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Monthly Archives: October 2019
Foreign aid leader’s visit focuses on UW partnership opportunities – University of Wisconsin-Madison
Posted: October 26, 2019 at 2:46 pm
Im a Badger, says Mark Green (left), walking toward the Stock Pavilion, and when I look at everything this fantastic university is doing, I say, the sky is the limit. Photo by Rodee Schneider
As a Wisconsin native and UW alumnus, USAID Administrator Mark Green understands better than most the breadth of expertise that exists on the University of WisconsinMadison campus. He saw it as a law student, as a state representative and later as a member of congress representing Wisconsins 8th district.
Green visits the lab of Tony Goldberg, an epidemiology professor in the School of Veterinary Medicine whose research focuses on global health and infectious disease. Photo by Rodee Schneider
On Oct. 18, Greens knowledge of UWMadisons academic range brought him to campus for a discussion about potential partnership opportunities between USAID and the university. Green has held the top post at USAID the United States foreign aid and development since 2017.
I cant think of any USAID interests where UW doesnt have a subject matter expert, said Green. The issues where we have questions, you have answers.
The agency frequently works with top U.S. universities on issues related to hunger and agriculture, economic development, education, global health and more.
Green, who also served as the U.S. ambassador to Tanzania from 2007 to 2009, spent the day on campus meeting with faculty, university administrators and researchers. His morning included a discussion with a group of campus leaders working on international issues, a visit with Chancellor Rebecca Blank, and a trip to the laboratory of TonyGoldbergin the School ofVeterinary Medicine to learn about global health and international studies in infectious disease.
PhD student Leah Owens, who is doing research in Goldbergs lab on molecular diagnostics of wildlife disease, shows Green components of their lab in a box, which is designed as a mobile field lab. Photo by Rodee Schneider
For USAID, the visit represents a broader effort to expand its partner base and tap into universities regional and technical knowledge and research expertise.
For UWMadison, the meeting offered a chance to explore new opportunities for mutually beneficial collaborations with USAID, potentially extending the reach and impact of work already occurring on campus.
We have a long history of research related to USAID interests, said Nancy Kendall, an associate professor of educational policy studies, who was part of a committee exploring opportunities for partnership with USAID. We want to see the Wisconsin Idea shared with the world.
Greens visit included a discussion with a group of campus leaders working on international issues. Photo by Rodee Schneider
While Greens global work exposes him to some of the planets biggest challenges, including hunger, natural disaster and political turmoil, given what hes seen from university partners, hes hopeful for the future.
One of the reasons Im really optimistic is your students. Theyre coming up with designs and innovation we never considered, said Green.
Im a Badger, and when I look at everything this fantastic university is doing, I say, the sky is the limit.
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Bulls-Eye: Imaging Technology Could Confirm When a Drug Is Going to the Right Place – On Cancer – Memorial Sloan Kettering
Posted: October 26, 2019 at 2:46 pm
Summary
Doctors and scientists from Memorial Sloan Kettering report on an innovative technique for noninvasively watching where a targeted therapy is going in the body. It also allows them to see how much of the drugreaches the tumor.
Targeted therapy has become an important player in the collection of treatments for cancer. But sometimes its difficult for doctors to determine whether a persons tumor has the right target or how much of a drug is actually reaching it.
A multidisciplinary team of doctors and scientists from Memorial Sloan Kettering has discovered an innovative technique for noninvasively visualizing where a targeted therapy is going in the body. This method can also measure how much of it reaches the tumor. What makes this development even more exciting is that the drug they are studying employs an entirely new approach for stopping cancer growth. The work was published on October 24 in Cancer Cell.
This paper reports on the culmination of almost 15 years of research, says first author Naga Vara Kishore Pillarsetty, a radiochemist in the Department of Radiology. Everything about this drug from the concept to the clinical trials was developed completely in-house at MSK.
Our research represents a new role for the field of radiology in drug development, adds senior author Mark Dunphy, a nuclear medicine doctor. Its also a new way to provide precision oncology.
Our research represents a new role for the field of radiology in drug development.
The drug being studied, called PU-H71, was developed by the studys co-senior author Gabriela Chiosis. Dr. Chiosis is a member of the Chemical Biology Program in the Sloan Kettering Institute. PU-H71 is being evaluated in clinical trials for breast cancer and lymphoma, and the early results are promising.
We always hear about how DNA and RNA control a cells fate, Dr. Pillarsetty says. But ultimately it is proteins that carry out the functions that lead to cancer. Our drug is targeting a unique network of proteins that allow cancer cells to thrive.
Most targeted therapies affect individual proteins. In contrast, PU-H71 targets something called the epichaperome. Discovered and named by Dr. Chiosis, the epichaperome is a communal network of proteins called chaperones.
Chaperone proteins help direct and coordinate activities in cells that are crucial to life, such as protein folding and assembly. The epichaperome, on the other hand, does not fold. It reorganizes the function of protein networks in cancer, which enables cancer cells to survive under stress.
Previous research from Dr. Chiosis and Monica Guzman of Weill Cornell Medicine provided details on how PU-H71 works. The drug targets a protein called the heat shock protein 90 (HSP90). When PU-H71 binds to HSP90 in normal cells, it rapidly exits. But when HSP90 is incorporated into the epichaperome, the PU-H71 molecule becomes lodged and exits more slowly. This phenomenon is called kinetic selectivity. It helps explain why the drug affects the epichaperome. It also explains why PU-H71 appears to have fewer side effects than other drugs aimed at HSP90.
At the same time, this means that PU-H71 works only in tumors where an epichaperome has formed. This circumstanceled to the need for a diagnostic method to determine which tumors carry the epichaperome and, ultimately, who might benefit from PU-H71.
Communal Behavior within Cells Makes Cancers Easier to Target
Findings about proteins called molecular chaperones are shedding new light on possible approaches to cancer treatment.
In the Cancer Cell paper, the investigators report the development of a precision medicine tactic that uses a PET tracer with radioactive iodine. It is called [124I]-PU-H71 or PU-PET. PU-PET is the same molecule as PU-H71 except that it carries radioactive iodine instead of nonradioactive iodine. The radioactive version binds selectively to HSP90 within the epichaperome in the same way that the regular drug does. Ona PET scan, PU-PET displays the location of the tumor or tumors that carry the epichaperome and therefore are likely to respond to the drug. Additionally, when its given along with PU-H71, PU-PET can confirm that the drug is reaching the tumor.
This research fits into an area that is sometimes called theranostics or pharmacometrics, Dr. Dunphy says. We have found a very different way of selecting patients for targeted therapy.
He explains that with traditional targeted therapies, a portion of a tumor is removed with a biopsy and then analyzed. Biopsies can be difficult to perform if the tumor is located deep in the body. Additionally, people with advanced disease that has spread to other parts of the body may have many tumors, and not all of them may be driven by the same proteins. By using this imaging tool, we can noninvasively identify all the tumors that are likely to respond to the drug, and we can do it in a way that is much easier for patients, Dr. Dunphy says.
The researchers explain that this type of imaging also allows them to determine the best dose for each person. For other targeted therapies, doctors look at how long a drug stays in the blood. But that doesnt tell you how much is getting to the tumor, Dr. Pillarsetty says. By using this imaging agent, we can actually quantify how much of the drug will reach the tumor and how long it will stay there.
Plans for further clinical trials of PU-H71 are in the works. In addition, the technology reported in this paper may be applicable for similar drugs that also target the epichaperome.
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Genome sequencing data to help in predictive and preventive medicine – Down To Earth Magazine
Posted: October 26, 2019 at 2:46 pm
Minister Harsh Vardhan claims project will help in cost-effective, precision medicine
Research laboratories working under the Council of Scientific and Industrial Research (CSIR) on Friday announced completion of whole genome sequencing of 1008 Indian individuals representing diverse ethnic groups in the country. The data will act as baseline information for developing various applications in predictive and preventive medicine.
The genomic data will help scientists understand genetic diversity of the Indian population and make available genetic variant frequencies for clinical applications. The data and knowhow are expected to produce evidence and help in development of technologies for clinical and biomedical applications, scientists explained.
The project called IndiGen was implemented by Delhi-based Institute of Genomics and Integrative Biology (IGIB) and Hyderabad-based Centre for Cellular and Molecular Biology (CCMB). The whole genome sequencing of individuals drawn from across the country has been completed, enabling benchmarking the scalability of genome sequencing and computational analysis at population scale, Union Minster for Science and Technology Harsh Vardhan said.
The genome data will be important for building the knowhow, baseline data and indigenous capacity in the emerging area of precision medicine, he said. The outcomes of the IndiGen will find applications in a number of areas, including faster and efficient diagnosis of rare genetic diseases, he added.
It will further lead to cost-effective genetic tests, carrier screening applications for expectant couples, enabling efficient diagnosis of heritable cancers and pharmacogenetic tests to prevent adverse drug reactions are some of the other benefits of this initiative.
Scientists have also developed IndiGenome card and mobile application for researchers and clinicians to access clinically actionable information. The minister said it would ensure privacy and data security, which is vital for personal genomics to be implemented at large scale.
CSIR has been engaged in genomic studies in India and its Indian Genome Variation has made major contributions in understanding genetic makeup of Indian population. It has also pioneered the application of genomics in clinical settings in the area of rare genetic diseases by means of DNA and genome based diagnostics and interaction with large number of clinical collaborators. (India Science Wire)
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Repairing the brain through stem cell therapy – Monash Lens
Posted: October 26, 2019 at 2:46 pm
Theres a new frontier in medicine that seeks to cure not just treat symptoms by regenerating healthy tissue destroyed by disease.
In the firing line are currently incurable diseases that impose enormous suffering, debilitation and costs. This includes the muscle wasting inflicted by muscular dystrophy, for example, or the loss of brain neural cells in the case of Parkinsons disease.
Its the latter that the startup Convalesce Inc is primarily targeting, based on the development of a self-assembling and self-repairing material called AmGel. It contains nanofibres capable of nurturing stem cells to replace damaged nerves a function that can make or break the use of stem cells therapeutically.
To get all the interacting factors right meant drawing on nanotechnology, bioengineering, cell biology, developmental biology and material science super-advanced stuff.
AmGels development and commercialisation, however, owes a great deal to a new model for producing the next generation of innovators in this case, Convalesces co-founder, Dr Subhadeep Das.
He graduated with a PhD in 2017 from an academy specifically established to use advanced multidisciplinary research techniques to address critical global challenges, including in energy, infrastructure and manufacturing. Called the IITB-Monash Research Academy, its a joint venture between the Indian Institute of Technology Bombay (IITB) and Monash University.
Speaking from the prestigious IndieBio accelerator program in San Francisco, Das explains that stem cell technology perfectly fits the academys mission. These are cells that are potentially game-changing for medicine, yet their use is held back by the cells complex relationship to its molecular, cellular and extra-cellular environment.
You cant just inject stem cells into inflamed and damaged tissue. They dont survive in that micro environment, Das says. The solution requires drawing on multiple disciplines like having smaller pieces for a jigsaw puzzle.
For Parkinsons disease, that involves understanding the biophysicality of the brain and the dimensions and topography of its subcellular structures. This has led to the designing of nanofibres that form a scaffold for stem cells to attach and grow into. This matrix also cues stem cell growth and development into functioning nerve cells.
To get all the interacting factors right meant drawing on nanotechnology, bioengineering, cell biology, developmental biology and material science super-advanced stuff, Das says.
The science, however, is just the first step towards a cure. Convalesce constitutes the second phase meeting the testing, regulatory and commercialisation hurdles needed to get a viable therapy to patients.
Das admits the learning curve has been steep in the segue from research to commercialisation. Working alone, he might not have succeeded.
Instead, he took advantage of ongoing support provided by the IITB-Monash Research Academy, including the provision of exclusive rights to the intellectual property for AmGel, and mentoring from across both universities, especially from the academys CEO, Professor Murali Sastry.
He discovered that while starting a company is tough, there are people who are willing to help if you reach out. Its making the connections in the first place that matters.
On that score, the Monash alumni office do a great job. They provided us with introductions to alumni that included highly successful entrepreneurs and heads of venture firms. These are people who are willing to help because of the connection with Monash University.
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The Trouble with Adam – lareviewofbooks
Posted: October 26, 2019 at 2:43 pm
OCTOBER 26, 2019
WHEN YA PUBLISHER Houghton Mifflin Harcourt put out Ariel Schrags Adam in 2014, it felt predetermined that this debut novel would eventually become a movie. Indeed, the promotional materials included a trailer for an imagined film, a digital elevator pitch. Moreover, as a preexisting YA property, the story had a potentially lucrative built-in audience, which is still necessary for many LGBTQ-themed features in the current film marketplace. The 2019 film adaptation of Adam is backed by major independent producer James Schamus (Brokeback Mountain) and directed by trans man Rhys Ernst (Transparent and the web series Weve Been Around), with Schrag, a cis lesbian, writing the screenplay.
But the basic story of Adam a cisgender white teenage boy poses as a trans man because an older cis lesbian he has a crush on mistakes him for one has been controversial since its inception. Suffice it to say that Adam has had a complicated relationship with the LGBTQ community because of this problematic masquerade and consequent erasure of trans masculinity. While there are trans male characters in Adam, they appear on the margins, remaining oblique rather than being front and center.
The tale is set in 2006, a significant time for the LGBTQ community in terms of media visibility. At the time, Schrag was writing for Showtimes The L Word, then in its third season and with a growing audience. Viewers of the show will remember that third season as the introduction of Max, a trans male character. Adam (the book and film) features a viewing party for The L Word, with the characters watching a scene where Max is confronted about his trans identity. The trans men at this viewing party call out the most glaringly unrealistic aspects, such as the fact that Max, only just starting hormone replacement therapy, has practically overnight grown beard scruff all over his face. The scene distills the media representation of trans masculinity at a specific moment in time. Max was more a prism for ripped-from-the-headlines trans themes than an actual character, spending the final season of The L Word pregnant and miserable, in a subplot clearly inspired by Thomas Beaties international notoriety as the pregnant man. The character today still provokes viewer animosity.
It is notable that this viewing party, while critical of the representation of Maxs physical transition, is unrealistically silent over the way Max is confronted on the show as a gender traitor. None of the queer characters at the viewing party is critical of this incendiary claim; instead, they prefer to joke about which characters on the show will sleep together next. For all Schrags efforts, in both The L Word and Adam, to create a space where the relationships of queer women and trans men can be explored, there are obvious limits to her imagination, which tends toward tabloid-style exploitation rather than empathetic investigation.
In a 2014 interview with The Rumpus, Schrag revealed that her books genesis was connected to Max and The L Word, with the shows lone cis male writer, Adam Rapp, being her unofficial muse. Schrag recalls that they
were doing the Max story line, and I started to have this fantasy that Adam Rapp would go out to clubs and pretend to be a trans man in order to gather fodder for this lesbian TV show, and the more I thought about it I thought thats hilarious and weird and fascinating. I became fascinated by this idea of a cisgender man passing as a trans man, especially because we were working on this story about a trans man trying to pass as a cis man.
Schrag wanted to create a story in which a teenage boy in a queer femme space would be confused for a trans man because this was an inverse of something that happens a lot to trans men in cisheteronormative spaces (and even queer spaces). It is true that being on hormone replacement therapy and going through a kind of second puberty can lead to many kinds of misunderstandings in trans presentation, all of which can be potentially comical. Unfortunately, Adams simplistic premise, by obscuring actual trans identity, produces little more than a shallow sex farce in which the historically complex relationships between butch lesbians and trans men in these queer spaces barely registers. Moreover, the experience of romance and sex with a trans masculine body is merely suggested, largely deployed for titillation, and undisturbed by any reality since Adam does not actually have such a body.
In fact, Adams ability to pass as trans is pretty dubious. Nobody suspects that he is faking it, and the consequences of being outed are, all things considered, nonexistent. Adam may not get the girl in the end, but his punishment is merely an education: to learn how to play his role, he is shown reading J. Halberstams Female Masculinity and watching a montage of trans masc YouTubers talking about their experiences. Adam absorbs all of this like a college student cramming for an upcoming exam, which he will pass by regurgitating the bullet points he has absorbed from studying actual trans men.
As director, Ernst presents these scenes earnestly, but what Adam is doing here is pretty insidious. The internet has long been a space where trans people can share their experiences in beneficial and potentially life-saving ways. By contrast, Adam uses it to cultivate his fraud, like a cynical catfisher who constructs fake identities in order to exploit unwitting strangers. Being an innocent, dumb teenager, his straight white male privilege gives him an all-too-easy out.
The essential vacuousness of Schrags and Ernsts treatment can be seen in their depiction of an actual trans character, Ethan. Introduced on Craigslist as the mystery man who lives with Adams sister and her on-again-off-again girlfriend, Ethan is a cool-headed, rather solitary figure who works at a movie theater. Ethan befriends Adam, who is at first unaware of his friends trans identity, despite seeing him in just a towel. While this cluelessness could be used to explore the complexity of trans visibility, the story takes an easier route, and Ethan becomes its most frustrating gambit. How Ethan relates to his body, his relationship with queer spaces, how he connects to masculine images, how he relates to other trans men, what gender dysphoria means to him all this exists as untapped story potential. Lacking any obvious flaws or complications, Ethan is a character so absent of nuance that he is one-dimensional, a simple foil for Adams masquerade. The other trans male characters in the story are equally one-note sounding boards.
Schrag uses trans masculinity as a Trojan Horse that allows a straight cis white boy to have eye-opening experiences of queer sexuality and gender fluidity. Given the storys fundamental lack of interest in actual trans people, it is depressing that the novel and film have been embraced in some quarters for what amounts to the crumbs of representation they offer. As transness gains real visibility in the media, Adam comes across at best as an inadvertent revelation of how, in the end, Ethans story would make a far more interesting movie than the title characters. But the promise of that story being fully realized relies on ambitious and serious artists receiving the kinds of platforms and exposure afforded to Schrag and Ernst.
Caden Mark Gardner is a freelance writer from Schenectady, New York. He is working as a co-author on an upcoming book on transgender cinema calledCorpses, Fools, and Monsters: An Examination of Transgender Cinema.
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Breast cancer awareness is for everyone – The Prairie
Posted: October 26, 2019 at 2:43 pm
October is Breast Cancer Awareness Month in the United States. Breast cancer is a common, deadly, and aggressive disease that can develop in any individual regardless of sex or age, not just menopausal cisgender women.
According to the Mayo Clinic, breast cancer is the second most common cancer diagnosed in designated females in the US. Breastcancer.org reports that 1 in 8 designated females will develop invasive breast cancer in their lifetime, as opposed to approximately 1 in 1000 designated males.
While deaths from breast cancer have decreased in the last 50 years, around 42,000 designated females are expected to die as a result of breast cancer by the end of 2019. Breast cancer has the highest mortality rate of any cancer in the US for designated females aside from lung cancer.
The 15-40 Connection is an advocacy group for young people who are diagnosed with cancer and focuses on spreading information for early detection. They report that cancer survival rates for people aged 15 to 40 have lagged significantly behind those of older individuals, and state that this can be attributed to low rates of diagnosis.
The Young Survival Coalition reports that more than 250,000 designated females who are living with breast cancer were diagnosed before 40, but stresses that diagnoses before 40 are difficult as there are no effective diagnostic procedures for younger designated females due to the denser breast tissue.
Frustratingly, breast cancer in designated females below 40 tends to be more aggressive; this, coupled with difficulty producing accurate diagnoses, results in a drastically lower survival rate for young breast cancer patients and a higher rate of metastasis.
The youngest known case of breast cancer was 8-year-old Chrissy Turner, who underwent a full mastectomy in her undeveloped right breast in November 2015. Her only symptom was a painful lump on her chest.
Extensive research has not been done on the occurrence of breast cancer in transgender men and nonbinary designated femalaes. Aside from a Dutch study on trans men who elected hormone replacement therapy, the majority of data on transgender individuals is available is from case studies and reports of diagnoses and treatments, Laurie Ray at Clue reports. The Dutch study found breast cancer to present in trans men at roughly the same percentage as cis men, but retrospective studies of trans patients in the US suggest that artificial androgens used for transitioning might promote the development of breast cancer. Regardless of the effects of different transitional procedures, it is crucial to understand that gender identity does not play a role in the expression of breast cancer.
Every individual must be aware of their physical health regardless of age, sex, or gender. In Amarillo, breast diagnostic and treatment procedures are typically performed at the BSA Harrington Breast Center, which provides a program for individuals who are at a higher risk of developing cancer. Additionally, WT is host to a branch of Zeta Tau Alpha womens fraternity, which boasts a breast cancer foundation in addition to their fraternity philanthropy program being breast cancer awareness. Further information about treatment, testing, and risk factors can be found at either link.
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For Trans People, Doctors Are Both Allies and Antagonists – Tonic
Posted: October 26, 2019 at 2:43 pm
When the doctor walked in and immediately asked me about my prostate during an appointment I'd made about an issue entirely unrelated to my gender, I knew things werent going to go well.
I dont have any reproductive organs, I answered.
He fumbled with his clipboard. Oh.
We tried to recover a neutral mood in the room, but the visit remained tense and awkward. I couldnt feel fully comfortable with him.
Trans patients face polar struggles in seeking medical treatment: We need doctors to diagnose us with gender dysphoria in order to receive trans-related treatments that align us with who we are, while general practitioners express total ignorance of our basic health needs and mishandle our gender identities and bodies instead. Close medical scrutiny, which is supremely important in making effective individualized care possible, is still taxing, complex, and draining to navigate.
I am a trans boy with chronic back and neck pain that has worsened over time. After my ability to drive to and stand at work deteriorated, I left my apartment, friends, and job to move across the country so my mom could help with my care as I sought a diagnosis. With so much lost and even more at stake, it was especially frustrating when doctors focused on the fact that I'm trans instead of my symptomslike in the visit where I had to explain my lack of reproductive organs.
By the time I turned to the healthcare abyss in search of answers, I was a veteran of the system, having undergone hormone replacement therapy and two surgeries over the prior four years. Navigating my medical transition was exhausting, expensive, and complicated, but the surgeons, therapists, and physicians I saw specialized in trans-related treatment. They gave me the nave belief that, with decent insurance, emotional support, and the willingness to complete a thousand forms, I could receive adequate care.
But needing non-trans-related care meant dealing with doctors who had little to no experience treating trans patients, who often conflated my gender with my wider health. Over the span of two years, many medical professionals immediately questioned if my gender-confirming surgeries were responsible for my pain. One doctor read my chart and cross-examined me about my genetic material. So, if we were to test your DNA and chromosomes, youd actually be a woman? she interrogated. A rheumatologist asked me if I believed in God, which apparently would give me the strength I needed toI dont knowsurvive this appointment? I was sometimes asked when I first felt I was trans, and whether I was considering further surgeries.
After ruling out these concerns, providers brushed me off with a painkiller prescription and the recommendation to see a psychiatrist. I did, and she helped me understand and handle the toxic cycle of pain and stress familiar to many chronically ill folks. But my pain never went away. I wondered if doctors suggestions for me to see a psychiatrist were informed not only by my symptoms or behavior, but by my previous medical record of gender-related therapy.
I underwent countless appointments, misdiagnoses, and stressful tests in search of a cause: MRIs, CT scans, X-Rays, corticosteroid shots, antibiotics, four rounds of physical therapy. Nearly a year after the onset of my pain, I remarked to one physicians assistant that doctors didnt seem to believe I had a legitimate health problem and asked inappropriate questions about my gender. The PA told me straight out, firmly but sympathetically: Youre young, transgender, and have a mental health diagnosis," he said, referring to the gender dysphoria diagnosis I'd needed in order to transition. "Most doctors will think you just want drugs or have psychological problems.
His candor was shocking. Throughout six years of working with doctors during my transition, I jumped through hoops to prove my mental stability in order to access the gender-confirming procedures I needed. Yet, regarding my chronic pain, the body I'd worked so hard to align with was used against meevidence that I was prone to psychological problems.
Doctors have always been trans peoples biggest allies and biggest antagonists. Doctors made it possible for trans people to access new levels of harmony in their own bodies, and doctors helped dispel the stigma that trans people are inherently mentally disturbed. But doctors were also the very people who determined that being trans was a mental illness in the first place.
In the 1940s and 50s, during the early years of trans medicine in the U.S., doctors instituted a system of gatekeeping to sort the real trans people from the rest. They prized trans folks' ability to pass"to move through society undetected as transand patients needed to play the game if they wanted approval for treatment. In Julia Seranos queer classic Whipping Girl, she describes how trans women learned to show up for their psychotherapy appointments wearing dresses and makeup, stick to a narrative about being trapped in a mans body, and deny being sexually active.
The functions and language of this system of control linger: When I had top surgery in 2012, my insurance listed my diagnosis as true transsexual, a term from endocrinologist Harry Benjamins 1966 Sexual Orientation Scale. Just this May, the worlds two gold-standard diagnostic tools, the World Health Organizations International Classification of Diseases (ICD) and the American Psychiatric Associations Diagnostic and Statistical Manual (DSM), de-categorized transness as a mental illness. Until then, trans patients were labeled as suffering from gender identity disorder (GID). The new ICD terminology is gender incongruence, and the DSM replaced GID with gender dysphoria.
Susan Stryker highlighted medical sciences power to regulate society in Transgender History , writing , Medical practitioners and institutions have the social power to determine what is considered sick or healthy, normal or pathological... to transform potentially neutral forms of human difference into unjust and oppressive social hierarchies. Still today, doctors play god with trans bodies, deciding who does and doesn't deserve access to careas I found out, this time around, in my experiences with general practitioners.
The doctor who cluelessly asked about my prostate was, ironically, the doctor who gave me the best advice about subjecting myself to doctor after doctor: You have to prepare yourself to go through this for a long time. By this, I think he meant not only physical discomfort, but the very process of seeking care itself, of dealing with the unpleasant assumptions, of being profoundly disappointed and dismissed.
I finally received a diagnosis when a friend recommended a rheumatologist close to home. His office didnt take insurance, but I was desperate. The doctor himself actually received me on time from the waiting rooma first. He went over my trans-related treatment briefly, but spent nearly all of the appointment directly addressing the actual symptoms I was there to discuss. He determined I have undifferentiated spondyloarthritis, an auto-inflammatory disease that affects the spine, joints, and where tendons and ligaments attach to bone. I will most likely struggle with pain for my entire life, although medications and physical therapy can help. I felt dejected, but grateful to regain a modicum of understanding and control. And I'd found a doctor who made me feel believed.
This should not have taken as long as it did, especially given the amount of specialists I saw. 2016 data suggests around 1.4 million people in the U.S. identify as trans, which means we can bust once and for all the myth that the average American (and doctor) has not met a transgender person. Trans healthcare is no longer a niche business, and with unprecedented media visibility for trans folks this decade, a lack of basic knowledge about trans identities and healthcare needs is more inexcusable than ever.
My doctor didnt specialize in trans healthcare, but he could provide tailored care for my specific body with kindness and respect. Im certain my positive experience at this practice was directly correlated to the fact that I paid out of pocket for the care, a more-lucrative exchange for doctors which subsequently incentivizes a more hands-on approach, but there are things all medical care providers can do to educate themselves and make trans patients feel more welcome.
We cant fix the outdated, for-profit healthcare system overnight, but we can start by advocating for the humanization of disenfranchised patient populations. Practices should prioritize having at least one doctor with some experience treating trans people and have all of their staff take full advantage of free resources about how to offer respectful and effective care, like the University of San Franciscos "Guidelines for the Primary and Gender-Affirming Care of Transgender and Gender Nonbinary People." Healthcare professionals with an online presence can openly list their trans-friendliness in order to help clients find them (and avoid doctors who aren't aware or respectful of trans health). Even seemingly small things, like safe space stickers and LGBTQ health brochures are always appreciated. It is an anomaly for anyone to have reliable access to good healthcare in America, but for trans patients like me, especially ones seeking care for chronic issues, it's, devastatingly, even rarer.
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What is menopause and perimenopause? – The Age
Posted: October 26, 2019 at 2:43 pm
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You have to surrender to it, British comedian Dawn French proclaimed last year of menopause. "I promise that, afterwards, theres life."
Disturbed sleep. Thinning hair. Anxiety. Mood swings. Memory loss. Weight gain. Or, for some women, nothing much at all.
Despite being a fundamental biological transition affecting half the world's population, the symptoms of menopause have been deemed, traditionally, "secret" women's business. Now it's starting to become more a part of the conversation.
In Britain, women are gathering at pop-up "menopause cafes" to swap notes on their experiences. Workplace policies to cater for menopausal employees are up for discussion too: Britain's Labour Party wants to mandate them for large organisations, and a major media company introduced one in October.
What is menopause and what is it with a "peri" in front? What happens to women experiencing it? What happens afterwards? And is there a male equivalent?
On average, a woman in Australia will have 400 to 500 periods in her lifetime. Menopause is when the periods stop. The word itself stems from the Greek pausis ("pause") and men ("month"), meaning the "end of monthly cycles".
Women are on a path to menopause from birth. A baby girl has more than a million eggs in her ovaries. Steadily, as she ages, they deplete. By the time puberty hits, only about 300,000 remain, and so it goes, through her adult life.
[Menopause] represents the end of a womans reproductive life, says Martha Hickey, professor of obstetrics and gynaecology at the University of Melbourne. Specifically, menopause is the final menstrual period a woman experiences it is a one-off event. All women will go through menopause. It is inevitable."
(In a reproductive life spanning decades, the average Australian woman will have two or fewer babies.)
Menopause is considered a normal part of ageing when it happens after the age of 40. But some women can go through menopause early, either as a result of surgery such as hysterectomy, or damage to the ovaries such as from chemotherapy. When menopause happens before 40, regardless of the cause, it is called premature menopause.
The average age of menopause is about 51 but it can happen sooner, with most women experiencing symptoms in the lead-up which brings us to perimenopause.
Comparing notes on perimenopause: there's a lot to talk about. Credit:Illustration: Dionne Gain
Technically speaking, the symptoms women experience in the lead-up to menopause are actually perimenopausal. Peri, a Greek word for "around" or "near" menopause refers to this transitional state.
Perimenopause is when a woman's ovaries begin to make less oestrogen and the body responds. It's a phase that lasts until menopause and, on average, begins when a woman is 47, although it can last from a year to a decade.
As the body makes less oestrogen, the pituitary gland produces higher levels of signalling hormones follicle-stimulating and luteinising hormones in an effort to keep the ovaries producing eggs and to make oestrogen and progesterone levels "normal".
This can lead to ovulation occurring twice in a cycle, the second time during a period, which can lead to high hormone levels. In other cycles, ovulation might not occur at all.
Some women describe perimenopause as a time of hormonal chaos akin to a second-wave puberty. Symptoms also include hot flushes, changes in libido, mood swings, memory problems, vaginal dryness and a higher risk of osteoporosis. Periods can be less regular, lighter or heavier, last longer or be briefer.Womens' experiences vary greatly some barely register anything.
"It's what's called the menopause transition when those symptoms start," Professor Hickey says. "That can go on for a number of years and the end of that transitional period is a year after the final menstrual period."
Genetic factors play some role in timing. If your mother and other close female relatives had an early or late perimenopause, it's likely you will too. But various studies also point to lifestyle factors, such as smoking, being linked to early onset while other studies have pointed to alcohol consumption delaying perimenopause.
Credit:IStock
After a woman has had 12 consecutive months of amenorrhea (lack of menstruation) she is said to be postmenopausal.
Perimenopausal symptoms ease but health risks related to the loss of oestrogen rise. This includes a decrease in bone density, which can lead to osteoporosis, where bones become thin and fragile. It also includes weight gain, which can increase the risk of obesity, diabetes and cardiovascular disease. Women are advised to keep active, which also releases endorphins that improve mood, and to do strength training to increase blood flow and strengthen the heart.
Hormone replacement therapy (HRT), or menopausal hormone therapy (MHT) as it's now known, is currently the most effective type of treatment available for perimenopause symptoms; more than 300,000 Australian women and about 12 million women in Western countries are using it. But it has been linked with breast and ovarian cancers.
"All medications carry risk and benefits," Professor Hickey says. "A benefit of HRT is that it's really good for symptoms. A risk is that it does increase the risk of cancer. I don't think we should beat around the bush about that. But it varies by the type of hormone therapy you take and it might vary depending on how long you take it for."
The risks are greater, for example, for users of oestrogen-progestagen hormone therapy than for oestrogen-only therapy. A large study by the Institute of Cancer Research in London found that women who took hormone therapy for five years were 2.7 times more likely to develop breast cancer than those who did not. Recent research also suggests that, in some cases, the danger can persist for more than a decade after treatment stops.
Another study found that women using hormone therapy for between one and four years have a 60 per cent higher chance of developing breast cancer compared with those who have never used it.
The report's authors, who examined 58 studies across the world, found that of 108,647 women who developed breast cancer at an average age of 65, almost half had used hormone therapy.
When asked if women should avoid hormone therapy due to the increased risk of cancer, Professor Kelly-Anne Phillips, the founder of the Peter MacCallum Breast and Ovarian Cancer Risk Management Clinic, has said the decision should be made on a case-by-case basis.
"Some women will find, short-term, it can help relieve their symptoms," she saidearlier this year.
Professor Phillips warned, however, that women who had been on hormone therapy for a year should have their treatment reviewed, adding there were alternatives for treating symptoms including weight loss, moisturisers for vaginal dryness and avoiding caffeine or alcohol.
The 'grandmother theory" is one explanation for menopause in humans.
Apart from humans, most mammals stay fertile until the ends of their lives. There are a few exceptions: killer whales, short-finned pilot whales, belugas and narwhals can live for decades beyond their reproductive years. Guppies also appear to go through a fish version of menopause.
But long postmenopausal lifespans are an aspect of biology that appears to be at odds with natural selection. Why do women suddenly stop having periods when they still have at least a third of their lives to live, during which they could be producing offspring?
Some experts, including Professor Hickey, believe high death rates of mothers during childbirth throughout history emphasised the importance of grandmothers in rearing future generations, unhindered by more children of their own. This is known as the grandmother theory.
Not really but andropause can affect men older than 40. Andropause is the gradual reduction of the male sex hormone (testosterone) with increasing age. Its symptoms include sexual dysfunction, weakness, fatigue, insomnia, loss of motivation, mood disorders and reduction of bone density. Though the symptoms aren't as severe as those of menopause, they can last for as long as 15 to 20 years.
An egg surrounded by sperm.Credit:Alamy
Although eggs succumb to menopause, pregnancy is still possible using a donor egg. During perimenopause, ovulation can occur, meaning a woman can conceive naturally, even if she is using hormone therapy.
When UK based former magazine editor Lynnette Peck and her friend Paula Fry first began to experience symptoms of perimenopause they found they had no safe space to share their feelings on the matter. In a bid to open up dialogue, they started a secret Facebook page in 2017.
Word got around quickly. Soon they had more than 700 members and then Feeling Flush was born; a public online community for women across the world to connect.
"We wanted women, including ourselves, to have places to share information and educate each other and have a moan," Ms Peck says.
"Women mostly ask us about hormone replacement therapy and the pros and cons. We are not medical experts so we point them to people who are. There is now a conversation. It was hidden before. Here in the UK, even political parties and huge brands are getting involved."
Professor Hickey notes that women make up almost half of the workforce in Australia and two-thirds of the voluntary sector. They continue to look after children across generations and are often the primary carer for parents.
Our society has a big a focus on youth and the preservation of youth and menopause is a maker of age in women and ageing in women is not a topic we still have very much discussion about," Professor Hickey says.
"It's quite likely that women who experience menopause may not have been informed fully about what to expect. It's quite possible a lot of men don't know very much about menopause at all."
Last week, British free-to-air television Channel 4 launched a menopause policy to support women experiencing perimenopausal symptoms such as hot flushes, anxiety and fatigue by giving them access to flexible working arrangements and paid leave if they feel unwell.
It's a shift Professor Hickey wants in Australia. She would like to see menopause treated as a "diversity issue" with workplaces actively supporting women experiencing it.
"Pregnancy would be a similar example: only women get pregnant, and we've learnt to adapt, and I think we need to take a similar perspective to menopause."
Melissa Cunningham is The Age's health reporter.
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LDS Church says proposed ‘conversion’ ban would silence therapists, but its motives are under fire – Salt Lake Tribune
Posted: October 26, 2019 at 2:43 pm
The Church of Jesus Christ of Latter-day Saints is pressuring state regulators to punt a proposed ban on conversion therapy for minors back to Utah lawmakers, or change it so that therapists can keep counseling young clients about putting religious convictions over sexual identity.
The church has a certain view about what is right and good with respect to gender and sexuality, and so its really hard for me to believe that amendments such as these would not be interpreted by some clinicians as license to continue pushing their particular version of health and well-being on vulnerable youth, said Lisa Diamond, a professor of psychology and gender studies at the University of Utah.
The Utah Psychological Association also opposes the churchs suggested rule alterations, saying that they are inconsistent with peer-reviewed science and in violation of the American Psychological Associations ethics code. The conversion therapy ban under consideration would not infringe on self-determination, parental rights or religious freedoms, wrote Nanci Klein, the associations director of professional affairs.
The rule would do nothing more than regulate the practice of mental health therapy by prohibiting licensed mental health professionals from subjecting minors to an unnecessary, ineffective, and life-threatening practice, Klein wrote in an email.
So Troy Williams, executive director of Equality Utah, said he hopes state regulators dont comply with the churchs request to kick the issue back to lawmakers.
I dont know whats going to happen," he said, but I hope science prevails over politics.
The church released its opposition to the rule, as written, in a short news release Tuesday. Its Family Services, which offers mental health and other counseling, submitted a more formal statement to state officials expounding on concerns that the rule as drafted is too broad and would fail to protect religious beliefs.
About 250 therapists with Family Services work with 28,000 clients in Utah each year, the networks letter states. Seeing one of these therapists requires a referral from a congregational leader (a bishop or branch president), a stake president (a regional leader) or a mission president, and the typical client is looking for counseling that respects and accounts for their religious identity and personal faith goals.
Family Services has prohibited therapies seeking to change sexual orientation and supports protecting children and youth from abusive conversion therapy practices," according to the correspondence. However, the lengthy letter enumerates a number of objections to the current proposals wording, including language crafted to protect transgender youths from conversion techniques.
The church expresses concern that the drafted rule would prevent therapists from encouraging young people to adopt a wait-and-see approach before pursuing gender transition. The letter also takes issue with proposed language restricting mental health professionals from trying to change presentation and behaviors" expressing aspects of gender.
[I]t is easy to imagine numerous dysfunctional presentations and behaviors that express aspects of gender, such as extremes in dress, grooming, language and sexuality, states the letter, addressed to a DOPL representative.
For instance, discussing a topic such as toxic masculinity might be off-limits for a therapist, the church posits.
To a lesser degree, the church outlined the same problem with the proposed wording on sexual orientation, arguing that it is overly broad and could mute conversations about pornography addiction, abstinence and integrating religious values with other aspects of life.
Major medical and mental health groups in the state spoke in favor of the proposed rule during a lengthy public hearing last month, saying restricting conversion therapy could save lives by protecting youths from a practice linked to suicide and depression.
Research shows more than 60% of LGBT youths who go through conversion therapy attempt suicide, Klein noted.
But some therapists say they can see where the church is coming from.
Julie de Azevedo Hanks, a therapist with Wasatch Family Therapy who is a Latter-day Saint, said she can appreciate the churchs concerns but does not share them herself. The rule language, in her view, would not stifle conversations with a teen whos addicted to gay pornography or other sex-related issues.
The problem isnt that hes looking at gay pornography. Its that he is looking at pornography many hours a day, said Hanks, whos also an assistant professor of social work at Utah Valley University. And you treat that behavior. It has nothing to do with whether its gay or straight.
David Matheson, a former conversion therapist who recently came out as gay, said he also has problems with the ban now under consideration. The current language fails to reflect the complexities of sexual fluidity and gender identity, he said, and would act as a blunt instrument where nuance is needed.
Theres a lawyer now sitting in the therapists office, and he doesnt belong there, said Matheson, who still works as a therapist but has disavowed his past conversion efforts.
He did, however, explain that he disagrees with the churchs doctrines and policies on LGBTQ people, which he called inhumane.
Diamond said these positions throw into question the churchs credibility on the topic of conversion therapy. And while the churchs letter condemns conversion tactics using electric shock and nausea, researchers have found the techniques that cause most harm to gay youths involve prayer, she said.
Because youre asking God to help you. And then nothing happens, and you feel like, Oh, God has forsaken me, she said. So when we think about the harm of conversion therapy, we have to remember that harm doesnt just come from having somebody shock you. Harm comes from receiving and internalizing the message that there is something fundamentally wrong about you.
Therapists who follow the ethical guidelines for their profession have no reason to fear that the proposed DOPL rule will curtail their freedom during counseling sessions, she said.
Gayle Ruzicka, president of the Utah Eagle Forum and an ardent opponent of the current proposal, disagrees and says the measure would infringe on both parental and personal rights. Teens who are questioning their sexual or gender identities should have access to therapy that conforms with their religious beliefs, she said.
Its a parents right for their children and our right as individuals," she said, to be able to express ourselves and get the therapy that we want.
Matheson argues that gender dysphoria extreme discomfort because of a discrepancy between peoples assigned gender and the one they identify with subsides for many people who experience it in childhood and that therapists should be allowed to proceed with caution with these clients.
Therapies that encourage transitioning may be enforcing a lifelong change on a childhood issue somewhat like forcing a child to grow up to be an astronaut because thats what they wanted to be when they were 7, Matheson wrote in an email.
Diamond, on the other hand, says this wait-and-see approach would not fall under the conversion therapy ban and is standard therapeutic practice.
Its not like the average therapist is encouraging children ... to identify as trans as early as possible, she said. This field is extraordinarily cautious, because were aware of how complicated development is.
Sue Robbins, board chairwoman for Transgender Advocates of Utah, said hormone replacement therapy and sex reassignment surgeries are typically done later in life, and minors more often use hormone blockers to put a pause on puberty. The blockers give young people time to work through their feelings on gender identity, she said.
While the churchs letter speaks about the likelihood that gender confusion or dysphoria in children will fade over time, Robbins said only a tiny percentage of people who transition pursue a reversal and those few often do so because of discrimination rather than a change of feeling.
"It's all about going back into the closet," Robbins said.
The proposed changes suggested by the church would leave children vulnerable to nonaffirming therapy based on junk science, Robbins said.
LGBTQ advocates had negotiated the legislation with the churchs attorneys and public affairs office and landed on language that representatives of the Utah-based faith agreed not to oppose, Williams said. He said the proposed rule would have the same effect as the legislation negotiated with the church, and hes not sure why Family Services now objects.
I was surprised and disappointed to see a 26-page rebuttal of what we had worked so hard on, he said.
DOPL denied a request for an interview, but officials have said the rule could take effect Tuesday at the earliest. However, the agency could also take the rule back to any of its licensing boards if it believes public input warrants further review, according to an agency spokeswoman. Public notice would be required if the agency changes the proposed language.
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Love Synth Pop? Thank Wendy Carlos, the Trans Woman Who Invented It. – NewNowNext
Posted: October 26, 2019 at 2:43 pm
by Sam Manzella 10/25/2019
Its impossible to imagine contemporary popular music without the synthesizer. The instrument, which generates audio signals that are then converted to sound, pervades almost every modern musical genre. Pop, dance pop, hip-hop, EDM, experimentalif its based in electronica, it can be traced back to the invention of the commercial synthesizer. And yes, that includes most of the LGBTQ artists who comprise your going-out (or broody staying-in) playlists (Kim Petras or Sophie, anyone?)
But behind its familiar (though still seemingly out-of-this-world) sounds is a name you may not recognize: Wendy Carlos, an accomplished musician, recording engineer, and transgender woman whose forward-thinking use of synths helped make them ubiquitous.
Carlos, now almost 80 years old, has two Ivy League degrees, three Grammy Awards (all for her 1968 classic Switched-On Bach), and a handful of critically acclaimed film scores (for 1971s A Clockwork Orange and 1980s The Shining, among others) under her belt. Her rise to fame in the music industry began in New York City. After graduating from Columbia University with a masters degree in music composition in the 1960s, a 20-something Carlos worked alongside electronic music innovators and Columbia professors like Vladimir Ussachevsky and Otto Luening.
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There, she also met Robert Bob Moog, a fellow audio engineer and the namesake of the Moog synthesizer, a classic analog version of the instrument. The two became fast friends, and their working relationship spanned some 40 years.
It was a perfect fit, Carlos recalled in a blog post dedicated to Moog in 2005, after the 71-year-old synth pioneer died of cancer. He was a creative engineer who spoke music; I was a musician who spoke science. It felt like a meeting of simpatico minds, like he were my older brother, perhaps.
In 1964, Moog debuted his bespoke synthesizera smaller, more portable version of the hulking wall-to-wall synths that most audio technicians and recording engineers usedat NYCs annual Audio Engineering Society (AES) convention. It would graduate to become the worlds first commercial synthesizer, and Carlos would use it to record Switched-On Bach, an electronic reimagining of Johann Sebastian Bachs classical compositions. The triple-Grammy-winning classical music recordwhich sold a record-breaking 1,000,000 copiesis widely credited with meshing popular music and synths together. (Before Switched-On Bach, the instruments were mostly relegated to more experimental, less commercially successful music.)
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Her prestigious honors aside, Carlos was struggling. In fact, shed been struggling with gender dysphoria since childhood, and she began to feel hopeless and suicidal in college.
It wasnt until 197910 years after shed swept the Classical Musical categories at the 1969 Grammysthat she came out publicly as transgender in a Playboy magazine interview. Carlos recalled how shed felt too anxious to perform live once she began hormone replacement therapy (HRT) and had initiated her physical transition in secret. But she could no longer deny who she was. When Playboy asked if she had any idea what wouldve happened if she hadnt begun to live her life as a woman, Carlos was frank: Yes. Id be dead.
The magnitude of her announcement then is difficult to overstate. In 2019, in an era when trans issues are addressed explicitly by presidential hopefuls on the Democratic Party debate stage, an industry pioneer coming out in a mainstream magazine is cause for celebration. In 1970s America, it was not only unheard-of, but a potentially career-ending move (not to mention dangerous). The cultural conversation around transgender acceptance, much less transgender equality, was still burgeoning in LGBTQ spaces; it barely existed in cisgender, heterosexual circles.
Since her initial coming out, Carlos has rarely addressed her gender identity in interviews. (She declined to be interviewed for this story.) That may have something to do with the way her story has been told. In 1979, Playboy asked her some pretty invasive, if not genuinely curious, questions. Even after she discussed her transition in great detail, reporters and editors continued to print her deadname. But in one 1985 article in People, Carlos said she hit her stride in composing new music after opening up publicly about who she really was. The burden had been lifted; it was time to create.
The public turned out to be amazingly tolerant or, if you wish, indifferent, she told the magazine. There had never been any need of this charade to have taken place. It had proven a monstrous waste of years of my life.
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Carlos candor at a time when transness or gender nonconformity wasnt even on most Americans radars paved the way for a generation of LGBTQ electronic artists to come. Decades after Switched-On Bach, the Tron soundtrack, and her other contributions to 70s and 80s synth music, a new wave of queer musicians can make the kind of songs and albums they envision and love without their identities holding them back.
One of those artists is Kiran Gandhi, a.k.a. Madame Gandhi, a Los Angelesbased electronic music artist and activist who credits Carlos with changing the game for marginalized people in electronic music.
Usually, we imagine the analog synth community as a very homogenous community, she tells NewNowNext. But for Gandhia queer woman of color whose songs like The Future is Female and Top Knot Turn Up are meant to empower marginalized peoplediscovering Carlos pivotal role in the popularization of synth music was so inspiring, and such a relief. It made her want to pick up the instrument that much more.In 2018, Gandhi performed at Moogfest, an annual gathering for synth enthusiasts and music industry professionals that takes place in North Carolina, where Bob Moog spent the last 30 years of his life. She was joined onstage by a lineup of other electronic musiciansall women or gender-nonconforming peoplein honor of Carlos and Switched-On Bachs 50th anniversary.
Gandhi was thrilled that Moogfests organizers hosted a tribute to Carlos, but she was especially grateful that they paid homage to her transnessa fact she was unaware of before the event.
[Wendy Carlos] made folks who are booking festivals more intentional about reaching out to gender-nonconforming folks and queer folks and women in a way that I dont think would have happened had she not been one of the biggest contributors to electronic music, she says. So this shiftactually putting Wendy Carlos on the mapmade us musicians more open-minded to say, Oh, wow, this genre is actually not what we thought it was. Its something else. And thats really freaking cool.
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