Panorama 25 Feb 20.30hrs: Trans Kids: Why Medicine Matters **Thread title edited by MNHQ**

[TimeLady]

"More young people than ever are exploring their gender identity. Last year, two and a half thousand under-eighteens were referred to NHS England's gender identity clinics for support. Some are hoping to get access to potentially irreversible treatments as soon as they can. Doctors are divided about the best way to help."

"Dr Faye Kirkland investigates how much we understand about the care being offered to transgender children."

I am assuming this is the inquiry ordered by Penny Mordaunt

I don't think so. The inquiry is supposed to look at why there has been such a massive increase in the numbers, especially among girls.

The Tavistock grant is to research outcomes. They're going to carry on this big experiment on children, they're just going to start recording some results from now on. It'll take years and years to find out how it works out for these young people. In the mean time, how many more children will be medicated and put on a track that ends with surgery, loss of fertility, loss of sexual function and other irreversible changes?

I think that's my major gripe with this programme - it was just taken for granted that there are all these trans kids and the focus was on how best to treat them.

Carmicheal touched on the issue when she said something about girls being dissatisfied with female gender roles. If that's the case though, why are we framing it as a medical issue at all? It's staring us in the face that it's gender (sex roles and stereotypes) that is the problem. I don't understand how PC can see the problem but still carry on working in a clinic and trying to fix kids with medical intervention to cope with what is a social problem.

I'd like to have heard a lot more from Prof Henehan.

Thing is every patient will have a medical record so research could surely include patients seen to date. I know some will disengage but all will have been recorded, medical records don't vanish and if there is a bunch of money the consent could be sought and data included?

I would like to see a study of mental health statistics in children over the last few decades, so covering eating disorders, self harm, gender dysphoria, depression etc and broken down like that so we can see how relative the trans kid stats are and if they merge into each other.

It makes no sense to me that one element of mental health is being approached so differently compared to all others. The response to the GOGD study was so ridiculous and it seems to be the only published effort so far.

We need to look at children's mental and physical health overall in relation to society as well as the dangers of TRA guinea pigging an entire generation. Why are children lacking a sense of belonging? Why is resilience not being taught or valued any more?

All Prof Heneghans evidence is here

blogs.bmj.com/bmjebmspotlight/2019/02/25/gender-affirming-hormone-in-children-and-adolescents-evidence-review/

WowWow Yes they ought to be able to do a retrospective trial. Some will be hard to track down if they have name changed and changed their NHS records but they should still be able to track down a good percentage with a bit of detective work.

The development of these interventions should, therefore, occur in the context of research. Treatments for under 18 gender dysphoric children and adolescents remain largely experimental. There are a large number of unanswered questions that include the age at start, reversibility; adverse events, long term effects on mental health, quality of life, bone mineral density, osteoporosis in later life and cognition. We wonder whether off label use is appropriate and justified for drugs such as spironolactone which can cause substantial harms, including death. We are also ignorant of the long-term safety profiles of the different GAH regimens. The current evidence base does not support informed decision making and safe practice.

Extremely well put together.

I think that final sentence from the Oxford Prof. Of Evidence Based Medicine needs repeating.

The evidence base does NOT support informed decision making and safe practise

Surely that trumps the opinion of someone going by the Twitter handle AngryMum (or similar name) and should lead to the immediate suspension of all hormones and blockers for trans kids.

‘They're just going to start recording some results from now on. It'll take years and years to find out how.’

Thanks PencilsinSpace. Odd that they are not doing this already

Thanks for the HB Twitter thread Ewe.

I felt a great deal of satisfaction reading that. It had the air of a deeply arrogant person seeing their years of tactics and politicking coming undone as factual reporting begins to break through the web of threats.

GC article in today's Daily Mail www.dailymail.co.uk/news/article-6745055/Social-media-pressurising-young-gender-change.html?login

In the UK we are lucky to have organisations who review research to promote evidence based medicine. Cochrane UK, NICE, the Centre for Evidence Based Medicine.
I've wondered what any of these have to say about puberty blockers etc for a while. It is extraordinary how prescribing and treatment has been client led to such an extent, with professionals complaining of the pressure they are under and little obvious oversight. I've no sympathy. I can't imagine why they wouldn't have had at least some basic long term follow up systems in place from the start if only to satisfy their curiosity.

The grant’s mentioned in this Observer article: ‘Separately, it has emerged that the trust has agreed to a unique study that will track young people referred to GIDS. It has been awarded £1.3m by the National Institute for Health Research. An independent research team will follow a group of volunteer young people referred to the service, even if they choose to leave it, the first time such a study will be conducted anywhere in the world.’

This is a scandal. I think that is quite clear now and it is only a matter of time before its fully in the open.

Maybe there'll actually be a proper debate in parliament soon... I won't hold my breath though. It appears that the ultimate push back will come from doctors. Fortunately our NHS is still kicking and unlike the US system the majority of doctors are not beholden to profit.

I feel sad for the children, young people and women who have been harmed (and will continue to be harmed) until we get to that point though.

I will try and watch the panorama show but live overseas so it might be tricky.

The Panorama programme touches on how politicised the whole issue is, and how trans lobby groups are aggressively pushing for more and earlier medicalised treatment of kids and the dangers of this, yet who do they refer people to at the end of the programme if they need support? The very same aggressive and extreme lobby groups! Mermaids and GIRES are listed on the BBC support pages: www.bbc.co.uk/programmes/articles/5zvRZW3yRHjqczdwd0gv3S0/information-and-support-gender-identity

I'm also interested to hear that Helen Belcher/Trans Media Watch believed they had an 'agreement' with the BBC. I also wonder what this involved?

Cam I just say that sarky remarks about HB not finding a supermodel to date are unpleasant and antifeminist? I'll never date any kind of model and I am still a worthwhile person.

Thanks for link about research grant EmpressAdultHumanFemale. Think that a good message from the Panorama programme was highlighting the quality of current evidence. IUsed2BanOptimist Interesting point about NICE. Wonder if this is all part of lack of funding for children’s mental health.

From what I understood Polly Carmichael to be saying on this programme she accepted the long term health risks of puberty blockers were unknown but their use might be appropriate to avert acute mental health crisis in a child.
Trans activists however do not accept GID is a mental health issue.
There is no logic to any of this.
The only sane place to start from is recognition that the best outcome for these children is acceptance of their body and no pharmaceutical or surgical measures. But as I understand it that position is regarded as unacceptably transphobic.

I'm also interested to hear that Helen Belcher/Trans Media Watch believed they had an 'agreement' with the BBC. I also wonder what this involved?

The BBC, as an impartial publicly funded broadcasting company, has no business making any "agreements" to push the agenda of political lobby groups. It is required to serve the whole population.

The programme and commentaries also focussed as usual on adolescents who have had difficulties with their gender identity from a young age.

There however is a large cohort of young people who have adolescent- onset gender dysphoria. None of the literature or studies consider this group, as it is a new phenomenon.

They are also likely to bypass adolescent services altogether and present directly to adult services, so won't be picked by the Tavistock research.

Also, the evidence review did not mention treatment for gender dysphoria that tries to avoid physical intervention (which should surely be the first port of call) - I am not talking about conversion therapy but therapy to build self esteem and promote resilience.

From what I understood Polly Carmichael to be saying on this programme she accepted the long term health risks of puberty blockers were unknown but their use might be appropriate to avert acute mental health crisis in a child.

And yet the prescribing information itself of the blocker class of drugs says not to prescribe in any person with coexisting mental health issues.

Nobody should be giving these drugs to physically healthy children. The practises of the Tavistock need looking into, just as any other group or person pushing this. I do not believe they are acting ethically, or in line with evidence based practice.

There is NO medical justification for blockers and hormones and surgery.

There is an association between ASD and identifying as trans. Not really surprising since gender is a social construct.

My ASD son doesn't really know what it feels like to be human but rather than feeling alien he went through a stage of identifying as a dog - trans speciesism. He doesn't feel like a human but that does not mean he must be a dog. Likewise he doesn't know what it feels like to be a boy but this does not mean he must be a girl.

The difference is that there is a narrative and medical 'treatment'/surgery that claims this is exactly what it means and that your body should be altered to better fit.

WRT sterilisation it has also been suggested that in reality young people with ASD are disproportionately represented in those being sterilised.

Professor Carl Heneghan was interviewed on last night's Panorama & as a consequence of his analysis concluded that 'informed consent is not possible'

BMJ EBM Spotlight paper:
Carl Heneghan
Editor in Chief BMJ EBM, Professor of EBM, University of Oxford

Tom Jefferson
Senior Associate Tutor University of Oxford
Visiting Professor Institute of Health & Society, Faculty of Medicine, Newcastle University

'Gender-affirming hormone in children and adolescents – Evidence review'
Posted on 25th February 2019

(extract)
"Gender dysphoria occurs when a person experiences discomfort or distress because of a mismatch between their biological sex and gender identity. Gender dysphoria can arise in childhood and adolescent which raises many questions about how best to handle the condition. This post sets out the current evidence for gender-affirming hormones in adolescents and children to aid decision making. (continues)

"Conclusions

There are significant problems with how the evidence for Gender-affirming cross-sex hormone has been collected and analysed that prevents definitive conclusions to be drawn. Similar to puberty blockers, the evidence is limited by small sample sizes; retrospective methods, loss of considerable numbers of patients in follow-up. The majority of studies also lack a control group (only two studies used controls). Interventions have heterogeneous treatment regimes complicating comparisons between studies. Also adherence to the interventions are either not reported or at best inconsistent. Subjective outcomes, which are highly prevalent in the studies, are also prone to bias due to lack of blinding, and many effects can be explained by regression to the mean.

The development of these interventions should, therefore, occur in the context of research. Treatments for under 18 gender dysphoric children and adolescents remain largely experimental. There are a large number of unanswered questions that include the age at start, reversibility; adverse events, long term effects on mental health, quality of life, bone mineral density, osteoporosis in later life and cognition. We wonder whether off label use is appropriate and justified for drugs such as spironolactone which can cause substantial harms, including death. We are also ignorant of the long-term safety profiles of the different GAH regimens. The current evidence base does not support informed decision making and safe practice."
blogs.bmj.com/bmjebmspotlight/2019/02/25/gender-affirming-hormone-in-children-and-adolescents-evidence-review/

www.mumsnet.com/Talk/womens_rights/3518188-BMJ-Prof-Carl-Heneghan-Evidence-Based-Medicine-Oxford-Panorama-Trans-Kids-Gender-affirming-hormone-in-children-and-adolescents-Evidence-review-concludes-There-are-significant-problems

I think it’s implicit in what Carmichael was saying that use of blockers in these circumstances is completely off piste. She didn’t have the courage to say that explicitly but she clearly knows and accepts that.
So that is where we are. Thus treatment involves use of drugs for a purpose for which they were not devised or licensed, against the guidelines for their usage, where long term risks are unknown.
It is emphatically not transphobic to express concern about this, and government and lottery must stop giving funds to people who say that it is.

An independent research team will follow a group of volunteer young people referred to the service, even if they choose to leave it, the first time such a study will be conducted anywhere in the world.

NIHR by the way is public (government) money. It will take years to provide sufficient evidence. Plus the issues of stupid woke changes to recording sex data by putting ‘gender’ etc as a category instead, and name changes likely being used making it much harder to track people for research. We have all discussed at length on here the problems that self ID and GRA cause for research which is going to directly harm the state of knowledge about trans people’s outcomes amongst other undermining of research data, which should be recorded and used consistently for everyone’s benefit.

Also there is the point that research participation is optional. I would not put it past those selfish wankers in the TRA lobby (who have stopped at nothing to achieve their men’s rights goals so far..) to encourage trans kids not to consent to follow up studies. We have to keep asking, who benefits?