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

The trans community is disproportionately affected by issues of mental ill health, suicide and self-harm. We have a duty to them to lower the temperature and look for common ground away from the toxicity of the current debate.

Is the first sentence a statement that is agreed? That as a group trans people have higher rates of mental health issues.

And whether it is right or not, what is the evidence that because it is a matter of debate is what is causing this vulnerability. Not wanting to be heartless, but if these issues happen to a higher extent in the trans community isn't that part of their issues. It just sounds like GC people are being told to shut up.

I took from this statement that as the new centres are meant to be more rigorous before accepting new patients, they will be better placed to do monitoring for trials.

But for me that raises the question of there may be little "evidence" during the period of treatment, and real problems may only occur later in life.

So as said up thread, surely the best most immediate assessment would be to go back through those previously treated and collect evidence from them.

Although given lack a accurate recording this may not be possible.

If it is only new patients who will be part of this clinical trial, are we going to end that in 20 years time the NHS (if it still exists) will be being sued for use of puberty blockers without having satisfactorly completed clinical trials.

Would appropriate retro data be available, though? I thought that one of the problems with handing out PBs so readily was that almost everyone then progressed to cross-sex hormones - which would be a massive confounding factor into research on the effects of PBs

I'm hostile to any trial which subjects children below the age of consent to potential infertility, brain and bone damage, loss of sexual function and more. It just seems so incredible that any civilised society would even consider such side effects as "acceptable". As @BonfireLady points out, these side effects are in Mengele territory.
In the past some in the medical profession have committed major outrages by experimenting on those unable to consent - look back at grim history of experimenting on the poor, different ethnic groups, those with mental disabilities, even more recently trialling drugs in African countries to avoid the restriction placed on live medical research in the West.
Given that the medical profession has not only stood by, but actively championed what's happened to children and young people under the guise of "trans rights" there needs to be considerable evidence that those involved in these "trials" are responsible ethical medics holding children's needs and safety at the forefront of that they're doing.
Although I'm optimistic that children's hospitals will enable this, given the medical profession's collusion in this scandal, we need convincing.

I'm very much for a clinical trial on one proviso: it needs to be ethical and safe.

If the only way to achieve this is to use retro data, so be it. For example, they could do IQ tests, brain scans and bone density tests on the previous cohorts now, then map them against averages for their age. Obviously it's not as good as getting an actual baseline data for each individual child, then checking it throughout the trial, but it's better than risking brain damage on someone who is yet to take puberty blockers.
Presumably any trial would need to track these things over a number of years, so retro data plotted against averages for ages could be useful e.g. a child who had puberty blockers from the age of 11-18, ending in 2020 would now be 22. There are several data points that could be captured here and used as part of the data analysis, such as age first started, number of years on blockers, age when blockers finished.

If instead they are accepting new patients, the ethics of selecting the right ones are a minefield, as stated above by several PPs. Informed consent for possible permanent brain damage is presumably impossible (also there is highly likely to be loss of fertility and possible/likely osteoporosis).

So yes, trials and evidence gathering is the way forward. But, to put it bluntly, that's also what Mengele did. Apparently his data gathering and analysis skills were excellent. However, it's only viable if it's ethical and safe (which Mengele's experiments clearly weren't).

https://www.newstatesman.com/politics/health/2024/03/inside-the-collapse-of-the-tavistock-centre

'between 2011 and 2014, 44 children aged 12-15 joined the Gids/UCLH early intervention study.'

'By 2016, those participating in Gids’ early intervention study had all been receiving puberty blockers for at least a year. “In terms of our early intervention I guess the other thing is that our results have been different to the Dutch… We haven’t seen any change in terms of psychological well-being,” Carmichael told trans health professionals'

'...over 30 years, Gids appeared to have collected no meaningful data on its patients or its only treatment pathway. It could not tell the court how many young people had been referred for puberty blockers, how old they were, what sex they were, or if they had gone on to take hormones. With true British understatement, three High Court judges expressed their “surprise” at this.

Wasn't the problem that they didn't even gather that evidence, though? There was some data Cass was refused, but my understanding was that there just was no data collection or proper diligence done by Gids.

Cass also wanted access to the data of outcomes of those already experimented on. This should be a priority before any new study.

Exactly, the devil will be in the detail -- of which we currently know zero. And if there aren't adequate diagnostic criteria, then the business of devising a trial will start to clarify that difficulty by achieving some sort of operational definition of the people who even begin to jump through the (hopefully many and rigorous) hoops that will precede participation in the trial.

I thought the whole thrust of the Cass Review suggested the necessity of such a trial.

I guess the devil will be in the detail but the main reason I’m against it is because there is no clinically objective way to diagnose “gender incongruence”. The diagnosis is always based on clothes, toys and the feelings of a child who nine times out of ten has spent far too much time on the internet and has been coached on what to say to get treatment. They know that same sex attracted, autistic children and those with significant mental health issues are massively over represented. I just don’t understand how they will be able to ethically “treat” children when there’s no serious diagnostic criteria in the first place.

I mean, we could propose all sorts of other experiments to see what happens when we subject children to various medical 'treatments'. To protest at the suggestion is not 'frothing'.

Not sure why there is quite so much hostility to this trial. We support the Cass Review because it was an appropriately scientific and fact-based investigation, which appears to have countenanced the idea of such a trial in principle.
If we discount in advance the possibility of the puberty blocker trial being similarly sober and scientific, then aren't we at risk of being as disreputably anti-scientific as the frothing Cass deniers?
Of course it will be challenging to define effective ethical parameters, but there are professionals whose job this is, and they will be scrutinised.
And, after all, there is the possibility that within the vastly inflated number of people who have been deemed as requiring these sorts of hormonal interventions, there is a hard core of individuals for whom they might be appropriate. Let clinicians look at this in an appropriate evidence-based way. Isn't that what we all wanted?

This.

No child with mental health issues so severe that they are threatening suicide should be anywhere near a clinical trial for puberty blockers. The idea that young children with “gender” issues are at massively increased risk of suicide or that threats of suicide get you treatment or on a study is so dangerous. You cannot possibly be considered to have the capacity to consent to experimental treatment that will affect your adult fertility and sexual function if you are a suicidal child.

The new centres are based in leading children's hospitals where medical ethics are the basis of developing of child medicine. So presumably the usual quacks and queer theory extremists who've been able to dominate this area will have limited influence?
Although, the shameful trans capture of the Great Ormond Street Hospital charity might suggest a loophole that activists might seek to exploit to put pressure on staff - but hopefully that won't get them near trials and ethics committees etc?

'Gender incongruence' is the woo they're going with these days.

Translates as: 'the feeling in your head about how you imagine someone of your sex should feel doesn't match how you feel'.

or the suicidal 12 year old with long standing gender dysphoria for whom other interventions have been ineffective.

But other interventions have not been taking place. I’m completely against a PB trial, but if this is an argument for who should be included, we need these children to have undergone long term therapy (as in years, not months) to look at the underlying causes of distress and help to resolve them, bearing in mind that puberty itself is the “cure” in many cases- ie even assuming you assume there will be this cohort, we’re years away from identifying who might be part of it.

I don’t see any way this trial could be done in an ethical or safe manner.

What are they treating exactly in this trial?

Quodraceratops do you know if the decision for a study like this by an ethics committee is available for the public to view? I don’t know very much about the process. And not getting very far with google!

I can't find anything online about who will be running the trial, where it will take place and who will be eligible. They will definitely need Research Ethic Committee (REC) approval - and they are very hawkish generally. Any trial must be appropriately registered on a public trial register - likely ClinicalTrials.gov.
I wonder if this is too much of a poisoned chalice for any centre or senior investigator to want to get involved. Ethics would be a total nightmare.

I am all for evidence collection which is why I think that the data from the last 10 or so years should be collected and analysed before any new children are experimented on. We know this evidence exists because Cass was denied access to it. This missing data could potentially tell us everything we need to know without subjecting a whole new cohort of children to treatment that they know has harmful side-effects and may lead to loss of sexual function and infertility.

@ArabellaScott

Quote from Health Secretary Statement

“The Cass Review made it clear that there is not enough evidence about the long-term effects of using puberty blockers to treat gender dysphoria and incongruence to know whether they are safe or beneficial”…

..hence the need for a properly constructed ethical trial

I am not underestimating the difficulties associated with framing that trial.
But I do not think we should be arguing with the intention of systematically collecting evidence (not just anecdote).

I remember the horror in the 80s(?) about the 'doping' of Eastern bloc gymnasts with what were basically puberty-blocking drugs of some sort.
We really are going backwards.

All of this.

https://www.statnews.com/2017/02/02/lupron-puberty-children-health-problems/

'In 1999, the FDA examined 6,000 adverse-event reports about Lupron filed by doctors, patients, and researchers. Although the FDA couldn’t locate its 1999 report on the matter, a court document that summarized the findings of the report said it found “high prevalence rates for serious side effects” including depression, joint pain, and weakness, and noted similar effects in men and women with very different ailments suggested the drug was causing the problems rather than underlying medical conditions.'

Lawsuit from 2001:

'The settlement resulted in a corporate guilty plea for conspiracy to violate prescribing laws and one of the largest fines at the time — $875 million.'

https://www.justice.gov/archive/opa/pr/2001/October/513civ.htm

There is evidence on the risks. These drugs are used in end-of-life care for men with prostate cancer. They've also been used for precocious puberty.

The side effects are quite well known, although granted for men with advanced prostate cancer they aren't likely to be long term, and for precocious puberty they are used on a more short term basis than might be suggested for 'gender incongruence' - I think in the UK at least they are only prescribed for precocious puberty in extreme cases because of the side effects.