The judgment in Keira Bell's case will be given tomorrow

[MaudTheInvincible]

The judgment of the Tavistock's appeal of the case will be given at 2pm.

www.gov.uk/government/publications/royal-courts-of-justice-cause-list/royal-courts-of-justice-daily-cause-list

Brave Keira. You have done so much to protect children from ideologically driven healthcare around the world. Your integrity and courage is inspiring and rare in this ridiculous day and age. 💚🤍💜

I don’t know if Keira’s lawyer saying the Appeal Court ruling calls Gillick competence into question means that people's suspicions about him were right or not

I believe his wording that Gillick was "not fit for purpose", and I think he may be right.

Puberty blockers are paradoxical. They are, effectively, an intervention to prevent adulthood.

Adulthood is the very thing that makes one able to make independent decisions. The lack thereof that Gillick deals with.

Gillick has, so far, only considered procedures that an adult could freely consent to, and that adults do already freely consent to. It has determined how to deal with consent issues for those not yet of age to undergo the same treatment as an adult.

But puberty blocking is one treatment an adult cannot consent to. The choice to not become an adult.

And I think that "not becoming an adult" is not necessarily hyperbole here. We don't seem to have a firm grasp on how much development is impeded, and looking at the children who've undergone it in the public eye, it really doesn't look encouraging. They don't seem to be fully functioning adults. I'm not convinced a 25-year-old puberty-blocked child is mature in the same way a normal 25-year-old would be.

And one very useful comparator is cross-sex hormones. Adults can consent to those, but we don't permit them for children. Why not?

If children can consent to puberty blocking, why not just let them take cross-sex hormones? Might that not be safer than an interim course of puberty-blocking drugs? What IS the point of the puberty blocking? Is it just a workaround for legal bar on cross-sex hormones?

Are PBs just a salve to peoples' conscience, so they can pretend they're not permanently affecting children? But they clearly are.

How are we getting different answers for puberty blockers and cross-sex hormones?

Something is going wrong here, and it is possibly the fact that puberty-blocking is a child-specific treatment, so we are not making the usual comparisons with adults we would for any other treatment.

Surely if people are claiming that puberty blockers are 'just a pause' then there must be robust data to back that up, detailing exactly how the body kickstarts puberty again once they come off the blockers?

Or is there no data because all kids who start blockers go on to CSH?

In which case the 'completely reversible' claim has zero credibility?

Or is there no data because all kids who start blockers go on to CSH?

It's not quite all - the Tavistock said they had 1 child on record who hadn't. But basically all. And there's no studies of what happened in similar cases that I'm aware of. They don't even do follow-up of the cross-sex-hormone pathway properly, never mind that case.

The established "puberty blockers then cross-sex hormones" path locks you in via the sunk-cost fallacy. Almost no-one would give up before reaching the end of the path.

In which case the 'completely reversible' claim has zero credibility?

Well, many places, including the NHS, have withdrawn that claim from patient guidance, as it's misleading to the point of being wrong.

The hormone blockage is potentially technically fully reversible - you could take them for as long as you like, and the hormone subsystem they block would resume operation afterwards.

But that doesn't necessarily mean you will then undergo normal puberty due to that hormone subsystem being back online - it may be too late. The overall treatment is not reversible, or at least hasn't been shown to be.

And one very useful comparator is cross-sex hormones. Adults can consent to those, but we don't permit them for children. Why not?

If children can consent to puberty blocking, why not just let them take cross-sex hormones? Might that not be safer than an interim course of puberty-blocking drugs? What IS the point of the puberty blocking? Is it just a workaround for legal bar on cross-sex hormones?

They do permit children to take cross sex hormones in the US though. www.pbs.org/wgbh/frontline/article/whats-it-like-to-start-taking-testosterone-at-age-15/

Anyway, this was published in 2016 by NHS England:

Ethical review
Abel (2014) considered the key ethical principles affecting decisions about early
prescribing of cross sex hormones. The principle of non-maleficence (“first, do no
harm”) offers the strongest ethical argument against early cross sex hormone therapy
because the long-term effects of this are not well known and it has the potential for
sterility. The assessment of an individual must therefore consider the balance of the
consequences of the treatment, including the benefits versus the potential harms.
Hormone blockers, by contrast, 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.
Beneficence (i.e. the obligation of physicians to help their patients) is another
key principle in considering early cross sex hormone therapy. While delaying
hormone therapy may conform to the principle of non-maleficence for this group, the
significant prevalence of patients stopping treatment and the inability to predict which
will continue with treatment, detracts from the argument for prescribing cross sex
hormones.
Given the possibility of patients stopping treatment, physicians must consider the
situation where cross sex hormone therapy renders permanent harm in a gender
non-conforming young person in whom the gender dysphoria dissipates. Helping an
adolescent to appreciate the seriousness of infertility is an important ethical
obligation and one complicated by the fact that the adolescent’s developing brain is
generally more limited than the adult brain in its ability to weigh long term
consequences (Abel et al., 2014). The task becomes more complex given the
prevalence of autism (Kaltiala-Heno et al., 2015) and psychiatric comorbidities that
can be as high as 22% to 44% amongst gender dysphoric adolescents (de Vries et
al., 2011; Spack et al., 2012).
For this reason, consideration of the long term impacts, including on fertility, has
been included in the eligibility and readiness criteria described in this policy
document, and will be assessed in each individual.

From here: PDF
Sorry about the formatting, I copied and pasted from the pdf on mobile.

Dr Johanna Olsen-Kennedy likes to move children on puberty blockers to cross sex hormones within no more than 2 years because of the unknown risks of puberty blockers.

I mean, I can't type that sentence without feeling furious but at the same time in this brave new world, at least she is taking some risks seriously.

It's interesting because it basically says the potential harm of cross sex hormones is serious, and that the effects are irreversible.

I haven't seen it established anywhere that the potential harm of blocker drugs is negligible, or that their effects are reversible. As we know there are class action lawsuits in the US regarding these drugs, and a strict lifetime dosage limit in adults. And as we've discussed, there don't seem to be any case studies of children who blocked puberty for several years and then had a normal puberty afterwards. The precocious puberty cases aren't on these drugs for six years and they don't wait til 16 to come off them either.
It seems quite contradictory.

If the High Court stated that blockers aren't a pause, they're just step one, then that reason for use doesn't really exist. If they aren't safer than cross sex hormones (bearing in mind the focus on irreversibility) the that reason for use doesn't exist. They're not cheaper than cross sex hormones, so that (cynical) reason for use doesn't exist.
If we're talking about a cohort of children who all go on to take cross sex hormones, why block puberty at all, why not alter it with cross sex hormones? Why poison them first?

In boys I can see its about reducing overall stature and limiting the masculinisation of features. (So they end up sexless and with a micropenis but pass easier). But in girls it makes no sense at all - testosterone is going to completely change the overall look so why bother blocking oestrogen? Or why not use an aromatase inhibitor like steroid users do? Especially if blockers lead to reduced height.

Doesn't make any sense.

Dr Johanna Olsen-Kennedy likes to move children on puberty blockers to cross sex hormones within no more than 2 years because of the unknown risks of puberty blockers.

That makes sense, I'm not saying I agree with it but it makes sense to limit the use of blockers.

Bearing in mind adults have the lifetime dosage cap for these drugs, but have no lifetime dosage cap for cross sex hormones, it suggests that the hormones are less dangerous than the blockers. So why use blockers?

In the Tavi's early results whrn they eventually produced them im pretty sure female satisfaction with puberty blockers was lower than male. Very understandable.

I wonder if the blockers are just a sop. An ironically very dangerous sop. Because as PP have stated, cross sex hormones are not permitted to be given to children.

It's almost as if its more polite to pretend that the actual decision is made post a certain age, be it 16 or 18, hence the repetition of the falsehood that these drugs "pause" puberty. Paused until the child is old enough to decide.

But in the same breath, transactivists state that "trans kids" know what they are and what treatment they should have and will not suffer any regret (and if they did they weren't really trans) etc. So effectively the decision is made at a much younger age, either by the child or by the child's parents.

The illegality of using cross sex hormones on children is like a kind of false modesty, and might do more long term harm than going straight to cross sex hormones instead of blockers.

I mean, we're talking sexual dysfunction in both cases, we're talking possible sterility in both cases, but with blockers there's the unknown psychological effects (increased suicidal ideation, possibly lower IQ), and the effects on bone density.
Also going straight to cross sex hormones means the child goes through some form of puberty in line with her peers.

Don't get me wrong, I think the idea is fucked up, and I don't agree with transing children at all, but this particular part of the regimen for children just makes no sense to me.

Thats interesting Flying Oink.

It might give people pause if the clinics were storming ahead with putting 13 year old girls on testosterone.

this particular part of the regimen for children just makes no sense to me.

What was the original idea, then? The Dutch pioneers, what were they thinking of? It was for males, specifically, right?

And they were theorising that those whose gender dysphoria resolved itself (as is normal) could come off them?

But none ever did, because the treatment stops dysphoria resolving?

I think that's right Necessary. Males who were becoming very distressed as puberty kicked in and fitted the profile for persisting beyond puberty. I will try to be completely fair and say it was a very small number who did go onto this treatment and there are certainly some young adult voices on the Internet who report being positive about having been on it.

From what Klink said in Webberley's tribunal the Dutch had a much stricter regimen than what GIDS ended up doing.
And yeah, it makes sense that it was originally aimed at males who were distressed at the masculinisation of puberty.
I don't know if that masculinisation can be reduced by just treating those males with oestrogen as well, or if the blocker is needed to stop things like growth spurts and the development of brow ridges or mature male hairlines etc.
It doesn't make sense to use it on girls, though, making the ftm child smaller?

It might give people pause if the clinics were storming ahead with putting 13 year old girls on testosterone. Yes, but I want to examine why. It is the irreversibility of male characteristics? Is it adherence to this notion that blockers are reversible when in all practical senses they don't seem to be?
Why is it pitched as a less extreme option, when there's a chance it does more damage?

And talking of outcomes for boys, I find it pretty paedophilic that the best outcome for a boy is to be visually "acceptable" and pass as a female when we know from the very public Jennings case that the end result was no sexual drive whatsoever and a lack of penile tissue to form a neovagina.
Again, if you ask a child what is more important - looking like the opposite sex or being able to have sex - they might choose the former, but the large number of adult male transitioners who keep their penis and continue to have a sex life suggests that adults choose function over form.

That's an interesting point. Aren't all women who have the protected characteristic of belief being excluded from "inclusive" single-sex services if they don't believe TWAW? So not just GC women but any woman who has religious beliefs that are incompatible with trans inclusion?

Also, what about women who have PTSD that is triggered by males? Aren't they being excluded on the grounds of disability?

sorry, that was the wrong thread! Hope it doesn't derail though I am very interested in the answer to that question.

@FlyingOink

I wonder if the blockers are just a sop. An ironically very dangerous sop. Because as PP have stated, cross sex hormones are not permitted to be given to children.

It's almost as if its more polite to pretend that the actual decision is made post a certain age, be it 16 or 18, hence the repetition of the falsehood that these drugs "pause" puberty. Paused until the child is old enough to decide.

But in the same breath, transactivists state that "trans kids" know what they are and what treatment they should have and will not suffer any regret (and if they did they weren't really trans) etc. So effectively the decision is made at a much younger age, either by the child or by the child's parents.

The illegality of using cross sex hormones on children is like a kind of false modesty, and might do more long term harm than going straight to cross sex hormones instead of blockers.

I mean, we're talking sexual dysfunction in both cases, we're talking possible sterility in both cases, but with blockers there's the unknown psychological effects (increased suicidal ideation, possibly lower IQ), and the effects on bone density.
Also going straight to cross sex hormones means the child goes through some form of puberty in line with her peers.

Don't get me wrong, I think the idea is fucked up, and I don't agree with transing children at all, but this particular part of the regimen for children just makes no sense to me.

Brilliant post. I think you're right - because even with their shitty record-keeping, there's no way they hadn't noticed no children on blockers desist.

Regarding the blockers, another case of a natal male teenager whose genitalia didn't develop sufficiently for the planned vaginoplasty. The surgical team went for a riskier alternative as a work around.

That teenager is now dead as a direct result of the complications at just 18. "But better a live daughter than a dead son", eh.

This is horrendous. www.jpagonline.org/article/S1083-3188(16)30174-7/fulltext

That is absolutely tragic. Just awful. And people roll their eyes at me when I say it’s a medical scandal.

Vaginal REconstruction? Sorry what? Is this not more a case of 'we'll bore a hole in your son's nethers and oops, what could possibly go wrong '?

The absence of a functional vagina has a negative effect on the quality of life of women. Multiple surgical procedures have been described for vaginal reconstruction in these patients
So far, maybe so good, because women do have vaginas and might need 'reconstruction ' in certain circumstances...

But after surgery, organ failure, extensive debridement (translation: scraping out the rotting flesh) and eventual death of the subject - oh, sorry, this wasn't an experiment you say, Sooty? OK, death of the patient - we get an admission that it was not a woman, and therefore there was no vagina to be reconstructed. THEY WERE EXCAVATING A HOLE

Although vaginal reconstruction has a positive influence on the quality of life in transgender women, physicians and patients need to be aware of serious complications that might arise.
No shit, Sherlock.

It is tragic that there is so much anger and revulsion at the medics to overcome before pity for the young man who died gets a look-in. Maybe that's just me.

But when one cannot trust medical papers to use correct language, what trust can be placed in any clinician.

May this young man who died a horrible and totally unnecessary death rest in peace . And may the same or equivalent be prevented from being inflicted on other young people.

@NotBadConsidering

That is absolutely tragic. Just awful. And people roll their eyes at me when I say it’s a medical scandal.

It is absolutely tragic

The bit that constantly horrifies me is the idea that the parent’s and transperson do these things because they think it will help and that they can at least get an an approximation of changing sex

The horror of finding out that due to blockers that, for example, the penis hasn’t developed fully and your child will never have a full sex life is just terrible

"the surgery was a complete success, unfortunately the patient died"

Reconstruction can only try to put back what was there. A women without a vagina (eg DSD) would not have reconstruction either, only those where the vagina had been damaged (cancer, injuries from child birth). The corruption and obfuscation of language leads to deaths.

But no it isn't an experiment. For it to be an experiment it would have started with the question 'is this the right thing to do?'

JHB talking about this in Talk Radio now and Rosie Duffield. Talking to Helen Joyce

RIP to that poor young man. What a terrible, avoidable thing to have died from.