R4 Today about the Tavistock report/resignation

This is why I find the concept of "passing" sinister. It skews the goal of treatment to be a cosmetic outcome in which a successful outcome is producing a modified version of a person who cannot be identified as their birth sex.

I'd have liked to have heard the interviewer ask Polly Carmichael some hard questions. For example: "Is it possible for people to change sex?" Then when she replies "No" (which is the only possible reply, since she is a doctor), a question about what the actual outcomes of the treatment would be - pushing her on the outcomes in terms of fertility and sexual function.

Professor Carl Heneghan was interviewed on last night's Panorama, 'Trans Kids: Why Medicine Matters' & as a consequence of his analysis concluded that 'informed consent is not possible'

BMJ EBM Spotlight paper:
Carl Heneghan
Editor in Chief BMJ EBM, Professor of EBM, University of Oxford

Tom Jefferson
Senior Associate Tutor University of Oxford
Visiting Professor Institute of Health & Society, Faculty of Medicine, Newcastle University

'Gender-affirming hormone in children and adolescents – Evidence review'
Posted on 25th February 2019

(extract)
"Gender dysphoria occurs when a person experiences discomfort or distress because of a mismatch between their biological sex and gender identity. Gender dysphoria can arise in childhood and adolescent which raises many questions about how best to handle the condition. This post sets out the current evidence for gender-affirming hormones in adolescents and children to aid decision making. (continues)

"Conclusions

There are significant problems with how the evidence for Gender-affirming cross-sex hormone has been collected and analysed that prevents definitive conclusions to be drawn. Similar to puberty blockers, the evidence is limited by small sample sizes; retrospective methods, loss of considerable numbers of patients in follow-up. The majority of studies also lack a control group (only two studies used controls). Interventions have heterogeneous treatment regimes complicating comparisons between studies. Also adherence to the interventions are either not reported or at best inconsistent. Subjective outcomes, which are highly prevalent in the studies, are also prone to bias due to lack of blinding, and many effects can be explained by regression to the mean.

The development of these interventions should, therefore, occur in the context of research. Treatments for under 18 gender dysphoric children and adolescents remain largely experimental. There are a large number of unanswered questions that include the age at start, reversibility; adverse events, long term effects on mental health, quality of life, bone mineral density, osteoporosis in later life and cognition. We wonder whether off label use is appropriate and justified for drugs such as spironolactone which can cause substantial harms, including death. We are also ignorant of the long-term safety profiles of the different GAH regimens. The current evidence base does not support informed decision making and safe practice."
blogs.bmj.com/bmjebmspotlight/2019/02/25/gender-affirming-hormone-in-children-and-adolescents-evidence-review/

www.mumsnet.com/Talk/womens_rights/3518188-BMJ-Prof-Carl-Heneghan-Evidence-Based-Medicine-Oxford-Panorama-Trans-Kids-Gender-affirming-hormone-in-children-and-adolescents-Evidence-review-concludes-There-are-significant-problems

This is an NHS leaflet about hormones:

www.teni.ie/attachments/9ea50d6e-1148-4c26-be0d-9def980047db.PDF

On page 10 it says:

"Ideally, medical treatment should be based on scientific evidence, but there is little research about the use of cross-sex hormones"

Then the next page - in fact the next paragraph - it says:

"Hormone treatment for trans people at reasonable dosages is remarkably safe".

Is that deliberately misleading or just misleading?

headteachers would know how best to respond to pupils questioning their gender identity.
Like the HT at my DCs' school who claims a 6 year old has always been a girl because he likes dresses/pink/unicorns/long hair?

LangCleg but doesn't that depend on the parents and doctors disagreeing?
I think it should be a preemptive hearing, and that the state (be it the justice system or the NHS) should be duty bound to ensure the patient is fully aware of all the possible implications of pursuing this treatment, because in the end, it will be taxpayers who pay the compensation.

Thanks for the link ChattyLion I’ll try to spend some time seeing what I can dig out.

Children should have someone who has their best interests at heart and that isn't always parents.

Yes. In court cases arbitrating contested medical treatments (or withholding of such), the parents will have a legal team, the health trust will have a legal team, and the child is represented by a court-appointed independent guardian.

Yes but as this is both a medical and legal change why don't we have both medical and legal advocates?
One would think the lawyers at least would recognise the importance of ensuring informed consent was properly informed.

How much have banks paid out in PPI compensation? And that's for being charged a bit extra, not having your breasts cut off.

Yes exactly, it should be what all the doctors are doing in line with GMC Good Medical Practice guidance, the law, standard medical ethics etc - giving medical treatment only that is in the child’s best interests, but because of the haranguing from TRA lobby groups and the coaching of kids and the fake suicide stats scaring the crap out of parents etc the pressure is on the health service to suspend normal ethics and safeguarding and just ‘affirm’. That’s in the NHS. Then there are also the private sector providers who are happy to ‘help’ and who will work independently outside of the NHS standard of care.

It's interesting when you compare how much pressure the clinicians involved in the recent cases of the terminally ill babies withstood. Even going to court to defend their decision to do no harm in the face of huge (misguided in my opinion) public outcry.

Courts. So in the case of the young boy who was transed by his mum and supported by Mermaids, the courts got involved because the father wanted to stop it/have custody.
Surely as this is still comparatively rare, we can afford a court hearing before transition for all children? An independent advocate for the child who can hear their side, assess whether the parents are homophobic, deluded, etc, and who can ensure the child is 100% informed of their future (sterility, lack of sexual function, small pool of potential partners and the unlikelihood of passing being part of this)

Children should have someone who has their best interests at heart and that isn't always parents. Children deserve to know the truth about what spineless adults are affirming them into.

This makes me think of the Philip Larkin poem "This be the verse", as there are going to be some seriously angry adults with their parents when they get to adulthood and are without fertility or choice. They are taking their choices away.

This is why I find the concept of "passing" sinister. It skews the goal of treatment to be a cosmetic outcome in which a successful outcome is producing a modified version of a person who cannot be identified as their birth sex.
Absolutely. And who is unable to function sexually, and who has developed coping mechanisms around how they look, and who has practiced lying to or concealing from their family, and who is isolated and massively vulnerable. But who "passes". Childhood chemical transition, including GnRH agonists, is solely for the aesthetic result. There's no psychological benefit to affirm affirm affirm, especially if other MH issues are ignored as a result. It's almost like it was designed to churn out vulnerable damaged paedo-fodder.

The sheer inadequacy of that, set against what we're told is sustained and severe mental anguish, is breathtaking.
Because passing is so rare. It's unachievable for many. I don't know how it can ever be achieved. Say facial feminisation surgery (ironically FFS) - if it became commonplace humans would develop other ways to determine what sex a stranger was, the same way we can see someone in trousers with short hair and not assume it's a man. Women especially. Because our safety relies on being able to tell.

Feels like the tide has actually turned now (not getting complacent though!)

Every so often I realise it has been rather peaceful without Fanny Haddock throwing in his two penn'orth opinions. He's going to come back from his media retreat in NZ to find quite a different atmosphere.

BBC story on teaching menstruation health in schools (currently advertised below the Tavi one linked above) uses the words women and girls throughout.

Feels like the tide has actually turned now (not getting complacent though!)

Sounds like some properly neutral investigation is going on - thank god, not before time. Curious to see what the reaction from the mermaids/gires end will be. There can be nothing wrong with scrutiny of these services but I wouldn’t be surprised if that’s not how they see it.

Professor from Oxford's centre for evidenced based medicine said the quality of existing evidence is terrible and informed consent not possible.
He is 'alarmed' by quality of international research.

There was a brief extract fom tonight's Panorama on R4, its going to be significant.

Thanks for the link. Huge change of tone from BBC towards reality.

These two interviewees really acknowledges how pressure groups have been trying to dictate NHS care. The ‘pro-trans lobby groups’ referred to (..and we all know who those are..) are clearly uninterested in the best interests of children. its all about building as big as possible cohort of people who will support their political cause. It is absolutely scandalous. Such a relief to see this start to be recognised more widely.

Encouraging headline on bbc

NHS child gender reassignment 'too quick' www.bbc.co.uk/news/health-47359692

Ali1ce you can search via this link below for UK REC-approved research project summaries. This the type of REC that researchers need to go to where their research study involves recruitment via the NHS of patients, or of NHS staff.

Other kinds of research have different REC set ups, but I’d assume that this research work mentioned is likely to have been based at the English NHS GIDS.

www.hra.nhs.uk/planning-and-improving-research/application-summaries/research-summaries/

Looks to me that you can see everything that has been submitted to a REC including the proposals that didn’t get REC approval (just filter for ‘unfavourable opinion’).

I think the issue may be that in the UK the parents/lobby groups are backed up by some 'medical professionals' from US, Australia etc with WPATH representing both TRAs and some medical practitioners.

Parents and patients are being enabled to take on NHS GIDS service because of the ambiguous nature of their pathways and protocols.

cf growinguptransgender.com/2019/02/13/offensive-dated-harmful-2019-research-from-gids/

Sport. Coming up on R4 soon.

just heard something about trans women and women on PM with Evan Davis. Couldn't hear what it was in relation to.

Is this how the NHS usually decides which treatments to offer? Do they normally decide based on how much pressure there is from patients or their parents rather than on the evidence?

It's interesting when you compare how much pressure the clinicians involved in the recent cases of the terminally ill babies withstood. Even going to court to defend their decision to do no harm in the face of huge (misguided in my opinion) public outcry.