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

I don't think the choice is as simple as "psychological treatment versus physical treatment". Psychological support is an important part of care for anyone experiencing distress, including people with gender dysphoria. But the question clinicians have to consider is what approach best addresses the source of that distress for each individual.

For some people, psychological support may be sufficient. For others, distress may persist despite psychological approaches, and clinicians may consider other interventions. The issue is not whether psychological care should be offered—it should be—but whether it is appropriate to assume that psychological intervention alone will resolve the distress for everyone.

The issue is not whether psychological care should be offered—it should be—but whether it is appropriate to assume that psychological intervention alone will resolve the distress for everyone.

No. The issue is whether it's ever appropriate to experiment on children with unproven physical treatments, instead of providing only psychological treatments.

I understand that is your position. However, the point is that uncertainty about a treatment does not automatically mean that withholding it is risk-free or preferable. The question is a comparative one: what approach best supports young people experiencing significant distress, taking into account the potential benefits, risks, and uncertainties of all available options.

No, you are underestimating me.

That's understandable.

You may not have been here very long to read what I have said in the past. An advanced search may be illuminating.

It is probably worth looking at my posts a year or two back now as I've largely given up delving into the nuances of why this is being done to women, preferring instead to focus on the injustice of it being done to women at all. Because no matter what the very good reason someone might have for it, it is still an injustice being done to women.

So I would gently suggest you are a little arrogant to asume pepople have not thought about this as much as you have, rather than considering whether people have in fact thought about it more than you for much longer than you and are talking to you ahead of you on a path of thought that they much further along than you.

I am saying:

1. It doesn't matter whether it's a complex phenomenom or (as I actually believe) a symptom with many different root causes, the male person's belief that they are a woman is still either (a) correct, because being "a woman" turns out to be a mental phenomenom not a physical one and most critically for this to work we can objectively observe it in everyone who claims to be a woman rgardless of their sex and no one who does not, or (b) incorrect, in which case regardless of the cause it is a delusion.

and also

2. Whether it is a delusion or a new "real" defintion of a woman, the fact of female people still exists, the things that happen to us because we are female still exist. So even if (a) were to be true and we have found a "real" mental commonality between trans women and female people who identify as women, it is still a choice whether to make this the definition of "woman" and so take the reality of the female body, the history of female exploitation, abuse and margialistion because of our bodies and the social and physical conseuences we still face today off the table when it comes to being a "woman". It is still a choice to decide none of that matters but this inner new commonality of mind does, not just enough to name it as a newly understood feature of humanity that oten, but not always sits alongside womanhood but to name it as womanhood and in so doing unname the female half of humanity altogether.

And that is what I find offensive and degrading. Not just a defintion of womanhood that is based on sterotypes (although let's face it, we all know that and homophobia is almost certainly what is really behind this), but the idea that the entire female half of the species needs redefining to accomodate men's feelings of identity at all.

So the meaning is derived from one sex needing different services to the other sex because of their sex? So when you said this

It's not necessarily about sexism per se, it's about gendered categories. I don't see how we can ever completely eliminate those, because - (as gender critical philosophy persistently reminds us)- of the salience of human reproductive roles. As long as we have a society that recognises and gives any meaning/ recognition to these categories/ roles, there will be people who feel that they are in the wrong one.

in an earlier post, you were talking about people’s need for different facilities or services because of their sex and that there will be some people who feel they need the services for the opposite sex?

I am finding it hard to imagine that the ECHR recognising that sex matters sometimes is a reason for someone’s feeling of gender distress. Can you explain more precisely what you mean and what is a gendered category?

I hope that in "taking account the potential benefits, risks and uncertainties of all available options" you are including the wider impact on the people around the trans person and on the laws and social contracts we all expect to support us?

This is not just about what might make trans people feel better, but also whether that creates a fair demand on the people who have to accomodate it, especially women who are the ones being expected to play along with woman-identifying males in our spaces and under our name.

I remain to be convinced that what appears to be a psychological issue should be treated via the removal of healthy body parts and the use of opposite-sex hormones.

I understand your position too.

You advocate for physical treatments because they might address the psychological issues.

I agree with you that there is uncertainty about the treatment. I hope this means you agree with me that by definition this means using PBs in this scenario (as opposed to for precocious puberty, when they are stopped at 8/9 years old) is experimental.

We don't experiment with children's physical bodies in any other field of psychology, so I'm unclear why anyone advocates for it in this one.

I think there is a difference between having spent a long time thinking about a subject and having arrived at conclusions that are coherent and defensible. Many people who disagree with you will also have spent years engaging seriously with these questions. The strength of an argument comes from the quality of its evidence and reasoning, not from how far along someone believes they are on a particular intellectual journey.

Oooooh , and I see the "young people" phrasing is creeping in now.

Pathways age bounds are 11 (12 for boys) up to 16th birthday ie ages 11,12,13,14 and 15.

So children. The majority of that age range would be called by most people children. 14 or 15 are the only point I'd think "child" sounds a bit young.

Oh sweetheart. The quality of evidence and reasoning is what is developed by engaging with diferent aguments and considering different perspectives. It literally is the journey.

Your argument is not coherent. You have not shown why the reason someone may believe themselves to be the opposite sex should change the qualty of the imact on women of accomodating that belief. You simply assert it.

My logic is impeccable. Which is why you keep dodging it and trying an emotional appeal.

I won't have time today, but over the weekend I'll link to some posts of mine where I've already explored everythig you aleady suiggested.

And replying again to note that despiet implying the arguments in the post you replied to are poor, you haven't actually engaged with them to demonstate how they fail.

Your posts are all fluff, all mights and maybes. There is no substance or courage.

14 or 15 are the only point I'd think "child" sounds a bit young.

Of course legally anyone under 18 is a child so I think we should always frame this trial as experimenting on children.

I have boundaries around what I choose to respond to, based on what I think is coherent and worth discussing. I don't feel obliged to engage with every point someone raises.

I also find the tone of your posts difficult to engage with. They come across as conveying a strong sense of correctness and superiority, which leaves little room for genuine discussion. From my perspective, this exchange isn't leading anywhere productive, so I'm happy to leave it there.

I understand the concern - it's a valid one given the huge impact of some of these interventions.
The difficulty is that calling gender dysphoria "a psychological issue" does not, by itself, tell us what the most effective treatment is. Many conditions involve psychological distress, but the appropriate treatment may include medical interventions with significant physiological effects. The question is how to balance the different risks and harms to help the patient in the best way possible

Benefits:

• Likes their body a little better - maybe.

Harms:

• Said body has been subjected to a hormonal treatment with potentially grave intellectual and physical consequences.
• If they continue to full medical transition:
• Their body is subjected to a life-long hormonal treatment.
• Their body is subjected to heavy surgery.
• Their body is permanently sterilised.

What am I missing?

Thanks for making your enagement clear. You can indeed chose what you reply to and what you don't. Those choices speak volumes.

You should however realise that my tone changed after you chose to "gently suggest" I hadn't really thought about this much and was only considering one aspect, an assumption I found incredibly arrogant. Perhaps you need some self reflection.

Happy to leave it here.

Electroconvulsive therapy has been found to be an effective treatment for some adults with severe depression.

Would you advocate for a trial of ECT on children with depression? It is a comparative use case for puberty blockers being that it is a physical treatment for a psychological disorder.

@Sunnibee Do you think this is an example of a quality argument from someone who has seriously engaged with the question of the potential problems of low bone density as a result of puberty blockers.

A boy was socially transitioned at 3 years old and has been told he's really a girl since that age. Now 11 the boy is so terrified of puberty that he won't leave the house and the lack of exercise is causing him to have lowered bone density anyway so it doesn't matter that puberty blockers reduce bone density in children

Apologies if this is too personal and feel free to ignore. But I believe you mentioned that you yourself have been long term taking testosterone in another thread? I'm interested in how you arrived at that decision for yourself if you think the weighting of benefits and risks is so imbalanced in this way?
As I said apologies if this is too personal and please ignore.

To be clear: Cass clarified that "Jo" never actually existed and is in fact an aggregation of several cases she's heard of. But this is indeed an argument she used, which is... baffling, at best.

I actually think the fact that this was a fictional case, which she didnt make clear at the time, makes her behaviour more questionable

It would entirely depend on the clinical context and the balance of potential benefits and risks, as with all areas of medicine. I don't think treatments should be ruled in or out simply because they are "physical" or "psychological", or indeed simply because of the age of the patient; they should be judged on the evidence, the severity of the condition, and the individual circumstances.

This is interesting in the sense that this thread started with me criticising Cass's lack of expertise and insight on these issues. I don't feel compelled to defend anything particular that Cass has said or argued.

Testosterone in adults doesn't have all the same effects I mentioned, far from it! It doesn't threaten the intellect, for one. It doesn't permanently sterilise the body, either.

It does have risks, but the major, major difference is that I was fully an adult when I made that decision, not a child. I was able to make that benefit-risk assessment, which a child isn't.

There's simply no possible comparison between my decision for myself, and a child being transed by the people around them.