender-affirming hormones. Additionally, the mandatory minimum requirement of “several years” is a direct step backwards from the SOC 7 guidelines, which for all its many serious faults, provides a more flexible framework on this very specific issue.
Overall Chapter:
This chapter has serious problems throughout: it legitimizes debunked, entirely unevidenced junk science like “Rapid Onset Gender Dysphoria” and the false hypothesis of “social contagion,” subjects autistic trans adolescents to a different, more restrictive standard to access gender-affirming healthcare compared to neurotypicals, and denies the fundamental right of bodily autonomy to all trans adolescents in favor of long-term gatekeeping. Restricting trans adolescents’ rights to agency over their bodies through prolonged gatekeeping, excessive “assessments,” and requiring several years of proof of gender dysphoria is reprehensible and profoundly harmful – just as has been shown in adults. In addition, the entire chapter caters to the tiny percentage of patients who will eventually detransition due to a change in gender identity or political views, at the direct expense of trans adolescents needing medical care.
Additionally, Laura Edwards-Leeper should have no place on this committee – even if one ignores the abhorrent Washington Post article she recently wrote, her transphobia - particularly concerning trans adolescents - is clear. She has repeatedly endorsed and espoused transphobic rhetoric on Twitter, and has openly supported a hate group. Specifically, she referred to trans girls as “boys” https://i.imgur.com/AN1qvFK.png while endorsing the transphobic talking point that trans men transition to “opt out of womanhood,” falsely linked gender dysphoria with viewing porn https://i.imgur.com/ijdDrWC.png, and endorsed the transphobic lie that trans identity is comparable to anorexia https://i.imgur.com/PPAtknk.png. Most egregiously, she has given money and support to an anti-transgender hate group (Genspect) which advocates banning gender-affirming healthcare for all minors, and which has multiple conversion therapists (Sasha Ayad, Az Hakeem, Roberto D’Angelo) listed as “advisors.” https://i.imgur.com/rWebdya.png.
All of these actions and statements are completely unacceptable for any member of WPATH, let alone one who sits on influential SOC revision committees for chapters on trans adolescents and children.
________________________________________________________________________________________________________

Child Chapter:

Statement 14:
The so-called “risks” of social transition (“locking in” an individual to a gender expression even on the rare chance they want to detransition in the future) for pre-adolescent children are exaggerated, speculative & hypothetical. Given the proven benefits of social transition for trans children, evidenced by a wide range of studies cited later in this section, Statement 14 must take a much stronger stance in support of social transition in all cases where the child requests it. The current language prioritizes the speculated convenience for potential rare future detransitioners over the immediate and long-term well-being of trans kids seeking to socially transition.
Overall Chapter:
While the proposed new chapter is better by leaps and bounds than that of the SOC 7, there are two pressing issues which must be addressed: first, the overblown, hypothetical “risks” of social transition proposed in Statement 14. Not only are these supposed risks unevidenced, their inclusion in the SOC gives ammunition to anti-transgender groups, and to unsupportive parents who wish to block their trans children from socially transitioning. The second issue is the inclusion of Laura Edwards-Leeper within the revision committee for this chapter. Edwards-Leeper has made multiple statements denying the fact that trans children exist (while endorsing openly transphobic views) https://i.imgur.com/CPBRI38.png https://i.imgur.com/OWPogbO.png. She has also given money and support to an anti-transgender hate group (Genspect) which advocates for banning trans healthcare for all minors, and has multiple conversion therapists (Sasha Ayad, Az Hakeem, Roberto D’Angelo) listed as “advisors.” https://i.imgur.com/rWebdya.png. Edwards-Leeper's transphobia and monetary support for a transphobic hate group should utterly disqualify her from having any say whatsoever in establishing the new Standards of Care for trans youth.
________________________________________________________________________________________________________

Intersex Chapter:

Introduction:
The very first sentence claims that sex is binary. Not only is this false on its face, it ignores and erases the intersex people the chapter is meant to be about. It also provides fuel for fallacious anti-trans talking points.
Statement 9:
The statement including “parental distress” regarding the genitals of intersex people as a factor in the decision as to whether or not perform surgery on nonconsenting infants or young children is reprehensible. The feelings of the parents as to their child’s genitals are irrelevant. It is the child’s body at stake, not that of their parents, so only issues related to the autonomy & well-being of the child should be considered. It must be made clear that the priority is the bodily autonomy of intersex people, not the comfort of their parents.
Further down, the phrase “gender ideologies” is used: this is a well-known transphobic dogwhistle, and it has no place in this chapter or any other. Later in the paragraph, studies referencing surveys of Intersex adults are cited to support the claim that the majority of Intersex adults support non-medically-necessary surgeries done to Intersex people congenitally or in young childhood. Yet this is irrelevant. The opinions of others should have no bearing on bodily autonomy being stripped from the infants & young children in question. Additionally, this ignores the very sizable group of Intersex adults who were harmed by these surgeries and who campaign for the bodily autonomy of Intersex people. Intersex people must be able to make their own decisions about their own bodies, rather than having that decision made for them before they are able to either assent or consent.

This is a direct follow-up to my previous post, so if you'd like more background info please read that! https://www.reddit.com/transgenderUK/comments/rf3ct4/please_give_feedback_on_the_new_wpath_standards/
Since then, WPATH extended the feedback period a month. It now closes Sunday, January 16th, at 11:59 PM GMT. This is our last week to make a difference before the feedback period closes and the final guidelines are released. Please share to all other trans people & trans-friendly doctors you know. Discord, twitter, facebook, other subreddits, etc. are all effective ways to get the word out.
My previous post was a bit rushed, since there was barely any notice of the guidelines coming out, only a two-week comment period, and quite a lot of material to get through to craft my post. So unfortunately at the time, I wasn't able to provide Suggested Feedback for each of the sections with major issues. Fortunately, the extension of the December 16 guideline has allowed me to write some! I've tried to make it as comprehensive and detailed as possible, backed up with scientific sources and relevant links. You can copy/paste my suggested feedback to WPATH (but change the wording a little in case they screen out identical feedback submissions,) or use portions of it & add your own commentary, or just wing it on your own!
Click the large chapter name links to go to the feedback form for each relevant chapter! (Alternatively, you can go to https://www.wpath.org/soc8 & click the button to arrive at the full chapter list PDF with links to the feedback pages. Should look like this: https://i.imgur.com/PDRHFAo.png)Paste each section of feedback (e.g. "Statement 3") in the corresponding feedback text box for that section & chapter. For example, submit feedback for Adolescent Chapter Statement 3 in this text box: https://i.imgur.com/RFSdt3G.png
________________________________________________________________________________________________________

Suggested Feedback by Chapter & Statement:

Adolescent Chapter:

Introduction:
There are two major errors within this introductory section. First, Lisa Littman’s debunked “Rapid Onset Gender Dysphoria” study is uncritically cited, only qualified by stating that there were “significant methodological challenges” with the study. There is no mention of the more recent study by Bauer et al in the Journal of Pediatrics which comprehensively debunked the junk science of “ROGD,” nor of the two peer-reviewed research articles by Arjee Restar & Florence Ashley which exposed the shoddy, unacceptably flawed methodology of Littman’s study.
Second, later on in the paragraph, it is stated that “the phenomenon of social influence on gender is salient,” citing a methodologically flawed, barely relevant recent study of detransitioners as the only evidence. This study was conducted by the co-founder (Vandenbussche) of a small online organization called “Post Trans,” which works with major anti-trans hate groups such as “Transgender Trend.” The participants of the study were recruited from the “Post Trans” website, from unnamed “private Facebook groups,” and from the extremely transphobic Reddit forum “r / Detrans.” Crucially, even with the major selection errors with the sampling methods, the study does not (nor was it designed to) say anything near what it is cited to support in this chapter. Neither was the study limited to detransitioners who had transitioned in adolescence. The only mention whatsoever of “social influence” throughout the entire study was in the discussion of “Reasons for Detransitioning,” a multi-selection survey of the 237 participants: none of the graphed 12 most common responses included anything related to social influence, though a negligible amount of participants (either one or several) out of 237 included “realization of being pressured to transition by social surroundings” as an additional reason, alongside many other additional reasons listed. This post-hoc statement about transition by a negligible percentage of self-selected detransitioners – a group that itself is a negligible percentage of all people (and adolescents in particular) who transition - does not constitute any evidence whatsoever of wide-scale social influence or contagion as a salient factor of gender identity formation in any segment of trans adolescents.
The following three sources relevant to this section should be added to the bibliography and in-text citations:
Bauer et al (2021,) “Do Clinical Data from Transgender Adolescents Support the Phenomenon of “Rapid Onset Gender Dysphoria”?” https://www.jpeds.com/article/S0022-3476(21)01085-4/fulltext
Restar (2019,) “Methodological Critique of Littman’s (2018) Parental-Respondents Accounts of “Rapid-Onset Gender Dysphoria” https://link.springer.com/article/10.1007/s10508-019-1453-2
Ashley (2020,) “A critical commentary on ‘rapid-onset gender dysphoria’” https://journals.sagepub.com/doi/abs/10.1177/0038026120934693
Statement 3:
Of all the sections within the chapter, this is the most egregious. It carries on a long, extremely harmful tradition of forcing extensive gatekeeping on trans people prior to any gender-affirming healthcare interventions. The time a therapist takes to force a “comprehensive assessment” on their patients can vary widely: from weeks, to months, to years. In this time, the patients are deprived of their bodily autonomy, and their body will unfortunately continue on the wrong physical trajectory, inflicting extreme dysphoria. This is a particularly salient point with adolescents, where intervention is very time-sensitive: most are undergoing puberty, which entails major, unwanted changes to their bodies which are difficult or impossible to reverse later. In this chapter, it is repeatedly mentioned that the 2014 de Vries study only included adolescents who had been subject to “comprehensive assessments.” Yet in recent months, two much larger American studes (Green et al, 2021 & Turban et al, 2022) have been published about the same topic in the Journal of Adolescent Health & PLOS ONE, respectively. In America, many gender clinicians do not require “comprehensive assessments” or gatekeeping disguised as "therapy" for adolescents prior to gender-affirming care. Yet regardless, the same sorts of positive results as in the de Vries study were found in both newer studies. Additionally, there is neither evidence nor rationale presented in this chapter for why “comprehensive assessment” is posited as the key issue which determines whether or not gender-affirming healthcare is in an adolescent’s best interests, other than the fact that “comprehensive assessments” were used in the de Vries study.
Forcing trans patients of all ages to jump through hoops to access care has generated additional difficulties besides the direct harm caused to the patient via loss of agency and increased dysphoria – it also ruptures the relationship between the patient and the therapist (turning it adversarial,) causes patients to lie in order to access the care they desperately need, and results in many patients justifiably turning to other sources to access the healthcare they cannot get through so-called “legitimate” means. The patient (whether adolescent or adult) - not the therapist – is best positioned to determine their own identity, gender-affirming healthcare needs, and status as transgender.
The gatekeeping recommended by this chapter also has an indirect but very significant additional negative consequence for all trans adolescents: long waitlists. When trans adolescents are subjected to mandatory long-term assessments prior to the initiation of gender-affirming healthcare, this causes far fewer adolescents to be seen, and none to be seen in a timely manner. This is particularly true in countries with public healthcare systems which are underfunded by the government. For example, the British GIDS (Gender Identity Development Service) - which has policies of extensive gatekeeping for any and all trans adolescents to receive medical care – by their own admission currently has waitlists in excess of three years between the time an adolescent is referred to their service and the time they get a first appointment. https://gids.nhs.uk/how-long-wait-first-appointment-gids
Finally, this section advocates for even further gatekeeping (“extended assessment”) of autistic trans adolescents compared to those who are neurotypical. This goes directly contrary to their well-being, and establishes a different, more difficult standard for them to access the same care as their neurotypical counterparts. Contrary to the assumptions made in this chapter, autistic adolescents are every bit as capable of knowing their gender identity, having a long-term, stable gender identity, and consenting to gender-affirming healthcare. They should not be punished for their neurotype with additional unwanted gatekeeping.
The following sources relevant to this section should be added to the bibliography and in-text citations:
Green et al (2021,) “Association of Gender-Affirming Hormone Therapy With Depression, Thoughts of Suicide, and Attempted Suicide Among Transgender and Nonbinary Youth” https://www.jahonline.org/article/S1054-139X(21)00568-1/fulltext
Turban et al (2022,) "Access to gender-affirming hormones during adolescence and mental health outcomes among transgender adults" https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0261039
Statement 5:
One very concerning practice endorsed in this section is “therapeutic exploration” with the goal of uncovering “potential factors driving a young person’s experience and report of gender incongruence.” In recent years, this practice (more frequently phrased as “gender exploratory therapy,” but with an identical meaning) has become a phrase used as a front for conversion therapy, both by conversion therapists themselves and by transphobic hate groups which support them. Here are some of many examples of this: https://genderexploratory.com/ https://gender-a-wider-lens.captivate.fm/episode/24-behind-the-curtain-getting-started-in-gender-exploratory-therapy http://gdworkinggroup.org/2018/11/12/how-i-work-with-rogd-teens/ https://www.genderdysphoriaalliance.com/treatment https://link.springer.com/article/10.1007/s10508-020-01844-2 https://twitter.com/genspect/status/1463818733068054529 https://twitter.com/genspect/status/1424276402782801920 The end goal of this “exploratory therapy” is very often for the adolescent to desist in their trans identity or to detransition. At best, it serves as an irrelevant delaying tactic. Even in the best-case scenario, forcing the adolescent through unwanted “exploration” of the so-called “underlying causes” of their dysphoria prior to the initiation of gender-affirming healthcare is extremely unhelpful: it both presupposes a fluid identity where frequently there is none, and presupposes the unsupported hypotheses of social contagion, trauma, sexual orientation, and/or different neurotypes as causes of gender dysphoria and trans identity. It does nothing to help actually move the trans adolescent forward in their transition or in advancing their well-being. It is entirely equivalent to the past focus on rooting out the supposed “underlying causes” of homosexuality (usually posited as similar to the supposed “underlying causes” of trans identity,) rather than simply accepting a person as gay, lesbian, or bisexual and helping them deal with challenges they face.
Unsurprisingly, the transphobic clinician Laura Edwards-Leeper leaned heavily into endorsing “gender exploratory therapy” in her recent fearmongering article in the Washington Post calling for gatekeeping of up to “several years” prior to the commencement of gender-affirmative healthcare for trans adolescents: https://www.washingtonpost.com/outlook/2021/11/24/trans-kids-therapy-psychologist/
Statement 11:
This section legitimizes the fully unfounded “concerns” of transphobic parents regarding alleged social contagion & perceived “very recent and/or sudden self-awareness of gender diversity.” This gives undue credence to the debunked junk science of “Rapid Onset Gender Dysphoria.” It also ignores the fact that often, the only thing that is “recent and/or sudden” is the surprise of the parents, rather than the duration that their child has experienced gender dysphoria.
Statement 12:
The main problem with this section is contained in subsection 12B: the requirement that “several years” of “well-documented gender incongruity” be present prior to any initiation of gender-affirming hormones. Gender dysphoria & trans identity can develop at a wide range of ages, and forcing a trans patient who doesn’t present with the standard narrative of dysphoria since very early childhood to wait “several years” in order to access gender-affirming hormones is unconscionable, and leads to increased dysphoria, mental distress, and in cases where puberty blockers have not been initiated, undesired & irreversible physical changes. Trans patients whose identities & dysphoria emerged more recently are no less trans – and require no more gatekeeping – than those whose identities emerged very early in life. Rather than forcing unneeded, unwanted years of therapy on these patients, a much better approach is to accept trans adolescents at their word & to proceed with a timely initiation of gender-affirming hormones. Additionally, the mandatory minimum requirement of “several years” is a direct step backwards from the SOC 7 guidelines, which for all its many serious faults, provides a more flexible framework on this very specific issue.
Overall Chapter:
This chapter has serious problems throughout: it legitimizes debunked, entirely unevidenced junk science like “Rapid Onset Gender Dysphoria” and the false hypothesis of “social contagion,” subjects autistic trans adolescents to a different, more restrictive standard to access gender-affirming healthcare compared to neurotypicals, and denies the fundamental right of bodily autonomy to all trans adolescents in favor of long-term gatekeeping. Restricting trans adolescents’ rights to agency over their bodies through prolonged gatekeeping, excessive “assessments,” and requiring several years of proof of gender dysphoria is reprehensible and profoundly harmful – just as has been shown in adults. In addition, the entire chapter caters to the tiny percentage of patients who will eventually detransition due to a change in gender identity or political views, at the direct expense of trans adolescents needing medical care.
Additionally, Laura Edwards-Leeper should have no place on this committee – even if one ignores the abhorrent Washington Post article she recently wrote, her transphobia - particularly concerning trans adolescents - is clear. She has repeatedly endorsed and espoused transphobic rhetoric on Twitter, and has openly supported a hate group. Specifically, she referred to trans girls as “boys” https://i.imgur.com/AN1qvFK.png while endorsing the transphobic talking point that trans men transition to “opt out of womanhood,” falsely linked gender dysphoria with viewing porn https://i.imgur.com/ijdDrWC.png, and endorsed the transphobic lie that trans identity is comparable to anorexia https://i.imgur.com/PPAtknk.png. Most egregiously, she has given money and support to an anti-transgender hate group (Genspect) which advocates banning gender-affirming healthcare for all minors, and which has multiple conversion therapists (Sasha Ayad, Az Hakeem, Roberto D’Angelo) listed as “advisors.” https://i.imgur.com/rWebdya.png.
All of these actions and statements are completely unacceptable for any member of WPATH, let alone one who sits on influential SOC revision committees for chapters on trans adolescents and children.
________________________________________________________________________________________________________

Child Chapter:

Statement 14:
The so-called “risks” of social transition (“locking in” an individual to a gender expression even on the rare chance they want to detransition in the future) for pre-adolescent children are exaggerated, speculative & hypothetical. Given the proven benefits of social transition for trans children, evidenced by a wide range of studies cited later in this section, Statement 14 must take a much stronger stance in support of social transition in all cases where the child requests it. The current language prioritizes the speculated convenience for potential rare future detransitioners over the immediate and long-term well-being of trans kids seeking to socially transition.
Overall Chapter:
While the proposed new chapter is better by leaps and bounds than that of the SOC 7, there are two pressing issues which must be addressed: first, the overblown, hypothetical “risks” of social transition proposed in Statement 14. Not only are these supposed risks unevidenced, their inclusion in the SOC gives ammunition to anti-transgender groups, and to unsupportive parents who wish to block their trans children from socially transitioning. The second issue is the inclusion of Laura Edwards-Leeper within the revision committee for this chapter. Edwards-Leeper has made multiple statements denying the fact that trans children exist (while endorsing openly transphobic views) https://i.imgur.com/CPBRI38.png https://i.imgur.com/OWPogbO.png. She has also given money and support to an anti-transgender hate group (Genspect) which advocates for banning trans healthcare for all minors, and has multiple conversion therapists (Sasha Ayad, Az Hakeem, Roberto D’Angelo) listed as “advisors.” https://i.imgur.com/rWebdya.png. Edwards-Leeper's transphobia and monetary support for a transphobic hate group should utterly disqualify her from having any say whatsoever in establishing the new Standards of Care for trans youth.
________________________________________________________________________________________________________

Intersex Chapter:

Introduction:
The very first sentence claims that sex is binary. Not only is this false on its face, it ignores and erases the intersex people the chapter is meant to be about. It also provides fuel for fallacious anti-trans talking points.
Statement 9:
The statement including “parental distress” regarding the genitals of intersex people as a factor in the decision as to whether or not perform surgery on nonconsenting infants or young children is reprehensible. The feelings of the parents as to their child’s genitals are irrelevant. It is the child’s body at stake, not that of their parents, so only issues related to the autonomy & well-being of the child should be considered. It must be made clear that the priority is the bodily autonomy of intersex people, not the comfort of their parents.
Further down, the phrase “gender ideologies” is used: this is a well-known transphobic dogwhistle, and it has no place in this chapter or any other. Later in the paragraph, studies referencing surveys of Intersex adults are cited to support the claim that the majority of Intersex adults support non-medically-necessary surgeries done to Intersex people congenitally or in young childhood. Yet this is irrelevant. The opinions of others should have no bearing on bodily autonomy being stripped from the infants & young children in question. Additionally, this ignores the very sizable group of Intersex adults who were harmed by these surgeries and who campaign for the bodily autonomy of Intersex people. Intersex people must be able to make their own decisions about their own bodies, rather than having that decision made for them before they are able to either assent or consent.

Edit 2: We talked and I found out that he thought he was giving useful feedback. Once I explained what he made me feel, he finally got it. He cried, I cried, he brought me flowers and chocolate and comforted me. He told me that essentially, he didn't understand how bad my eating disorder used to be and how it works in my head. He was completely mortified about how horrible he made me feel. I'm very glad he finally got it. I'm still on high alert so to speak but I feel much better than before. Also, you guys are awesome. Also, I'm now NOT dieting and instead baking myself an apple pie.
Edit: I didn’t expect all the support! You all are absolutely lovely. I’m going to have a serious talk with him about this and figure out his motivation - he can sometimes forget that I’m very different from him and thus need different things (I am 100% sure he’d love if I made a weight/attractiveness graph for him). I’ll also talk to some friends and my therapist and see what they think, as they know him and possibly see this all more clearly than me. I’ll decide if I want to continue this relationship after that.
And seriously, thank you all. I felt like I had to change but now I see that he’s the one who needs to have more empathy and understanding.
Hello, everyone! So I need some advice on this.
For background: my bf is great, very caring, no matter the issue we've worked through anything and come out happy. This is one of the few bigger issues I've had with him. We've been together for nearly 3 years. Also, I have in the past had a very severe eating disorder, which lead to hospitalization. He is aware but doesn't completely understand what it was like.
So, when we got together I weighed about 52-53 kg/114-116 lbs (at 170 cm/5'7''). I've gained about 4 kg/9 lbs since then, as a result of eating more, exercising more (I started running a year+ ago, about 20-30 km/12-19 mi per week), and birth control hormones. We were talking about BMI and weight as a possible health metric. As we got into the conversation more, he admitted that he was more attracted to me back when we met. I was extremely bothered by that, which he saw and tried to comfort me by drawing a graph showing his attraction plotted against my weight, saying that he's almost as attracted to me now as he used to be. He also told me to 'start thinking about dieting/not gaining more' - then reassuring me that I still have wiggle room and he's just warning me ahead of time.
Now, since I used to have severe anorexia, that whole ordeal made me extremely sad. I've talked about how the illness still influences me and didn't expect him to be so casual and tactless about this topic. It really screwed with my head, bad. It's not like I've gained that much, either - all my clothes still fit fine. At least that's what I thought before.
Usually, whenever we've had a disagreement, we talk about it extensively until we understand each other - most cases we just didn't understand what the other person meant and talking about it fixes that. With this topic, for the first time I just completely shut down. I thought I was recovered and accepted my body as it was, but now I feel utterly unattractive, like a huge flabby ball of fat. Every time I think about it I just feel intense hate towards my body. So - what should I do? I suspect it's just that he doesn't know how much this topic bothers me and because of that, he went all analytical. It's just a very difficult topic to talk about, with anyone.

I (m 22) have been recovered from anorexia for 4 years now and think I’m on the verge of a relapse. It could be related to stress because I’m about to enter my final year in college and have just been given bigger responsibilities in other areas of my life.
A few months ago, I decided to gain more weight as I was still quite thin and I was successful, but now I’m panicking. I obsess about my belly fat at every moment from when I wake up to when I go to bed.
A few days ago, I started tracking my weight and body fat percentage on a graph as well as making a big cut to my food intake, and now I’m terrified that my body will shed any muscle I’ve gained and keep all of the fat.
I keep second guessing myself and finding reasons not to go down any route and I feel trapped in a limbo. Should I join a gym to ensure any excess fat is removed? Start running? Is it possible that I’m just not seeing myself accurately (even at my lowest weight I was unsatisfied). Has anyone else been through this?

I have been noticing with quarantine/lock-down situations that we have been seeing a higher number of teens (14-18) looking for weight loss help. As most of us are adults here, we know that teens require more calories as they're still growing than what an adult with similar stats would. I'd like to use this post as a starting point for us as a community to promote and encourage HEALTHY and SUSTAINABLE habits for these teens, without shutting them down, downvoting them or suggesting deficits that are only appropriate for adults.
15F
18M
15FtM
16F
19M
17F
19M
I honestly have like 10 more of these posts, 16F, 15F, 17F, 17F, 18F, 14M, 15M, 16M, 14F, 14M, 17M. These posts are all from just the last few days. Whether we think these kids should be asking us for help or not, they are and for some of them, we're their only option. While medical advice is actively discouraged and against the rules of many health-related subs, there is no reason we can't provide these teens with some info and some support as we do for each other.

Statistics on Teens and EDs

For many of us, our weight problems also started in our early years and as teens, we are the most vulnerable. According to these statistics (sources on the page) binge-eating disorder will occur in "0.2% and 3.5% of females and 0.9% and 2.0% of males" (Stice E & Bohon C. (2012)) in adolescence at a 40/60% split (Westerberg, D. P., & Waitz, M. (2013)). Furthermore, "Three out of ten individuals looking for weight loss treatments show signs of BED" (Westerberg, D. P., & Waitz, M. (2013). In a different study, it was found that "Males represent 25% of individuals with anorexia nervosa, and they are at a higher risk of dying, in part because they are often diagnosed later since many people assume males don’t have eating disorders" (Mond, J.M., Mitchison, D., & Hay, P. (2014)).
I am not saying all these posters have eating disorders. But in an additional study, it was found that "in a large study of 14– and 15-year-olds, dieting was the most important predictor of a developing eating disorder" (Golden, N. H., Schneider, M., & Wood, C. (2016)). There are some more horrible statistics there under the Dieting subheading, but what I am saying here is that these teens are coming to us for help and they are vulnerable, so our advice should be considerate of this.

Yes, They Should See A DoctoGP

We are not medical professionals, and offering dietary advice to impressionable or at-risk teens is not what this sub is for, nor are almost any of us qualified to do. So yes, our first question or comment should ask "Do you have access to a doctoGP, and will your parents take you?". Follow-up questions can include suggesting gym teachers, coaches, school counsellors or trusted teachers or other adults.
However, as an Australian I often need to remind myself that a majority of people on Reddit are American, and therefore the answer isn't always as simple as "go to the doctor". Many of these teens may be embarrassed and haven't spoken to their families about their concerns; many of them can't afford to go at all; many of them have parents who won't take them or will give them their own advice instead. Instead, they've reached out to us.
Meanwhile, a massive amount of the posts I've referenced often speak about other issues such as bullying at home or school and depression or other mental illnesses. In all cases where this is mentioned, seeing a doctor or trusted adult should be priority no. 1. In the meantime, there are other pieces of information we can provide to support these posters.

"We Need Your Stats" & Teen BMI Calculator

"Even among clearly non-overweight girls, over 1/3 report dieting." - Source - Wertheim, E., Paxton, S., &Blaney, S. (2009)
Even for adults, the advice we give each other here is heavily dependent on height and weight. We often direct each other to the TDEE calculator, and say "eat 500 calories less than your maintenance". What's important (for everyone, not just teens) is to actually check whether they are obese, overweight or a normal weight. I have absolutely run a teenager's stats through a calculator and found they were a healthy weight or even underweight before on their posts asking for weight loss help. For these teens, the below caloric minimums could be helpful as well, to make sure they are eating enough. Additionally, we can recommend any number of the wonderful fitness subs out there to encourage them to move more, but they need no further help from us if they are at a healthy weight.
The Baylor College of Medicine - Children's Nutrition Research Center provides this BMI calculator for children and teens. We should all have this link in our back pockets to provide to teens, as it is designed especially for them.
With this info, our next question can be "Can you put your info into this calculator and tell us whether it says you are obese, overweight or a healthy weight?".
[EDIT] - A dietician in the comments has explained that BMI categories are mostly suitable for adults 20+, and that they should be used in combination with a growth chart. They also recommended that a dietician with pediatric experience is more suitable than a doctor in many cases. I found these growth charts for 2-18yo, male and female, with BMI/height and weight for age options.
[EDIT] - I have seen more criticism of the BMI concept in general, I've never heard of any of this and it just goes to show how much we don't know when we're teaching health and nutrition! A user has shared some info about how the BMI scale was not invented by a doctor, and is mostly build around white males. I'd love to see a deep dive post about this!

Teens Need More Calories Than Adults With The Same Stats

"Because the teenage years are a time of rapid growth and development, teenagers require more calories to sustain and fuel this growth." - Motley Health
I know that CICO is king. It's basic science and it works. But for teens, a focus on calorie-counting and "dieting" is linked to dangerous eating habits and self-esteem issues. Instead, it is recommended that adults "promote a balanced diet and exercise for fitness (not weight loss)" when speaking to teens about healthy eating.
However, it would be impossible for a teenager to look at this sub and not see a lot of conversation about calorie-counting and deficits. Therefore, Motley Health recommend the following caloric guides for teens.
I would only recommend directing them to these calorie graphs if they are already calorie-counting.
[EDIT] I have had a lot of comments discussing the higher ranges of ages here, and I am inclined to agree that anyone 17+ would possibly benefit from a more standard approach of TDEE -500. Your mileage may vary, but I would recommend erring on the side of higher calories and slower weight loss.
Caloric needs of Girls and Young Women

Age/years	Sedentary	Low activity	High activity
12-13	1700	2000	2250
14-16	1750	2100	2350
17-18	1750	2100	2400

Caloric needs of Boys and Young Men

Age/years	Sedentary	Low activity	High activity
12-13	1900	2250	2600
14-16	2300	2700	3100
17-18	2450	2900	3300

These caloric guides are further supported by similar numbers here at VeryWellFit, which cites Lifshitz F. 2008 and a health.gov Dietary Guidelines appendix.
[EDIT] I have had a lot of comments that the calorie guides for boys/young men seem really high - I have posted the sources above but in this case, I would highly encourage seeking professional advice and not eating less than 1500 calories (as a minimum for a sedentary adult man).
Considering the above research and the calorie guides here, our next question should be "How active are you?". Motley Health suggests the following definitions to go along with the above charts.

• Sedentary means that you do nothing, just sit on a sofa watching television, and often eating.
• Low activity is for people that walk a little every day, such as to and from school, as well as some occasional sports, such as compulsory physical education lessons.
• High activity is for anyone that does regular exercise, such as daily running, working out with a sports team or training in the gym 2-3 times a week.

With this information, we can combine our recommended 1lb/0.4kg a week loss with a deficit of 500 calories from these guides. Motley Health even states that a 1000 calorie deficit could be possible, but I am combining their recommendations with this sub's general philosophy.
The Baylor College of Medicine - Children's Nutrition Research Center also provides this Healthy Eating Calculator for teens and children, which instead of outputting raw numbers takes the user through a guide of what their diet should look like based on their activity level. We can redirect teens to this calculator as we would an adult poster to the TDEE Calculator.

Be Supportive

Ultimately, these teens are often posting here as a result of feeling low or helpless. We are so much more than a 500 calorie deficit. We can talk to them about their habits outside of their weight, what foods they like, commiserate with difficult home or school situations because we've all been there. We don't need to be afraid that we will accidentally encourage something harmful if we use the tools and information at our disposal as a result of our own research and hard work.
[EDIT] Some great additions in the comments - encourage patience! Weight loss is a long journey, and shortcuts are just not sustainable or healthy. Explain that it won't happen overnight, but that they are developing habits that will take them through the entire rest of their lives.

TL;DR

Questions to Ask Teen Posters

• Do you have access to a doctoGP, and will your parents take you? Follow-up questions can include suggesting gym teachers, coaches, school counsellors or trusted teachers or other adults.
• Can you put your info into this calculator and tell us whether it says you are obese, overweight or a healthy weight?
• How active are you? Examples of sedentary, low and high activity in the post under Teens Need More Calories subheading

Tools To Give Them

• BMI Calculator
• Healthy Eating Calculator
• Motley Health Weight Loss Advice for Teenagers article (amazing, well-sourced article that really aligns with this sub's CICO-focused values)

Further Reading

• National Eating Disorders - STATISTICS & RESEARCH ON EATING DISORDERS
• Motley Health - What’s A Healthy Diet?
• Royal Children's Hospital Melbourne - Growth Charts (use in conjunction with BMI calc)
• This post by u/ilikebluesocks - From one teen to all the others

Parents

I have seen a ton of parents in the comments discussing navigating weight loss with their teens - PLEASE check this one out, as it has tons of other resources for parents!

• National Eating Disorders - How to Open a Conversation with Teens About Healthy Eating

If any of you out there have any more resources or suggestions, put them here so our community can use it!
​

statistics tells me that in every 62 minutes at least one person dies of an eating disorder.
the first thing we do after learning addition is to count the calories we consume in a day.
boys planting their height vs weight graphs because fuck you, toxic masculinity still exists.
girls are taught 36-24-36 before compound interest since finance is only seldom important for her.
using area of a circle is equal to pi times radius squared to calculate the area of our tiny and taut waist.
crying because although we managed a B in mathematics our bodies are still failing those damned symmetry tests.
probability suggesting that people with anorexia are 56 times more likely to commit suicide that non-sufferers.
society making sure that our appetite remains inversely proportional to the rate at which we are dying.
learning calculus so that we understand better how our body changes its digits so soon.
cumulative frequency adding up to 30 million people that suffer from anorexia nervosa or bulimia nervosa.
it’s sad i know, but people still using a scale to measure their worth now and then.
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There's honestly a lot that has led up to now, but I'll try to keep this as short as possible.
Ever since I could remember I have always had anxiety. During my "teaching years" (learning right from wrong, what is impolite and rude) my parents and older peers often brought attention to my little faults. "That doesn't look good on you", "You'll look like a slob", "You're not doing this right, I'll just do it". Over and over I would hear things like this, especially from my mother (materialistic, self-centered). It withered away all sense of self-esteem I might of had by the time I was 5.
It was in 5th grade (11 years old) my depression became noticeable. I would often sit by myself under the trees outside and read because of playground teasing. I often chose to be away from others because I felt like I didn't belong. I was no longer getting A's on my tests, assignments, and quizzes. My teacher would never pick my hand, so I learned to never raise it.
I lost my first best friend in 6th grade (12 years old) after a fight, and was bullied by her and a few of her friends for a few years following. It was nothing severe, but a lot of rumors were spread.
I started cutting myself in 7th grade (13 years old). It started with my arms, then progressed to my thighs, and my lower stomach. I was smart about the process. I wore long sleeves every day, even in the summer, and even my sleeves were pulled up, my forearms would be entirely covered in thick bracelets and hair ties. In the summer I would stop cutting my thighs a month before June, giving me time for my tiny cuts to heal as I knew I would be forced into shorts (my mother would literally hide my long pajamas and jeans). It was a nightly ritual - my arms, my legs, every night. In order to stop the blood from dripping on the floor I would place baby wipes on large sections of cuts. It was what I thought I deserved. I believed I was wasting air with every breath, taking up space and getting in the way.
I had only stopped self-harming once I started to starve myself. My bout of anorexia was very short lived (lasting about 3 months), and when I had tried to self-harm I would become nauseous and nearly pass out. I haven't done either since and still feel a wave of disgust every time I felt compelled to try.
Everyday I came home, I would look up methods to kill myself. I had asked my parents to buy rope "for a woodshop project". I measured how tall our back deck was when no one was home. I would think about stealing my mom's keys in the middle of the night to start the car and barricade the garage door. If I survived 'till 18, I vowed the first thing I would do was get my firearm license to shoot myself. I had no hope, no will to live.
8th grade (14 years old) and I was outed to my parents about my depression by my school counselor. I hated them for this and still to this day can't forgive them. They were doing their job, but ignored my pleas in that it would only make things worse. And it did. My parents treated my depression and suicidal thoughts as a burden, begrudgingly taking me to therapy as if someone was dragging them by the ears. Refusing to listen to me about my feelings, "Here we go again", being a common phrase. I lost all my respect for my parents because of this.
9th grade (15 years old), I moved across the country following my parent's divorce. I wasn't too torn apart about the split, my first thought being "about time", as they had constantly argued whenever my father was home, it was a welcome promise of silence after 15 years of my witnessing them scream at each other. This was the year I wanted to actually improve my circumstance, and work on my depression - as I had been unwilling to do so before. I started excersizing, eating healthier and losing a lot of weight in the process (dropping to 120lbs).
I had to drop this in 10th grade (16 years old) however, as school became extremely overbearing. From now to my graduating year, I had struggled heavily in all my courses. I felt like I was doing everything right, but getting half of a result. I would visit teachers after school everyday to get help with the subjects, rewrite notes, colour coordinate, use pictures and graphs, highlight and condense information, study in intervals, create a distraction-free environment, utilize both physical and online resources for practice. Outside of this I was getting good sleep, still maintained a healthy diet - and yet I was still a C student. I had ended my senior year with low 50's across 4 classes, and low 80's across the other two.
I tried to return after grade 12 in order to upgrade my marks, but quickly realized I was making no progress; still using every study method and retention strategy I could think of and still failing. This, on top of winter car payments stacking up all at once, was enough convincing to drop out of upgrading (yes, that's exactly as sad as it sounds). However, I had a more hopeful outlook for my future and my depression. Suicidal thoughts were still consistent, but I realized I didn't want to die. I wanted my pain and silent suffering to end, but I didn't want to die, and I didn't want to see myself waste away. I called the mental health center hoping to get into therapy and was on a wait list for 3 months before finally getting in (I live in Canada and because of our free healthcare the wait lists are often extremely long).
It's almost been a year since I called the mental health center for the first time. I'm 19 years old, and by this point I had been on 5 different SSRI's, and 4 therapists. While I did meet with a therapist for the first time in January, over half of the 9 sessions booked were cancelled. I was doing EMDR therapy and had only gotten through one session after the other 4 sessions of info gathering. I later found out this was because my therapist was battling cancer, but nonetheless I still transferred to another therapist after months of silence as my depression, anger, and suicidal thoughts became all the more louder.
Because of COVID-19, I had been doing phone-call sessions with my new therapist. At this point I have heard so many different strategies to calm or distract oneself to ease their anxiety, therefore her advice wasn't helping much. However she did manage to pinpoint the idea that I may have undiagnosed ADHD. I tried getting a referral from my doctor myself to no avail, and with luck she did it for me and my appointment was in two weeks. In the meantime, we mutually agreed to stop the phone calls until the office opens again in order to continue with EMDR.
The appointment with the psychiatrist had not went as I hoped. I was hoping to try different medication, hoping that the medication used to treat ADHD would possibly help me, as the 5 SSRI's from the past had not (causing extreme fatigue - falling asleep in class and after school consistently). He instead prescribed me Wellbutrin, stating that it was hard to make a proper diagnosis, and that he simply think's I'm depressed. Even though the Wellbutrin won't solve my mysterious academic issues of making the same mistakes despite my efforts otherwise.
Those reading are generally caught up now to where I'm writing this. It's June 7th, 2020, and I still haven't gotten the help I need for my mental health. I've been actively trying to fight for my happiness for the past 9 months and I feel at the end of my rope. It's nothing but a waiting game now, as I have no choice but to hope that the Wellbutrin works until another 3 month wait to see my psychiatrist again to talk about the medication rolls around. I'm so tired of trying and ending up two steps backward from where I previously was. I'm tired of trying to stay positive - lying to myself when I want nothing more than to disappear. I actively want to kill myself even though I desperately don't want to (as contradictory as that sounds). I can't pretend that I'm happy anymore, that I don't hate making minimum wage at a job I hate, that I don't hate how a year of my life has been wasted when I want nothing more than to go to school and succeed at it, that I don't hate having to play the waiting game with my only other option in this small town is "Please check yourself into the hospital if you're feeling suicidal". I look back and realize that I am pretty damn close to where I was when I was in 7th grade, no hope, little will to live. That "little" part being the only main difference across the past 6 years separating how I felt then and now.
Tldr; I just want to be happy. I'm exhausted and tired of trying after all these years.
I'm just hoping this doesn't get flagged/removed for mention of suicide/self-harm, I'm sorry, I have no one else.

Boy oh boy, this bullshit again. You've probably seen the "stonks" format meme that says "what my parents think will happen when they take away my electronics" and then the stOnks graph, retitled "grades"...that essentially just happened with me and my dad. He basically spouted some boomer shit about how "you're always glued to that damn screen" and "these things are hurting your brain and rotting it" inhale I am so fuckin sick of this absolute bULLSHIT. I play videogames, watch YouTube, and browse Reddit to keep my thoughts of DEPRESSION from popping up in my head 24/7! Neither of my parents understand that if they stripped the Internet away from me, I would go from mildly depressed to self-harming in the course of a single fucking week. I get these horrific intrusive thoughts, and I'm "gLuEd tO mY ScReEn" to distract myself from the nihilistic NIGHTMARE roaring in my head. My dad actually, seriously tried to pull the "tHeSe vIolEnt vIdEo gAmEs ArE gOnNa makE yOu A pSycHopAth" bullshit, and I could hardly believe my ears, becuase my dad has sociopathic tendencies and almost no empathy and he's telling ME that I'm the "psychopath". I DO have violent urges, but playing games like Yandere Simulator help me take out my anger on something, y'know, NOT ACTUALLY ALIVE. I have a lot of issues, a few of them being clinical anorexia nervosa, body dysphoria, OCD, ODD, PTSD, ADHD, etc. (It fucking sucks btw) and all of that shit is like a constant weight on my shoulders that the internet and videogames just magically take away. But nooo, every fucking adult on Earth somehow thinks that we're slowly poisoning our brains. Sorry for the long ass rant, but I needed to say this without being yelled at by a boomer. If you have any advice, please comment because I would really appreciate it. Peace out, fellow Gen Z humans

I'm down 50 lbs!!!! SW: ~200lbs at 5'5", CW: ~149lbs
I could not have done it without the loseit community, and so I am forever thankful for you guys. The challenges has also been a major thing for me, especially the discord groups. Go team Pleiades! :D
This is gonna be a long one, because I want to help other people achieve their goals too, and reading other peoples experience has helped me a lot. So I want to go through what I learned in my weight loss journey.
TLDR; Progress pics: https://imgur.com/a/Zkgvq9O and https://imgur.com/a/SgVp8Dl
Now here is the long version:
How I got started on my Journey:
My weight kind of gradually creeped up on me. I feel like I had just kind of accepted that I was going to be a big person, and so I just ate whatever I wanted, not really caring about it, and of course, I kept gaining weight. I don't think I realized how big I was getting until I used my mom's scale during christmas 2018, and it blinked at me: 90,2kg: or 199lbs. I had been in the 80kg range for a looong time, steadily creeping up. But that was my first time seeing that number 9. Around the same time, I also realized the XL pants was getting too tight and I ordered a couple jeans in XXL online. They almost fit me. They were a little big. And I thought to myself; "I don't ever want these jeans to fit me". This was enough to shock me into getting my act together.
I joined a gym and went to a training group 2 times a week. At the same time I also found the loseit subreddit and started reading, both the FAQ and a lot of posts, and learned so much from you guys! This was a major help to me and made me confident enough to stick with what I was doing.
The sceince of losing weight:
The information that helped me the most was to learn this: 1 kg body fat = ~7700 calories (1lbs body fat = 3500 calories).
This somehow made losing weight into something tangible. Something I could understand. It was just maths!! I am a scientist and I love data and statistics so this was something I could resonate with. Following this, I made myself into my own science project, and made a big excel sheet where I tracked my calories in and my calories out and my weigh ins, to see if it was actually correct. And it was!
You can see my graph here: https://imgur.com/a/7ZYYEsz
Blue dots = actual weigh ins. Red line = How much I should weigh based solely on how much I have eaten, tracked through MFP, and how active I have been, tracked throug my garmin fitness watch. (P.S; the graph is from I started tracking, I had already lost a little before I started tracking).
Now the tracking IS only estimates! I found that I was over-estimating my deficit by about 100 calories a day, so my graph is adjusted for that. I think it is mainly due to the smart watch over-estimating activity a little, but probably also me under-estimating food intake. So you can see, it is quite sensitive and probably shows a little different results for everyone depending on how accurate your CICO tracking is. But it does work!!
So now I knew that I was losing weight, even when my scale weight was not moving, or was going up and down like crazy. If I was in doubt, I could just check my excel sheet and see that I was in fact losing weight, I just needed a bit of patience. This security of knowing for sure, really helped me to just stick to the program.
The reality of losing weight:
In order to actually stick to my calorie goals, I tried several different approaches to figure out what worked for me, and i changed up my game if I felt like it did not work or was not my thing. There are sooo many strategies out ther, IF, keto, veganism, etc. etc..
To me it was important to feel like I was not denying myself anything. I ate what I wanted and I ate when I wanted. Calories was the only thing that I was caring about. I ate the same things, but much smaller portions than I used to, mainly by weighing the food as I put it on my plate, so I could see the calories before I ate it and adjust accordingly. I tried to find food that I liked and enjoyed eating, but at the same time was low calorie. I ended up eating a lot more fruit and vegetables, and a lot less bread and starchy carbs. I had cake, I had ice cream, I had pizza. I just logged it and kept the portion sizes very very small to fit my budget.
My caloric budget was also very loose from day to day! I did have a daily goal that was quite low, but I made sure to be happy as long as I was in a deficit, however small that may be. Now I did aim for quite a high deficit. But I never went below the lowest recommended at 1200 calories a day. I started out trying to be between 12-1300 calories but eventually my goal icreased closer to 14-1500 with a maintenance around 2-2100 calories. I usually had one day a week where I could eat at maintenance (sometimes a bit above). And I had several days where I ended up between my goal and maintenance, and that was totally fine to me. As long as I was in a deficit I was good.
We are NOT perfect, we are human beeings. We are going to eat the food that we enjoy, even if it is food that is often labeled as unhealthy. Even fruits can be unhealthy in too high quantities, and you can even drink too much water. A little piece of cake here and there, it is not gonna do anything bad to you, it is the quantity that matters. If you try to be perfect, you are going to fail. So try to be nice and forgiving towards yourself! If I had eaten "too much" one day, I did not restrict later, but just started a new fresh day the next day! I was still at a deficit in the long run. Marathon, not a race. I don't think I could have endured for several months if I had been too hard on myself to be honest.
I basically tried to make this process as easy as possible for myself. I read a lot on the labels of my food, and at the store before I bought it, I tried to pick the options with the lowest caloric amount. I decieded that the most dangerous thing for my health right now was my weight, and the only way to reduce my weight was to reduce the calories. So I ate the things that made me get through the day on a caloric deficit. That included a lot of low-calorie ice cream, it included low-fat cheese (I effing love cheese and that was one of my hardest struggles), it included diet soda, low-fat yoghurt, the granola with the lowest caloric density, zero-calorie sauce substitutes, anything really I could find that was the food I liked, but lower in calories. It did not really taste the same, some of it was terrible (zero calorie caramel sauce??? yuck... but the zero calorie BBQ sauce and garlic dressing I found was actually decent!).
And the funny thing is.. I gradually changed from those substitutes, to more real food. I gradually started to eat more veggies, becuse at dinner, I could pile on the veggies and it was almost no calories, but I had to be careful with the sauce and carbs. I drastically reduced how much bread I ate, because it did not keep me full for so long and was quite calorie dense.
Mostly I ate fruits with yoghurt and granola, or oatmeal. And had small and tiny snacks during the day. If I felt hungry, I would eat one apple, or one small handfull of nuts. I tried to eat until I was "not hungry" instead of "full". I tried to be mindful of eating more protein, and healthy fats.
I see a lot of critique against CICO because it doesn't restrict on what you eat. But I think that is what a lot of people need. We can't change overnight to new habits. A lot of people try to change over night but burn out too quick. With CICO it is just facts, it's just maths. Of course it is healthier to eat more veggies, but if you lose weight by eating pizza, you still lose weight, and I think for a lot of people, that is the biggest threat to their health than a little bit of vitamin deficiency. You can take pills for that. I personally did take some multivitiamins + omega 3s to be on the safer side.
The struggles of losing weight:
One of my biggest struggles is that I have a huuge sweet tooth, especially in the evenings, and before I used to raid my kitchen to find anything sweet. And if I did not have anything ready, I would make a "microwave cup cake" or something if I had the ingredients.. I got really restless if I did not have anything. So I tried to find sweet things that would stop my sweet tooth binges. I found a low-caloric ice cream, and I ate some low-cal puddings etc.. anything really. But I weighed it out and tried to fit it into my budget before I actually ate it, and that made a difference for me. Because if I wanted chocolate, I would weight out 150cals worth of chocolate... and that's litterally one tiny piece of chocolate. Or I could have a small bowl of Ice cream for the same amount of calories.. so I went with the ice cream. It really helped me to not over-eat in the evenings. Some evenings I budgeted maybe 200 cals worth of calories for dessert and ended up eating 500 cals, but since my aim for calories was so low, I still ended up at a deficit. It did mean that a big part of my budget was just junk, but it was the only thing that got me through the day so I went with it. I was still losing weight! And gues what?? My sweet tooth has almost gone!! I don't really crave sugar that much in the evening and if I do, I usually make myself a cup of tea with milk and honey worth about 60 calories and it is enough to settle my "uneasiness". Work with your body instead of against it.. it takes time to change! (plus I notice now that when I am craving a lot in the evening is often days I have not eaten that much, so it kind of makes sense. Now I try to eat more in the day so I don't crave as much in the evening, but before it did not help at all, so it was better to go with it and control it, for me at least).
Working out while over weight / getting started at the gym:
Another advice I would give is to be very careful with running if you are heavy. I had huge problems with my knees when I was bigger, and I could almost not walk without some pain. I did find excercises at the gym that would help with increased knee stability, but I think a lot of the pain just automatically went away as the weight got lower. Running and beeing active now is so easy, it's a weird feeling. My legs can kind of just go by themselves, but before, every step was a struggle. I was carrying 50lbs more goddammit, trying to lift that now you can really feel how much weight that is. A lot of trainers or people who has always been fit doesn't understand this!! THey might push you too much because a smaller person can definetly increase the weights in the beginning but you are already in the negative there.
The most important thing to work on at the gym as a heavier person is actually posture and technique, with only body weight or very low weights, and using e.g the elipse machine to do cardio because it's softer on your knees. You can also WALK on the treadmill with an incline to get your pulse up :) Now if you keep working on your technique and posture, but lose weight, you will see A LOT of progress once your weight starts to come off! So it will be very small steps in the beginning to build a foundation, but you will have more muscles than you think because you have been carrying weight. So you might feel like the gym is no use in the beginning. I went to the gym MAX 2 times a week. Often just 1 time a week + walking every day. Aim for something you can actually follow through on. You will not lose weight in the gym unless you do a crazy cardio regiment that is not sustainable. Focus on diet first to lose weight, and use the gym to increase your health.
Moving into maintenance: (+ avoiding disorderly eating)
Now I weigh in at around 149lbs and I am at a healthy BMI. Maintenance is a whole other game! I have logged every single day, except maybe 4, since january 14th. But now I saw that I was actually a bit scared of NOT logging. Because logging = control. It meant I knew for certain I was eating enough or little enough. I was not trusting myself. This scared me because I knew that this could very well be signs of me moving towards disorderly eating if I really needed that control. I do NOT want to go down that route and all along I have tried to be very aware that I want to avoid that, because I have read so many stories of people starting out overweight but then ended up with anorexia and restrictions. That is also why I have been so little restrictive with my diet as possible. So I have decided that I am not logging my food anymore!
My last day of logging was Friday the 26th of july, and the last couple of days have been new to me, to not log. It is honestly a little scary. which means it was the right thing to do. But it is going very well so far and I am just eating what I have been eating lately, enjoying my food and at the same time just listen to my body and feed it what it needs to be healthy and happy :)
A journey of self care and self acceptance:
Another thing that really led me to go on this journey, was actually that I started to finally accept myself. I have been at my current weight before, through high school + some years after, and I always hated my weight and looks at the time. I really started gaining in 2015/16 and through 2018. But once year ago, summer of 2018, I was bigger than ever, hating it and looking back to how stupid I was before. And something really clicked with me. It clicked that I was good enough, just the way I was. I was beautiful and worthy. I was worthy of loving myself. So accepting myself at my bigger size, led to me starting to caring about myself again, about my health, about the way I presented myself to the world. And through this caring about myself, I then, eventually, realized that the ultimate and most caring thing I could do was to get to a healthy weight. So to me, my motivation has always been health and self care. You are beautiful and worthy no matter what size you are. But a heavy weight IS something that will reduce your health and mobility.
Self acceptance, confidence, mental and physical health after losing weight: I have struggled with periods of feeling down and depressed, low energy and tiring out very easily, not beeing able to do all the things I wanted to do, for many years now. I think some of it can be due to the weight beeing a strain on the body and not taking proper care of myself.
After losing weight, I have actually gained more energy and I have felt less depression. It is not completely gone, other factors do affect depression and mental health. Losing weight is not a miracle cure. But it has definetly improved my quality of life, my mental and my physical health.
My self image is still a work in progress!! Getting to a lower weight will not automatically make you love everything about your body. Don't get me wrong, I do like what I see in the mirror a lot more now. But I am not and will never be what magazines and media portrais as the ideal body. I am a woman now, I have stretch marks and sagging boobs (yes the boobs shrink :'(). But you know what! I do accept myself, just as I did when I was heavier. I have days where I feel good, I feel more confident now, but I also have days where I don't feel like walking around in a bikini or feel like my tummy and thighs are pudgy. Self acceptance is needed at every size. You are good enough just the way you are.
Another thing is that buying clothes are not cheap!!! I go thrifting as much as I can. lol. Buying clothes ARE much more fun now though to be honest.
I think I have covered most of what I wanted to say and share about what I have learned. Remember that we are all so different. This is what has worked for me, but I tried different things all the time, I checked in with the community to get advice if I was struggling and read other peoples experience but I also had to disregard a lot of advice because it did not work for me!! So yeah, I hope you can do the same for yourself and not follow things blindly but listen to yourself and your body on your own journey.
I think that was all. Thank you for listening to my TED talk :D
Also sorry about spelling errors etc., english is not my first language.
Edit: wow, such an overwhelming response! And thank you for the gold, that is too kind 😊 the loseit community really is the best ❤️
Edit2: Thank you so much again. I did not expect so much response, I thought it was wayy to much text to anyone to bother reading but I have got so many nice comments and messages and I really have just a big smile on my face now thinking about all of you good people :)I got several requests to share my excel spreadsheet, I won't share my personal one but I made a blank one with the same formula and a graph, I hope it works! but if you have any troubles with it, please contact me :) link: https://drive.google.com/file/d/1to6P1r3worIyCyb811PCqEOCe-VoX9AG/view?usp=sharing

A 3 part look at the little biotech crazy enough to bring dry cannabis to FDA and HC pharmaceutical standards.
The study and Data in question is contained in the PDF document linked below. Tetra Bio-Pharma TBP PPP0001. A First-In-Human (FIH) Cannabis Trial: Overview

Part #1

PPP0001 Phase 1 was completed June 2017
Phase 3 resumed April 09 2019 after a 2 month pause for mycotoxins measuring over the allowable limit for an FDA and Health Canada clinical trial. This G&M article explains that Health Canada actually has no limits in place for these mycotoxins and Tetra’s controls went above and beyond requirements.
This over view is of their phase 1 completed in June 2017. It unfortunately only includes half of the subject group. It was a single-center, randomized, placebo controlled, single and multi-dose, parallel group study. (Or in English) whole study completed in one facility, the subjects were placed at random, base line controlled group (placebo), two study groups with different dose profiles (1 day and 7 day)
The Purpose wording in this document goes as such.

This study was designed as a first-in-human study to investigate the safety and tolerability as well as the PK/PD (Cognitive) profile of this combination when smoked/inhaled as intended in clinical therapeutic use (I.e. patients with neuropathic pain).

Neuropathic and Advanced Cancer Pain are most commonly treated with the aid of Opiates and Opioids.
Quick Overview of the Document and Phase 1 Study.
Abstract - Objective of the study is to evaluate the safety, PK and PD (cognitive) in healthy volunteers. - This only discusses half of the study group. There are two volunteer profiles. SAD and MAD. This study discusses SAD. - 24 healthy subjects (SAD side) - Response to recruitment was good, but the screen fail rate was ~4:1 - Subject must have a history of Cannabis use >10 times in their life time. - Must not have consumed cannabis or cigarettes within 3 months of study start. - Cognitive tests were performed before and during treatment. - Pellets were one of two varieties of a 280mg dried pellet. A 25mg^THC and 5mg^CBD . A ratio of 9:2 (PPP0001) - Or the placebo which contained no THC but small amounts of CBD. (0.8mg^CBD )
A major skepticism of this trial I’ve seen online a few times is ”How do you run a placebo trial on inhaled cannabis with no THC? The patient is going to know”
Yes, but in this study that doesn’t matter. They’re assessing the cognitive PK (Pharmacokinetics) and PD (Pharmacodynamics) of THC on healthy subjects, and how fast the plasma levels are achieved. So the control group needs to be sober, while inhaling a cannabis product using the same method as the active group. Pharmacokinetics (PK) is the movement of drugs through the body. Pharmacodynamics (PD) is the study of the movement of drugs through the body.
Study Design - SAD subjects received their dose up to 3 times, 4 hours apart on the same day. (1 day group) - MAD subjects received their dose up to 3 times daily, 4 hours apart over 7 consecutive days. ”consecutive dosing should allow to test the tolerability of chronic administration” - Blood samples for measurement of THC, OH-THC and CBD were collected pre dose and over a 24-hour period post dose.
One much overlooked factor of TBP is the data they are collecting. As an example, In my Opinion it’s possible for this data to contribute to answering questions around testing for Impaired driving. The potentially negative effect on cognitive function (easily distracted, slow reaction times, disconnected from reality) from consuming Cannabis does not coincide directly with THC:Blood limits.(i.e. blood ng limits do not accurately reflect how high or impaired you are at the cognitive level) Tetra is measuring these levels and functions and I would imagine phase 3 would be doing the same.
Complexities

• Ventilation. The room had to have specialized ventilation capable of preventing exposing the placebo patients to the active dose. Only one subject in the room at a time.
• Staff performing procedures during dosing had to wear Environmental Protection suits.
• An external, experienced group of cannabis users from Santé Cannabis came to train the clinical staff on inhalation procedures with a titanium pipe. The pipe is looking to be protected Iintellectual Property via patent filing.

Note 1 this patent once granted will increase the $$ on the Intangible Assets line on the balance sheet* in the relating Quarter. The pipe itself would be an inventoried asset and the manufacture and sale would fall to the top line of Revenue and COGS. Like Finished cannabis goods. But the Patent (once granted) is an intangible asset. (We’re currently in Q2-2019) Somebody asked on the weekend why GWPharma was worth $4.5B (MC). One reason is that drug developers are awarded protections from competition or generic reproductions for 7-10 years depending on jurisdiction and other factors (also known as an “economic moat”). (Another is because GWPharma is the patent leader in this space). It’s very expensive to replicate somebody else’s success in this space. Although valuing patents is not always easy.
Intellectual Property = Intangible Asset = Company Value.
Note 2 Santé Cannabis is a world leading medical cannabis clinic and research organization, serving thousands of patients and recruiting for Health Canada approved Cannabis studies. - Recruitment turned away 4:1 during the screening process. - Some subjects became anxious after dosing. Note subjects had to be at least 3 months clean of cannabis and test was performed in a clinical setting. There’s a picture in the document for an idea of the setting the document also includes the “steps to follow” for the inhalation procedure.
General Observations

• Rate or dropouts from AEs was not higher than usual for FIH trials Note that cannabis is a known vasodilator, which opens your blood vessels and drops your blood pressure. (I.e. Fainting/Low Vital Signs)
• Logistics was the main challenge, i.e. performing medical procedures while wearing environmental protection suit.
• Subjects found the pellet and pipe easy to use
• Subjects followed the puff procedure but large variation in PK of THC and CBD between subjects (large variation of how the THC and CBD moved through cognitive system of the subjects, how it affected them and what it is affected by)
• The document overviews the PK profiles of THC and CBD between subjects.

Safety
The document includes a chart that shows the AEs (Adverse Events) in Cohort A (single day Study) and a graph that overlays the 5 day onward of the Cohort B (7 day group).
Conclusion

• Study went well
• C-max was achieved quickly, supports the hypotheses that PPP0001 should achieve fast (neuropathic) symptom relief.
• Dosing schedule did not result in accumulation, even after 7 days.
• Most AE’s were related to CNS (which I take to mean Central Nervous System). AEs decreased over time.
• Cognitive results yet to be analyzed and compared

FDA Clinical Phases

Part #2

The Mycotoxin Scandal😏 and the line so many people missed

The cannabis raw materials purchased by Tetra for use in its investigational drug met the requirements under the Cannabis Act and Good Production Practices and tested below allowable limits.

And this one

Tetra, having acted in accordance with the requirements of the Food and Drugs Act and GMPs, detected the presence of mycotoxins other than aflatoxin in the experimental lot used for the validation.
Tetra will take the next 6 months to assess the situation

Suspended Feb 5th, resumed April 11th after only 2 months. And this delay happened at the beginning of the trial. A Far cry from the 6 months projected initially, and certainly not a major setback,
Safety protocols, procedures and contingencies in place and working as expected. I guess some people were a little bruised when this all happened. Many people don’t understand or realize just how risky a pre-clinical biotech company actually is. Nor do they care to learn about the processes or even the regulations for which their investments (or everyday consumer products) must adhere to.
Some reading material on mycotoxins from the W.H.O.
Health Canada's Maximum Levels for Chemical Contaminants in Foods laid out in the Food and Drug ACT- which is referred to in Part 5, Good Production Practices of The Cannabis ACT. Testing, paragraph 94(1)

94(1) Despite subsection 93(1), cannabis that is a cannabis product or that is contained in a cannabis accessory that is a cannabis product may contain microbial or chemical contaminants provided that they are within generally accepted tolerance limits for herbal medicines for human consumption, as established in any publication referred to in Schedule B to the Food and Drugs Act.

In conclusion, the material purchased by Tetra Bio-Pharma TBP for PPP0001 from Aphria APHA met and exceeded GMP and Canadian Food and Drug ACT standards. The standards set out for clinical trial and pharmaceutical drug development under the Health Canada and the US-FDA is much more stringent. (Drugs need to be more pure than food) there are many pharmaceutical drugs derived from plants on shelves today and thousands of articles on mycotoxins and drug/food manufacturing processes. This is Quality Control at work.

Part #3

Panag Pharma Acquisition
I’ve included notes from the Management Circular from Sedar that was posted March 26, 2019 in regards to the Panag Pharma acquisition. They’re located the “recent Panag events” portion. Including some major points of interest from the Fairness Opinion by Paradigm.
Definitive Agreement Highlights. Jan 30 2018 - Access to Panag’s NHP portfolio. - Worldwide Licensing on Panag products. - More PhD’s on staff with literal Decades of Cannabinoid Research behind them.

Dr. Orlando Hung, a co‐founder of Panag, "The Panag team is very excited to have this well‐ timed opportunity with Tetra Bio‐Pharma, allowing us to continue our decades of translational cannabinoid research

Cost to Tetra. - $12M split as such. $3M cash and $9M via TBP shares. The shares will be paid at the lesser of two means. Either the 10 VWAP on the day of the agreement Or the discounted market price (as defined by the TSXV) as calculated 3 days prior to the closing date of the acquisition. The acquisition was closed April 18th via shareholder vote. - TBP closed on the 18th at $0.62 with a 10 day VWAP of $0.70 (12,857,142). The DMP on the 15th was $0.544 (16,554,117 shares) TBP has 166,831,631 shares outstanding for a maximum of 10% dilution.

The Agreement also contemplates the payment by Tetra to the Vendors of an aggregate amount of up to $15,000,000 in cash in milestone payments upon the achievement of operational targets associated with marketing approvals and commercialization of both human and veterinary drug products by the U.S. Food and Drug Administration (FDA) and the European Medicines Agency (EMA). Tetra is committed to fund Panag's research in an amount no less than $1,200,000 annually for a period of ten years after the closing date of the Proposed Acquisition

Notes on the Transaction from the MD&A-FY-2018 Posted March-15-2019

The Proposed Transaction will not result in the issuance of securities to non‐arm’s length parties as a group. Special Committee was composed of Benoit Chotard and Carl Merton, both of whom have no interest in Panag or the Proposed Transaction.

Assuming all milestones are met and all parties are satisfied, TBP is committing to $1.2M annually for 10 years plus up to $15M for milestones. Or $40M all said and done over a 10 year window. With a multitude of drugs on both companies books and a recent completion of a Phase 2 cannabis oil trial gives you an idea of where this funding is going. Interesting that Sante Cannabis is involved again. I will be keeping an eye on this group.
Tetra Working Capital - $11.9M working Capital as at YE-18^Nov-2018 - $7.1M from Aphria ^Nov-30-18 - $11.5M bought deal ^March-2018 - $4.2M private placement ^March-2018 - OPEX for 2018 YE was $11.9M - 80.7% of FY-18 OPEX is in RnD - 49.8% of FY-18 Total Expenses is RnD

5‐ Research and development expenses of $5,964,322 (November 30, 2017 ‐ $2,060,059) was due to the Corporation activities in its clinical trials for PPP001, PPP002, PPP004. The Corporation projects continuing the clinical development of PPP001, PPP002, PPP004 as it initiates the Phase II‐III trial. As at November 30, 2018 figures also include expenses associated with the other clinical development programs announced.

Tetra is currently funded for ongoing activities but will require more funding in the future before becoming self sustaining. Not including any Revenues expected to begin in FY-2019 or Revenues Panag is bringing in. Operational deficits and Bio-Tech companies go hand in hand. Know what you are investing in before you invest
Panag Pharma Team A strong team of PhD’s with multiple decades of Cannabinoid research behind them. Panag Pharma Team - Panag’s Dr.Melanie Kelly on Global News Morning. July 27/17 discussing why Medical and Recreational Cannabis should be left as two distinct avenues of access in Canada 1 month after The Cannabis ACT passes the senate
Recent Panag Pharma events unrelated to Tetra - May 9/18 Received HC licence for an NHP product for cold sores that targets the EndoCannabinoid System. - May 3/18 Initiated a clinical trial for an NHP topical for pain associated with inflammation.

This study consists of a randomized, double-blind, placebo-controlled crossover trial with open label extension evaluating Topical AOTC against placebo being run in the Pain Management Unit at the QEII Health Science Centre in Halifax, NS - Jan 24 2017 Panag was granted a patent on their EndoCannabinoid targeted drug for ocular pain and inflammation. The first technology of its kind to target ocular pain and inflammation.

Panag Pharma licences NHP products Via Health Canada - Beta-C - Cold sore formulation
Management Information Circular Posted to Sedar March 26, 2019
Background of the Talks to aquire Panag

In December 2017, Mr. André Rancourt, then Chairman of the Board, initiated discussions with representatives of Panag to explore the possibility of an acquisition of Panag by Tetra.
Tetra provided representatives of Panag with a draft proposal setting out indicative transaction terms on June 13, 2018.
August 31, 2018, the parties executed a non-binding proposal (the "Letter of Intent") pursuant to which Tetra would acquire all of the issued and outstanding shares of Panag.

8 months before the Vote.

Panag established an electronic data room in order to allow for due diligence to be conducted and provided access to the data room to Tetra and its legal advisors on October 10, 2018.
On December 3, 2018, Tetra and the Vendors entered into a further amendment to the Letter of Intent.

That gets us to where we are now. Paradigm Capital performed the Fairness Opinion. Which is included in the Circular.

The full text of the Paradigm Capital Fairness Opinion, setting out the assumptions made, matters considered and limitations and qualifications on the review undertaken in connection with the Paradigm Capital Fairness Opinion, is attached as Appendix “A” to this Information Circular.

Reasons for the Proposed Transaction Page 8 of the Circular.

• Enhancement of Shareholder Value. Cites Panag financial condition, current operations, management and competitive position, etc.
• Portfolio of Products and Markets. Panags IP in the field of pain management including ocular, topical, interstitial cystitis, cannabinoids and terpenes associated with cannabis.
• Clinical Development Programs and Product Lines
• Enhance Tetras competitive position.
• Timing of the transaction. > The Special Committee and the Board (excluding the Interested Directors) also considered that the Proposed Transaction will result in Tetra taking control of Panag prior to Panag having begun clinical trials in respect of its potential products. This will allow Tetra to control the process to take Panag’s drug candidates through development until commercialization.
• Strength of Panag Team. > would also allow Tetra to bring on board three of the founders of Panag who possess core expertise in the early phase development of drugs.
• Enhanced Capital Markets profile.
• Shareholder support. (At this time there was already 31% support in favor of the acquisition)
• Favourable terms of the Share Purchase Agreement.
• Shareholder Approval
• Evaluation and Analysis
• Receipt of Fairness Opinion
• Low Execution

Milestone Payments The 11 milestone payments can be found in the Fairness Opinion portion of the Circular which starts on page 21 of the PDF. I'll give you the titles but make you dig for the dirt. - 1. For the ocular drug for the pain and inflammation human drug market (4 milestones) - 2. For the ocular drug for the dry eye human drug market (4 milestones) - 3. For the ocular drug for pain and inflammation veterinary drug market (3 milestones) - 4. For the topical drug product for the human drug market (3 milestones) - 5. For the topical drug product for the veterinary market (3 milestones) - 6. C$750,000 payable upon issuance of the patent for interstitial cystitis formulations pursuant to patent application no: 62/586,516. (1 milestone) - 7. For the interstitial cystitis drug for the human market. (4 milestones) - 8. For the interstitial cystitis drug for the veterinary market. (3 milestones) - 9. For the topical NHP cannabinoid-based product for the Canadian human market (3 milestones) - 10. For the development of an alternative to smoking cannabis such as a nebulized formulation of tetrahydrocannabinol (“THC”) and cannabidiol (“CBD”) and filing of provisional patent applications. (5 milestones) - 11. C$100,000 per new natural health product (worldwide) that is commercialized and achieves C$1,000,000 in sales in respect of plant-derived products to the over-the-counter market, to a maximum of C$500,000 (1 milestone)
Fairness Opinion
rNPV Analysis. The fairness opinion ascribes 80% of the value of Panag to three products. - Treatment for Dry Eye Disease - Topical Treatment for Pain - Treatment for interstitial cystitis

In preparing the Opinion as to the fairness, from a financial point of view, to the Company and its shareholders, Paradigm Capital has considered, among other things, the following factors:
a) Panag currently has one commercial product available in the market, Topical AOTC and, as such, does not have meaningful revenue.
b) Panag has a portfolio of CBD-based pharmaceutical formulations currently at various stages of clinical testing and development. Paradigm Capital believes this portfolio is the primary source of value for Panag.
c) Paradigm Capital considered the anticipated future costs to Tetra for the use of Panag’s products based on the license and development agreement between Tetra and Panag dated May 19, 2017, if the Transaction is not completed. The Company will not incur such costs if the Transaction is completed. Paradigm Capital compared the value to Tetra under the license and development agreement to the value of the Transaction.
d) Paradigm Capital identified and reviewed a universe of comparable companies with portfolios of cannabinoid-based formulations/products at similar stages of development to Panag.

Fairness Opinion Conclusion

Based upon and subject to the foregoing and such other factors as Paradigm Capital considered relevant, Paradigm Capital is of the opinion that, as of the date hereof, the Consideration to be paid by Tetra pursuant to the Share Purchase Agreement is fair, from a financial point of view, to the Company and its shareholders.

With their relationship with Sante Cannabis, Acquisition of Panag Pharma which includes partnerships with Dahlhousie University, the NSERC, and close working relationship with Health Canada and the US-FDA, leads me to believe that Tetra Bio-Pharma is one of the best risk/reward plays within the global cannabis space today.
Caveat Emptor

Tetra Bio-Pharma Part 2

Every once in a while you come across someone on twitter who is 100% tapped in to an interest of yours.
I’d like to introduce you to Diane. @DianeReardon33. Unfortunately she is not on Reddit so we’re collaborating to bring you this TBP Part 2. Everything that comes after this sentence is courtesy of Diane.
Welp, patience has never been my virtue so I have decided to sit down tonight and do up a summary of sorts to give an interpretation of what Tetra have going on. I will include Panag activities/products now given the acquisition is near completion. Please feel free to comment below on any errors or omissions so I can edit. Enjoy 😀
Tetra now has access to 20 clinical trial sites throughout Canada and the USA which gives them access to + patients/study participants and will ultimately decrease trial duration time IMO.
PIPELINE:

• CAUMZ: starting P3 (~ June 2019)
  
• ppp005 - P2 results being analyzed (ETA for completion September 2019)
  
• Topical use of 20% Beta Caryophyllene alone and in combination with 0.025% capsaicin for pain caused by OA of the knee.
  
• ppp002 - not yet started P1 for chronic pain or chemotherapy induced nausea and vomiting.
  
• ppp003- last updated pipeline I saw indicated "pre-clinical", however Dr Chamberland has mentioned in numerous interviews that this trial is due to start this year and is excited about it. Would likely anticipate some update after Panag acquisition closes.
  
• ppp004 - last available pipeline indicates that it is in clinical trial application / investigational new drug stage.
  
• CAUMZ use with Fibromyalgia: announced 20 December 2018 successful completion of P1 and due to move into P2.
  
• ppp005 used concurrently with radiation: given 005 P2 data currently being analyzed, would anticipate this trial commencing after this in P3.
  
• CAUMZ versus Fentanyl: according to the clinical trial registration this trial to commence in P2.
  

DRUG DEVELOPMENT:

• 011: Tetra are working with Rhodes Technologies for the development of 011. This is a drug being developed off of the patent filed from 001 which "... will use isolates or synthetic-based supplies of cannabinoids and terpenes to develop these prescription cannabinoid-derived medicines".
  
• Tetra + Ovensa working to develop drug to tackle GBM.
  
• Tetra/Panag pilot study working with Veterinary Drugs Directorate at Health Canada to examine the use of a cannabinoid-based drug to treat ocular pain and inflammation in canines.
  

UPCOMING DRUG APPLICATIONS

• ppp001 (pellet) application package ready for submission to the European Medicines Agency as a herbal medicinal product.
  
• I anticipate ppp005 application package to EMA post-data analysis in the future.
  
• ppp002 (Dronabinol Adversa) NDA application to the FDA due later this year via the 505(b)(2) regulatory pathway. Drug approval would be for use in chemotherapy induced nausea/vomiting and anorexia associated with with weight loss in patients with AIDS.
  

NHP/OTC PRODUCT LINE:

• Beta - C: NPN/DIN # secured
• Cold Sore Formulation: NPN/DIN # secured
• “Legalization of recreational cannabis is expected to take place in Q3/Q4 of this year following which Tetra Bio-Pharma will launch no fewer than 7 cannabinoid based Natural Health products in the Canadian market. We will also look to license these products worldwide." (not 100% if this is still material or not)
  
• Genacol product development still taking place.
  
• HEMP energy drink via TNH.
  
• Crescita Therapeutics and Tetra Natural Health Collaborate to Enhance Transdermal Delivery of Beta-Caryophyllene in Tetra’s Dermatology Product Portfolio.
  

PATENTS

• 003 (awarded patent for composition and methods for treatment of ocular inflammation and/or pain).
  
• 001 (patent pending for composition of matter for unique/unknown discovery in the smoke of ppp001).
  
• Panag patent pending for interstitial cystitis.
  
• 23 August 2018 "The company also announced it submitted patent applications to expand its exclusivity for the development of pharmaceutical drug formulations to treat various forms of cancer and ocular disease. This latter protection complements the intellectual property owned by Panag Pharma.". I believe this is the patent that “...aims to protect new pharmaceutical combinations of cannabinoids and terpenoids to inhibit a specific signaling pathway, known as Hedgehog (Hh), and their use to combat human diseases.".
  

link to picture on twitter of patent’s screenshot
FUTURE ANNOUNCEMENTS:

• TBPs work/involvement in the US with Veteran's Affairs/PTSD.

NOTABLE PARTNERSHIPS & AGREEMENTS:

• TBP + The Lung Association - Ontario: “...to fill that gap by funding a research program that will investigate various health impacts of cannabis use. The goal of this program will be to better support patients and healthcare providers with evidence-based information.”.
  
• TBP + Sirius Air Solutions Inc(previously known as AES: “...to secure a source of supply for a specialized cannabis smoke air purifying system and a mask designed for law and emergency responders.”.
  
• TBP + Altus Formulations Inc. JV will enable “Increased intellectual property protection for products developed under the joint venture; Access to abuse deterrent technology to minimize non-medical use of cannabinoids; An enhanced development pipeline addressing new therapeutic areas; Opportunities for disease-appropriate delivery including intranasal and intravenous delivery; andIncreased oral drug absorption with immediate and extended release products.”. (definitive agreement being worked on)
  

LINKS
DAL researchers target Cannabinoid receptors with new line of Pain-Relief products
The Cannabinoids Δ8THC, CBD, and HU-308 Act via Distinct Receptors to Reduce Corneal Pain and Inflammation
Topical Use of 20% Beta Caryophyllene Alone And In Combination With 0.025% Capsaicin for Pain Caused by Osteoarthritis Of The Knee

We're going to have endless posts about this for the next couple of weeks. This will act as a megathread - please post new links you find in the comments and I'll update this main text post. - Please read the RESPONSES section at the bottom for counter arguments.
https://eatforum.org/eat-lancet-commission/

Food in the Anthropocene: the EAT–Lancet Commission on healthy diets from sustainable food systems - Science Article31788-4/fulltext)

https://eatforum.org/content/uploads/2019/01/EAT-Lancet_Commission_Summary_Report.pdf

• Prof Walter Willett, MD31788-4/fulltext#)
• Prof Johan Rockström, PhD31788-4/fulltext#)
• Brent Loken, PhD 31788-4/fulltext#) https://twitter.com/brentloken/status/1085683158694182913 "New plant-focused diet would transform planet's future"
• Marco Springmann, PhD31788-4/fulltext#) (Vegan)
• Prof Tim Lang, PhD31788-4/fulltext#)
• Sonja Vermeulen, PhD31788-4/fulltext#)
• Tara Garnett, PhD31788-4/fulltext#)
• David Tilman, PhD31788-4/fulltext#)
• Fabrice DeClerck, PhD31788-4/fulltext#)
• Amanda Wood, PhD31788-4/fulltext#)
• Malin Jonell, PhD31788-4/fulltext#)
• Michael Clark, PhD31788-4/fulltext#)
• Line J Gordon, PhD31788-4/fulltext#)
• Jessica Fanzo, PhD31788-4/fulltext#)
• Prof Corinna Hawkes, PhD31788-4/fulltext#)
• Rami Zurayk, PhD31788-4/fulltext#)
• Juan A Rivera, PhD31788-4/fulltext#)
• Prof Wim De Vries, PhD31788-4/fulltext#)
• Lindiwe Majele Sibanda, PhD31788-4/fulltext#)
• Ashkan Afshin, MD31788-4/fulltext#)
• Abhishek Chaudhary, PhD31788-4/fulltext#)
• Mario Herrero, PhD31788-4/fulltext#)
• Rina Agustina, MD31788-4/fulltext#)
• Francesco Branca, MD31788-4/fulltext#)
• Anna Lartey, PhD31788-4/fulltext#)
• Shenggen Fan, PhD31788-4/fulltext#)
• Beatrice Crona, PhD31788-4/fulltext#)
• Elizabeth Fox, PhD31788-4/fulltext#)
• Victoria Bignet, MSc31788-4/fulltext#)
• Max Troell, PhD31788-4/fulltext#)
• Therese Lindahl, PhD31788-4/fulltext#)
• Sudhvir Singh, MBChB31788-4/fulltext#)
• Sarah E Cornell, PhD31788-4/fulltext#)
• Prof K Srinath Reddy, DM31788-4/fulltext#)
• Sunita Narain, PhD31788-4/fulltext#)
• Sania Nishtar, MD31788-4/fulltext#)
• Prof Christopher J L Murray, MD31788-4/fulltext#)

Full PDF - 47 PAGES!31788-4)
Abstract
Food systems have the potential to nurture human health and support environmental sustainability; however, they are currently threatening both. Providing a growing global population with healthy diets from sustainable food systems is an immediate challenge. Although global food production of calories has kept pace with population growth, more than 820 million people have insufficient food and many more consume low-quality diets that cause micronutrient deficiencies and contribute to a substantial rise in the incidence of diet-related obesity and diet-related non-communicable diseases, including coronary heart disease, stroke, and diabetes. Unhealthy diets pose a greater risk to morbidity and mortality than does unsafe sex, and alcohol, drug, and tobacco use combined. Because much of the world's population is inadequately nourished and many environmental systems and processes are pushed beyond safe boundaries by food production, a global transformation of the food system is urgently needed.
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https://www.smh.com.au/environment/sustainability/civilisation-in-crisis-science-tells-us-how-to-eat-to-save-our-planet-20190116-p50rsp.html

Humanity must radically change the food we eat to avert catastrophic damage to the planet, including cutting our red meat intake by more than half, a major international consortium has warned.
Our predilection for diets high in meat, sugars and processed foods is stretching the earth to its limits and threatening the existence of humans and other species, food security and sustainability experts have said.
The EAT-Lancet Commission has devised the world's first scientific targets for a universal "healthy planetary diet", which it set out in a report titled Food in the Anthropocene, published on Thursday.
"Civilisation is in crisis," the editors of The Lancet wrote in an editorial accompanying the commission's report.
"We can no longer feed our population a healthy diet while balancing planetary resources," they said, adding that addressing food insecurity was "an immediate challenge".
Our main source of protein will need to be plant-based. Red meat should account for zero to no more than 14 grams of red meat a day, in line with the United Nations' Sustainable Development Goals to end hunger and the Paris Agreement on climate change.
Roughly 35 per cent of our calories should come from whole grains, while our intake of legumes, nuts, vegetables and fruit should double, the commission advised in its report.
The diet follows similar principles of the Mediterranean and Okinawa diets, the researchers wrote.
"The world’s diet must change dramatically," said Dr Walter Willett from Harvard University, who co-led the commission - a collaboration of 37 experts in health, nutrition, environmental sustainability, food systems, economics and politics from 16 countries including Australia.
The benefits of increased food production in the past 50 years are now being offset by the global shifts towards unhealthy diets, high in calories, sugars and animal-based foods, the commission authors said.
The world's meat production is on an unstoppable trajectory and is the single greatest contributor to climate change, the accompanying comment piece said.
The world’s population will be 9.8 billion by 2050 and increasingly wealthy with an appetite for animal-based foods.
The commission argued that feeding us all will be impossible without fundamentally transforming current eating habits, improving the way we produce food and reducing waste.
"The human cost of our faulty food systems is that almost 1 billion people are hungry, and almost 2 billion people are eating too much of the wrong food," the commission wrote.
The authors made a suite of recommendations to shift the way we produce food and eat so as to stay within the planet's "safe" boundaries and to avoid potential ecological catastrophe from climate change and the destruction of biodiversity, land and fresh water, as well as nitrogen and phosphorus flows.
Co-author of the commission’s report Tim Lang, from the University of London, said the food we eat and how we produce it determines the health of people and the planet.
"We are currently getting this seriously wrong," he said.
Adopting the "planetary health diet" would improve nutrient and micronutrient intake, and could avert 10.9 million to 11.6 million premature deaths a year, according to the commission’s modelling.

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Responses

https://www.efanews.eu/item/6053-the-eat-lancet-commission-s-controversial-campaign.html

The EAT-Lancet Commission's controversial campaign

A global powerful action against meat?

The kick-off meeting will held on January 17th in Oslo
EAT is a global, non-profit startup dedicated to transforming our global food system through sound science, impatient disruption and novel partnerships. According to the website, "the EAT-Lancet Commission on Food, Planet, Health brings together more than 30 world-leading scientists from across the globe to reach a scientific consensus that defines a healthy and sustainable diet".
But the campaign, that will be launched in Oslo on January 17th, sounds like a powerful push to shift global diets by discouraging animal products. It is fuelled by large budgets and will be mediatised for a long time to come, scheduling more than 30 events around the world. But a closer look into its background reveals some perturbing elements. The danger is that the overstatement of certain concerns will result in an anti-livestock narrative, create a false impression of scientific consensus, and do more harm than good in a world in need of nutrient-rich meals and sustainable food systems.
EFA News has received this text which we gladly publish to encourage public debate. These crucial issues, in our humble opinion, should be the responsibility of public authorities, rather than private associations that inevitably act as pressure groups.
By Frédéric Leroy, Martin Cohen
Will 2019 be remembered as the year of the EAT-Lancet intervention, arguing for a planetary shift to a so-called “plant-based” diet? Isn’t it remarkable how meat, symbolizing health and vitality since millennia, is now often depicted as detrimental to our bodies, the animals, and the planet? Why exactly is the minoritarian discourse of vegetarianism and veganism currently all over the media? This widespread representation of meat as intrinsically harmful is worrying, to the point that some academics, health professionals, and expert committees are now expressing concern that it will add to malnutrition in wealthy countries, and sometimes even act as a cover or trigger for disordered eating. As a rising societal trend, “plant-based” lifestyles have of course a complex raison d’être and display heterogeneity among their mostly well-intentioned adherents. Nonetheless, the main discourses look remarkably script-based and some of the soundbites are coming from well-respected actors.
Take Christiana Figueres, former Executive Secretary of the United Nations’ Framework Convention on Climate Change (UNFCCC). She has compared meat eaters to smokers - who likewise were once role models but later became pariahs - and believes that they should be having their meal outside of the restaurant. Or Harvard's professor Walter Willett, who has claimed that one on three early deaths could be saved if we all gave up meat, and Oxford's vegan researcher Marco Springmann who has called for a meat tax to prevent over “220,000 deaths” and save billions in healthcare costs.
Remarkable statements, all the more when coming from prestigious universities, as such calculations are based on weak and confounded epidemiological associations that do not allow for causal claims. Furthermore, they ignore the need for risk assessment and disregard inconvenient data, such as the lack of harmful effects on markers for cardiovascular risk and inflammation during intervention studies. The nutritional robustness of animal products is persistently undervalued, especially for the young and elderly, and the same is true for the ecological advantages of well-managed livestock. Comparable “meat-is-bad” narratives are spread by authorities as the World Wide Fund for Nature (WWF) and the World Health Organisation. An editorial in The Lancet32971-4/fulltext) (“We need to talk about meat”) centred on the advice that meat eating should be reduced to… “very little” and concluded with a cryptical message: “The conversation has to start soon”. But hold on, is it a conversation or a lecture?
EAT-Lancet: new kid on the block with all the latest gear
To be able to answer this question, one needs to find out where the action is. All of the scientists and organisations mentioned in the previous paragraph have a common background: they belong to the EAT-Lancet Commission (with the exception of Figueres who will nonetheless be a speaker at their upcoming Stockholm 2019 Food Forum). What exactly is EAT, now incontournable in food policy debates? Its origin is surprising: it was founded in 2013 by Gunhild Stordalen, an animal right activist for the Norwegian Animal Welfare Alliance and wife of hotel tycoon Petter Stordalen. The couple is among Europe’s richest and - according to an article in Forbes - displays a particularly lavish lifestyle despite its image of green avengers.
The Stordalens have both the means and networks to put their ideas into action, as their contacts include CEOs, politicians, and royalties. And if budgets allow it, influence can be purchased: 3.5 million NOK was paid to Bill Clinton - who went vegan in 2010 - for a one-hour speech at an EAT conference in 2014. Another scheduled speaker, at the Stockholm 2019 Food Forum, is Khaled bin Alwaleed. Khaled is a Saudi Prince who sees dairy as “the root of all environmental evil” and is on a “mission to veganize the Middle East”. The portfolio of investments of this powerful ally includes companies that develop… fake meat and dairy. Such as the Beyond Burger, which Gunhild happily endorses on social media. When talking about vegan junk food, the otherwise primordial issue of healthy diets suddenly seems to matter a lot less? After the 2018 Nexus Global Summit, held at the Headquarters of the United Nations in New York, Khaled posted a photo of himself alongside self-proclaimed “vegan political leaders”. Proudly posing among them: Gunhild Stordalen. The meeting’s aim was to “expedite the transition”, now that a tipping point is within reach, and make it permanent, instead of just a passing trend. Khaled also serves on the Advisory Council of the Good Food Institute, among “scientists, entrepreneurs, lawyers, and lobbyists, all of whom are laser focused on using markets and food technology to transform our food system […] toward clean meat and plant-based alternatives.”
The road to a plant-based future is paved with good intentions… and business calculations
This is the point where “Big Ag” steps in, having discovered that the “plant-based” lifestyle market generates large profit margins, adding value through the ultra-processing of cheap materials (e.g., protein extracts, starches, and oils). The world’s leading food multinationals are related to the EAT network via FReSH, a bridge to the World Business Council for Sustainable Development (WBCSD). The WBCSD is a CEO-led organization of over 200 international companies. Unilever, for instance, offers nearly 700 vegan products in Europe and has now also acquired the Dutch Vegetarian Butcher. The latter’s marketing activities, by the way, have been designed by a key politician of the Dutch Party for the Animals and a Seventh-day Adventist.
WBCSD’s origins go back to the Rio Earth Summit of 1992, where it was created by the industrialists Stephan Schmidheiny and Maurice Strong, the controversial architect of global climate policy. Strong was both a top diplomate for the United Nations and a businessman, for instance as president of Petro-Canada. As a strange hybrid product of the oil industry and environmentalism, he fostered some outspoken ideas (not to mention the bizarre esotericbeliefs of his wife and friends, with whom he supported the Lindisfarne group). Strong’s desire was to strengthen the grip of the UN on global affairs and to accommodate crisis-ridden capitalisms, with environmental alarm being ideal to set the machine in motion. Starting with the Stockholm Conference in 1972, he managed to establish sustainability as part of an international development agenda and became a key member of a long list of organisations, of which many now constitute… the EAT-Lancet constellation. Except for the WBCSD, Strong was instrumental in the development of the World Resources Institute (a close partner of EAT, see below) and the Stockholm Environment Institute and Beijer Institute (now both incorporated in EAT’s co-founder, the Stockholm Resilience Centre). In this shared ecosystem, we also encounter the World Economic Forum, the World Bank, the International Institute for Sustainable Development, the International Institute for Applied Systems Analysis, the WWF, etc. Strong stepped down in 2005 after he was mentioned in the Oil-for-Food scandal, but his legacy lives on.
In addition to its alliance with WBCSD and FReSH, EAT is closely working together with another food campaigning group called the Barilla Centre for Food and Nutrition (BCFN). Both Gunhild Stordalen and Walter Willett have been keynote speakers at its International Forum on Food and Nutrition. BCFN defines itself as an “independent think tank”, even if the owners of the pasta giant Barilla are on its board of directors. The authors of a study promoting BCFN’s double food pyramid have declared that they acted “in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest”. The model discourages the eating of meat and recommends… cereals. The more critical issue here is how something that resembles a marketing tool can end up as a scientific instrument for global policy development? And become part of a Memorandum of Understanding with the Italian Ministry for Education, to be presented as an “educative project” targeting primary schools?
“Social engineering” via the Shift Wheel, or: how to direct the public toward fake meat?
Taken together, EAT seems to have all it takes to implement its global agenda. In January 2018, a multi-stakeholder event was organised in Davos, to “improve synergies and accelerate progress” of food system change. In 2013, Stordalen had already contacted the Stockholm Resilience Centre with the demand to create a “Davos for food”. Co-organizers of the event included the Global Alliance for Improved Nutrition, the inevitable BCFN, and the International Food Policy Research Institute. The strategy was clear: market forces have to be shaped, consumers redirected. This is a task taken up by the Food and Land Use Coalition, an umbrella organisation where the broader strategic lines are divided between EAT, WBCSD, GAIN, IIASA, and a crucial EAT partner: the World Resources Institute. The WRI is funded by several governments, companies, and foundations (e.g., Ford, Rockefeller, Open Society, Bill & Melinda Gates, Shell), aiming to interfere in society at large. Particularly intriguing is its focus on something called the Shift Wheel in one of its working papers, as “a new framework based on proven private sector marketing tactics”. Some suggested options are to “disguise the change”, open up “new markets”, and make meat “socially unacceptable”. Potential interventions are familiar (in order of increasing compulsion): influencing nutritional labelling and dietary guidelines, 30-day diet challenges, taxing meat, and… removing meat from restaurant menus.
At first, the EAT-Lancet agenda seems to be a noble, academic endeavour. On second sight, however, it shapeshifts into a more ambiguous mix of honest scientists and researchers with an agenda, and of philanthropic ideologists and various vested interests. Moreover, the fact that the entire cluster is reassembling the remnants that were once developed by a Machiavellian oil businessman do not inspire confidence. Be that as it may, the pervasive influence of various industry platforms and Foundations, that have been funding this constellation over the years, have been criticised for directing policies toward quick-win methods. As such, they are pushing the system toward “market-based and techno-fix solutions to complex global problems”. Bill Gates-backed biotechnology efforts to produce fake meat and lab meat are telling examples.
Conclusion: what’s really going on?
The initial effect of the EAT-Lancet campaign seems to be not so much to promote animal welfare as to open up for “Big Ag” lucrative new markets and feed the hunger of governments for new tax bases. What start as academic and scientific debates become political arguments that are dangerously simplistic and may have several detrimental consequences for both healthand the environment. Of course, climate change is real and does require our attention. And, yes, livestock should be optimized but also be used as part of the solution to make our environments and food systems more sustainable and our populations healthier. But instead of undermining the foundations of our diets and the livelihoods of many, we should be tackling rather than ignoring the root causes, in particular hyperconsumerism. What we should avoid is losing ourselves in slogans, nutritional scientism, and distorted worldviews.
Frédéric Leroy, Martin Cohen
Frédéric Leroy (B) (@fleroy1974) is a professor of food science and technology, investigating the scientific and societal aspects of animal food products, writing in individual capacity.
Martin Cohen (UK) (@docmartincohen) is a social scientist whose latest book “I Think Therefore I Eat” (2018) takes a philosophical and sociological look at food science and argues for a more holistic approach to food and health debates.

https://www.scribd.com/document/397606855/Two-pager-Scientific-Evidence-on-Red-Meat-and-Health
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http://www.zoeharcombe.com/2019/01/the-eat-lancet-diet-is-nutritionally-deficient/
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copy and paste the code into your scripting pane
use control + enter to move through it line by line
report any bugs or questions in the comments:

# lesson 9: Analyzing an historical experiment. # for this, we need a new package: install.packages("MASS") library(MASS) library(psych) library(ggplot2) data("anorexia") anorexia # these data are from: # Hand, D. J., Daly, F., McConway, K., Lunn, D. and Ostrowski, E. eds (1993) # A Handbook of Small Data Sets. Chapman & Hall, Data set 285 (p. 229) ?anorexia describe(anorexia) # we have 72 participants and three treatment groups # let's see the balance of the treatment groups anorexia %>% group_by(Treat) %>% count() # okay, so 26 pts had the control group, 29 had cognitive bx thx, and 17 had # family thx. Cool. # note that simply pushing the data through that pipeline doesn't # change the original data set--it does its manipulations then disappears anorexia # the original data are unchanged unless we *ask* them to change. # the goal here is to see which therapeutic paradigm had the best impact # on post-weight of anorexic patients. # there are a few ways to analyze this. My instinct is always to # go straight to regression. What would that look like? model1<-lm(Postwt ~ Prewt + Treat, data = anorexia) summary(model1) # this is kind of annoying, though, because R auto-generates factors # into dummy variables, and it's decided that CBT is my control group. # just because it's alphabetically first. # we can make our own dummies: anorexia <- anorexia %>% mutate(control = if_else(Treat == "Cont", 1, 0 )) %>% mutate(cogbxthx = if_else(Treat == "CBT", 1, 0 )) %>% mutate(familythx = if_else(Treat == "FT", 1, 0 )) # stop and look. # 1) this time the underlying data-frame IS changed, because I asked it to. # 2) stop and take note how mutate works with if_else # if the condition fits the logical test, a 1 is given, otherwise, a 0 # this is perfect for assigning dummy variables. # let's regress again model2 <-lm(Postwt ~ Prewt + cogbxthx + familythx, data = anorexia) summary(model2) # now we are seeing the real changes of our treatments over the control. # we can graph it as such: anorexia %>% ggplot(aes(y = Postwt, x = Prewt, color = Treat)) + geom_point() + geom_smooth(method = "lm") + geom_abline(slope=1, intercept=0) # note that I've added a line from 0 with a slope of 1 # when the x and y axis are on the same scale, I like to do this to show # what a point experiencing no change looks like. # that way it helps visualize *how well* the two treatment conditions did. # my money is on family therapy, personally. # let's beautify this plot install.packages("ggthemes") library(ggthemes) anorexia %>% ggplot(aes(y = Postwt, x = Prewt, color = Treat)) + geom_point() + geom_smooth(method = "lm") + geom_abline(slope=1, intercept=0) + labs( title = "Pre- and Post- Weight for Patients with AN", subtitle = "Based on therapeutic paradigm", x = "Pre-weight", y = "Post-weight", color = "Treatment Paradigm", caption = "Data from Hand, D. J., Daly, F., McConway, K., Lunn, D. and Ostrowski, E. eds (1993)" ) + theme_fivethirtyeight() + scale_color_fivethirtyeight() # However, this plot isn't *great* because we are really thinking # of a pre- and post- condition and a scatterplot doesn't do well for that. # what we want is to think about change in weight relative to tx condition # so let's make a percent change variable. anorexia <- anorexia %>% mutate(pct_change = Postwt / Prewt) anorexia %>% ggplot(aes(y = pct_change, x = Treat, color = Treat)) + geom_boxplot() + geom_jitter(alpha = 0.7, width = 0.2)+ labs( title = "Pre- and Post- Weight for Patients with AN", subtitle = "Based on therapeutic paradigm", x = "Pre-weight", y = "Post-weight", color = "Treatment Paradigm", caption = "Data from Hand, D. J., Daly, F., McConway, K., Lunn, D. and Ostrowski, E. eds (1993)" ) + theme_fivethirtyeight() + scale_color_fivethirtyeight() # this just *feels* better and it makes it clear that if you wanna # put back on the lbs, do family therapy instead of CBT. 

I'm a 31 year old male, about 6'1", and 247 lbs. I don't smoke, drink alcohol, drink caffeine, use any illegal drugs, or use supplements other than fish oil. Previous medical issues: Obsessive Compulsive Disorder (OCD) (severe throughout childhood), obesity, bipolar 2 (became bipolar 1 over a year ago). Current medical issues: OCD (has almost entirely disappeared, but it shows up from time to time), Major Depressive Disorder (since childhood), ADHD, bipolar 1. The above were all professionally diagnosed. According to a support group I'm going to, although I didn't realize it at the time, in my 20s I probably also had body dysmorphia and an eating disorder that sounded a lot like anorexia (at least according to the women in the group that had dealt with eating disorders). Medications: I take 600 mg Lithium (i.e. Lithium carbonate) at night, 450 mg Lithium in the morning, and every third day and take an addition 150 mg Lithium in the morning. My blood Lithium levels are currently 0.3 mEq/L. I also take Adderall as needed. I'm prescribed 40 mg of extended release Adderall in the morning and 20 mg of instant release Adderall at noon (to alleviate some of the powerful drowsiness that regularly occurs during certain times of the day). I don't miss dosages.
I'm here because I very strongly suspect that eating Sodium induces rapid cycling mania in me and I don't know to remedy this. Even if you don't know how to remedy this, just giving me ideas of things that I could keep track of in a journal to potentially help me determine how to remedy this would be appreciated. I told my psychiatrist about this issue and all that she said was that I should eat 2 g of Sodium a day, which is just the recommended daily Sodium intake so this must presumably be a nutritional issue and not a psychiatric issue.
TL;DR: Except for being a little hungry, I feel 100% mentally normal after I eat very little of anything for a few days, especially when I minimize my Sodium. But I need to eat Sodium since it's an essential nutrient and since it'll help prevent Lithium induced diabetes insipidus in me in the long run. Sodium induces rapid cycling mania in me. How should I eat Sodium (e.g. when, alone or together with something or after eating something? etc.)
Background: My bipolar 1 disorder consists of a never ending (i.e. chronic) mixed episode, which means that I experience mania and depression at the same time. My mania is also ultra-ultra rapid cycling (i.e. before I was on Lithium, in terms of intensity of mania vs. time, the graph would be some kind of Fourier series where you add different sine waves together, although it would never goes anywhere near 0. It fluctuates a lot in intensity. Sometimes even fluctuating within seconds).
Additional medication details: Back when I was taking 900 mg Lithium a day (300 mg in the morning and 600 mg at night) this level was also measured at 0.3 mEq/L but I was experiencing mania (e.g. awake, fast and pressured thoughts, walking aimlessly around stressed while talking to myself) while at 1200 mg per day (600 mg in the morning and 600 mg at night) this level was 0.4 mEq/L and I was suffering some effects of Lithium toxicity (emotions went away, severe drowsiness, mental dulling). The point is that I'm extremely sensitive to Lithium but if I keep my Lithium levels just right then I will feel normal (i.e. how I felt before the mania). The Lithium even treats my depression so it's almost the perfect medication for my bipolar disorder.
This has always been consistent so in short, too little Lithium ==> mania too much Lithium ==> drowsiness and mental dullness. I eventually noticed that I'd become more manic shortly after eating a certain well-known brand of frozen pizza. I tested this out on their pizzas a few times (being sure not to eat anything else prior to eating the pizza) and sure enough, each time the mania came around 10-20 minutes after eating the pizza. I figured that it must have been one of those chemicals that's allowed by the FDA but banned by the EU so I started avoiding this pizza and other highly processed foods, which helped with my mania. In retrospect it may have been the Sodium in the pizza that increased my mania.
I then noticed that my mania would increase about 10 - 30 minutes after drinking caffeine so I wondered if caffeine somehow messed with my Lithium levels. As it turns out it turns out, caffeine reduces the absorption of Lithium into the blood stream. I've stopped drinking all caffeine and I have had significantly less problems with my mania ever since.
But I noticed that I would frequently become manic after having some meals (despite 90% of my diet being fruits and vegetables, and the rest being simple organic foods like bread, cheese, meat, and yogurt). After eating some foods and seeing what made me manic and what didn't, I eventually concluded that large sudden increases in sodium induce a kind of "pulse" in ultradian rapid cycling mania in me. For instance, eating 9 slices of Salami with about 900 mg of Sodium induced mania in me after about 10-20 minutes. The induced mania came on so strongly and suddenly that I had to stop myself from falling because of the dizziness, which was new, since dizziness had never been a part of my mania. It went like this: I had a gradual increase in energy until sometime around 10-20 later I was hypomanic and then manic for a very short time (maybe about 10-30 seconds). Then I would become drowsy and mentally dull for something like 30 to 50 seconds, and then I'd be manic again though to a lesser intensity than before but for a longer time (about 40 to 60 seconds), and then I'd be drowsy and mentally dull again but to a lesser extent than before and this lasted for a longer time, and so forth until it eventually dies down a lot the next day and completely 2 days after the 9 slices of Salami. This isn't a one time thing.
So the answer seems simple. Just keep my Sodium intake more or less constant throughout the day. If I'm on a low sodium diet then this works great! After a few days I start to feel normal again (i.e. as I felt before I was bipolar). But Sodium is an essential nutrient and being on Lithium while having low Sodium levels is know to greatly increase the likelihood of developing Diabetes insipidus. So it seems that I should keep my Sodium intake more or less constant throughout the day in a way so that at the end of the day they end up being around 2000 mg (the recommended intake of Sodium). But when I do that then I can still feel the mania fluctuating "just below the surface", where it every day will push the surface up while other times pulling it down so that I frequently become very tired or somewhat manic.
Something also happens to me when I don't eat enough Potassium for a few days and then drink coconut water (containing about a third of my recommended daily intake in Potassium). About 5-10 after drinking it, I felt like I had taken 60 mg of Adderall but without the focus. For 6 hours or so I wanted nothing more than to climb a mountain. It basically got me to a near hypomanic state (sometimes reaching hypomania, which is when it starts to feel uncomfortable). This Potassium induced hypomania is not rapid cycling. This Potassium effect is significantly less pronounced when I've had adequate Potassium the previous day. I personally enjoy it but is experiencing this Potassium induced hypomania healthy for me in the long run?
Now I know that I'm not the only person in whom Sodium induces ultradian rapid cycling mania since I met another bipolar guy at my support group (who coincidentally also had OCD, although a different variant than my own) who said that he noticed that taking in a lot of Sodium after being on a low Sodium diet also induced ultradian rapid cycling mania in him. He didn't say anything about Potassium though, he also wasn't on Lithium, and his mania was neither mixed nor non-stop like mine. Now the fact that I met another bipolar person with this same Sodium issues means that my problem is probably already known by some doctor or written about in some journal, in which case they might have advice that could help me. I don't know where to find this advice and since there's no AskPsyichiatry, I thought I'd start here.
Also, every single day at some point around noon - 5 p.m., I become very tired and mentally dull, as if I'm getting too much Lithium despite taking Lithium in the morning. Afterward a certain amount of time (or if I take a nap), I get back my energy. When I do sleep then I notice that my body starts to tingle all over and my muscles sometimes jerk uncontrollably (which doesn't happen while I'm awake, but does happen for a few minutes shortly after I take my 600 mg of Lithium Carbonate at night) and also my toes sometimes become numb (which, happens shortly after taking Lithium in the morning or at night and only lasts for a few minutes). So I suspect that my Lithium levels are somehow changing but I don't know how. When I'm near-hypomanic on Potassium then I don't feel like I'm on the verge of falling asleep, I'm merely a little tired. I have to find any obvious correlation between when I take my morning Lithium and when the mid-day drowsiness hits.

[IPWW] Introduction to this Post: Why and What

Inspiration for this post was the corn bowl post, which is truly a hidden gem on this subreddit that everyone should strive to emulate and make their own unique version of. :) Be sure to write your answer to the prompt along so you don't miss anything! Maybe even make an image post or flowchart to make it more unique, or even a map of the most famous locations for dining?
Everyone has to eat food, barring species that get their energy from other ways. Culinary habits aren't just eating food, though, but the culture around it: preparation, eating, and afterwards. Of course, if you don't eat food, you could still have some of these rituals or cultural aspects about whatever you do instead. Maybe there's a "dining etiquette" to absorbing sunlight together? Do you invite a buddy out to recharge your batteries at that new hip club maybe?
This is meant to be the one prompt to end them all when it comes to food prompts, and is honestly also half-resource and all a hyperadvanced shitpost that's too on-topic and has enough content to not really be bannable (or at the least, will be a legendary post for /worldjerking later). It also has a drug and alcohol section, because we all need to be asked about our drugs and alcohol weekly, you know? That wasn't part of the prompt, that was a rhetorical question. Don't answer that part.
But still, writing about food can be a rewarding exercise. Warhammer 40k does it, even, and it's one of the edgiest things out there. You wouldn't expect it to fluff down to food, but it does, and the world greatly benefits from that... I think. Maybe. In any case, it's good for your writing skills if not the world. This is me breaking out of my ironic layer that the rest of this post is written in: it is very difficult to write the sensation of taste, mostly due to the fact that humans cannot in fact taste words. But if you can do that, you've got some serious writing or art skills. I would full-heartedly recommend learning to communicate the sense of taste in your writing, as it makes your work much more memorable by being able to engage the reader better. Now back to irony! :D
These things are overlooked in worldbuilding mostly, and probably for good reason if I'm being completely honest. But screw practicality, today Eliza is going to take you through the magical real and definitely important world of cultural attitudes to food and ask you some random questions about your world's food. Remember, please answer as many as possible! This is a prompt after all, :) Bolded questions are what I want answered about your world, specifically, but this is a relatively freeform prompt. Answer the questions in whatever order you want, I know I didn't write them in the order they ended up in. I don't know who put them in this order. I certainly didn't, that's for sure. I added sentences randomly.

[TTOC] The Table of Contents

This table of contents will list the name of the section, then a tag you can search on your browser to jump to it instantly. It'll also list a short recap of the section so you can know if you want to read it or skip it, as this prompt is long. It's so long it even has an entire table of contents about it.

• Introduction to this Post: Why and What: [IPWW] The introduction to this post, with an explanation of why it was made and what it's about
• The Table of Contents: [TTOC] You're here!
• The Philosophy of Food: Values: [TPFV] The philosophy behind food and diet
• Selection of Food and basic Preparation Method: [SFPM] Selecting dietary options and some other details.
• Preparation for Eating: Cooking & Cultural: [PECC]: Selecting how to prepare food, and prepare to eat
• The Procedure of Eating Itself, plus Etiquette: [PEIE] Etiquette for eating, and how your species actually eats
• Aftermath: Cleaning, Etiquette and other Stuff: [ACES] What happens after eating, cleaning, etc
• Drinks or Drugs: the Other Food: [DDOF] What about the stuff that goes alongside the food
• Across Social Strata & Cultures: [ASSC] What about rich or poor people, what do they do
• In Conclusion: Your Response?: [ICYR] Are you going to respond to this prompt and how you should
• Links, Resources, Citations & Such: [LRCS] Every link in this in a single index making it easier to click them.

[TPFV] The Philosophy of Food: Values

One thing that a lot of people fail to consider is what people actually value in food. There's three main things that I find as a general metric, that I read on an article once and never found it again to be honest:

• Quality: how good the food is; its ingredients, nutrition, taste, and method of preparation.
• Portion size: how much you get of the food, whether it be from a "gourmet" size or up to a buffet.
• Cost: how much the meal costs, whether in time, effort, or currency.

The article had concluded that this can be drawn as a triangle, where you can only optimize for 2 at a time at most. Americans mostly prefer portion size and cost, Japanese quality and cost, so on and so forth. The article wasn't very scientific, so I don't care too much to find it to link it for you all to see. Maybe someone can find it for me? But the philosophy of diet is important for your culture in a fictional world, as it lets you tell a lot about them through minor elements like what food is advertised or the protagonists eat.
The philosophy of food is a major study, with entire books and projects devoted to analyzing it. You should at least crib somewhat from the field if you're going to write about food, to make it more useful to your world's theme. One great quote from this work is:

But perhaps the real reason why relatively few philosophers analyze food is because it’s too difficult. Food is vexing. It is not even clear what it is. It belongs simultaneously to the worlds of economics, ecology, and culture. It involves vegetables, chemists, and wholesalers; livestock, refrigerators, and cooks; fertilizer, fish, and grocers. The subject quickly becomes tied up in countless empirical and practical matters that frustrate attempts to think about its essential properties. It is very difficult to disentangle food from its web of production, distribution, and consumption. Or when it is considered in its various use and meaning contexts, it is too often stripped of its unique food qualities and instead seen as, for example, any contextualized object, social good, or part of nature. It is much easier to treat food as a mere case study of applied ethics than to analyze it as something that poses unique philosophical challenges.

Therefore, you should try to analyze food at least somewhat in your world, as it is a good way of quickly recapping your entire world's economics, ecology, culture, and philosophy. Do you agree with this statement or not, and why? Personally, I disagree with it on the grounds that this was written as a shitpost and the author does not have your best intentions in mind in the slightest. But that's your decision to make, and that's the beauty of having an independent mind, isn't it? :) In any case, I've devoted myself to writing this prompt, so time to continue!
The food pyramid is heavily promoted as a "healthy diet", or should I say was. Now it's been replaced with the newer edition. This shows that values and interpretations can be shifted over time according to new evidence and cultural attitudes. What are your society's beliefs on diet and nutrition? What do they value in a meal above other things? Nutrition is a very important thing as well. If you want to go full nerd, you could try to determine what nutrients your species would need if you want to go all out, or you could just crib some easy ones. Nutrition's really hard though, there's even classes about it.
Food is very important on a trade level, the Columbian Exchange a very obvious example that most people forget about. Has food related trade ever had such an impact in your world?

[SFPM] Selection of Food & Preparation Method

We're going to go about this primarily chronologically, so the first step we'll cover is selection of food and preparation method. This happens before even preparing the food. So the first most obvious part to this is geographical and resource concerns: you can't make a tradition of eating raspberries in the Philippines before shipping food. Similarly, you can't eat potatoes if you're Irish before the introduction of potatoes into Ireland. So, this influences selection of food quite a lot. Modern culinary styles will be more likely to use imported foods, with traditional culinary styles using local foods. So, what are your culinary styles? How do they conflict? What foods do you use? Remember that grains and plants available will vary; bread is more common in America.
Another issue is your species's ecological role, or even your specific race's genes. Deer eating meat happens sometimes, but is still a rarity for this very reason, and could be so in your world. Asian countries have much more lactose intolerance due to the way their specific ancestors developed, for instance, thus the lack of milk and cheese in Asian cuisine. These aren't necessarily limiting; if you're a panda, your tradition of eating bamboo might fuck you over, but you can still try. What're your races like when it comes to this? Do they work with or against their bodies? I won't cover specific macronutrients and micronutrients as these vary. What are your species's macronutrient/micronutrient equivalents? If this is too sciencey, you can just kind of handwave most of these as "whatever humans need + this" or "whatever humans need - this", it's a fairly easy formula and still seems realistic. :)
The last main issues while selecting food are religious traditions and regional ones. These aren't always the easiest path, or even have reasons, but might have reasons in history or geography as well. There's lots of religious reasons for many kosher bans, and some people believe the religious bans for pork are due to high rates of parasitism in pork in the region. ^{Note: I do not endorse this source. The fact that someone wrote it shows that someone believes it, and there's not much professional writing on that subject that I can find.} Do your cultures believe in any specific foods being bad or good to eat? Why or why not?
Finally on picking food, some of the minor issues; sometimes you have storage issues or other reasons like nomadism. I won't follow too much more on this, as this varies a lot over regions. So, you've selected your food! Now how are you going to cook it? Similar reasons apply as above apply in all cases: if you can't refrigerate it, gelatin is out of the question and might become a big thing later on for instance. Are there any foods that couldn't be made before but are now a huge deal, or ones that aren't important anymore?
So now that you know what food you're getting... how do you get it? Do you grow it, buy it? Do you store it yourself in a fridge or such? In more antiquated settings, you generally have to grow it or buy it at a market. In more modern places, we have restaurants, grocery stores, and personal gardens instead of outright farms or community gardens.
Also, on geographical concerns... don't forget about wildlife and pests! Deer are only really eaten in countries with deer, for obvious reasons. I won't go too far into detail on this, but also watch where your winds and temperatures are and how mountainous your land is, as that determines what will grow there and what animals will live there. Do you have any interesting fictional plants or animals used as ingredients in cooking, maybe? What about alien fungi?

[PECC] Preparation for Eating: Cooking & Cultural

Now you've got all of that selected. Thank god, now we can move into actually preparing the food... and the people eating. Yeah, you thought you just cook the food and eat it, right? What about setting the table? There are plenty of other things to consider than just how you cook the food! In Japan, the tea table is set up in a specific way, for instance. Do you have any traditional styles in your world for setting the table? Maybe any that vary? Maybe they represent something cool, it'd be neat if one matched the moon cycle or you had a different one for every day.
Do you need invites to eat with someone, or do you just come over? Eating is a very social activity in real life, but in your world it may vary, and it does across cultures in real life. This might've been due to the way your society functions, like how wolf packs all eat a kill together but tigers eat alone. Are dinner parties a big thing, or are restaurants more of a thing? Maybe you have restaurant analogues or such. I'd imagine restaurants for aliens would be pretty different. In some cultures, you share food, in others that's reserved for closer relationships. In America for instance it is okay to share appetizers but usually not entrees, or at least in my experience it is that way.
Most of the cooking methods will depend on the ingredients your people have, but also on their scientific knowledge and cultural traditions as described above, which might not even have purposes beyond some peculiar habit that picked up. These can be religious, cultural, traditional, environmental... the world's your oyster, but if you can it is best to try it and see if it'd be stupid.
In addition, a lot of traditional cooking equipment might not exist if your world never developed it. Are there alternatives to it, or do they just do without? Do only some people use specific types of cooking equipment? Most people in real life don't use butter churns anymore, and most people don't seem to have a food processor. Heck, what separates a chef from a regular person who knows how to cook? Training is one thing, but what about equipment? Do they get staff or assistants?
And don't forget: if your world has magic or technology that doesn't exist here, how would those fare in the kitchen? Magicians could be famous chefs, if they specialize in culinary arts. Or maybe magic makes food gross, or can't work with duplicating food for specific reasons like in Harry Potter. Heck, maybe you have molecular level gastronomy in your world. How does that taste, why's it worth using? Maybe you have LITERAL superfoods! Magical or scientifically altered foods that make you special temporary... or maybe just regular "lots of nutrient" foods. Any superfoods, whether ordinary or extraordinary?
And remember, not every species has to be able to taste the same things. Do any of your species have interesting taste senses? Maybe they can taste the color of the food, or electromagnetism? Humans are typically limited to umami, savoriness, sourness, sweetness and bitterness. And also spiciness, though that's not directly a flavor on its own. Some chemicals also alter our mouth like spiciness does, like menthol giving it a neat numbing sensation. Are there any exotic effects like that put in your culture's food?
So now, you need to select where to eat, if you know what you want and how you want it prepared. So, where do you go to eat? Throwing dinner parties is kind of rare in the West nowadays, as far as I know, but are a big cultural thing for those who do. Restaurants are a big option in a lot of countries, and fast food is an ever-growing industry due to work hours and economic concerns.

[PEIE] The Procedure of Eating Itself, plus Etiquette

So, we're on the last step now. You and your guests are at whatever place you want to eat at. You've got the table-analogue set up, you've got your food-analogue ready. But... how do you consume it? Lots of countries have different etiquette rules. And this is completely ignoring that your species might not eat like normal people, which is definitely worth considering if you consider nothing else from this prompt at all.
Does your species eat food normally, or in a unique way? Do they photosynthesize, or suck up plankton? Maybe they eat normally, except they have three hands and have specific rules about what those hands can do at the dinner table to avoid getting them mixed up? There are lots of things that biology could determine about the way your species goes about eating. This goes hand in hand with the previous sections' guide about selecting cooking methods, foods and locations and if you were making a species with a unique way of eating you should've already considered these from there. If not, go back to start of this prompt. :)
Is magic allowed at the table, or computing devices, or watching TV? Is conversation allowed, even? In China, it was considered rude to spoil a meal by talking during it. What all is acceptable in your world at the dinner table? Can you put your elbows on it? It's important to note a lot of this is based on historical things; it's theorized that the reason you weren't supposed to put your elbows on the table was to avoid breaking it... or it might just be to avoid inconveniencing the other people eating! :)
Sometimes, showing you like the food is important by making noises while you eat, sometimes it's considered gross. What's it like in your world? Are there any ways to show respect to the cook? Is it acceptable to show you disliked the food? Does the waiter position exist, and is it important to be polite to them?
Heck, sometimes there's just weird rules. Are you allowed to wipe your mouth with a napkin? Pick your teeth with a knife, or do you have little wooden sticks for that? What utensils does your species even use during the meal, what medium of storage for the food while you eat it? Communal style dishes or one each? Separate dishes for separate foods? Any specific manners? Etiquette is very complicated, there's even classes about it. Heck, how important even are manners to your culture? Some cultures don't particularly care about it, like America is very lax while Japan is very strict. This depends a lot on various factors, but you can kind of stereotype it as how important authority is, as it's a good quick way to get that information across in writing.
What about culturally important activities like feasts or fasting? Lots of cultures have fasting and feasts to celebrate or venerate specific things. Are there any culturally significant rites to food? In Japan, teatime has outright rituals related to it, where all the steps are very particular. There's even classes about it.
Of course, there is also the fact that you could always be poisoned during the meal. Are there any poisons that might be used if you're a prominent political figure in need of a good dose of death? Some poisons are flavorless, some have smells or are obvious though. What are the symptoms of some common poisons? They could be magical poisons too, of course, which lead to different results altogether. Poisons are a good way to tie food into your story, if you're making one, and get to show off all the things you answered in this prompt. :)

[ACES] Aftermath: Cleaning, Etiquette, and other Stuff

Yes, this is the only one I could get to spell a word :( If you have suggestions please post in the comments

Surprise. We weren't really done. What happens after the meal? Many cultures thank the host afterwards. How do you thank your host? Though, sometimes it's the guests that get thanked for coming... Do you thank your host, or does the host thank you? Or maybe you have a completely different cultural approach to it all, like if you don't eat it's not like the host made food or anything, maybe it's just a simple "bye" after you two photosynthesize together.
Sometimes you have to thank the host afterwards with a note or such. Sometimes, you need to figure out who pays the bill if it's a restaurant-analogue. Maybe you need to decide who cleans the dishes. Do you have anything that has to be cleaned afterwards? Any specific traditions of etiquette like scheduling the next time you eat together?
In restaurant analogues... Do you pay, or are they free? In some cultures, you tip the staff, in some it's considered rude to do so. I could imagine in some places you don't pay at all, like a soup kitchen. Maybe you have to barter for your food, or something, I dunno. Maybe you have traditional alternatives to restaurants, like cafeterias.

[DDOF] Drinks or Drugs: the Other Food

And Condiments and Such but that's not Catchy To Be Quite Honest

Okay, I lied again. This still isn't the last step either. So, what goes alongside your food traditionally? In almost every culture it's traditional to drink something at the same time while you eat, for convenience and to make up for any food that dries out your mouth or is spicy. Honestly we should've thought of this earlier. You might want to go back and redo the other parts of this prompt you responded to after doing this part. Keep that in mind and go over your previous notes while we cover this important step I forgot and am too lazy to merge into the previous sections. ;)
Drinks are also very culturally significant. Most species require water to survive. ^{[citation needed]} Your fictional ones may not, but they might have a water-analogue they need. What does your species absolutely need to drink to survive, or what's their drink-analogue? Sometimes though, we drink other things, like juice or alcohol. Alcohol was mostly for the intoxication effect, but some people believe (and there are some stories supporting it) that it was also drank for its antibacterial effect, though they were not 100% aware of it. Heck, what if your culture never even developed alcohol? It's presumed it was mostly developed on accident by storing grain that went bad.
On alcohol itself... it also has a lot of room for cultural specific aspects. In some cultures, getting drunk is bad, and in others it's okay. Heck, in some ^{mostly parody religions to be quite honest} it's encouraged! Are your religions against drugs or alcohol? Are there bars? Heck, fermenting doesn't have to only be for alcohol. Ever had fermented fish or seal? Probably not, but they're a thing that some cultures have.
There's also plenty of different kinds of alcohol, such as fruity ones versus fermented ones. Remember what I said about genes? There's a difference in drug and alcohol use as well from Asians and other cultures, due to the relative genetic separation and environmental differences. Can some of your races not hold their liquor, a common trope? Or are some better, like dwarves usually are? Are there any culturally specific types of alcohol? And not directly alcohol, but there's milk again which a lot of people are lactose intolerant and can't drink without issues. If you like furries, maybe you could have lactose intolerant cats for a joke? :3
And of course, there's also drugs. Drugs are often associated with eating, presumably because they're both temporary pleasureful things. Smoking sections are required in restaurants as a lot of people smoke while they eat, for instance. Alcohol itself is technically a drug. Marijuana can cause "the munchies". Are there any interesting drugs in your world? Ones associated with food? Ones that provide nutrients, maybe? It'd be a neat social conflict to have an alien race survive entirely off of cocaine, for instance, though it sounds incredibly stupid. Drugs are often associated with food: coca cola and cocaine, are a very famous one. What about the Opium Trade? Tea and opium being traded for each other! What about coffee and its caffeine? It could also be considered a drug.
There's also the fun "drug-like alcohol" tropes, or "drug-like food" where your food directly has a weird effect on your mind. Are there any mind-altering foods, spices, condiments, or beverages in your world? Any good ol' pan-galactic gargleblasters? It might not always make sense, but you could always add a plant that just happens to have an effect like that. Heck, back on the menthol and capsaicin discussion... what about an alcoholic beverage with both? That'd be great.
Finally, there's condiments and spices. These may not sound directly connected to drinks or drugs, but think about it: all of them were historically in great demand to provide extra buzz. The spice trade ring any bells? Spices and condiments are typically the most traded food related things, and are very important to economics. In fact, fish are the main reason waters are considered international ^{though there are others like how France has open beach access as a right for its citizens}.

[ASSC] Across Social Strata & Cultures

Now... you've considered all of that for one group of people. But what kind of group of people was that, the rich, middle class or poor? Rich people usually eat rare and expensive things because they're rare and expensive rather than for taste. Lobster, being common and cheap for a while, used to be fed to prisoners ground up, being considered the spider of the sea. Did anything like that happen in your world? Taste changes among classes?
Rich people are generally always demanding new spices, tastes, exotic foods. They were historically some of the biggest reasons for culinary crossover, and created "high" cuisine, similar to high art in that it's meant to be more than just a flavor exercise. They often employ the best chefs, organic farmers, and other such luxuries. Are there any major culinary styles stereotyped for the rich? What do they value in food? Rich people generally lead the direction of the high cuisines, with middle-class and lower-class people together directing general traditional cuisine.
Middle class people are kind of odd and exist mostly in developed countries in modern times, and can generally be stereotyped as preferring either healthy options or flavorful options. They often lead a majority of the direction of cooking, when they exist. They're very important to write about though, as they're what the majority of people (or at least, should be) are and will be, therefore, the majority of people eating in your world and need to be given the most detail.
Poor people generally eat whatever they can get their hands on. In developed countries, this often results in obesity from eating "junk food". Does your world have junk food, or anything similar? Any specific eating habits for the poor? Soup kitchens and charity are often trying to feed the poor, leading to my next point here...
Are there any eating disorders? These can be kind of triggering for some people to include, and often encourage people with them to relapse so I wouldn't personally recommend having them, but it's a question that you might want to answer. Anorexia, bulimia, some forms of obesity are all pretty important questions to answer after all as they may directly affect the people in your world in a negative way.
What is world hunger like in your world, and the political implications of it? Magic in many cases could completely undo world hunger, but sometimes it can't like in Harry Potter. There are many organizations in real life dedicated to ending world hunger. There's lots of political implications in all of this as well, as obviously hungry nations are less prosperous. Is it due to political reasons, distribution reasons, or does your world not have enough food to support everyone?
Are there any famous dinners in your world? One obvious one is the Red Wedding in Game of Thrones, or the Last Supper in Christian lore. Did anything interesting ever happen at the dinner table, or are there any superstitions about eating? In Harry Potter for instance, when 13 people dine together the first person who gets up is the first to die, which isn't a particularly auspicious omen. ^{Make your own debate over whether that was actually legitimate or not in HP, I don't really care}
What about famous chefs? Everyone knows Gordon Ramsey in real life, is there any famous chef like that in your world? Maybe a Food Channel analogue. Has any chef ever impacted your world's politics or culture?
Finally, sometimes the State itself interferes with food. As mentioned in the first chapter, it used to be recommended to eat amounts from one food pyramid, then another. Agriculture is one of the most subsidized industries in the US at the time of writing ^2017-01-30 and so the State can easily influence a lot of what people eat via tariffs and taxes. Do your governments introduce "junk food" taxes? Do they influence anything else in their citizens' diets? Fascist dystopias enforcing food bans is such a big trope there's even a book about it.
Oh wait, one more thing...** is there anything important about food culturally besides eating it, cooking it, and etc?** There's plenty of examples of comedy about food ^(the mom's spaghetti joke being a big one, for instance) and lack of food causing social changes.

[ICYR] In Conclusion: Your Response?

Also some extra stuff I couldn't fit anywhere else without making a really tiny section that wasn't worth it

So before we get to my conclusion, what about your main characters? If you don't have any, you can ignore this section, but if you do, what's their relationship with food? Do they have any important detail about food? An addiction, a food they hate, a food they associate with something important? Do they even eat, do they wish they could if they can't? These aren't bolded as they don't apply to everyone. Feel free to ignore these, but please answer all the bolded ones if you reply to this prompt. :)
In conclusion, this was a huge waste of time to think about every single detail. But maybe there's something that's worth responding to? I think you should respond to all of this, to be sure. There's lots of useful things to think about, and this can make your world feel much more realistic. You might want to make a flowchart or graph maybe for the chronological portion? You should present it in an interesting way, or at least in paragraphs instead of a wall of text in my opinion.
Inspiration for this post was the corn bowl post, which I found really creative and wanted to make a prompt to inspire more, creative and distinct versions of it. :) I really feel like food can add a lot to a world.
I am really glad if you respond to this prompt and write up an answer to every question I have bolded through here, :)
First ^{not at all} serious prompt post, please be nice. :) I'm considering making prompts on the following next, with the same rigorous quality vetting:

• How your species makes waste (if nay), their bathroom habits and their culture of waste management, as a direct sequel to this prompt perhaps? I'm not sure on it as it might be a bit too gross sounding, but I think it has some important diamonds in the rough that might be useful for worldbuilding...
• How do your people carry out the growing of crops and the ranching, care and treatment livestock, as a direct prequel to this prompt maybe? It's kind of covered a lot more than the food stage is honestly, I don't know if it really needs the treatment and detail this one had.
• A more drink, alcohol, and drug focused prompt, as they were really glossed over in this one sorry guys :( I promise to ^not make a full version devoted entirely to food and drink with the same stringent quality measures as this one.

I might decide to repost this one periodically to see if anyone has changed their outlook on any of this, but I don't want to spam so I might not either. Maybe this can be updated periodically to reflect new developments in food philosophy? Leave your thoughts below please!
Unfortunately, I kind of hit the Reddit character limit, so I couldn't go as far into detail as I wanted. :( I might post more questions and details to this prompt in the comments later, don't worry too much about it!!! I'll be sure to answer any questions you have left over after reading this!! :)

[LRCS] Links, Resources, Citations & Such

This is just a list of all the previous links, in easy clickable format for the lazy: :)

• https://www.reddit.com/worldbuilding/comments/5o0n2o/a_typical_aknut_meal_meyn_earth_equivalent_corn/
• https://www.reddit.com/worldjerking
• http://warhammer40k.wikia.com/wiki/Imperial_Food_and_Drink
• http://www.food.unt.edu/philfood/
• http://foods.weneedfun.com/wp-content/uploads/2016/03/Food-Pyramid-9.jpg
• https://www.disabled-world.com/artman/uploads/newfoodpyramid.jpg
• http://www.publichealthonline.org/nutrition-courses/
• https://en.wikipedia.org/wiki/Columbian_Exchange
• http://www.pepper.ph/fruits-veggies-cant-grow-philippines/
• http://www.news.cornell.edu/stories/2005/06/lactose-intolerance-linked-ancestral-struggles-climate-diseases
• https://www.theguardian.com/science/2015/may/19/hard-to-bear-pandas-poorly-adapted-for-digesting-bamboo-scientists-find
• http://www.biblicalarchaeology.org/daily/ancient-cultures/daily-life-and-practice/making-sense-of-kosher-laws/
• https://en.wikibooks.org/wiki/Hebrew_Roots/Unclean_foods/Diseases
• http://www.smithsonianmag.com/smart-news/people-ate-pork-middle-east-until-1000-bcwhat-changed-180954614/
• http://www.collectorsweekly.com/articles/the-1950s-most-nauseating-jell-o-soaked-recipes/
• http://peopleof.oureverydaylife.com/set-japanese-table-10303.html
• http://www.ehow.com/how_7868596_set-european-table.html
• http://homeguides.sfgate.com/set-table-east-indian-meal-59628.html
• https://www.theatlantic.com/technology/archive/2012/09/the-20-most-significant-inventions-in-the-history-of-food-and-drink/262410/
• http://www.snopes.com/weddings/newlywed/secret.asp
• http://www.etiquettescholar.com/dining_etiquette/international_dining_etiquette.html
• http://traditions.cultural-china.com/en/214Traditions9276.html
• http://www.foodandnutrition.org/Stone-Soup/June-2013/How-to-Be-Polite-When-Eating-at-a-Japanese-Restaurant/
• http://www.itsallaboutetiquette.com/
• http://www.history.com/topics/holidays/ramadan
• http://www.jewfaq.org/holiday5.htm
• http://www.japanesehouse.org/tea-ceremony/learning-tea-ceremony/
• http://www.thank-you-note-samples.com/thank-you-for-dinner.html
• http://www.forbes.com/forbes/welcome/?toURL=http://www.forbes.com/sites/maggiemcgrath/2014/02/28/the-definitive-guide-to-splitting-the-dinner-bill/&refURL=&referrer=
• http://www.bbcamerica.com/anglophenia/2012/08/tipping-in-america-how-to-do-it-and-what-to-expect-if-you-dont
• http://www.news.com.au/travel/travel-advice/where-tipping-is-actually-considered-rude/news-story/e3f4cadc8786137bab0fb995ffa29f5a
• http://www.collective-evolution.com/2013/07/04/a-man-has-not-eaten-or-drank-any-liquids-for-70-years-science-examines-him/
• https://en.wikipedia.org/wiki/Flying_Spaghetti_Monster
• https://www.ncbi.nlm.nih.gov/pubmed/7484321
• https://www.britannica.com/topic/opium-trade
• https://en.wikipedia.org/wiki/Spice_trade
• http://www.riseagainsthunger.org/
• http://gameofthrones.wikia.com/wiki/Red_Wedding
• https://pics.onsizzle.com/judas-we-still-on-for-thursday-peter-thursday-judas-yeah-5116240.png
• http://cdn.smosh.com/sites/default/files/2015/11/ramsay-memes-hakuna.jpg
• http://www.taxpolicycenter.org/publications/should-we-tax-unhealthy-foods-and-drinks
• http://tvtropes.org/pmwiki/pmwiki.php/Literature/NineteenEightyFour
• https://www.youtube.com/watch?v=SW-BU6keEUw
• https://www.reddit.com/worldbuilding/comments/5o0n2o/a_typical_aknut_meal_meyn_earth_equivalent_corn/

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I am a hard right libertarian. I often find myself in many communities with other conservative individuals. In those circles, I hear and see a tremendous amount of criticism towards LGBT people. This is something I absolutely can't stand as it is irrational, inhumane, and essentially authoritarianism rooted from subjective moral superiority.
A few months ago I got into a strenuous debate with a fellow conservative about the origin of transgender people and gender identity. I was pretty uneducated in this subject at the time so I dove in and tried to find as much research over the issue as possible.
What I found only further supported my perspective about gender identity. Change my view, gender identity is biological and its supported by a substantial pool of evidence.
Here is some of the research I've found credible and thorough:

It is believed that during the intrauterine period the fetal brain develops in the male direction through a direct action of testosterone on the developing nerve cells, or in the female direction through the absence of this hormone surge. According to this concept, our gender identity (the conviction of belonging to the male or female gender) and sexual orientation should be programmed into our brain structures when we are still in the womb. However, since sexual differentiation of the genitals takes place in the first two months of pregnancy and sexual differentiation of the brain starts in the second half of pregnancy, these two processes can be influenced independently, which may result in transsexuality. This also means that in the event of ambiguous sex at birth, the degree of masculinization of the genitals may not reflect the degree of masculinization of the brain. There is no proof that social environment after birth has an effect on gender identity or sexual orientation. Data on genetic and hormone independent influence on gender identity are presently divergent and do not provide convincing information about the underlying etiology. To what extent fetal programming may determine sexual orientation is also a matter of discussion. A number of studies show patterns of sex atypical cerebral dimorphism in homosexual subjects. Although the crucial question, namely how such complex functions as sexual orientation and identity are processed in the brain remains unanswered, emerging data point at a key role of specific neuronal circuits involving the hypothalamus.

-Savic, Garcia-Falgueras, Swaab. Sexual differentiation of the human brain in relation to gender identity and sexual orientation.

1. Bao, Hahn, Kranz, Kaufmann "Structural Connectivity Networks of Transgender People". 94 subjects, 23 FtM, 21 MtF, 25 cisFemale, 25 cisMale: average age 26. Transsexual subjects did not fulfill criteria for current comorbidities but 9 reported history of depression (n = 2), specific phobias (n = 3), obsessive compulsive disorder (n = 1), anorexia nervosa (n = 2), and substance abuse (n = 4). All patients reported subjective feelings to belong to the other gender before or at puberty. Investigating structural networks in female-to-male and male-to-female transsexuals, we observed differences in hemispheric and lobar connectivity as well as local efficiencies when compared with healthy controls.
   
2. Berglund "Berglund, H. et al. “Male-to-Female Transsexuals Show Sex-Atypical Hypothalamus Activation When Smelling Odorous Steroids". A positron emission tomography (PET) study showed that smelling androgens (male pheromones) caused transwomen to respond in the hypothalamus region of their brain in a manner similar to XX karyotype women. However, smelling estrogen-based pheromones also caused them to respond in the hypothalamus region in a manner similar to XY karyotype men. This combination of results suggests that transwomen occupy an “intermediate position with predominantly female features” in the way the hypothalamus reacted.
   
3. Yokota, Y. et al “Callosal Shapes at the Midsagittal Plane: MRI Differences of Normal Males, Normal Females, and GID”. An MRI study of 22 transwomen and 28 transmen examined the shape of the corpus callosum in the brain at a specific cross-sectional plane, and compared this shape with that observed in 211 XY karyotype males and 211 XX karyotype females. Their results demonstrated that not only could the sex of the patient be determined with 74% accuracy from the MRI picture, but the shapes of the brains in the transsexuals strongly reflected their gender, and not their biological sex. (in 1991 there was research done on this that showed no discernable difference but the sample size was signifcantly lower and the MRI technology used was brand new at the time of study [Emory]).
   
4. Bentz "A polymorphism of the CYP17 gene related to sex steroid metabolism is associated with female-to-male but not male-to-female transsexualism." CYP17 -34 T>C SNP allele frequencies were statistically significantly divergent between FtM transgender people and cisfemale controls; genotype distributions were also divergent in a statistically significant manner.
   
5. Hare "Androgen receptor repeat length polymorphism associated wth male-to-female transsexualism." Genes involved in sex steroidogenesis are components to transgenderism and gender dysphoria; specifically, androgen receptor repeat length polymorphisms were observed in an MtF-transgender population, but not a cismale population; this warrants the conclusion that male gender identity is mediated by the androgen receptor.
   
6. Gooren "The biology of human psychosexual differentiation." Meta-analysis of sex-steroid production and prenatal androgen exposure in transgender people.
   
7. Swaab "Sexual differentiation of the human brain: relevance for gender identity, transsexualism, and sexual orientation." Analysis of prenatal androgen exposure similar to Gooren, but notes that neurological testosterone availability in MtF trans people is deficient, causing transgenderism or non-heterosexualism.
   
8. Garcia-Falgueras "A sex difference in the hypothalamic uncinate nucleus: relationship to gender identity." The structure of the anterior hypothalamus plays a strong role in the development of transgenderism; INAH3 volume in transwomen resembles ciswomen, and INAH3 volume in transmen resembles cismen.
   
9. Luders "Regional gray matter variation in male-to-female transsexualism." MtF transgender people were analyzed by fMRI; gray matter variation throughout the brain more closely resembled the layout of a cisfeminine brain, rather than that of a cismasculine brain, implying gender identity depends on cerebral layout.
   
10. Rametti "White matter microstructure in female to male transsexuals before cross-sex hormonal treatment. A diffusion tensor imaging study." By diffusion-tensor-imaging MRI and fractional anisotropy analysis of various transgender and cisgender people, FtM transgender people more closely resembled a masculine-structured brain than a feminine- structured brain, noted by the study in the structures of the right superior longitudinal fasciculus, the foreceps minor, and the corticospinal tract. White matter microstructure therefore plays a role in gender identity.
    
11. Burke "Hypothalamic response to the chemo-signal androstadienone in gender dysphoric children and adolescents". Androstadienone, a particularly fragrant chemosignal responsible for sex-based differences in hypothalamic microstructure; children with gender dysphoria were observed to express differences in hypothalamic activation in accordance with identified gender, rather than assigned gender.
    
12. Boston University Medical Center. "Transgender: Evidence on the biological nature of gender identity." The researchers conducted a literature search and reviewed articles that showed positive biologic bases for gender identity. These included disorders of sexual development, such as penile agenesis, neuroanatomical differences, such as grey and white matter studies, and steroid hormone genetics, such as genes associated with sex hormone receptors. They conclude that current data suggests a biological etiology for transgender identity.
    
13. Zubiaurre “Cortical Thickness in Untreated Transsexuals”. A 2012 study examined cortical thickness in the brain between 29 XY karyotype males, 23 XX karyotype females, 24 transmen, and 18 transwomen. None of the transsexual subjects had received any hormone treatment prior to the study. Using an MRI, the researchers found that the transwomen had more cortical thickness than the XY males in three regions of the brain. The transmen showed evidence of masculinization of their grey matter. In all transsexuals studied, the key differences from their biological sex were found in the right hemisphere. On a graph, transpeople statistically fell in the middle between the XX and XY karyotypes.
    

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Okay, Flare77 here with another shitpost to give another poor servant their time in the spotlight by giving them a proper observation because they deserve it. Last time, I made a write up about our famed thief of Sherwood forest, Robin Hoodless. If you missed that out, check here. On that note, I’d like to address a misunderstanding that I’ve caused. Apparently Robin’s poison multiplier works on any debuff and NP debuff application still works after the NP but that is still up for debate (but scientists say that it's like that so I won't argue). Got that cleared up? No need for pitchforks and public lynching? Good. Now let’s get back to real business.
Now, I’m sure everyone has experienced this feeling. You go up to your FP gacha. As someone without 5* servants, you try to roll up your saved up 2000 FP in hopes of getting a silver servant or fou-kun power ups. You click that button. First 9 rolls are 1* xp cards and 1* CEs you don’t need. Maybe a bronze zerk here or two. The last draw is up, your hopes are dwindling, but in that moment it happens. A bronze caster card.
Yes
Could it be?
Oh yes, it’s – NOT ANDERSEN.
And then just like that, your mood has been dampened. That’s right, Mozart has been haunting the FP gacha for those who are hoping that they get the beloved white mage Andersen. Almost everyone would be happy to get Andersen in their FP rolls and that amount of smiles is proportional to the frowns that people make when they get Mozart instead, and I’d have to say with good reason.
That's because in hindsight Andersen is a better support in most cases.
But I did say most. I didn't say ALL.
Anyway, before I say anything else, I’ll just say that Mozart and Andersen are like the anti-thesis to each other so I’ll really be comparing the 2 of them a lot. Andersen is, without a doubt, one of the best servants you can get in FP gacha, and he's running up there as one of the best supports in the game as well. If we liken it to kids playing dodgeball, Andersen would be that guy who’s super-fast and super-agile that he’s always guaranteed first pick. In comparison, Mozart would be that skinny kid (lol he actually looks anorexic in his card art) with snot on his face that’s always picked last, if not picked at all. Well, that's really understandable.
Now, just to be identical to my last post, let’s enumerate the bad points about Mozart.

• He looks like shit!

Let’s get this out of the window first. My idea of Mozart was an iconic powder wig wearing pretty boy. Instead what I got was an anorexic zombie. I’m sure there are people here who don’t care about party synergy and the like as long as you can have a party full of your waifus, but Mozart is most definitely not waifu material. I mean, even Boudica gets picked by other players and that's saying something considering how bad her design is. Worst part is, he's not too grotesque to even spawn his own meme, unlike our smiling thunderpants wearing friend out there!

Anyway since that part is over, let's proceed.

• His stats suck!

Well, this one cannot be helped. Mozart is a 1* servant and as such, he’s really restricted in his stat growth. With only 7.1k max HP, he surely will be easy to kill and considering he only has 5.1k max attack, no way in hell would he be your main hitting star.

• His NP sucks! It deals no damage!

Well, this one is a rather huge misconception among most players how no damage NPs are bad but for now let's agree that his NP's not going to be among the best highlights if placed on the party. It does have a really funny animation if its something. If you can't kill your enemy, you can catch them off guard as they laugh their ass off from that ghastly concerto.
Okay, now that we've addressed the downsides, let's talk about what makes Mozart a good support.
But before we get to that, we need to know why Andersen is considered one of the best supports in the game. Andersen fits in with almost any kind of party. In contrast, Mozart isn’t as applicable as he is. If I made a power curve graph about the servants of this game, Mozart would most likely be below the average power line in most cases. But there IS a way to build a party in which Mozart would be a more ideal choice than Andersen (which leads to him being better than most supports). Andersen works decently with any kind of party while Mozart works exceptionally well with this kind. Note how I phrased it with “decent” and “exceptional”.
Anyway, what's this party build you may ask? Arts NP parties.
Okay I've laid out a bit of a test in which I sought out to see how much damage Robin's Yew Bow can hit with Andersen and Mozart separately.
Andersen's result has this. Not bad right? That's without master damage buff after all... well, as much as I'd like to excuse it, here's what Mozart has to say in response.
Now that is a HUGE difference. No matter how you look at it, a 50k damage gap is really big.
So, how did Mozart get Yew Bow to deal this much damage? Ah, well, let's just state his strengths finally.

• Protection of the Muses(false) EX

Now, THIS is Mozart's bread and butter skill. This is his ticket to the majors, his lucky baseball bat, his catcher in the ry- ok I'm using this phrase wrongly now. Anyway this skill is by far the best party attack boosting skill. The only problem is, it lasts only 1 turn and only for arts cards. This means that this skill goes in direct conjunction with an arts NP that deals damage.
Yew Bow, Kazikli Bay, Ascalon, you name it! With a base boost of 22%, it outclasses any party damage boost. At max level (tho this will only be hypothetical since no one would be balsy to lvl 10 this skill as of now) thats a good 44% damage boost! That's almost half!
But, well actually, Mozart can increase your damage potential by more than half. How so?

• Requiem for Death

As much as the title sounds cool, it doesn't instakill. That makes me sad a bit but well, the name is Requiem FOR death, not OF death. It's a support NP that will make the enemy weakened to a state where death would be calling upon them in the next move. Now, how cool does that sound?
Anyway, I mentioned earlier that Mozart is Andersen's antithesis, right? Well, that's because of their NPs. Marchen Meines Lebens, aka Andersen's NP, is a chance NP to give your party an ATK and DEF boost while always giving them a healing buff. Requiem of death works the opposite. It gives a chance to reduce ATK and DEF to the enemy party all the while cursing them to become sickly snot nosed anorexic kids, like Mozart is. He's like "If I won't get chosen for dodgeball, you might all as well not be!" and poof, everyone on the opposing team becomes as pathetic weak as he is!
Now I left off with a question of how Mozart can increase damage potential by more than half, right? Well, that's if his NP's DEF debuff hits the opponent. Requiem of Death reduces defense by 20% (and if DW ever gets to fixing their NPs to match flavor texts, it can max out to 40% def reduction) and add to it the 44% damage bonus that Protection of Muses(false) EX gives and you get yourself 64% damage boosting. Now, you've gotta admit, if your NP is hitting for atleast 100k, the bonus damage you can squeeze out is pretty fcking big.
Anyway adding Mozart to your party has its shares of pros and cons.
The other pros come with being able to add more 5* servants and CEs in your party since he has relatively low cost as a 1*.
The cons come with how low his health is and his need of protection in some cases. Another problem is that he's not a traditional "I can keep everyone healthy!" support but a "I can make the others sickly!" type. Compared to Andersen, he also doesn't have an NP boosting skill so you have to compensate for that. Notice how I use Ley Line for his CE?
And another con is... he's not good for a "whack-a-mole" party, which I've seen a lot of people love using, to my ire. Instead of thinking of a proper party, people just love to slap their waifus haphazardly without a care in the world, and good thing DW still hasn't punished that strat yet.
Anyway, that's my take on Mozart. He's a niche support and works only in one specific instance, but that one instance could probably be the best there is used properly. In my way of building a party, I think about how I can improve a certain servant's abilities just to get as much out of them as possible, all the while compensating for their weaknesses. Mozart might not be able to compensate someone else's weakness since he's too sick to help himself but he can boost your party's spotlight in a huge manner. In countless number of servants trying their best to improve themselves so people can use them, Mozart realized he can't do that and in turn just worsens the others! Pretty dirty but hey, a man's gotta do what a man's gotta do lol.
And that about sums it up. Mozart might not be for everyone, but he can be for some people! Next time you see him in FP gacha, don't be too mad. Just think that he's ready, snot and anorexia and all, to assist your main servant in the right moment!
PS: I still hate reddit formatting.