HEALTH Attempted Suicide Rates More Than Double After Gender-Reassignment Surgery: Study

Plain Jane

Just Plain Jane

Attempted Suicide Rates More Than Double After Gender-Reassignment Surgery: Study​


BY TYLER DURDEN
TUESDAY, APR 02, 2024 - 07:20 PM
Rates of attempted suicide who identified as transgender more than doubled after receiving a vaginoplasty (surgically turning one's dick into a vagina), according to a peer-reviewed study published in The Journal of Urology.
(Teeradej/Shutterstock)
The study looked at rates of psychiatric emergencies both before and after gender-altering surgery among 869 males who went under the knife, and 357 females who underwent phalloplasty (turning one's vagina into a dick) in California between 2012 and 2018.

While researchers found that rates of 'psychiatric emergencies' were high both before and after gender-altering surgery, suicide attempts were markedly higher among those who received vaginoplasties, the Epoch Times reports.

"In fact, our observed rate of suicide attempts in the phalloplasty group is actually similar to the general population, while the vaginoplasty group’s rate is more than double that of the general population," wrote the author of the study.

Among the 869 patients who underwent vaginoplasty, 38 patients attempted suicide—with nine attempts before surgery, 25 after surgery, and four attempts before and after surgery. Researchers found a 1.5 percent overall risk of suicide before vaginoplasty and a 3.3 percent risk of suicide after the procedure. Almost 3 percent of those who attempted suicide after undergoing vaginoplasty did not present with a risk of suicide prior to surgery.
Among the 357 biologically female patients who underwent phalloplasty, there were six suicide attempts with a 0.8 percent risk of suicide before and after surgery. -Epoch Times
Aside from suicide attempts, the study found that the proportion of those who experienced an emergency room and inpatient psychiatric encounter was similar between the two groups - with 22.2% of vaginoplasty and 20.7% of phalloplasty groups experiencing at least one psychiatric encounter.

According to the study, 33.9% of biological males undergoing vaginopasty would experience a post-surgery psychiatric encounter vs. 26.5% for biological women who underwent phalloplasty, if an episode had occurred before surgery.

That's a lot.

As the Epoch Times notes further:

Suicide Rate 19-Fold Higher​

In an interview with The Epoch Times, Dr. Alfonso Oliva, a board-certified plastic and reconstructive surgeon, said research into the psychiatric outcomes and long-term follow-up of those who have sex-reassignment surgery is lacking, but an important paper is worth mentioning. In a 2011 paper published in PLOS ONE, researchers found that people who underwent sex reassignment surgery had substantially higher rates of overall mortality, suicidal behavior, and psychiatric morbidity compared with the general population.
It’s hard to refute this paper because it’s a longitudinal study,” Dr. Oliva said. “In Sweden, everyone is in a database, and through diagnosis codes, they’re able to follow what happens to every citizen in terms of their medical history. They waited more than 10 years after people had surgery and found that death by suicide had an adjusted hazard ratio of 19.1.”

You can “quibble” about emergency room encounters, but this study shows that for patients who had transgender surgery, their suicide rate after 10 years was 19-fold higher than the general population, Dr. Oliva said. Additionally, the study excluded people with psychiatric illnesses, so these are individuals thought to have no psychiatric illness outside of dysphoria.

Surgical Procedures​

A phalloplasty is a multistep process undertaken by a biological female who wants to transition to a male, where a penis is created using tissues from the genitals and forearm or thigh. The external genitals, such as the labia or outer labia, are used to create a scrotum, and testicular implants are inserted months later along with an implant that will cause erections.
Vaginoplasty is the most commonly performed gender-reassignment surgery for those with gender dysphoria, with more than 3,000 procedures performed annually. According to Johns Hopkins Medicine, vaginoplasty is a surgical procedure that involves removing the penis, testicles, and scrotum to create a vulva and functional vagina. Surgeons typically create a vaginal canal using the skin surrounding the existing penis and scrotum or by using a skin graft from the abdomen or thigh.

A penial inversion is the most commonly performed procedure where the skin is removed from the penis and inverted to form a pouch that is inserted into the vaginal cavity created between the urethra and the rectum. Surgeons then partially remove, shorten, and reposition the urethra and create a labia majora, labia minora, and clitoris.

Another surgical method involves using a robotic system that enables surgeons to reach into the body through a small incision in the belly button to create a vaginal canal. The type of vaginoplasty performed varies among patients. For example, younger patients who have never experienced puberty may have insufficient penile skin to do a standard penile inversion.

“When you take a child who’s about to undergo puberty—and they suggest giving puberty blockers to stop puberty at age 10 to 11 1/2—and when you do that for little boys, they aren’t able to get tissue from the penis and scrotum, so creating a vagina is very difficult,” Dr. Oliva told The Epoch Times. “You have to use tissue from other areas of the body, such as the peritoneum or the colon. Some researchers in Brazil are actually looking into using tilapia fish,” he added.

After a vaginoplasty is performed, the recovery process is extensive and vaginal dilation must be performed at varying intervals throughout the patient’s life.

Vaginoplasty Associated With Serious Risks​

In addition to an increased risk of suicide, vaginoplasty is associated with numerous physical complications, including wound separation, vaginal stenosis, hematoma, rectovaginal fistulas, granulation tissue, bleeding, infection, skin or clitoral necrosis, suture line dehiscence (when the surgical incision opens), urinary retention or vaginal prolapse.
According to a 2021 paper in the International Brazilian Journal of Urology, a rectovaginal fistula is the “most devastating complication” of a vaginoplasty that can occur “despite careful technique” and without obvious injury to the rectum.

A rectovaginal fistula is an abnormal connection between the rectum and vagina that can cause fecal incontinence, hygiene issues, vaginal or anal irritation, and potentially life-threatening abscesses and fistula recurrence.

A 2021 review in Andrology found that rates of complications following penile inversion vaginoplasty ranged from 20 to 70 percent, with most of the complications occurring during the first four months following the procedure.

In a 2018 Clinical Anatomy review and meta-analysis, researchers reviewed 125 articles to assess neovaginal complications following surgery. After selecting 13 studies that included 1,684 patients, they found a complication rate of 32 percent, with a reoperation rate of 22 percent for non-esthetic reasons.

“For cosmetic surgery, if the complication rate was more than 2 percent to 3 percent, you wouldn’t have any patients,” Dr. Oliva told The Epoch Times. “These are very high percentage rates that we just accept.”

Dr. Oliva said complications with these surgical procedures are very high and he thinks this is why suicide rates are so high.

People think this is going to solve the problem and it doesn’t,” he said.

A June 2018 paper on postoperative outcomes of 117 patients who underwent vaginoplasty published in the Journal of the American Society of Plastic Surgeons found that 26 percent of patients experienced granulation tissue, 20 percent had intravaginal scarring, and 20 percent experienced prolonged pain.

In a 2017 paper published in The Journal of Urology, researchers followed patients who underwent penile inversion vaginoplasty. Of 330 patients, 95 (29 percent), presented with postoperative complications. Three of those patients developed a rectoneovaginal fistula, and 30 patients required a second operation.

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In a 2016 study published in Urology, researchers retrospectively reviewed clinical records of 69 patients who underwent vaginoplasty from January 2005 to January 2015. Although complications during surgery were not reported, 22 percent of patients experienced major postoperative complications.

“We’ve been transitioning adults in the United States since 2007, but where’s the data from gender identity clinics? Why is nothing published in the United States about long-term function? Why do we have nothing published on sexual function? We should be able to follow that and should be studying it and we’re not,” Dr. Oliva told The Epoch Times.


View: https://twitter.com/MattWalshBlog/status/1774549470702711177?ref_src=twsrc%5Etfw%7Ctwcamp%5Etweetembed%7Ctwterm%5E1774549470702711177%7Ctwgr%5E785fb2e988f2146ffca50588e9b37931d69c33d0%7Ctwcon%5Es1_&ref_url=https%3A%2F%2Fwww.zerohedge.com%2Fmedical%2Fattempted-suicide-rates-more-double-after-gender-reassignment-surgery-study
 

kyrsyan

Has No Life - Lives on TB
I'm not shocked although it makes my heart hurt. Some people become obsessed about gender being the source of their problem. And then after surgery, they discover that gender wasn't the issue. Some can move forward and deal. A lot can't because they were so wrapped up in the idea that their problems would go away when their sex changed.
 

Plain Jane

Just Plain Jane
It will be fascinating to see statistics about females who got bottom surgery. They have to give up part of the arm muscle to form the phallus and they also have to do the dilation frequently.
 

WalknTrot

Veteran Member
It will be fascinating to see statistics about females who got bottom surgery. They have to give up part of the arm muscle to form the phallus and they also have to do the dilation frequently.
And the guys who had a fake vagina "imposed" have an infection-prone, poorly healing open wound (and also never ending dilation) for life.

The malpractice lawsuits within 10 years are going to be epic. And this decade will be an historical example of professional ethics gone missing- right up there with the German Nazi medical experiments.
 

CaryC

Has No Life - Lives on TB
And the guys who had a fake vagina "imposed" have an infection-prone, poorly healing open wound (and also never ending dilation) for life.

The malpractice lawsuits within 10 years are going to be epic. And this decade will be an historical example of professional ethics gone missing- right up there with the German Nazi medical experiments.
Just for consideration: there won't be an epic amount of law suits. Reason: The government will impose immunity. Can't be having all of our trendy doctors being sued and thus upping the cost of the change. Similar to not charging abortion doctors with murder. Might loose some doctors. It will fall under the "you elected to have this surgery, don't blame me" clause.
 

PghPanther

Has No Life - Lives on TB
"Trans people are strong and brave, also if you use a pronoun they don't like they might kill themselves and it will be your fault"

I can't ever recall ever encountering a transgender person in my life.......or if I did I wouldn't really know if they really were .......and/or what they were or begin with to know what to call them anyway.

Maybe if they are so offended by my ignorance of their situation we just shouldn't do much in the way of mixing in society..........its seems its that way to begin with or else I'd be familiar with all this to begin with.

As it is.....I only see and hear about this stuff in the media and never experience it in my day to day life.

They way I see it ..........if you have a dick with no hips you were born a male no matter how much hormones, breast surgery, make up and hair extensions you use in an attempt to say otherwise.
 
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Toosh

Veteran Member
These poor people need help. Instead they have been used as useful idiots by people pushing a political narrative. I often wonder about those family and friends, silenced/censored by social media, who are left feeling, "Should I have spoken out?"
 

Housecarl

On TB every waking moment
Simple psych rule of thumb... if you can't be alone with your self and look out for your own best interests, then no amount of external changes are going to magically "satify" that need. SIGH.

That rule of thumb seems to have fallen out of fashion in the mental health community.

And apparently is both politically/ideologically and fiscally driven.
 

JMG91

Veteran Member
These poor people need help. Instead they have been used as useful idiots by people pushing a political narrative. I often wonder about those family and friends, silenced/censored by social media, who are left feeling, "Should I have spoken out?"
Yup. Many of them have mental issues related to physiological problems, IMO. Someone on this board recently posted a video of a woman was detransitioning, and she discovered after mutilating herself—and deciding to visit a naturopath—that she was able to cure her mental problems by fixing physical ones. I’m assuming it was most likely a combo of nutrient deficiency and unbalanced hormones; these two things will do terrible things to a person.
 

ainitfunny

Saved, to glorify God.
Nothing compels me to ENTER YOUR UTTER MADNESS.
I am sane and you are not. And if it appears to me that you are a male, Then i might address you as "Sir" , if that causes you to commit suicide, the cheese has already slipped from your cracker, and I feel NO GUILT FOR THAT.
 

Doc1

Has No Life - Lives on TB
I'm not shocked although it makes my heart hurt. Some people become obsessed about gender being the source of their problem. And then after surgery, they discover that gender wasn't the issue. Some can move forward and deal. A lot can't because they were so wrapped up in the idea that their problems would go away when their sex changed.

Except that their sex never did change. All they did was go through a series of cosmetic - and rather superficial - plastic surgeries and have hormone treatments. None of this changes their biological sex in the slightest. IOW the surgeries affects less than one percent of their total body mass and leaves them incapable of performing the biological functions of their chosen gender.

The transgender men cannot father children and the transwomen cannot conceive and deliver children. It's a cruel joke to play on people who are demonstratively mentally ill and doctors who endorse and perpetrate these surgeries should have their licenses revoked...after they are publicly horsewhipped!

Best
Doc
 

Griz3752

Retired, practising Curmudgeon

Attempted Suicide Rates More Than Double After Gender-Reassignment Surgery: Study​

How about making sure these surgical candidates are offered a way out their "issues" as part of the initial consultation??

Has to be way more cost effective than providing expensive surgeries and then still having to provide the follow on consultation/treatments.
 

Plain Jane

Just Plain Jane
How about making sure these surgical candidates are offered a way out their "issues" as part of the initial consultation??

Has to be way more cost effective than providing expensive surgeries and then still having to provide the follow on consultation/treatments.
Good Heavens! Big Pharma would lose a lifelong dependent customer! sarc
 

jward

passin' thru
You reposted
Ryan Saavedra
@RealSaavedra

Psychologist Jonathan Haidt on why he says social contagion is behind the surge in the number of cases of people claiming to be transgender: "Because it happens in clusters of girls, it happens in clusters of girls who had no previous gender dysphoria when they were young."

HAIDT: So there’s very important, older research by Nicholas Christakis and, James Fowler where they looked at, they had gigantic health data sets, the Framingham Heart Study, and they were able to see that, you know, if one person takes up smoking, their friends are more likely to take up smoking, but actually, so are their friends friends and even friends, friends, friends. So the things we do spread out through social network. We affect each other. Now it turns out, when you’re looking at emotions, girls and women, when they study women, when a woman is depressed, that spreads out to her network. Whereas when a man is depressed, it doesn’t. Women talk about their feelings. They’re more connected in that way. Girls are connecting on social media, where it just turns out in many communities, the more anxious and depressed you are, the more you get support. The more extreme your symptoms, the more you get likes and followers. You know, of course it’s good to destigmatize social, mental illness. We don’t want people to be ashamed. But boy, is it a terrible idea to valorize it, to tell young people, ‘You know what? The more you have this, the more popular you’ll be, the more support you’ll get.’ And so you get this explosion, not just of anxiety – anxiety is in part, I think, spread sociogenically, it’s called, from social causes, not from internal causes – but we get it for dissociative identity disorder. And it seems to be the case for gender dysphoria as well.

HOOVER: And you think that the data demonstrates that it is above and beyond just the phenomenon of coming out and increased awareness?

HAIDT: Yes. Because it happens in clusters of girls. It happens in clusters of girls who had no previous gender dysphoria when they were young. So it’s very different from the kinds of gender dysphoria cases that we’ve known about for decades. I mean, it is a real thing. But what happened, especially when girls got, was YouTube and Instagram early, but then especially TikTok, girls just, you know, girls get sucked into these vortices and they take on each other’s purported mental illnesses.
View: https://twitter.com/RealSaavedra/status/1774229750409498900?s=20
 

jward

passin' thru
You reposted
Jonathan Haidt
@JonHaidt

A review in Nature, by @candice_odgers, asserts that I have mistaken correlation for causation and that “there is no evidence that using these platforms is rewiring children’s brains or driving an epidemic of mental illness.” Both of these assertions are untrue.


@zachmrausch and I have been collecting the published studies on both sides since 2019, organizing them, and making them available for public viewing and commenting, in multiple Google docs available here:

In the “social media and mental health” doc, we currently list 22 experimental studies (16 of which found significant evidence of harm) and 9 quasi-experiments (8 of which found evidence of harm. Odgers cited only the 9th one.) We also examine the many meta-analyses and review papers. I lay out the evidence for causality (not just correlation) and walk the reader through the Google doc in this post at After Babel:

People really need to stop saying that the evidence is “just correlational.” Sure, there are a lot of correlational studies (79 in our Google doc, of which 64 found significant correlations with variables related to poor mental health.) But there are also many experiments supporting my claims of causation.

I’ll write a post at After Babel | Jon Haidt | Substack in April responding more fully to the arguments of the skeptics (including Odgers). For now, I point interested readers to a post in which I laid out 6 problems with the way that the skeptics have conceptualized the debate:

I just want to note two more problems with Odgers’ review.

First: She says that I am offering a simplistic one-factor explanation: it’s social media! But I am not. My story is about two major factors (end of the play-based childhood, rise of the phone-based childhood), each of which has many components that bring a variety of harms to different children in different ways. My book is full of lists of causal pathways. There is no one causal pathway that, on its own, explains “the kind of large effects suggested by Haidt.” Yet when you add up all the different ways that the phone-based childhood is harming different kids, some of which we learned about in that Senate hearing on January 31, you end up with a lot of kids being harmed in many ways, and these many harms combined can easily explain the “large effects” even though most pathways affect only a subset of kids.

Yet Odgers and the other skeptics focus intently on studies that operationalize social media in one crude way (total # of hours per day), and then correlate that number with some measure of anxiety, depression, or other mental ailment. When the correlations turn out to be around r = .15 for girls (which is actually a number we agree on, as I explain in the previous link), the skeptics conclude that this is not large enough--by itself--to explain the epidemic, so social media must be only a trivial contributor to the epidemic. This is an error caused by an overly narrow operationalization of a complex phenomenon: the radical transformation of daily life that happened for teens between 2010 and 2015. Only a sliver of the story is captured by the crude measure of “hours per day” on social media.

The skeptics’ skepticism would be more compelling if they had an alternative explanation for the multi-national decline in mental health that happened in the early 2010s, but they do not. Odgers claims that the “real causes” of the crisis, from which my book “might distract us from effectively responding,” are the lingering effects of the 2008 Global Financial Crisis, which had lasting effects on “families in the bottom 20% of the income distribution,” who were “also growing up at the time of an opioid crisis, school shootings, and increasing unrest because of racial and sexual discrimination and violence.”

I agree that those things are all bad for human development, but Odgers’ theory cannot explain why rates of anxiety and depression were generally flat in the 2000s and then suddenly shot upward roughly four years after the start of the Global Financial Crisis. Did life in America suddenly get that much worse during President Obama’s 2nd term, as the economy was steadily improving?

Her theory also cannot explain why adolescent mental health collapsed in similar ways around the same time in Canada, the UK, Australia, and New Zealand, as Zach and I have shown:

Nor can she explain why it also happened in the Nordic countries, which lack most of the social pathologies on Odgers’ list:

Nor why it also happened in much of Western Europe:

Nor why suicide rates for Gen Z girls (but not alway boys) are at record levels across the Anglosphere:

I just can’t see a causal path by which America’s school shootings, lockdown drills, inequality, or racism caused girls in Australia to suddenly start self-harming or dying by suicide at the same time as American girls.

In short: There is a great deal of evidence for my claims that something terrible is happening to teens in many countries, and that a major contributing factor is the sudden international arrival of the phone-based childhood. I lay out this evidence––with hundreds of footnotes––in chapters 1, 5, 6, and 7 of The Anxious Generation. I have also laid it out in many posts at After Babel | Jon Haidt | Substack. All along, Zach and I have “shown our work” in public Google Docs and Substack posts, and we have invited others to critique it. Zach has made supplemental files for every chapter in The Anxious Generation, which give links to the datasets and data points that he used to create the graphs in the book. We invite you to check our work:


Our work has benefited from cordial, normal, academic debates with the skeptics. We will continue to welcome their critiques. But please, everyone, stop saying that the evidence is “just correlational.”

5:57 PM · Mar 31, 2024
1.5M
Views
 

Matt

Veteran Member
Face it these people have serious mental issues and they will never be happy even with a few years of psychotherapy help.
Agreed!.... these people are broken... not capable of being fixed.

Why do we as a society, insist on prolonging the misery of everyone by keeping the unsalvageable around.... stop narcaning the junkies, stop putting the frequent fliers on probation, stop catering to the morally depraved child phuckers and other sexual deviants....
 

Plain Jane

Just Plain Jane

15 Year Study: Vast Majority Of Children Grow Out Of Gender Confusion​


BY TYLER DURDEN
THURSDAY, APR 04, 2024 - 09:05 AM
Authored by Steve Watson via Modernity.news,
A landmark study conducted over the past 15 years has concluded that most children who experience confusion regarding their gender identity grow out of it and go on to feel content with their lives as men and women.


The study, carried out in the Netherlands by researchers from the University of Groningen, involved more than 2,700 children, tracking them from age 11 to their mid-twenties.


The Daily Mail reports that every three years, the individuals were asked how they felt about their gender.

At the beginning of the study, around 11 percent, or one in ten of the children, expressed ‘gender non-contentedness’.

However, by the age of 25, just 4 percent, or one in 25, said they ‘often’ or ‘sometimes’ felt discontent with their gender.

The study comes as the controversy over allowing children to be given puberty blocking hormones, or even gender reassignment surgery, rages on.

View: https://twitter.com/ModernityNews/status/1775592750819283346?ref_src=twsrc%5Etfw%7Ctwcamp%5Etweetembed%7Ctwterm%5E1775592750819283346%7Ctwgr%5Ee1403ade743958847e11a6a98d731bc73a38e9ee%7Ctwcon%5Es1_&ref_url=https%3A%2F%2Fwww.zerohedge.com%2Fmedical%2F15-year-study-vast-majority-children-grow-out-gender-confusion


The researchers noted, “The results of the current study might help adolescents to realise that it is normal to have some doubts about one’s identity and one’s gender identity during this age period and that this is also relatively common.”


Published in the journal Archives of Sexual Behavior, the study found that around 19 percent became more content with their gender over 15 years, while just 2 percent became less comfortable. Overall, 78 percent felt the same.

The authors further noted that “Gender non-contentedness, while being relatively common during early adolescence, in general decreases with age and appears to be associated with a poorer self-concept and mental health throughout development.”

Patrick Brown, a fellow at the conservative Ethics and Public Policy Center noted “This study provides even more reason to be skeptical towards aggressive steps to facilitate gender transition in childhood and adolescence.”

Brown added, “The fact that rates of satisfaction are lower even just a few years later suggests that for the vast majority of people, prudence and caution, rather than a rush towards permanent surgeries or hormone therapies, will be the best approach for teenagers struggling to make sense of the world and their place in it.”

A recent report by health data analytics firm Definitive Healthcare revealed that the rate of gender dysphoria increased in every state in America except South Dakota from 2018 to 2022 across all ages.

In some states it has increased by over 200 percent in just four years.

View: https://twitter.com/TheChiefNerd/status/1745441348788887961?ref_src=twsrc%5Etfw%7Ctwcamp%5Etweetembed%7Ctwterm%5E1745441348788887961%7Ctwgr%5Ee1403ade743958847e11a6a98d731bc73a38e9ee%7Ctwcon%5Es1_&ref_url=https%3A%2F%2Fwww.zerohedge.com%2Fmedical%2F15-year-study-vast-majority-children-grow-out-gender-confusion


Since 2014, there has been an explosion in young adults identifying as transgender:


View: https://twitter.com/jean_twenge/status/1653792270653751297?ref_src=twsrc%5Etfw%7Ctwcamp%5Etweetembed%7Ctwterm%5E1653792270653751297%7Ctwgr%5Ee1403ade743958847e11a6a98d731bc73a38e9ee%7Ctwcon%5Es1_&ref_url=https%3A%2F%2Fwww.zerohedge.com%2Fmedical%2F15-year-study-vast-majority-children-grow-out-gender-confusion


This has gone hand in hand with a massive increase in transgender surgeries and so called ‘gender affirming care’.

View: https://twitter.com/jackmolay/status/1694667753792078280?ref_src=twsrc%5Etfw%7Ctwcamp%5Etweetembed%7Ctwterm%5E1694667753792078280%7Ctwgr%5Ee1403ade743958847e11a6a98d731bc73a38e9ee%7Ctwcon%5Es1_&ref_url=https%3A%2F%2Fwww.zerohedge.com%2Fmedical%2F15-year-study-vast-majority-children-grow-out-gender-confusion
 

JMG91

Veteran Member
How about making sure these surgical candidates are offered a way out their "issues" as part of the initial consultation??

Has to be way more cost effective than providing expensive surgeries and then still having to provide the follow on consultation/treatments.
That’s what the medical establishment wants. They make a killing off of these surgeries.
 

amarilla

Veteran Member
I believe a lot of these people need to quit focusing on themselves and do something for someone or something (like a dog or cat.) Volunteer somewhere. Same for depressed people. Not all of them, but a lot of them would be better if they did something other than think only about themselves. It would also make them more interesting and would help them find friends.
 

Southside

Has No Life - Lives on TB
I believe a lot of these people need to quit focusing on themselves and do something for someone or something (like a dog or cat.) Volunteer somewhere. Same for depressed people. Not all of them, but a lot of them would be better if they did something other than think only about themselves. It would also make them more interesting and would help them find friends.
The ones that focus on themselves usually do not make "good friend" material.
 

Mark D

Now running for Emperor.
Scalpels can't fix the fallout from mental/emotional/sexual abuse, and misguided social engineering.
 
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