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. 💚🤍💜

What I’m saying is that I wouldn’t agree, as a general principle, that a person who wants to dress in stereotypically women’s clothes (etc) must be trans. But that doesn’t affect the way I treat trans individuals, and it’s not for me to judge or second guess the reasons that led any particular person to be trans.

When you talk about people being trans, what exactly do you mean? There are many definitions and I'd like to know which one you are using in your posts. You're obviously not using the all-encompassing Stonewall trans umbrella definition, since you exclude cross-dressers. What is your definition of 'trans'?

I'm conscious of the post count's inexorable advance toward the limit, so and I'd like to take the opportunity to say thanks to all for an informative thread.

@Helleofabore:
So I take it Butterfly that you accept the sections of Baker that I copied and pasted that are relevant to the topic of adolescent female transitioners.

I don't think I've ever disputed the relevance or importance of this research. Anything that helps make treatment safer for young people is invaluable.

And if you knew anything, anything at all about the current cohort which I believe you don’t, you would know that the starting point for the teenage females who are trans in this current cohort is very poor and usually combined with comorbidities.

I do! It's well known and documented and I know people going through it right now! I've never disputed this. I agreed with this point in a post back on page 21, saying that Should trans boys be given access to blockers, if they ask for them, after careful evaluation? As a matter of principle, of course my answer should be an unreserved yes - however, I think a measure more leeway can be given here.

...when it comes to a tug of war between the two, it's testosterone that seems to have right of way in terms of permanent, irreversible and distressing effects that are liable to cause harm and lead to negative long term outcomes.

I do think that trans boys have less immediate, devastating pressure to get on an early treatment pathway; testosterone is a vicious body-warping engine of transformation, and -without wanting to minimise their struggles in the slightest, as the monkey's paw definitely curls in other ways- they tend to get an easier ride as late transitioners.

You're arguing against an argument I've never made! I think we agree that today's point of contention is the 2017+ Tanner 2/3 Female-Assigned cohort.

I think I've argued my case (that wholesale banning Blockers for all adolescents isn't the answer) reasonably well, and hopefully dispelled at least some of the fears and myths about long term outcomes (i.e. that we actually have a fair number of datapoints, and we don't hear about them because they're largely happily living their lives trying not to get drawn into the gravitational pull of these debates which can have very negative effects on our mental health).

Right from the start, I was expecting to have to defend my own integrity as a personal datapoint - I'm an outsider jumping in and providing a voice that challenged some of the well-entrenched and picked-over concerns evidenced here. I think it's a little ludicrous that it's been assumed that I haven't been closely following the research. I'm a living part of the research, even if I haven't been cited.

Like many on this forum, I've been following the (sparse) news about research into Blockers quite intently - it's a subject of understandable curiosity to me, and I've often worried about the long term impacts especially for those who enter the treatment process even earlier than I do. I've been reassured by the tentative evidence so far, despite lamenting the new struggles faced, and am horrified by the news of the chronic systemic struggles that GIDS has had to deal with, which have made it extremely difficult to provide the quality of care that patients deserve. Other teams around the world have been better able to withstand the ongoing demands of the Gender Renaissance, and are slowly publishing their findings.

As has been pointed out, this isn't just a problem that GIDS is facing - waiting lists are utterly atrocious across the board, and it can take half a decade to practically arrive at the point of receiving actual treatment for a condition that's come to hang as a miserable blight over one's life. These factors have a massive impact on the integrity of research, as the treatment pathway extends well beyond the realm of endocrine interventions. I know the lack of ability to access surgery throughout my early twenties had a huge effect on my own mental health, which would have impacted on any followup studies that were performed. I know also that the vicious social attitudes of the time -which sadly are still a factor- contributed to a hugely negative effect on my own levels of anxiety - I've quoted hypervigilance and a constant baseline need to keep others at arm's reach for my own protection.

I'd like to give a bit of a reality check on the results of the quality of life and mental health studies that involve blockers as part of a treatment pathway; the numbers involved and the conclusions drawn from them can be a little abstract and detached from the personal aspect. I've also noticed that the goalposts keep shifting in these kinds of discussions when it comes to evidence.

We start with 'transitioning is an inherently harmful erasure of the GNC behaviour we used to know, love and build entire communities around when there weren't healthcare provisions in place; we should teach people to love and accept their bodies and stop subdividing themselves up into unhelpful identities. Nobody should transition.' This is a viewpoint regularly expressed by some posters on this thread. I actually find this a hugely compelling philosophical stance on the entire concept of attempting to modify our bodies to align with societal expectations, and when argued from the perspective of non-trans people trying to protect people they don't consider to be trans, it has a great deal of merit. However:

When demonstrated that there are cohorts of people for whom expressing GNC behaviours and presentations are insufficient to address gender dysphoria and for whom transitioning seems to be the only treatment that tips the cost/benefit scales favourably, the argument shifts. 'Ok maybe it might help some people; perhaps there is a clinical need in some cases - but how do you know who will benefit? How do we know who is 'genuine' and who is just confused? A lot of kids are confused and distressed during puberty but they don't grow up to be trans, do they?'

In sympathy of this thorny issue, psychiatric clinicians have developed a systematic evaluation system over several decades of revision and iteration to create a cost/benefit suitability metric for protecting against harm and providing a case for hormonal and surgical intervention. It isn't perfect, but it seems to at least serve as some kind of guide. The goalposts change. The stance becomes 'people are being tricked by the medical establishment into believing that transgenderism is a medical condition and that the only way to be happy is to transition! We have no proof that transition makes people with GD happier; doctors are just putting words into their mouths so they can claim success in their experiments and Big Pharma can make lifelong patients out of them'.

When studies are conducted that report high rates of happiness over transitioning many years after the fact, and the abject failure of conversion therapy, it becomes 'you can't trust people to self-report their own happiness; the methodology of these studies is questionable. Only evaluation by psychiatric clinicians can really prove people are actually happy.'

When followup studies on transitioners are conducted by psychiatric clinicians, and similarly find positive outcomes, it becomes 'ok maybe transitioning is able to make some adults happy. They aren't really happy of course - they still show heightened anxiety and depression in comparison with the rest of the population, and some of them regret having GRS.'

When it's pointed out that gender dysphoria is an ongoing issue that carries its physical and psychological scars forward throughout and out the other side of transition; that it's hard living in a transphobic world that grew up on using trans people as the punchline to a joke and debates your right to exist and hurts you when it recognises you as 'other' causes anxiety and depression; where being unable or unwilling to have surgery yet due to waiting lists or worries about outcomes carries its own psychological load, and where ghoulish cadres of online trolls maintain libraries of undesirable surgical outcomes in order to torment and harass trans people and 'prove' to them that their surgeries are imperfect (we know, we're sad about it, we'll live with it): we go right back to 'well that's proof that nobody should transition as it'll only make them sad, then.'

When a compromise technique is developed to help 16+ people (who have been established as meeting the diagnostic criteria and are deemed likely to transition in adulthood anyway) from avoiding the unwanted effects of puberty so they can avoid the worst of their gender dysphoria and have a better chance of escaping transphobia in adulthood, it becomes 'This is an off-label use of a poorly researched experimental drug! They can't consent! They should have to wait until they're 18!'

When initial studies are provided showing that transitioning actually seems to work for appropriate adolescents in the 16+ cohort, and a tiny generation of trans people silently grows up and disappears off to live their lives while a few brave individuals stick around and open themselves up to public scrutiny, it becomes 'You have no evidence of positive outcomes! What about side effects? What about long-term damage? You're transing kids, reinforcing the gender binary and setting them up for a lifetime of medicalisation!'

When evidence of positive outcomes is provided, which still reflect the heightened anxiety and bleakness of living with a miserable secret past in a society that hates you but sometimes doesn't know it yet, it becomes: 'These results are inconclusive and the sample sizes are small! There are confounding factors!'

Yes. There are. It's still hard to be trans even if you don't get beaten up for walking to the shops anymore. You're still infertile. You're still on lifelong medication. These are miserable things, but we respectfully assert our agency in being able to choose to endure them, as we are all too aware that the alternative is worse. When we point this out, the argument becomes 'It's duplicitous and cowardly anyway. People should be open and proud about being trans. They should challenge restrictive and outdated notions of gendered expression. Why are you in such a desperate scramble to conform to society's expectations?' sigh aaand we're right back to the beginning again. We medically transitioned because conforming to society's expectations demonstrably wasn't alleviating gender dysphoria, and nor was simply socially transitioning and/or not conforming. There was something else there; another axis on our graphs.

When clinicians move to treating earlier stages of puberty in order to improve both immediate and long-term dysphoria-reducing effects and address some of the confounding factors, the goalposts shift again. 'It is unproven at this younger age range! There will be permanent side effects! Gillick competence can't apply in the case of gender dysphoria! There are co-morbidities!'.

All good points, worthy of sober consideration and great care. So this protocol has been in effect for nearly a decade in the Netherlands, and not long after in other places. Time alone doesn't convey authority, of course, but reports show that while there are some (expected) complex negative and irreversible side effects from wholesale delaying puberty, none of them seem to be absolute show-stoppers, many of them are rendered irrelevant by later/adjusted surgical or hormonal interventions, and as always, it's up to clinicians to work closely with the individual on a case by case basis to decide what works for them. This is the protocol that GIDS tries to follow, but logistical constraints mean that patients who come to them have been waiting 2+ years for their first appointment already (nowadays it's 3+)

Meanwhile, Gillick competence has been tested to the limit in the UK in a landmark case and, while it evidently has huge flaws, GIDS is eventually found to be acting within the law in prescribing blockers to under-16's (the tiny proportion who even get that far), sadly obstructing a year's worth of kids who actually managed to get their way through the waiting lists in the process.

The goalposts have now shifted again, becoming: 'Ok so maybe it's ok - though difficult and complicated - for assigned-male patients. What about the recent extremely young female-assigned cohort that has seen a significant increase in numbers? And a small but growing number of prominent detransitioners? Isn't this evidence of so-called ROGD/social contagion?'

That's where you're arguing from now, @Helleofabore. And I think it's a good point. There are unanswered questions.

It's been established that:

-GD/GI is an observed, subjective phenomenon.
-We don't know 'why' it happens.
-Treatment helps some people address GD/GI.
-Adolescents are more likely to desist than adults.
-Adolescents who reach the stage of endocrine intervention are less likely to desist.
-Endocrine intervention in the 16+ cohort as part of what is now a worldwide well-represented and standardised 25+ year old protocol can still result in expressed regret and even detransition in a small number of cases - much like amongst adults - but is largely very successful.
-Endocrine intervention in the tanner 2/3 cohort, while also adopted worldwide, has complicating factors and more significant negative side effects - and there are especial concerns about younger female-assigned patients with comorbidities.
-Claims that blockers are completely reversible for this younger cohort are rightly contested. GIDS has altered its documentation on this subject, as have other services worldwide, in light of treatment now being offered to under-16's.
-A pivot toward affirmation/informed-consent based models of treatment has coincided with an increase in referrals due to social factors. Caution should be observed in ensuring that high standards of care are maintained in the face of overwhelming pressure and interference from lobby groups.
-It's important to carefully evaluate all patients and the current NHS-wide logistical issues are straining capacity to breaking point.

There's a history of trying to map 'causes' onto people's experience of gender dysphoria.

For some time, it wasn't commonly believed that FTM/AFAB trans people even existed as a 'real' phenomenon, and after that was disproven (by the time I discovered the concept of transsexualism was a serious, known phenomenon with a name, it was in a mid-90's documentary about some of the first adolescent trans men to go to GIDS, for reference), the ratio of presentation to gender clinics was heavily skewed toward MTF/AMAB, and that was used as 'evidence' in ludicrous pseudoscience theories that tried to 'explain' the ratio with flawed taxonomies to filter out the 'fakers'; then after that, when media representation showed the wider world that trans men actually exist - a sizeable number of whom later transitioned in adulthood anyway as they'd had no idea it was an option in childhood - the ratio stabilised toward an even split.

We've largely settled down into a healthy awareness of how social factors can affect the rate at which people seek referrals to gender clinics, in the same way that social factors affect the rate at which people seek referrals to Autism and ADHD clinics. (Of course, neither of these offer potentially irreversible medical treatment pathways - though ADHD medication can have some pretty severe negative side effects, and either way a diagnosis has a significant impact on a person's legal standing and self-image).

There have been frequent references to the growing number of detransitioners - still a small proportion of those who pursue transition, but a real and significant phenomenon that has become more visible now that the total number of transitioners has significantly increased. Their existence indicates that transition isn't a universally positive panacea - it won't fix your life if you're sad for other reasons. It might help with gender dysphoria, however. For some, medical transition isn't what they hoped it would be; for some, it's a disaster. This isn't a new phenomenon but it's a sobering one. I regularly check up on a number of detransitioner communities - I'm very glad that people feel more able to discuss this subject. It's important, if challenging. It's always been!

Historical studies that have investigated the statistics in the past have often focussed on the use of the term 'regret' while completely failing to acknowledge the broad definition of the term 'regret'. Poor surgical outcomes are cited as sources of regret. Brutal treatment by a trans-hostile society is cited as a source of regret. Parental disapproval and familial estrangement is cited as a source of regret. This has obfuscated stats and led to an incredibly unhelpful perception within parts of the LGBT community that detransition is a myth.

Within the detransitioner communities there also exists a growing cadre of retransitioners, who after a few years, have realised that actually, their gender dysphoria does still exist and they do still want treatment after all; many of them have alas reported that coercive tactics have been used by some detransitioner communities to silence them for complicating the narrative or betraying a shared bond - a criticism also levelled at trans communities for doing the same in turn. They're only just starting to find the courage to speak about their own experiences, often from a position of great fear and embarrassment, and pointing out that transition, detransition and even retransition aren't linear journeys that 'prove' a person was or wasn't trans. There's nothing to prove. They cite, with a sense of wry irony, the need to give people 'thinking room' in making drastic life-changing decisions, and that this also applies to detransitioners.

A greater awareness that a linear transition pathway isn't suitable for everyone experiencing gender incongruence - that medical treatment, if it is warranted, is about finding a place that is comfortable for you rather than conforming to society - aided by a more nuanced understanding of gender and greater social acceptance of transness in general, has allowed us to step out from this oppressive and obstructive need to keep fighting to 'prove' transness is even real at a foundational level.

In so doing, nuanced discussion on the subject is possible; it's been resoundingly established that gender dysphoria is real - as we've been saying for at least a hundred years in a recognisable form - and transition can help some people. When discussing the 2017+ tanner 2/3 female-assigned cohort, the conversation is framed in terms of worrying whether or not it will work for them like it does for others. This implies that we can, at least, acknowledge that it works for some others.

Attempts to keep resetting back to 'but actually, does it though?' so we go through arguing the same point all over again, don't help anyone. They don't answer anything that hasn't been answered hundreds of times before. We're here, discussing one particular corner in contrast to the rest, because it evidently does.

There are important questions about the safety of very young tanner 2/3 transitioners in the female-assigned cohort when it comes to endocrine interventions, which are as yet unresolved. There is some pretty grim evidence that it isn't a perfect shining road to happiness. If it's been represented as that, then something has gone very terribly wrong somewhere.

I don't understand why we keep coming back to this and demanding I provide evidence defending a position I don't even hold!

I'm not an ambassador for a monolithic 'trans ideology' that preaches gendered souls and that everyone who fails to conform must transition; I'm a previous patient who believes in careful evidence-based approaches to healthcare and has benefited from 25+ year old treatments that are now being wholesale attacked and demonised in the press and in court cases, and the result is a practical threatening of a lifeline for people like I was, some of whom I know personally, which has prevented any useful treatment being administered for anyone who might need it.

I've had to watch the already desperate flailing of young people I know over the last few years rise to fever pitch following a court case about one person who was already old enough to have a child or join the army at the point at which she pursued irreversible treatment. The eventual outcome of that case? 'No it's fine, actually carry on, Gillick competence stands intact and trans kids aren't magically incapable of making informed decisions after all. Sorry to all those kids who just irrevocably lost a year's worth of time-critical lifetime-dysphoria reducing treatment, some of whom had it cruelly taken away at the last minute, for no reason.'

If I'd been in that situation, staring down the barrel of the NHS coldly demonstrating how little it actually gives a damn about people like us, watching my prospects trickle away, I'm not sure I'd have been strong enough to withstand it. From regularly speaking to many kids in that situation now, and their families, I'm full of admiration at their courage and endurance.

I'm so sorry also to those who feel the system has let them down; that society has let them down; that politicians have let them down; that their own communities have let them down. I'm so, so sorry for those who have struggled against parental disapproval and rejection just to get to the point where they even could make their feelings known.

I acknowledge the agony of being a parent and wanting the best for your child when they are behaving in ways that confound your beliefs, especially if you struggled with similar issues in your childhood. I understand your caution, and your hope that it'll all turn out fine and your daughter will just grow up to be a happy GNC woman like you. I understand your worries that she'll grow up to regret leaping into taking drastic measures that strain the boundaries of medical science. This is a fair and rational fear that any parent has. My parents had it too! They maintain to this day that even though their fears proved unfounded, they were right to be cautious - and I agree.

I think my generation suffered in ways that are almost incomprehensible to those growing up now, but that suffering afforded us a clarity of judgement (and message) that is much harder to find now.

So, yes, we need to carefully scrutinise the 2017+ tanner 2/3 cohorts, especially the female-assigned ones with complex MH comorbidities, to see if a medical pathway is actually right for them; yes we need to step out from under the ridiculous shadow of stereotyped assumptions, boy and girl toys, and pink and blue brains, and give gender non-conforming kids space to work things out.

Calling for a wholesale ban on blockers, however, isn't the way to address this. It disregards all the positive outcomes for people who needed them and it not only directly hurts the people who do benefit from them but also causes immense psychological harm to have them removed as an option.

Many (not all) on this thread have suggested doing just that - because they might not be suitable for everyone and we should all just be happy being gender non-conforming anyway. That isn't our reality. It's just throwing the desperate people who need them under the bus. I'm gender non-conforming, AND I'm trans. These are separate things. You can be one, none or both of them. The need to seek treatment is about gender dysphoria/incongruence; not about conforming to stereotypes. Being a gender non-conforming boy did not work for me; I tried. I really, really did. I grew up into a gender non-conforming woman, and I'm proud of who I am. Others will find different paths. All those paths are right. All those paths are 'real'.

Trans isn't a straightjacket. It's an option; a catalogue of options, in fact; a key in the lock of the concept of gender, and feminism has turned it and set us free.

Safeguarding safeguarding safeguarding safeguarding
Children children children children children

Girls girls girls girls girls girls

Let's keep the the needs of children centred in all this. Their right not to be coerced or gaslit by adults. Their right to grow and develop as children free from external influences telling them they might be born in the wrong body and that drugs and surgery will fix their pubertal angst. Their freedom to grow to an adulthood free from drugs, surgery and major body modification .

Then having the adult freedom to explore their identity, live as the same or opposite sex and enjoy the full range of legal rights that are accorded to everyone in this country.

Thank you Keira for all your efforts in trying to ensure this.

I've had to watch the already desperate flailing of young people I know over the last few years rise to fever pitch following a court case about one person who was already old enough to have a child or join the army at the point at which she pursued irreversible treatment. The eventual outcome of that case? 'No it's fine, actually carry on, Gillick competence stands intact and trans kids aren't magically incapable of making informed decisions after all. Sorry to all those kids who just irrevocably lost a year's worth of time-critical lifetime-dysphoria reducing treatment, some of whom had it cruelly taken away at the last minute, for no reason.'

Why does any child need to be medicated for this condition which apparently is not a physical illness or a mental health condition? And if it's not a physical illness or a mental health condition why does it require any medication at all?

This is nothing to do with Gillick competence. It's about a child's ability to consent to medical treatment which will leave them sterile and with impaired sexual function, at an age when they have yet to experience sexual activity and desires. Many women on here have said they didn't want children... until they did, sometime in their 20s or 30s. Pre-pubescent children cannot possibly understand what they are giving up. This is what is being cruelly taken away from these children.

And all this is being done to treat a condition which is not an illness. (I would like to know what you think it is since it isn't a physical illness or a mental health condition, but still requires medication.)

I acknowledge the agony of being a parent and wanting the best for your child when they are behaving in ways that confound your beliefs, especially if you struggled with similar issues in your childhood.

What 'beliefs' do you think are being confounded?

Calling for a wholesale ban on blockers, however, isn't the way to address this. It disregards all the positive outcomes for people who needed them and it not only directly hurts the people who do benefit from them but also causes immense psychological harm to have them removed as an option.

You seem to have forgotten that this discussion is about a specific group of people - children. The needs of adult transitioners are different.

Allow me a moment.

I want to modify the things you say have been established:

-GD/GI is an observed, subjective phenomenon. and as such has been classified as a medical condition, not a medical condition, a quasi medical condition on that basis of what those who experience it reequest not somthing seen in other dysphoric ailments.
-We don't know 'why' it happens.

• Some Treatment helps some people address GD/GI. But, as many studies in this thread show, very many individuals experience absolutely zero impact on mental health issues at all

-Adolescents are more likely to desist than adults. if left alone, not started down a medical pathway -Adolescents who reach the stage of endocrine intervention are less likely to desist actually, they may want to but it is too late by then, irreperable damage is done - See KB -Endocrine intervention in the 16+ cohort as part of what is now a worldwide well-represented and standardised 25+ year old protocol can still result in expressed regret and even detransition in a small number of cases - much like amongst adults - but is largely very successful Erm... is it? Is it really worldwide well-represented and standardised? Then what was Weberley doing when she made it up as she went along because there is/was no standardised pathway and what are the Ednocrine Society, GIDS and the Tavi talking about whent hey, this week, expressed the need for more research? -Endocrine intervention in the tanner 2/3 cohort, while also adopted worldwide, has complicating factors and more significant negative side effects - and there are especial concerns about younger female-assigned patients with comorbidities. But it's only girls! And this is the core of what we, the Endorine Soc, GIDS etc have been trying to make HW et al see -Claims that blockers are completely reversible for this younger cohort are rightly contested. GIDS has altered its documentation on this subject, as have other services worldwide, in light of treatment now being offered to under-16's. And yet lobbying continues to make this unecessary here in the UK. So many arguing that kids a young as 11 should be medicalised, not doing so is utter transphobia etc! -A pivot toward affirmation/informed-consent based models of treatment has coincided with an increase in referrals due to social factors. Caution should be observed in ensuring that high standards of care are maintained in the face of overwhelming pressure and interference from lobby groups. It's us and our support of lobbying groups that have forced a change. And you can't uphold high standards when the organisations and individuals involved didn;t have any - See Helen Weberley and the Tavi's lack of records! -It's important to carefully evaluate all patients and the current NHS-wide logistical issues are straining capacity to breaking point. And here we are looking at female services being used up by transwomen. So females end up ill, with decreased life expectancy so a transomwn can get their medication, chest implants etc etc. All documented along the eway on this thread and a few others over the last few days

You see we care when women's rights, medicines and health are taken up by the people you feel sorry for. We see the imbalance, we see how women's health is being negatively impacted and we will continue to say NO!

And, as others have said, this thread is primarily about children. The safeguarding of children, who are not mini adults, whose bodies need entirely different care.

And if you read my posts I have pointed out that in saying

Should trans boys be given access to blockers, if they ask for them, after careful evaluation? As a matter of principle, of course my answer should be an unreserved yes - however, I think a measure more leeway can be given here.

...when it comes to a tug of war between the two, it's testosterone that seems to have right of way in terms of permanent, irreversible and distressing effects that are liable to cause harm and lead to negative long term outcomes.

I do think that trans boys have less immediate, devastating pressure to get on an early treatment pathway; testosterone is a vicious body-warping engine of transformation, and -without wanting to minimise their struggles in the slightest, as the monkey's paw definitely curls in other ways- they tend to get an easier ride as late transitioners.

you have not acknowledged the effects of puberty blockers on teenage females. You say that as a matter of principle, you cannot say they shouldn’t if they want them. And then point out that Testosterone is irreversible.

We have also then pointed out that there seems no going back once children (under 18s) are set on the medicalised path. In other countries, this has also proven true. Not just in the UK.

I think I've argued my case (that wholesale banning Blockers for all adolescents isn't the answer) reasonably well, and hopefully dispelled at least some of the fears and myths about long term outcomes

Really, I have not noticed your posts arguing for puberty blockers being the absolute last resort.

If you have, I have missed it or it has gotten lost in amongst posts that seem to say that there is little effect and you even posted one study that indicated little problem with bone density as if to say ‘you are all believing falsehoods’. When we have other studies and the Lupron evidence (which also actually includes regular posters personal experience with that drug themselves) that adequately counter that one study you have produced.

If you have posted that you have issue with the current affirming only treatment that is being pushed by activists and that you support treatment options that offer extensive assessment for comorbidities and significant and long term psychotherapy before any puberty blockers or CSH are even mentioned (which according to the court transcripts seem to not be the case at the moment) and I have missed those post.

Please point me to the posts, and accept my apologies.

@MrsOvertonsWindow: Let's keep the the needs of children centred in all this
I thought that was what we were talking about? The needs of children? Their right to express themselves and exercise agency in informing the trajectories of their own lives?

@OldCrone: Why does any child need to be medicated for this condition which apparently is not a physical illness or a mental health condition? And if it's not a physical illness or a mental health condition why does it require any medication at all?
Because treatment, which should only come after a sober cost/benefit analysis of positive and negative factors and informed consent, helps some people address GD/GI - and that outcome is deemed by both themselves and their clinicians as being worth the negatives.

You seem to have forgotten that this discussion is about a specific group of people - children. The needs of adult transitioners are different.
Did you read what I said? Banning all uses of blockers causes direct, immediate unnecessary harm to children who need them, and reduces their future prospects, all for fear of the possibility of causing harm to some children who might not. This is nothing to do with the needs of adult transitioners. It's about adolescents, dealing with immediate problems in adolescence, with a view toward their futures as well.

There we have it, blockers must be given even if they cause immense harm to those who do not need them.

No Hatched, you're overlaying a personal adult view of an ideology on what you think suits children.
The rest of us - mothers, parents, teachers, safeguarding experts, scientists, biologists, doctors, psychologists, educators and a host of other occupations with the majority of us being women, know that children must be allowed to safely develop as children. We use our professional experiences along with our experience of parenting and children to inform us in what keeps children safe.
Drugs and surgery promoted by self interested adults / groups harm children.

Did you read what I said? Banning all uses of blockers causes direct, immediate unnecessary harm to children who need them, and reduces their future prospects, all for fear of the possibility of causing harm to some children who might not. This is nothing to do with the needs of adult transitioners. It's about adolescents, dealing with immediate problems in adolescence, with a view toward their futures as well.

And this is where we go around and around isn’t it.

all for fear of the possibility of causing harm to some children who might not.

It is the continued grouping of the adolescent male and female transitioners as one homogeneous group that is the problem. You are well aware that our concerns are more for the young female adolescent transitioners although it is concerning for young males too.

Those young females who have been let down considerably by GIDs and clinics worldwide because any hint that research into their motivation and needs was deemed as problematic, and when it came to simply reviewing the GIDS patient files… they cannot be used for any useful research.

So your argument hinges on the continuing affirming only treatments for all transitioners (you qualify this as for those who need them), when clinicians are saying it is causing harm amongst that female group (the dominant group). That historic protocols and pressure on resources are allowing patients for whom hormonal treatment is not the best option for them.

And now with the even bigger backlog you are suggesting the clinics, in desperation, should simply keep on the same path. Regardless of whether the patient is male or female?

Have I read that correctly?

That historic protocols and pressure on resources are allowing patients for whom hormonal treatment is not the best option for them.

Should be

That historic protocols and pressure on resources are allowing patients for whom hormonal treatment is not the best option for them to be referred to that treatment option.

@ButterflyHatched what sort of condition do you believe is being treated by this medication? What is gender dysphoria if it isn't a physical illness or a mental health condition? What exactly is being treated here? Why does it require medication? We don't normally give untested, irreversible medication with severe side effects to children (or anyone else) to 'treat' something which is neither a physical nor a mental health condition.

@RedDogsBeg

There we have it, blockers must be given even if they cause immense harm to those who do not need them.

For a condition which is not a mental health condition, and is (obviously) not a physical illness.

Why? Why are healthy children being medicated in this way?

@CuriousaboutSamphire

Allow me a moment.

I want to modify the things you say have been established:

-GD/GI is an observed, subjective phenomenon. and as such has been classified as a medical condition, not a medical condition, a quasi medical condition on that basis of what those who experience it reequest not somthing seen in other dysphoric ailments.
-We don't know 'why' it happens.

• Some Treatment helps some people address GD/GI. But, as many studies in this thread show, very many individuals experience absolutely zero impact on mental health issues at all

-Adolescents are more likely to desist than adults. if left alone, not started down a medical pathway -Adolescents who reach the stage of endocrine intervention are less likely to desist actually, they may want to but it is too late by then, irreperable damage is done - See KB -Endocrine intervention in the 16+ cohort as part of what is now a worldwide well-represented and standardised 25+ year old protocol can still result in expressed regret and even detransition in a small number of cases - much like amongst adults - but is largely very successful Erm... is it? Is it really worldwide well-represented and standardised? Then what was Weberley doing when she made it up as she went along because there is/was no standardised pathway and what are the Ednocrine Society, GIDS and the Tavi talking about whent hey, this week, expressed the need for more research? -Endocrine intervention in the tanner 2/3 cohort, while also adopted worldwide, has complicating factors and more significant negative side effects - and there are especial concerns about younger female-assigned patients with comorbidities. But it's only girls! And this is the core of what we, the Endorine Soc, GIDS etc have been trying to make HW et al see -Claims that blockers are completely reversible for this younger cohort are rightly contested. GIDS has altered its documentation on this subject, as have other services worldwide, in light of treatment now being offered to under-16's. And yet lobbying continues to make this unecessary here in the UK. So many arguing that kids a young as 11 should be medicalised, not doing so is utter transphobia etc! -A pivot toward affirmation/informed-consent based models of treatment has coincided with an increase in referrals due to social factors. Caution should be observed in ensuring that high standards of care are maintained in the face of overwhelming pressure and interference from lobby groups. It's us and our support of lobbying groups that have forced a change. And you can't uphold high standards when the organisations and individuals involved didn;t have any - See Helen Weberley and the Tavi's lack of records! -It's important to carefully evaluate all patients and the current NHS-wide logistical issues are straining capacity to breaking point. And here we are looking at female services being used up by transwomen. So females end up ill, with decreased life expectancy so a transomwn can get their medication, chest implants etc etc. All documented along the eway on this thread and a few others over the last few days

You see we care when women's rights, medicines and health are taken up by the people you feel sorry for. We see the imbalance, we see how women's health is being negatively impacted and we will continue to say NO!

And, as others have said, this thread is primarily about children. The safeguarding of children, who are not mini adults, whose bodies need entirely different care.

Thanks Curious.

I agree with your clarifications there.

And question

Endocrine intervention in the 16+ cohort as part of what is now a worldwide well-represented and standardised 25+ year old protocol can still result in expressed regret and even detransition in a small number of cases - much like amongst adults - but is largely very successful

And what about its application to under 16 year olds?

@MrOvertonsWindow: ...and having actually made these decisions myself as a child and asked for this treatment as a child and benefited from it, as a child, is irrelevant? Banning blockers would have drastically decreased my quality of life both at the time and later.

@RedDogsBeg: No. Banning an effective treatment that works for most people who exhibit a set of symptoms because there are a tiny number of people it seems to work for and then many years later doesn't is just a very strange way of looking at things. It makes sense to carefully regulate when it's applied and to whom, though, and to be doubly certain when a combination of sociological factors and comorbidities can stack the deck a certain way for a particular cohort that stands to lose the most from an uncautious attitude.

Their right to express themselves and exercise agency in informing the trajectories of their own lives?

What hope of them making good healthy choices when there is a complete bias to affirming only treatment? Where comorbidities are not treated first, or even identified in some clinics due to the push against this type of treatment as it is considered conversion therapy.

Where there is no balance shown by some support groups and others who advocate a balanced approach are called transphobic.

Where charities are sending out free binders to girls at their friend’s addresses? Some charities, indeed some teachers in schools, even teach children that their parents are transphobic and that glitter families are there for them.

If none of the above existed, I might consider that children had clear ability to make wise decisions. Having a teenager, I can assure you that the decisions of this magnitude that my teen would have made two years ago would be very different to now and that is through maturity. But the influences they face are certainly not without extreme bias.

And we have practitioners raising the alarm that these children are coming in pre-rehearsed and misinformed for multiple countries.

So if we want children to have agency, maybe it is time for activist groups to give them actual balanced information. Not, here is some negatives, oh look here are all the positives focus on them. Not, we know what is better for you than your parents, contact us and we will give you that binder and no… you will feel so much better, don’t worry about the few negatives. (I have seen this across quite a few prominent sites).

Because there is no hope for balance at this time.

an effective treatment that works for most people who exhibit a set of symptoms

Symptoms? Is it a mental health condition now? Non-illnesses aren't usually described as having 'symptoms'.

Or are they treating people who aren't actually ill?

It makes sense to carefully regulate when it's applied and to whom, though, and to be doubly certain when a combination of sociological factors and comorbidities can stack the deck a certain way for a particular cohort that stands to lose the most from an uncautious attitude.

And can you tell us then, how this regulation is being done at GIDS and based on what? What research has actually been done on the post 2015 referrals that has allowed a new protocol to be developed. One that doesn’t allow a cued up adolescent to quickly move through any process?

Did you read what I said? Banning all uses of blockers causes direct, immediate unnecessary harm to children who need them, and reduces their future prospects

That's not true. It depends on what you consider is relevant to their future prospects. Focusing on boys, as you have, use of blockers means no sexual urges, an undeveloped penis, and the need to use bowel instead of inverted penile tissue.
That sounds like much worse future prospects for having sex.
The future prospects that are improved in boys by the use of blockers are all related to passing. Form not function.
And there appears to be little point in using them in girls, aside from the prevention of menses, because they just make the girl shorter. Plus girls' bone density suffers more and recovers less. So really there's not much to recommend them in boys and nothing to recommend them in girls.

@OldCrone

an effective treatment that works for most people who exhibit a set of symptoms

Symptoms? Is it a mental health condition now? Non-illnesses aren't usually described as having 'symptoms'.

Or are they treating people who aren't actually ill?

Exactly.

A prescribed treatment protocol for patients who are neither mentally or physically ill?

and the justification for the harms it causes is oh well, that's okay, oh dear never mind?

I'm not even convinced that blockers are all that necessary for passing in most boys. An eighteen year old white male is unlikely to have developed a mature hairline yet. He's not going to be as heavyset as when he is thirty or fifty. His features are less masculine than an older man.
We haven't really had a large contingent of boys transitioning at 18 before, so we can't compare boys on blockers who transition at 18 to boys who transition at 18 without blockers. I know this thread is focused on girls, but I'm not convinced there's much of a case for boys either. And the stunting of the penis due to blockers is really quite a serious thing to do to someone.

Where else in the medical field are people treated when they are neither mentally or physically ill?

Where else within the medical field are people prescribed medication and a course of treatment that can have serious long term irreversible effects when they are neither mentally or physically ill?

Where else in the medical field are people treated when they are neither mentally or physically ill? Well, there was that doctor who treated hundreds of patients for cancer, none of whom had cancer - Farid Fata?!?! $20 million ish collected from Medicare and private insurance companies.

@Helleofabore: It is the continued grouping of the adolescent male and female transitioners as one homogeneous group that is the problem. You are well aware that our concerns are more for the young female adolescent transitioners although it is concerning for young males too. I'm sympathetic to this argument - more sympathetic than I should be, it turns out, as I've just discussed this point with trans guys of my acquaintance and their responses were...well I feel enlightened.

So your argument hinges on the continuing affirming only treatments for all transitioners (you qualify this as for those who need them), when clinicians are saying it is causing harm amongst that female group (the dominant group). That historic protocols and pressure on resources are allowing patients for whom hormonal treatment is not the best option for them.
I think we want to continually review historical protocols and take a careful look at social factors when it comes to diagnostic criteria. But see below.

@FlyingOink: And there appears to be little point in using them in girls, aside from the prevention of menses, because they just make the girl shorter. Plus girls' bone density suffers more and recovers less. So really there's not much to recommend them in boys and nothing to recommend them in girls. Your statement re: their use in male-assigned individuals denies the reality of many, many many lived experiences. For female-assigned, see below.

So it was asked for earlier:

Having done a quick check of my various adolescent-transitioning trans guy mates, their incisive takes on the whole 'female-assigned patients should be treated differently' argument are:

"Not having access to blockers when my puberty hit caused me massive problems with depression."

"This is massively underestimating the trauma of going through puberty as an AFAB person whose gender identity isn't female - and sure, part of that is society sexualising teenagers who're read as female, but there's a whole lot of physical stuff going on there too."

"I would abso-bloody-lutely have gone for puberty blockers if I'd been able to - a chunk of the reason I was suicidally dysphoric was the sudden onset of menstruation/breast-growth/hips-widening which smacked straight into my brain going 'this is a one-way thing and there is no way to reverse it'"

"I get very pissed off by it (this argument), honestly. Blockers earlier would have made my life so much nicer!"

"We'll do whatever the fck we want with our breasts and wombs, and arguments about trying to control how we interact with our own bodies are not* any better because they're coming from women."