Tavi finally publish their study...

Who do we know who's a researcher in the area? Would Emma Hilton be fair enough, as a biologist or is that too general?

How about Stella O'Malley, would she be in a position to ask for them?

I have no idea how this works!

How can we get the data by sex? Can we FOI GIDS for it?

I'm not sure about this. Guess there are at least two routes. There's FOI, and then there's the research integrity route.
In general, research data should be openly available for others to re-analyse these days, but I see confidentiality is given as a reason for this not being the case. However, this is not a reason not to provide data split by sex - means and medians for groups of 19 and 24 people should be fine. Clinicians and researcher in the area could be e-mailing the authors....

How can we get the data by sex? Can we FOI GIDS for it?

See Michael Biggs comment to see how important this is - possible GIDS are hiding something here.

journals.plos.org/plosone/article/comment?id=10.1371/annotation/71faadb8-de18-4c65-9482-93ded40984b6

What you can't see here but is starting to emerge now, is that there is no follow-up of the children after they finish. Not even by the adult service. Once they have fully transitioned, that's it.

So you treat kids with highly damaging drugs not licensed for this use. They then proceed to cross-sex hormones and surgery. That's the end. There is no medical pathway that includes aftercare.

So now the first cohort of puberty blocked children is in the same place as the thousands of women in the US who got Lupron.

Crumbling bones in their 20s. Any kind of bone, with all of the other issues this brings.

Atrophied vaginas with all of the problems postmenopausal women face in their 20s. If they have sexual function, a womb locked into excruciating unbearable spasm for minutes, hours, even days after orgasm. (This is why most FTM patients have a hysterectomy within 5 years of taking testosterone.)

We still don't know the longterm effect of arrested brain development. During puberty, a process called neural pruning ensures much better functioning of your brain in adulthood. It's a necessary and beneficial change. We don't know if cross-sex hormones restart this process. We don't know if starting this process post-puberty, once the brain has reached a later age, has the same beneficial effect. But we're not following these young adults to find out.

Michael Biggs' comment is very good.

Also interesting to see the timeline for review. By the time of the Bell v Tavistock case (early Dec iirc?) the paper was already in its second round of peer review and yet the Tavistock decided not to present any of this amazing evidence in court.

Excellent commentary.
There's a lot in that which the authors need to act on. I hope they have the integrity to do so.

journals.plos.org/plosone/article/comment?id=10.1371/annotation/71faadb8-de18-4c65-9482-93ded40984b6

Commentary on the article- highlighting the failure to present results by sex, and the negative effect on bone density.

That is a good commentary.

In terms of not presenting results by sex: "in the preliminary results and likewise in the Dutch study ... girls’ body image worsened following GnRHa, while boys’ body image improved. By combining both sexes, the paper makes it impossible to discern such patterns."

Also: "preliminary results for the first 30 patients showed that the increase in self-harm ... was greater for girls than for boys"

Also the final paragraph regarding all but one child continuing to cross-sex hormones:

"The most important outcome—but the least surprising—is that 43 out of 44 patients continued to cross-sex hormones. It is hard to square this finding with the authors’ claim that “pubertal suppression may be both a treatment in its own right and also an intermediate step in a longer treatment pathway” (p. 22). Considered as a treatment in its own right, the suppression of puberty with GnRHa might be the only treatment provided by the NHS for which there is no objective evidence that the benefits outweigh the risks—as the authors themselves admitted in their statistical plan. The only justification for puberty suppression is to prepare a child for lifelong medicalization with cross-sex hormones and surgeries, with irreversible consequences for sexuality and fertility."

journals.plos.org/plosone/article/comment?id=10.1371/annotation/71faadb8-de18-4c65-9482-93ded40984b6

Commentary on the article- highlighting the failure to present results by sex, and the negative effect on bone density.

How low is the bar? Surely if you had advocated for these drugs, to thr point in one case a dr was suspended, youd want/expect/need more of an outcome of " no change" with no control group to compare to, for all your hard work?

They are going back to court, spending all that money and time on the back of a study where half weren't even fully followed and a "no change" outcome. ?

Even if the previous treatment of using puberty blockers for gender identity issues is reinstated, plausible deniability over "completely reversible" and "almost no adverse outcomes" has gone. Medical practitioners in the UK will know this.

I'm very troubled by the young age of some of these children. 12 years old is very young and immature. To give PBs and stunt adolescent brain development and then think they can make informed consent at 16 when they haven't been able to develop neurologically leaves me feeling cold. My DD has an executive function age below her years. She looks like a teen of her age and sometimes sounds like one but her impulse and decision making is very childish.

Changes in BMD were consistent with suppression of growth.

This is unusually honest. They usually gloss this more and say "there was no loss/change in bone density". Hoping readers don't register the fact that bone density should be increasing rapidly in normal development at this point.

I think they may have changed this in review, because there was some reporting on the first draft around this point, eg this by Michael Laidlaw. (Where did his Twitter go?)

What would need to be established is whether it's possible to catch up with the missed bone density gain later.

And I assume the Tavistock aren't doing any such studies because by that point they've passed their puberty-blocked children onto adult services? Is anyone?

Here's another thread by Will Malone about a previous study.

That study was pretty blasé:

We have shown that there is no actual change in BMAD or tBMD in young transgender adolescents on long term GnRHa therapy, and certainly no true fall as initially suspected. We suggest that yearly DEXA scans may not be necessary. We also suggest that reference ranges may need to be re-defined for this patient cohort.

In both cases they're effectively asserting "it's okay, because we've stopped growth". They're (possibly more accurately) viewing "puberty blockers" as "growth blockers" or "maturity blockers", in which case, yes, maybe you wouldn't expect to see gain while receiving them.

But will you get it back later? Studies?

Times reports it also:

www.thetimes.co.uk/article/01718952-6591-11eb-908c-00b0fcb974f6?shareToken=5d13efa8babcf054d5272568ada1b731

There is an obvious explanation as to why psychological functioning and distress data show no improvement.

These children are frozen. Their peers continue to develop. That's why earlier analysis showed that they showed an initial improvement, but within a year were either as bad as or worse than before.

Because their peers are moving on. They're standing still. They're old enough not just to notice but understand that this is not good for them.

Physical development arrested.
Brain development arrested.
Emotional development arrested.

Their peers are falling in love, taking first tentative steps exploring sexuality. They're maturing emotionally. Their decision making and reasoning improves. Their ability to handle challenging situations improves. And so on.

But these kids are on PBs and have to wait until they're 16 before they can move on. They cannot ever catch up, because their peers continue to develop.

So, if this is the preferred answer to the criticism of puberty blockers, then puberty blockers cannot be said to offer a pause that alleviates distress and allows time to consider the options in an atmosphere free from stress and pressure.

So what are they then? Logically, the stepping stone to the whole package of life-altering medical transition.

Changes in BMD were consistent with suppression of growth.

I view this as unethical. BMD is supposed to increase to peak level during puberty.

Think of dwelling in the foothills until puberty, then rapidly climbing a very high mountain, then coming off post-puberty on a gentle slope that then declines much more noticeably in postmenopausal women (whose levels remained above the foothills of their childhood though). BMD levels in these kids on PBs never leave the foothills. They remain below the levels of a postmenopausal woman.

Not to specifically point this out is to deliberately minimise a severely harmful side effect of PBs.

Without looking but from memory, only 3 of the boys tried to freeze sperm and failed.

Maybe Mermaids could comment on that.

No change is pretty bad. You would have thought placebo effect and regression to the mean should have shown some positive impact so no change would suggest a possible negative impact?

Also, didn't Biggs find an increase in self harming in girls in earlier data? Now hidden by mixing sexes.

There is a real possibility that people declined to complete the study because of worsening mental health, or because they detransitioned or other wise stopped medical treatment. This is not discussed in the article. No way can this be used as an evidence base for puberty blockers.

rogdmum - is the average age to go onto CSH 16/17? So there were 14 children who started PBs at 13 and the other children in the study were older?

Am I overlooking it, or is there no breakdown of the "psychological functioning"/distress data for males and females? It's noted in the discussion that a previous study found a benefit for males and not females(? - am I remembering this right?). If so, there may also be some obfuscation here.
While there's an argument for not doing too many significance tests on the data, why are they not publishing the effect sizes and confidence intervals for the males and females separately? I hope there's supplementary info available somewhere....

Apologies I got the drop out rate wrong- only 14/44 followed up to 36 months. That's pretty terrible & the reviewers really should have questioned why that was. They also should have summarised their data by sex, as height & bone mass density develop differently in males & females. The tables are poorly done.

The numbers are tiny and they have a very high drop out rate- almost 50% over 3 years, with no comment made on this. They've conflated the male and female data in the tables so unpicking what happened to bone mass density and height in the different sexes is impossible. The overall result seems to be no change in psychological
functioning (including self-harming) so no happier and no less risk of self-harm, shorter, fatter and lower bone mass density. Seems like a pretty useless 'treatment'. Median time to starting puberty blockers after first consult was less than 4 months.

Mermaids reporting of this study is deeply irresponsible (cherry picking qualitative data and missing the overall messages). What a surprise....