Hospitals & Asylums

Pulse Nightclub v. Human Rights Campaign HA-17-1-17

By Anthony J. Sanders

The Actuary attributed integrity to Obergefell v. Hodges (2015) in the tardy 2015 Annual Report that was not called for. In 2016 Social Security Matters blog hosted several postings regarding LGBT people that were rudely received by the public, before and after the Pace nightclub rampage shooting of June 12, 2016, that was never mentioned. Around January 12, Social Security Matters engaged with the FBI to misinform the public in violation of 18USC§1512 in regards to the true federal budget, OASDI and SSI accounts in furtherance of a Judeo-Christian scheme to rob a widow and all the orphans of their social security benefits. Social Security Matters was the single contact point for the federal/Microsoft government, but they abused words ‘budget cuts’ and after removing my explanation for the low morale that the Commissioner did not produce an SSI 2016 annual report, have been hijacked by the FBI who hijacks the budget processes of the Department of Justice, Congress and WHOMB non-accountants all in contempt of my accounting directions. sanderstony@live.com was permanently disabled by the FBI incidental to accusing them of self-incriminating regarding the state secrecy electoral infringement in a news blog posting. Having censured Tony Sanders or, more likely, the email address from the SS Matters, because the FBI is desperately trying to justify their citizen’s arrests (not to mention their cut of the forfeitures) because the author is not contactable by the emails they disrupt (mass murder?) to provide the public misinformation only I exhibit the capacity to redact. Social Security Matters computer specialists needs to convict the FBI for two counts of Unauthorized Access to Stored Information (hacking) under 18USC§2701. Please take the time to restore my blog-postings.

US v. Noor Zhi Salman. Grand Jury Indictment. US District Court Middle District of Florida. Orlando Division. Case No. 6.17-cr-18-on28, January 12, 2017

The two count indictment alleges that, from an unknown date, at least April 2016 through and including June 12, 2016 the defendant did knowingly aid and abet Omar Mateen by (1) providing material support or resources in violation of 18USC2339A & B (a)(1 & 2) and (2) engage in misleading conduct toward the Officers of the Fort Pierce, Florida, Police Department and Special Agents of the Federal Bureau of Investigation, with the intent to hinder, delay and prevent the communication of federal law enforcement officers and judges of the United States of information relating to the commission and possible commission of a federal offense in order to prevent them from communicating to agents of the Federal Bureau of Investigation and the United States Department of Justice and judges of the United States of information relating to the attack on June 12, 2016 at the Pulse Night Club, in Orlando, Florida, in the Middle District of Florida in violation of 18USC§1512(b)(3). The defendant is ordered to forfeit all assets foreign and domestic under 18USC981(a)(1)(G) any firearms and ammunition used in the offense and $30,500 pursuant to 18USC§924(d) or substitute property under 21USC§853 and 28USC§2461(c). The indictment is signed by three assistant US Attorneys including the chief of the criminal division and the foreman of the grand jury.

The arrest by the FBI without the prior signature of a judge is a trial error under Rule 4 (b, D) of the Federal Rules of Criminal Procedure. A federal magistrate judge is now determining flight risk of the pre-trial detainee before a federal judge can be found to take the case. Historically, occupying powers have used collective punishment to retaliate against and deter attacks on their forces by Resistance movements (e.g. destroying entire towns and villages where such attacks have occurred). Art. 33 of the Fourth Geneva Convention provides No protected person may be punished for an offense he or she has not personally committed. Collective penalties and likewise all measures of intimidation or of terrorism are prohibited. Pillage is prohibited. Reprisals against protected persons and their property are prohibited. The major issue is that the indictment seems to have been pirated/ defrauded by the FBI before a Judge could issue a federal arrest warrant served by US Marshall under Rule 4 Fed. Crim. P. In the commission of this false arrest the FBI infringed on both Jury and Social Security Commissioners to intimidate and terrorize HA and pillage the fools at Social Security Matters blog and the widow’s very questionable inheritance from her deceased husband. I would furthermore like to accuse the FBI of permanently disrupting my Microsoft live email when I blogged the truth, the FBI was self-incriminating regarding their election infringing state secrecy allegations in the press. The FBI arrest needs to be ruled a trial error. Both Assistant US Attorneys who wrote the Indictment and FBI are self-incriminating to accuse the defendant with providing misleading information under 18USC§1512(b)(3). How ridiculous to think the defendants have not yet forfeited the arms and ammunition that were used to commit the offense. It is difficult to judge the fact that the FBI, DEA, OJP federal grants, ONDCP and US Sentencing Commission must be abolished under the Slavery Convention of 1926. The FBI must be dismissed with a self-incrimination conviction under 18USC§1512 and Art. 33 of the Fourth Geneva Convention before the terrorism trial can start to liberate Congress from the rampage shooter (Pelosi’s Permanent Select Intelligence Committee, FBI?) in good grace with the Geneva Conventions. Can the shooter’s family disgorge the $30,500 inheritance to the United States without any claims for victim compensation? Does the family know of any more ISIS finance the US can receive? Do the surviving victims and the families of those who died in the gay bar shooting and Human Rights Campaign need compensation under Art. 14 of the Convention against Torture or do they owe the shooter’s widow their compensation under Art. 14 of the Covenant on Civil and Political Rights? Since 2014 Medicaid has been paying for Hormone Replacement Therapy (HRT) for Male-To-Female types and penectomies. Medicaid needs to stop paying for HRT for MTF types and sex change operations because the estrogen causes a “Warfarin dependency”. The FDA has to revise its policy so that Warfarin dependency is an absolute contraindication for HRT for MTF types.

HRT of the MTF type

Since 2014 Medicaid has been paying Hormone replacement therapy (HRT) of the male-to-female (MTF) type. HRT of the MTF type is a form of hormone therapy and sex reassignment therapy that is used to change the secondary sexual characteristics of transgender and transsexual people from masculine (or androgynous) to feminine. It is one of two types of HRT for transgender and transsexual people, the other being female-to-male, and is predominantly used to treat transgender women. The main effects of HRT of the MTF type are as follows: Breast development and enlargement. Softening and thinning of the skin. Decreased body hair growth and density. Redistribution of body fat in a feminine pattern. Decreased muscle mass and strength. Widening of the hips (if epiphyseal closure has not yet occurred; see below). Decreased acne, skin oiliness, scalp hair loss, and body odor. Decreased size of the penis, scrotum, testicles, and prostate. Suppressed or abolished spermatogenesis and fertility. Decreased semen production/ejaculate volume. Changes in mood, emotionality, and behavior. Decreased sex drive and incidence of spontaneous erections. Breast, nipple, and areolar development varies considerably depending on genetics, body composition, age of HRT initiation, and many other factors. Development can take a couple years to nearly a decade for some. Its effectiveness remains to be seen.

After the gay bar shooting, that was the largest rampage shooting in US history Medicaid coverage for HRT for MTF and sex change operations must be re-evaluated. The FDA must redetermine Warfarin dependency be an absolute contraindication for estrogen consumption. Medicaid must not cater to or pay for gender dysphoria, to corruptly convince pubertal teenagers whose beard growth might be reduced, to be sickened by HRT for MTF type therapy, waiting to believe in breasts no one at the gay bar sees anymore. Medicaid must stop paying for the new fangled volunteer penectomy and invagination that revolutionizes the ancient practice of castrating eunuch slaves that might reduce estrogen needs to such a level they would not need Warfarin, but would probably not even reduce the dose of this absolute contraindication for Hippocratic HRT for MTF type use for timely failure to develop breasts under the Nuremberg Code. Medicaid must stop paying for HRT of the MTF type puberty corruption propaganda or sex change operations. Medicaid shall pay for the surgical removal of all extra reproductive organs of XXY, XYY Kinefelter syndrome transgender and XXX cisgender people and stop catering to the hormonal demands of their precancerous organs on teenage runaways unless these HRT for MTF type drugs are proven to improve, rather than harm, the patients’ health, and sex life, worse than a cigarette. Medicaid does not pay for cigarettes.

Absolute contraindications – those that can cause life-threatening complications, and in which hormone replacement therapy should never be used – include histories of estrogen-sensitive cancer (e.g., breast cancer), thrombosis or embolism (unless the patient receives concurrent anticoagulants), or macroprolactinoma. In such cases, the patient should be monitored by an oncologist, hematologist or cardiologist, or neurologist, respectively. Relative contraindications – in which the benefits of HRT may outweigh the risks, but caution should be used – include: Liver disease, kidney disease, heart disease, or stroke. Risk factors for heart disease, such as high cholesterol, diabetes, obesity, or smoking

Family history of breast cancer or thromboembolic disease. Gallbladder disease. Circulation or clotting conditions, such as peripheral vascular disease, polycythemia vera, sickle-cell anemia, paroxysmal nocturnal hemoglobinuria, hyperlipidemia, hypertension, factor V Leiden, prothrombin mutation, antiphospholipid antibodies, anticardiolipin antibodies, lupus anticoagulants, plasminogen or fibrinolysis disorders, protein C deficiency, protein S deficiency, or antithrombin III deficiency. As dosages increase, risks increase as well. Therefore, patients with relative contraindications may start at low dosages and increase gradually.

The most significant cardiovascular risk for transgender women is the pro-thrombotic effect (increased blood clotting) of estrogens. This manifests most significantly as an increased risk for thromboembolic disease: deep vein thrombosis (DVT) and pulmonary embolism, which occurs when blood clots from DVT break off and migrate to the lungs. Symptoms of DVT include pain or swelling of one leg, especially the calf. Symptoms of pulmonary embolism include chest pain, shortness of breath, fainting, and heart palpitations, sometimes without leg pain or swelling. Deep vein thrombosis occurs more frequently in the first year of treatment with estrogens. The risk is higher with oral estrogens (particularly ethinylestradiol and conjugated estrogens) than with injectable, transdermal, implantable, and nasal formulations. DVT risk also increases with age and in patients who smoke, so many clinicians advise using the safer estrogen formulations in smokers and patients older than 40. Because the risks of warfarin – which is used to treat blood clots – in a relatively young and otherwise healthy population are low, while the risk of adverse physical and psychological outcomes for untreated transgender patients is high, pro-thrombotic mutations (such as factor V Leiden, antithrombin III, and protein C or S deficiency) are not absolute contraindications for hormonal therapy. Warfarin (Coumadin) is a prescription for unnecessary surgery because necessary drugs including anesthesia are contraindicated. Surgeons seem to have better luck prevailing upon transgender HRT consumers to take heparin for a few days before surgery and/or stop taking HRT because they have breast cancer than medical doctors attempting to prescribe metronidazole to cure gastroenteritis just like alcoholics trying to avoid cancer diagnosis. After the gay bar shooting that was the largest rampage shooting in US history Medicaid must redetermine Warfarin dependency to be an absolute contraindication.

In spite of the induction of breast development, HRT in transgender women does not appear to increase the risk of breast cancer. Only a handful of cases of breast cancer have ever been described in transgender women. This is in accordance with research in cisgender men in which gynecomastia has been found not to be associated with an increased risk of breast cancer. On the other hand, men with Klinefelter’s syndrome, who have two X chromosomes (similarly to cisgender women) in addition to hypoandrogenism, hyperestrogenism, and a very high incidence of gynecomastia (80%), show a dramatically (20- to 58-fold) increased risk of breast cancer that is between that of cisgender men and cisgender women (though closer to that of the latter). The incidences of breast cancer in normal men (46,XY karyotype), men with Klinefelter’s syndrome (47,XXY karyotype), and cisgender women (46,XX karyotype) are approximately 0.1%, 3%, and 12.5%, respectively. Also of potential relevance is the case of women with complete androgen insensitivity syndrome, who are genetically male (i.e., 46,XY karyotype) and have normal and complete morphological breast development and in fact breast sizes that are on average larger than those of cisgender women yet, similarly to cisgender men, appear to have little (or possibly even no) incidence of breast cancer. The risk of breast cancer in women with Turner syndrome (45,XO karyotype) also appears to be significantly decreased, though this may be related to ovarian failure/hypogonadism rather necessarily than to genetics. Similarly to the case of breast cancer, prostate cancer is extremely rare in transgender women who have been treated with HRT for a prolonged period of time. Whereas as many as 70% of men show prostate cancer by their 80’s, only a handful of cases of prostate cancer in transgender women have been reported in the literature. As such, and in accordance with the fact that androgens are responsible for the development of prostate cancer, HRT appears to be highly protective against prostate cancer in transgender women.

The most common estrogens used in transgender women include estradiol (which is the predominant natural estrogen in women) and estradiol esters such as estradiol valerate and estradiol cypionate (which are prodrugs of estradiol). Estrogens may be administered orally, sublingually, transdermally (via patch), topically (via gel), by intramuscular or subcutaneous injection, or by an implant. Dosages are typically reduced after an orchiectomy (removal of the testes) or sex reassignment surgery.

The most commonly used antiandrogens in transgender women are cyproterone acetate, spironolactone, and GnRH analogues. Spironolactone, which is relatively safe and inexpensive, is the most frequently used antiandrogen in the United States. Cyproterone acetate, which is unavailable in the United States, is more commonly used in the rest of the world. Spironolactone prevents the formation of androgens in the testes (though not in the adrenal glands) by inhibiting enzymes involved in androgen production. It is also an androgen receptor antagonist (that is, it prevents androgens from binding to and activating the androgen receptor). Cyproterone acetate is a powerful antiandrogen and progestin that suppresses gonadotropin levels (which in turn reduces androgen levels), blocks androgens from binding to and activating the androgen receptor, and inhibits enzymes in the androgen biosynthesis pathway. It has been used as a means of androgen deprivation therapy to treat prostate cancer. If used long-term in dosages of 150 mg or higher, it can cause liver damage or failure.

Non-steroidal antiandrogens used in HRT for transgender women include flutamide, nilutamide, and bicalutamide, all three of which are primarily used in the treatment of prostate cancer. These drugs are pure androgen receptor antagonists. They do not lower androgen levels; rather, they act solely by preventing the binding of androgens to the androgen receptor. However, they do so very strongly, and are highly effective antiandrogens. Bicalutamide has improved tolerability and safety profiles relative to cyproterone acetate, as well as to flutamide and nilutamide, and has largely replaced the latter two in clinical practice for this reason.

In both sexes, the hypothalamus produces gonadotropin-releasing hormone (GnRH) to stimulate the pituitary gland to produce luteinizing hormone (LH) and follicle-stimulating hormone (FSH). This in turn cause the gonads to produce sex steroids such as androgens and estrogens. In adolescents of either sex with relevant indicators, GnRH analogues such as goserelin acetate can be used to stop undesired pubertal changes for a period without inducing any changes toward the sex with which the patient currently identifies. GnRH agonists work by initially overstimulating the pituitary gland, then rapidly desensitizing it to the effects of GnRH. After an initial surge, over a period of weeks, gonadal androgen production is greatly reduced. Conversely, GnRH antagonists act by blocking the action of GnRH in the pituitary gland. There is considerable controversy over the earliest age at which it is clinically, morally, and legally safe to use GnRH analogues, and for how long. The sixth edition of the World Professional Association for Transgender Health’s Standards of Care permit it from Tanner stage 2 but do not allow the addition of hormones until age 16, which could be five or more years later. Sex steroids have important functions in addition to their role in puberty, and some skeletal changes (such as increased height) that may be considered masculine are not hindered by GnRH analogues. GnRH analogues are often prescribed to prevent the reactivation of testicular function when surgeons require the cessation of estrogens prior to surgery. The high cost of GnRH analogues is a significant factor in their relative lack of use in transgender people. However, they are prescribed as standard practice in the United Kingdom.

Progestogens are not commonly prescribed for transgender women. The most common progestogens used in transgender women include progesterone and progestins (synthetic progestogens) like CPA and medroxyprogesterone acetate (MPA). These drugs are usually taken orally, but may also be administered by intramuscular injection. Progestogens, in conjunction with the hormone prolactin, are involved in the maturation of the lobules, acini, and areola during pregnancy: mammary structures that estrogen has little to no direct effect on. However, there is no clinical evidence that progestogens enhance breast size, shape, or appearance in either transgender women or cisgender women, and one study found no benefit to breast hemicircumference over estrogen alone in a small sample of transgender women given both an estrogen and an oral progestogen (usually 10 mg/day medroxyprogesterone acetate). Anecdotal evidence from transgender women suggests that those who take progesterone supplements may experience more full breast development, including stage IV on the Tanner scale (many transgender women do not develop Tanner stage V breasts).

Umpqua Bank brought my attention to the Umpqua Community College rampage shooting wherefore the name of this case was changed to Pulse Nightclub v. Human Rights Campaign for recognition all the way to the US Supreme Court. My opinion may be edited further this January, with the same date of media aided dialogue with the skillful victim witness advocacy of the widow Noor Zhi Salman who must contribute her inheritance from Omar Mateen for the US Attorney Victim Witness Specialist (and/or better

offer) to start compensating the surviving victims and families of the deceased to pay for their public testimony regarding the rampage shooting, solicitation for further donations and liability of the Warfarin manufacturer for not being absolutely contraindicated for use with HRT for MTF types. The business deal is that the widow is due an equal share of the compensation with the families of deceased victims.

Section 16 Torture Compensation of the Social Security Amendments of January 1, 2017 provides:

a. To amend Torture 18USC§2340A(a) so 'outside the United States' is removed so - Whoever commits or attempts to commit torture shall be fined under this title or imprisoned not more than 20 years, or both, and if death results to any person from conduct prohibited by this subsection, shall be punished by death or imprisoned for any term of years or for life.

b. To amend Exclusive Remedies 18USC§2340B so ‘The State shall ensure in its legal system that the victim of an act of torture obtains redress and has an enforceable right to fair and adequate compensation, including the means for as full rehabilitation as possible. In the event of the death of the victim as a result of an

act of torture, his dependents shall be entitled to compensation under

Art. 14 of the Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment of 26 June 1987’.

c. United Nations Compensation Commission rates:

1. People forced to relocate as the result of military action $2,500 -$4,000 for an individual and $5,000-$8,000 for a family;

2. People who suffered serious bodily injury or families reporting a death as the result of military action are entitled to between $2,500 and $10,000;

3. After being swiftly compensated for relocation, injury or death an individual may make a claim for damages for personal injury; mental pain and anguish of a wrongful death; loss of personal property; loss of bank accounts, stocks and other securities; loss of income; loss of real property; and individual business losses valued up to $100,000.

4. After receiving compensation for relocation, injury or death an individual can file a claim valued at more than $100,000 for the loss of real property or personal business.

5. Claims of corporations, other private legal entities and public sector enterprises. They include claims for: construction or other contract losses; losses from the non-payment for goods or services; losses relating to the destruction or seizure of business assets; loss of profits; and oil sector or heavy industry losses.

6. Claims filed by Governments and international organizations for losses incurred in evacuating citizens; providing relief to citizens; damage to diplomatic premises and loss of, and damage to, other government property; and damage to the environment.