Puberty Blocker Trial Paused

My impression, is that, as with the original Dutch study, what adult men have said they wanted is the driving force behind it all.

The Dutch study was done in response to TiMs lamenting that they didn’t pass. The cohort in the Dutch study was not deemed otherwise mentally unwell, whereas the trans-identified children now are usually very unwell, with multiple mental health co-morbidities.

These children’s mental health distress is often centred around what they deem treatment, ie blockers, hormones etc. Whereas in the original study it was the OUTCOME that was supposed to improve functioning, not the PROCESS.

It’s unsurprising that social media, the media, activists etc have somehow convinced children that they need blockers etc or they’ll be suicidal but it’s kind of crazy that we’re at this point now,

Those prescriptions are last-resort & time-limited to periods far briefer than either the original study proposal or the MHRA suggestion, not least because of the known risk of depression & suicidality that they carry, even in adult subjects.

We already prescribe GnRHa for a variety of reasons post puberty

I thought that was only done in cases where there was a serious medical problem?

Not, apparently, to people with gender incongruence issues.

And the reason they are suggested as a treatment is to prevent puberty, and the reason that the study has been paused is because 'blocking' puberty, among other things, causes infertility.

I don't think it's possible to separate the use of the drugs from their purpose.

Why is that the purpose of the pathways trial though?

Why is it not exploring the impact of any other pathway except this one?

We know that the medication blocks puberty, we know the side effects of these medications as they have been identified from use with other conditions. The Pathways trial is about exploring the impact on gender incongruence related symptoms and outcomes

The MHRA intervention asks for tighter monitoring of known negative side effects so medication / participation will be halted if/when they occur.

I've been reading Hannah Barnes's book today. They were originally only prescribed from age 16 upwards - that was experimental and reducing the age ever lower was also experimental and the result of pressure. There is no coherent explanation or evidence base behind the basic premise of this trial.

It's all become so corrupted and distorted over time that I don't think they even know what they're arguing for anymore. If they do, they're certainly not articulating it successfully. Why is Cass protesting that these drugs should be given to young children? What kind of paediatrician wants to experiment on children to see what happens if you prevent them from going through puberty? Why?

Government is too much of a boys' club to bother thinking about any of this deeply enough to deal with it appropriately. That's why we're in this mess.

From 2023. Sorry about the blurriness in advance...

But the goal of the study isn't "to block puberty". It's to, as stated in the study, look for benefits and harms of GnRHa drugs.

If it's being sold to participants as stopping their puberty, that's a PR issue.

We already prescribe GnRHa for a variety of reasons post puberty.

Not, apparently, to people with gender incongruence issues.

But what would be the point if the goal is to prevent puberty?

We already prescribe GnRHa for a variety of reasons post puberty.

Jolyon Maugham’s analogy of researching the efficacy of condoms when applied after sex made a fair point.

I don't think so. If a trial of putting condoms on after sex showed that it was dangerous because it made a man's penis fall off then it wouldn't be ethical to have a trial about putting them on before sex to see if that was better.

The NHS website says

The PATHWAYS Trial is a UK-wide clinical study investigating the effects of puberty-suppressing medication in children and young people (CYP) who experience gender incongruence...
The medication being studied is a gonadotropin-releasing hormone analogue (GnRHa), which temporarily pauses puberty. Although this treatment is already used in some countries, there is limited high-quality evidence about its benefits and risks in this context. The PATHWAYS Trial aims to provide robust, independent possible evidence on benefits and harms.

The trial isn't therefore primarily about "pausing puberty" - its about the effects of GnRHa.

It still makes sense to me to look for benefits and harms when provided from the age of 14.

Certainly research is needed on how best to support or treat these children. But this is not research. This is severely flawed experimentation.

Cass couldn't possibly consider the initial approval was a mistake. It's not like she has done any reports which highlight significant mistakes from the medical community.

"you should not be subjecting children to a flawed study.…"
I agree with this bit, but I'd say the whole trial has been massively flawed from the start. Please stop.

Geez at that quote. How about reality ethics concerns? We are meant to take that into account not do whatever.

“It feels to me like they are responding to political pressure rather than to science.”

Annoying when that happens isn't it, Hilary?

She is more critical of the suspension of a trial than the suspension of 300+ kids puberty.

Apparently Dr Cass is critical of the suspension of the trial.

“I have not changed my position an inch since I wrote my report, and yet, suddenly, people from the gender-critical side of the debate
seem surprised or discomforted that I'm supporting a trial,” she said.
“I called for a trial two years before the report, and I said in the report that everything that we do to these young people needs to be done in the context of a proper research programme, because otherwise we can't improve what we're doing for them.”

Cass told The Observer she was “disappointed” by the MHRA’s intervention. “There are no new research findings and the MHRA hasn’t presented any new evidence,” she said. “It feels to me like they are responding to political pressure rather than to science.”
The trial was launched after Cass’s 2024 review of gender services, which said research was needed since there was little evidence whether or not puberty- suppressing hormones helped children with gender dysphoria. After the paediatrician’s report, the NHS stopped use of the drugs at gender identity clinics, although they continue to be used for children whose puberty begins abnormally early.
Cass said the trial was necessary because “we genuinely don’t know if some children will benefit or have no benefit”.
By raising the age limit to 14, it would cut out children who might benefit, which “will make the results invalid”, Cass said. “It would make the design really, really flawed and you should not be subjecting children to a flawed study.…

I think it's vital to point out how poor methodology and thought processes have dogged medicine, arguably particularly women's health for years.

It's not just invisibility of women in healthcare, it's also the deliberately flawed premises of studies to show an outcome that supports an ideology.

That's why I use CS v VB because it shouldnt be like that because an EMCS is an outcome of an attempted VB - it's not somehow disconnected and ELCS have very different risk profiles to EMCS so lumping them together is fundamentally flawed. Yet this is how data was compared for years and years. It was only in around 2009 when women started questioning this and going hand on a second that this started to change. 2009. (I know because I was doing a lot of reading on the subject and it's all on MN as to how this developed over the years). It's made me realise the sheer level of arrogance and pig headedness within the profession at times.

There was one particular WHO study that said in its conclusion that VBs were less risky - except when you looked at the data they were using that's not what it said at all. It said that ELCS were marginally less risky than a VB. WHO deliberately wrote an incorrect conclusion because their results didn't match their political agenda.

It's absolutely fucking bonkers.

This of course is like gold dust to conspiracy theorists. And it is exceptionally troubling because it undermines health research in general.

It is so fucking frustrating.

If your basic premise, your methodology and what you are seeking to find out are off in your hypothesis then your study is not fit for purpose. This is a study messing about with sex. For it to be effectively not immediately saying "oo well there might be differences between the sexes" is to fail to understand and acknowledge the known issues about default male body in medical research. This isn't an out there concept. It's one that's very much one which is front and central within research circles ATM. It absolutely is a regressive space to be in.

But that's the issue and point. The whole idea of being a trans kid is based on regressive ideals rather than actual robust science.

It's always women who get the shitty end of the stick on this too.

Very good point!

I guess this fits with the screwed up definitions they hold for what sex is.

When you define sex as a compilation of superficial features that are manufactured by exogenous hormones and cosmetic surgery, puberty can be regarded as the process by which these features are acquired.

Redefining puberty so it strips it of its entire meaning/ focus on reproduction aligns with redefining ‘woman’ so it no longer refers to reproductive role.

I came across a post from Emma Hilton on x saying that if Cass thinks the trial is pointless if limited to children 14 and older why were those 14+ included in the trial in the first place

And as is often pointed out, whose interests are served by having potentially available a group of people who are legally adult, but whose bodies look like those of children, and who may not be fully mature psychologically and emotionally?

What is quite scary is the number of children (and adults) who seem to believe that taking cross sex hormones results in a child going through the puberty for the opposite sex.

Rather than just damaging their body.

Some of the beliefs being expressed would be considered indicative of psychosis (i.e. a loss of contact with reality) and treated as such if it weren't for all the social pressure to be "on the right side of history" on this subject.

The fact that this trial doesn't separate girls and boys at all and make a clear distinction is a fairly hefty oversight.

This is an excellent and vital point!

It strikes me just how MANY issues there are with the trial, and that it's hard to grasp them all at once.

Then, how revelatory it feels when you think you've considered them all, and then someone brings up another one, like this- and how obvious it seems when you see it.

It really is like a hall of mirrors.

Which is basically about sexist ideas of woman = sexually attractive and beautiful + homophobia.

Which is all kids of wrong. Especially when you consider this is about children and their sexual appeal.