Why Much More Than the Manifesto is Needed on Nashville Shooter Motivations

Following conservative pundit Steven Crowder’s release of three pages of a "manifesto" written by the Nashville school shooter, controversy erupted over whether Crowder selectively publicized content to bias the public against leftist dogma.

One the pages implicates “white privilege”—a favorite bogeyman of critical race theorists and the progressive left—as motivation for the killing rampage. 

The leaked salvo reads, “Kill those kids!!  Those crackers going to private fancy schools….Bunch of little f*ggots w/ your white privlages (sic)….”

Nashville Channel 5 reporter, Phil Williams, tweeted that the pages leaked were “EXTREMELY misleading” according to “sources”:



Instead of denouncing Crowder, his critics should decry the government authorities who arbitrarily kept this killer’s writings from the public.  Multiple media outlets requested the shooter’s manifesto through public records only to be denied by the Nashville Police Department and FBI.  These outlets, including Star News Digital Media Inc., are suing for the records in both district and federal court.  Even if all documents authored by the shooter are released, however, insight into the killer’s motivations will remain seriously incomplete.  The murderer’s medications also need to be public information.

The killer of six innocent people on March 27, 2023 was a 28 year-old female.  According to the non-profit, The Violence Project, female mass shooters (defined as killing four or more people outside of the perpetrator) are incredibly rare.  Of 172 mass shooters studied between 1966 and 2021 only four were female (and 2 of those had a male partner).  The database reports 13 mass shootings at K-12 schools during that time frame, all committed by males.  A U.S. Department of Education 2018 study examined active shooter incidents at schools, meaning “one or more individuals actively engaged in killing or attempting to kill people in a populated area.”  Between 2000 and 2017 there were 37 active shooter incidents at K-12 schools with 153 casualties.  All 37 active shooters were male.

So why did this lone female shooter murder six innocent people at a primary school?  Was this mentally unbalanced person’s resentment over “white privlages” the sole impetus in breaking the trend of male school-targeting mass murderers, or could medications have played a role—more specifically, exogenous testosterone?

According to Nashville police, the female shooter identified as a transgender man and was undergoing treatment for an “emotional disorder.”   In desiring to present herself to society as a man, perhaps she only socially transitioned.  If she decided to experiment with cross-sex masculinizing hormones, however, more questions arise: when did she start, how high were her levels, and how thoroughly were they monitored?  While the shooter’s autopsy report is public, it did not include testing for anabolic steroids.  Masculinizing cross-sex hormones include anabolic-androgenic steroids—a term leftists glaringly avoid.

I am not the first to ask this question.  After the shooting occurred, high-profile figures in politics and media questioned if potentially prescribed hormones could have played a role in the murderous rampage.  Articles from Newsweek and The Washington Post were quick to judge this line of inquiry as baseless and merely “anti-trans rhetoric.”  Trans-rights activist groups like the Human Rights Campaign claim that “cross-sex hormones or gender-affirming hormones” (note the avoidance of “anabolic steroids” terminology) are safe in young people under medical supervision, despite these drugs lacking FDA approval for gender dysphoria.

Internal documents from medical university gender affirming care clinics contradict the claims that cross-sex hormones are safely monitored, however.  North Carolina medical systems expanded drug treatments for sex changes outside the realm of specialists and infused it into primary care training.  The UNC-Chapel Hill Family Practice Department delivers “gender affirming care” or transition services, which include prescribing cross-sex hormones.  A public records request revealed two UNC family practitioners lecturing on “Updates in Gender Affirming Care” in early 2023.  One slide discussed “room for improvement” in the resident gender affirming care clinic.  Documented informed consent stands out as systemically lacking, but more ominous reads this bullet:

A few instances of unsafe hormone levels without a plan of care documented:

  • Estrogen level >800, no follow up plan or dose adjustment noted

  • Testosterone level >1300, plan to “continue current dose”

  • Increasing testosterone from 40 to 100mg/week over a 6-month span without any labs (despite 2 in person visits)

The UNC slide deck fails to specify what symptoms manifest from the “unsafe” hormone overdoses documented at its gender clinic.  But known side effects of testosterone cypionate, the anabolic steroid recommended in the UNC presentation, include mood swings and hypomania

Studies on the effects of exogenous testosterone on human psyche are poor and largely limited to those who abuse steroids for athletic performance enhancing aids.  One 2020 population-based Icelandic study surveying secondary school students (50% surveyed were female) determined, “Anabolic androgen steroid users had more anger issues, anxiety, depression, and their self-esteem was lower than among non-anabolic androgen steroid users.”   A 2014 Endocrine Society Scientific Statement related, “there are no clear predictors of [anabolic-androgenic steroid]-induced psychiatric effects, and it appears that there are wide variations in individual sensitivity to both androgen excess and androgen withdrawal or deprivation.”

Potential adverse consequences of exogenous steroids on human psychiatry should not be ignored—unless the patient claims to be transgender apparently.  In that case, major medical entities like the American Medical Association, American Academy of Pediatrics, and other medical organizations overwhelmingly tout the benefits of steroids.  The occasional transgender health clinic—in a “mostly peaceful protest” moment—might allude to generic changes in emotional state with hormone administration.  But internal presentations by gender affirming clinics themselves expose the truth: absent documentation of informed consent, unsafe hormone levels, and inconsistent monitoring reveal gender affirmation clinics are not the safe utopian setting medical activists claim.

There is no evidence that the Nashville school shooter was taking cross-sex hormones anabolic steroids.  And if she was, the drugs may or may not have played a role in her aggression.  But the question deserves to be asked in the public arena: did pharmaceuticals pave the way for this murderer’s evil path?

Nancy Andersen, MD received her board certification in general surgery following residency training at UNC-Chapel Hill.

Image: Screenshot from ABC 7 video, via YouTube



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