Systematic review: puberty suppressing drugs do not alleviate gender dysphoria

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digest.bps.org.uk/2018/07/23/systematic-review-puberty-suppressing-drugs-do-not-alleviate-gender-dysphoria/

I know there is sometimes more heat than light generated by discussions of the best approach to take when children and young people (it seems increasingly) say they identify with the opposite sex so I hope this review provides some helpful evidence, rather than opinion, about the pros and cons of an ‘affirmative’ approach towards gender dysphoria.

Sorry the link doesn’t seem to be clicky.

clicky link

That article is quite heartening, experts expressing concerns about the current affirmative approach.

I think the stats are 100% of children on puberty blockers go onto fully transition later. So no, of course blockers don't cure gender dysphoria, they affirm it.

That is interesting.

I'm really shocked at the paucity of studies and follow up.

What are the lobbying groups making of this I wonder? Fake news, no doubt.

It's great to see a critical paper published by the BPS which up until now has been pretty uncritical.

There is no magic hormonal treatment for a complex psychological condition - who knew?

There is a critical comment now but other comments seem to be supportive of the scientific method.

No-one expects puberty blockers to alleviate gender dysphoria, and no one is making that claim.

However cross-sex hormones will.

garam but should kids be making that decision to go onto cross sex hormones when their brain development has been diminished.

They don't get the chance to change their minds their brains don't develope the same way

garam peer-reviewed references?

I saw this in Reddit and was quite heartened by the comments (it was on r/science, which is usually one of the better reddits). Lots of people pointing out the importance of puberty on brain development, and that puberty generally relieves dysphoria (would be interested to see the stats in that) and that the trans suicide stats are very shonky.

Would have liked to see a bit more acknowledgement that puberty blockers are not a switch and stopping taking them does not mean it's as if you've never taken them.

I'm a bit weirded out by systematic reviews on trans related issues. SR methodology brings together and synthesises available research with strict criteria re quality and applicability to the core question framing the review. Yet, there are relatively few studies re trans related issues, few longitudinal ones and very few of any real methodological worth. It seems we need the actual studies before we attempt to synthesise them in any way.

I am not sure why SR of trans studies would weird you out. It is the same for any medical intervention and having few studies meeting the inclusion criteria and those being low quality is not an uncommon outcome - just look at the Cochrane Library. Indeed, if you want to do any trial the first thing you must do is a SR to see if the evidence already exists (it would be unethical to run a trial where the results were already clearly known). The fact there is no high quality evidence supporting the use of puberty blockers is a valid outcome from a SR especially where the observational data shows negative outcomes. The ‘we don’t know’ should at the very least mean this intervention is not given outside a trial.

Indeed, if you want to do any trial the first thing you must do is a SR to see if the evidence already exists (it would be unethical to run a trial where the results were already clearly known). The fact there is no high quality evidence supporting the use of puberty blockers is a valid outcome from a SR especially where the observational data shows negative outcomes. The ‘we don’t know’ should at the very least mean this intervention is not given outside a trial

I use and have conducted SRs, but not in medicine or health. I agree that conducting a SR before a trial is logical - but what I am objecting to here is the implication in the OP as well as some other OPs using SR methodology that the SR somehow says something definitive. 'We need more research' is of course a legitimate finding - but that was my main point.

It seems we need the actual studies before we attempt to synthesise them in any way.

Yes. I agree the quality of the evidence base is dire. Or, as Tavi puts it, low or very low.

SR do say something definitive and that is often, as in this case, that evidence is lacking and further research is required (click through to actual review). I agree that the title of the article/thread is wrong - it should be more along the lines of ‘SR found no evidence to support the use of puberty suppressing hormones... ‘. What is worrying is that the guidelines recommend the use of these drugs despite there being no evidence to support it or proper studies of their safety in for this indication.