Reddit thread by a Psychiatrist about youth gender medicine studies

There are an unusual number of people on the spectrum of psychopathology in surgery.

Which is not necessarily a bad thing, some jobs require people who can act without excessive emotional content or without being distracted by empathy in high risk and dangerous situations. Surgery being one of them. But it's why a lot of surgeons aren't great at understanding patient goals around outcomes, they can't easily predict how people will feel about what happens.

I have never heard if there are a lot of psychopaths in psychology, but to be honest it wouldn't surprise me. Along, perversely, with people who become overly emotionally engaged.

If we say we care about trans kids, that must mean caring about them enough to hold their treatments to the same standard of evidence we use for everything else.

This is what needs to be repeated. Why do medical ethics and best clinical practice disappear within this medical field?

Now that two studies have failed to report meaningful benefit we can no longer say, as we could as recently as 2021, that the short-term benefits are so strong that they outweigh the potential long-term risks inherent in permanent body modification. Some non-trivial number of patients come to regret these body modifications, and we can no longer claim in good faith that there are enormous short term benefits that outweigh this risk.

The gender affirming clinicians had two bites at the apple to find the benefit that they claimed would justify these dramatic interventions, and their failure to find it is much greater than I could have imagined two years ago.

A definitive answer to those who feel that good intentions and a lot of sentimental saviourism is all that is needed.

It's a worrying summary from a professional. He can however take a running jump with his last bit about 'but anyway, down with transphobia in all its forms' which as we all know means, 'strip women of equality, access and the right to be a recognised sex class', which is grim. But I suppose that part doesn't directly affect him as actively participating in transitioning children to long term harm does, and as we increasingly see, so many people can only manage to care when they have direct skin in the game.

Thanks for sharing, I'll have a look at this.

Thanks for the Jesse Singal link, Kesstrel. I noted in my post yesterday how few variables were reported in the study but I just assumed it was because they hadn't collected any information about, for example, self esteem or social relationships. It's a bit mind-blowing to read about the things that weren't reported, presumably because the differences weren't significant.

Jesse Singal has written a really long, two part analysis of this study going into the detail behind what this reddit post summarises. It's open to non-subscribers if anhyone is interested:
https://jessesingal.substack.com/p/on-scientific-transparency-researcher

https://archive.ph/Nax6n

Archive. You can post archive links; sometimes they are autohidden, but usually they come through once a mod has had a look at it.

Thank you for posting this link, what an interesting read.
From the article:
"If we say we care about trans kids, that must mean caring about them enough to hold their treatments to the same standard of evidence we use for everything else." Exactly.

That study by Chen et al is extremely concerning in how its positive conclusion will be picked up and used as support for GAC.

Despite how its positive conclusion is a) contradictory for boys and b) without consideration of girls being more likely to provide the researchers with socially desirable answers and c) despite the actual results of wide variation in those not clearly explained graphs. All suggestive that the researchers ‘found’ evidence to fit a pre determined conclusion.

I'm a therapist myself, moderately light tough register re all things woke, but pretty active in strongly supporting patient/client complaints, and the ASA are very prescriptive in telling us what we can and can't advertise. No complaints from me here.

Every patient I have to think about possible negative outcomes, despite having a good track record in the field. Indeed my whole profession has next to zero issues or excitement, lol. But the worries are always there.

But gosh, do I have to be careful how I promote myself, and how I convey potential risks to patients, and critically know what I can't reasonably treat, when to decline patients, when to cut treatments short.

To the point where I can't mention in my promotional material the simple uncontroversial everyday ways that all of us pick up the things I treat. And I really mean uncontroversial.

Yet, YET...medical professionals can literally say they can help you change from one sex to another, and accept the word of desperately unhappy teens as proper permission to make them sterile, anorgasmic, or at the very least, osteoporotic well before menopause/middle age.

Yet, YET...I can't mention sneezing or picking up your socks!

The mind boggles.

Pmk

I think that's an incredibly important point, Truthlikeness. Of course there is no comparison group in the Chen et al study.

Yes, definitely. But I think there's an element of the road to he'll is paved with 'ooh! I wonder what this button will do'. Curiosity, combined with psychopathy, no fear of the consequences, desperate patients and supine regulators.

I googled 'genital ablation' (re. another thread) and found a paper on cutters and the people they cut. It got me wondering what would happen if one of them, say, got an appropriate medical qualification and, just thinking outside the box here, got into gender affirming surgery.

Aside from the reddit thread itself. I think it's almost perhaps more amazing that it was allowed on reddit in the first place.

His musings on the fact the levels of improvements are below what would be expected even of a placebo are interesting, leading to the inevitable conclusion that the treatments are actively detrimental in terms of treating gender dysphoria (we know they are harmful in other ways).

"Putting biological girls on testosterone is conceptually similar to giving men anabolic steroids, and I remain genuinely surprised that it wasn't more beneficial for their mood in the short term. Some men on high doses of male steroids are euphoric to the point of mania."

I've never known anything like trans ideology that is so wide in its spread, yet so lacking in any depth. It's like getting up in the morning, looking out of the window, and seeing nothing but opaque clouds, assuming that there's a storm underway. But on opening the window, seeing that all there is, is condensation in the glass, and it's a bright sunny day.

For the last decade, we've been too afraid to open the window. But now those windows are opening to the horror of TRAs. And it's sunny out there.

This Chen study is going to be one they talk about in the years to come. How people running studies could be so tainted by ideological capture? And how facile and lacking in depth and intellectual rigour the whole "philosophy" was.

Thanks for posting this, it was a very interesting read. There seems to be sunlight seeping into all the gaps in trans ideology at the moment.

The replies are equally interesting, particularly who gets angry with the OP and who doesn't. The mildest of queries into efficacy provokes intense rage in some people.

That's a great article. Very encouraging that it's stayed up (so far) on Reddit. I haven't read this thread or the comments on Reddit but will do so later when I have some time to dedicate to it.
Placemarking myself here in the meantime.
Thanks for posting it OP.

Excellent article thank you OP, and really interesting Reddit discussion (including from the Mod!)

"train spotters" DAMN TYPOS, lol

"I support Christians/Atheists/vegetarians/vegans/red-heads/train collectors/Marvel fans etc etc to live their best life, yada yada"

How preposterous is all that?

This exchange in the comments was telling:

Specifically saying you support gender affirming care first and foremost but here are the concerns I have - is valid. I've literally had this exact conversation in very very public spaces and on very very public platforms. My career wasn’t eviscerated. It’s possible to have these conversations if gone about the right way.

No one should have to say they support something just to be safe making an impersonal, rational, scientific critique of some data.

Having to dance around prefacing dialogue with 'of course I support trans people to live their best life however they see fit blah blah' is the same mental labour as having to remember to use chosen pronouns. And muddies the water for everyone when you have to say you support something which has no evidence base, while pointing out it has no evidence base. Which, of course, is the point.

I would say "the road to Hell is paved with good intentions", but I don't think you can even credit doctors and surgeons in these cases with the merest good intentions.

More like "the road to Hell is paved with arrogant assertions".

Firstly, the continued use of the idea of "real trans people" by these medical persons, without any real sense of what that actually represents. Many talk about gender dysphoria, but are they saying that they think dysphoria is caused by being a trans person?

We really need an explanation of what medical professionals mean when they talk about "real trans people"? Is a "real trans person" someone who suffers from gender dysphoria, and transition is seen as a cure or treatment for the dysphoria? Or do they believe that "real trans people" are people who were literally born in the wrong body and gender dysphoria is the inevitable result of this mismatch between body and brain?

That is a considered and thought-provoking post. I’m headed back in to read the responses. I initially copied thevfirst sentence of this paragraph because it’s so good, but the whole paragraph was good, so here goes:

If we say we care about trans kids, that must mean caring about them enough to hold their treatments to the same standard of evidence we use for everything else. No one thinks that the way we "care about Alzheimer's patients" is allowing Biogen to have free rein marketing Aduhelm. The entire edifice of modern medical science is premised on the idea that we cannot assume we are helping people merely because we have good intentions and a good theory. If researchers from Harvard and UCSF could follow over 300 affirmed trans teens for 2 years, measure them with dozens of scales, and publish what they did, then the notion that GAH is helpful should be considered dubious until proven otherwise. Proving a negative is always tricky, but if half a dozen elite researchers scour my house looking for a cat and can't find one, then it is reasonable to conclude no cat exists. And it may no longer reasonable to consider the medicalization of vulnerable teenagers due to a theory that this cat might exist despite our best efforts to find it.

I found that post really interesting. Thank you, Miri1985. I had never read the Chen et al article referenced in the post. It's open access so here is the link if anyone else needs to read it too.

https://www.nejm.org/doi/full/10.1056/NEJMoa2206297

I am actually quite surprised at the limited number of outcomes reported in the study - appearance congruence, life satisfaction and depression/anxiety - and what comes across as a rather blasé attitude to the finding that anxiety/depression levels didn't really improve among participants 'designated male at birth'.

There's a study of detransition listed in the citing articles for Chen et al. It points out the methodological limitations to the 'but hardly anyone detransitions' argument.

https://link.springer.com/article/10.1007/s10508-023-02623-5

I'd be so frustrated if I were James Esses.