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

Two prominent transwomen clinicians, one who could led WPATH next year have stated they are against some of the current practices in trans health. Marcy Bowers and Eric Anderson. Particularly fast tracking to hormonal treatments. Article by Abigail Shrier.

bariweiss.substack.com/p/top-trans-doctors-blow-the-whistle

This study is well worth a read.

journals.sagepub.com/doi/full/10.1177/26344041211010777

Published April 22, 2021
Kasia Kozlowska, Georgia McClure et al

Australian children and adolescents with gender dysphoria: Clinical presentations and challenges experienced by a multidisciplinary team and gender service

Part of the conclusion

Our findings indicate that engagement with families, a trauma-informed model of mental health care, and ongoing discourse pertaining to the effects of unresolved trauma and loss need to be part of all gender dysphoria clinics and the services with which they collaborate. Because of their impact on subjective well-being and the development of the self, specific loss and trauma events present crucial opportunities for both long-term psychotherapy and more immediate, targeted treatments. The move to a more comprehensive, holistic model of care—one that takes into account the individual’s developmental history and the experiences that make up that history—has also been echoed in the work of other clinician-researchers (D’Angelo, 2020a; Entwistle, 2019; Giovanardi et al., 2018; Kozlowska et al., 2021; Williamson, 2019).

Our study found that the children and families who came to the clinic had clear, preformed expectations: most often, children and families wanted a diagnosis of gender dysphoria to be provided or confirmed, together with referral to endocrinology services to pursue medical treatment of gender dysphoria. Parents (vs. children) also largely came with the same expectations, though they were more likely to be interested in incorporating holistic (biopsychosocial) elements, including treatment of mental health comorbidities, family support/therapy, and long-term psychotherapy for the child. It was our impression that these expectations had been shaped by the dominant sociopolitical discourse—the gender affirmative model. It will be interesting to track the expectations of children and families in the years to come as sociopolitical discourses become more varied and diverse and as the voices are heard of both those who have done well and those who not done well via the medical pathway.

Our study also found that despite the high rates of family conflict, relationship breakdowns, parental mental illness, and maltreatment (see Table 3)—and our own clinical perspective that both individual and family work were indicated for the majority of families—few families rated themselves as being in a clinically severe range on self-report (SCORE-15). Coupled with the dominant sociopolitical discourse—the gender affirmative model that prioritizes the medical treatment pathway—it is not surprising that the large majority of children and families were not motivated to engage in or to remain engaged in ongoing therapy. These data bring three important phenomena into focus. First, when children and families were given the space and structure to tell the child’s developmental story—nested in the story of the family—they were able to identify and provide a detailed narrative of the key issues that had contributed to the child’s presentation and distress. Without this space and structure, the issues remain undeclared and unaddressed. Second, some families—but also some clinicians—function within a non-holistic (non-biopsychosocial) framework where the child’s developmental experiences are disconnected from their clinical presentation. This non-holistic framework is likely to promote a healthcare delivery model that dehumanizes the child (by not examining the child’s and family’s lived experience) and that promotes medical solutions (correcting the identity/body mismatch) for a problem that is much more complex. Third, as noted earlier, our experience suggests that, insofar as the gender affirmative model is taken as equivalent to medical intervention, clinicians (including ourselves) who work in gender services are coming under increasing pressure to put aside their own holistic (biopsychosocial) model of care, and to compromise their own ethical standards, by engaging in a tick-the-box treatment process. Such an approach does not adequately address a broad range of psychological, family, and social issues and puts patients at risk of adverse future outcomes and clinicians at risk of future legal action.

_

Australia and NZ College of Psychiatrists publish a warning there is not enough evidence.

//www.ranzcp.org/news-policy/policy-and-advocacy/position-statements/gender-dysphoria

The Royal Australian and New Zealand College of Psychiatrists have now updated their guidance.

They are now warning that there is NOT ENOUGH evidence to recommend affirming only treatments or indeed any particular treatment plan. They now say that underlying health issues should be treated at the same time. And warn that medicalisation of children and teens be very careful and thoroughly explored considering the ‘paucity’ of evidence at this time.

Interestingly, they indicate that there are a couple of long term studies under way which will be interesting to see when they are published. One is a longitudinal study on trans patients in Australia.

The NICE finding

arms.nice.org.uk/resources/hub/1070905/attachment

The summary of the conclusion is

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.

_

A treasure trove of studies relating to whether there is conclusive improvement to transgender people's lives after medicalised treatment paths can be found in this Medium article by JLCederblom

medium.com/^@JLCederblom^/the-lukewarm-perjury-of-jack-turban-a85903109051

There is an abridged version as well.

It is actually a run down of the evidence presented by Jack Turban's Declaration in Support of Plaintiff's Motion for a Preliminary Injunction in Brandt et al vs Rutledge et al in the US District Court for the Eastern District of Arkansas.

In it is this review listed as footnote 15. Baker, K. E., et al, (2021) Hormone Therapy, Mental Health and Quality of Life Among Transgender People: A Systematic Review. Journal of the Endocrine Society.

academic.oup.com/jes/article/5/4/bvab011/6126016

I was interested particularly in this finding.

Quality of Life

Among adolescents, a mixed-gender prospective cohort (n = 50) showed no difference in QOL scores after a year of endocrine interventions, which included combinations of GnRH analogues and estrogen or testosterone formulations [30]. No study found that hormone therapy decreased QOL scores. We conclude that hormone therapy may improve QOL among transgender people. The strength of evidence for this conclusion is low due to concerns about bias in study designs, imprecision in measurement because of small sample sizes, and confounding by factors such as gender-affirming surgery status.

And this under Depression

Among adolescents, 2 mixed-gender prospective cohorts (n = 50 and n = 23, respectively) showed improvements in depression scores after 1 year of treatment with GnRH analogues and estrogen or testosterone formulations (both P < 0.001) [30, 38]. Another prospective study reported that BDI scores improved almost by half among adolescents (n = 41) after a mean of 1.88 years of treatment with GnRH analogues to delay puberty (P = 0.004) [34]. The overall improvement after several subsequent years of testosterone or estrogen therapy in this cohort (n = 32) was smaller, however, resulting in no significant change from baseline [35]. No study found that hormone therapy increased depression.

Anxiety

Among adolescents, 1 prospective study saw mean anxiety scores in a mixed-gender group (n = 23) improve from 33.0 ± 7.2 to 18.5 ± 8.4 after 1 year (P < 0.001) [38], but another reported no changes in anxiety after approximately 2 years of puberty delay treatment with GnRH analogues and 4 years of hormone therapy (n = 32) [35].

Suicide

The risk of bias for this study was serious due to the difficulty of identifying appropriate comparison groups and uncontrolled confounding by surgery status and socioeconomic variables such as unemployment. We cannot draw any conclusions on the basis of this single study about whether hormone therapy affects death by suicide among transgender people.

_

This is a twitter thread that has some more studies.

twitter.com/threadreaderapp/status/1336607674344103938?s=21

This is a report on The Swedish changes - based on lack of evidence.

genderreport.ca/the-swedish-u-turn-on-gender-transitioning/

Thanks for those, bookmarking.

For anyone interested, I shall post some very long posts with lots of links to the studies and papers so people can read them if they have not seen them before, formatting is a bit tricky:

The Dutch Model is falling apart

By Stella O'Malley / 2 January 2023

First, Stella O’Malley writes about an article in Nederlands that is throwing a great deal of light on the Dutch Protocol. It also seems that there will be a review of the patients that the Dutch team had not previously included in their papers.

This article in the Nederlands points out the dangers on only using a nation’s own sources with no international input or even wide review.

genspect.org/the-dutch-model-is-falling-apart/

_

Then SEGM has published on Colin Wright’s substack a version of their previously published article.

5 False Assumptions Behind Youth Gender Transitions

2nd Jan 2023

www.realityslaststand.com/p/5-false-assumptions-behind-youth

Here is the original

segm.org/false-assumptions-gender-affirmation-minors

( segm.org )

[This reviewed Stephen M. Rosenthal‘s paper in Nature, 10 August 2021:

“Challenges in the care of transgender and gender-diverse youth: an endocrinologist’s view”

www.nature.com/articles/s41574-021-00535-9 ]

The five unproven assumptions are:

Unproven Assumption 1: Gender identity, which underlies gender dysphoria, is a fundamental personal characteristic that is biologically “ingrained.”

Unproven Assumption 2: The sharp rise in the number of youth presenting with gender dysphoria does not signal a true increase in cases—it’s merely better detection.

False Assumption 3: Medical interventions in gender-dysphoric minors have clear eligibility criteria.

False Assumption 4: Medical interventions for gender dysphoric minors have been demonstrated to be safe and effective.

Unproven Assumption 5: Detransition does not represent medical harm and is rare.

_

This has then had quite a few interesting links.

www.tandfonline.com/doi/full/10.1080/0092623X.2022.2160396?src=

Some Limitations of “Challenges in the Care of Transgender and Gender-Diverse Youth: An Endocrinologist’s View”

from J. Cohn, Published online: 24 Dec 2022

Abstract:

There is significant disagreement about how to support trans-identified or gender-dysphoric young people. Different experts and expert bodies make strikingly different recommendations based upon the same (limited) evidence. The US-originating “gender-affirmative” model emphasizes social transition and medical intervention, while some other countries, in response to evidence reviews of medical intervention outcomes, have adopted psychological interventions as the first line of treatment. A proposed model of gender-affirming care, comprising only medical intervention for “eligible” youth, is described in Rosenthal (2021). Determining eligibility for these medical interventions is challenging and engenders considerable disagreement among experts, neither of which is mentioned. The review also claims without support that medical interventions have been shown to clearly benefit mental health, and leaves out significant risks and less invasive alternatives. The unreliability of outcome studies and the corresponding uncertainties as to how gender dysphoria develops and responds to treatment are also unreported.

This has many other links to follow.

Then there was this review of US Military health insurance records for transition persistence.

academic.oup.com/jcem/article-abstract/107/9/e3937/6572526?redirectedFrom=fulltext&login=false

”Continuation of Gender-affirming Hormones Among Transgender Adolescents and Adults”

Christina M Roberts,
David A Klein, Terry A Adirim,
Natasha A Schvey, Elizabeth Hisle-Gorman

22 April 2022

Results
The study sample included 627 transmasculine and 325 transfeminine individuals with an average age of 19.2 ± 5.3 years. The 4-year gender-affirming hormone continuation rate was 70.2% (95% CI, 63.9-76.5). Transfeminine individuals had a higher continuation rate than transmasculine individuals 81.0% (72.0%-90.0%) vs 64.4% (56.0%-72.8%). People who started hormones as minors had higher continuation rate than people who started as adults 74.4% (66.0%-82.8%) vs 64.4% (56.0%-72.8%). Continuation was not associated with household income or family member type. In Cox regression, both transmasculine gender identity (hazard ratio, 2.40; 95% CI, 1.50-3.86) and starting hormones as an adult (hazard ratio, 1.69; 95% CI, 1.14-2.52) were independently associated with increased discontinuation rates.

_

Here is another study:

The Myth of “Reliable Research” in Pediatric Gender Medicine: A critical evaluation of the Dutch Studies—and research that has followed

E. Abbruzzese, Stephen B. Levine, Julia W. Mason

www.tandfonline.com/doi/full/10.1080/0092623X.2022.2150346

Our analysis of the Dutch protocol has been written with three goals in mind. First, we wanted to definitively refute the claims that the foundational Dutch research represents “solid prospective research” that provides reliable evidence of net benefits of youth gender transition. In fact, it is much better described as case series—one of the lowest levels of evidence available (Dekkers et al., Citation2012, Mathes & Pieper, Citation2017). Second, we aimed to demonstrate that the type of non-comparative, short-term research that the gender medicine establishment continues to pursue is incapable of generating reliable information. And third and most importantly, we wanted to remind the medical community that medicine is a double-edged sword capable of both much good and much harm. The burden of proof—demonstrating that a treatment does more good than harm—is on those promoting the intervention, not on those concerned about the harms. Until gender medicine commits to conducting high quality research capable of reliably demonstrating the preponderance of benefits over harms of these invasive interventions, we must be skeptical of the enthusiasm generated by headlines claiming that yet another “gender study” proved benefits of transitioning youth. This time-honored concern about risk/benefit ratio is a sobering reminder that the history of medicine is replete with examples of “cures” which turned out to far more harmful than the “disease.”

I don't think they should be promoted, I am just saying I miss trust total bans

It isn't a total ban.

They will be available for conditions they are already approved for (precocious puberty) and via research trials - like drugs for any conditions they aren't already approved of.

What's changed is that they won't be prescribed off label any more. Why anyone would support that continuing is beyond me.

It takes allot of resource to give children good psychological care and the reality is that funding for mental health is being cut not improved . That is frightening given the level of stress that they are under.

Completely agree that children's mental health care needs serious improvement and investment. Cant' see how blocking puberty or handing out untested drugs is a solution, though.

I am just saying I miss trust total bans

Lots of medicines are ‘banned’ in the way these are to be ‘banned’. For example, strong opiates aren’t used unless clinically necessary. Do you disagree with that?

It would be interesting to hear if anyone one here
has had a positive experience of thier use as a precursor to gender re assignment

Do you agree that evidence based medicine is important? Do you think anecdotal evidence constitutes good evidence? Why not read the Cass report?

https://cass.independent-review.uk/wp-content/uploads/2024/04/CassReviewFinal.pdf

I don't think they should be promoted, I am just saying I miss trust total bans . It would be interesting to hear if anyone one here
has had a positive experience of thier use as a precursor to gender re assignment. I acknowledge though that the majority of outcomes were negative . It takes allot of resource to give children good psychological care and the reality is that funding for mental health is being cut not improved . That is frightening given the level of stress that they are under.

As a pp has pointed out, it doesn’t take much effort to find out the consequences of using these powerful drugs.
At the very least, there is no good evidence of their effectiveness in treating gender dysphoria.

They have not been totally banned, as they are still available for the treatment of precocious puberty, which is a real and damaging medical condition. However, they are prescribed with care, and for a limited time only.
Many drugs are appropriate in some circumstances, but contra-indicated in others. This is not authoritarian. It is good, safe medical practice.

Maybe you should catch up with a bit of reading, as many of us have been doing for at least the last 5 years. You could start with "Time to Think" by Hannah Barnes, then have a look at the Cass review, upon which the recent announcement by Wes Streeting is based.

I'd like to thank the UK for doing this, notably all the amazing women here who have provided impetus, as this puts an indefinite halt to children from my homeland the Isle of Man having access to these drugs too.

The Isle of Man is not in the UK or EU, but is a Crown Dependency situated in the Irish sea between Scotland, England, N.I., Ireland, and Wales. Our 'NHS' is called Manx Care and has been buying 'gender services' for Manx and Manx-resident children from the Tavistock. These 'services' are now suspended indefinitely, other than the maintaining of waiting lists.

I suspect that most Manx people would be horrified if they knew the reality of 'puberty blockers' in the context of their use within a medically untested framework of gender ideology. Till now, the 'T' has sneaked along with the LGB and all that residual guilt that many on the Island feel about being so slow to the table regarding decriminalising homosexuality for men (1992), legalising abortion for women (2019), etc. They want to now be seen as progressive and modern and #kind.

On this matter, puberty blockers for children, I'd urge our Chief Minister to take the lead from the UK's Secretary of State for Health.

Bastards, aren’t they?

I wonder how much of the push on children (or adults) to consider becoming different sex is down to drug company profits.

As a drug for precocious puberty they would have a limited target audience. Start using them on kids for being the usual confused pile of hormones kids are as they approach puberty, then a massive new market appears.

History teaches us that one cannot let the medical establishment do whatever it wills. It must be held in check.

Alliance are an absolute train wreck.
Alderdice, Glass et al would be horrified by the monstrosity it has become.

Thanks be to God. Someone has had a bit of sense.

Sorry meant to quote @olivia8888

Most of us on here, me included, do not have detailed clinical understanding of the physical consequences of puberty blockers.

I think you'll find there are women here who do. There is a lack of evidence that drugs used as "puberty blockers" improve mental health. What reason do you think young children and teenagers should be taking them for exactly?

Most of us on here, me included, do not have detailed clinical understanding of the physical consequences of puberty blockers. There is conflicting information available and definitely more research needed. My understanding was that in the case of dysphoria they were used as a delay in order to give a person enough time to decide if they wanted to follow up with gender affirming hormones. It is very difficult to know if the reports of the side effects are exaggerated for political reasons or a valid reason to deny the treatment to everyone regardless? I suspect there a compelling anecdotes on both sides. I am suspicious of a total ban as it feels authoritarian?

The point is: we don't know what effect it could have on children, outside of it's use for precocious puberty. There are no good long term studies, and there can't be, because it's not ethical. So we shouldn't be using untested drugs on healthy children.

I have no idea.

Perhaps one day I'll understand

I honestly never understood how they were ever considered. They( even when followed by cross sex hormones)never changed the sex of the child/adult.
Who the fuck gives high strength drugs to a child when the best case outcome is staying the same albeit damaged sex.

One MP who contributed to the debate today described a situation (don’t want to go into detail) where a child had been waiting for a long time for treatment.

As that treatment might have been puberty blockers, leading to cross sex hormones and possibly surgery, what I felt on hearing this was relief.

2. Children with genuine dysphoria are being denied treatment.

There isn't any concrete evidence that 'treatment' would be beneficial though. Watchful waiting was the protocol until very recently and it seems sensible to prioritise this again