Puberty Blocker Trial Paused

Completely agree!!

Didn't she attend a meeting to agree the trial before the report that carries her name was published?

I expect that somewhere along the lines a behind the scenes agreement to carry out a trial was part and parcel of the report being allowed to be published.

I think the part that needs unpacking is - what is the problem with gender incongruence that PBs are considered a potential treatment for (or part solution to).

Gender incongruence is framed as neither a healthy or unhealthy condition but one that can give rise to distress. With this in mind, is the goal of treatment to remove the distress but not the incongruence, because there is nothing wrong with incongruence? Or, is it the case that removing the experience of incongruence is the goal, and therefore ‘fixing’/ curing the condition?

TRAs and WPATH hate engaging with ‘the medical model’ because it requires there to be a diagnosable disease or condition and treatment goals. They just want people to be able to make body modifications if/when they choose

If the trial goes ahead, would Cass bear any responsibility if the test subjects sued later down the line?

Or is she at a sufficient distance to avoid any of that?

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.”

It's interesting she should say that because when I heard there was going to be a trial I thought it was a political decision not a clinical one. I'm now wondering if she was one of the ones who were putting on the pressure to make that decision, Streeting has been saying all along that he was only doing what was recommended in the Cass report. Maybe her response above it sour grapes because she's not getting her way.

There is a lay explanation here: www.kcl.ac.uk/ioppn/assets/pathways/trial/pathways-trial-easy-read.pdf

“PATHWAYS TRIAL is a research study that will explore how puberty suppressing
hormones (medicines that pause puberty) impact the physical, social, and emotional
wellbeing of young people with gender incongruence.”

If you want the full protocol, it’s here: www.kcl.ac.uk/ioppn/assets/pathways/trial/pathways-trial-protocol.pdf

It’s incredibly light on the whole definition of “gender incongruence”:

^“Gender incongruence is characterised by a marked and persistent disparity between
an individual’s experienced gender and the birth-registered sex, which may lead to a
desire to ‘transition’, to live and be accepted as a person of the experienced gender”^

I would expect to see far more critical discussion on the epidemiology, pathophysiology, clinical presentation and description of the unmet medical need that the trial is hoping to address. Defining gender and transition would be a start.

She's implicitly starting the trial with an assumption that the use of puberty blockers to block natural puberty could be a good and justifiable treatment for some children with mental and emotional distress. In so she's accepting the premise that some children are 'trans' and will never be happy unless they feel that they can pass as the opposite sex.

On one hand she says that "most children desist once past puberty", but then she's also saying that not endorsing the blocking of puberty is "unethical". The reason, one assumes, that she thinks age14 and over is unethical is that the children that will be attending are hoping to have their puberty blocked before they get to that age. Totally contradictory and inconsistent.

Maybe someone could propose an RCT where those in the treatment group were just told no by the adults.

Even the new cut-off age of 14 doesn't distinguish between girls and boys, who as a cohort experience puberty at different ages.

This seems very much to be about enabling a cohort of boys to "pass" better as adults - that is, adults as measured in years against society's decision that 18 is legally an adult, but possibly not mature physically or mentally/emotionally.

Realistically it should be TWO completely separate trials. Not one.

Because sex.

I hadn’t realised that they hadn’t done this.

that’s either a shocking example of how VERY badly these so called drs and experts understand the issues. Or possibly they knew it was never going to go through ethics. Based on Keira’s post upthread and everything else we know I think tbe former.

I find it incredible that this isn’t being shouted loudly by those advocating for the trial

I think those advocating for the trial are as diverse a group as the group of children and young people who sit within the ‘trans’ label.

Aligned with this, there are quite disparate hopes within the group who are seeking puberty blockers.

One of the key points that the Cass Report made was that trans identifying kids were a multiple cohort with lots of different issues and very differing needs

One of these is on the basis of sex - girls have very different needs and as adults may have very different outcomes due to that sex because puberty blockers to stop development of sex act in different ways on different sexes.

Yet at no point when talking about children does Cass herself seem to emphasize this. This is pretty important as all the research to date has been dominated by males - the amount done on females is limited and what we do know about seems to have worse outcomes for girls.

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

It's like saying C-sections are bad and comparing data on studies purely on outcomes rather than the method you attempt to give birth - thus emergency CS are an outcome of attempting a VB as well as assisted deliveries whilst attempting a planned CS might include a small percentage of VBs or EMCS.

If you fail to make this type of distinction you get results which are wildly distorted. Given this is literally about sex it's essential for the study not to be gender neutral in its findings because it may make particularly adverse outcomes for one sex invisible.

I find it incredible that this isn't being shouted loudly by those advocating for the trial. It's a huge issue.

That’s my understanding too.

Jolyon Maugham’s analogy of researching the efficacy of condoms when applied after sex made a fair point.I think his take that this is part of a conspiracy to conclude that they ‘don’t work’ is off.

I don’t think the proposed trial makes it clear what the purpose of blocking puberty is, which might account for the MRHA considering a 14+ study viable.

A useful interjection from Cass would be to explain what she thinks the delay enables or improves. She ruled out ‘time to think’ stating there was evidence that this isn’t an outcome.

It's Baroness Cass now. Her reward for producing her report was a seat in the Lords.

Couldn’t agree more.

💯

I am dismayed by the quality of journalism. I would like to hear critical evaluation and intelligent challenge of differing positions. ‘Balance ’ is usually ticked off by presenting opposing view points. To me, balance comes from critically evaluating a view point.

Yes there are a number of current cultural assumptions that have allowed the acceptance of trans as a real thing.

One is the idea that you have a right to be happy and happiness is the goal. This belief means that no distress or discomfort should be expected to be tolerated. And particularly not for an extend periods (like maybe a during puberty).

Another is that identity is an internally driven concept which is innate rater than a socially constructed concept agreed between people. This in fact is one of the biggest assumption changes which isn't discussed enough.

Another is the shift in how we view children, child development and childhood and the move to giving children more autonomy. 'Child voice' and children know what they want ideas are now prevalent in a way they weren't 30 years ago when children were viewed as developmentally unable to make decisions and adults presumed authority over them. This type of thinking led to things such as Gillick and, in my opinion is also central to understanding the grooming gangs phenomenon and why it was ignored. But t's also central to the trans thing.

You then get people who want to promote queer theory, upturn all norms, especially around children, and the ground is ready for them to use all these 'new' assumptions:

Being your authentic self makes you happy and no one should be allowed to stop you being it.
So you must have the drugs you want to be happy.

If I understand the MHRA position, they're saying that if it turns out that it's 'safe' for children from 14, then the age can be lowered later. Which is a sensible, conservative position for a drug trial.

But we already use these drugs to treat conditions post puberty.

The goal here is to prevent puberty.

I think this is probably a ‘me thing’ but I couldn’t care less about what they are saying on Reddit or the trantrums IRL, when it comes to PBs the people I focus on are the medics and medical institutions.

It appears that they may have problems ignoring activism, but surely the antidote of this is a demand that they stick to medicine and the scientific method and take the same approach to this drug trial as all others?

Diagnostic manuals are littered with subjective diagnoses that are, to all intents and purposes, stories used to explain a combination of thoughts, feelings and behaviours.

The stories change over time. Homosexuality was once mental illness, as were learning disability and autism. Today, LD and autism are neurodevelopmental conditions, but if some autism advocates have their way, autism will go the same way as homosexuality and be removed from medical discourse.

Within the ‘trans world’ many/ most would like gender dysphoria and gender incongruence to follow the same trajectory as homosexuality, but they also want to maintain access to medical intervention, so they are stuck.

Im interested in a particular group of vulnerable and distressed young people who make sense of their significant struggles and dire quality of life through the lens of gender. It’s useful to have a name to group them/ the phenomenon, to enable shared learning.

But here we can also blame the bbc and other broadcasters for never giving a more balanced view.

re Reddit; yes that is 100% the narrative. And of course, no other reasoning is allowed. Therefore many believe this to be true.

The effects of the drugs can be both wanted and unwanted, and those effects can occur in patients who begin the regimen at 14 as well as those who begin a regimen at a younger age. They can still have impact on quality of life and mental health measures linked to 'gender incongruence', even if you start at 14. So there is still something to learn from the outcomes of a trial that begins at 14.

I think it's the reddit style mantrum simplistic argument that says if you don't start at 11 or younger it's not worth doing at all.

If I understand the MHRA position, they're saying that if it turns out that it's 'safe' for children from 14, then the age can be lowered later. Which is a sensible, conservative position for a drug trial.

I don't think I have enough knowledge to have an opinion whether 'safe' can be established or not; but the logic seems sound.

I think it would be reasonable to question the ethics and validity (and coherence) of "gender incongruence" being in the ICD as it is.

That doesn't seem particularly scientific as a starting point.