Tavistock puberty blocker study published

[PaleBlueMoonlight]

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

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

I've just started reading and already I am alarmed by the loss of data unless I have misunderstood?

44 patients had data at 12 months follow-up, 24 at 24 months and 14 at 36 months

So by 2 years they only have data from 24/44 (54% of participants) and at 3 years 14/44 (32%) Does this mean that when they refer to 'no change at 36 months' they are basing that comment on the 32% of participants? Will this paper even GET through peer review?

The activist response has always been that to have controls would involve denying some children puberty blockers, which is perceived as unacceptably cruel.

From the study conclusion: "We identified no changes in psychological function, quality of life or degree of gender dysphoria."

So treatment has no impact? Am I reading that right? If so, what is the justification for medicating children and preventing natural pubertal development?

This bit sucks:

"In exceptional circumstances a low BMD was acceptable if:
i. it was felt to be clinically appropriate by the treating clinicians, who felt that on the
balance of risks, pubertal suppression was justified despite the later risk of osteoporosis"

BMD is bone mineral density and this is an exception to the exclusion criteria.

Blockers are known to reduce BMD, with a slow recovery rate after treatment ends. This is basically saying that they will accept patients onto the trial too be treated with blockers event of they already have a clinically low BMD, despite the increased risk of osteoporosis.

Incidentally, another medical condition that causes low BMD is anorexia (because of the malnutrition). Trans teens have a higher incidence of eating disorders than the general teen population. There is an exclusion criteria for an anorexia diagnosis or very low weight, but this makes me suspicious that weight-restored teens who are technically recovered from an eating disorder are still being permitted to enter the trial.

So they're left infertile for no fucking benefit. Jesus fucking Christ No wonder they didn't want the judges to see it.

@MsMarvellous

From the study conclusion: "We identified no changes in psychological function, quality of life or degree of gender dysphoria."

So treatment has no impact? Am I reading that right? If so, what is the justification for medicating children and preventing natural pubertal development?

That's how I read it as well, so it's either poorly written or that's actually what their research found. 😲

1.4 The appropriate management of Gender Dysphoria in children and adolescents is contentious and debated in the absence of an adequate evidence base. A currently small number of families, usually associated with a long standing parents support/pressure group, have been vociferous about their frustration with our protocol for physical intervention. Specifically, the time taken to complete a comprehensive assessment of Gender Dysphoria prior to referral for physical intervention is referred to as “a delay in treatment” and there is increasing pressure to offer cross sex hormones from the age of 14 years, rather than the current 16 years.

Young people experienced little change in psychological functioning across the study. We found no differences between baseline and later outcomes for overall psychological distress as rated by parents and young people, nor for self-harm. Outcomes that were not formally tested also showed little change

😮

Is this just puberty blockers - so does the cross hormine bit of treatment 'work' is that when they start to feel better? Please let there be a bit where they feel better..

sorry me again - this sounds unusual....
21 Patient Story
The board were visited at the start of their meeting by Ms E, her son F (12) and her daughter G (11); the children were both patients of the Trust.

Polly Carmichael's section:

1.4 The appropriate management of Gender Dysphoria in children and adolescents is contentious and debated in the absence of an adequate evidence base. A currently small number of families, usually associated with a long standing parents support/pressure
group, have been vociferous about their frustration with our protocol for physical intervention. Specifically, the time taken to complete a comprehensive assessment of Gender Dysphoria prior to referral for physical intervention is referred to as “a delay in treatment” and there is increasing pressure to offer cross sex hormones from the age of 14 years, rather than the current 16 years.*

Adult services continue to have long waiting lists, this creates
problems for some older service users who are keen to move to adult services to pursue surgical interventions and places a strain on the GIDS resources, as until they are on a stable hormonal regimen it is not appropriate to discharge service users over 18 years old to their GP.

3.9 We provide two types of endocrine liaison clinic: The Early Intervention Clinic is available for carefully selected young
adolescents in at least Tanner stage 2 of puberty and up to age 15;
and Standard clinics for adolescents aged 15
– 18 years.
3.10 After a series of physical tests young people may be prescribed
hormone blockers. This intervention is putatively completely
reversible. The blockers produce a state of hormonal neutrality. The
pausing of physical pubertal development aims to reduce distress
associated with this and so facilitates reflection and further
exploration of the young person’s gender identity. Such interventions are considered as part of an overall treatment plan offered by the Gender Identity Development Service and other therapeutic treatment/consultation and psychological monitoring
remain ongoing. When possible the GIDS clinicians attend the
endocrinology liaison clinics with their patients but when not
possible another GIDS clinician will be present. This is considered
important as it represents the integration of the mind and body.

sorry, rubbish bolding fails, can't work them out but the content is interesting.

I cant work out if this is good in that it doesnt change development or bad in that they still have psychological issues after treatment

compare with this:

Density was measured over three years for 31 children. The authors state reassuringly that bone density did not decline in absolute terms. This is misleading, because growing children need density to increase (Laidlaw2018). The abstract acknowledges that the children experienced a decline relative to the norm for their age group, and this decline was especially marked for girls.

users.ox.ac.uk/~sfos0060/Biggs_ExperimentPubertyBlockers.pdf

In fact, if you read Michael Biggs' paper and then the High Court decision, and now this Tavistock study, the foreshadowing is startling.

page 10
The implicationsof treatment for fertility werediscussed at the first and second medical visits and all young people were urged to consider storing gametes before starting GnRHa

(Bearing in mind that the age of children recruited to this study were between 12 and 15)

"44 patients had data at 12 months follow-up, 24 at 24 months and 14 at 36 months"

Am probably reading this wrong, but nearly two thirds desisted?

@InvisibleDragon

"44 patients had data at 12 months follow-up, 24 at 24 months and 14 at 36 months"

That is a ludicrously high drop out rate. Basically 66% of participants were lost to follow-up after 2 years. Haven't read the full paper yet, bit of they don't correct for the fact that most of their participants stopped reporting data, it completely invalidates everything they report.

They only followed up patients until the end of puberty blocker treatment - i.e. up to the point where they started CSH (except 1 who stopped treatment).

So yes, 44 patients had data at 12 months follow-up, 24 at 24 months and 14 at 36 months.

So all this study tells us is that, after between 1 and 3 years on puberty blockers, there was little change in psychological function and some suppression of growth.

And then 98% went on to CSH but there was no follow-up after that point.

Fucking hell.

Not surprising. Wpath in 2016 released similar numbers (even 100% in their case at the end of the study). Though they have taken down the link now.

"those in this study had persistent and consistent gender dysphoria throughout their childhood, it is not surprising they would seek to continue treatment after 16"

Well it is a self fulfilling prophecy. You don't allow the child to develop normally and mature, you perpetually keep them in their dysphoric state.

@MillieEpple

Is this just puberty blockers - so does the cross hormine bit of treatment 'work' is that when they start to feel better? Please let there be a bit where they feel better..

Other studies suggest that changes in body image or satisfaction in GD are largely confined to gender affirming treatments such as cross-sex hormones or surgery

I think that’s the bit where they feel better, Millie.

But at least:

it is unlikely that the treatment resulted in psychological harm

Oh, yay. High bar.

There is repetition too of how overwhelmed the service was, the pressure to keep up with the flood of referrals and time limits, and the hints of pressure from parents supported by lobby groups to move ever faster towards medication.

This place sounds like it was a pressure cooker of emotion and stress on all sides.

@ItsAllGoingToBeFine

"44 patients had data at 12 months follow-up, 24 at 24 months and 14 at 36 months"

Am probably reading this wrong, but nearly two thirds desisted?

No, 43 of 44 went on to CSH and 1 desisted.

But the study was designed to stop follow-up as soon as a patient stopped puberty blockers.

So if a patient started puberty blockers at age 15 and went on to CSH a year later at age 16, they stopped follow-up at that point and only had 1-year data for that patient.

From th bbc this is a bit confusing though wrt no change:

Preliminary findings which showed that after a year on blockers, there was a significant increase in those answering the statement: "I deliberately try to hurt or kill myself", were not replicated across the duration of the study.

It strikes me that the Tavi were in a unique position to have done multiple studies and collect multiple data over the last 10 years. It is staggering that this study is all they have come up with. No wonder the judges were "surprised".

Does it say how many of those starting the trial actually went ahead with gamete preservation?

Only in the stuff I was looking at published by the Dutch equivalent of GIDs said that very few adolescents went through with it, despite it being a) strongly encouraged and b) freely available to them at no financial cost.

@Signalbox

It strikes me that the Tavi were in a unique position to have done multiple studies and collect multiple data over the last 10 years. It is staggering that this study is all they have come up with. No wonder the judges were "surprised".

Absolutely. I am "surprised" at this too. The lack of data collection is shocking.

Might relate to this?

Why has it been left to feminists to safeguard children.