Good Law project have succeeded...

[Wandawomble]

goodlawproject.org/news/tavistock-success/

[quote Wandawomble]@RobinMoiraWhite you agree with medicating children for something they imagine they are?
Ok then.
In plain sight.[/quote]
Well, its something I have 'imagined I am' since about 7 or8 to my now late 50's - I would call that my gender identity - you might disagreee, but then you arent me. So as long as appropriate processes are in place to ensure that , as far as can be managed, the treatment is given to those who will benefit from it, managed through an appropriate professional environment, then YES.

@WarriorN

Is that where NICE or whatever come in?

Yes, nice guidance is frequently reviewed and guidance is changed based on new evidence.

Indeed. NICE currently have no guidance relating to the use of puberty blockers for gender dysphoria in children.

They are currently carrying out an evidence review of the existing available evidence on gender affirming hormones and on GnRH analogues for children and adolescents with gender dyshporia and it is due to be made available before the end of March - not long now!

gahh dysphoria!

So as long as appropriate processes are in place to ensure that , as far as can be managed, the treatment is given to those who will benefit from it, managed through an appropriate professional environment, then YES.

I wouldn't disagree with that. It's how any treatment should be handled.

The only problem is meeting those "so long as" clauses. The "to those who will benefit from it" is the biggie, and even the original Dutch researchers seem to be getting cold feet on that. And this judgment acknowledges the issues - albeit by deferring to Cass.

And your personal history is not terribly relevant to the cases we're discussing. (a) How can you know whether you be better off now if you had been given this treatment you didn't get, and (b) it appears to be primarily troubled females making up this new demographic - a sudden upswing in apparent GD which has all the hallmarks of a social contagion, substituting for previous cohorts anorexia or cutting.

Are you saying that a fully socialised person on the autistic spectrum is incapable of making decisions about themselves?

What the blinking heck is a "fully socialised" autistic person? Would you be suggesting that you can erase the brain features of autism: difficulties with social understanding, a tendency to highly focused interest areas, a tendency to view things in a very black and white way, and lagging emotional maturation - ALL of which make an autistic person potentially more vulnerable than an NT person if the same age, and which may also explain why some autistic people may be more susceptible to believing they are trans as a reason why they don't "fit in" with same sex peers - if you expose an autistic person to more "socialisation"?

Autistic people are entirely valid; however suggesting that they don't have differences in their brain make up and perceptual systems that might mean they need a bit more protection for a bit longer is immensely disingenuous and hugely offensive. Erasing acknowledgement of valid differences isn't inclusive.

The judgement was fairly straightforward. If a doctor, a child, and the child's parents all agree that a particular medical treatment is best for that child, you don't need a court order to proceed. Take off your GC hats and imagine if that wasn't the case for any other condition.

@gardenbird48
Yes, there are NICE guidelines.
www.england.nhs.uk/commissioning/wp-content/uploads/sites/12/2016/08/clinical-com-pol-16046p.pdf

"New" is not experimental.

"Hormone blockers, by contrast [to sex hormones], have largely been considered free of long-term harm based on generations of follow-up studies with the large population of individuals prescribed such drugs for precocious puberty"

So as long as appropriate processes are in place to ensure that , as far as can be managed the treatment is given to those who will benefit from it

Genius. What a great idea. So how do we do that then?

There is no way to determine those children who will benefit as distinct from the majority of children who will benefit from being left alone.

I imagine quite a few parents and adults will benefit though...

The majority of child presentations are girls, probably same sex attracted and with co morbidities, Girls wanting to run away from femaleness are not the same patient population as adult men - many of whom are married and already have had children who want to run into it.

Well, its something I have 'imagined I am' since about 7 or8 to my now late 50's - I would call that my gender identity - you might disagreee, but then you arent me. So as long as appropriate processes are in place to ensure that , as far as can be managed, the treatment is given to those who will benefit from it, managed through an appropriate professional environment, then YES.

It is nice that you were so clear about your situation and that that feeling persisted for you but for many children and young people that feeling doesn't persist. Hence detransitioners. When you look at the impact a medical transition has on the body, and the permanent changes and long term detriment to health, I would suggest that even one misdiagnosis is one too many.

Judging by the advertising and preparations being made by Medical Negligence law firms I would think that diagnosis standards are going to be scrutinised.

What do you think the GI clinics can do to assess children effectively to determine if they are going to persist or desist? They haven't been successful enough in that so far.

Given that a child or young person taking puberty blockers or cross sex hormones when there is still quite a strong chance they will be perfectly fine without them and given the known health issues they cause, do you think it more sensible to allow those children to reach adulthood before making a decision?

nb. Please take the aim of 'passing' out of the equation - I believe that is a bit of a red herring given that many trans people are choosing not to present, or minimally present as the sex with which they identify (think Danielle Muscato, Alex Drummond etc). Given the stress that attempting to pass seems to generate for people I think that there should be strenuous attempts to move away from that aim as much as possible.

Hormone blockers, by contrast [to sex hormones], have largely been considered free of long-term harm based on generations of follow-up studies with the large population of individuals prescribed such drugs for precocious puberty

And let’s all ignore the fact that these children are

-not experiencing precocious puberty
-that they are at a time point where they are supposed to be going through puberty

• put on the direct pathway from puberty blockers to cross sex hormones - 43/44 12-15 year olds according to the Tavistock study who start PB go onto cross sex hormones - which includes children had their sperm/eggs removed.

Nothing to see here... all perfectly normal.

Given the stress that attempting to pass seems to generate for people I think that there should be strenuous attempts to move away from that aim as much as possible.

as long as it's considered fair game to mock the appearance of trans people who do not pass, this will never happen. it seems to be some mners' favourite bloodsport though and I never ever see "gender critical" posters calling one another out when they do this. at most they say things like "oooh careful you'll get zapped tee hee" but I have never, not once, seen a GC poster say oi that's not cool.

The big elephant in the room, is still, WHY are so many more young girls thinking they would prefer to live their life as a male? Historically it was young men who suffered dysphoria and a small amount might transition in later life....there are many reasons young girls are running away from womanhood (sexual abuse, sexual trauma, not wanting to be a lesbian etc etc.) The fact is we KNOW young autistic girls are being caught up in this mess & their bodies are being irreversibly harmed-for that reason alone society should halt this insanity until people are aged over 25 at least (imho)

Actually, reading the judgment, I'm not sure that this is the win that GLP are claiming.

The judge is clearly very supportive of the Bell judgment ("I should be entirely clear that even if I was not in effect bound by Bell, I self-evidently entirely agree with its analysis and conclusions having been one member of the Divisional Court. Nothing that is said below is intended to depart, to even the smallest extent, from anything that was said in Bell"). Doesn't sound great for the GLP's appeal of Bell!

The judgment is clearly limited to saying that PBs are not part of a "special class" of medical treatment to which a parent can never consent. This is because that "special class" doesn't, in reality, even exist - cases to date have been decided on their individual merits. It would have been a huge departure from established law if the judge had found that PBs do constitute a "special class" (they would be the only treatment in that class!).

As it is, the judge has upheld the existing rules on the legal basis for parental consent and - crucially - said that clinical guidelines are the appropriate place for restrictions on prescribing PBs. The judge says that the Cass review is the "opportunity for significant safeguards to be put in place in order to ensure that parents and children are given full and objective advice as to the benefits and disbenefits of PBs".

That's where overarching rules on PBs will be effected. The Cass review is the important one. This case is just a bit of fluff for the GLP.

@DadJoke

The judgement was fairly straightforward. If a doctor, a child, and the child's parents all agree that a particular medical treatment is best for that child, you don't need a court order to proceed. Take off your GC hats and imagine if that wasn't the case for any other condition.

@gardenbird48
Yes, there are NICE guidelines.
www.england.nhs.uk/commissioning/wp-content/uploads/sites/12/2016/08/clinical-com-pol-16046p.pdf

"New" is not experimental.

"Hormone blockers, by contrast [to sex hormones], have largely been considered free of long-term harm based on generations of follow-up studies with the large population of individuals prescribed such drugs for precocious puberty"

Dadjoke

That is NHS England - not NICE. NICE have confirmed that they have no guidelines for use of GnRH to treat gender dysphoria in children.

Secondly, according to this Policy Statement at the top of the document, this is not about puberty blockers commission cross sex hormones for young people with continuing gender dysphoria from around their 16th birthday.

They are mentioned further down but I haven't got time to wade through the whole thing especially as it is nothing to do with the NICE guidelines I mentioned. Feel free to show me the section where NHS England have published guidelines for use of GnRH in children under 16.

Policy Statement
NHS England will, as part of the Gender Identity Development Service for Children and Adolescents, commission cross sex hormones for young people with continuing gender dysphoria from around their 16th birthday subject to individuals meeting the eligibility and readiness criteria as set out in Section 6 of this document. In exercising this discretion, the specialist multi-disciplinary team will be cognisant that international guidelines recommend the prescribing of cross sex hormones to gender variant young people at ’around 16 years’. In creating this policy NHS England has reviewed this clinical condition and the options for its treatment. It has considered the place of this treatment in current clinical practice, whether scientific research has shown the treatment to be of benefit to patients, (including how any benefit is balanced against possible risks) and whether its use represents the best use of NHS resources. This policy document outlines the arrangements for funding of this treatment for the population in England.

Re. your last statement - have you even read the information about the harms Lupron causes to not only people who have taken it for its intended purpose - prostate cancer, but people who have taken it for precocious puberty. Lupron is one of the class of drugs used as a puberty blocker.

It causes so much harm to people that it has had more than 10,000 adverse events - including crumbling skeleton, loose teeth, fits, abnormal pain, in some cases sudden death. Patients harmed by this drug are preparing a class action against the manufacturer.

Can you point to these generations of follow-up studies with the large population of individuals prescribed such drugs for precocious puberty and show where they prove that they are free from long term harm?

They are currently carrying out an evidence review of the existing available evidence on gender affirming hormones and on GnRH analogues for children and adolescents with gender dyshporia and it is due to be made available before the end of March - not long now!

Thankyou for that information Gardenbird, that will be an interesting read next week.

Thankyou for that information Gardenbird, that will be an interesting read next week.

Thank you - I am keeping an eye on their evidence search tool so I hope to be able to pass on the info when they publish it. It will be very interesting.

It causes so much harm to people that it has had more than 10,000 adverse events - including crumbling skeleton, loose teeth, fits, abnormal pain, in some cases sudden death. Patients harmed by this drug are preparing a class action against the manufacturer.

The reports from those who took this drug 15 + years ago, maybe even less, are most often ignored. However, just reading the life shortening and lifelong medical conditions being reported by women detransitioners and transmen, some of these side effects are now being discussed. Along with strokes, kidney damage and other effects.

"Hormone blockers, by contrast [to sex hormones], have largely been considered free of long-term harm based on generations of follow-up studies with the large population of individuals prescribed such drugs for precocious puberty"

I think that the lid might get blown off this when the class action finally starts. From what I have read, the numbers are growing quickly for those claiming for harm from use for precocious puberty.

Hormone blockers, by contrast [to sex hormones], have largely been considered free of long-term harm based on generations of follow-up studies with the large population of individuals prescribed such drugs for precocious puberty.

That is an assumption not supported by the available evidence, DadJoke. You'll note that there is no source given in the NHS policy statement (not NICE guidelines as gardenbird48 points out) for this claim.

It is indeed an assertion commonly made by proponents of the use of PBs for gender dysphoric children, and I am sure made in good faith, but it is unfortunately not true.

Puberty blockers as used in children with precocious puberty are underresearched. There is a serious lack of evidence of the benefit of these drugs outweighing the harms. The available studies are few and far between, followup is rare and study subject numbers are typically very small. There are no "generations of follow-up studies with the large population of individuals prescribed such drugs".

A number of controversies surround the prescription of these drugs in children with precocious puberty, and those children are typically on them for a far shorter time than children with gender dysphoria.

gardenbird48 quite rightly states above it is irresponsible to claim that puberty blockers are safe for children with gender dysphoria just because they are considered safe for children with a completely different medical condition. It is even more irresponsible to claim this given that there is insufficient evidence to assert that they are safe for any child, whatever the condition it is prescribed for.

There's something that's bothering me about parental consent here.

In most medical decisions, there is a clear medical problem with a clear treatment plan.

Simple case: this medicine / operation will fix this physiological problem. There is a clear harm that is caused by not treating, which hugely outweighs any side effects / harms from the treatment. The treatment plan is based on a strong evidence base and is recommended by the medical team to the parents.

This means that parents routinely consent to treatments like chemotherapy for their children, for which the harms are potentially quite large (infertility, hair loss, unpleasant side effects). Because the outcome of not treating is that their child will certainly die.

That even covers novel, experimental treatments that might not work at all, because the outcome otherwise is that the child dies. The parents weigh up the small chance of the child surviving a bit longer with the experimental treatment against the harms it causes to make a decision about whether to accept an experimental treatment.

But in the case of puberty blockers, I'm struggling to see a clear harm resulting from not treating. The argument is that puberty blockers alleviate psychological distress and give more thinking time, but the Tavistock's own research refutes that: blockers did not significantly reduce psychological distress and almost all patients treated proceeded to take cross-sex hormones, so it's not clear that the thinking time argument holds either. There are also indications that puberty blockers make effective transition harder - ftm transitioners don't grow as tall as they would otherwise, whilst mtf transitioners don't get sufficient penis growth to facilitate creating a neo-vagina.

The idea that puberty blockers are just a pause button is just that. A nice idea. A hypothesis. But there's no meaningful scientific evidence to support their use.

Parents can consent on behalf of their child when they child is not Gillick competent, but all of that is predicated on the treatment offered meaningfully addressing a medical problem.

In cases where parents are not considered to be acting in the best interests of their child (e.g. Charlie Gard), the medical team can request the law intervenes to protect the child. But in the case of puberty blockers, it's the medical teams that are suggesting a treatment plan that causes harm with very little benefit, which the parents then consent to.

In complex cases, some form of independent guardian can be appointed to advocate for the needs of the child. Could they become standard in making decisions about prescribing blockers for children who wish to transition?

Every time that the GC side "wins" or the genderist side "wins" the complexities involved become more apparent and the uncertainties grow. It just means more sunlight as time passes.

The Good Law Project might think that with enough litigation, enough resources, and enough pressure, eventually the medics will be put into a position where they will be told what to do and they will comply. Try it then. Push this as far as you can and on the day you can finally turn from your task and announce "we've won!", you'll find yourself looking at a massive crowd of people looking on in horror at what you've done.

From a Dentons point of view this looks like a disastrous way to "win".

The idea that puberty blockers are just a pause button is just that. A nice idea. A hypothesis. But there's no meaningful scientific evidence to support their use.

Reading narratives from parents, this is where it gets stuck. They are concerned, upset, worried, and puberty blockers seem like a pause button to take stock.

The framing of these drugs in that way is giving these parents a false impression of what they're doing.

It should be more along the lines of this is the first step to XY and Z. Not this is a breather.

As it is, the judge has upheld the existing rules on the legal basis for parental consent and - crucially - said that clinical guidelines are the appropriate place for restrictions on prescribing PBs.

So essentially the GLP have just spent a lot of money to get a judge to confirm the status quo? The only thing preventing GIDS from treating on the basis of parental consent was GIDS own guidelines.

Am I right in thinking that Keira's Mum was supportive of her transitioning? So doesn't this case just mean that a person like Keira is in the exact same position as they would have been without the Bell case?

I'm also confused about the argument that for Lisa Littman's study into ROGD it was torn down by certain TRA's because it used the data of parents. Which is it, do all parents know their children or is it so called "loving" parents aka ones who don't question only who know their children well enough to consent to this.

Am I right in thinking that Keira's Mum was supportive of her transitioning? So doesn't this case just mean that a person like Keira is in the exact same position as they would have been without the Bell case?

Presumably you would need consent of both parents. If they are in disagreement it would end up in court.

In Bell, Tavi said:

"There is a fundamental misunderstanding in your letter, which states that parents can consent to pubertal suspension on behalf of a child who is not capable of doing so. This is not the case for this service, as is clear from the above. Although the general law would permit parent(s) to consent on behalf of their child, GIDS has never administered, nor can it conceive of any situation where it would be appropriate to administer blockers on a patient without their consent. The Service Specification confirms that this is the case.

And in this case they are saying:

"In relation to referral from GIDS to the endocrine team, the Tavistock would only proceed to refer for treatment where i) it is the clear wish of the young person to be referred for assessment by the endocrinologist and that they understand the nature of the referral (even if their level of understanding falls short of the requirements for 'Gillick Competence' as delineated in the Divisional Court's judgment in Bell); ii) with the agreement and support of the child or young person's parent(s)/carer(s); and iii) with the agreement and recommendation from the clinicians working with the child or young person."

So whose consent are they now relying on?

The 'clear wish of the young person to be referred' is not 'consent' - that's what the Bell judgment says - and Tavi said very clearly in Bell that they would not proceed on the basis of parental consent.

If they have done a complete 180 and are now relying on parental consent, and if puberty blockers are an essential, lifesaving treatment for children with gender dysphoria, then wouldn't it be extremely negligent not to proceed even if the child did not express a clear wish to be referred? My children never expressed a clear wish to go to the dentist, in fact they frequently expressed a clear wish not to go. I used my parental consent to override their wishes and took them anyway. To do otherwise would have been negligent.

GIDS statement in this case suggests to me that they are still, in practice, seeking to rely on the child's 'consent' - they've just rebranded it as the child's 'clear wish' which, unlike consent, has no legal weight.

'GIDS has never administered, nor can it conceive of any situation where it would be appropriate to administer blockers on a patient without their consent clear wish'

I am astonished at GIDS dishonesty and at the failure of the court to see through this semantic sleight of hand.

Or maybe PBs aren't an essential, lifesaving treatment after all. The Royal College of Surgeons says in its Professional Standards for Cosmetic Surgery:

34. A parent can consent to an intervention for a child or young person who does not have the maturity and capacity to make the decision, but you should involve the child in the decision as much as possible. If you judge that the child does not want to have the intervention, then you must not perform it.

www.rcseng.ac.uk/standards-and-research/standards-and-guidance/service-standards/cosmetic-surgery/professional-standards-for-cosmetic-surgery/

That's the consent model GIDS are now seeking to use. It's very different from the way the NHS treats consent for essential, life saving treatments on minors, or even routine medical treatments.

But if PBs are so inessential then why are children being given this experimental and potentially extremely harmful treatment in the first place?