To nominate the principle authors of the CASS review for this..

[NameChangeCass]

“Advocates of evidence based medicine have criticised the adoption of interventions evaluated by using only observational data. We think that everyone might benefit if the most radical protagonists of evidence based medicine organised and participated in a double blind, randomised, placebo controlled, crossover trial of the parachute.”

https://www.bmj.com/content/327/7429/1459.short?fbclid=IwAR0hTt57o-yFS61aJE-IGCpKSPaDs--rdrPlbiby_wBCF1czpAWDaCcAEcM_aem_ATiWMtvZxiSzw8pj9CX271gyDByuMHTOKwQskBcCXx9aZOj1IPusHJ_z79olcRiFlhE

What is a trans child?

A child who claims to be trans, and they never lie or make mistakes (and if they do they're really cis and we don't care about them because something something cis-supremacy).

So a child who thinks they are the opposite sex to the sex they are? And OP thinks these children should be given strong medication which has little evidence that it works?

Why would that be essential healthcare? Medication with little evidence to treat a problem which isn't a physical problem but a mental/emotional idea? What?

So what you’re really worried about is the impact on your job?

What I don’t get is how talking therapies to try and support children with gender distress to try and be comfortable with their own bodies or to try and deal with whatever other issues they have is deemed as the “conversion therapy” whereas the medical pathway to fuck up their path to adulthood and their bodies is seen as OK? Can you explain?

Its interesting in a way. It is possible that the op is say someone who does random satisfaction surveys from children using mermaids in which case she/he is in an echo chamber and will only see children who are claiming a lasting transgender identity so all the "research " will confirm that more medical care is required for these children to live as their authentic selves. What about all the other dc who aren't in touch with mermaids (other possible charities available) my own dc for example who at the age of 7 identified as a dog (probably because the puppy was cute and got lots of attention).

Children struggling with gender dysphoria due to puberty are entitled to and should get good quality, well evidenced medical care the thing is lupron has been shown to have more harm than benefits and better care for example providing better mental health support would be more effective. Some children will have long lasting gender dysphoria and would benefit from being able to go through gender reassignment but again a lot slower a physical process is needed and a lot more mental health support to ensure that they understand that they can never actually change sex.

We do not know nor have we ever allowed minors to choose to jump out of an aeroplane either with or without a parachute so we shouldn't let them take harmful drugs when in 99.99% of cases other methods would work better and be less harmful

Edited for wrong their

My position is based on what I know from evidence, from conducting research with trans children, their families, and professionals and service providers working directly with trans people.

OP, were you involved in any of the research deemed 'low quality' by the Cass Report/NICE?

(edited to say I meant to quote OP rather than the reply)

OP For my first science degree we were taught statistical methods that would stand up to scrutiny. These were strengthened for the next degree and research I did. And also to look at research now and see how it is worthless for ‘evidence’ because of how biased it is. Like Cass did.

OP you say you have done your own research. You are pro gender ideology, therefore did you make sure your research took this into account?

Look at this to see how to make research go the way you want and see if you are part of the problem. If so, what a waste of everyone’s time and emotion for you to put them through a worthless exercise. But at its worst, bad research is dangerous.

Handy blog looking at some of the myths that have already taken root about Cass going into detail about what studies were looked at what were not. I know be shocked to discover that ‘they disregarded 98% of them’ is total bollocks

https://www.quackometer.net/blog/2024/04/breaking-down-cass-review-myths-and-misconceptions-what-you-need-to-know.html

”we know that PBs are a safe and effective medicine that can help until children”

Who is “we”? Why won’t anyone share the evidence that proves puberty blockers are ‘safe and effective’. If there is genuine evidence that they are safe and effective, I suspect we wouldn’t even need this thread because I assume you would have posted it.

I wouldn’t consider myself GC but I am against children being prescribed life changing medicines without there being evidence that they’re safe.

we know that PBs are a safe and effective medicine

except that just saying it - and even really wishing it were true - does not make that statement any less total misinformation.

Indeed, to make that claim on a thread that is supposedly about the Cass report is pretty staggering.

It is very apparent that we do not know that puberty blockers are either safe or effective. And we certainly don’t have the evidence to justify denying young people their basic right to development.

@NameChangeCass come on now OP you are Susie Green aren't you!

I wonder if Susie Green knows the difference between principle and principal...

I wonder if Susie Green knows the difference between principle and principal...

Gah I've been holding back on this, but it irks me every time I see the thread title!

https://www.quackometer.net/blog/2024/04/breaking-down-cass-review-myths-and-misconceptions-what-you-need-to-know.html

We can see from the report and papers that Cass did not insist that only randomised controlled trials were used to assess the evidence. The York team that conducted the analyses chose a method to asses the quality of studies called the Newcastle Ottawa Scalele*^. This is a method best suited for non RCT trials. Cass has selected an assessment method best suited for the nature of the available evidence rather than taken a dogmatic approach on the need for DBRCTs. The results of this method were discussed about countering Myth 1.

The Newcastle-Ottawa Scale (NOS) is a tool designed to assess the quality of non-randomized studies, particularly observational studies such as cohort and case-control studies. It provides a structured method for evaluating the risk of bias in these types of studies and has become widely used in systematic reviews and meta-analyses.

The NOS consists of a set of criteria grouped into three main categories: selection of study groups, comparability of groups, and ascertainment of either the exposure or outcome of interest.
Each category contains several items, and each item is scored based on predefined criteria. The total score indicates the overall quality of the study, with higher scores indicating lower risk of bias.
This scale is best applied when conducting systematic reviews or meta-analyses that include non-randomized studies. By using the NOS, researchers can objectively assess the quality of each study included in their review, allowing them to weigh the evidence appropriately and draw more reliable conclusions.

One of the strengths of the NOS is its flexibility and simplicity. It provides a standardized framework for evaluating study quality, yet it can be adapted to different study designs and research questions. Additionally, the NOS emphasizes key methodological aspects that are crucial for reducing bias in observational studies, such as appropriate selection of study participants and controlling for confounding factors.

Another advantage of the NOS is its widespread use and acceptance in the research community. Many systematic reviews and meta-analyses rely on the NOS to assess the quality of included studies, making it easier for researchers to compare and interpret findings across different studies.

As for future studies, Cass makes no demand only DBRCTs are conducted. What is highlighted is at the very least that service providers build a research capacity to fill in the evidence gaps.

It is of precisely no surprise to me, @Ereshkigalangcleg, that the OP has entirely misrepresented … well, everything.

Obsfucation for ideological reasons. Thats like the unofficial slogan of this weird movement that seems determined to treat vulnerable children with significant comorbidities as sacrificial lambs for the cause.

It’s true the highest level of evidence is never going to be applied to gender medicine. It’s never going to be ethical or possible to randomise control or double blind gender change drugs or surgeries to anyone, of any age.

That doesn’t mean we should let people spend a lifetime of dysphoria, so uncomfortable with their sex they can’t function socially, psychologically or have intimate relationships. The review highlights the likely causes being a mixture of factors - biological, psychological and social.

Cass states it has not been possible to find evidence for the effectiveness of talking therapies for managing gender distress. (Unlike anxiety/ depression).

The Cass review also states that for some the best outcome will be transition. (Many overlook this statement).

A significant problem with puberty blockers is that most children with gender dysphoria will desist, and puberty is part of that process. So stopping it in most cases will stop the solution.

However identity consolidation is more stable in later adolescence, from around 16 years. There is more of a case for use of cross sex hormones from 16 in a small minority, as is done in countries like Finland. More countries are starting to adopt this more conservative approach.

Of course all cases should be followed up long term so the evidence can be gathered, and benefits and risks can be better understood. The lack of this has been a big failure in the care of people with GD.

Absolutely correct.

You want to test puberty blokers on children @NameChangeCass . What the heck.

Have you heard of 'First do no harm'.

Surely you have cone across confused teens . Giving them drugs to stop puberty because they 'think' they might be in the 'wrong' body. Whose body are they in then. Giving drugs to stop puberty causing irreparable harm is abuse!

Blockers not blokers

Pubertal blockade from Tanner 2 or 3 onwards is not ‘safe’ (all medical intervention involves risk and the risk/reward benefit for a healthy, normally developing body age 10plus is different to the risk/reward benefit of a child who erroneously begins puberty age 5 due to a brain tumour) and there is no proof that pubertal blockade is ’effective’ in the treatment of gender dysphoria.

If anyone has proof that GnRHa drugs are effective in the treatment of gender dysphoria (NOT fantasies from transgender adults who retcon their own histories and say they wish they had been given blockers 30/40/50 years ago) I would be interested to see it, because all the studies I’ve see are unconvincing (small numbers, no significant improvement in gender distress noted, side effects including early onset osteopenia, tooth loss, IQ drop of 10 points and more).

Ending the chemical castration of gay, autistic and looked after children (the groups that make up the majority of the patient cohort) is a very good thing, IMO.

Excellent post @TheClogLady

Ending the chemical castration of gay, autistic and looked after children (the groups that make up the majority of the patient cohort) is a very good thing, IMO.

Well of course it is. How could any right thinking person disagree?

Yet we have the OP and others cheering these abuses on. How did this come to be?

The thing is, OP, we know that if someone jumps out of a plane without a parachute there is an almost certain risk of death. So, no need to carry out RCTs on the efficacy of parachutes.

We also know a lot of things about the drugs which are used to block puberty.

We know that these drugs have been used to chemically castrate sex offenders as a form of punishment and risk management, where the physical side effects experienced by the person given the drugs have been either of secondary importance or not given any consideration at all.

We know that they have been used to treat certain aggressive forms of cancer, generally in patients who are already highly likely to die.

We know that they are used as sparingly as possible to treat women with endometriosis and children experiencing precocious puberty, based on a careful risk/benefit analysis and taking into account the known, serious, side effects.

We know that these drugs have a negative impact on brain and bone development, meaning that they can cause serious unwanted side effects such as osteoporosis and a significant drop in IQ.

So we know that they are not safe, we know that at least some of the side effects are not reversible, and we know that in practice they are not used to "pause" sexual development to give children time to think, because in almost 100% of cases those children go on to cross sex hormones as soon as they are able to.

Quite apart from the practical difficulties of carrying out proper clinical trials, arising from the fact that children will soon know whether they have been allocated to the test group or the control group, I fail to see how, given everything we already know about these drugs, it would even be ethical to carry out clinical trials, knowing what harm will most likely be done to children in the test group.

Also, as much as I hate to say it, it looks likely that healthcare systems in other countries such as the US will continue to hand out puberty blockers like sweeties, meaning that if we just wait a few years we will be able to see the effects of the widespread use of puberty blockers ourselves, without harming our own population.

Let's let those American doctors and hospitals with deep pockets pay out millions of dollars in compensation to people whose health they knowingly damaged for profit, rather than exposing our already overburdened NHS to inevitable clinical negligence claims in the future by continuing with "treatments" we have plenty of evidence to suggest are harmful and little to no evidence to suggest are beneficial.

In the meantime, it would be far kinder to explain to our dysphoric children that whether they take puberty blockers or not, there are no drugs or surgery in existence which will transform them into an adult of the opposite sex to the one they were born as, and they would be better off learning to love the bodies they are in rather than risking infertility, sexual dysfunction, osteoporosis and brain damage in a fruitless effort to achieve the impossible.

So everyone who disagrees with you does so because they argue from a position of bad faith?

That’s quite telling.

And that includes Dr Cass herself of course. 🫠