Medical Treatment for gender identity evidence archive thread

Just a reminder though....

Please look back on the Break it down for me? original thread for many more links to studies and papers....

https://www.mumsnet.com/talk/womens_rights/3145470-Break-it-down-for-me?page=1

And some will inevitably pop up on the 2nd Break it down thread too.

https://www.mumsnet.com/talk/womens_rights/5445899-break-it-down-for-me-2-general-break-it-down-archive-thread?reply=148603352

STUDY: Finland’s detransition numbers

Discontinuing hormonal gender reassignment: a nationwide register study.

Riittakerttu Kaltiala, Mika Helminen, Timo Holttinen & Katinka Tuisku

19 August 2024

https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-024-06005-6

Background

With increasing numbers of people seeking medical gender reassignment, the scientific community has become increasingly aware of the issue of detransitioning from social, hormonal or even surgical gender reassignment (GR). This study aimed to assess the proportion of patients who discontinued their established hormonal gender transition and the risk factors for discontinuation.

Methods

A nationwide register-based follow-up was conducted. Data were analysed via cross-tabulations with chi-square statistics and t tests/ANOVAs. Multivariate analyses were performed via Cox regression, which accounts for differences in follow-up times.

Results

Of the 1,359 subjects who had undergone hormonal GR in Finland from 1996 to 2019, 7.9% discontinued their established hormonal treatment during an average follow-up of 8.5 years. The risk for discontinuing hormonal GR was greater among later cohorts. The hazard ratio was 2.7 (95% confidence interval 1.1–6.1) among those who had accessed gender identity services from 2013 to 2019 compared with those who had come to contact from 1996 to 2005. Discontinuing also appeared to be emerging earlier among those who had entered the process in later years.

Conclusions

The risk of discontinuing established medical GR has increased alongside the increase in the number of patients seeking and proceeding to medical GR. The threshold to initiate medical GR may have lowered, resulting in a greater risk of unbalanced treatment decisions.

And

”It has long been assumed that very few patients embarking on medical GR regret their choice and seek to reverse it. From the 1970s to the 2010s, estimates of those regretting their initiated GR were only in the region of 2% [5, 6]. However, more recent research suggests that alongside the increase in the number of people accessing medical gender reassignment, reversing the initiated transition seems to be increasing [7]. In recent samples, 20–30% of those who initiated hormonal GR discontinued hormonal treatment in four to five years [8, 9]. It is possible that some patients discontinue hormonal treatment because they have reached their transition goals.”

And

“More importantly, those who have detransitioned have repeatedly reported that before their embarking on medical GR, insufficient attention was given to their mental health and psychosocial problems, which, in retrospect, they believed played a major role in their desire to transition. They have expressed concerns that assessments for medical gender reassignment were too superficial, with no search for explanations for their distress beyond an assumed stable sex-discordant identity requiring transition.”

PUBERTY BLOCKERS AND BONE DENSITY FROM THE CASE OF LEO

www.svtplay.se/video/33358590/uppdrag-granskning/mission-investigate-trans-children-avsnitt-1

The video from Sweden on the effects of puberty blockers on Leo and others.

As the poster who posted this initially states:

A trans child, Leo was treated for puberty blockers for 4 years. Leo ended up with osteoporosis (significantly below any normal bone density interval), fractures in the back, constant pain and worse mental state.

The journalist also found an additional 12 cases in Stockholm only where children had serious side effects (bone fractures, deep regret from voice changes, injuries, deteriorating mental health and significant weight gains). Leo’s case was not reported and not one of these.

DISCUSSION ON HOW FAR SHOULD PEOPLE EXPECT THEIR IDENTITY TO BE SUPPORTED

“Should a psychological idea take precedence over a physical fact?” — Dr. Paul McHugh, Distinguished Services Professor, Johns Hopkins University School of Medical

https://x.com/stellaomalley3/status/1945881924389806122?s=46

Full interview

NEUROPSYCHOLOGICAL FUNCTION AND PUBERTY BLOCKERS

The Impact of Suppressing Puberty on Neuropsychological Function
UCL, Queen Square, Institute of Neurology
Sallie Baxendale 2023

https://www.authorea.com/users/713322/articles/697715-the-impact-of-suppressing-puberty-on-neuropsychological-function

ABSTRACT
Concerns have been raised regarding the neuropsychological impact of medications that interrupt puberty, given the magnitude and complexity of changes that occur in brain function and structure during this sensitive window of neurodevelopment. This review examines the literature on the impact of pubertal suppression on cognitive and behavioural function in animals and humans. In mammals the effects are complex and often sex specific. There is no evidence that cognitive effects are fully reversible following discontinuation of treatment. No human studies have systematically explored the impact of these treatments on neuropsychological function with an adequate baseline and follow up. However there is some evidence of a detrimental impact of pubertal suppression on IQ, concordant with findings in the wider literature on gonadotropin-hormone-releasing-hormone expression in relevant brain structures. Critical questions remain unanswered regarding the nature, extent and permanence of any arrested development of cognitive function that may be associated with pharmacological blocking of puberty in humans. The impact of puberal suppression on measures of neuropsychological functions should be an urgent priority for future research. Neuropsychologists should be an integral member of the multidisciplinary team caring for people treated with puberty blockers to monitor the impact of these treatments.

Key Points

1. Adolescence is a critical window of neurodevelopment and puberty plays a critical role in these neurodevelopmental processes.
2. The suppression of puberty impacts brain structure and the development of social and cognitive functions in mammals, the effects are complex and often sex specific.
3. No human studies have systematically explored the neuropsychological impact of pubertal suppression in transgender adolescents with an adequate baseline and follow up.
4. Animal studies, single case reports and studies of the impact of puberty blockers in children with precocious puberty indicate that these treatments may be associated with reductions in IQ.
5. The impact of pubertal suppression on measures of neuropsychological function should be an urgent priority for future research.

SEGM has a page with links to studies. This is a great archive.

It covers treatment, and side effects, mental health, suicide, even social transitioning.

https://segm.org/studies

Prevalence of Personality Disorder Diagnoses in People Referred to Specialized Gender Identity Clinics in Finland

Marja Kaila-Vanhatalo, Tommi Tolmunen, Aino Mattila and Riittakerttu Kaltiala
Published Online: 28 Apr 2025

https://doi.org/10.1521/pedi.2025.39.2.95

Abstract

A higher prevalence of personality disorder diagnoses has been found among individuals with gender dysphoria. However, previous studies on this topic have been limited and methodologically inconsistent. The object of this research was to determine the prevalence of personality disorder diagnoses in individuals requesting medical gender reassignment. A registerbased follow-up study tracked individuals who contacted the nationally centralized gender identity services in Finland in 1996-2019 (n = 3,665) and 8:1 age- and sex-matched population controls (n = 29,292). All their specialist-level psychiatric treatment contacts in 1994-2022 were identified in the National Care Register for Health Care. ICD-10diagnoses and dates of the contacts were extracted.

Among the gender dysphoria group, 15.0% (551 out of 3,665) had received a diagnosis in the personality disorder group (F60-69 excluding F64.x), while among the control subjects, 2.1% (625 out of 29,292) had received such a diagnosis.

The long awaited Johanna Olson-Kennedy study

https://www.medrxiv.org/content/10.1101/2025.05.14.25327614v1

Mental and Emotional Health of Youth after 24 months of Gender-Affirming Medical Care Initiated with Pubertal Suppression

Johanna Olson-Kennedy, Ramon Durazo-Arvizu, Liyuan Wang, Carolyn F. Wong, Diane Chen, Diane Ehrensaft, Marco A. Hidalgo, Yee-Ming Chan, Robert Garofalo, Asa E. Radix, Stephen M. Rosenthal

May 16, 2025

Abstract

Background and Objectives Medical interventions for youth with gender dysphoria can include the use of gonadotropin releasing hormone analogs (GnRHas) for suppression of endogenous puberty. This analysis aimed to understand the impact of medical intervention initiated with GnRHas on psychological well-being among youth with gender dysphoria over 24 months.

Methods Participants were enrolled as part of the Trans Youth Care United States Study. Eligibility criteria for youth included a diagnosis of Gender Dysphoria and pubertal initiation. Youth with precocious puberty or pre-existing osteoporosis were ineligible. Youth reported on depressive symptoms, emotional health and suicidality at baseline, 6, 12, 18 and 24 months after initiation of GnRHas. Parent/caretaker completed the Child Behavior Checklist at baseline, 12 and 24 months after initiation of GnRHas. Latent Growth-Curve Models analyzed trajectories of change over the 24-month period.

Results Ninety-four youth aged 8-16 years (mean=11.2 y) were predominately Non-Hispanic White (56%), early pubertal (86%) and assigned male at birth (52%). Depression symptoms, emotional health and CBCL constructs did not change significantly over 24 months. At no time points were the means of depression, emotional health or CBCL constructs in a clinically concerning range.

Conclusion Participants initiating medical interventions for gender dysphoria with GnRHas have self- and parent-reported psychological and emotional health comparable with the population of adolescents at large, which remains relatively stable over 24 months. Given that the mental health of youth with gender dysphoria who are older is often poor, it is likely that puberty blockers prevent the deterioration of mental health.

Puberty Blocker and Aging Impact on Testicular Cell States and Function

Varshini Murugesh, Megan Ritting, Salem Salem, Syed Mohammed Musheer Aalam, Joaquin Garcia, Asma J Chattha, Yulian Zhao, David JHF Knapp, Guruprasad Kalthur, Candace F Granberg, Nagarajan Kannan

March 27, 2024.

https://www.biorxiv.org/content/10.1101/2024.03.23.586441v1.full

Abstract

"Spermatogonial stem cell (SSC) acquisition of meiotogenetic state during puberty to produce genetically diverse gametes is blocked by drugs collectively referred as ‘puberty blocker’ (PB). Investigating the impact of PB on juvenile SSC state and function is challenging due to limited tissue access and clinical data. Herein, we report largest clinically annotated juvenile testicular biorepository with all children with gender dysphoria on chronic PB treatment highlighting shift in pediatric patient demography in US. At the tissue level, we report mild-to-severe sex gland atrophy in PB treated children. We developed most extensive integrated single-cell RNA dataset to date (>100K single cells; 25 patients), merging both public and novel (52 month PB-treated) datasets, alongside innovative computational approach tailed for germ cells and evaluated the impact of PB and aging on SSC. We report novel constitutional ranges for each testicular cell type across the entire age spectrum, distinct effects of treatments on prepubertal vs adult SSC, presence of spermatogenic epithelial cells exhibiting post-meiotic-state, irrespective of age, puberty status, or PB treatment. Further, we defined distinct effects of PB and aging on testicular cell lineage composition, and SSC meiotogenetic state and function. Using single cell data from prepubertal and young adult, we were able to accurately predict sexual maturity based both on overall cell type proportions, as well as on gene expression patterns within each major cell type. Applying these models to a PB-treated patient that they appeared pre-pubertal across the entire tissue. This combined with the noted gland atrophy and abnormalities from the histology data raise a potential concern regarding the complete ’reversibility’ and reproductive fitness of SSC. The biorepository, data, and research approach presented in this study provide unique opportunity to explore the impact of PB on testicular reproductive health."

And an article

https://www.dailymail.co.uk/health/article-13276501/Mayo-Clinic-puberty-blockers-trans-kids-fertility-cancer-medicine.html

THE FINAL CASS REPORT - APRIL 2024

The page with the link - sorry it is a messy link....

webarchive.nationalarchives.gov.uk/ukgwa/20250310143933/cass.independent-review.uk/home/publications/final-report/

This link should download the pdf

Overview of key findings

-There is no simple explanation for the increase in the numbers of predominantly young people and young adults who have a trans or gender-diverse identity, but there is broad agreement that it is a result of a complex interplay between biological, psychological and social factors. This balance of factors will be different in each individual.

-There are conflicting views about the clinical approach, with expectations of care at times being far from usual clinical practice. This has made some clinicians fearful of working with gender-questioning young people, despite their presentation being similar to many children and young people presenting to other NHS services.

-An appraisal of international guidelines for care and treatment of children and young people with gender incongruence found that that no single guideline could be applied in its entirety to the NHS in England.

-While a considerable amount of research has been published in this field, systematic evidence reviews demonstrated the poor quality of the published studies, meaning there is not a reliable evidence base upon which to make clinical decisions, or for children and their families to make informed choices.

-The strengths and weaknesses of the evidence base on the care of children and young people are often misrepresented and overstated, both in scientific publications and social debate.

-The controversy surrounding the use of medical treatments has taken focus away from what the individualised care and treatment is intended to achieve for individuals seeking support from NHS gender services.

-The rationale for early puberty suppression remains unclear, with weak evidence regarding the impact on gender dysphoria, mental or psychosocial health. The effect on cognitive and psychosexual development remains unknown.

-The use of masculinising/feminising hormones in those under the age of 18 also presents many unknowns, despite their longstanding use in the adult transgender population. The lack of long-term follow-up data on those commencing treatment at an earlier age means we have inadequate information about the range of outcomes for this group.

-Clinicians are unable to determine with any certainty which children and young people will go on to have an enduring trans identity.

-For the majority of young people, a medical pathway may not be the best way to manage their gender-related distress. For those young people for whom a medical pathway is clinically indicated, it is not enough to provide this without also addressing wider mental health and/or psychosocially challenging problems.

-Innovation is important if medicine is to move forward, but there must be a proportionate level of monitoring, oversight and regulation that does not stifle progress, while preventing creep of unproven approaches into clinical practice. Innovation must draw from and contribute to the evidence base.

THE FIRST WPATH FILE LEAK

Here is one link to the WPATH pdf

https://static1.squarespace.com/static/56a45d683b0be33df885def6/t/65e64b9e5cbd756da9fbbdfa/1709591479160/Final+WPATH+Report.pdf

and another

https://environmentalprogress.org/big-news/wpath-files

Here are some of the reactions:

https://www.dailymail.co.uk/news/article-13156695/Trans-healthcare-doctors-exposed-admitting-patients-young-mentally-ill-understand-consequences-treatment.html

https://www.telegraph.co.uk/news/2024/03/05/wpath-tansgender-hormone-therapy-cancer-links-leaked-emails/

https://sex-matters.org/posts/updates/wpath-the-truth-about-gender-affirming-healthcare/

https://genspect.org/the-wpath-files-revealed/

Here is a summary from Michael Shellenberger.

https://x.com/shellenberger/status/1764800595473686865?s=20

And the first part. Much more of it requires images.

Here is the threadreader version:

https://threadreaderapp.com/thread/1764799914918490287.html

THE WPATH FILES

Advocates of gender-affirming care say it’s evidence-based.

But now, newly released internal files from the World Professional Association for Transgender Health (WPATH) prove that the practice of transgender medicine is neither scientific nor medical.

American Medical Association, The Endocrine Society, the American Academy of Pediatrics, and thousands of doctors worldwide rely on WPATH. It is considered the leading global authority on gender medicine.

And yet WPATH’s internal files, which include written discussions and a video, reveal that its members know they are creating victims and not getting “informed consent.”

Victims include a 10-year-old girl, a 13-year-old developmentally delayed adolescent, and individuals suffering from schizophrenia and other serious mental illnesses.

The injuries described in the WPATH Files include sterilization, loss of sexual function, liver tumors, and death.

WPATH members indicate repeatedly that they know that many children and their parents don’t understand the effects that puberty blockers, hormones, and surgeries will have on their bodies. And yet, they continue to perform and advocate for gender medicine.

The WPATH Files prove that gender medicine is comprised of unregulated and pseudoscientific experiments on children, adolescents, and vulnerable adults. It will go down as one of the worst medical scandals in history.

Why I Am Publishing WPATH Files And How I Got Them

The written WPATH Files come from WPATH’s member discussion forum, which runs on software provided by DocMatter.

Ninety seconds of the 82-minute video was made public last year. We are making the full video available for the first time.

One or more people gave me the WPATH Files, and my colleagues and I attempted to summarize them as a series of articles. We quickly realized the topic was too sensitive, complex, and large to be dealt with as a work of journalism, and we moved the project to the research institute I founded seven years ago, Environmental Progress (EP).

The Files are authentic. We redacted most names and left only those individuals who are leading gender medicine practitioners to whom we sent “right-of-reply” emails. We know WPATH members discussed our emails internally. No WPATH leader or member has denied that the Files are anything other than what they appear to be.

EP is publishing a 70-page report to provide context for the 170 pages of WPATH Files. Mia Hughes is the author of the report. It and accompanying summary materials can be downloaded at the link below. That link also provides a link to the full WPATH video.