Tavistock puberty blocker study published

Thanks for linking that twitter thread about Michael biggs' work. I had wondered if his research had been integral to all of this unravelling. People who keep a closer eye obviously think it is. I wonder if they would ever have published the study if its existence hadn't been highlighted & those important questions asked publicly by people who are difficult to dismiss (Oxford Prof, newsnight). I believe in one of his blogs he thanked the students who, before he realised anything was up, told him to go and educate himself on trans issues.

Thanks to everyone doing the phorensic work on this thread. It seems now that pb aren't really a treatment in their own right, but a way of holding children until they are old enough to get the actual treatment, and the children are expected to move from one to the other. Thats why the high court are right to make sure a child can consent to the whole thing right at the beginning.

I wonder if the nhs will go through with the appeal.

Obviously sheep. However we know in human puberty the hippocampus also changes a lot and this is a very important stage to go through

sometimes the scale of things just hits you all over again. How the hell did anyone think this was a good idea? Even for boys the purported benefits in no way justify the treatment. For girls... exactly what are they trading off for an extra inch of height and smaller hips? It's horrific.

Given that and that their bone density is permanently affected, it would seem to me that it's unlikely that the brain development just restarts as if it had never been interrupted.

This result suggests that the time at which puberty normally occurs may represent a critical period of hippocampal plasticity. Perturbing normal hippocampal formation in this peripubertal period may also have long lasting effects on other brain areas and aspects of cognitive function.

Obviously sheep. However we know in human puberty the hippocampus also changes a lot and this is a very important stage to go through.

eprints.gla.ac.uk/131843/

eprints.gla.ac.uk/130496/

Human hippocampus:

www.frontiersin.org/articles/10.3389/fnins.2014.00070/full

Perhaps someone else who knows more about the Wilcoxon test could comment on statistical methodology?

I haven't properly looked at any of it, but Wilcoxon works by ranking the scores and comparing the rankings. So the reporting of mean vs median is a red herring as the actual values of the scores don't matter for the test.

I'd guess that either the extra participants made the apparent significant increase disappear (which is fine) or lumping the two self-harm statements together made the significant increase in one of them disappear (which strikes me as potentially dodgy.)

Though studies in sheep have found sex specific changes to the brain due to blockers. (Apparently teen sheep are closest to teen human brains for research purposes.) iirc spatial skills was one issue.

I'm Not sure happy, I think they tend to start cross sex hormones at around 16 or later?

Some people can have puberty very late and the brain is still maturing in your 20s,

I wonder if there will be something in the times tomorrow?

So does a child who takes puberty/hormone blockers ever actually go through puberty & mature? (Sorry if not understanding clearly) Do they have the brain of a pre pubescent child or have I misunderstood that part?

Sorry if previously posted?

Good thread. It will be interesting to hear from Michael Biggs.

twitter.com/mum3sun/status/1337823412597776385?s=21

GnRHas are routinely used as testosterone blockers in adult MtF patients within the NHS* and rarely used for FtM (usually testosterone alone is enough, and it’s only if testosterone doesn’t cause total cessation of menstruation that blockers are added).

Some MtF patients are able to come off GnRHa once estrogen levels reach (High average) female numbers. Orchiectomy (alone or with a ‘vaginoplasty’ or ‘vulvaplasty’) obvs makes a blocker/anti androgen unnecessary.

*in the private sector a range of anti androgen meds are used, mostly because GnRHa drugs are very costly, so if the NHS isn’t funding them, they become a lot less desirable.

Ideally this would have been a randomised controlled trial. However from what I can gather, these participants (and/or their families) would not have been happy with any treatment other than PBs. I understand that recruitment would have been difficult to such a design.

But when we look at the outcomes assessed (bone mineral density, height, weight, psychological functioning etc) why didn't they capture the same data from an age- and sex-matched healthy cohort? Comparing to baseline is meaningless in children of this age.

Puberty blockers aren't really puberty blockers, they are hormone blockers. I imagine taking puberty blockers and cross -sex hormones would give a better aesthetic.

There are no irreversible changes in female puberty which are comparable to those due to testosterone.

Oh, 100%, I was just noting their fucked up reasoning for it. Which, like everything else they come out with, makes no sense. (I hope it didn't come across like I was condoning it 😳)

It's clear female puberty doesn't cause any irreversible changes in the way so many transmen who transition as adults (so no PB's) ''pass''.

The BBC report links to the 2015 board papers which contain the Preliminary Results from the Early Intervention Research in Appendix 7. In all 30 participants, and in the 16 natal girls, there was a statistically significant increase in the scoring for “I deliberately try to hurt or kill self” from baseline to after a year on puberty suppression. The table shows the means and SD, rather than the medians and IQR, as in the manuscript.

Self-harm
Looking at two self-harm items measured by the YSR, a significant increase was found in the first item “I deliberately try to hurt or kill self”. Adolescents had the option to score these items as: not true, sometimes true, often true. More adolescents tend to score this item in the “sometimes true - range” at T1 compared to T0, especially natal girls.
T0: Baseline (After Second / third appointment at the GIDS)
T1: 1 year on puberty suppression
I've attached the table of results as an image

So why are the results different?
Firstly the preliminary results look at changes for each of the two self-rated statements individually. The results in the manuscript adds together the two self-rated statements and report this as a self-harm score.
Secondly it is notable that the table of preliminary results presents the results as means and the manuscript as medians. Perhaps someone else who knows more about the Wilcoxon test could comment on statistical methodology?
Thirdly it may be that the results were different for the first 30 participants than when the total 44 were included.

Can anyone tell me-if a child takes puberty blockers do they ever stop taking them? Or do they take them for the rest of their life? Trying to understand if they ever actually go through puberty & mature, or not....

There are no irreversible changes in female puberty which are comparable to those due to testosterone.

Just thinking about consent, for girls, even if looking at only puberty blockers and not the almost inevitable cross sex hormones, wouldn't they have to weigh up:

• continuing puberty and possibly wanting later mastectomy vs
• puberty blockers - no mastectomy but shorter stature, lower bone density, sterility. reduced sexual function

And It just seems like something that would be discussed at length for e.g. life saving cancer treatment, but done so easily for this group of children.

You know the two kids from one family that visited the board (a boy of 12, who wanted to be a girl, and a girl of 11, who wanted to be a boy) - they were asked what they'd like to be done differently in the service. They said they would want a Minecraft server for all the children at the Tavistock to use.
Which is fine, because they're children, and that's the sort of decision a child would make.
My partner just pointed out that Minecraft is particularly popular with people with autism.
I also wonder how much the service has been influenced by a small group of very influential families.

Anything that reduced the size of my breasts as a young teen I would have taken with both hands, fuck the consequences, will deal with that later. The way grown men started treating me once breasts appeared, was scary. Thats before even getting into boys my age. It was horrific.

It says on the Leeds leaflet that blockers make "breasts less full so binding is easier." OMG. Lifelong consequences for that. TBF I might have taken them at that age if it got rid of breasts that were uncomfortable, laughed at for bouncing in sports, poked at by boys. Being given a good bra would have probably been a better first step.

Jeez Molesmokes "Every clinician interviewed as part of the 2019 Trust Review raised concerns about cases where children were prescribed PB and put on the “trans pathway” to life-long medicalisation and sterilisation when the primary issue seemed to be homophobic parents seeking “Conversion Therapy” to “trans the kid straight” (my paraphrase of the situation);"
Every clinician! And I imagine that clinicians questioning it, and not being supported, are the ones that leave. So the ones that remain are increasingly avid believers.

(Presumably if breasts have begun to grow.)

It says on the Leeds leaflet that blockers make "breasts less full so binding is easier."

I've also seen transmen take them on YouTube to stop periods.

Why were puberty blockers ever thought to be a good idea for girls? Within their own logic, it's kind of understandable for boys who want to become trans women, stopping testosterone changes, but for girls?

Purely to stop breast growth, isn't it, so they don't ''need'' a mastectomy?

Thank you sultanasofa

There don't appear to have been any serious adverse events and suicidaility was not reported as an adverse event at all.

If I treat a cohort of cancer patients with an experimental new drug, especially if I don’t have a control group, and the patients become more unwell than they were at baseline, I must stop the trial.

The data you’ve just explained and quoted doesn’t match what was reported after the preliminary findings, so I’m a bit confused.
www.bbc.co.uk/news/health-49036145
Perhaps the preliminary findings were before the 12 month time point?