NHS announce independent review of puberty blockers and cross sex hormones!

[rogdmum]

www.england.nhs.uk/2020/01/update-on-gender-identity-development-service-for-children-and-young-people/

Am pleased.

It also need to be looked at that blockers directly lead to cross sex hormones in nearly all cases. Its irrelevant how "safe" they find them to be if it's not acknowledged that they start the whole.process and lead to even more damaging treatment.

It all needs to be tied in together as opposed to just looking at medical.outcomes

If this is full of clinicians and lobby groups (all with mega conflicts of interest because they get their incomes from this) then how can it be independent? We know what happens as soon as anyone from a trans lobby group gets anywhere near discussion or debate. They do their normal bluster and fluster to disguise the lack of facts and arguments alongside shovel loads of accusations against anyone who suggests that their way might be problematic. The Chair - no matter how well intentioned - will be silenced by this, accused of transphobia by the third meeting (if not before) and unable to explore co morbidities, lack of research and data, lack of therapy for children and the pressure on all clinicians from self interested adults and groups.
Any group / individual consulted will be dismissed as transphobic and hateful.

Could we have a NICE guideline on what is a woman?

Perhaps a short Technical Appraisal on diagnosis?

What is gender dysphoria, and why does it need to be treated with hormone blockers and cross-sex hormones?

This is from an NHS document about GIDS for children and adolescents.

1.2.1 About Gender Dysphoria
The language in this area is evolving. Gender identity refers to an individual’s subjective sense of being male, female, both, neither or something else.

Is this what passes for a rational statement in the NHS? How can anyone have a "subjective sense of being male, female, both, neither or something else"?

I don't have a "subjective sense of being male, female, both, neither or something else", because these are not feelings. Everyone is either male or female. Nobody is both, neither or anything else.

So the NHS has decided to treat children, who have a 'feeling' that they are something they are not, with medication which endangers their general health. Why?

I know a NICE review of thyroid guidelines involved many different people - charities put out invites and questionnaires.

There will be a lot of charities putting their penny's worth in, on the affirmative side.

We are going to need to be very active to get the right message through.

There seems to be a rigid view that GD must be treated medically which a growing number of people with GD say isn't necessary.

The problem is that self id takes away any hint of it being a medical issue that should be treated.

The narrative that we can be born in the wrong body has been very damaging. So many have believed it. Alongside a society obsessed with appearance and selfies and social media.

I’m actually very worried about this. There is a risk that the Wild West could get a lot wilder.

It’s a while since I’ve worked closely with NICE guidance and so I’m hoping I’m wrong. From experience though, whenever NICE have been asked to appraise something and there isn’t sufficient high grade evidence they push the decision-making back to local clinicians and commissioners. The local process is to assess the needs of individual patients in light of emerging evidence and circumstances and there is some wording which i’ve forgotten about not setting precedents.

As there is limited evidence about the long term effects of these medicines, I can’t see NICE having any different outcome from this review. And however hard the pharma companies and interested parties lobby, I can’t see the risks (and astronomical future payouts) of recommending such treatments to be ignored by the grown-ups either.

Which leaves a vacuum of local decision making. Now who do we think is going to offer to ride into town and offer help with training and policy development?

As I say, I hope I’m wrong.

Pharmaceutical companies have had huge influence. When NICE was set up it was thought that they wouldn’t be particularly interested in NICE’s conclusions as the UK is a relatively small drugs market compare to America. But American insurance companies starting paying attention and suddenly pharmaceutical companies were very interested. They would swamp appraisal teams with data, send biased marketing information to patient groups and effectively pay them to lobby NICE - preferably with a few ‘sob stories’ to get mainstream media involved. Beta-interferon for MS was a classic case of forcing NICE to ignore the evidence through campaigning.

I hope it really will be 'evidenced based' as they claim it will be.

Some more from the NHS document I posted a link to earlier.

Gender Dysphoria (GD) describes the distress that is caused by a discrepancy between a person’s gender identity and that person’s sex classified at birth (and the associated gender role and/or primary and secondary sex characteristics) (Fisk, 1974; Knudson, De Cuypere, & Bockting, 2010b). Assigned sex is classified at birth based on the appearance of the genitals. The term transgender is used where a person’s gender identity is different to their sex assigned at birth.

So the NHS is using the incorrect terminology that people are 'assigned a sex at birth'. They also say that the 'associated gender role' causes some of this distress. Are they really saying that a person who dislikes the gender role which society imposes on them because of their sex might need to have their body altered to better fit what society expects?

More from the NHS document, which reads as though it was written by transactivists.

Currently a diversification of gender identifications is taking place. A person may identify with characteristics and behaviours which (their) society may recognise as not being consistent with their experienced gender, or they may identify by another descriptor such as non-binary. Binary implies that an individual identifies exclusively as a man or a woman, however there is a growing recognition that many people do not regard themselves as conforming to the binary male/female classification.

Some children experience anxiety and other forms of distress associated with the difference or incongruence between their assigned sex classified at birth and the gender characteristics and behaviours they identify with.

Why is a dislike of gender stereotypes anything to do with the NHS?

In addition, some may strongly dislike the physical sex characteristics of their biological sex.

Finally, something which might be termed a medical condition, more precisely a mental health condition. A strong dislike of your own body is not a healthy state, and an individual suffering in this way clearly needs psychological support to come to terms with their body.

Thanks for those extracts Oldcrone they're not what I would consider to be neutral and objective. Still, even if you accept the premise of "not identifying with the gender you were assigned at birth", it is still a stretch to recommend that people with such beliefs should be treated with hormones for which the longer term outcomes are largely unknown.

I won't cite them here, but we know what is likely to be used as the or-else arguments, but does that demonstrate quality added life years? What would perfect health even have to look like to someone seeking treatments? More hormones, more surgery? Wouldn't it be kinder - seeing as being kind is the phrase du jour - to be honest? Humans cannot change sex.

Still, even if you accept the premise of "not identifying with the gender you were assigned at birth", it is still a stretch to recommend that people with such beliefs should be treated with hormones for which the longer term outcomes are largely unknown.

If "not identifying with the gender you were assigned at birth" means just thinking the stereotypes are shit (I certainly don't 'identify' with femininity), then most feminists would have to be included as trans or non-binary.

How have we got to a place where gender non-conformity is seen as something that needs medication?

How have we got to a place where gender non-conformity is seen as something that needs medication?

Indeed.

How have we got to a place where gender non-conformity is seen as something that needs medication?

This is the crux of the issue, isn't it?
Sexism is rampant, and homophobia seems to be back with a vengeance. It's not a secret that without puberty blockers and cross-sex hormones most kids will desist and many will be same-sex attracted. For some reason, medical professionals prioritise (prefer?) 'trans'.
Dr. Russell Reid avoided being struck off because apparently he was such a help to the trans community, and that was 10 years ago. I think this review will be a complete whitewash.

So no detransitioners, parents of ROGD kids, whistleblowers from the Tavistock? None of those are independent either. Is anyone independent if you exclude everyone who is 'currently involved in the debate'?

From my perspective, if the idea is to look at the medical evidence of efficacy, it wouldn't include any of those people either. If I am looking at evidence for a controversial cancer treatment, I want to know what the studies say and where there are gaps. Not the opinions of people who tried it, good or bad.

Goosefoot Why would you exclude the whistleblowers? They were at the front line of treatment and saw what was happening there. It would be wrong to exclude their evidence as medical professionals. If you only include doctors who are in favour of the medical route which is being taken now, you will get a biased result.

And the medical evidence includes the experience of people who have been treated. Both those who feel it helped them and those who don't. In the absence of any rigorous studies about this treatment, the evidence of the patients is all we have.

I want to know what the studies say and where there are gaps.

It's all gaps. There are no studies. Not even the one the Tavistock said they were carrying out.

But the whistleblowers are largely saying either 'there is no evidence/strong evidence that this is the right treatment' or 'pressure groups are distorting clinical decision making' - ie neutral review is what's needed. A review of the evidence shouldn't need personal contributions.

A review of the evidence shouldn't need personal contributions

But they are being used as the first step of "treatment" for gender dysphoria. The contributions from the whistle blowers will help to explain that alot if the dysphoria a result of trauma, homophobia etc which isnt being explored . It's no good just looking at the drugs when its supposed to be drugs and side effects vs suicide. The presence of underlying causes of the GD that haven't been treated are very much relevant

The review needs to look at the medical evidence and where it stands. I think that is where all of this keeps circling back to - what does the medical evidence say about who is being treated, what are the outcomes. If the opinion of the whistleblowers is correct, than the review should show that there is no evidence for the path being pushed by the clinics. And if the clinics aren't recording things adequately, so that the efficacy of their treatments remains unknown, that should become evident as well.

Those would both be serious outcomes and I think much stronger without the opinions either of the doctors or the patients inserted.

The review needs to look at the medical evidence and where it stands. I think that is where all of this keeps circling back to - what does the medical evidence say about who is being treated, what are the outcomes.

From the link in the OP:
To support this planned review, an independent expert group is being established to make recommendations on the evidence, that will support a review of puberty suppressants and cross-sex hormones and whether changes are required to existing clinical policies that underpin the use of these on the NHS.

NICE will also undertake a thorough review of the latest clinical evidence to help inform the working group’s review

The working group will be made up of 20 members from a range of clinical and academic backgrounds and will include members of the public.

Why would they need members of the public on this panel if they are looking at medical evidence? And why describe it as 'an independent expert group' if it includes members of the public? How will they choose these members of the public to be people who are able to understand the evidence but are impartial?

And the other question is what evidence is there? The Tavistock doesn't seem to keep track of their patients and ex-patients with proper follow-ups, and have published nothing from their early intervention study.

This article explains where we are now:
users.ox.ac.uk/~sfos0060/Biggs_ExperimentPubertyBlockers.pdf

Exactly OldCrone . The Tavi don’t keep track of their patients either after they are transferred to the adult service or if they stop attending. They have no idea what the outcomes are after children/adolescents leave their service. They also have no idea about the outcomes for children who didn’t go through the Tavi but where parents instead opted for private counselling.

I still want to know who these members of the public are. At least it sounds like this will be announced fairly soon.

That should at least be flagged up as an issue as far as informed consent goes shouldnt it?

That has to surely feature in the review?

The medical evidence says absolutely nothing about the ROGD cohort, because TRA's deny there is a ROGD cohort, and studies into the ROGD cohort don't happen.

So I can't imagine anything this 'independent' review comes up with will remotely apply to these kids. The only thing such a review could honestly say about blockers and cross sex hormones in these kids is...there is no evidence, either for efficiacy or harm. It's evidence-free treatment.

The whole thing is so fucking rotten. Why should we believe, in a landscape of mass regulatory capture, that this will be any different?