Hilary Cass on Woman's Hour 9.10.24

I was mostly questioning Cass's use of the word "trivial". I have osteoporosis at a fairly usual age (sixties) and it is manageable but not trivial. Early onset osteoporosis is not a trivial cost. Even if it some people decide it is an acceptable cost that doesn't make it trivial. And of course a downside in the distant future may seem trivial compared to more immediate concerns and still turn out to be anything but trivial when it eventually happens.

The disutlity for society of different treatments is normally adequately represented by the cost to the public sector. I can’t think of another condition where the public, rather than the public sector, are expected to not only provide the ‘treatment’ but directly bare the disutility of that treatment.

The difference here though is the ‘treatment’ is not limited to medical treatment (drugs and surgeries) but also to society (pretending a man is a woman, changing language, removing single sex spaces etc).

For clarity, I understood that.

I, obviously, failed to make it clear that calculating the disutility for society in addition to that for the carers is not something I've seen done and I don't think it's covered adequately by the Treasury discount.

To be fair, the social costs of transition are mostly outside Dr Cass' remit. Her report did mention the effects on families and the need for (proper!) support for families.

I do agree on your second point though, especially as Dr Cass specifically mentioned surgery which I would have expected to be outside her remit as most surgery and especially the kind of surgery that resulted in the young man's death isn't practised on children here.

Yes carers are sometimes included eg for dementia drugs. The difference here though is the ‘treatment’ is not limited to medical treatment (drugs and surgeries) but also to society (pretending a man is a woman, changing language, removing single sex spaces etc). Therefore a proper assessment of treatment must include the total costs to everyone of doing that too.

People defend this 'treatment' for so-called 'transgender children' generally fall into 3 categories.

1. Parents of 'transgender children'. People like Susie Green and the parents of Jazz Jennings. Anyone who posts on social media about getting 'treatment' for their 'trans child'. They can't afford to have doubts due to what they have done to their children.
2. People with a vested financial interest in there being a constant supply of 'transgender children' to treat with drugs and surgery. People like Helen Webberley and the Irish 'yeet the teets' surgeon in Florida.
3. Late transitioning males who use the belief in 'trans children' to sanitise their own identity as 'transwomen' by suggesting that they were just like those children when they were young, and that therefore their own Malaga Airport tendency is not a fetish, because obviously it isn't a fetish for the children.

Two things there - the cost of ‘not be able to live in your identified gender’ only ever counts the cost to the individual in question, never the cost to everyone else of a system that upholds regressive sex stereotypes and forces the association between those regressive stereotypes and sexed language and provision, or requires everyone to deny reality of someone’s sex.

I don't think Health Economics is set-up to do that, interestingly. You sometimes see carer utilities (gains) or disutilities (effectively, added caring responsibilities or impact) calculated with respect to an intervention, such as a new procedure or drug. There's also the rate of the discount over time (set by the Treasury).

https://source-he.com/will-discount-rates-change-for-uk-hta/

That's the sort of conundrum that should probably spark a few papers if York or another centre felt up to it. (In addition to world leader status in systematic reviews as part of evidence appraisals, York is, relatedly, world leading in health economics and appraisals.)

A reminder of an actual study into this found no benefit (once the paper had been corrected):

https://www.thepublicdiscourse.com/2020/09/71296/

Two things there - the cost of ‘not be able to live in your identified gender’ only ever counts the cost to the individual in question, never the cost to everyone else of a system that upholds regressive sex stereotypes and forces the association between those regressive stereotypes and sexed language and provision, or requires everyone to deny reality of someone’s sex. This includes the impact of obscuring facts in public health messaging that may lead to deaths eg from cervical cancer, or rapes arising from men accessing female spaces.

Secondly, how trivial were the costs to the transgendered individuals who died as a result of ‘transitioning’ or the young woman with locked in syndrome? Her statement relies on ignoring those outcomes which is anything but an evidence based assessment,

Thank you for the transcript @zibzibara

I enjoyed listening to the interview. Dr Cass is very reassuring. Professional, balanced and sticking firmly to her remit and to the facts.

Though I was surprised that she stated so confidently that for people with a "long-standing trans identity" " the costs ... of medical treatments, in terms of any side effects or any negatives of the medical or surgical interventions, are trivial compared to how difficult it would be to not be able to live in your identifed gender." That would be true for some of them and some of the interventions but the Transparency podcast has talked to transmen with enduring gender dysphoria who don't think that the benefits of all the medical and surgical treatments they had outweigh the negatives. Including the presenters.

Surgery often is mutilation - in that mutilation involves removing body parts. The body is no longer whole - and that is often how the person feels about themselves.

There's an excellent documentary programme on Netflix 'Regretters' about two men who transitioned decades ago ( each for different reasons)...one of them was the first to undergo 'sex change' surgery in the 1960s. Both recalled the trauma of waking up to discover that their genitalia had gone...and wandering what they had done. It was a feeling that never left them.

That is very telling, though, isn't it? That gender clinicians and counsellors have been doing no longer term follow ups, as would be standard practice in normal healthcare. After cancer surgeries and treatments, for example, patients are called on regularly to monitor their recovery. You should certainly expect this in the case of children receiving such drastic measures as blocking natural puberty.

And as I understand it one particular surgeon ( I'm sure there are more), an Irish woman, actually gets her patients to sign a form saying that they will not take legal action in case of complications.

🎯

The likelihood of Jazz Jennings detransitioning is small, given all that has been invested in his life, but you can’t convince me he isn’t suffering physically and mentally from vaginoplasty surgery, the complications that ensued and the lifetime of problems ahead.

For me, the horror of people defending this on the basis of no regret is that these children have had their adult judgement capability removed, and then everyone is like oh they say they're fine.

I really don't think it is as low as you suggest. Even those who don't detransition often face regret and some degree of trauma over what they have done to themselves.

I have come to the belief that some
male posters are not here to convince people at all. That is not the aim.

If you're trying to convince others of your position, it's usual to post links to sources which provide evidence. If you simply say "You can find them yourself" people are likely to assume that you have no evidence, because if you did, surely you would have posted the links.

Tavistock doctor said:

"the reality is that no one knows, because sex changes are 'the only medical or surgical intervention for which there is no follow-up data collected or follow-up studies'.
He said 26 per cent of his patients at the Tavistock and Portman regretted transitioning"

That's the problem. We don't have comprehensive data about detransition. Remember the academic who was refused funding for his research on this subject because of "transphobia"
I suspect in our post Cass world, he'd now be allowed to push on with this vital research.

So you can’t provide any studies then?

there are multiple studies. You can find them yourself.

Ah, is it just apathy that prevents dadjoke from backing up his argument?

Cos people who appear the very opposite of apathetic are often absolutely paralysed by it when asked for links.

You could organise all these studies that you keep mentioning in a nice handy reference manager and provide the reference that you think supports your point easily, Dadjoke, Mendeley is free IIRC.

Surgery is not mutilation

Most surgery isn’t - this surgery is. How can removing healthy and necessary body parts in order to “treat” something that (at best) isn’t properly defined and (at worst) is completely fictitious, at the behest of a child who is likely to be neurodivergent and otherwise distressed, and who has been persuaded by (at best) well-meaning but irresponsible and (at worse) perverted adults that they are something that they are not, be anything other?

You need to read it again, because that’s not what the research says.

Surgery is not mutilation, and there are multiple studies. You can find them yourself.

So we have established that the systematic review you linked does not provide evidence of regret rates. Only, as I said, how many people returned to the surgeon who mutilated them asked for reversal of permanent surgery and had this recorded in clinic notes. Do you have any better studies that do?