Trans20 Melbourne Children's Hospital Study BMJ

[ChipOnMyOvary]

bmjopen.bmj.com/content/9/11/e032151?rss=1

I was saddened to read this article, describing the research plans of the Melbourne Children's Hospital into 600 of their present and future patients (over a 3 y sign up period) with gender dysphoria for a 20-year longitudinal follow-up study.

There are several worrying aspects including the absence of a nonaffirmed control group - all study groups will be affirmed in their target gender identity: "Furthermore, it is not ethically possible to incorporate an untreated control group in the Trans20 study design. This is because withholding treatment for the purposes of forming a comparison group may cause patients significant distress and therefore pose significant risk of harm to individuals."
I understand no treatment would be unethical, but the only treatments offered appear to be gender affirming rather than purely supportive of general psychological well being with watchful waiting and appropriate treatment for other mental health conditions. Such approaches are denigrated.

There will be "translational impact by informing future treatment guidelines and gender affirming healthcare practices." So no place for wait and see. Treatment specifics for different groups seem sketchy, however eg will all patients be given puberty-blocking drugs at the onset of puberty or will some just be continued on the psychosocial pathway?

Aims and outcomes include to : "Identify clinical outcomes following different types of gender-affirming interventions (both psychosocial and medical)." There is a handy flow chart showing progression of patients from enrolment, as young as 3 y, through pschosocial support, blockers and hormones to discharge and followup.

The "gender slider tool" use could only serve to confuse a child about the supposed plasticity of sex, with its male and female scales: "The Gender Slider, developed by the Trans20 project team in consultation with the RCHGS, is a visual analogue scale to help patients describe their gender identity. This tool consists of two continuous scales, male and female, where individuals move the slider on each scale to reflect their gender identity, from ‘not at all’ to ‘completely’. "

They seem to anticipate low dropout rates, which clearly would affect the anticipated power of their study. It is a worry that dropout due to dissistance would be discouraged as different affirming treatments could not be suitably compared.

This really feels like experimenting on children. Maybe I'm overreacting.

Madness.

You aren't overreacting.

I wish you were.

I have lots to say and will keep analysing it thoroughly but I will just start by saying it’s heartbreaking, depressing, and medically shocking that they are only now putting together a method for following up these children.

Thanks for your input. I also need to study the paper and background in more detail.

First of all, it is at least good that they are at least following up on the kids now as a pp said.

However they have specifically designed this study in order to ensure as many of these Children as possible complete transition. That’s because once you’re on blockers, the evidence shows, there’s no going back. Quite literally afaik no child has gone on blockers has not then gone in to cross sex hormones. And a natal puberty is what used to resolve gender ID in kids. 50-90% of them.

There is Zero evidence for their claim that failing to affirm would cause more psychological distress than affirming would. Because no one is doing the study because of claims it would be unethical because it would cause distress. It’s an entirely circular argument.

Well, in 20 years they'll probably have 600 patients that are angry that they were prevented from going through puberty, ended up sterile, suffering from depression, and they were prevented from exploring their identities without medical intervention.
But as PP pointed out, this research should have started 20 years ago.

This study they quote and rely on for their argument is worrying.

scholar.google.com/scholar?q=.+Trans+Pathways%3A+the+mental+health+experiences+and+care+pathways+of+trans+young+people.+Summary+of+results.+Perth%2C+Australia%3A+Telethon+Kids+Institute%2C+2017.#d=gs_qabs&u=%23p%3DRAVvXNjd6tEJ

Sorry long link. It has every possible trope in it, including 48% suicide attempts?!

And, of course, 75% girls.

The massive amounts of mental health issues are all argued as being due to transphobic.

*transphobia