Netherlands Puberty Blocker Review Comes to Opposite Conclusion, Dismisses Cass Review

This shouldn’t surprise anyone. I don’t think anyone would argue that medical interventions—whether surgery or hormonal treatment—always produce outcomes that are preferable to allowing natural physiological processes to occur. The real question is not whether intervention has disadvantages, but how those disadvantages compare with the consequences of not intervening. Clinical decisions are made by weighing the likely overall benefits and harms of each option in the context of the individual patient’s condition.

In the case of CAIS, for example, clinicians balance the risk of cancer against the benefits of retaining the testes to produce natural hormones for as long as appropriate.
Similarly, for children with gender dysphoria, the question is how to weigh the potential harm of being required to undergo the irreversible changes of natal puberty—which, for some, may result in profound and long-lasting psychological suffering—against the risks and harms of medical intervention, such as infertility and other potential long-term consequences. The ethical question is about balancing competing risks, not comparing a risky intervention with a risk-free alternative.

meant to quote @AimsAndObjectives post above

I'm getting those cargo-y vibes really strongly now.

@BonfireLady Because the process of puberty wasn't blocked from starting, there is no indication that there would be brain damage.

Interestingly, if the testes are not removed before normal pubertal age, then female secondary sex characteristics develop naturally at the appropriate time because the body converts the testosterone into oestrogen. There seems to be some evidence that this gives an overall more successful outcome in several respects for the person with CAIS, including in psychosexual development, than removing the testes at a pre-pubertal age followed by exogenous oestrogen at 11 to 12 years old. So this is more evidence that allowing puberty to start naturally, even where full pubertal development is complicated by a DSD, is advantageous.

blockers combined with oestrogen is not the issue, because the body is still receiving the hormones necessary for pubertal developmental. The concern is blockers without any other hormonal intervention.
surgeries can wait .

There is nothing inherently more "experimental" about intervening than not intervening when a child has a medical condition causing significant distress. Choosing not to provide a particular treatment is still a clinical decision with consequences, not a neutral default. If the natural course of the condition is uncertain, or if delaying treatment may itself alter long-term outcomes, then both action and inaction involve uncertainty and risk.
The important question is for this child , in this circumstance, and given the available evidence which is the best balance of benefits versus harms.

You seem concerned about children remaining on puberty blockers for an extended period. At what age do you envisage the male children undergoing castration? Because even once they are given oestrogen, they will need to continue to take hormone blockers until they are castrated to stop the effects of testosterone.

Might want to review the evidence before diving head first into more child experiments.

Jonni Skinner

Puberty is just the physical changes — bone growth, the growth spurt, secondary sex characteristics, brain maturation — that estrogen or testosterone cause in a developing body. It doesn't matter where the hormone comes from.

I'm going to borrow your words to me: this is simply wrong on the biology and medicine. Specifically, the words between your hyphens/em dashes are correct and the words either side are not. It's been explained already by a PP that puberty requires more than just oestrogen or testosterone.

Your claim that it's "impossible to go through the puberty of the opposite sex" is doing political work, not describing biology.

No, it's describing biology. Someone with CAIS will not go through a normal female puberty when given oestrogen. For example, as you say, there is no uterus and the person in question has testicles not ovaries. There is no normal female puberty in the world that involves testicles. The important thing here is that there has been no disruption to the hypothalamus releasing the Gonadotrophin Releasing Hormone (GNRH), so the normal pubertal development pathway is still firing, despite the CAIS DSD.

No one claims these women are stuck in a permanent pre-pubescent state, failed to mature into adulthood, or suffered brain damage from having their puberty driven by external rather than gonadal hormones.

Puberty has been driven by GNRH, just like it is for everyone else because nothing has blocked it from getting started. Considering no testosterone can ever be processed effectively, and the person with CAIS most likely assumed themself to be a normal female until there was no observable sign of pubertal development, the only hormone that makes sense for bone health and secondary sex characteristic development is oestrogen. Because the process of puberty wasn't blocked from starting, there is no indication that there would be brain damage.

Also DSDs have absolutely nothing to do with gender identity.

What relevance is that stat to my question - how do you define informed consent? And how does the small numbers of 11 year olds given PB to date change the ability of 11 year olds to give informed consent for this trial?

Could you at least make sure your AI responses answer the questions asked before pasting them here.

A parent's signature and a clinician's reassurance describe a process. They do not, on their own, supply the capacity that eleven year olds do not yet have.

https://x.com/prof_curiosity1/status/2068592576001687876

That doesn't follow, there doesn't have to just be one explanation for a piece of evidence for it to be regarded as evidence. There are almost always multiple possible explanations for the same thing. In scientific medical terms, this is usually thought of in the terms of 'this piece of evidence is consistent with the hypothesis that..." rather than saying its the only possible hypothesis.

Your position is (I think) some children are very distressed because they are not the sex they would like to think themselves as. So they need time to think about this so we should give them PBs. And then cross sex hormones, which will definitely make them into mature adults (because, reasons). But they'll be infertile. But at least they won't be distressed!

Have I missed anything?

I don't think there's been any inconsistency in my position. If you believe there has, you're welcome to explain what you think is inconsistent.

No thanks. I'm learning way more sitting back watching you operate.

As mentioned in the stats I shared earlier, there were 3 children age 11 who were prescribed PBs out of 2700+ for the latest year we have stats. That's just 0.1% of children referred into the system. It's an exceptionally rare occurence. Also I think age 11 is old enough to take seriously a child's account of their own experience and needs. We do so in other contexts (e.g. in court processes the perspectives of a child of this age would be given meaningful weight).

Like I said, I have boundaries around what I respond to based on what I think is productive and worth engaging with.

I don't feel entitled to a reply or conversation from anyone—that wasn't the point of my post to Flirts. I was simply suggesting that if she was going to interject, it would be more interesting and constructive to engage with the substance of the discussion rather than making continuous disparaging comments about me personally.

I don't think there's been any inconsistency in my position. If you believe there has, you're welcome to explain what you think is inconsistent.

The man who invented lobotomies got a Nobel prize for it.

To be fair to the doctors back in the 1940s they had precious few treatments for mental illness & vast asylums full of some potentially very dangerous people. Things were very different in the days before there were anti-psychotic drugs.

If it's not the only explanation it can't be evidence, can it?

I tried. For several pages. You chose not to.

As it turned out I have found it very illuminating watching the patterns in how you engage, which I might have missed had I been caught in the post-by-post immediate cadence.

Thank you very much for giving me that opportunity, I have learned a lot from it.

I shall continue to respect your wishes not to engage with you on things you do not consider worthwhile, and also continue to post what I think is worth saying.

What do you mean by informed consent? Participants consented at least as much as 11 year olds do to PB.

That's a bit rich, since you repeatedly ignored @FlirtsWithRhinos 's posts yesterday.

I've dipped in and out of this thread and you are all over the place with your claims. Also, you are not posting any evidence and are being very selective in which posts you reply to.

That clears up the suddenly very well informed posts (well, presenting as well informed at least. As someone who deals with a lot of AI content at work, treat all "facts" with caution no matter hiw confidently delivered.)

I gave up discussing with them because it's just Dr Google fed through AI. This poster has appeared here before under other names. They are not a scientist & have no expertise in the field yet discount experts like Dr Az Hakeem & Baroness Cass. They have no bona fides. It's pointless engaging with them as they are ignorant & just bulldozing through the usual TRA bollocks.

Presumably they weren't carried out on the basis of informed consent?

Humans can, of course, use AI bots to write their posts.

The man who invented lobotomies got a Nobel prize for it.

Devastating.