Tavi finally publish their study...

[rogdmum]

“ Overall patient experience of changes on GnRHa treatment was positive. We identified no changes in psychological function. Changes in BMD were consistent with suppression of growth. Larger and longer-term prospective studies using a range of designs are needed to more fully quantify the benefits and harms of pubertal suppression in GD”

Looking forward to the experts going through it...

journals.plos.org/plosone/article?id=10.1371/journal.pone.0243894

I'm very troubled by the young age of some of these children. 12 years old is very young and immature. To give PBs and stunt adolescent brain development and then think they can make informed consent at 16 when they haven't been able to develop neurologically leaves me feeling cold. My DD has an executive function age below her years. She looks like a teen of her age and sometimes sounds like one but her impulse and decision making is very childish.

Even if the previous treatment of using puberty blockers for gender identity issues is reinstated, plausible deniability over "completely reversible" and "almost no adverse outcomes" has gone. Medical practitioners in the UK will know this.

How low is the bar? Surely if you had advocated for these drugs, to thr point in one case a dr was suspended, youd want/expect/need more of an outcome of " no change" with no control group to compare to, for all your hard work?

They are going back to court, spending all that money and time on the back of a study where half weren't even fully followed and a "no change" outcome. ?

journals.plos.org/plosone/article/comment?id=10.1371/annotation/71faadb8-de18-4c65-9482-93ded40984b6

Commentary on the article- highlighting the failure to present results by sex, and the negative effect on bone density.

journals.plos.org/plosone/article/comment?id=10.1371/annotation/71faadb8-de18-4c65-9482-93ded40984b6

Commentary on the article- highlighting the failure to present results by sex, and the negative effect on bone density.

That is a good commentary.

In terms of not presenting results by sex: "in the preliminary results and likewise in the Dutch study ... girls’ body image worsened following GnRHa, while boys’ body image improved. By combining both sexes, the paper makes it impossible to discern such patterns."

Also: "preliminary results for the first 30 patients showed that the increase in self-harm ... was greater for girls than for boys"

Also the final paragraph regarding all but one child continuing to cross-sex hormones:

"The most important outcome—but the least surprising—is that 43 out of 44 patients continued to cross-sex hormones. It is hard to square this finding with the authors’ claim that “pubertal suppression may be both a treatment in its own right and also an intermediate step in a longer treatment pathway” (p. 22). Considered as a treatment in its own right, the suppression of puberty with GnRHa might be the only treatment provided by the NHS for which there is no objective evidence that the benefits outweigh the risks—as the authors themselves admitted in their statistical plan. The only justification for puberty suppression is to prepare a child for lifelong medicalization with cross-sex hormones and surgeries, with irreversible consequences for sexuality and fertility."

Excellent commentary.
There's a lot in that which the authors need to act on. I hope they have the integrity to do so.

Michael Biggs' comment is very good.

Also interesting to see the timeline for review. By the time of the Bell v Tavistock case (early Dec iirc?) the paper was already in its second round of peer review and yet the Tavistock decided not to present any of this amazing evidence in court.

What you can't see here but is starting to emerge now, is that there is no follow-up of the children after they finish. Not even by the adult service. Once they have fully transitioned, that's it.

So you treat kids with highly damaging drugs not licensed for this use. They then proceed to cross-sex hormones and surgery. That's the end. There is no medical pathway that includes aftercare.

So now the first cohort of puberty blocked children is in the same place as the thousands of women in the US who got Lupron.

Crumbling bones in their 20s. Any kind of bone, with all of the other issues this brings.

Atrophied vaginas with all of the problems postmenopausal women face in their 20s. If they have sexual function, a womb locked into excruciating unbearable spasm for minutes, hours, even days after orgasm. (This is why most FTM patients have a hysterectomy within 5 years of taking testosterone.)

We still don't know the longterm effect of arrested brain development. During puberty, a process called neural pruning ensures much better functioning of your brain in adulthood. It's a necessary and beneficial change. We don't know if cross-sex hormones restart this process. We don't know if starting this process post-puberty, once the brain has reached a later age, has the same beneficial effect. But we're not following these young adults to find out.

How can we get the data by sex? Can we FOI GIDS for it?

See Michael Biggs comment to see how important this is - possible GIDS are hiding something here.

journals.plos.org/plosone/article/comment?id=10.1371/annotation/71faadb8-de18-4c65-9482-93ded40984b6

How can we get the data by sex? Can we FOI GIDS for it?

I'm not sure about this. Guess there are at least two routes. There's FOI, and then there's the research integrity route.
In general, research data should be openly available for others to re-analyse these days, but I see confidentiality is given as a reason for this not being the case. However, this is not a reason not to provide data split by sex - means and medians for groups of 19 and 24 people should be fine. Clinicians and researcher in the area could be e-mailing the authors....

Who do we know who's a researcher in the area? Would Emma Hilton be fair enough, as a biologist or is that too general?

How about Stella O'Malley, would she be in a position to ask for them?

I have no idea how this works!