BBC interview with Cass. 'Both sides weaponised'

My view:

Puberty is a vital part of development in physical, intellectual, emotional and reproductive terms. Going through puberty is a necessary component in the transition from childhood to adulthood.

If you prevent an individual from undergoing puberty, you end up with an incomplete adult. This is not acceptable under any circumstances.

Many individuals have transitioned as adults, never having been given puberty blockers, and claim it alleviates their gender related distress. This should be the protocol adopted for gender distressed people, after careful assessment.

This trial should be stopped. It is morally wrong.

I’m going to gently sidestep our overnight visitor, and come back to this, because I’ve had some overnight thoughts of my own about the possible hypothesis this study could be testing.

In my post that you replied to, I said that one thing it could be testing is the hypothesis that “stopping puberty in children with gender distress will alleviate their gender distress,” and I said that hypothesis needed unpacking. But I missed one of the most fundamental unpacks:

What does “alleviation of gender distress look like?”

If it looks like some sort of general removal of depression and anxiety, then why would puberty blockers be the drug being tested, when we already have vast reams of research on multiple sorts of anti-depressants? We don’t need a new drug in that particular market, so surely that isn’t what is being tested.

So it must be specifically about gender distress. And there are only two ways (that I can think of) one might think about that being alleviated:

One, “alleviating gender distress” could mean that the child no longer feels uncomfortable in their sexed body, that they no longer feel like they were “born in the wrong body.” That is a plausible definition of “alleviating gender distress” but there’s no plausible reason to expect that to be the outcome of stopping puberty. In fact, given everything we know about how puberty works, that is the opposite of what we might expect to happen. By stopping the child from going through the natural development of the brain (as well as the body) that happens during puberty, you are almost guaranteeing that they will have no “changes of mind,” as it were, about their view of their sexed body.

The alternative is, two: “alleviating gender distress” means “increased happiness simply because stopping puberty in this way is seen by the child as the first step on a path towards medically altering the body to make it fit their mental image of what their body should be.”

Now, if the latter is the case, that is a whole can of worms for the research team, and that the ethics committee should have been aware of. Because if that is the case, then you are not ever going to be able to test the “effectiveness” of just stopping puberty on gender distress - because it is not ever considered a just in the minds of the experimental subjects.

If you cannot say to the subjects “you will be given this drug and nothing more, ever” and have them believe you, then you are not testing just that drug - particularly when you are looking at psychological outcomes - you are testing the effect of knowing that they have (finally!, after begging and begging) taken the first of many steps on a path that they have already decided is the right path for them.

In other words, there is no way to test the effectiveness of stopping puberty on alleviating gender distress in isolation. Again, the whole premise of the study falls down.

I don’t get it. These are supposed to be the best of the best in terms of research. If one of my undergraduates had given me a research proposal with this many unfounded assumptions and untestable hypotheses, I’d have sent them back to start again.

I had similar conversations about another very blunt speaker with friends. They declared she was a bigot. I prodded and asked what it was that they disagreed with and went through each issue raised. They agreed in principle with each point but found the language too blunt and very accurate without emotional softening.

I then had a similar conversation 12 months later and those friends still rejected the blunt and accurate language while still agreeing with what was said. Some people may never cope with an accurate discussion about what they support.

They are conditioned too deeply at the moment to use accurate language. It may be different in 10 years. But for now, some people need emotional softening because their instinct is to be kind and inclusive and accurate language strips that softer approach away.

It is why there is a need for a range of voices. As long as those avoiding blunt language don’t denigrate those who use the accurate terms, there shouldn’t be a problem.

It's a different situation though.No-one is proposing a clinical trial that deliberately puts girls with anorexia on a pathway to sterility and long-term ill health to see if it helps some of them.

I didn't think there was any doubt that there are multiple reasons for gender dysphoria. It's more that it's not terribly relevant to this trial, since there is no identifiable reason or subgroup for which puberty blocking is more likely to be helpful than any other.

And (playing devil's advocate) Az Hakeem has pointed out that at least in adult men a high degree of autism correlates with a high level of satisfaction with transition. So autism might not in itself be a reason not to put children on the pathway to transition if you're going to do it at all which is mad.

This is a clinical trial on children. "Think of the children" is what normally happens in clinical trials, children are treated extra-specially. The question is whether this clinical trial should have lower ethical standards than other trials on children.

Maybe, but as far as most of the public and certainly Laura Kuennsberg were concerned, you'd find it difficult to dispute or argue, with any authority, against what she'd said.

Baroness Cass was President of the RCPCH

So was Russell Viner, the guy who was responsible for the first 'Puberty Blocker Trial'. The one that had to go to several ethics committees to get approval and that then disregarded its own age restrictions. The one with no follow ups.

The whole 'experienced paediatrician' with gravitas means nothing these days.

Apologies. I am aware that there are (I think…?) brain scan studies that demonstrate gross similarities between subjects with gender dysphoria and those with anorexia. The theory that they both involve some underlying body imaging issue was proposed (again, I think - was a while ago that I read the paper).

You’re right though - we do understand much more about anorexia than about gender dysphoria - and that is part of the problem, no? We are allowed to investigate all the underlying possible issues surrounding things like anorexia. We are shut down when we suggest that there are multiple possible reasons that a child may express gender distress.

I think @TwoLoonsAndASprout has managed to properly articulate the thoughts I have had about this trial way better than I ever could:

"If you cannot say to the subjects “you will be given this drug and nothing more, ever” and have them believe you, then you are not testing just that drug - particularly when you are looking at psychological outcomes - you are testing the effect of knowing that they have (finally!, after begging and begging) taken the first of many steps on a path that they have already decided is the right path for them."

These children have been coached and convinced that PBs are simply the first step on a medical and surgical pathway that will enable them to convince the world that they are the opposite sex and it will all be rainbows and glitter.

I remain horrified that this ever gained ethical approval.

Yes, but she is a journalist with an obvious bias ( as far as they are concerned) whereas Baronness Cass is an experienced paediatrician with gravitas and authority.

Plz point to all the gender criticals critiquing the genocide then?

Oh wait, there are none.

The same as always, demonising & dehumanising non conformists to conservative ideals.

Lol, 'mixed sex toilets' as 0.000000001 trans girls.

Listen, if you people cared anything about the well being of children we would heard something from you about the 20 odd thousand massacred in Gaza, alas, nary a whisper. But as you were.

Yes, but she is a journalist with an obvious bias ( as far as they are concerned) whereas Baronness Cass is an experienced paediatrician with gravitas and authority.

Meh, "think of the children!" has long been used as a tactic used in an attempt to prevent rational debate by misdirecting empathy towards an object which may not have been the focus of the original argument. In terms of sports & toilets they are hardly the one's mostly effected.

As far as what makes children trans I defer to the experts like Cass…….some maintain a trans identity through out their whole lives

Cass concluded that there are ‘many ways in to a trans identity’, which led her to recommend services that address underlying causes that need addressing (e.g sexual abuse, trauma, mental illness, unmet Austin needs, homophobia). She also recognises that standard gender non conformity and adolescent identity exploration can, because of the zeitgeist, lead to children questioning their gender identity when in another social climate they wouldn’t. Cass has highlighted that, in all of the above cases, support tends to result in desistance.

Clearly, when looking at outcomes for children who have adopted a ‘trans identity’ - whatever that means to them, the best outcome is for them to feel comfortable with their bodies without any physical intervention (hormones, surgery). I expect that better outcomes come from also desisting with their ‘trans identity’ because if they do persist they will have to navigate a world where their internal sense of self doesn’t align with material reality and corresponding laws and social attitudes. It maybe that this misalignment causes less distress than the internal misalignment within their mind, but they should be able to access evidence based treatment for this misalignment - which many want to ban under the guise of conversion therapy.

Cass suggests that there could be a very small number of children for whom there are no obvious or yet discovered underlying causes. These children have not got neurodevelopmental conditions, histories of abuse/ trauma/ mental illness, they aren’t gay etc. yet they struggle with their sexed bodies. If this is the case, and there is a very rare condition leading to this, and if puberty blockers were trialled, one would imagine we are talking fewer than 20 kids per year, and that other treatments should be explored or developed because the costs of PB and cross sex hormones are high. Therefore, you would expect, in addition to a PB trial, money being invested in exploring / developing treatments that enable people with the condition to lead happy lives and retain fertility, sexual function and not be damaged by exogenous hormones that damage organs.

I am not wholesale against trialling PBs. I think, through rigorous inclusion and exclusion criteria, an ethical study could be conducted. However, when arguments for a trial are made without equal support for developing and trialling other treatments that, ideally, could replace PBs and cross sex hormones, I suspect ideology is at play.

. I personally think that it’s not much different from the things that cause anorexia or other body dysmorphic disorders, that we also don’t understand well, but you are right,
We do know that anorexia isn't something that is free from comorbidity though. Indeed we are seeing it absolutely is about other issues but this isn't well recognised.

Suggesting that it's like anorexia because there may be no underlying issue is ignorant of what we do know of anorexia.

It would be worthwhile exploring before making the comparison.

But it will be more data than we have now, gathered before and during treatment. We have to start somewhere. If this shows no short term benefit in these children and no significant difference to their level of distress, or significant levels of harm to bone density and cognition, then nothing else is needed.

The belief is that the drugs provide an immediate benefit to mental wellbeing by reducing puberty related distress. That's what's being tested. Do these kids get relief from their distress now, yes or no. Tavistock claimed they did but there's no paperwork to prove it.

"Meh" was in reference to the obvious flawed reasoning of gender criticals using children to justify their own bigotry not any suffering that may have been incurred.

But yeah, do continue to distract from the point of child exploitation if it gets you thru the night.

I’m going to gently sidestep our overnight visitor, and come back to this, because I’ve had some overnight thoughts of my own about the possible hypothesis this study could be testing.

In my post that you replied to, I said that one thing it could be testing is the hypothesis that “stopping puberty in children with gender distress will alleviate their gender distress,” and I said that hypothesis needed unpacking. But I missed one of the most fundamental unpacks:

What does “alleviation of gender distress look like?”

If it looks like some sort of general removal of depression and anxiety, then why would puberty blockers be the drug being tested, when we already have vast reams of research on multiple sorts of anti-depressants? We don’t need a new drug in that particular market, so surely that isn’t what is being tested.

So it must be specifically about gender distress. And there are only two ways (that I can think of) one might think about that being alleviated:

One, “alleviating gender distress” could mean that the child no longer feels uncomfortable in their sexed body, that they no longer feel like they were “born in the wrong body.” That is a plausible definition of “alleviating gender distress” but there’s no plausible reason to expect that to be the outcome of stopping puberty. In fact, given everything we know about how puberty works, that is the opposite of what we might expect to happen. By stopping the child from going through the natural development of the brain (as well as the body) that happens during puberty, you are almost guaranteeing that they will have no “changes of mind,” as it were, about their view of their sexed body.

The alternative is, two: “alleviating gender distress” means “increased happiness simply because stopping puberty in this way is seen by the child as the first step on a path towards medically altering the body to make it fit their mental image of what their body should be.”

Now, if the latter is the case, that is a whole can of worms for the research team, and that the ethics committee should have been aware of. Because if that is the case, then you are not ever going to be able to test the “effectiveness” of just stopping puberty on gender distress - because it is not ever considered a just in the minds of the experimental subjects.

If you cannot say to the subjects “you will be given this drug and nothing more, ever” and have them believe you, then you are not testing just that drug - particularly when you are looking at psychological outcomes - you are testing the effect of knowing that they have (finally!, after begging and begging) taken the first of many steps on a path that they have already decided is the right path for them.

In other words, there is no way to test the effectiveness of stopping puberty on alleviating gender distress in isolation. Again, the whole premise of the study falls down.

I don’t get it. These are supposed to be the best of the best in terms of research. If one of my undergraduates had given me a research proposal with this many unfounded assumptions and untestable hypotheses, I’d have sent them back to start again.

I assume she means someone who is influential enough to be invited onto a mainstream BBC politics show.

Helen Joyce is probably influential enough but the BBC wouldn't invite her on shows because she might have said bigoted things such as the majority of children desist after puberty