News outlets had, until recently, stated that 28-year-old prostitute Brenda Córdoba was murdered by a man, however, reports now state that the suspected killer does not identify as male.
According to La Voz, the incident took place in November 2021, however the suspect, Alex Maia Sam Estela, and an alleged accomplice, Christian Santiago Machado Abad, were arrested following a raid in October of this year. Estela, they note, identifies as transgender, while Abad is a transvestite.
In their reporting, La Voz goes to great lengths to ensure readers are aware of Estela’s gender, using “she” pronouns and referring to Estela as a trans woman.
A gender clinician previously investigated twice by national medical authorities is yet again under scrutiny and is facing the possibility of losing his license to practice.
Dr. Esben Esther Pirelli Benestad, 73, who identifies as a “trans woman,” has recently been notified by the Norwegian Health Authority (NHA) that they are considering withdrawing his authorization to practice as a doctor, reportedly in response to complaints from other doctors over his tendency to bypass recommended medical protocols.
Benestad, a sexologist, trans activist, and Professor Emeritus at the University of Agder, is considered Norway’s most prominent transgender person. Previously known as Esben Benestad, he announced his decision to declare a female identity on a television program called En Anselse Rødt in 1994, and the official addition of the feminine alias “Esther Pirelli” was approved by local authorities in 2000.
Norway’s TV 2 recently noted that Benestad had a history of failing to refer patients to the National Treatment Service for Gender Incongruence (NBTK) at Oslo University’s Rikshospitalet, preferring instead to administer or recommend cross-sex hormones, surgeries, and puberty-blocking drugs to patients out of his private clinic without proper oversight – and in some cases, in violation of established medical guidelines.
Benestad was first investigated in 2004 by the NHA for providing puberty-blocking drugs to young boys under the age of 14 in violation of Norwegian law. In September 2003, Chief Medical Officer at Rikshospitalet, Arnt Jakobsen, wrote a letter to the medical authorities describing Benestad’s practices as questionable, and referred to a boy between the ages of 14 – 15 who had been given “female sex hormones.”
At the time, Benestad denied providing hormones to teens, but admitted to “delaying puberty” in children. During an interview conducted in November 2009, Benestad recalled being reported to health authorities after prescribing puberty-blocking drugs to a nine year-old boy on an experimental basis.
In 2008, Benestad was again reported to national health authorities for misconduct related to three female patients he had referred for radical mastectomies. Benestad had fabricated diagnoses of health conditions in order to bypass medical guidelines and secure the female patients the procedures. Their ages are not known.
During the course of the second investigation, Benestad boasted about evading medical policies and laughed that he could not be sent to prison, as law enforcement “would have trouble finding out what jail” to place him in.
“I have a warning hanging over my head. If I do this again, they’ll take my license away,” Benestad said, and added that he could still prescribe hormones, despite attempts to prevent him from doing so.
This May, it was revealed that a young patient being given cross-sex hormones by Benestad had committed suicide.
The parents of the minor, who chose to remain anonymous, gave permission to the media to publish on their experience. Speaking with Blikk Magazine, they explained that the youth was placed on drugs to halt puberty by National Treatment Service for Gender Incongruence (NBTK) at Rikshospitalet.
While on puberty blockers, the teen was also privately being administered hormones by Benestad, thereby undermining the NBTK’s policy banning cross-sex hormones for minors under the age of 16. Shortly after, the youth’s treatment was again overtaken by NBTK. Approximately four months later, the unnamed minor committed suicide.
The parents told Blikk that they did not oppose the transitioning of minors, and were instead concerned that their child’s death would lead to measures preventing other ‘trans teens’ from accessing ‘gender affirming’ medical procedures.
Regarding the most recent complaint into Benestad, Anne Myhr, a director at the Norwegian Health Authority, told TV 2 that she could not comment on the specifics of the investigation as it is currently pending. According to Myhr, Benestad was allotted the usual three-week deadline to provide a statement to the NHA, and medical authorities will decide whether or not to proceed with a formal investigation after Benestad’s response has been considered.
Benestad’s academic career spans two decades, with his primary focus being on paraphilias. Benestad has advocated for normalizing sexual fetishes and is largely credited with introducing the concept of “gender euphoria” as an alternative to “gender dysphoria.” Benestad is also a member of the World Professional Association for Transgender Health (WPATH) and has spoken at conferences hosted by the organization.
He was a speaker at a 2009 WPATH conference in Oslo where academics involved in a pedophilic and sadomasochistic fetish forum presented a concept of a eunuch gender identity which appears to have influenced Benestad’s own interest in the subject.
“There is an organized group called ‘Eunuch Genders,’ which are somatic males that want to remove their testicles because they they feel that those testicles aren’t them. Of course they are entitled to do that. I believe in self-determined gender,” Benestad said just months after the 2009 Oslo conference.
Christina Ellingsen, a Norwegian women’s rights campaigner, spoke to Reduxx on the investigation into Benestad’s license. She expressed hope that medical authorities would finally hold Benestad accountable for intentionally disregarding medical safeguarding policies.
“The entire field of trans health is seemingly pioneered by egomaniacs who will stop at nothing to legitimize their fetishes. Benestad is one example on a local level. But when WPATH allows men with castration fetishes to influence the standards of care used globally, Benestad is not the only bad apple. The whole industry is rotten and needs to be shut down,” Ellingsen says. “Norway has let Benestad off the hook several times in his career, but hopefully he will be held accountable this time.”
Ellingsen is the lead representative for Women’s Declaration International’s Norway chapter. Earlier this year, she revealed she was under investigation by law enforcement for a series of tweets asserting that men cannot be lesbians or mothers. If charged and convicted, Ellingsen faces up to three years in prison under Norway’s increasingly pro-gender ideology “hate crime” legislation.
“I hope the authorities are able to recognize the irreparable damage [Benestad] is enabling. Studies are beginning to reveal the high proportion of detransitioners who experience same-sex attraction. He is essentially authorized to conduct sterilizing medical experimentation on a vulnerable group, the majority of which being underage bisexual and lesbian women,” Ellingsen says. “These patients have a right to be protected against harm, and this right is currently being ignored, for seemingly no other reason than to accommodate a man who has very clearly turned his fetish into a career.”
In 2021, Benestad came under fire for requiring sexology students to attend a BDSM fetish club.
The club mandated a specific dress code of fetish gear, which one female student objected to and publicly criticized. Just months prior, Benestad presented a TED talk in Arendal wherein he compared being a fetishistic cross-dresser to being a member of a marginalized Indigenous community.
We discuss a case of a 63-year-old male who presented with generalized itchy papulonodular rash a few weeks after receiving a vaccination against SARS-CoV-2. The patient had a negative medical history for atopic dermatitis and other pruritic skin conditions, and clinical presentation was consistent with prurigo nodularis, which was confirmed later by tissue biopsy and microscopic analysis. The pathophysiology of this skin condition is thought to be due to an overlap between the immune and nervous systems. Due to the hypothesized involvement of the immune system in this disease, it. is presumed that the patient had a dysregulated immune response caused by his recent SARS-CoV-2 vaccination.
Pruritus is an unpleasant sensation that causes the desire to scratch and can be a debilitating symptom associated with many primary and secondary skin disorders . Chronic pruritis can lead to the development of other pruritic secondary skin lesions, which will lead to a continuous itch-scratch cycle . The two most common secondary skin lesions associated with chronic pruritis are lichen simplex chronicus and prurigo nodularis (PN) . PN presents as papular and nodular lesions with excoriations, ulceration, and post-inflammatory hyper-pigmentary changes . An interplay between the nervous and immune systems has been thought to be involved in the pathogenesis of PN . Certain dermatological and non-dermatological conditions have been frequently associated with PN such as diabetes mellitus type 2 and atopic dermatitis . In addition, emerging scientific evidence has reported PN as one of the rare skin-related complications seen in patients receiving the SARS-CoV-2 vaccination . This report discusses the case of a 63-year-old gentleman who presented to the dermatology department with skin lesions consistent with PN after he received his first dose of the Pfizer-BioNTech SARS-CoV-2 vaccine.
A 63-year-old gentleman was referred to the dermatology clinic in October 2021 due to generalized itchy skin lesions. The rash started five months prior to the day of the office visit, and it appeared initially as erythematous, painful, and itchy papules over the bilateral lower limbs and gradually progressed to include the whole body sparing the neck and face. Lesions were associated with intermittent attacks of severe pruritus that lasted for approximately 30 minutes. The patient reported that the onset of symptoms started two weeks following the first dose of the Pfizer-BioNTech vaccine, which he received in April 2021. However, he denied any new skin lesions or worsening of previous lesions with subsequent booster doses of the same vaccine. Past medical history was negative for similar skin manifestations in relation to food, medications, or contact with animals. Past medical history was positive for type 2 diabetes mellitus for 30 years, which has been managed by only oral anti-glycemic medications with a recent hemoglobin A1C of 9. The patient did have a history of atopy or other pruritic skin conditions, and screening for thyroid stimulating hormone (TSH), liver function tests (LFTs), and estimated glomerular filtration rate (eGFR) was normal. Reviewing the patient’s primary care doctor’s notes indicated that he had no history of any psychiatric conditions or cognitive decline. Several over-the-counter moisturizing creams, topical herbal treatments, and honey were used by the patient to relieve the itchiness and rash without any positive outcomes. The rash was severe enough to cause disturbance in his sleep pattern and quality; however, his daily activities were not affected.
On examination, the patient had erythematous and brown papulonodular lesions associated with varying degrees of hemorrhagic crusting, erosions, and ulceration. Lesions were widespread and involved extensor upper (Figure 1) and lower (Figure 2) extremities and were symmetrically distributed over the upper back with a classic butterfly distribution (Figure 3) ). A 4 mm punch biopsy was performed on two active lesions in different locations, and two tissue samples were sent for histopathological analysis. Histopathology showed irregular acanthosis, hypergranulosis, and elongated rete ridges consistent with chronic picking and scratching of the skin (Figure 4). The patient’s clinical lesions and histopatholgical findings were consistent with the diagnosis of PN. He was started on topical steroids and emollients including QV cream (Ego Pharmaceuticals, Braeside, Victoria, Australia) and petroleum jelly, and was prescribed oral antihistamines for initial treatment. Due to the extent of involvement, he was scheduled to receive narrowband ultraviolet B (NUVB) phototherapy as well.
Figure 1: Extensor forearms showing erythematous, excoriated papules, and post-inflammatory hyperpigmentation.
Figure 2: Widespread erythematous and brown lichenified papular lesions in the extensor side of both lower limbs.
Figure 3: Upper back showing excoriated papules and nodules in a butterfly distribution.
Figure 4: Histopathology of prurigo nodularis with H&E stain.
H&E: hematoxylin and eosin
Pruritus is defined as an unpleasant sensation that causes the desire to scratch, and it is the most common skin-related symptom . The itch sensation can be localized to the site pathology or generalized, and symptoms might be intermittent or constantly eliciting the desire to scratch . Pruritus is mostly due to a primary skin disorder, but up to 25% of cases can be caused by systemic diseases . The most common primary skin disorders that cause pruritis include xerosis, eczematous dermatitis, urticaria, and papulosquamous disorders . On the other hand, systemic causes of pruritus present without visible skin lesions and are mostly due to malignancy and hepatic or renal dysfunction, which leads to the accumulation of waste and metabolic byproducts known to cause itchy skin .
Chronic rubbing and itching from either primary skin lesions or systemic diseases can lead to the development of other skin disorders such as lichen simplex chronicus and PN, which tend themselves to be pruritic and lead to a continuous itch-scratch cycle . PN is a reactive inflammatory skin condition that presents with papular or nodular lesions associated with excoriation or ulceration . Lesions are typically found in a symmetric bilateral distribution of the body extensors with sparing of the face and groin . The exact pathogenesis of the disease remains unclear, but immunologic and neuronal dysregulation is thought to be an integral mediator of the pathophysiology of PN . Patients who present with PN usually have a positive history of atopic dermatosis, but other secondary causes of pruritus including psychiatric conditions should be investigated as well . Common laboratory tests ordered for patients with PN include TSH, liver enzymes, and renal function tests . In addition, the SARS-CoV-2 vaccine has been reported to be a possible trigger for the development of multiple dermatologic conditions including PN . Due to the important role of the immune system in the pathogenesis of PN, it was thought that our patient had an immune dysregulation elicited by his SARS-CoV-2 vaccination .
Diagnosis is made clinically based on the patient’s history and physical exam with the presence of characteristic PN lesions . A biopsy is not routinely indicated for diagnosis and should be considered if a patient fails initial treatment or if the diagnosis could not be confirmed clinically . Histopathology of these lesions shows epidermal hyperplasia with hypergranulosis, overlying compact hyperkeratosis and sparse papillary dermal perivascular lymphocytic infiltrate . Treatment of PN can be challenging and multifactorial to address the different contributory factors to this disease . Managing an identified underlying cause for pruritus in these patients should be the first step . Generally, all patients must receive education about the importance of proper skin hygiene including the use of recommended bathing cleansers and body moisturizers to avoid skin irritation and xerosis, which represent the most common causes of purities . A first-generation oral antihistamine can be considered to further reduce symptoms of pruritus . For patients with limited or localized disease, treatment can be achieved with topical or intralesional steroids . Phototherapy with NUVB is the mainstay of treatment for patients with widespread involvement . Other systemic treatments can be utilized for those who fail or have contraindications to light therapy . They include systemic immunosuppressants, thalidomide, lenalidomide, and anticonvulsants .
PN is a disorder with a multifactorial etiology. The immune system plays a crucial role in the pathogenesis of PN, and dysregulation in the immune system elicited by the SARS-CoV-2 vaccine can trigger the development of this condition in predisposed individuals. It is important to continue to further investigate the pathophysiology of this skin condition and its association with the SARS-CoV-2 vaccine.
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