Am I unreasonable to be pleased that Puberty Blockers have been banned by the executive in Northern Ireland with unanimous cross-party support

Yes, thankfully

What an awful case

I see that Moira Deeming in Australia, which is abundant in trans-rights activism, just won her defamation case on precisely this issue.

There are MN threads on it including a new one about the recent ruling (that I think was just yesterday?)

I mean, not even 'centre' or 'right' but trying to make out that reasonable opinions are akin to the Nazis.

The tactics utilised towards people questioning the narrative have been extraordinary. You've got to wonder what's going on.

Same here!

I personally have always been left leaning, it’s remarkable how many people have declared me “far right” because of my views on this one specific issue. Despite being firmly left in almost all my other political opinions…

But @SophieStrange, the politican putting the mockers on unfettered access to puberty blockers for children in the United Kingdom (and by extension, for children dependent on those same services bought by the Isle of Man and the RoI) is the left-wing Labour Secretary of State, Wes Streeting.

The left-wing Labour government has stopped this, indefinitely. A few damp squibs spluttered in the House of Commons, but it has been decisively removed by the Labour government as any kind of programme.

No-one has resigned over it as far as I am aware, either on the Labour benches or those of the Greens or the Lib Dems. The left-of-centre is accepting of this. There is cross-party acceptance.

Also, it's not even accurate to say that the voices in favour of reviewing puberty blockers are right leaning. Most of the most prominent GCs are classically left. It's just that as soon as people start standing up for children's rights to a normal puberty, the left 'expels' and de-platforms them.

It’s really not difficult to form an opinion on the use of un-evidenced medical and surgical treatments used off-label to treat a condition that is poorly defined and comorbid with many other psychological/psychiatric difficulties that are not being properly addressed, and that may lead to life long lack of sexual function and possible sterility.

Also, there is nothing inherently wrong in being a social conservative, and social progressives haven’t always driven policy that benefits women and girls, for example, by taking a relaxed attitude to pornography and promoting sex positivity.

I read neither the DM nor the Spectator on a regular basis, but they’re not always wrong about everything.

The left has been extraordinary tribal on this issue. I'm not sure why, it's been shocking to witness.

And for anyone who thinks that the progressive left always calls things right, here's a cautionary tale for you ...

www.spiegel.de/international/germany/past-pedophile-links-haunt-german-green-party-a-899544.html

I think this is very flawed reasoning and one that is likely to lead to very problematic outcomes. Don't you have your own brain and conscience to think for yourself? Why outsource such an important question to your 'tribe'?

For me, the question is not 'why does the right question puberty blockers for children', but why the left doesn't.

All correct thinking people should want children's medicines to be properly tested and overseen - right?

It’s so very difficult to form a view on this, because there isn’t an resolution to the issue that won’t causes sadness for someone.

The thing I’d emphasise would be to note the political and media figures who have led the campaign against the availability of puberty blockers. Most of them are social conservatives who have not historically been on our side over reproductive rights, equal pay and conditions, etc, and not on that of respect for evidence-based science and medicine either.

So I absolutely don’t believe the good faith of the right or the religious when they claim to care for women’s safety, and I’ve the strong suspicion that whatever side of an ethical argument the Daily Mail and The Spectator put themselves on the likely to be the wrong one.

Safeguarding children should be important to everyone. Every time a child is harmed, whether by their family or a stranger, questions are asked and everyone says lessons must be learned. Well many questions have been asked and the lessons are staring us in the face.

Sorry about the length.

Each post may contain multiple links to completely different studies or papers coming form different aspects.

Marcus Evans paper

www.cambridge.org/core/journals/bjpsych-bulletin/article/freedom-to-think-the-need-for-thorough-assessment-and-treatment-of-gender-dysphoric-children/F4B7F5CAFC0D0BE9FF3C7886BA6E904B

Many interesting links but worth remembering this:

Evans said: During the 1980s, I led a parasuicide service in King's College Hospital, London, and treated a number of individuals who had self-harmed or attempted suicide after gender reassignment surgery. These patients had a history of serious and enduring mental illness and/or a personality disorder. Having developed a late-onset gender dysphoria, they were often angry at the loss of their biological sexual functioning and aggrieved with psychiatric services, which they felt had failed to examine their motivations for requesting reassignment surgery and/or to adequately investigate their psychological difficulties. A common theme in their presentations was a belief that physical treatments would remove or resolve aspects of themselves that caused them psychic pain. When the medical intervention failed to remove these psychological problems, the disappointment led to an escalation of self-harm and suicidal ideation, as resentment and hatred towards themselves were acted out in relation to their bodies.

And

Winston also highlights how often medical transition may not meet the expectations of patients:
‘He said 40 per cent of people who undergo vaginal reconstruction surgery experience complications as a result, and many need further surgery, and 23 per cent of people who have their breasts removed “feel uncomfortable with what they've done”. He added: “What I've been seeing in a fertility clinic are the long-term results of often very unhappy people who now feel quite badly damaged. “One has to consider when you're doing any kind of medicine where you're trying to do good not harm, and looking at the long-term effects of what you might be doing, and for me that is really a very important warning sign.” He added that the long-term effects of taking hormones “are likely to affect reproductive function”.’

___

Gender-Affirming Care Is Dangerous. I Know Because I Helped Pioneer It.’
https://www.thefp.com/p/gender-affirming-care-dangerous-finland-doctor

From Dr Riittakerttu Kaltiala, Finnish Psychiatrist who developed the treatment plans for Finnish Gender Clinics.

And

Here is Dr Az Hazeem saying he had about 26% of his patients regretted transitioning.

https://www.dailymail.co.uk/news/article-12623643/Being-trans-non-binary-new-sub-culture-risk-raising-nation-chemically-castrated-children-Doctor-spent-12-years-working-vulnerable-teens-Tavistock-warns-gender-ideology.html

He said 26 per cent of his patients at the Tavistock and Portman regretted transitioning.

A documentary on the Dutch Protocol

There are currently almost 3,000 young people on the waiting list for gender care in the Netherlands. They are vulnerable adolescents who are frequently subjected to discrimination. Many of them suffer severe mental distress. Doctors at the gender clinic in Amsterdam are pioneers in care for transgender young people. The treatment developed here years ago is now used worldwide. Now, criticism is growing. International experts are questioning the scientific evidence put forward by the clinicians in Amsterdam. Zembla investigates the Dutch transgender protocol.

What this covers is that no gender clinic has been able to replicate the results of the Dutch paper. One patient of the group died due to the surgery complications of gender surgery and even de Vries questioned why no one seemed interested in that patient while accepting the study. Dr Riittakerttu Kaltiala (Professor of Pschyiatry, Tampere and who set up gender clinics) and Mikael Landen (Professor of Pscyhiatry, Gotenberg) and Dr Angela Samfjord (Head of Child and Adolescent Psychiatry at the University of Gotenberg ) all are interviewed about the quality of the study behind the protocol and its flaws that became apparent later. Ie. The 55 patients is so small and de Vries acknowledges that they are not really similar to todays cohort of adolescent transitioners. That only 32 filled in the survey with positive results. The others were not chased up and one died.

Gerard van Breukelen, a professor of Methodology at Maastricht university goes on record to say that the methodology of that initial study was weak. There was no control group so the conclusions should not have been considered as strong as the gender clinicians claimed. Other academics declined to be interviewed due to fear for their employment as it is such a contentious issue. When talking to de Vries, she mentions that many more studies have been done by other countries now. And the doco makers mention that all those studies de Vries refer to have stated that the evidence is low quality. A Swedish team led by Landen was asked to do a full review by the Swedish government and he confirms that the evidence was just not there. Hence the Swedish government withdrew treatment.

The mention the Cass review and discussion ‘locking in’ of identities contradicts the ‘time to think’ narrative. They interview three transitioners. One detransitionered before surgery and one is happy with transition but not with the process the team followed. The one who detransitioned was put on hormones despite not even socially transitioning as he felt wearing a dress was ‘a man wearing a dress’. But was put on hormones but didn’t go through surgery after all. It also wraps up with Lucy who was stuck on the waiting list and who believes that if she was given PBs, she would not have ended up transitioning. She has obviously detransitioned now after double mastectomy and testosterone, then ovaries and uterus removal.

_

The newly released peer reviewed reanalysis of the UK study. McPherson & Freedman both worked on the initial analysis of the patient clinical data.

https://www.tandfonline.com/doi/full/10.1080/0092623X.2023.2281986

Psychological Outcomes of 12–15-Year-Olds with Gender Dysphoria Receiving Pubertal Suppression in the UK: Assessing Reliable and Clinically Significant Change

Susan McPherson & David E. P. Freedman

Published online: 29 Nov 2023

Abstract

The evidence base for psychological benefits of GnRHA for adolescents with gender dysphoria (GD) was deemed “low quality” by the UK National Institute of Health and Care Excellence. Limitations identified include inattention to clinical importance of findings. This secondary analysis of UK clinical study data uses Reliable and Clinically Significant Change approaches to address this gap. The original uncontrolled study collected data within a specialist GD service. Participants were 44 12–15-year-olds with GD. Puberty was suppressed using “triptorelin”; participants were followed-up for 36 months. Secondary analysis used data from parent-report Child Behavior Checklists and Youth Self-Report forms. Reliable change results: 15–34% of participants reliably deteriorated depending on the subscale, time point and parent versus child report. Clinically significant change results: 27–58% were in the borderline (subclinical) or clinical range at baseline (depending on subscale and parent or child report). Rates of clinically significant change ranged from 0 to 35%, decreasing over time toward zero on both self-report and parent-report. The approach offers an established complementary method to analyze individual level change and to examine who might benefit or otherwise from treatment in a field where research designs have been challenged by lack of control groups and low sample sizes.

Do you think the same about rape, trafficking, sexual abuse….etc….

pubmed.ncbi.nlm.nih.gov/33663938/

Surgical Outcomes Following Gender Affirming Penile Reconstruction: Patient-Reported Outcomes From a Multi-Center, International Survey of 129 Transmasculine Patients

Isabel S Robinson et al. J Sex Med. 2021 Apr

Of the 1,212 patients completing the survey, 129 patients underwent genital reconstruction surgery. Seventy-nine patients (61 percent) underwent phalloplasty only, 32 patients (25 percent) underwent metoidioplasty only, and 18 patients (14 percent) underwent metoidioplasty followed by phalloplasty.

Results: Patients reported 281 complications requiring 142 revisions. The most common complications were urethrocutaneous fistula (n = 51, 40 percent), urethral stricture (n = 41, 32 percent), and worsened mental health (n = 25, 19 percent).

These results support anecdotal reports that complication rates following gender affirming genital reconstruction are higher than are commonly reported in the surgical literature. Patients undergoing clitoris burial in addition to primary phalloplasty did not report a change in erogenous sensation relative to those patients not undergoing clitoris burial. Postoperative patients report improved genital self-image relative to their preoperative counterparts, although self-image scores remain lower than cisgender males.

Finland’s detransition numbers

Discontinuing hormonal gender reassignment: a nationwide register study.

Riittakerttu Kaltiala, Mika Helminen, Timo Holttinen & Katinka Tuisku

19 August 2024

Background

With increasing numbers of people seeking medical gender reassignment, the scientific community has become increasingly aware of the issue of detransitioning from social, hormonal or even surgical gender reassignment (GR). This study aimed to assess the proportion of patients who discontinued their established hormonal gender transition and the risk factors for discontinuation.

Methods

A nationwide register-based follow-up was conducted. Data were analysed via cross-tabulations with chi-square statistics and t tests/ANOVAs. Multivariate analyses were performed via Cox regression, which accounts for differences in follow-up times.

Results

Of the 1,359 subjects who had undergone hormonal GR in Finland from 1996 to 2019, 7.9% discontinued their established hormonal treatment during an average follow-up of 8.5 years. The risk for discontinuing hormonal GR was greater among later cohorts. The hazard ratio was 2.7 (95% confidence interval 1.1–6.1) among those who had accessed gender identity services from 2013 to 2019 compared with those who had come to contact from 1996 to 2005. Discontinuing also appeared to be emerging earlier among those who had entered the process in later years.

Conclusions

The risk of discontinuing established medical GR has increased alongside the increase in the number of patients seeking and proceeding to medical GR. The threshold to initiate medical GR may have lowered, resulting in a greater risk of unbalanced treatment decisions.

And

”It has long been assumed that very few patients embarking on medical GR regret their choice and seek to reverse it. From the 1970s to the 2010s, estimates of those regretting their initiated GR were only in the region of 2% [5, 6]. However, more recent research suggests that alongside the increase in the number of people accessing medical gender reassignment, reversing the initiated transition seems to be increasing [7]. In recent samples, 20–30% of those who initiated hormonal GR discontinued hormonal treatment in four to five years [8, 9]. It is possible that some patients discontinue hormonal treatment because they have reached their transition goals.”

And

“More importantly, those who have detransitioned have repeatedly reported that before their embarking on medical GR, insufficient attention was given to their mental health and psychosocial problems, which, in retrospect, they believed played a major role in their desire to transition. They have expressed concerns that assessments for medical gender reassignment were too superficial, with no search for explanations for their distress beyond an assumed stable sex-discordant identity requiring transition.”

_

Here is one link to the WPATH pdf
https://static1.squarespace.com/static/56a45d683b0be33df885def6/t/65e64b9e5cbd756da9fbbdfa/1709591479160/Final+WPATH+Report.pdf

and another
https://environmentalprogress.org/big-news/wpath-files

Here are some of the reactions:
https://www.dailymail.co.uk/news/article-13156695/Trans-healthcare-doctors-exposed-admitting-patients-young-mentally-ill-understand-consequences-treatment.html

https://www.telegraph.co.uk/news/2024/03/05/wpath-tansgender-hormone-therapy-cancer-links-leaked-emails/

https://sex-matters.org/posts/updates/wpath-the-truth-about-gender-affirming-healthcare/

https://genspect.org/the-wpath-files-revealed/

Here is a summary from Michael Shellenberger.
https://x.com/shellenberger/status/1764800595473686865?s=20

And the first part. Much more of it requires images.

Here is the threadreader version:

https://threadreaderapp.com/thread/1764799914918490287.html

THE WPATH FILES

Advocates of gender-affirming care say it’s evidence-based.

But now, newly released internal files from the World Professional Association for Transgender Health (WPATH) prove that the practice of transgender medicine is neither scientific nor medical.

American Medical Association, The Endocrine Society, the American Academy of Pediatrics, and thousands of doctors worldwide rely on WPATH. It is considered the leading global authority on gender medicine.

And yet WPATH’s internal files, which include written discussions and a video, reveal that its members know they are creating victims and not getting “informed consent.”

Victims include a 10-year-old girl, a 13-year-old developmentally delayed adolescent, and individuals suffering from schizophrenia and other serious mental illnesses.

The injuries described in the WPATH Files include sterilization, loss of sexual function, liver tumors, and death.

WPATH members indicate repeatedly that they know that many children and their parents don’t understand the effects that puberty blockers, hormones, and surgeries will have on their bodies. And yet, they continue to perform and advocate for gender medicine.

The WPATH Files prove that gender medicine is comprised of unregulated and pseudoscientific experiments on children, adolescents, and vulnerable adults. It will go down as one of the worst medical scandals in history.

Why I Am Publishing WPATH Files And How I Got Them

The written WPATH Files come from WPATH’s member discussion forum, which runs on software provided by DocMatter.

Ninety seconds of the 82-minute video was made public last year. We are making the full video available for the first time.

One or more people gave me the WPATH Files, and my colleagues and I attempted to summarize them as a series of articles. We quickly realized the topic was too sensitive, complex, and large to be dealt with as a work of journalism, and we moved the project to the research institute I founded seven years ago, Environmental Progress (EP).

The Files are authentic. We redacted most names and left only those individuals who are leading gender medicine practitioners to whom we sent “right-of-reply” emails. We know WPATH members discussed our emails internally. No WPATH leader or member has denied that the Files are anything other than what they appear to be.

EP is publishing a 70-page report to provide context for the 170 pages of WPATH Files. Mia Hughes is the author of the report. It and accompanying summary materials can be downloaded at the link below. That link also provides a link to the full WPATH video.

Bone density issues caused by GnRH

Bone Health in the Transgender Population
Published online 2019 Jul 2.

Micol S. Rothman and Sean J. Iwamoto

www.ncbi.nlm.nih.gov/pmc/articles/PMC6709704/

This

Also unknown are the long-term effects of puberty blockade, the effect of changes in body composition and the optimal type, timing, dosage, and route of administration of GAHT for bone outcomes.

Conclusion
The results of the studies that reported impact on the critical outcomes of gender dysphoria and mental health (depression, anger and anxiety), and the important outcomes of body image and psychosocial impact (global and psychosocial functioning), in children and adolescents with gender dysphoria are of very low certainty using modified GRADE. They suggest little change with GnRH analogues from baseline to follow-up.

And

GnRH analogues are frequently employed to provide puberty blockade in adolescents with gender incongruence or gender dysphoria. From their use in other medical conditions such as prostate cancer, their deleterious effects on the bone are well known, although these have the potential to be reversible if treatments are stopped or add back therapies can be given

And

However, Z-scores in the trans boys also showed an expected drop during GnRHa treatment. Similarly, they did not fully make up their bone loss as Z-scores at age 22 were still lower than baseline

Meaning, the authors acknowledge little is known about the lasting effects of puberty blockers. In this study, they propose some positive effect from cross sex hormones for females but ths results show that it doesn’t really make up the loss from puberty blockers.

PLUS

Just adding this piece about bone density for young transitioners here:

https://segm.org/theeffectofpubertyblockersontheaccrualofbonemass

1st May 2021

Dr Michael Biggs (an advisor to SEGM) has been calling for the release of data from the Tavistock’s experiment since 2019. A subset of the data were finally released following the judicial review into puberty suppression at the Tavistock clinic. Biggs’ reanalysis has just been published in the Journal of Paediatric Endocrinology and Metabolism. It finds that after two years on GnRHa, the Z-scores for a significant minority of the children had declined to a level that should trigger clinical concern.

_

www.svtplay.se/video/33358590/uppdrag-granskning/mission-investigate-trans-children-avsnitt-1

The latest from Sweden on the effects of puberty blockers on Leo and others.

As the poster who posted this initially states:

A trans child, Leo was treated for puberty blockers for 4 years. Leo ended up with osteoporosis (significantly below any normal bone density interval), fractures in the back, constant pain and worse mental state.

The journalist also found an additional 12 cases in Stockholm only where children had serious side effects (bone fractures, deep regret from voice changes, injuries, deteriorating mental health and significant weight gains). Leo’s case was not reported and not one of these.

_

Plus

Puberty Blocker and Aging Impact on Testicular Cell States and Function

Varshini Murugesh, Megan Ritting, Salem Salem, Syed Mohammed Musheer Aalam, Joaquin Garcia, Asma J Chattha, Yulian Zhao, David JHF Knapp, Guruprasad Kalthur, Candace F Granberg, Nagarajan Kannan

March 27, 2024.

https://www.biorxiv.org/content/10.1101/2024.03.23.586441v1.full

Abstract

Spermatogonial stem cell (SSC) acquisition of meiotogenetic state during puberty to produce genetically diverse gametes is blocked by drugs collectively referred as ‘puberty blocker’ (PB). Investigating the impact of PB on juvenile SSC state and function is challenging due to limited tissue access and clinical data. Herein, we report largest clinically annotated juvenile testicular biorepository with all children with gender dysphoria on chronic PB treatment highlighting shift in pediatric patient demography in US. At the tissue level, we report mild-to-severe sex gland atrophy in PB treated children. We developed most extensive integrated single-cell RNA dataset to date (>100K single cells; 25 patients), merging both public and novel (52 month PB-treated) datasets, alongside innovative computational approach tailed for germ cells and evaluated the impact of PB and aging on SSC. We report novel constitutional ranges for each testicular cell type across the entire age spectrum, distinct effects of treatments on prepubertal vs adult SSC, presence of spermatogenic epithelial cells exhibiting post-meiotic-state, irrespective of age, puberty status, or PB treatment. Further, we defined distinct effects of PB and aging on testicular cell lineage composition, and SSC meiotogenetic state and function. Using single cell data from prepubertal and young adult, we were able to accurately predict sexual maturity based both on overall cell type proportions, as well as on gene expression patterns within each major cell type. Applying these models to a PB-treated patient that they appeared pre-pubertal across the entire tissue. This combined with the noted gland atrophy and abnormalities from the histology data raise a potential concern regarding the complete ’reversibility’ and reproductive fitness of SSC. The biorepository, data, and research approach presented in this study provide unique opportunity to explore the impact of PB on testicular reproductive health.

And an article

https://www.dailymail.co.uk/health/article-13276501/Mayo-Clinic-puberty-blockers-trans-kids-fertility-cancer-medicine.html

Gender-Affirming Treatment of Gender Dysphoria in Youth: A Perfect Storm Environment for the Placebo Effect—The Implications for Research and Clinical Practice

Alison Clayton. 14 November 2022

Introduction

In the last decade, there has been a rapid increase in the numbers of young people with gender dysphoria (GD youth) presenting to health services (Kaltiala et al., 2020). There has also been a marked change in the treatment approach. The previous “common practice” of providing psychosocial care only to those under 18 or 21 years (Smith et al., 2001) has largely been replaced by the gender affirmative treatment approach (GAT), which for adolescents includes hormonal and surgical interventions (Coleman et al., 2022). However, as a recent review concluded, evidence on the appropriate management of youth with gender incongruence and dysphoria is inconclusive and has major knowledge gaps (Cass, 2022). Previous papers have discussed that the weaknesses of the studies investigating the efficacy of GAT for GD youth mean they are at high risk of bias and confounding and, thus, provide very low certainty evidence (Clayton, 2022a, b; Levine et al., 2022). To date, however, there has been little discussion of the inability of these studies to differentiate specific treatment effects from placebo effects. Of note, the term “placebo effect” is no longer used to just simply refer to the clinical response following inert medication; rather, it describes the beneficial effects attributable to the brain-mind responses evoked by the treatment context rather than the specific intervention (Wager & Atlas, 2015). This Letter argues that the current treatment approach for GD youth presents a perfect storm environment for the placebo effect. This raises complex clinical and research issues that require attention and debate.

Sections include:

A Brief Introduction to the Gender-Affirming Treatment Model for Children and Adolescents with Gender Dysphoria

Risks of Gender-Affirming Medical and Surgical Treatments

A Recent Example from Medical History of the Dangers of Medical Advice Based on Weak Evidence: The Iatrogenic Tragedy of Prone Infant Sleep Position and Sudden Infant Death Syndrome

Gender-Affirming Treatment for Youth with Gender Dysphoria: A Perfect Storm for Placebo Effect

Overstatement of the Certainty of Benefits and Under-Acknowledgment of Risks

The Dangers of an Exaggerated Suicide Narrative

An Excessively Negative Portrayal of the Previous Standard and Current Alternative Treatment Options

Clinicians’ Media and Social Media Promotion of Gender Affirmative Treatment

The Exclusive Promotion of Gender-Affirming Treatments within Child and Adolescent Gender Clinics

Conclusion

In conclusion, this Letter has noted that although GAT for GD youth lacks a rigorous evidence base, it is undertaken as routine medical treatment in a strongly placebo effect enhancing environment. It is within this environment that research into its effectiveness is being undertaken. One consideration raised by this relates to clinical practice: When does such a strongly placebo effect enhancing environment meet optimal clinical practice standards? When, if at all, does it veer into the territory of unethical practice that involves deception and undue influence? This Letter has also highlighted that such a placebo effect enhancing environment presents grave problems for research (particularly non-DBRCT research). It seems unlikely that the current research being undertaken in this field will be able to untangle benefits that are due to the placebo effect from those due to the interventions’ specific effectiveness. Thus, especially given the adverse risk profile of the hormonal and surgical interventions, it may be that yet again well-intentioned physicians are engaging in medical practices that cause more harm than benefit (Clayton, 2022b). The research and clinical conundrums presented in this Letter have no easy answers. However, as a first step, there is an urgent need for more awareness of the placebo effect and for rigorous and thoughtful debate over how best to proceed in research and clinical practice in this area of medicine.

link.springer.com/article/10.1007/s10508-022-02472-8

I think this is a good short explainer on why affirming only is problematic.

www.smh.com.au/national/nsw/now-i-m-hopeful-we-can-we-talk-about-teens-and-gender-20211031-p594q6.html

Now I’m hopeful we can talk about teens and gender

Dr Sandra Pertot

I found this very clear as an explanation

Although there is agreement across all clinicians working with gender-questioning adolescents that they typically report a history of mental health problems, increasingly some clinicians will consider the possibility that the client has come to the belief they are transgender as a way of providing an explanation for and resolving their pre-existing problems. In my experience, gender-affirming therapists strongly disagree, believing that anything other than immediately affirming the client’s expressed belief they are transgender will compound the harm. My view is that it is precisely because of the high rate of mental health problems in this group that a careful and comprehensive mental health assessment is required as a first step. Shepherding all of these vulnerable young people down the same pathway is poor clinical practice.

Some commentary around current medical procedures.

(Plug this link into archive dot ph)

https://www.wsj.com/articles/the-american-academy-of-pediatrics-dubious-transgender-science-jack-turban-research-social-contagion-gender-dysphoria-puberty-blockers-uk-11660732791

The American Academy of Pediatrics’ Dubious Transgender Science

By Julia Mason and Leor Sapir
Aug. 17, 2022

A spate of headlines this month declared that America’s surge in transgender identification wasn’t being caused by a social contagion. These articles were prompted by a new study by Jack Turban and colleagues in Pediatrics, flagship journal of the American Academy of Pediatrics. The study claimed that social influence isn’t the reason that as many as 9% of America’s youth now call themselves transgender. Thus, Dr. Turban argues, efforts in conservative states to regulate on-demand puberty blockers, cross-sex hormones and surgery must be resisted.

Yet Dr. Turban’s study is deeply flawed and likely couldn’t have survived a reasonable peer-review process. The swift response from the scientific community made both points clear—with even those who support hormones and surgery for gender-dysphoric youth noting that Dr. Turban’s shoddy science undermined their cause.

_

Social contagion discussion

jamanetwork.com/journals/jamanetworkopen/fullarticle/2768726

July 28, 2020

Association of Media Coverage of Transgender and Gender Diverse Issues With Rates of Referral of Transgender Children and Adolescents to Specialist Gender Clinics in the UK and Australia

Ken C. Pang, PhD Nastasja M. de Graaf, MSc; Denise Chew, MD;

Question
Is media coverage of transgender issues associated with referrals of transgender and gender diverse (TGD) children and adolescents to specialist gender services?

Findings
In this serial cross-sectional study across an 8-year study period during which more than 5000 TGD young people were referred to 2 pediatric gender clinics in the UK and Australia, a significant association was found between weekly referral rates and the number of TGD-related items appearing within the local media 1 to 2 weeks beforehand, for the UK only in week 1 and for Australia only in week 2.

Meaning
An increase in media coverage of TGD-related topics over recent years was associated with an increase in the number of TGD young people presenting to 2 gender clinics on opposite sides of the world.

However, we are also mindful that others have speculated that increased media content (specifically via social media) might act as a double-edged sword or a means of social contagion, whereby some individuals erroneously come to believe through exposure to such media that their nonspecific emotional or bodily distress is due to gender dysphoria and being TGD

This study has limitations. Our data provide evidence of an association between relevant media stories and clinical referrals of TGD young people but, given the nature of the study design, no indication of causation. Moreover, our study weighted each media item equally (despite likely differences in reach and accessibility) and was unable to quantify actual levels of media exposure among referred patients. Another limitation is that this association might not generalize to other services. After all, the RCHGS and GIDS were chosen for this study because they are publicly funded, do not charge attendance fees, and provide the only specialist pediatric gender services within their respective regions, thus ensuring that their referral data are likely to be relatively comprehensive and complete accounts of clinical demand within each catchment area; most other pediatric gender clinics will not share these same characteristics. Another important limitation of our study is that it only examines traditional forms of media and does not include social media, which are a very important source of information as well as a critical means for finding support and fostering connectedness and community among young people, including TGD adolescents.32-35 Social media were not examined in our study given the difficulties of readily accessing such information across time, but in the future, collaborations with relevant social media companies, such as Facebook, might allow us to address this gap.

Additionally on social contagion:

This document contains some important information. One of which is that even in 2018, Polly Carmichael recognised there was social contagion.

March 2018: Polly Carmichael had told an ACAMH conference:
“without a doubt there are some young people who are finding a community, friends and all sorts of things through joining a group who have an interest around gender and I think that for some of those we would be very foolish not to acknowledge that it's probably the case that they are caught up in something rather than it being an expression of something that has arisen from within. So there is a lot of concern.”

“I have been shocked by some of the things that are swilling around the internet that young people have access to. There are numerous groups on Reddit and Tumblr that many of the young people that are attending our service are going onto..maybe it's also the dissing of expertise, in a way, so that there is a feeling that this is about who I am, so what does anyone else know? It's a very odd situation in some way.`”

www.transgendertrend.com/wp-content/uploads/2023/03/Medical-Scandal-at-the-Tavistock.pdf

New FDA warning for PBs:

publications.aap.org/aapnews/news/20636/Risk-of-pseudotumor-cerebri-added-to-labeling-for?autologincheck=redirected

The Food and Drug Administration (FDA) has added a warning about the risk of pseudotumor cerebri (idiopathic intracranial hypertension) to the labeling for gonadotropin-releasing hormone (GnRH) agonists that are approved for the treatment of central precocious puberty in pediatric patients. These products include Lupron Depot-Ped (leuprolide acetate), Fensolvi (leuprolide acetate), Synarel (nafarelin), Supprelin LA (histrelin) and Triptodur (triptorelin).

The new warning includes recommendations to monitor patients taking GnRH agonists for signs and symptoms of pseudotumor cerebri, including headache, papilledema, blurred or loss of vision, diplopia, pain behind the eye or pain with eye movement, tinnitus, dizziness and nausea.

And

Six cases were identified that supported a plausible association between GnRH agonist use and pseudotumor cerebri. All six cases were reported in birth-assigned females ages 5 to 12 years. Five were undergoing treatment for central precocious puberty and one for transgender care. The onset of pseudotumor cerebri symptoms ranged from three to 240 days after GnRH agonist initiation.

France - declares there is not enough evidence. The latest from National Academy of Medicine, France. They have issued a press release about treatment for gender disphoria in children and adolescents.

SEGM have translated it, but also linked up the original version.

segm.org/France-cautions-regarding-puberty-blockers-and-cross-sex-hormones-for-youth

Extract

Transgender identity is a feeling of identifying as a gender different from that assigned at birth, which is persistent and lasts more than 6 months. This experience can cause significant and prolonged distress, which can contribute to an increased risk of suicide [a].

No genetic predisposition has been found.

While this condition has been long recognized, a sharp increase in demand for medical interventions has been observed (1,2) first in North America, then in Northern Europe, and, more recently, in France, particularly among children and adolescents. A recent study of a number of high schools in Pittsburgh revealed a prevalence that is clearly higher than previously estimated in the United States (3): 10% of students declared themselves to be transgender or non-binary or were unsure of their gender [b]. In 2003, the Royal Children's Hospital in Melbourne diagnosed only one child with gender dysphoria, whereas today it treats nearly 200.

Whatever the mechanisms involved in adolescents - excessive engagement with social media, greater social acceptability, or influence by those in one’s social circle - this epidemic-like phenomenon manifests itself in the emergence of cases or even clusters of cases in the adolescents’ immediate surroundings (4). This primarily social problem is due, in part, to the questioning of an overly dichotomous view of gender identity by some young people.

The demand for medical interventions, due to the distress that this condition (which is not a mental illness per se) causes, leads to a growing supply of care in the form of consultations or care in specialized clinics. This involves many pediatric subspecialties. The psychiatric consultations are utilized first, and if the identity is authentic and the discomfort persists, endocrinology, gynecology and, ultimately, surgery become involved.

However, great medical caution must be taken in children and adolescents, given the vulnerability, particularly psychological, of this population and the many undesirable effects and even serious complications that can be caused by some of the therapies available. In this regard, it is important to recall the recent decision (May 2021) of the Karolinska University Hospital in Stockholm to prohibit the use of puberty blockers.

If France allows the use of puberty blockers or cross-sex hormones with parental authorization and no age limitations, the greatest caution is needed in their use, taking into account the side-effects such as the impact on growth, bone weakening, risk of sterility, emotional and intellectual consequences and, for girls, menopause-like symptoms.

An article in the Washington Post from Dr Laura Edwards-Leeper & Erica Anderson

(Note: Dr Anderson is a male transitioner who is also a gender clinician)

“ I think this is a bad idea in 99% of circumstances. Professionals who know what they’re doing should be involved; and by not including parents, it ultimately makes the situation worse for the kid (unless the parent is abusive- that’s the 1%). I’ve actually never seen this go well”

www.washingtonpost.com/outlook/2021/11/24/trans-kids-therapy-psychologist/

mobile.twitter.com/drlaurael/status/1462968319636480004

The Washington Post article points out that many clinicians are not following the WPATH guidelines of comprehensive assessment and rmental health support.

The standards of care recommend mental health support and comprehensive assessment for all dysphoric youth before starting medical interventions. The process, done conscientiously, can take a few months (when a young person’s gender has been persistent and there are no simultaneous mental health issues) or up to several years in complicated cases. But few are trained to do it properly, and some clinicians don’t even believe in it, contending without evidence that treating dysphoria medically will resolve other mental health issues. Providers and their behavior haven’t been closely studied, but we find evidence every single day, from our peers across the country and concerned parents who reach out, that the field has moved from a more nuanced, individualized and developmentally appropriate assessment process to one where every problem looks like a medical one that can be solved quickly with medication or, ultimately, surgery. As a result, we may be harming some of the young people we strive to support — people who may not be prepared for the gender transitions they are being rushed into.

Here is a study on a small sample of trans patients and the standard of care.

www.mdpi.com/2227-9032/10/1/121/htm

A few things stand out.

1. the number of patients with underlying mental health issues. And how they are being completely let down by affirming only treatment.
3. -The number of visits before receiving hormones was 2.7 appointments.
5. -67 patients average age 27.8 years -range was 12- 54
6. -42 females, 22 males, four NB (3 f / 1 m)
7. -Female mean age is 18 years, male 23 years.
8. -Out of the 67, only 9 (13%) had NO mental health diagnosis. 10 (15%) had diagnosed ASD, 4 with ADHD (6%), 3 (4%) with OCD, 1 with Bipolar, 7 (10%) with a Personality Disorder. 13 (19%) had documented childhood abuse, neglect or violence.

From this study

Nine patients had stopped hormone therapy; one related to practice policy because they had not attended any GIC follow-up (the patient has restarted since the audit). Thus, eight patients had stopped hormones voluntarily (20% stopping rate; six trans men, two trans women).

This is the other study with the figures 8.8% & 8.3%:

//www.ncbi.nlm.nih.gov/pmc/articles/PMC5580378/

135 natal males (119 living in the female role, 12 in the male role, 4 did not report their current gender role) and 66 natal females (60 living in the male role, 5 in the female role, 1 did not report a current gender role)

So... 8.88% of males and 8.33% of the females (this does not include those who did not answer the question which if the answer was to detransition would make these figures higher). And in Figure 3. 22.2% of those who socially transitioned, detransitioned.

Access to care and frequency of detransition among a cohort discharged by a UK national adult gender identity clinic: retrospective case-note review

Published online by Cambridge University Press: 01 October 2021

R. Hall, L. Mitchell and J. Sachdeva

Conclusions

Service users may have unmet needs. Neurodevelopmental disorders or ACEs suggest complexity requiring consideration during the assessment process. Managing mental ill health and substance misuse during treatment needs optimising. Detransitioning might be more frequent than previously reported.

www.cambridge.org/core/journals/bjpsych-open/article/access-to-care-and-frequency-of-detransition-among-a-cohort-discharged-by-a-uk-national-adult-gender-identity-clinic-retrospective-casenote-review/3F5AC1315A49813922AAD76D9E28F5CB

Doctor scrutiny on gender clinic reveals legal and safety fears

The Australian , Natasha Robinson, 17th February 2023

https://www.theaustralian.com.au/science/doctor-scrutiny-on-gender-clinic-reveals-legal-and-safety-fears/news-story/8af81768fde27884caf18fff345ab78a?amp&nk=251396453faa0730705a45251160583c-1676662448

(Plug the above link into archive dot ph)

https://archive.is/DMT87

Senior physicians at the NSW Children’s Hospital Westmead’s gender clinic have studied the physical and mental health of 79 patients in a rare academic study of the outcomes of children who presented with gender distress and gender dysphoria. The findings cast doubt on the scientific basis of the gender-affirming approach followed by the nation’s other children’s hospitals.

In an open access academic paper, CHW psychiatrists, endocrinologists and other physicians, and a senior medical ethics expert, called for a “much more nuanced and complex approach” as analysis revealed 88 per cent of children presenting at Westmead’s gender clinic had at least one co-morbid mental health condition, with more than 50 per cent diagnosed with behavioural disorders or autism. One in five children who consulted the clinic with gender-related distress later had these feelings resolved, and almost one in 10 with a formal diagnosis of gender dysphoria, some who had taken puberty blockers and cross-sex hormones, later discontinued transitioning.

And

The CHW doctors have raised concerns that “many unknowns remain” regarding the long-term effects of puberty blockers, which are described by the Royal Children's Hospital Melbourne as “reversible in their effects”. International evidence is in fact casting greater doubt on whether the effects of these medications are reversible. Endocrine reviews of the CHW patient cohort documented side-effects in 23 of the 49 young people prescribed puberty blockers, including low bone density, hot flushes, weight gain and anxiety. The CHW doctors raised concerns about long-term effects on patients’ sexual function in adulthood.
Within the 9 per cent cohort of patients with a diagnosis of gender dysphoria who had desisted – that is, discontinued the transgender pathway 4-9 years after consulting the gender clinic – three had undergone puberty suppression beginning at the average age of 12. Three had taken cross-sex hormones, one from as young as 15, but not prescribed by CHW. The effects of cross-sex hormones, including infertility, are irreversible.

This is the study

Distress: A Prospective Follow-Up Study

by Joseph Elkadi, Catherine Chudleigh, Ann M. Maguire, Geoffrey R. Ambler, Stephen Scher and Kasia Kozlowska

www.mdpi.com/2227-9067/10/2/314

This prospective case-cohort study examines the developmental pathway choices of 79 young people (13.25–23.75 years old; 33 biological males and 46 biological females) referred to a tertiary care hospital’s Department of Psychological Medicine (December 2013–November 2018, at ages 8.42–15.92 years) for diagnostic assessment for gender dysphoria (GD) and for potential gender-affirming medical interventions. All of the young people had attended a screening medical assessment (including puberty staging) by paediatricians. The Psychological Medicine assessment (individual and family) yielded a formal DSM-5 diagnosis of GD in 66 of the young people. Of the 13 not meeting DSM-5 criteria, two obtained a GD diagnosis at a later time. This yielded 68 young people (68/79; 86.1%) with formal diagnoses of GD who were potentially eligible for gender-affirming medical interventions and 11 young people (11/79; 13.9%) who were not. Follow-up took place between November 2022 and January 2023. Within the GD subgroup (n = 68) (with two lost to follow-up), six had desisted (desistance rate of 9.1%; 6/66), and 60 had persisted on a GD (transgender) pathway (persistence rate of 90.9%; 60/66). Within the cohort as a whole (with two lost to follow-up), the overall persistence rate was 77.9% (60/77), and overall desistance rate for gender-related distress was 22.1% (17/77). Ongoing mental health concerns were reported by 44/50 (88.0%), and educational/occupational outcomes varied widely. The study highlights the importance of careful screening, comprehensive biopsychosocial (including family) assessment, and holistic therapeutic support. Even in highly screened samples of children and adolescents seeking a GD diagnosis and gender-affirming medical care, outcome pathways follow a diverse range of possibilities.

Conclusions

The data from this study show that when young people with gender distress present to health services seeking medical interventions, they end up following a diverse range of developmental pathways. The availability of gender-affirming medical interventions for the treatment of gender dysphoria is a recent one, evolving from the work of clinicians in the Netherlands. Early studies have suggested that medical interventions were associated with positive outcomes. This early body of work consequently served as the foundation for subsequent treatment guidelines and became established in medical systems via streamlined assessment processes and treatment pathways. The concept of medical affirmation was embedded in the broader culture by media and internet channels.

Together, these processes gave young people with gender-related distress a clear message: “This is the best way to proceed,” and “The medical affirmation pathway will take away your gender dysphoria.” For many young people and their families, however, these messages favouring medical interventions, coupled with professionals’ affirmation of this pathway, potentially displaced their consideration of other options or other pathways.

The young people and families who presented to our service typically came to us with settled ideas concerning their prospective treatment pathways. In particular, based on what was known at the time, and given the severity of the young persons’ distress, they and their families considered medical treatment for gender dysphoria to be the single best option. In the last five years, however, the gender-affirming medical model has been questioned by both clinicians (who have highlighted the current lack of a solid evidence base and detransitioners (who have highlighted the potential for adverse outcomes). The current evidence suggests the need for a much more nuanced and complex approach. As research data pertaining to long-term outcomes continues to accumulate, “the best way to proceed” is likely to be seen as ranging over a much more diverse range of treatment options and pathways, with each supported by a stronger evidence base than is currently available.