Health Secretary updates MPs on Government and NHS England’s work to improve gender identity services & implement recommendations of Dr Hilary Cass’s independent review. Includes extension of puberty blocker ban to Nov 26th & review of adult svcs

so I’m going to assume until I read otherwise that the clinical trial Streeting is talking of could only be allowed to include
-kids who are already taking PBs
-kids in future exceptionally getting given PBs as a new thing

Important to remember, it’s not a total outright prescribing ban of all PBs to all kids in the UK. PBs have not been made against the law for all young people to take.

It’s also worth bearing in mind that the bar for ‘exceptionally’ accessing PBs might be so high that it actually pretty much never is permitted in practice, bearing in mind the emerging picture of high risks of taking PBs.

The government update OP links to says this at the end that I think is ultimately reassuring:
We will proceed with caution at every step, always putting the evidence first, and putting people above politics.

The government are not stopping kids who have already taken PBs from continuing. They are just saying no new routine prescriptions of PBs. They also want those kids already having PBs to have warnings of the risks of continuing. I haven’t seen what improvements the government or NHS is requiring in terms of the record keeping around how the group continuing to take PBs are getting on. That would seem to be essential.

Thsnk you, very useful.

An exceptionally useful thread thank you

Gender dysphoria is a subjective diagnosis. (At best.)

Are medical ethics also subjective?

This thread might be of use in how we got here.

https://www.mumsnet.com/talk/womens_rights/5057269-5057269-puberty-blockers-how-exactly-did-we-get-here?

The original trials were rejected by en ethics committee. They just kept going to different committees until one relented. They immediately crossed their own ethical boundaries that had been approved on age restrictions.

Thinking all ethics committees and designers of trials have the same ethics as you/me/most people is part of the problem. Where are the original members of the original ethics committee that approved it now? As the guy who started all this is incredibly powerful in the NHS and it doesn't seem that he is going to be held to account for any of it. He will probably be on any ethics committee.

en.m.wikipedia.org/wiki/Russell_Viner

https://cass.independent-review.uk/nice-evidence-reviews/

Just for completeness.

'In January 2020, a Policy Working Group (PWG) was established by NHS England to undertake a review of the published evidence on the use of puberty blockers and feminising/masculinising hormones in children and young people with gender dysphoria to inform a policy position on their future use. Given the increasingly evident polarisation among clinical professionals, Dr Cass was asked to chair the group as a senior clinician with no prior involvement or fixed views in this area.
The evidence reviews were published in March 2021. Unfortunately, the available evidence was not deemed strong enough to form the basis of a policy position.'

There is nothing physically wrong with children who experience feelings of gender incongruence. They are physically healthy. Their bodies are good and right and developing normally, whatever their feelings about them. So there is nothing that needs physical treatment and no reason to think that physical treatment will improve their condition.

I don’t see how any trial can be ethically set up that gives a treatment which doesn’t address the underlying mental condition and instead gives a harmful drug to a healthy body.

Posting for those not on Twitter as it's an excellent analysis

Amy Sousa:

To be clear, when I say that gender dysphoria is not real I am not basing this analysis on what I wish gender dysphoria meant or what I think it could mean or what I think it should mean. I am basing my analysis on the given diagnostic criteria provided by the DSM-5-TR.

The diagnosis is premised on a bogus religious claim that all humans are born with an innate gender identity that coincides with western hierarchal sex role stereotypes. The "dysphoria" is defined as distress at being nonconforming with sexist tropes. But conformance with sexist tropes is not a natural or healthy way of existing, it is only able to be signaled by purchasing external products such as clothes, haircuts, toys, makeup, etc. Preferences for purchasing these products are literally listed as diagnostic criteria for children within the DSM-5-TR. Thus within the diagnostic criteria, one's consumer purchases are the basis of a mental health diagnosis!

Debunking gender dysphoria as a bogus, toxic, manipulative ploy:

1. There is no such thing as an innate "gender identity" that all people have. There are no innate identities of any kind. Identities are abstract mental self-defining concepts that are necessarily fluid and fragile.

1. There is no such thing as an identity incongruence. It is impossible to have an identity that is wrong for your body. Again, an identity is something one thinks about oneself, a self-referential mental concept. Our made-up personal conceptions may cause us comfort or discomfort, but there is no right or wrong mental conception for any particular body.

1. The diagnosis of "gender dysphoria" strips all political agency from patients who could be activated to critique regressive cultural standards and challenge systemic sexism. Instead, the diagnosis ignores all other underlying issues, holds the patient's body personally responsible for their discomfort, and turns the patient into a compliant lifelong medical dependent. The patient now needs to continue to buy products and services in order to be able to signal their "true identity."

1. The term "gender dysphoria" is being used for two things: As a cover for male fetishism (@WomenReadWomen) and as a marketing tool for synthetic sex surgeries and drugs (@bjportraits).

Without this diagnosis, we would observe the dangerous experimental surgical interventions on healthy children as what it is: the most brutal mass torture of children the world has ever seen.

Yep. Define 'gender incongruence' and define 'gender congruence'.

Feeling unhappy in your body?

Why does that necessitate medical alteration of said body?

If not for anorexia or BDD or BIID, why for 'gender incongruence'?

Honest to goodness how much more of this shit do we have to keep explaining?

Here's some info from Any Sousa on the 'condition'.

x.com/KnownHeretic/status/1831711199718994428

I look forward to our taxes being drained to fund the public enquiries in the future 🙄

It's not like a cancer drug where the child is certain to die within two years from such cancers that are rare but fatal, so any experimental treatment is a potential hope.

I knew one such child, it sadly didn't work for her as with many others, but since her death one child has been cured and cancer free for a number of years.

PBs are entirely different whereby we already know that the stats from the Tavi say that in the past 80-90% of children desist and grow out of it, and who knows if even the remaining set might desist even later, given there are adult detransitioners.

This is it.

How do you screen to avoid transitioning those who would turn out to be gay adults if allowed to go through puberty?

I can't see how it will get through to be honest

Such a good example. There's a reason we steer these children away from the toxic pro Ana sites where their disordered thinking about food and their bodies will be encouraged. Because we try to safeguard these mentally vulnerable children.
But children thinking they're born in the wrong body - welcome to Mermaids, Stonewall, Gendered Intelligence, GIRES and countless other groups. 😡

Has anyone ever suggested we try treating anorexic children with Ozempic and bariatric surgery?

We could monitor the effectiveness and any side effects. 'Ethically and safely'.

Yes they do - but so closely scrutinised with difficult issues around consent, parental rights to consent, quality of life, long term impairment versus saving a life being intensely discussed and evaluated.

The notion of treating mentally unwell children who believe they've been born in the wrong body with life altering drugs (and subsequent brutal experimental surgery) rather than addressing their co morbidities and disordered thinking ought to be morally unacceptable.

Adults are a different matter but the targeting of children and the failure of trusted adults and organisations to protect them from this ideology is unacceptable. We now need the moral courage to say "no more".
No more gaslighting children that their bodies can be fixed with a sex change. No more pretending that life long bodily impairment is an acceptable price to pay
No more kowtowing to queer theory activists trying to smash the social contract, family life and child safeguarding.

Edited to say that yes - hopefully going through the motions to try to run trials and then to find that they're not ethical or possible in consent terms will happen.
But we shouldn't have to jump through these hoops in order to safeguard children.

But nonetheless there are children presenting at clinics with extreme gender dysphoria.

Which is WHAT?

What is Gender Dysphoria?

I just don't think I can say a priori that there simply aren't any children whose experience of gender incongruity might, just might, necessitate treatment on its own terms.

What is Gender Incongruity then?

Once you have defined it in medical terms, then you need to be able to diagnose it with some tests. Putting a doll and a truck in a room? Putting two sets of clothes out? What would the test be? What if they picked the doll and the trousers? Or the truck and a dress? What then?

If you are arguing that a trial should go ahead, you need to explain why.

How is 'liking the wrong toys' a medical condition?

Well obviously it isn't, and I absolutely share the scepticism about 'gender incongruence' and 'gender identity'. But nonetheless there are children presenting at clinics with extreme gender dysphoria. I strongly believe that almost all of them will be there as a result of other conditions, or as a result of how terrifying it is to grow in to womanhood in a society that so aggressively sexualises womens bodies.
I just don't think I can say a priori that there simply aren't any children whose experience of gender incongruity might, just might, necessitate treatment on its own terms.
The PB trial won't (or at any rate shouldn't) be happening in a vacuum. Ethically it could only happen if there was adequate psychological exploration and screening for eg trauma, autism, etc. The development of those psychological and screening protocols, alongside any data that can be gathered if any children pass through that screening and are deemed suitable for the PB trial, will be an evidence-based way of determining whether there are in fact children whose interests are served by medical intervention.

The whole point is that we need to use appropriate and well-established evidence-gathering protocols to move forward. I would hope that the trial might be constructed in a way that left open the possibility that no children were deemed appropriate subjects for PBs. That would be an evidence-based (rather than social media based) way of putting the whole issue to bed.

Medical trials that are treating a medical condition.

How is 'liking the wrong toys' a medical condition?

No matter which way you look at it, medical experimentation on children is probably not going to be a good idea.

But surely medical trials involving children do in fact occur? Otherwise how could data on treatment options for children be generated?

Retro data would be as good as the way it is handled.
If someone has gone on to take cross-sex hormones already at the time when their data is added, the age at which this started/ended (and the number of years they've been taken for) can also be captured as data points.

It's then down to the data analysis to see if any statistically significant conclusions can be drawn which separate the effects of puberty blockers from the effects of cross-sex hormones. Possibly so, possibly not.

So yes, imperfect, but again... better than risking permanent brain damage on a new cohort of children who are yet to receive any medical intervention. No matter which way you look at it, medical experimentation on children is probably not going to be a good idea.