[DRAFT] Repeal: Affordable Transgender Hormone Therapy

[ShrewLlamaLand]

The World Assembly,

Noting that previously passed legislation may not be amended or otherwise modified by this Assembly, only repealed, and thus correction of such legislation first requires a repeal to be passed;

Observing that the target resolution defines "hormone therapy" as "medical treatment involving the use of naturally occurring hormones";

Concerned that this definition does not include synthetic testosterone blockers, "antiandrogens", commonly used in feminizing treatment;

Troubled that this defintion excludes synthetic estrogen and testosterone derivatives, which are often required for effective administration of these hormones;

Further observing that, while the target resolution mandates hormone therapy be "afforable" and "easy to access", it does not specify how these requirements must be satisfied;

Believing that this existing terminology may allow for nations to effectively bypass this legislation by providing ineffective, or difficult to access, treatment to transgender individuals;

Hoping that the repeal of this resolution would encourage the drafting of a more comprehensive replacement;

Hereby repeals GA#467: Affordable Transgender Hormone Therapy

The World Assembly,

Noting that previously passed legislation may not be amended or otherwise modified by this Assembly, only repealed, and thus correction of such legislation first requires a repeal to be passed;

Observing that the target resolution defines "hormone therapy" as "medical treatment involving the use of naturally occurring hormones";

Concerned that this definition does not include synthetic testosterone blockers, "antiandrogens", commonly used in feminizing treatment;

Further observing that, while the target resolution mandates hormone therapy be "afforable" and "easy to access", it does not specify how these requirements must be satisfied;

Troubled that no method of oversight has been specified to ensure that nations comply with these vague regulations;

Believing that the existing terminology may allow for nations to effectively bypass this legislation by providing ineffective treatment to transgender individuals;

Hoping that the repeal of this resolution would encourage the drafting of a more comprehensive replacement;

Hereby repeals GA#467: Affordable Transgender Hormone Therapy

[Tinfect]

OOC:
Your arguments are flimsy and you've given us no reason to trust your intentions; no support.

[The New Sicilian State]

Believing that the existing terminology may allow for nations to effectively bypass this legislation by providing ineffective treatment to transgender individuals;

"How? If you just mean that the current resolution doesn't support synthetic hormones, just leave it at that. Do you have a replacement in the works? How would you dictate the oversight of member states' affordable, easy access to hormone therapy? I think the current legislation is sufficient in those measures."

OOC:
Your arguments are flimsy and you've given us no reason to trust your intentions; no support.

OOC: This. ^ Opposed.

[South Reinkalistan]

"Against on the merit that ShrewLlamaLand has been long known to be home to a set of astoundingly poor legislators that respond poorly and with puerility to criticism."

[Tinhampton]

Hoping that the repeal of this resolution would encourage the drafting of a more comprehensive replacement

...and where is it?

[ShrewLlamaLand]

OOC:
Your arguments are flimsy and you've given us no reason to trust your intentions; no support.

I'll respond to this by stating that, in real life, male to female hormone therapy is much less effective without an antiandrogen being prescribed. You usually need to greatly increase the estrogen dose to compensate, resulting in increased side effects and possible long-term effects including increased risk of cancer, or potential to form blood clots leading to stroke. Even then, the outcome is usually worse overall.

I'm not really sure why my intentions are relevant in the General Assembly, but you'll have to take my word on that they're in the right place this time

Believing that the existing terminology may allow for nations to effectively bypass this legislation by providing ineffective treatment to transgender individuals;

"How? If you just mean that the current resolution doesn't support synthetic hormones, just leave it at that. Do you have a replacement in the works? How would you dictate the oversight of member states' affordable, easy access to hormone therapy? I think the current legislation is sufficient in those measures."

Oversight is not necessary as long as the requirements are clearly set out; the target resolution does not sufficiently detail what "affordable and easy to access" entails.

A replacement resolution will be drafted if this resolution attracts significant enough support.

edit: Jocospor and I had previously drafted a resolution that could serve as the basis for a reaplcement resolution, obviously it needs heavy editing: viewtopic.php?f=9&t=462407

[Tinfect]

I'll respond to this by stating that, in real life, male to female hormone therapy is much less effective without an antiandrogen being prescribed.

OOC:
You're telling this to someone who takes estrogen without anti-androgens and is having no problems, nor do I have overly-high estrogen perscriptions. I assure you, I am ten-thousand times more knowledgable on this than you.

I'm not really sure why my intentions are relevant in the General Assembly, but you'll have to take my word on that they're in the right place this time

We'll see.

[Morover]

“The origin of this repeal has been a greater reassurance on the quality of our resolution than any other indicator thus far.”

[ShrewLlamaLand]

I'll respond to this by stating that, in real life, male to female hormone therapy is much less effective without an antiandrogen being prescribed.

OOC:
You're telling this to someone who takes estrogen without anti-androgens and is having no problems, nor do I have overly-high estrogen perscriptions. I assure you, I am ten-thousand times more knowledgable on this than you.

...and let's dispel once and for all with this fiction that ShrewLlamaLand doesn't know what he's doing. He knows exactly what he's doing.

You may well be right, but I assure you I do have some idea what I'm talking about more generally regarding medication. Such a treatment may work very well for you personally, and I won't ask any personal details, but that's simply not the case for the majority of transfeminine individuals who will require an antiandrogen.

Various studies support this:

"Most patients will require the addition of an anti-androgen medication to further inhibit testosterone production or to block the androgen receptor. Anti-androgen treatments such as spironolactone (in doses up to 400 mg daily) and cyproterone (in doses up to 100 mg daily) are effective adjunctive therapies, given in addition to oestrogen to lower testosterone concentrations into the female range."
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5366074/

"Estrogen alone is often not enough to achieve desirable androgen suppression, and adjunctive anti-androgenic therapy is also usually necessary."
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5182227/

...and many more.

I'd be very happy for you to contribute with further suggestions regarding this proposal if you have them.

I'm not really sure why my intentions are relevant in the General Assembly, but you'll have to take my word on that they're in the right place this time

We'll see.

I can't really offer you anything more than my genuine reassurance this is the case.

[Separatist Peoples]

Ooc: we all know what your genuine reassurance is worth. I'll take the lead from the knowledgeable trans woman on this one.

IC: "Opposed."

[WayNeacTia]

CCD involvement? Hard pass.

[Maowi]

Observing that the target resolution defines "hormone therapy" as "medical treatment involving the use of naturally occurring hormones";

Concerned that this definition does not include synthetic testosterone blockers, "antiandrogens", commonly used in feminizing treatment;

OOC: If you sincerely are concerned about this, write a new proposal about antiandrogens, instead of trying to repeal this, which achieves absolutely nothing.

[Kenmoria]

“Firstly, the enforcement mechanism clause doesn’t make sense in the context of the Administrative Compliance Act, which mandates compliance with all General Assembly Legislation. If the target resolution had included an enforcement mechanism, it would have been simple duplication.

Secondly, though you have a point with regards to synergetic hormones, I don’t think a repeal is the correct solution. If you are concerned that existing legislation does not guarantee access to antiandrogens, then write some legislation guaranteeing access to antiandrogens. A repeal is not necessary.”

[Purple Rats]

Non sense. If there is problem with some medication, then this problem can be change otherwise, there is no need to repeal.

Against.

[ShrewLlamaLand]

CCD involvement? Hard pass.

Ooc: we all know what your genuine reassurance is worth. I'll take the lead from the knowledgeable trans woman on this one.

Ah, the classic "against due to author", a staple of the General Assembly.

With regards to your second comment, again, I assure you I have some knowledge of medicine. The vast majority of transgender women also take an antiandrogen.

The following study shows the massive effect this actually makes in reducing serum testosterone concentration: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6612061/

It also demonstrates there can be a massive difference even between different antiandrogens: cyproterone acetate (a specific androgen receptor blocker) is more effective and most commonly used outside the United States, while in the US spironolactone (a diuretic with weak antiandrogen activity) is commonly used instead as the first drug is not approved by the FDA.

[ShrewLlamaLand]

Observing that the target resolution defines "hormone therapy" as "medical treatment involving the use of naturally occurring hormones";

Concerned that this definition does not include synthetic testosterone blockers, "antiandrogens", commonly used in feminizing treatment;

OOC: If you sincerely are concerned about this, write a new proposal about antiandrogens, instead of trying to repeal this, which achieves absolutely nothing.

It's too narrow to legislate on and would probably be declared an amendment. As my first clause says, the current (very poor) definiton of "hormone therapy" cannot be changed without a repeal.

Noting that previously passed legislation may not be amended or otherwise modified by this Assembly, only repealed, and thus correction of such legislation first requires a repeal to be passed;

Such a proposal would also fail to address the vague nature of "afforable" and "easy to access".

I am going to make some minor changes now, specifically to this clause, which multiple nations have pointed out could be improved:

Troubled that no method of oversight has been specified to ensure that nations comply with these vague regulations;

edit: removed the above clause, reworded the clause after.

I have, unfortunately, found an even larger issue with the original resolution legislation.

The current definition of "hormone therapy" explicitly mentions "naturally occurring hormones", which completely excludes synthetic derivatives of these hormones.

For treating transmasculine individuals, the half life of testosterone in blood is about 70 minutes - treatment with only "naturally occuring hormones" would require an injection every few hours and would make female to male transgender medical treatment effectively impossible. Real-life treatment involves the injection of slow-release synthetic hormone derivatives via intramuscular injection that forms a drug depot inside the body.

This definition also excludes many synthetic estrogen derivatives used for improved absorption or in alternative routes of administration in male to female individuals.

While the original authors had their heart in the right place when drafting this resolution, it is clear that their lack of medical knowledge has created a very ineffective piece of legislation.

[Imperium Anglorum]

probably be declared an amendment

See [2017] GAS 1, [3] <https://forum.nationstates.net/viewtopic.php?p=30876886#p30876886>.

There is a reason that Amendment violations are separate from Contradiction violations. An amendment contradicts the existing terms, but breaks the game specifically because previous legislation can't be modified. If it wasn't for this underlying difference, Amendment violations could otherwise fall under Contradiction violations. So there must be something substantively different between the two, and we believe it is that Amendment violations actively attempt to somehow alter the text of the extant legislation.

[ShrewLlamaLand]

probably be declared an amendment

See [2017] GAS 1, [3] <https://forum.nationstates.net/viewtopic.php?p=30876886#p30876886>.

There is a reason that Amendment violations are separate from Contradiction violations. An amendment contradicts the existing terms, but breaks the game specifically because previous legislation can't be modified. If it wasn't for this underlying difference, Amendment violations could otherwise fall under Contradiction violations. So there must be something substantively different between the two, and we believe it is that Amendment violations actively attempt to somehow alter the text of the extant legislation.

See my above edit, unfortunately there are even larger flaws with the current legislation.

[Separatist Peoples]

CCD involvement? Hard pass.

Ooc: we all know what your genuine reassurance is worth. I'll take the lead from the knowledgeable trans woman on this one.

Ah, the classic "against due to author", a staple of the General Assembly.

With regards to your second comment, again, I assure you I have some knowledge of medicine. The vast majority of transgender women also take an antiandrogen.

The following study shows the massive effect this actually makes in reducing serum testosterone concentration: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6612061/

It also demonstrates there can be a massive difference even between different antiandrogens: cyproterone acetate (a specific androgen receptor blocker) is more effective and most commonly used outside the United States, while in the US spironolactone (a diuretic with weak antiandrogen activity) is commonly used instead as the first drug is not approved by the FDA.

Ooc: you can pop that card back into the deck. That you are author is relevant but not dispositive. When repealing legislation, it is common to expect a replacement when the argument is not one of nullifying policy entirely.

The guarantee on a replacement is heavily tied to reputation. And yours is in tatters.

[Norway2037]

Who fucking gives a shit about this fictional game, sincerely a real trans woman

[ShrewLlamaLand]

Ooc: you can pop that card back into the deck. That you are author is relevant but not dispositive. When repealing legislation, it is common to expect a replacement when the argument is not one of nullifying policy entirely.

The guarantee on a replacement is heavily tied to reputation. And yours is in tatters.

If I was to draft such a replacement well before submitting this resolution, would you change your stance on this?

Who fucking gives a shit about this fictional game, sincerely a real trans woman

Thanks for your input.

probably be declared an amendment

See [2017] GAS 1, [3] <https://forum.nationstates.net/viewtopic.php?p=30876886#p30876886>.

There is a reason that Amendment violations are separate from Contradiction violations. An amendment contradicts the existing terms, but breaks the game specifically because previous legislation can't be modified. If it wasn't for this underlying difference, Amendment violations could otherwise fall under Contradiction violations. So there must be something substantively different between the two, and we believe it is that Amendment violations actively attempt to somehow alter the text of the extant legislation.

The original draft, given the flaws I have addressed, is entirely ineffective as it legislates on a poor, far too narrow defintion of "hormone therapy".

If I was to draft what would effectively be a replacement resolution without a repeal, I would not only be very restricted in what can be legislated on (given it cannot just reword, nor contradict anything in the original resolution), but I would also need to do so while legislating on multiple classes of drugs in much the same way as the original resolution does... effectively the target resolution would become almost entirely redundant.

As you correctly pointed out in GA#410: Repeal "Marriage Equality"

(ii) there are no real good reasons to keep redundant legislation around,

So you'll have to explain to me why that wouldn't be the case here?

[Sciongrad]

OOC: If you sincerely are concerned about this, write a new proposal about antiandrogens, instead of trying to repeal this, which achieves absolutely nothing.

It's too narrow to legislate on and would probably be declared an amendment. As my first clause says, the current (very poor) definiton of "hormone therapy" cannot be changed without a repeal.

Noting that previously passed legislation may not be amended or otherwise modified by this Assembly, only repealed, and thus correction of such legislation first requires a repeal to be passed;

Such a proposal would also fail to address the vague nature of "afforable" and "easy to access".

I am going to make some minor changes now, specifically to this clause, which multiple nations have pointed out could be improved:

Troubled that no method of oversight has been specified to ensure that nations comply with these vague regulations;

edit: removed the above clause, reworded the clause after.

I have, unfortunately, found an even larger issue with the original resolution legislation.

The current definition of "hormone therapy" explicitly mentions "naturally occurring hormones", which completely excludes synthetic derivatives of these hormones.

For treating transmasculine individuals, the half life of testosterone in blood is about 70 minutes - treatment with only "naturally occuring hormones" would require an injection every few hours and would make female to male transgender medical treatment effectively impossible. Real-life treatment involves the injection of slow-release synthetic hormone derivatives via intramuscular injection that forms a drug depot inside the body.

This definition also excludes many synthetic estrogen derivatives used for improved absorption or in alternative routes of administration in male to female individuals.

Bracketing for a moment your interpretation of the statutory language, explain to me again why you believe an additional resolution couldn't separately address the provision of synthetic hormones.

[ShrewLlamaLand]

Bracketing for a moment your interpretation of the statutory language, explain to me again why you believe an additional resolution couldn't separately address the provision of synthetic hormones.

See my response to IA above.

Such a proposal would not address the concerns regarding the vague terminology "affordable and easy to access", and would largely make the existing resolution redundant.

[Imperium Anglorum]

Your warrant for why no replacement could be done seems incorrect. Defining in another proposal the words "hormone therapy" isn't contradiction because if you read this here target, it says—

Defines, for the purposes of this resolution, "hormone therapy" as a medical treatment involving the use of naturally occurring hormones for the purpose of altering one's secondary sex characteristics to more accurately reflect their gender identity,

That aside,

but I would also need to do so while legislating on multiple classes of drugs in much the same way as the original resolution does... effectively the target resolution would become almost entirely redundant.

As you correctly pointed out in GA#410: Repeal "Marriage Equality"

(ii) there are no real good reasons to keep redundant legislation around,

So you'll have to explain to me why that wouldn't be the case here?

Because it's not yet redundant.

[Separatist Peoples]

Ooc: you can pop that card back into the deck. That you are author is relevant but not dispositive. When repealing legislation, it is common to expect a replacement when the argument is not one of nullifying policy entirely.

The guarantee on a replacement is heavily tied to reputation. And yours is in tatters.

If I was to draft such a replacement well before submitting this resolution, would you change your stance on this?

Ooc: 8 months ago? Possibly. But I am a cynical man, and you and yours passed up too many opportunities to engage in good faith. I'm not confident you'd actually pursue the draft once this was repealed.

This cynicism is well documented elsewhere, and not unique to you.

I also echo the sentiments of Sciongrad. I don't think a repeal is necessary to repair the issues you identified.