♪ >> from our studios in new york city, this is "charlie rose." in all these discussions we are going to come back and forth. four regions are important. the prefrontal cortex is involved in executive function and decision-making and what we call character formation. defects in the prefrontal cortex can lead to an increase in aggression. -- ventraltratum

also four kinds of aggression. the ma killer is the orchestrator of emotion, positive and negative. it influences the hypothalamus. the hypothalamus has many functions but we will focus on its role in aggression and sexuality. we are basically are oh scientists in my lab and we want to understand some of the most fundamental questions about aggression. how is aggression, a ehavior,onary ancient b how is that hardwired into the brain? where is aggression in the brain? we have studied this problem in and we'remice particularly interested in the relationship between the parts of the brain that control aggression and those that control mating or sexual behav ior. mating and aggression are closely related behaviors. in nature you often find that periods of aggression are at

their highest when animals are mating. these behaviors reinforce each other. at the same time, they are mutually exclusive. a male will direct mating towards a female of the species aggression towards another male. there's a paradox. how can these behaviors be mutually exclusive but also reinforce each other in some way? we have begun by trying to pinpoint the neurons that control aggressive behavior and we have started i looking in a very evolutionarily ancient region of the brain which eric brought up call the hypothalamus. we began by trying to measure the electrical activity of cells that were active during aggression or mating, in a tiny region of the hypothalamus. we found something quite surprising. within this very small region of the brain we found a mixture of neurons, some of which were active, turned on when the animals were fighting, this was done in males, some of which

were turned on when the animals were mating with a female, and some of these were active during both fighting and mating, 25% of them overlap. was an interesting observation, a correlation, and we really wanted to understand the function of these neurons. we began by using very modern techniques now called up to genetics -- opto genetics to activate and inhibit these neurons. we can turn them on and turn them off with a time resolution of milliseconds. i'm going to show you a video of what happens to a male mouse when you activate these aggression iran's in the brain -- neurons in the brain. some of the viewers might find the image a bit disturbing but what we are doing does not hurt the mouse. these are all protocols that

have been approved by our institutional animal use and care committee and nih approved. you will see the mouse in a cage with an inanimate object. when the light comes on we are stimulating these aggression neurons in the mouse. we can actually trigger the mouse to attack a rubber glove. if there were another mouse there he would attack the other mouse as well. we wanted to ask, are these neurons necessary for normal aggression? mice will normally fight for each other, if you introduce an insured or mouse into the cage where a male mouse lives, very shortly thereafter the resident mouse will attack the intruder. we ask if we shut these neurons off, can we stop a fight dead in its tracks? will show you,eo it's possible to do that. these mice are fighting naturally. when the light comes on we inhibit these neurons and the

fight stops. we will show you that again in slow motion. the mice are fighting and suddenly the light comes on, we stopped the attack dead in its tracks. charlie: how did the near on snow to respond -- neurons know to respond to light? genetically implant in these neurons deep in the brain a protein that comes from a light sensitive algae. that protein makes an ion channel through the membrane of the near on that turns the near on -- of the neuron that turns the neuron on only when light activates this channel. that shows us that these neuron's are necessary and sufficient for aggression. >> we discovered as we were manipulating the conditions for

turning these neurons on very surprising. you needed high intensity stimulation to activate aggression but low intensity stimulation would promote mounting behavior. the mouse which i to mate with whatever other mouse was in the cage -- would try to mate with whatever other mouse was in the cage. we could switch the behavior of the same animal from attempt of mounting to a mixture of mounting and attack just by increasing the intensity of light. that tells us that in this tiny region of the brain there is a mixture of neurons controlling both the mating instinct and the fighting instinct, and perhaps that will account or may account for the tension between the sex drive and the aggressive drive. charlie: it's extraordinary. >> it explains why aggression ression. to sexual aggerssio >> a lot of people think

aggression is more prevalent in people with mental illness. mental illness on its own does not increase the rate of aggression. it is more likely to occur in individuals with issues of substance use dependence, especially prior history of aggression. everyone gets very concerned when mass shootings happen. this person must be mentally unfit. studies, itoss doesn't pan out. there are multiple forms of aggression. there is socially sanctioned aggression, such as fighting in war, medically induced aggerss ression. the two big ones will be impulsive aggression and premeditated aggression. impulsive aggression is not exactly spontaneous. people perceive a threat or frustration and their threshold

to blowup is very low. they blow up an experience or display a temper touch or more physical aggression. premeditated aggression, which can happen in anybody, is taught through -- thought through. the people most likely to do that is psychopaths, maybe 1% of the population. some people have a disorder of impulsive aggression, 3% or 5% to 6%. those important distinctions to put forth, because we have an impulsivew to treat aggression. we are not sure how to treat premeditated aggression. charlie: what did we see at the nero biological level? >> people with aggression is similar to what we're hearing at this table. the doctor talked about 4% of

boys being chronically aggressive. we also see the same sort of thing biologically pretty see problems with serotonin function, where serotonin function is diminished. we see evidence of heightened other neurotransmitters that will facilitate aggression. we see problems in the frontal area of the brain. we present to these individuals, pictures of individuals who are angry or threatening, the amygdala will overact to that stimulus compared to healthy volunteers. that correlates with how aggressive these people have been over the course of their lives. thing going along with this is serotonin and the amygdala really have to do with the tendency to be aggressive. what makes you aggressive in the here and now has to do with how you interpret social signals. people that are aggressive -- it may very well be because they

had been aggressive as a child -- 10 to have problems of social internation processing. they don't take in enough information about what's going on and they make a hostile inference as to what the other people is doing. you can have a situation where the threshold may be high or low and when you are coming into the to is that you are prime think somebody brushing up against you are looking at you funny is threatening or frustrating to you. you have a serotonin system in the frontal lobe that is not working so well. you have a high accelerator, breaks are bad, you will have a crash. >> one of the key things that emerged is the treatment of depression often is designed to increase the level of serotonin. is there a increased incidence of this kind of aggression and people who are depressed and have low levels of serotonin? >> not necessarily. the early studies i did were

interesting in that. we saw this problem in individuals who did not have a primary mood disorder. their brain systems involved in activation are not working well. when they aredism severely depressed. charlie: we talked about certain individuals who cannot control their impulses. >> m.l. has been talking about people in a hospital context. we work with people at the street level were violent psychopaths, even killers. charlie: what the psychopath mean? >> an individual who lacks conscience, remorse, guilt. because of that lack of feelings, they do outrageous things. there stimulation seekers, their impulsive. >> there is the cold,

calculating, callused type. then you have the antisocial lifestyle, doing horrible things to other people. we have been studying their brains using brain imaging to look to see what part of the brain may not be working right, what part may be physically different. what we find in normal people is that their prefrontal cortex is working well, as you see there, in the green. this is where we brain scanned murderers. what we see our murderers who are impulsive, they do not plan there murderers, they are hot-blooded in terms of their homicide. what we see on the left is poorer functioning in that frontal region of the brain. why is it that that part of the brain can predispose to aggression? it is a part of the brain involved in checking on impulsive behavior. we all get angry at times. what stops us lashing out?

we have a good frontal cortex that is working well to regulate and control our aggressive behavior. those are hot-blooded murderers, but what about the cold-blooded murderers? when we brain scan them, they had pretty good frontal functioning, which makes sense because these are killers who premeditate their homicide. they had the wherewithal to do that. the interesting question becomes, what is it then that is producing them to be violent in a predatory fashion? let's turn to the next slide. we will look at another brain region. this is the m mikula on the left. dala on the left. cold-blooded psychopaths, they have a physical shrinkage in the amygdala. it is reduced in size by 18%. on the right you can see the areas within the amygdala

colored in blue that are physically deformed. dala is important in generating emotions. if there is a shrinkage, that will reduce fear. what stops a lot of us breaking the law of the lands, we are frightened about the punishments we would get if we were caught. youif you lack that fear, are more likely to commit offenses in a cold-blooded fashion. there's more to it than that. on the left you can see where it is located in the brain. can seeight, you there's greater activity in psychopaths when they are anticipating rewards. we have the idea that psychopaths are reward driven.

they want the goods, just like an addiction. the idea is anticipation reward is part of the brain, firing up a lot more. maybe that is why psychopaths are more likely to pursue rewards and gains that they want. they have the drive to do that. and they don't have the emotional amygdala to hold them back in a way to give them anticipatory fear. >> this is a spectacular series of findings. when i was a medical student, none of these imaging techniques were available. you had very little insight of what was going on and the living brain of people. we now have insight into the biological substratum of different kinds of aggressive syndromes. just the beginning, how much we have learned, different categories, impulsive versus

premeditated, different categories. charlie: even affecting the size of the amygdala. the question is, because of your reference to imaging, can you look at imaging and decide it is most likely to be aggressively violent? >> it's a great question. we are beginning to get clues about who may be more likely to be violent in the future. myself and colleagues brain scanned males in the community. those individuals with a smaller volume to the amygdala were more cold-blooded. they were four times more likely to commit a violent act in the next three years. that is prediction over and above right history of violence, prior history of psychopathy. get valueinning to used by imaging to try to understand who are at risk for becoming the next generation of future offenders.

kindie: are we seeing this of research used in trials, in criminal trials? >> the key question here is if a psychopath is -- what is causing that amygdala sure gige -- shrin kage? it could be genetic. we also know that trauma reduces the size of the amygdala in children. neglect reduces the size of the amygdala. i don't think psychopaths ask to threen with an amygdala sizes too small. if that brain empowerment predisposes them, alters them, doing the terrible things they do, the fascinating question as to what extent do we hold them fully responsible for their actions? evidence. not dna probabilistic statement, and that is imperfect in front of the law.

as techniques get better and we see not only the amygdala -- the amygdala is associated with isormality, danger associated with another abnormality, we will be in a better position. ♪

this behavior is essential for the proper development of parenting is one

of the strongest and most enduring social bonds in human societies are at parental behavior is widely concerned in the animal kingdom. in mammals, females lactate and they take riemer responsibility of the parental care. female see this temperance is watching over the first -- chimpanzee is watching over her child. what about father's? the contribution of males in parenting is very variable. , for example in the silverback monkey and gorilla playing with his infants, in some species males are paternal, they nurture their young. in some other species, males attack the children and

sometimes kill them. biologist in my group used a laboratory mouse to try to understand basic biology of parenting behavior. we would like to identify the brain areas that are involved in driving parental behavior and we would like to understand how these brain areas are regulated, in order to have animals that are parenting and some animals that are neglecting their infants. mothers as well as non-mothers are spontaneously maternal. which means that when they are put in presence with cubs, they will spontaneously build a nest, they will groom them, and huddle with them for long periods. in contrast, males are infanticidile. however, males that have access to the females become paternal

three weeks after meeting with a female, which corresponds exactly to the gestation time in mice. males who become fathers also become paternal. ook advantage of these extremely interesting paradigm and differences in behavior between males and females and maless and infanticidile to try to understand what are the brain role. what are the neurons that drive parental behavior? in the first set of experiment we identified a specific set of cells in the hypothalamus activated during parental behavior. neurons,sk all these required for the parental drive. in a subsequent experiences -- experiments, we ablated these neurons in parental males and females.

surprisingly and remarkably, now these animals neglect their infants or attack them. these experiments suggest these near runs are required for parental behavior. experiments, we ask whether the activity of these new runs was sufficient to create parental behavior. we took aggressive males and we artificially stimulated these nurturing neurons. amazingly, these aggressive males stopped attacking the cubs and they groomed their infants. what this experiment says is the activity of these near ons is sufficient to drive parental care. experiment we identify a set of cells in a different area of the hypothalamus that is activated when aggressive males attack their infants. we call these the parental neglect neurons. in another experiment, we activate these neurons in ,emales and found these females

instead of caring for their infants, now neglect or attack them. overall, these experiments suggest the brain set of components, a cells in the hypothalamus that drive parental behavior and a net of set of -- another set of cells that drive parental neglect. opens new opportunity to understand the control of parental behavior -- and why some animals are parental and some animals are neglecting or attacking these infants. parental behavior is widely conserved among animals. these also raise the possibility that the function and regulation of the cells is widely conserved across the animal kingdom. charlie: how do you stimulate

the neuron's to make the aggressive males more nurturing? modern methodsse in nero science -- neuroscience that enable to shine light on neurons that have been genetically modified and have an ion channel that is light activated. the activity of genetically defined population of neurons. >> there is been fascinating work done by teams understanding the evolution of parenting of bonding between males and females. there is a very nice system where some species are monogamous and some are polygamists. males and females form these long time pair bonds and both are nurturing towards their young. what has been found in this system is that not only are the

high levels -- are there higher levels of oxytocin, but in the males there is a similar hormone produced by the hypothalamus which seems to be important in determining both paternal behavior and pair bonding behavior. in the monogamous species there are more receptors and higher levels of [indiscernible] we have oxytocin in females which seems to be important in driving pair bonds and maternal behavior. [indiscernible] did a fascinating series of experiments determining how oxytocin impact some female maternal behavior and for males, pair bonding and parental -- paternal behavior. it monogamy that produces the higher levels of oxytocin or is it higher levels of oxytocin that produce monogamy? susanne: oxytocin is primarily

involved with maternal behavior. teams whoe same worked on how vasopressin relates to pair bonding and maternal behavior in both has shown that you can take both that are not monogamous and at best the present and make --- and add vasopressin and that changes their behavior. what is it about human biology that is both similar and different to other primates is what drives our research. humans have a large brain and exceptionally long juvenile and infancy periods. because we are born so helpless and so unable to take care of ourselves, parenting becomes exceptionally important. human babies are totally

defenseless and even throughout their juvenile period they need much more investment by their than similar species that are closely related to us. that tells us that in humans particularly, understanding the role of parenting behavior and the biology of behavior is very important. charlie: what is the effect on children who are deprived of nurturing? aree know that children exposed to a continuum of care. this infant and mother are having a wonderful conversation. this is what we want to see in all infants and mothers are at -- mothers. under profound deprivation, all of that is missing. inhave a pair of twins directing. sittingmber of babies in institutions, the lack of caregivers. there is one you can see in the back. there's a very low investment in these children, unlike the

videos we saw in the beginning. interaction,social we think, plays a fundamental role in building the brain. what we started to observe was in the study, what happens to the developing brain and kids growing up in institutional care. we formed a manipulation in which we saw a large number of children abandon the institutions -- abandoned in institutions and romania. some were placed in high quality foster care and some remained in the institution. i want to show you a video of what a child at the age of two looks like. this is on an outing with a bunch of kids from an institution or you notice the she's 22ing over, months of age, she's been in the institution close to the time of birth. the other little girl is rocking. off camera there are other kids rocking. that certain vocal rocking is very typical of kids who grow up in institutions -.

the first thing we did is recorded the brain's electrical activity by simply placing sensors on top of the head. the billions of neurons in the brain generate electrical activity we can pick up. from that activity, for the power the brain is producing, how much electrical activity is there, we can color code that. that indicates more or less power. on the right side you see an image of a never institutionalized brain. the distribution of electrical activity is portrayed here to reflect much more brain activity in red sitting over the frontal lobe. you looked on the left panel, that is the institutionalized group. the kids in the institution are drastically underpowered. at that point we became concerned i thought, what's going on?

when the children were 8 to 10 be performed at a resonance imaging to look at the detailed anatomy of the brain. on the right is an m.r.i. scan. we are showing gray matter. gray matter represents the cell bodies, appendages of neurons. matter really does the communications of the brain. white matter shows up whitish and gray matter shows up grayish. on the far right you see the amount of gray matter in the never institutionalized -- these are the children who grew up in families in bucharest, romania. when you look at the children who have been institutionalized on the far left, they show less brain matter, as do the kids we put in foster care. the is showing us that brain has much less gray matter by a function of being in an institution. in the next slide we show the same reduction in white matter.

it is almost suggesting that we know that there is a smaller brain is a function of being in an institution. >> before chuck these studies, people knew that -- chuck did these studies, people knew that deprivation was bad for cognitive development. they did not know that affected the brain directly. would it be different if there was some kind of activity with the kids in institutions, a much more collegiality that was produced from outside? >> yes. aboutoment we will talk what happens when you put kids in families to your question is, can you improve an institution. >> charlie is asking another question, could it be parental substitutes. >> we know it has to be the investment the caregivers make who care about that child.

what goes on in institutions is you don't have that. charlie: you can feel a sense of the brain will develop if you can feel there is some contact, somebody knows we you are and recognizes you and there is some active caring for you? >> precisely. it is social interaction that really is stimulating brain development. is a lack of social interaction. kids in an institution who got cognitive and linguistic stimulation but no caregiving, they would just be as poorly off as the kids we see. the question is how much recovery is there. in this study we placed half of the kids into foster care, high quality foster care. at the beginning of this video -- we will see that little girl when she is 22 months of age, iq below 50 in an institution. atypical motor behavior. after this we put her in foster care and this is now her in foster 8 months later. her iq is now in the mid-60's.

this is her interacting with her foster care mother. this is merely 8 months of foster care. now about four years of age, she has spent half her life in foster care. look at that interaction she's having. this is the same little girl we saw in the beginning it was crawling backwards, rolling over, had barely any language and now her iq is in the 80's. there is tremendous recovery that can occur by placing children into a family. it seems to be regulated by a critical period. placement before the age of around 2 years of age leads to better outcomes. placement after two years of age leads to much less desirable outcomes. on the next slide we can show the eeg. on the right is the brain of the never institutionalized child. more red means more activity. in the next slide we see the critical period. now, the brain that is left at it institution after age 2,

looks identical to the institutionalized brain. the child is in a family but not until they were older than 2. now the children placed before 2 cap brain activity that looks just like the kids who have never been in an institution. we see this inflection point and development, removal from an institution and placed into a good family before 2 leads to much better outcomes than children placed after 2. charlie: timing is everything. if you don't have it, it puts a ceiling on how much you can produce. >> the window of opportunity for brain plasticity is reduced. ♪

>> what we can bring to bear on this subject is not only a deep discussion about the sociological and psychological issues with biological underpinnings, when we begin to speak about the biological underpinnings we want to distinguish as you already implied two different concepts. gendercal sex and identity. anatomical sex is a body parts associated with sexuality and reproduction. gender identity is a more subtle complex image that is a sense of oneself as a male, female, or something else. let's begin with anatomical sex. it is determined by our genes. enes are agent chromosomes --

ancient chromosomes and we have 23 pairs of chromosomes. we get one pair from our father and one pair from our mother. of these -- the difference between the mothers and fathers contributions are real but modest. the sex chromosomes, the difference is quite profound. women are xx and men are xy. the chromosomes are quite different than the order soames. they have a very important function in determining sex. let's begin with the y chromosome and see how that determines the sex of the man. we are born with an undifferentiated gonad that can develop into testes or ovaries. y chromosome there that has a region in it which is

called the sex determining region of y, that contains a gene that activates the differentiation of the undifferentiated gonads into the testes. if that y gene is not there, you have an xx, female gonad develop. let's look at the mail differentiation. the testes develop within the first seven weeks in utero. if the testes matures as a result of the sex determining releases y, the testes a massive amount of testosterone comparable to the level you have at puberty in the adult. that is responsible for giving you the male body form, the brain characteristic of mail functioning, as well as having actions and basically every aspect of your being. if the sex determining region of y is not there, you have development of the ovary. the ovary secretes estrogen and

progesterone and it gives you the female body form and changes in the brain. these are extremely important changes. that is the easy part here this is the anatomical part. the more subtle part is the gender identity. tell me the experience you went through. phyllis as much as you can about what led up to your decision, as much astell us you can about what led up to your decision. >> in many ways my experience is probably typical for other transgender people. i was four or five years old when i first started to have strong feelings that i felt more like a boy. i was born a sectoral, barbara. i felt like a boy, i played with boys. i remember wishing i could be in the cub scouts and boy scouts. every halloween i would dress up as an army man or football

player. as i got into middle school, early teen years, i did start to feel more and more uncomfortable with this. i did not feel i should have breasts. i did not feel comfortable at all wearing dresses, makeup, jewelry. it became increasingly uncomfortable when i got into high school. i started to be teased more by kids. i had a lot of confusion about my gender and i felt very ashamed of it. i never spoke with friends or family about it once. charlie: no one? >> no. i felt very ashamed and very confused. this was in the days before the internet, so there wasn't a lot of information about this tort of thing. -- sort of thing. as i got into my 20's, i was doing well in my career, i was doing medical and research training, but i was increasingly uncomfortable and like many

trans people i started to think about suicide. this is a picture of me back when i was barbara. i was a bridesmaid at my little sister's wedding. i remember vividly just the agony that i felt, the discomfort, putting on that dress, wearing jewelry, wearing makeup. after 30 years i remember that's. complete my training and begin a job at stanford 20 years ago at the age of 40. about two years into that i developed breast cancer. i was still very confused about my gender identity, but i knew i did not like to have breasts and so when the doctor said he needed to do a mastectomy to remove the cancer, which was picked up early and i was cured of, i said, while you are there, please take off the other breast. he was horrified by this.

since cancer runs in my family, he did agree to move the other breast. i just can't tell you how therapeutic that was. i felt so relieved to have those breasts removed. i recognized that was a different response my mom had when she had her mastectomy. she sighed as a huge blow to her femininity. -- saw it is a huge blow to her femininity. then the doctor began to talk to me about reconstructing my breasts. i was horrified, there is no way you are putting these back on me. it occurred to me that there was something different about my gender. a year later i was reading the "san francisco chronicle" when i read a several page article about the life of james green. i realized for the first time in my life that there were other people who experienced the same sorts of gender confusion, there were other people like me and i

might be transgender. i went to see a sex change pioneer at stanford and he ran a gender clinic. evaluated me they told me that i thought i was transgender and they offered me the possibility of changing my was immediately irresistible to me and very quickly within weeks i decided to change sex. i had already had the upper surgery. i did not want lower surgery, so all that was needed was to take testosterone. you can see the effects it has had on me. it is powerful stuff. when of the most surprising things about the testosterone was that to my great surprise it became harder for me to cry. that itfemales report becomes much easier for them to cry. that was perhaps surprising. the main experience i had was i felt after i changed sex, it's

hard to describe the intense relief i felt like this weight lifted off my back and i have been so much happier since. i've never had another suicidal thought. at the time i decided to do this, i had been a scientist at stanford for several years. this was 20 years ago. all my colleagues and friends and family were immediately supportive and i have been very fortunate to have my career continue and to have lots of wonderful students and so forth. >> i want to show you a powerful example of identical twins. in this case, one of the male twins -- we have proven that these twins are indeed absolutely identical and born male -- one of them at age 3 started to say everything about being a girl.

if there was any issue that came , she turned it into an issue of gender. -- one of those things hallmarks, preferring to wear female underwear and female pajamas, etc. the familyof 7, decided with the help of a counselor to change her name to and to have the child assume a female role. here is twin sister with twin brother, at the age of just about 9 to 10 years of age. charlie: what grade? >> fourth-grade. switched all the attachments to them, the hearings, the closing, the hairstyle, the shoes, you could

switch one for the other. the fact of the matter is that kids with their clothes on our virtually interchangeable pre-puberty. -- their model levels hormonal levels at this particular point are interchangeable. everything happens really at puberty. here they are at age 14. because it is so difficult to live in a gender different from your biologic sex, when you have a toxic effects of your genetically hormone to raven -- driven puberty, which would basically make twin sister look exactly like twin brother. and you can see that she looks still almost like a 9 or 10 year old. she has had her puberty

suppressed. the next slide shows the level of sex hormones across the human lifespan. look at the blue line, which is the male level of testosterone, the hormone that was receiving and that some of us make, but during fetal life, especially in the mid trimester, the level of testosterone in the fetus rises to a level close to the full adult range. and then it falls, and then there's another blip right after birth, second puberty. then things go completely dormant spirit if they did not go dormant we would have a whole bunch of pubertal looking fifth-graders running around. everything is suppressed. >> when we're thinking about possible causes for transgender, wouldn't it be possible that some aberration in testosterone

secretion or estrogen secretion during intrauterine development or shortly thereafter might be one of the contributing factors. >> it is certainly possible. .t's a very dynamic stage we still don't know what that second bump is after birth, wh ether boys without testes or otherwise normal show any differences because of that. that when we went to look at a hormone, we have to be able to get it out and measure it. you can't get it out of the brain. it isn't the hormone level that is important, but the affinity of the receptor for the hormone. it's very difficult to measure such things. it is fascinating, to see what is the biological underpinning of transgender

identity. it is so important because kids who are in the wrong sex, there are incidents of suicide attempt is very serious. >> it's one of the highest risks of any. in the pubertal process, the whole system reawakens again, the system that had been awakened in utero suddenly comes back. hypothalamic hormones hitting the pituitary cause the release of other hormones that strike the ovary or the testes and cause the release of what we ,all the sex steroid hormones, which are testosterone and estrogen mainly. those things produce the differences between the body of the male and the female associated with puberty. we have been able to probably since the 1980's we have been able to block the release of the

hormone from the hypothalamus to the pituitary. once you do that so far upstream, everything downstream goes down to zero. we have a record of this medication being completely successful in shutting them down until the appropriate time, and also the fact that it's completely reversible. look how revealing this is. the twin sister affirms a female identity and the puberty blocks years to get, two more time for counseling without the pressure of body change. that is important for it if we are going to give her estrogen, that will permanent -- have per manent effects. look at what would happen to her if she had not been given this blockade. she would look exactly like twin brother. he's in early puberty for a 14-year-old. so would she have been because they are identical. here are the twins at age 17. just after that

picture was taken, she began estrogen. while at the same time having her male hormones blocked. with that, our patients don't need breast surgery when they feminize because it is so effective. she is now entering junior high school, as is her brother. she's fabulous. dutch whooctober the taught us reported that first follow-up of the patients, 55 of whom whose puberty was blocked and for whom sex steroids related switch -- the dutch group had surgery at 18, at which point their gender dysphoria, total uncomfortableness with their gender disappeared. the dutch found that the kids treated this way are psycho orially functioning as well

better than the control group of non-transgender kids they are being compared to. charlie: a powerful argument for surgery? >> a powerful argument for available surgery at the right time for the right people. >> when of the nice things about the dutch approach is it delays puberty. havepuberty sets in, you physical changes that make it much more difficult to reverse. to prevent those physical changes coming, in addition to the biological changes it toays, it allows the child think through whether this is the quest they want to be on. some people say i'm in the wrong body, i want to be a man when they are a woman, but change their mind after a few months. only they allows not physiological process to be handled in a more satisfactory way, but the psychological evaluation to see whether this

is the way the kid actually feels or if this is a temporary decision in their minds. >> the dutch gave me their protocol in 2006, and we started using it in boston children's hospital, at which time we were the only major medical center to do so, but not that many years since 2006 and over 40 programs now are doing it. it is becoming the standard of care. ♪

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♪ angie: gathering gloom sweeping through the markets where numbers have hit their lowest point in seven years. luxembourg lost half $1 billion in one day for glencore. that the