Ban on puberty blockers to be made indefinite on experts’ advice

The announcement of an indefinite ban is a step forward.

There are multiple threads to what happens next.

The first is proposed puberty blockers trial which in practice may or may not happen. We shall see. Even if it does happen [horribly unethical] we know what it will show definite evidence of real physical and mental damage from puberty blockers, alongside dubious positive benefits.

The second is the assembly of evidence from those who have already taken the blockers. Previously this data was not gathered under the Tavistock, but this information gathering is starting to happen. We shall hear about the results. They are going to be negative of course for the most part.

Thirdly and perhaps most importantly is the political element. It seems to me Streeting is using the TAs own weapons against them in the way they used moderate language to shift ground and undermine women for years. Notice most TAs regard Streeting as basically being Hitler while rhetorically he appears to give ground to them in certain ways. The thing is time is on his side. Their extreme anti-Streeting hatred undermines their ability to influence policy. The TAs are basically undermining the gender moderates, actually far more dangerous than many TAs because they seem more reasonable, by either pushing them to break with Streeting or become EVIL themselves.

Streeting can say he is open to new evidence over time, but the TAs will not provide anything, because they have nothing. Remember the BMA council saying they would have evidence by Xmas that Cass was wrong. Nothing turned up so far.

By the time the ban is reviewed in 2027, there will be nothing new, BUT the evidence that they are a disaster will be even better documented. So Streeting can look even more reasonable.

This political element is key. Note the SNP see the writing on the wall. They have caved already. So that leaves the Lib Dems, Plaid and the Greens who might be fighting the 2028 election on pushing for experiments on kids or instead come round to saying Streeting was right all along. Politically this is a useful wedge issue for Labour. On other issues center/left parties have serious criticisms of Labour, but this is an issue where they can potentially morally grandstand and also neutralise some right wing rhetoric too.

Personally I think Streeting peaked long ago. He is a clever politician though and knows that seeming moderate is in the long term beneficial for him. He wants to be Prime Minister.

I don’t think the trials will happen. By the time they would be starting, there will be a lot more evidence coming from the lawsuits in the states, and a lot more awareness in the public. I know they are still saying they will, and are planning the terms, but things are moving fast now and I feel confident that by the time the trial could start, there will be enough knowledge in the general public and more evidence from detransitioners of the extreme harms that result from the medical pathway. I really hope I’m not wrong 🙂

Mentions ethics in reply to this question..

https://x.com/carla_denyer/status/1866892147146039724?t=gQ-DyfhUAUDCdJ-qhVbnfg&s=19

I do share the concerns about the trials. But #nodebate is over. Transactivist groups are no longer able to dabble in children's healthcare, moulding it for their own reasons. These trials are in children's hospitals who live and understand ethical dilemmas about treating the most unwell of children. I know the NHS has plenty of useful idiots pushing the trans ideology at every opportunity, but the days of deals done behind closed doors are over.
There will be major scrutiny of these trials. The adults pushing for children to be experimented on and potentially losing their future health and fertility no longer have anywhere to hide.

It seems the trial/study will definitely go ahead.

Streeting's ban affects initiation and onwards from there of PBs in both NHS and private unless it's in the context of the trial. It's meant to close loopholes and workarounds involving European pharmacies etc.

The trial protocol hasn't been released in its final form but it seems it's imminent. NHS Comms very much needs to come out and clarify matters for people and create some decent public-facing materials.

I'm intrigued about what an electronic sit-stand desk does now

Superb post.

This is the key fact & the elephant in the room for any clinical trial. When a doctor diagnoses a condition where the known outcomes are that untreated 80% of people's symptoms self-resolve, and where we have no reliable way of identifying the 20% who will have persistent symptoms - AND where there is no good evidence that active treatment does any good to that 20% - the sensible, logical and ethical option is to wait and see. Putting a large number of people through experimental treatment we know is unnecessary for 80% is totally unethical, and that's before we start to discuss the trial participants being children and the side effects of treatment being permanent effects including an impact on fertility. I really, really don't see how an ethical committee can sign this off and if they do I want the papers to go in the public domain for full scrutiny.

https://www.bbc.co.uk/news/articles/cdr0xrpzjzko

"I wholeheartedly support letting kids choose whether or not to take it and recording the long-term outcomes of either in detail."

I mean if you offered a 12 year old to sign up to a clinical trial where you only eat pepperoni pizza and drink coca cola for 10 years to see the effect on a developing body, I'd bet you'd get quite a number signing up to that. Is that ethical to let a 12 year old choose even though as an adult you can fully understand what potential impact a study like that would have on their body and psyche? Even if they thought it would be amazing because they'd never have to eat broccoli again?

Kids can't choose things that have long-lasting and potentially devastating effects on their bodies, because even if they're intelligent, articulate and knowledgeable, they simply don't have the experience to actually conceptualise what a permanent decision means for their future selves.

Comments are open on the guardian about puberty blockers and my goodness , it’s like some commenters are stuck in 2017 and the cass report never happened. Trans kids will die, the opposition to trans children is due entirely to right wing American Christian influences, puberty blockers are completely safe and reversible, etc etc.

How can there be a benefit, in any other way that immediately short term and psychological, for anyone in blocking a natural bodily process - for goodness sake - and then adding in hormones in quantities not suited to the natural constitution?

Dysphoria turns into short term Euphoria - and then reality sets in.

Many thanks for this clarity

Thank you.

Sounds like you may have dodged a problematic counsellor there tbh. I think no counselling is preferable to bad counselling.
Hope things go OK tomorrow at your meeting.

I agree.

We've been in this position before but things were a lot worse. When she was actively gender questioning and in the throes of a huge mental health crisis, we had to refuse care from CAMHS because of how she had been misrepresented in their paperwork. The hospital CAMHS team said she "identified as a boy". They later clarified that she never did and we eventually entered the CAMHS pathway. She's not at that same crisis point now. We got through that 2 years ago so we'll get through this.

Re tomorrow, I shall be back to being my reasonable self 😁 Each sport should be validated on its merit to decide whether it should be mixed or single sex. There's plenty of available guidance about this for schools.

I missed this astonishingly bad take response to what looks like a murder threat.

@BonfireLadySorry I tagged you in a reply and can't untag you but I was going to ask Butterfly why your point about the lack of any evidence for the use of puberty blockers in autistic teenage girls was completely ignored.

I wholeheartedly support letting kids choose whether or not to take it and recording the long-term outcomes of either in detail.

Funny, there’s already been ample opportunity for clinics - Tavi no exception - to collect that very data, but they haven’t have they? Why is that, hmm?

I've just seen this message now.

This is not Baroness Cass' position. But you know that.

I can't even be bothered being angry at your misrepresentation of this.

If a trial paases ethics and proves beyond any doubt that puberty blockers have clear benefits that fully outweigh the harms of unknown, highly likely permanent impact on brain development (amongst other things) I'll support their provision.

Likewise re partial lobotomies for people with depression. And gastric bands for people who are distressed about their bodies and have turned to anorexia as a solution. The ethics of such trials seem pretty similar to me.

@BonfireLady I'm so sorry to hear you're going through such a difficult time.

It makes me angry that confused children who know they need counselling aren't getting offered it. I have experience if this myself where gender confused adolescents want the puberty blockers and counselling as they know they are also depressed/ anxious but only get the puberty blockers.

How did we get t this point where the first approach for confused children with mental helath concerns is body altering drugs rather than exploring their feelings and experiences?

Sounds like you may have dodged a problematic counsellor there tbh. I think no counselling is preferable to bad counselling.
Hope things go OK tomorrow at your meeting.

Er, wrong thread 😄.

I bought an electronic sit-stand desk, but I rarely stand. I should have saved my money! It also stops me crossing my legs.

I'm going to add a personal note to this thread. I have a difficult day ahead of me tomorrow (meeting in school... related to the wider subject of gender identity) and I need to vent.

Why do I specifically need to vent today on this thread?

I'm so fucking angry. Partly about my meeting tomorrow but that's by the by. My meeting is about safety and fairness in relation to mixed sex sports in school. I mentioned on a previous thread that my daughter had been injured by a spiked volleyball that was hit by a boy. She's lucky that the net took most of the impact (she was playing at the front of the court, right by the net) and that all she was left with was a black eye, broken glasses and a cut to the eye from the broken glasses arm. It could have been a lot worse. Anyway. That's not why I'm really angry right now.

My specific anger today is because I came as close to losing my temper as I have so far, but I managed to rein it in. If I can't control my anger, I'll be "proving" that I'm a threat to my daughter, such is the well trodden playbook that so many parents will be familiar with.

My daughter desperately needs counselling. Not for gender identity issues, she's no longer actively gender questioning. She needs counselling because she's really struggling with adolesence. She's autistic and struggling with friendships. She's hurting because friendships go wrong. She gets overwhelmed and sometimes this can lead to a meltdown, especially if her anxiety is already high (which it is because she's baffled by how friendships work) and there is a trigger at just the wrong moment.

Previously she resisted counselling but now she's ready. Annoyingly, she's very specific about which counselling service she wants to go to, but we're working with that as it's better than complete refusal.

I've been trying to speak to the counselling service for a couple of months now to talk about her safeguarding needs around gender identity and autism conflation. They finally contacted me by email on Friday. Telling me that they had a space for her this week on Monday. Obviously we can't take that space until we know that the counsellor who will work with her understands that when my daughter talks about hating her breasts, and that she finds sex based stereotypes confusing and unnecessary, and that there's lots of stuff in school and online about this kind of thing, the counselling is not "neutral" if the counsellor isn't aware of the Cass Report. My daughter will mostly want to talk about friendships, but as she builds a rapport with her counsellor, I have no doubt that she'll share some of the things she still talks to me about regarding breasts, periods and how she hates how puberty has changed everything. She was happy as she was.

They phoned me today. I've been told we risk losing the place if we don't take the counselling now. But what made me really angry is that the lady I spoke to told me that they have lots of experience talking to autistic girls about their feelings (confidentially of course), that the Cass Report has no relevance to their counselling service and had I considered that my concerns were actually related to my own anxiety about my daughter growing up and finding her own identity. They offered me counselling to help with this.

For fuck's sake.

I shouldn't have to work this hard to safeguard my daughter and to get her the care that she needs to help her navigate the twists and turns of being an adolescent autistic girl.

Butterfly, I think you got some of my anger because of what you said about how we already know what the results of the trial will be. You didn't deserve all my anger, so that's why I added the edit. If you genuinely have experienced debilitating feelings of gender dysphoria (I'll take it at face value that you have) that must be awful. But that doesn't mean your experience invalidates the concerns of parents like me. Or of women who don't want TW identifying into women's sports, spaces and services and other similar things that I've seen you comment on.

Clearly not.

I saw a discussion today at Genspec which raised something that I didn't know before but makes perfect sense.

Those on long term puberty blockers don't mature as normal (which is kind of the point) this effects bones and mental maturity which most of us were already aware of but ALSO mean that all your other organs don't mature either. Many patients have immature hearts and kidneys and other vital organs.

The idea that you should just continue experimenting on children without knowing the full effects and in the knowledge that even a few of them will change their minds is appalling.

I'm not convinced that even the individuals who would apparently 'benefit' from blockers will do so long term. I don't know how medics can make a risks versus benefits assessment and conclude that continuing as we have been is anything but a disaster in waiting.

I hope that any ethics assessment sees the inherent problems but it entirely depends who is doing the assessment.

I agree that a good starting point should be a decent follow up on any known patience. Unfortunately there will be reporting bias (the happiest transitioners may be more likely to respond then the unhappiest) but it can form a starting point at least. Reporting of side effects long term will be valuable if nothing else to giving information to those wanting to start blockers.

When you find good quality evidence of that benefit, I'll campaign for what you're asking, yes.

So you'll join both Baroness Cass and myself in supporting the provision of treatments for those for whom there is clear benefit and hoping that they will continue to be available in future for this purpose?