Stonewall's response to Transgender Trend

And if it is to help people to feel happy about their body, why are other treatments not free on the NHS for exactly the same purpose. Why are these treatments free if it is not an illness, a disorder or a mental health condition.

suggestions, it will probably be rather less confusing if you consider what I actually wrote, rather than your creative but inaccurate paraphrasing.

For the avoidance of any further opacity:

• It is not unethical to take steps to collect the evidence necessary to determine which of 2 treatment options is safest and most effective. Therefore, no circular logic problem.

• It is is ethical to collect this evidence via well-designed clinical intervention studies involving participants who are able to understand the risks associated with potentially serious treatment side effects and who can give informed consent.

• Until this evidence exists, it is not unethical for a clinician who is uncomfortable with the risk of serious side effects for unproven benefit, and/or unconvinced of a patient's ability to give informed consent, to refuse to prescribe a particular treatment.

I support all social and psychological measures in the first instance to reduce distress that trans identified and non-binary people might experience - we know that this is in large part due to lack of social support and inclusion, so this has to be addressed first. Doing so might reduce medical pathways as individuals do not then have to meet the higher threshold of legislation that requires surgery etc to recognise their gender ID.

What do you mean by this? It has never been a requirement in the UK for transgender people to have surgery in order to obtain a GRC.

You also fail to consider any other people in this support for "all social and psychological measures". If others are adversely affected by this support, what then? Do you believe they should also have the right to be supported and included?

As I've said before the word 'cure' is problematic - it suggests, illness, disease, pathology - which most trans people would not identify with, and which medical experts do not agree with either - the WHO recognise it is not a disorder or mental health condition.

If it's not an illness, a disorder or a mental health condition, why does it require any medical treatment?

@Awiltu

OK, so you seem to be saying that until there is an evidence base for medical treatment it is unethical to give that treatment.

No, until there is a sound evidence base which clearly demonstrates that a particular treatment produces more benefit than harm, it isn't unethical not to give that treatment.

As in - until there is a sound evidence base which clearly demonstrates that puberty blockers produce more benefit than harm in gender dysphoric young people, it isn't unethical not to give puberty blockers. #

__

But you have defined parameters that make this an impossible achievement (but I guess that's maybe the whole point?!)

On one hand you're saying:

"Show me the evidence"

And on the other hand you are saying:

"It is unethical to take any steps to get the evidence"

(especially as you won't approve of small sample size studies, so to get the power that you want in the research you will need very large scale studies.)

You have created a circular logic ensuring your demands can never be met.

That's not how research and development of treatment protocols for patients works.

I have no agenda myself (makes no odds to me however anyone chooses to identify, I'll relate to them in the same way) The only thing I'm interested in is finding the ways forward that best support the individual, and I recognise that individuals arrive at places in their lives through different pathways and appropriate support will vary accordingly.

As I've said before the word 'cure' is problematic - it suggests, illness, disease, pathology - which most trans people would not identify with, and which medical experts do not agree with either - the WHO recognise it is not a disorder or mental health condition. So people might have medical treatment that is in alignment with and supportive of their gender identity, but I wouldn't describe that as a cure as it is not an illness we are dealing with.

I support all social and psychological measures in the first instance to reduce distress that trans identified and non-binary people might experience - we know that this is in large part due to lack of social support and inclusion, so this has to be addressed first. Doing so might reduce medical pathways as individuals do not then have to meet the higher threshold of legislation that requires surgery etc to recognise their gender ID.

These boards are very against any social mechanisms in this respect so I believe they inadvertently promote medical pathways for trans-identified people, despite claiming to be against this. This board does not, in general, want to see an inclusive culture for trans identified people, which increases their distress.

I have asked before on these boards for people to post evidence they can find (statistically significant evidence, I don't think that's too much to ask) that more relaxed processes for legal gender recognition in the multiple countries that have now employed these for several years, has led to any detriment, along any measure, for women in these countries.

Nobody has provided any evidence / studies of negative impact on women in these countries. So, whilst we're talking about evidence and studies, it would be great if people could post the statistically significant research they can find on this. (And of course, with such large populations to work with, the methodological issues that constrain research with trans people will not be such as issue here, so this should be quite achievable.)

It strikes me in a lot of this conversation that a dominating attitude from GC feminists seems to be that of 'knowing better than the original source'...the propensity to dismiss the evidence and research that exists appears to mimic the propensity to dismiss the lived realities of trans-identified people as they describe them - to refute the asserted identity and claim they are mistaken. It seems arrogant.

until there is a sound evidence base which clearly demonstrates that a particular treatment produces more benefit than harm, it isn't unethical not to give that treatment.

Worth repeating again and again.

@suggestionsplease1 Comparing evolution of suitable treatments for gender dysphoria, to those for cancers now?? That’s an odd shift.

Clinicians in Europe are assessing risk vs benefit of treatments carefully, as the cohort for gender dysphoria has shifted, which is appropriate. You don’t agree.

Talking of sound evidence, just a little reminder that Stephanie Davis Arai of Transgender Trend was shortlisted for the John Maddox prize.

The John Maddox Prize for Standing up for Science recognises the work of individuals who promote science and evidence, advancing the public discussion around difficult topics despite challenges or hostility.

Could that description BE more applicable?? 😁

suggestions, you are still confusing reporting a numerical difference with interpreting that difference as though it were real. Here is a direct quote from the paper where the authors themselves quite legitimately do the former (my italics added):

"On the contrary, the immediately eligible group, who at baseline had a higher, but not significantly different psychosocial functioning than the delayed eligible group, did not show any significant improvement after 6 months of psychological support"

I assumed you must have access to raw data to be able to come to your summary version

No, my summary version was based on applying basic scientific literacy and knowledge of research methods. Academics and researchers perform the same sort of critical evaluation every single time they read a research paper - they don't just swallow the conclusions whole.

This study has been published in a reputable, peer - review journal

Like it or not, the peer review and editorial process isn't infallible (or free from bias) and very few papers involving human behavioural research that are published are completely free of methodological issues. A paper which provides data on an under-researched area is more likely to be published even if some aspects are problematic, because it will be of interest to the journal's readership.

OK, so you seem to be saying that until there is an evidence base for medical treatment it is unethical to give that treatment.

No, until there is a sound evidence base which clearly demonstrates that a particular treatment produces more benefit than harm, it isn't unethical not to give that treatment.

As in - until there is a sound evidence base which clearly demonstrates that puberty blockers produce more benefit than harm in gender dysphoric young people, it isn't unethical not to give puberty blockers.

Anyway, I think the tutorial in critical evaluation of research studies has probably gone as far as it's likely to in clarifying things for you, suggestions, so that should free up your time to respond to Datun's earlier post (the one at 12.55.07, in case you missed it).

You're as much of a keyboard warrior as anyone else on this thread, Suggestions.

It's wanting to promote a desire in people for something they can never have. And trying to get everyone else to pretend they can, even when they all know they can't.

This is the crux.

Sorry, I perhaps shouldn't have used the phrase keyboard warrior there - I thought it was used to refer to someone who posts a lot on a subject they feel strongly about but it appears it can also imply an abusive style, and that's not what I meant.

@Awiltu you are happy to refer to 'numerically...higher'' measures as if this had some importance - this is news to me - 5.00009 is numerically higher that 5.00008 but it's unlikely to tell us anything meaningful unless you have participants in the billions perhaps, whilst ignoring the statistically significant information the researchers found:

"GD adolescents receiving also puberty suppression had significantly better psychosocial functioning after 12 months of GnRHa (67.4 ± 13.9) compared with when they had received only psychological support (60.9 ± 12.2, P = 0.001)."

If you think that is an unbiased, good way forward for analysing studies I am staggered.

I assumed you must have access to raw data to be able to come to your summary version - that you feel that the drop out rate means you can not make inferences about the benefit of puberty blockers - the researchers would have accounted for the drop out rate in their analysis, as standard, and they still are reporting statistical significance. I thought you had maybe run a different analysis to arrive at your conclusion, because otherwise I don't see how your speculation is justified. This study has been published in a reputable, peer - review journal:

"The Journal of Sexual Medicine maintains the highest standards of peer review and pursues editorial approaches that help us avoid bias. All submitted manuscripts are reviewed for quality, novelty, scientific importance, and relevance to The Journal's readership."

But you must think they have gone wrong somewhere?

And you seem to think that just about every study, in every country, by every organisation, university etc, ever carried out on this area has gone wrong somewhere, yes?

You must think all the literature reviews collating the information have gone wrong somewhere too?

That is a really unusual position for a researcher to take, and would normally indicate great bias on the part of that researcher.

Imagine instead that the same study was conducted with a group of participants who were all considered equally eligible for immediate treatment with puberty blockers. In that case, it would only be unethical to assign a participant to the psychological-only intervention arm if there was an existing body of evidence demonstrating that this intervention was ineffective or produced an inferior outcome to puberty blockers in this group of individuals. No such evidence base exists for gender dysphoric adolescents (no matter how hard TRAs try to pretend that it does).

OK, so you seem to be saying that until there is an evidence base for medical treatment it is unethical to give that treatment.

Let's put aside for the time being that it sounds very likely that you won't accept any evidence given anyway (as the study we're talking about feels it has indeed found that evidence), and lets focus on the fact that this involves a circular argument - 'you can't treat someone until you prove it is effective, you can't prove it is effective until you treat some people with it'.

That's not how treatment plans work in their infancy - imagine if you were developing a cancer drug, and you're beginning to see some nice evidence from your computer modelling, testing on lab-grown human cells and then on your animal studies ...you're getting a very good idea that this is going to be very helpful in the treatment of cancer - do you not start the trials on human patients because someone out there feels that it's not safe enough? You have to take a well-judged approach in collaboration with all the experts in the field (and not at the say-so of a keyboard warrior) and you move forward with the treatment on human patients at the right time and you improve the quality of life and save lives in the process of doing this. If you waited years until the keyboard warrior's unreasonable (and clearly impossible with your circular reasoning) evidential requirements were met lives would be lost and quality of life would maintain at a low level for all those people who would hope to benefit.

suggestions said that trans people don't want a cure that would stop them desiring to be and to be recognised as they other sex, they just want to be the sex that they identify as and for others to acknowledge that.

I didn't even want to address that sentence. It's got hopeless written all over it.

It's wanting to promote a desire in people for something they can never have. And trying to get everyone else to pretend they can, even when they all know they can't.

I can't believe anyone with an ounce of empathy would ever write anything so wretched.

What is this treatment for if it's not trying to cure some aspect of 'being trans'?

suggestions said that trans people don't want a cure that would stop them desiring to be and to be recognised as they other sex, they just want to be the sex that they identify as and for others to acknowledge that.

Although their desire to be the opposite sex is causing them distress (gender dysphoria), they don't want this feeling to be cured, allowing them to live happily in the body they have (which might be an achievable goal), instead they want to be the opposite sex, even though this is impossible. The treatment is an attempt at a cure for being the opposite sex to that which they want to be, and is always doomed to failure because people can't change sex.

They don't want a cure for wanting to be the opposite sex, but they do want a 'cure' for being the sex they are. Is that right suggestions?

suggestions appear to think that any published study putting a remotely positive spin on transition is a kind of irrefutable truth, exempt from any further critical evaluation. The mere fact such studies exist at all should be enough to silence all further argument.

That kind of "just accept this and don't think about it too much in case you end up at wrongthink" approach seems oddly familiar...

If I have interpreted the tone correctly, I think that some posters are upset that their plopped down links were not accepted as overwhelming evidence to support their claim. I take it that we were supposed to be impressed with the sheer number of them and not expect any coherent narrative about them.

I mean, the fact that the plop even included one that was corrected to reflect the fact that there was actually NO evidence of improvement and the 51 bank of studies came with a clear and obvious lack of balance points to a 'plop' gotcha rather than an actual honest discussion and maybe honest interpretation of each and every study that was presented.

However, I also believe that some posters on this thread have a rather prejudiced view on, what are we referred to? 'the GC feminists'? and maybe even quite a different understanding of what many of us believe to what the reality is.

I find it odd that @suggestionsplease1 does not seem to have applied any evaluation or rigour to the mass citation drop of a few pages previous.
Or any sort of coherent narrative between them?

And I'm still no closer to understanding why suggestions is so keen to promote treatment of a condition that suggestions doesn't think should have any kind of cure.

Imagine instead that the same study was conducted with a group of participants who were all considered equally eligible for immediate treatment with puberty blockers. In that case, it would only be unethical to assign a participant to the psychological-only intervention arm if there was an existing body of evidence demonstrating that this intervention was ineffective or produced an inferior outcome to puberty blockers in this group of individuals. No such evidence base exists for gender dysphoric adolescents (no matter how hard TRAs try to pretend that it does).

Really key point!

And to deal with this separately, because it's an important point:

We are not talking about a lab experiment where rats are injected with a drug or a placebo, we are talking about a vulnerable human population where the primary intention is to improve their wellbeing; the studies are secondary to this purpose. The preliminary, detailed work would have been about assessing who was suitable for psychological intervention alone, and who was suitable for medical pathways alongside psychological intervention. The cohorts would have been decided on this basis. If they were not determined on this basis that would have been an unethical way forward for the participants in this study and they could probably sue the researchers.

Do you not agree?

This study was indeed a secondary outcome of a clinical process primarily intended to improve the mental health of participants. Where it gets muddy is that assignment to treatment arms appears to have been on the basis of the presence or absence of factors other than gender dysphoria. All participants were considered eligible for puberty blockers to treat gender dysphoria. Participants were only assigned to the "delayed-eligibility" group because clinicians considered there were additional psychological or psychiatric factors beyond gender dysphoria that needed to be explored or addressed before puberty blockers could be given. So the ethical element to treatment arm assignment relates to the ethics of addressing these additional mental health issues, not the ethics of treating gender dysphoria per se.

This key difference has a knock-on effect in how we can interpret the study's findings. The study hasn't compared whether psychological intervention alone or psychological intervention plus puberty blockers produces better outcomes in a population of similar gender-dysphoric adolescents. The study has actually compared whether psychological treatment of gender dysphoric teens with additional complex mental health issues produces better outcomes than using puberty blockers in a group of gender dysphoric teens without additional complex mental health issues. They're comparing apples and oranges.

Imagine instead that the same study was conducted with a group of participants who were all considered equally eligible for immediate treatment with puberty blockers. In that case, it would only be unethical to assign a participant to the psychological-only intervention arm if there was an existing body of evidence demonstrating that this intervention was ineffective or produced an inferior outcome to puberty blockers in this group of individuals. No such evidence base exists for gender dysphoric adolescents (no matter how hard TRAs try to pretend that it does).

suggestionsplease1, why on earth would you assume that I have access to the raw data from this study? I found the paper online with a 30-second Google search of key terms and numbers from the summary in the Finnish report - something you could easily have done yourself in order to answer your own questions. I gave a short evaluation of what is, methodologically speaking, a very straightforward study design and analysis - anyone with a reasonable grasp of research methodology could have given the same sort of critique. Do researchers often appear on Mumsnet to announce "Aw, shucks, forgot to do that darn multiple comparisons correction" about their own published work?

The paper's authors are listed on the link I gave. If you want to discuss access to the raw data, you should contact the corresponding author.

OK on your first point it appears that the rigour I would expect for discussion of studies has been relaxed - that would never have been permitted when I was examining research, and yes we were all very aware of the import of power - please see my analogy where I referred to the issue of power specifically (it was a central point I made). If your approach is typical it seems examination of research has really dumbed down in recent years - what do you think on that point?

Do you understand the difference between reporting data and interpreting data, suggestions? Reporting data involves an objective description of the information collected and the output from statistical analyses. Interpreting data involves presenting an opinion about what your observations and statistical results mean, and specifically whether they do or do not support the experimental hypotheses made prior to data collection.

There is nothing remotely "dumbed down" or "relaxed" about reporting that 2 summary measures appear to be numerically different but are not statistically different. In fact something like "Although there were apparent numerical differences in X and Y, this difference did not reach statistical significance when tested with analysis method A" is fairly standard wording in the results section of a quantitative study.

What would be dumbed down would be to take that numerical difference, ignore the statistical result, and interpret the data as if that difference was a genuine statistical difference. Which I didn't.

I have to say that I would not be happy with a researcher drawing the conclusions you seem happy to arrive at, when they have such a relaxed approach to the analysis of data and are happy to ignore statistical significance whilst believing they are correct in drawing conclusions that differ from the researchers' own.

Again, you seem to fundamentally misunderstand what a research paper is, and what it isn't. A paper presents the objective findings from a data collection exercise, along with the authors' interpretation of what those findings mean and how they relate to the research questions they are asking. Data interpretation is subjective - it is the authors' opinion about what their results mean. There is almost always more than one way to interpret a particular set of data, and the authors' own interpretation is not automatically gospel just because they're the ones making it. Science is full of differing opinions and interpretations of the same body of evidence.

When a research paper is reviewed for publication, the most important issue is whether the methodology used to collect the data is sound. Beyond that, reviewers (and editors) generally don't pull authors up on their interpretation of the data unless it's outrageously off-target or a clear over-reach. It's then up to readers to make up their own minds whether they think the data support the authors' interpretation or not.

Just for anyone interested, this article from a year ago:
www.voorzij.nl/more-research-is-urgently-needed-into-transgender-care-for-young-people-where-does-the-large-increase-of-children-come-from/