If You See It, Kill It ? Who's Is My Enemy ? Come And Take It, I'm I Next One To Die By Delphyne

If You See It, Kill It ? Who's Is My Enemy ? Come And Take It, I'm I Next One To Die By Delphyne. So Let's Make State Psychiatric Hospitals Great Again In 2025. This Truth Channel Is Exposing Everyone And Everything You Read, See And Hear Today And All Of Our Government Is Lies To Its Own People's. See All The Video's Below For More Information About Your Cutting Off Your Children Body Parts And About Killing Each Other... Right Now Today... This Is So Sad The World Today ?

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I'm sorry you've gone through so much pain in the world today. You should be loved no matter what size you are, or what you may look like. I hope one day you'll be surrounded with people that love you because of who you are and not how well you fit into societal standards. And if makeup makes you feel confident, then wear makeup >:D you shouldn't have to force yourself to be uncomfortable in your own body. Do whatever makes you feel safe. We at this channel would like to add this quote for everyone to open your own mind this year: Your body diet is not only what you eat. It is also what you watch, what you listen to, what you read, the people you hang out with and the things you subject your mind, body and soul too. Always be mindful of the things you put into your body emotionally, spiritually and physically.

Stop All The Killing Now Today... This Video Above Is Who's Is My Enemy by Delphyne - Antiracist, Climate Justice, Black Lives Matter, Anti-Trump, Trans Woke Etc... Thank You For Watching Our Channel (What If Everything You Were Taught Was A Lie?) Yes We All The People Of The U.S.A. So If You Our Black-White-Yellow-Brown-Red-Woke-Trans-High Yellow-Etc. We At This Channel Do Not Care About Anyone Skin Color At All Now Or In The Past Time. All Info. shared in this channel is for non-hate and non-race and historical purposes to educate, elevate, entertain, enlighten, and empower through old and new film and document allowance is made for fair use for purposes such as criticism, comment, news reporting, scholarship, and research.

To the mother-warriors of all genders, breathing humanity into the future with the careful whisper of a child's pronouns, standing down white supremacy with a bold exhale, raising up an army of radical love to stand between mother earth and the forces of hate clamoring to take her down with them.

Note: So now the content on this channel may cover lots of controversial topics and explore differing perspectives. It is intended for informational and discussion purposes only. Views expressed by guests or in comments do not necessarily reflect the opinions of the channel owner. We encourage respectful dialogue and open-mindedness. However, viewers are advised to conduct their own research and exercise critical thinking when engaging with the content. This channel does not endorse or condone any form of hate speech, discrimination, or violence. Viewer discretion is advised.

How We’re Fighting Back:
This is a state-sponsored erasure of trans people. Our office is working with the State Department and has done outreach with local LGBTQ+ organizations. Congress must protect and promote the legal recognition for trans and nonbinary Americans. The beliefs that have driven the hatred towards trans-people in recent years are not based on science - despite erroneous claims that they are - but on fear - Fear of that which they do not understand and actions that their lack of knowledge and education create. So here I go, yet again. Talking about This Stuff! Here is an infallible argument for you. If I hate trans-gendered people so much why do I watch your videos? You seem to think all the conservatives hate trans-people. That to me is sad.

If you place the number 6 on the ground and look at it from the bottom... its the number six... Wow its the number 6 ? But if you look at same number 6 from the top... its the number nine... Wow its the number 9 ? So now The democrats say 6 and republicans say 9... no its a 6, no its a 9, no its a 6, no its a 9 etc. etc. etc. so this goes on forever ?

Yes He Is Dead Conservative Charlie Kirk was fatally shot on September 10, 2025... O.K. He Dead... And He Is Shot Dead By Tyler James Robinson, A 22-Year-Old Man O.K. He Alive Still Today... So Let's Stop All The Killing Now Today. I’m Surprised People Haven’t Realized Already That Everything Is Staged. We At This Channel Do Not Care About The Killer Tyler James Robinson At All... Everything Is About Keeping Us Divided And At Each Other’s Throats.

We Do Not Care About If He/She Eat Meat Or Is A Vegetarians ?
We Do Not Care About If He/She Likes Women Or A Trans Men ?
We Do Not Care About If He/She Like Either "Team Red" or "Team Blue"
We Do Not Care About If He/She A Christian Vs. Satan Worship ?
So How About We Stop Hating Each Other & Let's Stop The Killing Now Today?

What Is A Man? 'Is Like Putting Lipstick On A Pig' You Are Still A Man ?
What Is A Woman? 'Is Like Putting Beard On A Pig' You Are Still A Woman ?
What Is A "Congenital Adrenal Hyperplasia" ? I Was Born With Both Male And Female Parts... Its Female External Genitalia ?
What Is A Trans Man? 'Is Like Putting Lipstick On A Pig' You Are Still A Man ?
What Is A Trans Woman? 'Is Like Putting Beard On A Pig' You Are Still A Woman ?

Conservative activist Charlie Kirk was fatally shot on September 10, 2025, while speaking at Utah Valley University in Orem, Utah, during a Turning Point USA event.

He was killed by a single gunshot to the neck fired from approximately 142 yards away by Tyler James Robinson, a 22-year-old man who was positioned on the roof of a nearby building.

Robinson was arrested on September 12 after his family notified authorities, and he later confessed to the crime in text messages and to his father.

Prosecutors charged Robinson with aggravated murder and other counts, alleging the attack was politically motivated, and announced they would seek the death penalty.

Mr Gray cited further lengthy text message exchanges between the defendant and his roommate, whom he described as his romantic partner. Authorities have said the roommate is transgender and transitioning from man to woman.

We may never know the full true story on some events but we know beyond a doubt that whatever happened was NOT the official narrative. That’s where we start. Remember kids, the U.S has a history of false flag attacks going back to at least the Spanish-American war. The rifle walked off the roof went into the forest and wrapped itself In a towel. Thr fact it happened before 9-11 and Kirk was questioning America's support of "Israel first " should have been a big hint. For me it was the aftermath. While carrying him away absolutely no blood trail. Men taking down the set minutes later walking all over the area and again absolutely no blood trail. Absolutely impossible.

I told my grandson the other day when there was a mention of stopping trans from having a gun. "Who's next, me, you. . .who? This is the foot in the door, don't cheer for it." Shall not be infringed. I told him, "You may not like what they say but it is free speech. You may feel sick to your stomach but it is free speech. As long as there is no advocating of violence towards another, let them have their free speech as everyone should." You may like that they get fired but who will eventually flip the bill? First unemployment then welfare. If they can't support themselves then we end up supporting them. Is that what/who you want your money to go to?

Let them have their celebrations, yes it's disgusting. Let them cheer and shout and dance as they show it on the internet. I like that they do this as now you know who to avoid, to walk away from, to hope they find truth. Pay attention to who these people are but let them be unless the harming of others rises. Protect yourself, your loved ones, your neighbor, your community. Stand strong for those around you and be prepared, stay aware. Don't engage these people they will only bring you down to their level. Like I said let them shout, dance, cheer but let them do it alone. No one watching, no one commenting, no one caring. Let them do it in their own empty echo hall. Just be aware of who they are so that you can be prepared if needed.

I am a nobody, but. I have some experience with firearms. I never shot long distance because I did not train to be a sniper. That being said, as much experience that I have had to go up on a building and murder some one would be immense pressure. And as a normal person Robinson did not have a 4ft rifle in his blue jeans. And a scope is zeroed in, so he would have to remove the scope to have it stashed in his blue jean. he is seen walking up the stairs, he would not be able to, they said he broke the rifle down and put it in his back pack when he jumped off the roof, and how did he get onto the roof? It should have been locked? I think he is a patsy, I think the FBI knew the rifle was a plant, how did they not find the bullet that Killed him? Mr. Kirk? Why did they not have a proper crime scene? This is all bull shit to us.

Kirk was a government shill. Same people who put him on to do what he does are the same people who took him out. He was as Christian as Donald Trump. Kirk unfortunately did enact the cardinal sin of questioning Zionists endeavors in Gaza. It was confirmed by those in his inner circle he was stressing over calling it out. I too believe multiple things can be true at once. Who ultimately made the decision to hire a fall guy and pull the trigger is something we may never know.

Nobody uses such precise language when talking about how long it takes them to complete a task like this. They either say less than 12, 24, 36, 48 hours etc. The governor even said something along the lines of "in less than 36 hours...." then he immediately corrects himself to get the 33 in there. He said 33 hours 3 times in that press conference, by the way.

Until that number was mentioned, my conspiratorial worldview was taking a backseat, but when that press conference happened it immediately went into overdrive.

Fun fact: Mormonism has a lot of Freemason influence baked into their space opera sex cult today.

I was thinking and feeling bad for those in the audience who witnessed his assassination. Then thinking they wanted people to be a witness to this. Then thinking, they want us all to be a witness to this. I couldn't get away from the reels playing over and over again on Facebook. They want us traumatized and afraid like an abusive partner. Such a creepy demonic heavy vibe hangs in the air.

In 1984 Tried To Warn Us We The People About Every record has been destroyed or falsified, every book rewritten, every picture has been repainted, every statue and street building has been renamed, every date has been altered. And the process is continuing day by day and minute by minute. History has stopped. If you want a picture of the future, imagine a boot stamping on a human face forever.

I Was Born With Male And Female Parts "Congenital Adrenal Hyperplasia" Female External Genitalia - https://rumble.com/v6jta7p-i-was-born-with-male-and-female-parts-congenital-adrenal-hyperplasia-female.html

In The Womb Stephanie Now Age 28. Was Meant To Develop Male. But An Issue With Her Adrenal Glands Reversed The Process. So I Was Born With Male and Female Parts Congenital Adrenal Hyperplasia in Men Which Cause Female External Genitalia. So I Right Now Have All Male DNA And ALL Testing Shows I Have Male Sex Chromosomes Also As You Can See From This Photo Of A Un-Named Male With Congenital Adrenal Hyperplasia This Is A Genetic Disorder And This Man Have Fully Working Female External Genitalia Below. But For This Video You Are Watching Now. I Stephanie Do Not Want To Show You My Naked Body At ALL... Wow! You seem normal to me. And you are very pretty. Don’t let anyone get you down!!

Thank you for sharing your story Stephanie! Our creator made you in your mother's womb exactly like he intended you to be. I can share with you the verses in the bible that address your situation. You belong to God in a way that is just different! I can't share the knowledge about this subject online as it would just be attacked by those that do not have eyes to see or ears to hear so, write back if you want me to share with you what the bible says about it. If you don't want to hear about it, I understand. God's enemy greatly desires that you not know what treasure you posses because of your condition.

What Are the 72 Other Genders? https://www.medicinenet.com/what_are_the_72_other_genders/article.htm

Male to Female Sex Reassignment Surgery Live ** Very Graphic ** Think Twice Guys ? - https://rumble.com/v2hpw3e-male-to-female-sex-reassignment-surgery-live-very-graphic-think-twice-guys-.html

That was repulsive. And the end result was nothing like a female. How can doctors do this? It’s mutilation.

This should never be allowed. You are born male or female period. If you can't accept that get mental health asap! There will always be crazy doctors out there willing to do this surgery & not for your best interest. It's for theirs money.

WOW. I actually like watching surgeries but this one is so disheartening and makes me sad to my core. People are advocating for teenagers to go through this with very little or no psychological interventions. Kids are told this is reversible too, but this surgery proves its not and confirms why there is a 67% complication rate. They are literally multilating that area of the body and the end result is nothing even close to what a female looks like. Plus, subsequent surgeries do not change that fact. The video is also missing information regarding a loss of sexual function and probable urinary tract complications or the fact that the person will have to use a dilator for the rest of their lives because, just as ear piercings naturally close if you take the earring out for a while, so will this surgically created hole in this person's body.

This video needs to be shared everywhere and definitely shown to kids who've been convinced this is the right thing to do to their body. My heart hurts.

I can't watch this video, but I'm glad it exists. People need to know what is happening. But, who could/would one share it with..?.. ugh

That should be outlawed even for adults! yikes!
For anyone that thinks this is ok for a child under the age of 21, yes, 21 you should be taken into the surgery room to cut off your private parts.... This is genital mutilation. It has nothing to do with care , it's absolutely insane that doctors are allowed to do this to people. But it feels like i'm just screaming into the void , the truth will come out eventually , i hope..

WoW This Looks Fun Lady's Keyhole Top Surgery For Female to Male Transgender -- https://rumble.com/v2zsoao-wow-this-looks-fun-ladys-keyhole-top-surgery-for-female-to-male-transgender.html

So sad. If they aren’t happy in their body gave them, what makes them think they’ll be happy if they change! Just an evil agenda! People need Jesus!

That looks like a frontal lobotomy on a pair of tits. Doesn't take a lot research to figure out how successful that fad was. So called doctors that agree to 'perform' this procedure should have their hands cutt off and sowed to their chest! How stupid!

The female to male change causes several massive downsides: depression, major health issues, and a huge increase in suicide rates.

I'm sorry but if people are worried about transgenders being assaulted or physically traumatized, then what do they call this??? This looks pretty freaking traumatic to me, not to mention an assault on the person's body. You can hear the surgeon struggle to remove the breast. Might as well be carving up a raw turkey!

A Teen who claims to be "gender neutral" is to have her 30D breasts removed to eradicate her female features. Opi Baron, 19, has planned drastic surgery to have her breast tissue removed and become completely flat-chested. She said: "You are brought up and taught from a young age that there is only 'boy' and 'girl' and just two boxes that you can fit into but that's not the case. "Instead of it being black or white, male or female, it's like there are a whole range of shades in the middle which is where I am.

"If you saw me in person I have feminine traits but I have abandoned the attempts to fit into that box of being female." Opi, of St Neots, Cambs, has a form of Gender dysphoria where a person experiences distress because there is a mismatch between their biological sex and gender identity.

Despite being raised a girl, and having been with her boyfriend Phill Abbott for the past year, the 19-year-old is non-binary - meaning she identifies as neither a man nor a woman.

Speaking on her relationship with Phill, a pharmaceutical salesman, Opi said: "The narrow-minded attitude of a large degree of people out stands me because there are many more sexualities than 'straight' or 'homosexual'.

"There's nothing out of the ordinary in my relationship, we do everything that everybody else does."

The teenager is now looking to raise at least £6,000 to pay for the surgery. It would remove her breast tissue but Opi would keep her glands so that she could breast feed in the future if she decides to have children.

Opi, a data entry clerk for the NHS, added: "I'm already excited to take the bandages off. I haven't got my procedure secured and I'm already excited about the 'after' moments.

"Phill being a man said he liked my boobs but if I didn't want them he was fine with that. He is more concerned about me being happy."

We Hope This Video Will Help Someone Girl and Teen and Woman Before Getting Surgery For Your Breast Removal... Thanks!

New Mandate Law To Force All U.S.A. Female To Get Sex Genital Mutilation Survivors - https://rumble.com/v2hjog8-new-mandate-law-to-force-all-u.s.a.-female-to-get-sex-genital-mutilation-su.html

Eriska: My mom has been a labor and delivery nurse at a county hospital in Minnesota for over 20 years. I remember her telling me in or around 2010 that because they were a Somalian refugee sanctuary, they started to see a lot of Somalian births. She said that a lot of the woman were circumcised, clitoris removed and lips stitched with the opening barely large enough for finger. So obviously sex had to be painful but my mom said that wasn’t even the most bizarre part; which was after giving birth, many demanded to be stitched back up like they were before. There were a few meetings then it became required of doctors, if the woman chose, to repair the circumcision's if it became damaged in childbirth, which they were always damaged unless it was c section, the doctors had an obligation to repair their circumcision. And by repair I mean return to their circumcised state.

How can they say it's not a problem with one religion when FGM is only done by one "religion"; Islam. They're either lying or they're recognizing that Islam is NOT A RELIGION. Islam is a political ideology. What is the main reason why they oppose practices that go back hundreds or even thousands of years? Why is so-called FGM only bad now when women willingly did it for many centuries?

Female genital mutilation (FGM) is a non-medical procedure that involves partial or total removal of the external female genitalia. It is most often carried out on young girls between infancy and age 15 and has no health benefits for girls and women, causing severe bleeding and problems urinating, cysts, infections as well as complications in childbirth and increased risk of newborn deaths. When Jane was about 9, her mother drove her and her friend to a Houston strip mall. She told Jane there was something dirty on their bodies that needed to be cleaned. There, in an empty room, a woman subjected them to female genital mutilation.

“I remember feeling pain for a good three weeks after that. I was continuously bleeding, it hurt to use the restroom,” Jane, who is now 28, said. “It was never something that was discussed even after it happened.”

Jane, who spoke anonymously to protect her family’s identity, is one of a growing number of American survivors breaking the silence on the centuries-old practice of FGM. Despite reports of FGM being performed on Americans, in December a Michigan district judge struck down a federal ban on the practice, leaving girls in many states at increased risk. In April, President Trump’s Department of Justice ignited outrage by declining to appeal the case.

18 U.S. Code § 116 - Female genital mutilation From Sec. 116. Female genital mutilation ...

(a) Except as provided in subsection (b), whoever knowingly circumcises, excises, or infibulates the whole or any part of the labia majora or labia minora or clitoris of another person who has not attained the age of 18 years shall be fined under this title or imprisoned not more than 5 years, or both.

From AMENDMENT XIV

SECTION 1.
No state shall make or enforce any law which shall abridge the privileges or immunities of citizens of the United States; nor shall any state deprive any person of life, liberty, or property, without due process of law; nor deny to any person within its jurisdiction the equal protection of the laws.

Ideally, these two laws should end any genital mutilation upon any minor, male or female. Sadly, it does not yet.

Fact Sheet Reauthorization of the Violence Against Women Act (VAWA)
This week, President New World Order signed into law the Violence Against Women Act Reauthorization Act of 2022, bipartisan legislation passed by Congress as part of the Omnibus appropriations package.

One of the driving forces of President Biden’s career has been fighting back against abuses of power. That force led him to write and champion the groundbreaking Violence Against Women Act (VAWA) as a U.S. Senator, landmark legislation that first passed in 1994. In the nearly three decades since, he has worked with Members of Congress from both parties to pass legislation to renew and strengthen VAWA three times: in 2000, 2005, and 2013. Each time, he worked to expand access to safety and support for all survivors and increase prevention efforts. Preventing and responding to gender-based violence wherever it occurs, and in all of its forms, has remained a cornerstone of the President’s career in public service—from VAWA reauthorization to a national campaign to combat campus sexual assault to reforms to address sexual assault and harassment in the military.

While incidents of domestic violence and sexual assault have declined significantly since VAWA first took effect—and efforts to increase access to services, healing, and justice for survivors have improved with each iteration of VAWA—much work remains.

Defending Women from Gender Ideology Extremism
"Defending Women from Gender Ideology Extremism and Restoring Biological Truth to the Federal Government" is an executive order signed by Donald Trump on January 20, 2025, the day of his second inauguration as president of the United States.

The order promotes the concept of "sex-based rights" and the rejection of "gender ideology," which it defines as an effort to "eradicate the biological reality of sex" in language and policy.

The executive order requires federal departments to recognize gender as a male-female binary only (determined by biological sex assigned at conception) and mandates the replacement of all instances of "gender" with "sex" in materials.

It also directs federal agencies to cease all funding for gender-affirming care, prohibit gender self-identification on federal documents such as passports, and stop the funding or promotion of "gender ideology".

Additionally, the order instructs agencies to cease applying Bostock v. Clayton County, which provided Title VII protections for LGBTQ+ individuals.

The U.S. Equal Employment Opportunity Commission (EEOC) has announced that it is returning to its mission of protecting women from sexual harassment and sex-based discrimination in the workplace by rolling back the Biden administration's gender identity agenda.

This includes enforcing laws governing sex-based rights, protections, opportunities, and accommodations to protect men and women as biologically distinct sexes.

The executive order has also directed the secretaries of state and homeland security to ensure that passports, visas, and other official government documents reflect male and female as the only two sexes.

Agencies are prohibited from promoting gender transition, and prisons are instructed not to use taxpayer funds for gender transition services.

The order defines "gender identity" as "an internal and subjective sense of self" and directs agencies to take steps to eradicate the use of the term and to implement regulations, guidance, forms, and communications to comply with this order.

https://www.whitehouse.gov/presidential-actions/2025/01/defending-women-from-gender-ideology-extremism-and-restoring-biological-truth-to-the-federal-government/

If A Man Or Woman Of The Same Sex Shall Lay Down With Another Man Or Woman Of The Same Sex Let Him Be Stoned To Death... God Or Jesus Said ( You Must Kill Them) Per The Bible... Say Us The Lord ?

The Bible does not say "thou shalt not kill," but rather "thou shalt not murder" in the original Hebrew.

The commandment in Exodus 20:13 is often mistranslated as "thou shalt not kill," which can lead to misunderstandings about its meaning.

The commandment specifically prohibits murder, not all forms of taking life, which allows for exceptions such as self-defense, manslaughter, and capital punishment.

What Does the Bible Say About Says The Lord?

The Bible contains many instances where God speaks through prophets or directly to individuals, often prefaced with "Thus says the Lord." For example, in Jeremiah 1:11, God speaks to Jeremiah through a vision, saying, "Thus says the Lord, the God of Israel, ‘Like these good figs, so I will regard the captives of Judah, whom I have sent out of this place into the land of the Chaldeans’”.

Additionally, the Bible often emphasizes that God is with His people, as seen in Isaiah 41:10, which states, "So do not fear, for I am with you; do not be dismayed, for I am your God. I will strengthen you and help you; I will uphold you with my righteous right hand”.

https://www.openbible.info/topics/if_a_man_shall_lay_with_another_man_let_him_be_stoned

By the authority vested in me as President by the Constitution and the laws of the United States of America, including section 7301 of title 5, United States Code, it is hereby ordered:

Section 1. Purpose. Across the country, ideologues who deny the biological reality of sex have increasingly used legal and other socially coercive means to permit men to self-identify as women and gain access to intimate single-sex spaces and activities designed for women, from women’s domestic abuse shelters to women’s workplace showers. This is wrong. Efforts to eradicate the biological reality of sex fundamentally attack women by depriving them of their dignity, safety, and well-being. The erasure of sex in language and policy has a corrosive impact not just on women but on the validity of the entire American system. Basing Federal policy on truth is critical to scientific inquiry, public safety, morale, and trust in government itself.

https://www.whitehouse.gov/presidential-actions/2025/01/defending-women-from-gender-ideology-extremism-and-restoring-biological-truth-to-the-federal-government/

Accordingly, my Administration will defend women’s rights and protect freedom of conscience by using clear and accurate language and policies that recognize women are biologically female, and men are biologically male.

Sec. 2. Policy and Definitions. It is the policy of the United States to recognize two sexes, male and female. These sexes are not changeable and are grounded in fundamental and incontrovertible reality. Under my direction, the Executive Branch will enforce all sex-protective laws to promote this reality, and the following definitions shall govern all Executive interpretation of and application of Federal law and administration policy:

(a) “Sex” shall refer to an individual’s immutable biological classification as either male or female. “Sex” is not a synonym for and does not include the concept of “gender identity.”

(b) “Women” or “woman” and “girls” or “girl” shall mean adult and juvenile human females, respectively.

(c) “Men” or “man” and “boys” or “boy” shall mean adult and juvenile human males, respectively.

(d) “Female” means a person belonging, at conception, to the sex that produces the large reproductive cell.

(e) “Male” means a person belonging, at conception, to the sex that produces the small reproductive cell.

(f) “Gender ideology” replaces the biological category of sex with an ever-shifting concept of self-assessed gender identity, permitting the false claim that males can identify as and thus become women and vice versa, and requiring all institutions of society to regard this false claim as true. Gender ideology includes the idea that there is a vast spectrum of genders that are disconnected from one’s sex. Gender ideology is internally inconsistent, in that it diminishes sex as an identifiable or useful category but nevertheless maintains that it is possible for a person to be born in the wrong sexed body.

(g) “Gender identity” reflects a fully internal and subjective sense of self, disconnected from biological reality and sex and existing on an infinite continuum, that does not provide a meaningful basis for identification and cannot be recognized as a replacement for sex.

Sec. 3. Recognizing Women Are Biologically Distinct From Men. (a) Within 30 days of the date of this order, the Secretary of Health and Human Services shall provide to the U.S. Government, external partners, and the public clear guidance expanding on the sex-based definitions set forth in this order.

Woman with Male Chromosomes
Being a woman with male chromosomes, or XY chromosomes, is a condition known as androgen insensitivity syndrome (AIS) or can be part of a broader category of disorders of sex development (DSD). People with AIS have XY chromosomes but develop as females due to a genetic mutation that affects the body's response to male hormones.
This condition can go unnoticed until puberty, when differences such as the absence of menstruation or the inability to conceive may become apparent.
Some individuals with AIS may not be diagnosed until adulthood.

Congenital Adrenal Hyperplasia in Men
Congenital Adrenal Hyperplasia (CAH) in men is a genetic disorder affecting the adrenal glands, which are located above the kidneys. The most common form of CAH is due to a deficiency in the enzyme 21-hydroxylase, leading to a lack of cortisol and aldosterone production, and an excess of androgens.

In men with CAH, symptoms can include excessive facial hair, a functional and average-sized penis, and in some cases, under-virilization, which may cause female external genitalia.
Additionally, men with CAH may experience infertility due to testicular adrenal rest tumors, which can cause severe testicular damage.

Quality of life (QoL) in men with CAH due to 21-hydroxylase deficiency has been studied, showing that disease severity and poor treatment control are inversely associated with QoL.
Men with CAH often require glucocorticoid substitution to manage androgen production and maintain a normal QoL.

Treatment for CAH in men typically involves glucocorticoid replacement therapy to restore normal hormone levels and prevent complications. Long-term follow-up and monitoring are essential to ensure optimal treatment and to manage any potential fertility issues.

Men with CAH may have normal fertility if they have been optimally treated, but some may require additional help to have children.
Once pregnant, women with CAH may require a caesarean section to deliver, and genetic counseling may be beneficial for families.

Congenital Adrenal Hyperplasia in Females
Congenital adrenal hyperplasia (CAH) is a group of genetic disorders affecting the adrenal glands, which are located above the kidneys. In females with CAH, the adrenal glands produce excessive amounts of male hormones, or androgens, leading to a range of symptoms and complications. These can include ambiguous genitalia, early puberty, and altered development of secondary sex characteristics.

The most common form of CAH is caused by a deficiency in the enzyme 21-hydroxylase, which affects about 95% of cases.
This deficiency leads to a reduced production of cortisol and aldosterone, while increasing the production of androgens. Females with this condition may have external genitalia that appear more masculine, which can cause significant psychological and social challenges.

In addition to physical symptoms, females with CAH may also experience early puberty, which can lead to rapid growth and early closure of growth plates, potentially resulting in shorter stature.
Hormonal imbalances can also affect fertility and menstrual cycles.

Treatment for CAH in females typically involves hormone replacement therapy to correct the imbalances and manage symptoms. This may include the administration of glucocorticoids and mineralocorticoids to normalize hormone levels and prevent complications.

Congenital adrenal hyperplasia (CAH) refers to a group of genetic disorders that involve the adrenal glands, a pair of small organs located above the kidneys. Endocrinologists Amir Hamrahian and Roberto Salvatori and endocrine surgeon Lilah Morris-Wiseman explain the diagnosis, causes and treatments of CAH.

What is congenital adrenal hyperplasia?
Healthy adrenal glands produce important hormones, including:

Cortisol, which regulates your body’s response to stress or illness.
Aldosterone, which balances salt and fluids in your body and regulates your blood pressure.
Sex hormones, such as DHEA-S, testosterone and androgens needed for growth and development of both boys and girls.
Adrenaline (also called epinephrine) — and to a lesser degree noradrenaline (norepinephrine) — the “fight or flight” hormones that help your body respond to stress.
In people with CAH, a genetic condition leads to a lack of one of the enzymes (a step in the building process) needed to produce one or more of the above hormones. There are two major types of CAH:

Classic congenital adrenal hyperplasia: This form is usually diagnosed soon after birth. Infants with classic CAH may have ambiguous external genitalia (i.e., females who don’t have typically female-appearing external genitalia), and they may make too little cortisol and aldosterone and too much male hormone (androgens).
Nonclassic congenital adrenal hyperplasia: This form is milder, more common, and often diagnosed in later childhood or early adulthood. Usually, women with nonclassic CAH present only with signs of too much androgens (i.e., excess body hair, early puberty, irregular periods). Men often have no symptoms.
What causes congenital adrenal hyperplasia?
The most common cause of CAH is a genetic mutation (change) in the 21-hydroxylase enzyme. The adrenal gland needs 21-hydroxylase to make appropriate amounts of hormones. If someone doesn’t have enough 21-hydroxylase, called 21-hydroxylase deficiency, this can result in decreased cortisol production. To compensate for low cortisol levels, the body stimulates the adrenal glands. The resulting adrenal stimulation leads to increased production of androgens (male hormones).

The severity of CAH relates to how much the genetic mutation affects this enzyme’s activity. In people with non-classic forms of CAH, the enzyme’s activity is reduced, but sufficient to make enough cortisol and aldosterone. However, the level of male hormones remains elevated.

Congenital Adrenal Hyperplasia Symptoms
Signs and symptoms of CAH vary, depending on which gene is defective and the level of enzyme deficiency.

Classic CAH
Female infants with classic CAH might be born with an enlarged clitoris or external genitalia. Conversely, male infants with classic CAH do not have any genitalia changes.

Both male and female infants can be affected by a lack of cortisol, aldosterone or both. Low cortisol and aldosterone levels may lead to low appetite, nausea, dizziness, fatigue and other symptoms. In addition, it may lead to “adrenal crisis” — a medical emergency that needs immediate treatment. Adrenal crisis can cause:

Low blood pressure
Low blood sugar
Dehydration
Vomiting
Diarrhea
Call 911 or seek medical care immediately if you or a loved one is experiencing symptoms of adrenal crisis.

The adrenal crisis often happens when people with CAH are sick, have a fever or an infection, undergo surgery or stop their medications.

Nonclassic CAH
In individuals with nonclassic CAH, often there are no signs when they are born. The condition is not diagnosed during routine infant blood screening, and usually becomes evident in late childhood, teenage years or early adulthood.

Both boys and girls can present with early appearance of pubic hair, acne and rapid growth during childhood, which may result in a shorter final height.

Teenage and adult females may experience irregular or absent menstrual periods and excessive facial and body hair and deepening voice.

Males and females with either form of CAH may also have fertility problems.

How is CAH diagnosed?
CAH may be diagnosed before or after a baby is born.

Diagnosing CAH Before Birth (Prenatal Testing)
There are several tests that can be used to detect CAH in fetuses, including amniocentesis and chorionic villus sampling (needle sampling of the fluid surrounding the fetus). This invasive testing is only performed before birth when a fetus is at risk for CAH due to their parents having a genetic mutation or a sibling having CAH.

Diagnosing CAH After Birth
Routine newborn screening for CAH during the first few days of life is mandatory in the United States. This test identifies only the classic form of CAH; therefore, diagnosis of the classic form is almost always made soon after birth. Any infant with a screening test suggestive of CAH should undergo further evaluation.

Routine screening tests are not able to identify the nonclassical form of CAH. The diagnostic workup of nonclassical CAH in older children and adulthood may include several blood tests, such as:

Morning 17-hydroxyprogesterone (17OHP)
ACTH stimulation test
Genetic testing
Congenital Adrenal Hypoplasia Treatment
The goal of CAH treatment is to reduce excessive androgens and replace deficient hormones. People with classic CAH need to take hormone replacement medications throughout their lives, while people with nonclassic CAH may or may not require treatment based on their symptoms and gender. Medications may include:

Corticosteroids (e.g., hydrocortisone, prednisone, dexamethasone) to replace deficient cortisol.
Fludrocortisone to replace missing aldosterone and help the body retain salt and keep blood pressure normal.
Salt supplements, which help increase intravascular volume (fluid in your vessels) and blood pressure.
Oral contraceptive pills for regulating menses.
Anti-androgen drugs such as spironolactone to treat excess androgen levels.
Your health care provider will adjust your medications based on regular physical exams, blood tests to check hormone levels, and monitoring for treatment side effects.

Your doctor will provide information on what to do if you get sick. For example, if you have fever or vomiting, or plan to undergo surgery, you might need to take higher doses of the medicines you normally take.

Girls with CAH may wish to alter the appearance of their genitalia for functional or cosmetic reasons.

Differences in sex development
Differences in sex development (DSD) is a group of rare conditions involving genes, hormones and reproductive organs, including genitals. It means a person's sex development is different to most other people's.

Sometimes the term Disorders of Sex Development is used, as is Variations in Sex Characteristics (VSC) or Diverse Sex Development. Some people prefer to use the term intersex.

Why does DSD happen?
You or your child may have sex chromosomes (bundles of genes) usually associated with being female (XX chromosomes) or usually associated with being male (XY chromosomes), but reproductive organs and genitals that may look different from usual.

This happens because of a difference with your genes or how you respond to the sex hormones in your body, or both. It can be inherited, but there is often no clear reason why it happens.

The most common times to find out that a person has a DSD are around the time of their birth or when they're a teenager.

Types of DSDs
There are many different types of DSD. Some examples are:

Usual female pattern genes with genitals that look different to girls' genitals
Some people have XX (usual female) chromosomes with ovaries and a womb, but their genitals may not look the same as many females.

For example, they may have a more developed clitoris and their vagina may be closed.

Doctors refer to this condition as 46,XX DSD.

The most common cause is congenital adrenal hyperplasia (CAH). A person who has CAH lacks an enzyme (chemical substance) that their body needs to make the hormones cortisol and aldosterone.

Without these hormones, their body produces more androgens (sex hormones that are naturally higher in males). If the child is female, the raised androgen levels before birth can cause their genitals to look different, such as a larger clitoris and a vagina that is not open in the usual place.

CAH can also cause serious health issues, such as life-threatening kidney problems that need to be treated as soon as possible

Find out more:

The Great Ormond Street Hospital for Children: CAH (congenital adrenal hyperplasia)
Living with CAH - what is CAH?
Genes usually seen in males with genitals that look the same as most girls' and some internal male structures
Some people have XY (male) chromosomes, but their external genitals may develop in the usual way for girls or boys.

Sometimes it's difficult at first to know whether their genitals are more similar to girls' or boys'. A person may have a womb and may also have testicles inside their body. Sometimes the testicles might not work properly.

Doctors refer to this condition as 46,XY DSD.

Many people with 46,XY DSD are boys born with the opening to pass urine towards the bottom of their penis or below it.

For some, the scrotum appears separated into two smaller sacs, one on either side. Doctors call this peno-scrotal hypospadias and boys and men with this DSD can have either fully developed or partially developed testes.

There are several causes of 46,XY DSD. One possible cause is androgen insensitivity syndrome (AIS), where the body "ignores" androgens or is insensitive to them.

Sometimes a person's body does not respond at all or only partly responds to androgens.

Complete insensitivity to androgens makes a person with XY chromosomes female. Partial insensitivity to androgens can mean that some people are male and others are female.

Ordinary looking genitals but different sex development
Some people have a chromosome pattern other than the usual XY or XX. They may have one X chromosome (XO), or they may have an extra chromosome (XXY).

Their internal and external sex organs can be either male or female, but they may not go through a full physical development at puberty. For example, a child with female sex organs may not start having periods.

Doctors call this sex chromosome DSD.

One type is Klinefelter syndrome, which is where a boy is born with an extra X chromosome (XXY).

This can mean they do not produce the usual level of testosterone, the sex hormone responsible for the development of male characteristics, such as the testes and body hair. Testosterone is also important for bone strength and fertility in men.

Another example of this type of DSD is Turner syndrome, which is where a girl is born with a missing X chromosome.

Girls and women with Turner syndrome are often infertile and their height may be shorter than average.

Find out more:

Klinefelter’s Syndrome Association
Turner Syndrome Support Society - What is TS?
Female with usual external genitals, but without a womb
Some females are born with an underdeveloped womb or without a womb, cervix and upper vagina. The ovaries and external genitalia look the same as most girls and women and they develop breasts and pubic hair as they get older.

This is called Rokitansky syndrome. It's also known as Mayer-Rokitansky-Küster-Hauser (MRKH syndrome). The cause is not clear, but girls and women with Rokitansky syndrome/MRKH have XX chromosomes.

Often the first sign of Rokitansky syndrome is that a girl does not start having periods. Sex involving the vagina may also be difficult because the vagina may be shorter than most women's.

Not having a womb means that a woman cannot become pregnant, but it's sometimes possible to take eggs from their ovaries, fertilise them, and implant them in another woman's womb (surrogacy).

You can find more support and information on Rokitansky syndrome at:

DSD Teens – MRKH (a.k.a. Mayer-Rokitansky-Küster-Hauser Syndrome)
MRKH Connect – What is MRKH
Sex characteristics usually seen in males or females
Some people with a very rare type of DSD have both ovarian and testicular tissue (sometimes one ovary and one testis). Their genitals may appear female or male or could look different from either.

Most people with this type of DSD have XX (female) chromosomes. The cause is not usually clear, but some people with the condition have been found to have genetic material that's usually seen on the Y chromosome appearing on their X chromosome.

Doctors refer to this condition as 46,XX ovotesticular DSD.

What happens after the birth of a baby
Doctors will check a baby for DSD soon after birth because of signs such as undescended testicles or if a baby's genitals look different.

Tests may be done to help get a clear diagnosis and find out whether any immediate treatment is needed.

Tests may include:

a further physical examination of your baby done by a specialist
an ultrasound scan to examine their internal organs
blood tests to check their genes and hormone levels
In England you need to register your baby’s birth within 42 days. This is usually enough time to complete the tests, discuss the results with your child’s care team and identify your baby’s sex.

Many forms of DSD do not require any medical care other than understanding the baby's development and knowing what to expect as they grow older.

A specialist nurse in your care team can help you learn about DSD and a psychologist will help you address any concerns you have.

Find out more about what happens when your baby is born with genitals that look different, in the First Days leaflet. This is on the DSD Families Resources website page.

Advice for parents of older children
Sometimes a DSD may be diagnosed if an older child does not go through puberty properly. For example, your child may not start showing the changes linked with puberty, or they may start puberty but not have periods.

Speak to a GP if you have any concerns about your child's development at puberty. They can refer your child to a specialist. This will usually be a consultant paediatric endocrinologist, who specialises in hormones, or an adolescent gynaecologist.

A team of specialist healthcare professionals will work with you to understand your child's condition and offer you and your child support and advice.

A psychologist in the team can talk with you or your child about sexuality, relationships and body image among other subjects.

Some people with DSD may need hormone therapy and psychological support. Some may want to think about altering their existing genitals, for example by using vaginal stretch techniques.

Some people with DSD consider altering the appearance of their genitals by having surgery.

If you think you have a DSD
If you think or know you have a DSD, information and support is available.

Speak to a GP, as they'll be able to refer you to a team of specialist healthcare professionals. They can answer your questions, help you stay healthy and put you in touch with others with DSD if that's something you're interested in.

You can stay with the gender linked to your sex at birth, which is the sex on your birth certificate. But if your legal sex does not represent who you are or how you identify, you may want to discuss your options with your care team.

If you have a DSD and want to explore parenthood, you can also discuss this with your specialist care team.

Where to get support
If you have a DSD or you're the parent of a child with a DSD, you may find it useful to contact a group involving others with the same or similar experiences.

These groups can often offer more information and advice about living with a DSD, and may be able to put you in contact with others who've been in a similar situation to you.

You are welcome to ask your care team about people with experience of your diagnosis in your local area who are happy to be contacted. National DSD support groups include: Congenital Adrenal Hyperplasia Support Group and DSD Families.

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Female genital mutilation (FGM) is a non-medical procedure that involves partial or total removal of the external female genitalia. It is most often carried out on young girls between infancy and age 15 and has no health benefits for girls and women, causing severe bleeding and problems urinating, cysts, infections as well as complications in childbirth and increased risk of newborn deaths.

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The Report Was Released In March 2023
The UN report in question was released on 8 March 2023 by UNAIDS. You can download a PDF copy to read for yourself.

https://web.archive.org/web/20230416234047/https://icj2.wpenginepowered.com/wp-content/uploads/2023/03/8-MARCH-Principles-FINAL-printer-version-1-MARCH-2023.pdf

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