Puberty Blocker Trial Paused

I think you have given this much deeper consideration and "gaming out" of scenarios than the entirety of people who signed off on the trial, ever did.

I am also simultaneously wondering if there wasn't a strong element of the opposite of the "speak up" rule/culture in aviation (and ironically medicine) where people had concerns but were too cowed to raise them?

I agree to an extent, but what seems to be missing is accurate research evidence on diagnosis. For virtually all medical treatments the first step is diagnosis and then treatments are trialled before they are rolled out generally. The diagnostic criteria for gender distress are so woolly and subjective, and the process so easy to manipulate, that it amounts to little more than self-diagnosis (or parental diagnosis).

If through extensive clinical research it was possible to find a way of establishing exactly who the tiny minority of adolescents who can only live without considerable ongoing distress if their body resembles someone of the opposite sex are, then it might be appropriate to look at research trials to look at the most effective early hormonal treatment (including PBs). Maybe there are research projects doing this at the moment, but Pathways is still jumping the gun and risks harming children whose distress is transient, arises from other causes, or could be alleviated in other ways.

@Brainworm:

I am not in favour of the Pathways trial, I think it is/ was unethical. My point was that it’s important that research is conducted to inform how best to treat young people with the condition or symptoms of gender distress.

Thank you for that. I agree with you that good research should be conducted.

My point is and has always been that, from a research point of view, there is not, and has never been, a reason to propose that stopping puberty will alleviate gender distress.

We have historical evidence from all over the world about things that do - the most powerful one being, do nothing (ie, the “watchful waiting” approach that was the gold standard before the Dutch got their hands on things).

So why test this drug as a possible mental health treatment? The only reason it was ever given in the first place was to stop little boys from developing secondary sex characteristics so that they would be more convincing as women. Testing its effectiveness by itself for alleviating gender distress just smacks of trying to justify its use without referring to any of that messy gender reassignment surgery stuff.

Anyway, I think we’re on the same page.

I understand you feel that some sort of controlled test is necessary, but in the world of research, you need a valid reason for proposing a particular solution to a problem - otherwise you would be testing “having crushed glass for breakfast” as a means to alleviate gender distress.

Why is it thought that stopping puberty, specifically, will alleviate gender distress?

And furthermore (as I have said on another thread)

What does “alleviation of gender distress” even look like?

(the below is cut and paste from my other post:)

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.

The Tavi’s approach, back in the broom
cupboard days, was focussed on ‘reconciling different parts of the self’. It was all about psychotherapy.

One of the surprising elements of the turn that GIDS took is that it happened at the Tavi, whose specialism was/ is psychodynamic psychotherapy. However, this is also why it was able to go so far. If it’s specialism was medicine, it’s likely that existing governance systems would have stopped things going so far.

As I understand it, the '50 suicides of trans kids' is an outright lie,

Thank goodness so many qualified and certified transvestigators are here to protect their pearls from becoming whittled down to nothing from all of the clutching. All of these postings consistently vilify the clinicians, but NEVER the parents who have to give their legal permission if they're under age 16. On top of that, the National Child Mortality Database (surprise surprise), actually noted that out of 647 suicides between April 2019 and March 2025, 107 identified as LGBTQIA+, 46 of whom identified as trans. But of course these numbers can't be correct, since they are based on scientific data parameters.

Let's just go back to just hanging the witches like they did centuries ago, since that was fear mongering without science. Just like abortions being illegal until 1968 - how many women lost their lives because science wasn't recognized as being a legitimate source. In 2023, almost 278,000 were performed, not only saving women's lives but also helping their lives better about not being ready to have an unwanted child. Please just stop going to the doctors and look for the shamans to help promote pseudo science facts. RFK, Jr. would be happy to come to England and straighten out the medical establishment to give you what you want to hear, that people who have no medical background should be in charge of everyone's health (which he doesn't have either). A win-win.

True, but that doesn't answer the question. Not all psychotherapy is the same, by any means. What I'm asking about is scientific investigation into what approaches actually work. I suppose you could argue that if doing some random unselected thing works for 90-95% of children that's already pretty good...

True, but that doesn't answer the question. Not all psychotherapy is the same, by any means. What I'm asking about is scientific investigation into what approaches actually work. I suppose you could argue that if doing some random unselected thing works for 90-95% of children that's already pretty good...

@fanOfBen:

Has anyone, anywhere, ever, made any serious attempt to develop psychotherapeutic interventions for these children? If they have I haven't heard about it, and I feel that avenue should be explored extremely thoroughly before anyone even considers giving these children life-altering drugs.

I mean, before the Dutch Protocol, psychotherapy and literally doing nothing (the “watchful waiting” approach) were the only things that were done. And in 90-95% of cases, children desisted from their gender distress. Now, as a PP pointed out, we have a completely different cohort of kids presenting with gender distress, and we have a whole society that has been taught that the only approach to gender distress is “gender affirming care,” so it’s not clear how we go back to that approach. But yes, 20 years ago, all anyone would have done would have been talk therapy, at the most.

@fanOfBen:

Has anyone, anywhere, ever, made any serious attempt to develop psychotherapeutic interventions for these children? If they have I haven't heard about it, and I feel that avenue should be explored extremely thoroughly before anyone even considers giving these children life-altering drugs.

I mean, before the Dutch Protocol, psychotherapy and literally doing nothing (the “watchful waiting” approach) were the only things that were done. And in 90-95% of cases, children desisted from their gender distress. Now, as a PP pointed out, we have a completely different cohort of kids presenting with gender distress, and we have a whole society that has been taught that the only approach to gender distress is “gender affirming care,” so it’s not clear how we go back to that approach. But yes, 20 years ago, all anyone would have done would have been talk therapy, at the most.

Yes, while some of these kids have well meaning desperately trying up navigate their way through and are unknowingly trying to retrieve their child from the grip of a cult and just get the best treatment for their child (while being you by the activists that medical harm is the best treatment as opposed to therapy), some parents are very keen to have a ‘trans child’. We have observed apparent motivations being attention seeking (the sets of excited parents featured on breakfast tv), homophobia/rejecting effeminate behaviour in boys (the Susie Green model) and just plain wishing they had a child if the opposite sex and communicating that to the child.

I have come across an influencer local to me who currently has two ‘trans’ identifying kids and apparently the third is considering (but is aged about 4). Her identity and her business is based around ‘trans’ kids so of course that is going to affect them. She seems rather unhinged so who knows what pressure and manipulation occurs behind closed doors.

Quite, though the parents and activists pushing this will be very displeased indeed. Maybe now the real reasons for blocking puberty will come to public consciousness.

Yet now they'll probably be susceptible to the claims of increased suicide ideation made by the 'responsible adults' around them.

I think we are on the same page. If you don’t work in the field, I expect we might look at it from different perspectives- but I think there is strength to this. You benefiting from balance that comes with distance and me from balance that comes with proximity.

I’ve worked with 100s of children who have made sense of their distress as arising in full or in part from ‘gender incongruence’. Of these, there a 2 boys who stood out as their issues could not be made sense of in the same way as the 100s of others. Both were very young when they started expressing distress at being boys, neither were socially transitioned up until their teens, and whilst both gay or likely to be gay, they weren’t concerned about their sexuality. I am not saying that these boys are evidence of a stand alone condition, but it does give me pause for thought about one existing. If a specific condition does exist, I imagine it to be very rare and not to account for 99% of what is currently labelled ‘gender distress’ or ‘gender incongruence’. I interpret Cass as having concluded the same, but may be misinterpreting her work because of my own.

Some clinical trials are conducted with fewer than 50 participants worldwide. I can imagine something akin to this to be possible for PBs - but only once we have established if there is a specific condition and how we would identify those with the rare condition from those whose symptoms are often misunderstood as being linked to the condition (diagnostic overshadowing).

Kings College London - basically the research group that’s carrying out the study.

I just can't fathom what's going on in this woman's head at all. She so very nearly grasped it. Then she floundered and bottled it.

It's a mystery. But I do think this is the beginning of the end for child transitioning, at least in this country. Very few people will want to actually break the law for their child by obtaining drugs illegally. In fact, an important component of parents who have Transhausen's Syndrome, in my view, is the validation they get from authority: the fact that proper medical people with important-sounding titles are taking their child's gender dysphoria seriously, prescribing them drugs and offering them surgery, while at the same time other authoritative figures (teachers, social workers and so on) are going along with the pretence that the child is the opposite sex by using opposite-sex pronouns, the child's new name, the child's desire to use the wrong changing room etc.

Once that stops, once you don't have the validation from either doctors or teachers, then the boast of "Look at me, I have a trans child" becomes much less attractive. Instead it just becomes a nuisance, I imagine. So I think soon if a child starts saying "Mum, I think I'm a girl," the parent will say, "No, you're not, Malcolm - now be a good boy and eat your dinner up." Just like the olden days.

Who is the trial sponsor?

@Brainworm:

I am not in favour of the Pathways trial, I think it is/ was unethical. My point was that it’s important that research is conducted to inform how best to treat young people with the condition or symptoms of gender distress.

Thank you for that. I agree with you that good research should be conducted.

My point is and has always been that, from a research point of view, there is not, and has never been, a reason to propose that stopping puberty will alleviate gender distress.

We have historical evidence from all over the world about things that do - the most powerful one being, do nothing (ie, the “watchful waiting” approach that was the gold standard before the Dutch got their hands on things).

So why test this drug as a possible mental health treatment? The only reason it was ever given in the first place was to stop little boys from developing secondary sex characteristics so that they would be more convincing as women. Testing its effectiveness by itself for alleviating gender distress just smacks of trying to justify its use without referring to any of that messy gender reassignment surgery stuff.

Anyway, I think we’re on the same page.

Yes, maybe she needs to remind f herself if the core principle. “First do no harm”.

If your trial anticipates sterilisation, bone density losses, cognitive impairment etc then it should have been a non starter.

Why on earth they would allow children to stay in the program for up to 12 months if they start seeing bone density or cognitive impairment I can’t fathom.

Surely, the minute ANY of those issues start that child should be out of the program - once those drugs start affecting bone density, it’s not going to get any better unless they stop taking the drugs. As this is a known and worryingly common side effect (see the Lupron class action in America) it should be a major red flag.

But then the whole ‘study’ is a giant red flag so I guess that level of medical sanity is too much to ask for.

Lupron puberty blockers have harmed vast numbers of people in America. Surely the study designers should have looked at these first?

Good news.

The gvt website states ‘The MHRA has now raised new concerns – directly related to the wellbeing of children and young people – and scientific dialogue will now follow with the trial sponsor’

Shocker 🙄

If being transparent they should be listing what the ‘new concerns’ are. But again shocker - they’re not.

Quite, though the parents and activists pushing this will be very displeased indeed. Maybe now the real reasons for blocking puberty will come to public consciousness.

I hope the children who were lined up for this trial get good quality support. The irresponsible adults around them should never have put them in this situation. I hope that with maturity and about 10 more years of life experience, they can look back and see what a bullet they dodged.