Tavistock puberty blocker study published

[PaleBlueMoonlight]

www.bbc.co.uk/news/uk-55282113

Finds 43/44 (98%) progress from PBS to cross sex hormones

You know the two kids from one family that visited the board (a boy of 12, who wanted to be a girl, and a girl of 11, who wanted to be a boy) - they were asked what they'd like to be done differently in the service. They said they would want a Minecraft server for all the children at the Tavistock to use.
Which is fine, because they're children, and that's the sort of decision a child would make.
My partner just pointed out that Minecraft is particularly popular with people with autism.
I also wonder how much the service has been influenced by a small group of very influential families.

Just thinking about consent, for girls, even if looking at only puberty blockers and not the almost inevitable cross sex hormones, wouldn't they have to weigh up:

• continuing puberty and possibly wanting later mastectomy vs
• puberty blockers - no mastectomy but shorter stature, lower bone density, sterility. reduced sexual function

? Which would be hard for anyone, at any age.

And It just seems like something that would be discussed at length for e.g. life saving cancer treatment, but done so easily for this group of children.

@yourhairiswinterfire

Why were puberty blockers ever thought to be a good idea for girls? Within their own logic, it's kind of understandable for boys who want to become trans women, stopping testosterone changes, but for girls?

Purely to stop breast growth, isn't it, so they don't ''need'' a mastectomy?

Except that the puberty blockers aren't given until after puberty has started, so a girl would already have some breast growth, and would still 'need' a mastectomy to obtain a 'male' chest.

There are no irreversible changes in female puberty which are comparable to those due to testosterone.

Can anyone tell me-if a child takes puberty blockers do they ever stop taking them? Or do they take them for the rest of their life? Trying to understand if they ever actually go through puberty & mature, or not....

@everythingthelighttouches

Thank you sultanasofa

There don't appear to have been any serious adverse events and suicidaility was not reported as an adverse event at all.

If I treat a cohort of cancer patients with an experimental new drug, especially if I don’t have a control group, and the patients become more unwell than they were at baseline, I must stop the trial.

The data you’ve just explained and quoted doesn’t match what was reported after the preliminary findings, so I’m a bit confused.
www.bbc.co.uk/news/health-49036145
Perhaps the preliminary findings were before the 12 month time point?

Thanks for alerting me to this.

The BBC report links to the 2015 board papers which contain the Preliminary Results from the Early Intervention Research in Appendix 7. In all 30 participants, and in the 16 natal girls, there was a statistically significant increase in the scoring for “I deliberately try to hurt or kill self” from baseline to after a year on puberty suppression. The table shows the means and SD, rather than the medians and IQR, as in the manuscript.

Self-harm
Looking at two self-harm items measured by the YSR, a significant increase was found in the first item “I deliberately try to hurt or kill self”. Adolescents had the option to score these items as: not true, sometimes true, often true. More adolescents tend to score this item in the “sometimes true - range” at T1 compared to T0, especially natal girls.
T0: Baseline (After Second / third appointment at the GIDS)
T1: 1 year on puberty suppression
I've attached the table of results as an image

So why are the results different?
Firstly the preliminary results look at changes for each of the two self-rated statements individually. The results in the manuscript adds together the two self-rated statements and report this as a self-harm score.
Secondly it is notable that the table of preliminary results presents the results as means and the manuscript as medians. Perhaps someone else who knows more about the Wilcoxon test could comment on statistical methodology?
Thirdly it may be that the results were different for the first 30 participants than when the total 44 were included.

There are no irreversible changes in female puberty which are comparable to those due to testosterone.

Oh, 100%, I was just noting their fucked up reasoning for it. Which, like everything else they come out with, makes no sense. (I hope it didn't come across like I was condoning it 😳)

It's clear female puberty doesn't cause any irreversible changes in the way so many transmen who transition as adults (so no PB's) ''pass''.

@happydappy2

Can anyone tell me-if a child takes puberty blockers do they ever stop taking them? Or do they take them for the rest of their life? Trying to understand if they ever actually go through puberty & mature, or not....

I have seen a TW on Twitter say they still take them, but I have no idea if they are representative or not.

Puberty blockers aren't really puberty blockers, they are hormone blockers. I imagine taking puberty blockers and cross -sex hormones would give a better aesthetic.

@MissLucyEyelesbarrow

Agree with all *@sultanasofa*'s points. This is an abysmally designed study, abysmally written up.

A couple of things not already mentioned that leapt out to me:

They were comparing bone density to baseline, i.e. each individual's bone density pre- and post-treatment. That is bizarre when you are studying adolescent children. Their bone density should be increasing, so the fact that it didn't decrease during treatment isn't reassuring at all - quite the opposite. Where are the comparisons with a non-treated group? Even without a formal control group, they could easily have compared the treated children's bone density to average for their age group. The fact that they didn't suggests they are trying to gloss over the very worrying finding that PBs inhibit normal skeletal development.

One of the authors is Russell Viner. Guess what his job is now? President of the Royal College of Paediatrics and Child Health

Agree absolutely.

Ideally this would have been a randomised controlled trial. However from what I can gather, these participants (and/or their families) would not have been happy with any treatment other than PBs. I understand that recruitment would have been difficult to such a design.

But when we look at the outcomes assessed (bone mineral density, height, weight, psychological functioning etc) why didn't they capture the same data from an age- and sex-matched healthy cohort? Comparing to baseline is meaningless in children of this age.

GnRHas are routinely used as testosterone blockers in adult MtF patients within the NHS* and rarely used for FtM (usually testosterone alone is enough, and it’s only if testosterone doesn’t cause total cessation of menstruation that blockers are added).

Some MtF patients are able to come off GnRHa once estrogen levels reach (High average) female numbers. Orchiectomy (alone or with a ‘vaginoplasty’ or ‘vulvaplasty’) obvs makes a blocker/anti androgen unnecessary.

*in the private sector a range of anti androgen meds are used, mostly because GnRHa drugs are very costly, so if the NHS isn’t funding them, they become a lot less desirable.

Sorry if previously posted?

Good thread. It will be interesting to hear from Michael Biggs.

twitter.com/mum3sun/status/1337823412597776385?s=21

So does a child who takes puberty/hormone blockers ever actually go through puberty & mature? (Sorry if not understanding clearly) Do they have the brain of a pre pubescent child or have I misunderstood that part?

I'm Not sure happy, I think they tend to start cross sex hormones at around 16 or later?

Some people can have puberty very late and the brain is still maturing in your 20s,

I wonder if there will be something in the times tomorrow?

Though studies in sheep have found sex specific changes to the brain due to blockers. (Apparently teen sheep are closest to teen human brains for research purposes.) iirc spatial skills was one issue.

Perhaps someone else who knows more about the Wilcoxon test could comment on statistical methodology?

I haven't properly looked at any of it, but Wilcoxon works by ranking the scores and comparing the rankings. So the reporting of mean vs median is a red herring as the actual values of the scores don't matter for the test.

I'd guess that either the extra participants made the apparent significant increase disappear (which is fine) or lumping the two self-harm statements together made the significant increase in one of them disappear (which strikes me as potentially dodgy.)

This result suggests that the time at which puberty normally occurs may represent a critical period of hippocampal plasticity. Perturbing normal hippocampal formation in this peripubertal period may also have long lasting effects on other brain areas and aspects of cognitive function.

Obviously sheep. However we know in human puberty the hippocampus also changes a lot and this is a very important stage to go through.

eprints.gla.ac.uk/131843/

eprints.gla.ac.uk/130496/

Human hippocampus:

www.frontiersin.org/articles/10.3389/fnins.2014.00070/full

@happydappy2

So does a child who takes puberty/hormone blockers ever actually go through puberty & mature? (Sorry if not understanding clearly) Do they have the brain of a pre pubescent child or have I misunderstood that part?

No one really seems to know if their brains mature once they move onto CSH. They don't go through the genital body changes obviously - which is why susie green was laughing about how small Jackie's penis was and Jazz Jennings has had so many vaginoplasty surgeries because there wasn't enough tissue to work with.

Given that and that their bone density is permanently affected, it would seem to me that it's unlikely that the brain development just restarts as if it had never been interrupted.

Obviously sheep. However we know in human puberty the hippocampus also changes a lot and this is a very important stage to go through

sometimes the scale of things just hits you all over again. How the hell did anyone think this was a good idea? Even for boys the purported benefits in no way justify the treatment. For girls... exactly what are they trading off for an extra inch of height and smaller hips? It's horrific.

Thanks for linking that twitter thread about Michael biggs' work. I had wondered if his research had been integral to all of this unravelling. People who keep a closer eye obviously think it is. I wonder if they would ever have published the study if its existence hadn't been highlighted & those important questions asked publicly by people who are difficult to dismiss (Oxford Prof, newsnight). I believe in one of his blogs he thanked the students who, before he realised anything was up, told him to go and educate himself on trans issues.

Thanks to everyone doing the phorensic work on this thread. It seems now that pb aren't really a treatment in their own right, but a way of holding children until they are old enough to get the actual treatment, and the children are expected to move from one to the other. Thats why the high court are right to make sure a child can consent to the whole thing right at the beginning.

I wonder if the nhs will go through with the appeal.

or lumping the two self-harm statements together made the significant increase in one of them disappear (which strikes me as potentially dodgy.

Quoting myself. On further reflection, and to do them justice, if the increase in "I try to hurt or kill myself" was a real increase and not just a statistical fluke, then I think you would really expect it to be accompanied by an increase in "I have suicidal thoughts." I'm not a psychologist, but it seems to make good sense.

So while I do suspect them of creating this Self Harm index (lumping the two scores together) to disguise the increase that Michael Biggs highlighted - it still seems like a reasonable enough thing to do. I think I'm willing to absolve them of dodginess on this score, because I think lumping the two scores together would only work to disguise a statistical-fluke increase and wouldn't work to disguise a real effect.

Allmywhat even in sheep they said that they needed to test with a cohort of female sheep to know if the impact was any different.

It is mind boggling.

Meandering and all, and all posters, thanks for sharing all thoughts.

Yes I think we will hear from Biggs soon.

@yourhairiswinterfire

There are no irreversible changes in female puberty which are comparable to those due to testosterone.

Oh, 100%, I was just noting their fucked up reasoning for it. Which, like everything else they come out with, makes no sense. (I hope it didn't come across like I was condoning it 😳)

It's clear female puberty doesn't cause any irreversible changes in the way so many transmen who transition as adults (so no PB's) ''pass''.

I didn't think you were condoning it. I was just emphasising that there are no good arguments for giving this 'treatment' to girls, because they'd probably need a mastectomy anyway if they persisted in their trans identity and there are no irreversible changes from going through female puberty which are comparable to the changes due to testosterone experienced by boys.

Clyme, that's my feeling about pbs. There must be some impact on the brain. There's lots of trimming and connecting going on. The other article I linked to suggested a huge turnover of cells in the hippocampus during prepubescence and puberty, part of the remodelling that goes on.

I remember TRA 'kilgoresprout', god knows what they call themselves now but most knew who they were years back..proper going down my neck when I was on twitter, when they were trying to convince me the goods of puberty blockers and how they were lifesaving, and reversible and so on. When they said it was just a pause button, and I pointed out how if puberty does not happen, the the huge brain development that goes on at that time would presumably also be paused. They went off it, and ended up blocking me too. But thats when I started thinking a lot about PB drugs, as it seemed totally nonsensical that everything else was blocked, but apparently brain develpment went on as usual and it was hugely bigoted to claim otherwise!

@allmywhat

Perhaps someone else who knows more about the Wilcoxon test could comment on statistical methodology?

I haven't properly looked at any of it, but Wilcoxon works by ranking the scores and comparing the rankings. So the reporting of mean vs median is a red herring as the actual values of the scores don't matter for the test.

I'd guess that either the extra participants made the apparent significant increase disappear (which is fine) or lumping the two self-harm statements together made the significant increase in one of them disappear (which strikes me as potentially dodgy.)

Thanks very much and apologies for potentially misleading people!

So many experts on this thread! I believe we've got all the bases covered. Legal, medical, psychology, autism, safeguarding, statistics.... Thanks everyone for sharing your knowledge.