Stonewall's response to Transgender Trend

For those who haven't seen the Swedish position:
segm.org/Sweden_ends_use_of_Dutch_protocol#:~:text=According%20to%20the%20%E2%80%9DDutch%20Protocol,at%20the%20age%20of%2016.

These studies cannot by their very nature be compared with the design and execution and rigour of a clinical drugs trial, although I'm certain the clinicians involved did their best to make the study as informative as possible, and will continue to assess the changing landscape of their patient numbers and profiles

What I get from your comments, @suggestionsplease1, is that you consider it unethical to have put a group of young people through a psychoanalytical treatment pathway instead of on medication to block puberty. Is that correct?
Do you not consider it a positive that minors suffering from gender dysphoria might be supported just as well by psychoanalytical treatment as medicalisation? Would it not be preferable if this provided a long-term solution to their dysphoria?
Or are you a strict proponent of The Dutch Protocol?
Your consistent use of the phrase 'GC feminist' is troubling. What do you mean by 'GC'?
Have you listened to Sue Evans, 40+ years a psychoanalyst, and formerly of Tavistock GIDS? Webinar posted previously.
What do you take from her experience?

@suggestionsplease1 Can you provide the same statistical rigour for any of the studies you have cited here, or otherwise interpret their design and conclusions as representing significant meaning to the treatment of minors suffering from gender dysphoria?
The study cited in the Finnish clinic's review was the most applicable and informative available at the time and has given them cause for caution in this new and alarmingly expanding cohort.

You don't seem to agree, but who are you to question the clinicians on the ground with a wealth of direct patient experience?

Blinded studies with placebos don't just take place in "rats in a lab injected with a drug or placebo", suggestions.

Of course you will be aware that your relaxed approach diverges greatly from the standards GC feminists are applying to the research.

I note that you have not answered my questions about the figures, Can you provide the raw data please, or at least the p values / the means, range - it sounds like you have access to this data so it is appropriate that you make it available to others to analyse.

"Well sure, but you will see that I said it would be unethical for the participants in the studies to be randomly allocated to treatment groups with no individualised plans - that would be unethical right?"

No it wouldn't - that's exactly how randomisation to a treatment arm works, for example in a blinded RCT. In fact, randomly allocating participants to a treatment that isn't individualised minimises the risk that outcomes will be affected by bias and confounding factors. In the case of this study, participants weren't randomly allocated, and there was indeed a confound of a difference in the psychological and psychiatric profile of the 2 groups.

I think we are talking at cross purposes here - I understand how randomisation works, what I am talking about is the treatment of the human participants in this study. 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?

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.

Please provide the raw data.

Everyone identifies the causes of and expresses their difficulties with their sexuality or gender ID in different ways, and of course cultural shifts and changing beliefs can be instrumental in this - so being gay / trans at certain times in certain cultures might cause a lot of shame to a person and distress in that way, and at other times another gay person or transgender person might attribute the source of their distress not inwardly but outwardly, perhaps at a hostile social environment and discrimination they face.

But of course no one, gay or transgender, who experiences distress WANTS to experience that distress, but how they articulate the distress takes different directions "I wish I wasn't gay/ trans" / "I wish I didn't have so much trouble living as gay / trans person due to the culture that we're in. (ie I am happy in myself being gay/ trans).

Regarding medical transition I think all other alternatives should ideally be explored first, but there are times when it is an appropriate way forward.

I know you are determined to follow the Denton playbook of conflating trans and sexual orientation, suggestionsplease1, but making them synonymous is going a bit far! Particularly since you can't even define sexual orientation in the context of gender ideology.

Are we allowed to refer to 'numerically higher' numbers of something in discussions of results where the results are not significant?! Is that not frowned upon? Was a p value calculated? Do you have what it was if so? Or the 2 means?

Perfectly valid to clarify when reporting results that there was an apparent numerical difference which did not reach statistical significance - that is effectively saying it looked like there might be a difference but this difference wasn't "real" when tested statistically. With an underpowered study (as this one was), a numerical difference which doesn't reach significance might be an indicator that with a bigger sample size the difference might have reached significance.

What you can't do is treat a non-significant numerical difference as if it was a "real" statistical difference and draw any conclusions from the existence of that difference.

While we're being strict about stats, this study involved lots of statistical tests, comparing outcomes at multiple different combinations of time-points within each group, and also between groups. The more individual statistical comparisons that are run as part of an analysis, the higher the chance that one of the tests will produce a significant result in error (called a false positive). The correct statistical practice to guard against the problem of false positives when making multiple comparisons is to make a correction to the p value used, so that the "bar" for a significant result is higher and the chance of a false positive is reduced. There are several accepted methods for doing this, but I couldn't find any evidence that this study applied any correction. If a correction had been applied, many of the weaker significant results wouldn't have survived (and the study results would have looked a lot less interesting).

And you seem to be conflating degree of psychosocial function with degree of gender dysphoria when you write that "the opposite is true" about my speculation. That's really not valid, they are not synonymous concepts.

I agree, however it's the study itself that does the conflating. There were no measures of gender dysphoria severity obtained, only measures of psychosocial function. The whole premise of the study was that gender dysphoria results in psychological distress which in turn impairs psychosocial function, and treating gender dysphoria successfully should therefore be associated with a reduction in psychological distress and an improvement in psychosocial function. The authors used psychosocial function as a proxy measure of distress associated with gender dysphoria.

Well sure, but you will see that I said it would be unethical for the participants in the studies to be randomly allocated to treatment groups with no individualised plans - that would be unethical right?

No it wouldn't - that's exactly how randomisation to a treatment arm works, for example in a blinded RCT. In fact, randomly allocating participants to a treatment that isn't individualised minimises the risk that outcomes will be affected by bias and confounding factors. In the case of this study, participants weren't randomly allocated, and there was indeed a confound of a difference in the psychological and psychiatric profile of the 2 groups.

I think you're putting a bit of a slant in your summary version (and drop out of course may be completely unrelated to improved or worsened mental health; mental health is not a central factor in drop out rates for other longitudinal research as far as I'm aware, which is probably often at similarly high levels over an 18 month period)

It's a huge drop-out rate considering the timeframe and circumstances. That order of participant attrition would usually raise alarm bells during the peer review process, particularly if the authors haven't included any explanatory information or data.

The drop-out occurred after the 6-month time point when participants were assigned to a treatment group. This means that GIDS lost track of 2/3 of participants within a year of starting them on puberty blockers (1/3 within the first 6 months). They also lost track of similar numbers of participants over the same timescales in the group which they identified as showing evidence of more complex or serious psychological or psychiatric problems.

The issue is not whether changes in mental health caused participants to drop out. The issue is that, in a study speciifically designed to measure mental health outcomes following intervention, we don't know how the mental health of participants who dropped out changed over time in comparison to participants who remained in the study, so we don't know how participant drop-out has influenced the study's results.

Why don't we go to the researchers' conclusion: "Psychological support and puberty suppression were both associated with an improved global psychosocial functioning in GD adolescents. Both these interventions may be considered effective in the clinical management of psychosocial functioning difficulties in GD adolescents."

Because the data presented in the study don't justify the "both interventions are effective" conclusion in the final sentence.

So yes, for my friend, I don't think societal attitudes would have made a huge amount of difference, but they would have improved things a bit for her. For example she would have changed pronouns if that had been a viable option decades ago. She has a unisex first name and is a Dr so that lessens some of the tension she experiences amongst pronouns anyway. She has always presented in a more (stereotypically) masculine fashion. Her psychosocial functioning is strong despite the gender dysphoria she experiences limiting her in intimate relationships.

I haven't asked her your question but I am pretty sure I know her answer as I know her very well - her feelings are so central to her identity that you would be asking her to be a different person if she was to accept that a magic wand could 'cure' her. It's so deep rooted, so instinctual, so integrated to her self-concept, so tightly wound around everything else that she is, that it's not amenable to 'cure' without fracturing her altogether.

And I think this sense is something that both gay and trans people can relate to.

Sure, philosophically you can entertain that phenomenon, but then it just wouldn't be you anymore, you would have lost yourself, you wouldn't know who you were anymore.

(She's quite happy with her friends using female pronouns for her as we have done for decades btw, I'm not being disrespectful!)

Out of interest, is this a thing now:

No, the opposite was true. The cohort assigned to the immediate-eligibility group had numerically (though not statistically) higher measures of psychosocial function than the delayed-eligibility group, and the delayed group were assigned to that cohort precisely because they demonstrated signs of more significant psychiatric or psychological difficulties.

Are we allowed to refer to 'numerically higher' numbers of something in discussions of results where the results are not significant?! Is that not frowned upon? Was a p value calculated? Do you have what it was if so? Or the 2 means?

And you seem to be conflating degree of psychosocial function with degree of gender dysphoria when you write that "the opposite is true" about my speculation. That's really not valid, they are not synonymous concepts.

"It is not unethical to compare two treatment pathways where definitive objective evidence of clinical benefit is lacking, precisely in order to collect that missing evidence."

Well sure, but you will see that I said it would be unethical for the participants in the studies to be randomly allocated to treatment groups with no individualised plans - that would be unethical right?

I don't have any particular problems with the study, I was simply pointing out that it would not meet the virtually impossible standards some people are setting for research to be considered in this area of discussion. This was a point I have made very clear all along; research can generate valuable information despite certain limitations being unavoidable.

I think you're putting a bit of a slant in your summary version (and drop out of course may be completely unrelated to improved or worsened mental health; mental health is not a central factor in drop out rates for other longitudinal research as far as I'm aware, which is probably often at similarly high levels over an 18 month period)-

...Why don't we go to the researchers' conclusion: "Psychological support and puberty suppression were both associated with an improved global psychosocial functioning in GD adolescents. Both these interventions may be considered effective in the clinical management of psychosocial functioning difficulties in GD adolescents."

But of course no one, gay or transgender, who experiences distress WANTS to experience that distress, but how they articulate the distress takes different directions "I wish I wasn't gay/ trans" / "I wish I didn't have so much trouble living as gay / trans person due to the culture that we're in. (ie I am happy in myself being gay/ trans).

Regarding medical transition I think all other alternatives should ideally be explored first, but there are times when it is an appropriate way forward.

Why indeed datun. Why indeed.

And then we come to the other hand. That trans are now such a very wide group that gender dysphoria is now just one group of those who transition.

Indeed.

And I can easily see why those who claim they have gender euphoria, wouldn't want to find any kind of cure, or cause.

Why would you want to stop something that made you feel so euphoric?

It really does come down to that datun.

On one hand we are told that gender dysphoria is a debilitating condition to suffer from, including death by suicide .... and then we see the activist stance ' Cure suggests you feel trans-identified people have a problem. The word cure was used to suggest gay people had a problem too. I think most of us would turn around now and say that it is not us that have the problem; it's society that has a problem with us. '

There are people who have suffered gender dysphoria all their life, some who have transitioned and some who have not, who state that they have worked so hard to reduce the dysphoria. Transitioning works only for some people with gender dysphoria, it does not work for others. There are transitioners telling the world that transitioning has not alleviated their dysphoria.

Yet, we have posters and activists loudly talking over the top of these people. Shutting down their experiences.

And then we come to the other hand. That trans are now such a very wide group that gender dysphoria is now just one group of those who transition. Yet. They are usually the ones used in the emotional manipulation of the general population.

I do discount adults who are fully entrenched in their political agenda who declare that they would have transitioned as a child/teen. Because, the reality is, they could just as likely not transitioned at that age. And if they had received high quality mental health care earlier, which I think that we all can agree on, they might not have been in the situation as an older adult of making that statement.

They are also making that statement with the benefit of 'hindsight', not the optimism of the future or alternatively having to evaluate a future of significant medical issues (a future not so optimistic). Including very early loss of ovaries which may have meant dramatic life shortening dementia or other serious side effects. Let's not forget the serious side effects of these treatments on the female body.

All they are doing in reality, is pushing their political agenda and downplaying the fact that they really may not have chosen that very risk path, but want to encourage children and teenagers to do so.

I didn't ask about any of those things!

However, I knew what the answer would be.

I don't even care what that poster thinks, to be honest. I just quite enjoy seeing the scrabbling around to find an answer that means no they don't want a cure for gender dysphoria and they're not really interested in exploring the causes of it.

But will continue to amplify the need for its treatment, and how people with it are so desperately unhappy.

Meaningless jibber jabber.

Also note how 'people with gender dysphoria' and 'trans people' get swapped in and out at an alarming rate, depending on whether the argument being had is about treatment or rights.

Very very true. Worth focussing on this wording.

Not only are sexual orientation and transgenderism not the same, the one directly conflicts with the other. Which is why invoking homosexuality to endorse transgenderism is so intellectually dishonest.

The Denton report details the tactic of linking them together to gain public support. It doesn't work irl. Not least because a proponent of transgenderism is unable to reconcile the definition of sexual orientation with gender ideology.

Also note how 'people with gender dysphoria' and 'trans people' get swapped in and out at an alarming rate, depending on whether the argument being had is about treatment or rights.

I have a friend (yes I know, sample n = 1) who is a mid 50's woman, who has for the entirety of her life felt real unhappiness and disgust with her female form and a sense that she should have been born a boy. She has been unable to have intimate relationships due to this. She looks on these options now with envy, that happiness and relationships might have been possible for her had she been in her teens at this time, but she considers at her age that that ship has sailed.

I'm quite happy being a gay woman myself, I don't want a cure, and I imagine many trans people might say the same - they 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.

Cure suggests you feel trans-identified people have a problem. The word cure was used to suggest gay people had a problem too. I think most of us would turn around now and say that it is not us that have the problem; it's society that has a problem with us.

Are you saying that your friend's disgust with her female body is entirely due to 'society'? How would a change in societal attitudes help such a person to accept her body and enable her to have intimate relationships? Is she a lesbian who has internalised the homophobia around her to the extent that she thinks, like Fox Fisher, that homosexual relationships are 'deviant'?

You are comparing the experiences of two very different people: a desperately unhappy woman who hates her body and as a result has found intimate relationships difficult, and you, a gay woman who is happy with her sexuality, and saying they are somehow the same. In what way are they the same?

If your friend could be cured of her disgust with her body (and her internalised homophobia if she is same-sex attracted), why do you think this would be such a terrible outcome? Why do you think altering her body, and becoming a lifelong medical patient, is preferable?

Interview with Dr Littman, the person who coined the term ROGD, for your interest:

Awiltu

Thank you for the summary.

That is hugely interesting. The study and the drop off rates. I would have loved to see the reason for drop off. It most likely confirms the clinics really were not following up people.

However, were those drop offs due to going private, desistance with improved mental health care, moving to adult services ?

And if these patients started PBs surely they need following up for health checks regardless of transition status? Because they should be monitored after such a cocktail.

For anyone interested in the study referred to in the Finnish review, a search suggests that it is this one (the relevant details match up):

Costa R, Dunsford M, Skagerberg E, Holt V, Carmichael P, Colizzi M. Psychological support, puberty suppression, and psychosocial functioning in adolescents with gender dysphoria. J Sex Med 2015;12:2206–2214

To answer some of suggestionsplease1's questions, as the full text is behind a paywall:

And it's Finnish not UK based evidence. I'm not allowed to include any non-UK evidence because it's not relevant to our particular culture and population, but you apparently are?

It's a UK study conducted in London at GIDS.

But this study would obviously fall far short of your requirements for us to consider - where is the reference to the matched cohort design? What a poorly designed study eh, not to include that.

This was a longitudinal study of 2 cohorts of gender-dysphoric young people. All 201 participants received psychological assessment and intervention for 6 months via GIDS before eligibility for puberty blockers was assessed. At the 6-month point, participants who were assessed as eligible for puberty blockers were assigned to one of 2 cohorts.The immediate-eligibility cohort received psychological support plus pharmacological puberty suppression, while the delayed-eligibility cohort received psychological support only. Assignment to the delayed-eligibility cohort was on the following basis: "In those specific cases clinicians needed more time to make the decision of starting GnRHa because of possible comorbid psychiatric problems and/or psychological difficulties."

Both cohorts were followed up 12 months and 18 months. Results for both cohorts were compared to a large sample (N=169) of young individuals without observed psychological/psychiatric symptoms who completed the same adolescent psychosocial function measures as the two gender-dysphoric groups.

Of course you will know full well that the baseline characteristics for both cohorts are likely very different - namely in the degree to which they experienced gender dysphoria in the first place - those experiencing greater distress (amongst other considerations), would have been more likely to be put forward for GnRH analogues in addition to psychological intervention, and those for whom it was considered that their distress could be adequately managed by psychological intervention alone of course were in that cohort.

No, the opposite was true. The cohort assigned to the immediate-eligibility group had numerically (though not statistically) higher measures of psychosocial function than the delayed-eligibility group, and the delayed group were assigned to that cohort precisely because they demonstrated signs of more significant psychiatric or psychological difficulties.

You will, of course, know that. It would be unethical to proceed in any other way - unless you think they're just taking the 270 kids and randomly assigning them to a treatment group with no individualised plan?

It is not unethical to compare two treatment pathways where definitive objective evidence of clinical benefit is lacking, precisely in order to collect that missing evidence.

But of course, as it happens the results you have found show that all cohorts fared well.

The results are more nuanced than that.

The study showed that measures of psychosocial function improved significantly across the entire participant group (pooled across both cohorts) after 6 months of psychological intervention and support. However, when each group was considered separately, significant improvement in psychosocial function was observed only in the delayed-eligibility cohort, who (according to the criteria for assignment to that cohort) showed signs of more serious psychological and psychiatric difficulties.

From the 6-month point, where the 2 cohorts diverged in the treatment received, the immediate-eligibility group (who received puberty blockers plus psychological support) showed significant improvement in psychosocial function at the 12- and 18-month follow-up points, compared to the 6-month point.

In contrast, the delayed-eligibility group (who received psychological support only) showed small numerical improvements in psychosocial function measures at 12 and 18 months, which were not statistically significant. However, in the delayed-eligibility group, psychosocial function at 12 and 18 months remained significantly better than at baseline (prior to starting any psychological intervention).

Also worth noting that, despite the apparent differences between outcomes for each cohort, direct comparison of psychosocial function at 18 months showed no statistically significant difference in psychosocial function between the group that had received puberty blockers plus psychological intervention and the group that had received psychological intervention only.

So this would obviously fall far, far short of the rigorous study design that you need to consider, so I don't know why you're even referring to it? It doesn't count right? Just like the the scores of studies I have linked to.

The study is flawed, but not for the reasons you suggest.

This study had enormous problems with participant retention. By the 12-month time point, less than 2/3 of participants remained in each cohort, and by the 18-month point, only around 1/3 of participants in each cohort remained in the study. The reasons for loss to follow-up are not reported, so we have no idea whether these participants left because their mental health improved or because it worsened. That is a huge drop-out rate - so big that it raises questions about how well-matched the final cohorts remaining after 18 months were, and makes it very difficult to draw meaningful conclusions about the impact of puberty blockers.

The summary version - psychological intervention improves mental health in gender dysphoric adolescents, especially those who are experiencing greater psychological difficulties or psychiatric comorbidities. Any additive benefit of puberty blockers is difficult to evaluate due to the very high dropout rate during follow-up.

But I don't dismiss the possibility of an element of social contagion in what is happening presently amongst young girls. But how do you think those teenager are going to feel supported if you start lecturing them about that?

Why would you lecture young girls about the entirely rational reaction to being objectified in a porn soaked environment?

No, you tackle the cause, not the symptom.

One way of doing that is to take trans ideology out of schools, and replace it with feminism. Teach girls, and boys, what is happening and how to stop it.

And I don't know how you're not permanently cross eyed with the dual opinion that gender dysphoria can cause suicide and depression and yet you don't think it should be cured.

Plus, yet again, you have to conflate it with something completely different in order to purloin an argument that no-one's asked you about in the first place!

Seriously, I don't think I've ever heard anything more contradictory.

Or predictable.

The number of times I've listened to how awful gender dysphoria is, causing depression, suicide and misery, which is a major cornerstone of 'be kind' and yet no one seems to want a cure for it.

And yet, adults who suffer from gender dysphoria have claimed that they would like to not suffer from gender dysphoria. It is NOT like being gay according to them. So, do we take your word for it suggestions, or others who have been through at great deal of support for their gender dysphoria to be able to cope with their material reality?

And you keep saying you are uncomfortable with medical transition for children and teenagers, yet keep posting material supporting medicalised transition for teenagers.

😁 Well that came as a complete surprise.

Nowadays there is a lot more knowledge and awareness of medical possibilities that weren't generally known about before, so the same expressions of distress are likely more visibly directed towards that end nowadays rather than sublimated. If you were born in the 1960's for eg, it just would never have entered your head that a girl could medically transition. So how could you aim at or express a goal that didn't (seem to) exist at the time?

I have a friend (yes I know, sample n = 1) who is a mid 50's woman, who has for the entirety of her life felt real unhappiness and disgust with her female form and a sense that she should have been born a boy. She has been unable to have intimate relationships due to this. She looks on these options now with envy, that happiness and relationships might have been possible for her had she been in her teens at this time, but she considers at her age that that ship has sailed.

But I don't dismiss the possibility of an element of social contagion in what is happening presently amongst young girls. But how do you think those teenager are going to feel supported if you start lecturing them about that? We've all been through the teenage years, I think we all have an idea that the most sure fire way to get a teenager to double down on a position is to patronise them and tell them how wrong they are. Which is why I support a more relaxed approach to gender issues in general - if as a parent you accept the pronouns and name that your child wishes and at the same time build nothing into it then you dissipate the tension around the issue, allowing that young person to explore with support and feeling more secure that they can return to their original gender ID if that is right for them further down the line.

I find your 2nd sentence difficult - it has connotations of the times people wanted to find a cure for homosexuality. I'm quite happy being a gay woman myself, I don't want a cure, and I imagine many trans people might say the same - they 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.

Cure suggests you feel trans-identified people have a problem. The word cure was used to suggest gay people had a problem too. I think most of us would turn around now and say that it is not us that have the problem; it's society that has a problem with us.

So what is this cure you're hoping for, and who is it beneficial for - the people who are trans identified, or yourself (I say that generally for people articulating this idea, not you personally) so that you might feel more comfortable?

Fully caught up now…

… oh I do hope we haven’t hit another dead end…