Finnish study on transition and psychiatric outcomes in sex and gender shows increased psychiatric morbidity

My comment was about the purity of the data, not any ethical considerations, in response to a comment about excellent studies that the NHS was capable of conducting.

With the results of the Finnish study just being published, I agree that there is far less need for the puberty blocker trial to demonstrate their lack of efficacy.

However, even with the Finnish study there are still unanswered questions, about the very specific subgroup Cass referred to for whom puberty blockers were potentially beneficial. The new draft KCSIE safeguarding guidance for schools refers to some young children 'living in stealth' approaching puberty in a fearful and anxious state, so this group is being taken seriously in safeguarding documents outside of the Cass review. I know nothing about this group of children being referred to, and I'm sure that many on here will have opinions about them, but this Finnish study doesn't help them. They're going to still end up taking puberty blockers, so if we're talking about need for a trial (outside of ethical considerations), then it would be good to have solid data to protect future cohorts of that group too.

@anyolddinosaur You seem to believe any data held by the NHS is rubbish - except that that will be collected in the puberty blocker trial. If the NHS cant accurately record data normally it wont be doing so in this trial either.

I don't think you understand how clinical trials are run compared to day-to-day record keeping. Cleaning and validating clinical data from trials, which is taken at specific times and for a specific purpose is a massive job and a huge industry. If, in a clinical trial, a doctor isn't recording data that they are meant to be recording then that will be flagged and followed-up.

We know that the Tavistock was utterly shite at record-keeping. That people are now pretending that the same shit data is a valid source for wide-ranging statistical analysis is mind-boggling. Even the Finnish study, which has a complete dataset is extremely restricted in what it looked at in order to be able to draw valid conclusions.

You're not going to be able to convince me that all the people saying 'there is no control group' actually knew about the group of gender distressed young people with matched characteristics to those in the puberty blocker trial but who were not taking puberty blockers, who were undergoing the same assessments in order to be able to clarify which effects were from taking puberty blockers and which were not, and what they really meant was 'I don't think the matched group of kids who aren't taking puberty blockers who will be compared to those who are taking puberty blockers is good enough to tease out the effects of the puberty blockers'.

If you want to say that the group with matched characteristics not taking the medicine being studied isn't actually any good as a control group, then perhaps you'll be making the same criticism of the control group in the Finnish study and disregarding its conclusions?

Nope - the puberty blocker trial has a comparator group of children in the observational study. Which has different inclusion criteria, assessments and care. So that's bobbins as a comparative group.

The trial itself proposes 2 groups - 1 starts blockers straight away, 1 waits 2 years. Problem is that with a wide age range the 2 groups may end up being indistinguishable- say a 14 year with a 4 year history of gender dysphoria is recruited and goes into the 'straight to treatment' group aged 14, then a 12 year old with a 2 year history is recruited to the 'wait 2 years' group - and starts blockers aged 14 with a 4 year history of gender dysphoria. What are you hoping to learn from comparing them? It's a rubbish protocol and should never have been approved. Junk science & grossly unethical.

@anyolddinosaur Edit to add - I remember some children were going to be paid for being included, can anyone remind me where I find the details for payments?

Is this it? Scroll down to page 63:
https://www.kcl.ac.uk/ioppn/assets/pathways/trial/pathways-trial-protocol.pdf

After sitting on the results, O-K published a pre-print of the results.
Mental and Emotional Health of Youth after 24 months of Gender-Affirming Medical Care Initiated with Pubertal Suppression | medRxiv

From the abstract:
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.

Basically: mental health of children on puberty blockers did not improve according to the metrics included in the pre-print.

However, several other metrics which were included in the clinical trial protocol are still unpublished.
(Historically, it was observed in many clinical trials across all medical fields there was a cherry-picking of the best results, leaving out the negative, so recently there was a push to register the trials in advance, declaring all the tests that were going to be conducted, so that negative/inconclusive results are more difficult to be conveniently omitted from the final publication).
Here there is a good explanation about trial pre-registration:
Should You Pre-Register Your Research Study? A Quick Guide - Enago Academy
So this study can be evaluated better once it is fully published.
Edited for clarity.

Yes - John’s Hopkins-based study commissioned by Olson-Kennedy - of the “if they [girls who have undergone mastectomies under the guise of gender affirming care] want breasts later in life they can go and get them.”

Olson-Kennedy sat on the results because “they could be weaponised against the trans community”.

Agree.
The stated excuse reason is that everyone who will be looking at the data is a horrible, anti-trans bigot.

Wasn't there a US study that they refused to release on the grounds that it would be weaponised by TERFs (because the outcomes were so bad)

If I may expand on my point. Those of you saying there is a control group are correct, in as much as there is a group being called a 'control group' and it is matched with Pathways trial participants for markers such as age, sex, presence of ND etc.
However, it is also correct to say that it is not really a control group because the group excludes any child who is clinically eligible for blockers and wishes to receive them.
So the Pathways Trial group are children who want blockers and the 'control group' excludes children who want blockers. So you are comparing apples with pears.
I think this may be where some of the control group confusion stems from.

I would think that it is probably because they have reason to think that if the study's results are allowed to reflect reality accurately, those results will not be to their liking, for whatever reason.

or people who have made up qualifications, or a degree in gender studies or Russian philosophy and the like.

No kidding. Not really dismissible as a tiny bunch of crackpots, or armchair medical “professionals” or even “concerned parents.”

An impressive volume and skill base in the signatories to this letter.

I could have sworn that too. I think from the responses from medical professionals that I’ve seen (though this is an educated guess at this point) that the information about the Pathways trial was released (or found) first, and many early responses were to this. Then the Pathways Horizontal Intensive was released (found) and the existence of a non-randomised, pseudo control group was made clear.

None of that justifies the equivalent of running a study on why eating crushed glass might help gender confused kids.

I stand corrected regard the control group- although I would have sworn that in one of the iterations of the protocol there was an issue regarding not being seen as frequently/not receiving the same psychological support/not being matched.
However, I still think the linkage trial could have been be informative and should have happened before a puberty blocker trial, as, even with not so great quality data, it could have suggest a better design of the puberty blocker trial regarding length of follow up or consent about fertility just to name two things.
I still think that, given the evidence of suspected side effects (especially when followed by hormones) and the results of Olson-Kennedy trial, the window for an ethical trial has closed.

My apologies - I did interpret their objection somewhat incorrectly. The professionals’ specific issue with the study wrt a control group was the following:

• There is no randomised control group to allow a reliable comparison. The planned comparison with a subgroup from PATHWAYS Horizon Intensive will not provide a reliable control, as this group will be too different from the group in Trial.

https://can-sg.org/2025/12/18/open-letter-to-wes-streeting-on-the-pathways-puberty-blockers-trial/

My question to you, though, is this. Why, given that the Finnish study has shown such strong evidence despite the fact that it was retrospective of physical and psychological harm to children from this medical pathway, do you think it is ethical to carry out another study that will be almost guaranteed to physically and psychologically harm a significant portion of the participants? Like, I am with you on the purity of the data - in a perfect world that’s what we would have had from the Tavi. But we didn’t, and we now know more about how dangerous this treatment is. So how can you justify putting children through this study just to supposedly get a beautiful, pure set of results?

I agree with you. So many threads are so informative to a lurker like me and they get ruined by not very intelligent posts.

If they said there wasn’t a control group they were either lying or hadn’t actually read all the documents relating to the trial.

Ok, I just cannot be arsed with this. You are clearly possessed of a much superior intellect to me - and indeed to the multiple medical professionals who spoke up against the Pathways trial.

Read the exclusion criteria. If they are clinically eligible for puberty blockers and wish to receive them, they are not eligible. Not a control group.

https://www.kcl.ac.uk/ioppn/assets/pathways/trial/pathways-trial-protocol.pdf

Nope, that’s not what I said or think.

It would certainly provide better data than the Tavistock retrospective study.

No, you don’t understand the summary correctly. You appear to not know what the Pathways Horizon study of gender confused children is.

That you were unaware of its existence and this subgroup which would act as a control group to the puberty blocker trial demonstrates the poor analyses of the trial on social media I mentioned earlier.