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Feminism: Sex and gender discussions

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

999 replies

MaudTheInvincible · 16/09/2021 19:19

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. 💚🤍💜

The judgment in Keira Bell's case will be given tomorrow
OP posts:
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7
MrsOvertonsWindow · 03/10/2021 22:38

Nope - random adults determined that children will be given drugs and surgery before they are legally and emotionally competent to decide to abandon their future fertility and physical health - let alone the impact on their long term mental health..

No no no. As Mumsnet saying goes:
NO is a complete sentence.

MrsOvertonsWindow · 03/10/2021 22:39

Keira has made a significant impact on all this by exposing the appalling lack of standards and lack of ethical tested medial treatment of children in this area.

Helleofabore · 03/10/2021 22:48

The whole point of this thread is that there is a recognizable difference with this cohort.

This current cohort is also over taxing the limited resources of the NHS. There is very little evidence that puberty blockers will provide any benefit to this group of female adolescents and may in fact, cause harm. There are noted serious negative side effects that we have evidence for with very large numbers from Lupron. One of the drugs used for puberty blockers.

But Let’s stop playing around here and limiting the discussion to puberty blockers. We know that 98+% go on to CSH once they are on puberty blockers.

To therefore limit the discussion to puberty blockers is disingenuous.

OldCrone · 03/10/2021 22:56

[quote ButterflyHatched]@Helleofabore...you keep talking about there being no evidence that blockers improve mental health.
70-strong study: pubmed.ncbi.nlm.nih.gov/20646177/

If you know any kids on blockers, try asking them.
Did you grow up with any at the time when it was age-relevant? I did. There were plenty of us. The effects were very clear. We were still trans - still experiencing gender dysphoria - but they stopped it getting worse.[/quote]
A free pdf of that paper is available here.
www.academia.edu/download/31777111/de_Vries_(2011)_Puberty_Suppression_in_Adolescents_with_GID_JSM.pdf

I noticed this in the introduction which is interesting:
Although some gender identity clinics have adopted this strategy of puberty suppression for adolescents with GID, other professionals working with gender dysphoric youth remain critical (e.g., Viner et al. [17]). They are concerned that GnRHa may be physically hazardous for adolescents and that psychological functioning may be negatively affected by suppressing puberty. Furthermore, they state that one’s gender identity is still subject to change during adolescence and that adolescents are therefore unable to make decisions regarding GR.

The reference Viner et al is this one:
Viner RM, Brain C, Carmichael P, Di Ceglie D. Sex on the brain: Dilemmas in the endocrine management of children and adolescents with gender identity disorder. Arch Dis Child 2005;90(suppl II):A78

Carmichael and Di Ceglie are/were at GIDS (I'm not sure who the other authors are). So in 2005, GIDS were very cautious about the use of puberty blockers, stating much of what we are concerned about now. What changed?

I haven't been able to find this paper, not even an abstract. All I can find is this page where a pdf can be requested from the authors.
www.researchgate.net/publication/291111442_Sex_on_the_brain_Dilemmas_in_the_endocrine_management_of_children_and_adolescents_with_gender_identity_disorder

Helleofabore · 03/10/2021 23:01

Oh no oldcrone that link isn’t working for me. Total me I was in the wrong aisle…

Helleofabore · 03/10/2021 23:01

But thanks anyway.

That was really interesting about Viner and Carmichael et al though.

Helleofabore · 03/10/2021 23:08

@CharlieParley

Given that puberty blockers are already used in children experiencing early onset puberty to delay it, I would assume they're safe in the appropriate dose, and I make no claim whatsoever to know more than endocrinologists on this. I don't know why you are, to be honest.

Your assumption is wrong scarpa, for two reasons. Number one is that you are assuming that treating precocious puberty and blocking puberty at normal adolescence are the same thing. They are not.

In the case of children diagnosed with precocious puberty, PBs are used to halt abnormal development.

In those patients PBs are typically discontinued at the earliest possible time to allow the child to go through an early, but not precocious puberty. (Around nine years of age or so.)

These children are going through a normal puberty at a normal time for children (precocious puberty is almost always caused by underlying health conditions or as a result of medical treatments for other serious health conditions). And they still suffer horrendous longterm side effects.

In the case of children diagnosed with gender dysphoria, PBs are used to halt normal development.

When PBs are discontinued, the child does not proceed with normal development because it a) lags far behind its peers - and we've had various accounts of how damaging that is - and b) the body continues to age throughout the adolescent years even though puberty is halted.

There is enough evidence for instance to show that when brain development is arrested through the use of GnRH analogues (only called PBs when used to halt puberty), the brain is permanently altered (such as a lower IQ and certain brain functions like spatial memory).

Number two is that even in children with precocious puberty, the effects of puberty blockers are life-limiting and seriously harmful. I have written about this at length on other threads, so I'm just reposting this one from the previous thread about this appeal:

I urge you to read up on GnRH analogues (only called puberty blockers when used in pediatric medicine), their history, the deaths they caused, including in children and the downright irresponsible way in which the FDA continues to ignore tens of thousands of reports of serious adverse side effects of the drug. Between 2013 and 2019, that's more than 46,000 including over 6000 deaths in the US alone. The FDA itself on investigating these reports (and other reports concerning different drugs) has publicly stated several times that it estimates that only between 1 and 10% of serious adverse side effects are ever reported to the FDA, so the true number of people damaged by GnRH analogues is likely more than ten times larger than the known figures.

Please note what this is: a discussion of the facts of giving puberty blockers to children with precocious puberty or stunted growth. Objections to their use in these children has nothing whatsoever to do with hatred, irrational or otherwise and everything to do with preventing harm coming to children from a medical treatment.

Puberty blockers aren't damaging.

This is an insidious lie. It goes hand in hand with two other insidious lies:

Puberty blockers have been used in children with precocious puberty for decades without problems.

and

The safety of puberty blockers used in children has been very well researched and there are no longterm side effects.

For the truth we have to look to the US, where thousands of women who received the GnRH analogue Lupron to treat precocious puberty or ensure a taller stature are desperately trying to raise awareness of the debilitating, life-limiting longterm side effects of the drug.

By now, most of us here on Mumsnet know about the effect GnRH analogues have on bone health, causing brittle bones which has caused paralysis in cases where the spine was particularly damaged by the drug as well as incontinence. Most of us have heard about the chronic, debilitating pain puberty blockers caused in the young patients and now adult child patients.

What's less known is that GnRH analogues are extremely powerful neural function modulators, also causing debilitating mental health issues, including severe depression, personality disorders, suicidality, anxiety and other mood disorders.

The EU completed a review of mental health issues caused by GnRH-analogues in 2010. Since then warnings about the drugs causing depression and suicides have had to be added to the patient leaflets in the EU.

In the 28 years since licensing the drug, the FDA has carried out several safety reviews of Lupron, acknowledging its dangerous side effects in all patient groups for whom the drug is used, but it is unwilling to withdraw the licence. (If you know anything about how the FDA goes about licensing drugs, you'll know the process is neither transparent nor as thorough as it should be.)

After the company that developed Lupron was forced to enter into evidence all studies it conducted on the efficacy of the drug when used in women with endometriosis, Dr David Redwine analysed the raw data and found that the FDA had only been provided with summaries that misrepresented the findings and omitted data from patients who were adversely affected. When he submitted a 300-page report to the FDA it did not dispute his findings. A year after Dr Redwine's submission it merely published a response saying no regulatory action necessary.

In 2012, a law proposal in New York was tabled to prohibit the prescription of the drug without including a warning on the bottle stating that it could cause death, heart attacks, diabetes and seizures.

Given the immense commercial interests connected to this drug, which makes more than 600 million dollars annually in the US alone, it is almost impossible to get that licence withdrawn. And not just in the US. The 2010 EU report for instance is almost entirely redacted in order to protect those "commercial interests."

<a class="break-all" href="https://www.google.com/url?sa=t&source=web&rct=j&url=www.madamadari.com/endometropolis/wp-content/uploads/2014/10/Redwine-Lupron-presentation-Brazil-The-D-is-silent.pdf&ved=2ahUKEwjx46SXiIvyAhXkhf0HHYUnC4sQFjAJegQIJRAC&usg=AOvVaw1SqpRS48-bp8-JZgo8FrUE&cshid=1627657618764" rel="nofollow" target="_blank">Here is Dr Redwine's analysis of the data btw.

So, yes, puberty blockers are indeed damaging and they have horrific side effects (just to add a few more: causing cancer, gastro-intestinal diseases, heart diseases, lung diseases, fetal malformations, ovarian hyper stimulation syndrome, polycystic ovarian syndrome and so on). And it doesn't matter whether it's Lupron or Triptorelin (branded as Trelstar, Decapeptyl, Gonapeptyl), Goserelin (branded as Zoladex), Histrelin (branded as Vantas, Supprelin), Nafarelin (branded as Synarel) or Buserelin (branded as Suprefact, Suprecor). Lupron is merely the best known because most sold of the lot. All of them have a known adverse event profile. That's because GnRH analogues are bloody dangerous drugs listed as "Hazardous" for HCPs handling them btw, that cause a lot of life-long, debilitating and often disabling side effects.

So much for not damaging and used without problems. Now a quick foray into how well researched their safety is in children. In a development that should surprise no one, they're not well researched at all. Available studies are sparse, subject numbers are usually in the single digits. Studies frequently omit data from child patients with adverse reactions (or as in the case of children who died while receiving Lupton for precocious puberty, the study authors declare no connection between death and drug without providing any supporting evidence for such a declaration).

This is a well known problem in drug trials generally, owed in no small part to the conflict of interest that arises from having the drug company seeking to sell the drug fund and organise its safety trials.

The situation is so dire that in one paper I read recently, one study author researching treatment options for precocious puberty lamented the absolute dearth of reliable studies into the safety of GnRH analogues when used in children.

There is no comprehensive body of research into the safety of these drugs when given to children for precocious puberty or stunted growth. It does not exist in anywhere near the volume that it needs to to prove safety. Everyone assumes it does, because the drug is widely subscribed.

Lots of information about the dangers of Lupron can be found on this website:

lupronvictimshub.com/index.html

Some patient and parent testimonies are here:

www.hormonesmatter.com/lupron-precocious-puberty-parents-patients-speak/

Looking into this horror show of drugs however at least explains why the use of puberty blockers in children diagnosed with gender dysphoria has not been shown to improve mental health outcomes.

Because these drugs cause mental health problems. Several patient and parent accounts in the link above describe children who turned suicidal, some as young as 8, after being put on these drugs for precocious puberty.

We are constantly confronted with the claim that children diagnosed with gender dysphoria must be given puberty blockers because they are so severely depressed, even suicidal that not to do so is hateful and unjustified.

How do you justify giving drugs proven to cause depression and suicidality in child patients to children who are already depressed and suicidal?

I hope Charley doesn’t mind me reposting this here. I think it is a good reminder.
OldCrone · 03/10/2021 23:08

@Helleofabore

Oh no oldcrone that link isn’t working for me. Total me I was in the wrong aisle…
I see what you mean.

Try the pdf link from here:
scholar.google.co.uk/scholar?hl=en&as_sdt=0%2C5&as_ylo=2011&as_yhi=2011&q=puberty+suppression+adolescents+disorder+author%3Asteensma+author%3Ade+author%3Avries&btnG=

Helleofabore · 03/10/2021 23:15

And purgatory posted this too.

www.lupronvictimshub.com/

2002 a prospective study found "joint disorder/pain = 76%, depression = 35%, hypertension = 7.04%, weight changes = 14.8%" with lupron treated patients. And, to name just a few, safety label changes have added hepato-biliary disorders, interstitial lung disease, and convulsions to lupron's label.

From a FDA study.

PurgatoryOfPotholes · 03/10/2021 23:25

Helleofabore, you mentioned a lack of data from post-2015 patients. This came out on Friday. Literally three days ago. Adults, not children, but the abstract looks really interesting.

Abstract

Background

UK adult gender identity clinics (GICs) are implementing a new streamlined service model. However, there is minimal evidence from these services underpinning this. It is also unknown how many service users subsequently ‘detransition’.

Aims

To describe service users’ access to care and patterns of service use, specifically, interventions accessed, reasons for discharge and re-referrals; to identify factors associated with access; and to quantify ‘detransitioning’.

Method

A retrospective case-note review was performed as a service evaluation for 175 service users consecutively discharged by a tertiary National Health Service adult GIC between 1 September 2017 and 31 August 2018. Descriptive statistics were used for rates of accessing interventions sought, reasons for discharge, re-referral and frequency of detransitioning. Using multivariate analysis, we sought associations between several variables and ‘accessing care’ or ‘other outcome’.

Results

The treatment pathway was completed by 56.1%. All interventions initially sought were accessed by 58%; 94% accessed hormones but only 47.7% accessed gender reassignment surgery; 21.7% disengaged; and 19.4% were re-referred. Multivariate analysis identified coexisting neurodevelopmental disorders (odds ratio [OR] = 5.7, 95% CI = 1.7–19), previous adverse childhood experiences (ACEs) per reported ACE (OR = 1.5, 95% CI = 1.1–1.9), substance misuse during treatment (OR = 4.3, 95% CI = 1.1–17.6) and mental health concerns during treatment (OR = 2.2, 95% CI 1.1–4.4) as independently associated with accessing care. Twelve people (6.9%) met our case definition of detransitioning.

Conclusions

Service users may have unmet needs. Neurodevelopmental disorders or ACEs suggest complexity requiring consideration during the assessment process. Managing mental ill health and substance misuse during treatment needs optimising. Detransitioning might be more frequent than previously reported.

www.cambridge.org/core/journals/bjpsych-open/article/access-to-care-and-frequency-of-detransition-among-a-cohort-discharged-by-a-uk-national-adult-gender-identity-clinic-retrospective-casenote-review/3F5AC1315A49813922AAD76D9E28F5CB

NotBadConsidering · 03/10/2021 23:36

but you keep claiming there is no evidence that blockers have a positive effect on mental health, and that's just not true!

They don't 'cure' gender dysphoria, but they delay one of the factors that makes it worse. CSH and GRS, meanwhile, largely do. That's...the whole point!

The Pediatrics study did not control against other children with gender dysphoria. It showed that there were positives one year after surgery around the age of 20. One year. In comparison to other general 20 year olds who were not gender dysphoric.

This makes sense. Teenagers who believe that surgery is an amazing goal that finally gets realised are sure to be happy about it, euphoric even, as they must be to explain the fact they are happier than your average 20 year old. But this study does not show what would have happened if left alone. And it does not show the years after. Imagine if you have surgery and it’s all you’ve ever wanted and someone asks you how good it is, you’re biased to saying yes, but now? That study was published in 2014. Where are they now? How happy are they now? How different could it have been if left alone? We don’t know because a) there was no “left alone” group and b) we don’t know how happy these adults are now, while they’re still young but long past the point of being studied.

It’s the same with the Costa study. 12 months. That’s sod all. It’s the same thing. They’re convinced puberty is the devil, so when it’s “paused” they feel better. It’s hardly groundbreaking. But what about later on? What about if they’d been left for longer?

Not to mention how neither of these studies are applicable to girls with trauma.

It just highlights the point I made earlier about the impatience of trans healthcare. It’s all about Now! Now! Now! The fallout is years later.

Helleofabore · 03/10/2021 23:39

Thank you Purgatory

That looks hugely interesting!!!

And yes… there is that ‘unmet needs’ that I suspect may be quite likely to be more prevalent. Because of what we do know about this current group and their comorbidities.

It is interesting about ‘detransitioning’ stats. I look forward to reading that and getting my head around it too.

PurgatoryOfPotholes · 03/10/2021 23:42

Some highlights.

Twelve cases (12/175, 6.9%) were agreed by all authors to meet the case definition for detransitioning. Regret was specifically documented in two cases. Eight were natal males (seven male to female, one male to non-binary); all had accessed oestradiol and one had accessed GRS. Four were natal females (three female to male, one female to non-binary); all had accessed testosterone and chest surgery during this episode of care, none had accessed GRS. Nine of the twelve had evidence of discontinuing hormones, two had no information documented about hormones and one continued with hormones. Four of these 12 were re-referred into the service during the period of data collection since de-transitioning.

Six cases did not strictly meet the criteria for detransitioning but showed some overlap of experience. One of these six has been re-referred. Four natal males (three male to female, one male to non-binary) had made only partial role transitions so did not meet the case definition; they inconsistently used hormonal interventions and expressed uncertainty about their gender and/or transitioning. Two natal females (one female to male, one female to non-binary) expressed gender identity confusion, one used testosterone inconsistently and both cancelled chest surgery; neither, however, clearly reverted back to their original gender role and therefore did not meet the case definition.

(Continues)

As data collection occurred for only 16 months after the most recent discharge, we may have underestimated the frequency of detransitioning. There is some evidence that people detransition on average 417or 8 years18after completion of transition, with regret expressed after 10 years.10Furthermore, as there is no automatic mechanism to inform GICs of service users who subsequently detransition, other instances may have been missed. We gleaned only a limited understanding of those who detransitioned, owing to our reliance on notes. Regret was specifically documented in two cases but may or may not have been experienced by others too. Conversely, the process of transitioning and subsequently detransitioning may, in its own right, have been a positive experience for some.

(Continues)

Notwithstanding the possibility that the rate of detransitioning we found (6.9%) is an underestimate, it is notably higher than the only other published figure from a UK clinic of 0.33%11despite using the same case definition. This likely reflects methodological differences insofar as we looked at patients discharged by the GIC and had access to subsequent information over a 16 month period rather than looking only at service users in treatment. A US survey-based study of people identifying as transgender described patterns of detransitioning and then attempts to retransition akin to our observations.12

www.cambridge.org/core/journals/bjpsych-open/article/access-to-care-and-frequency-of-detransition-among-a-cohort-discharged-by-a-uk-national-adult-gender-identity-clinic-retrospective-casenote-review/3F5AC1315A49813922AAD76D9E28F5CB

Very important to note that the patients discharged for non-attendance may include detransitioning patients, whose views have gone unrecorded.

Helleofabore · 03/10/2021 23:45

NotBadConsidering

That interesting. Did it refer to the improvement with puberty blockers only then?

I think I posted a study that followed up on patients on the European mainland over a 10+ year period and included stats relating to after genital surgery patients. On that one, by 10 years 8-9% were no longer living as the sex they had transitioned too. It was a released around 2015 to 2017.

PurgatoryOfPotholes · 03/10/2021 23:48

I need to check the citations, next.

In this week's one, it very clearly says "[t]here is some evidence that people detransition on average 4 or 8 yearsafter completion of transition, with regret expressed after 10 years", with three citations given for that statement.

Datun · 04/10/2021 00:00

ButterflyHatched

Can you say why you think you have gender dysphoria?

There appear to be consistent reasons for the youth showing up at gender clinics, often around homophobia. But I have heard people theorise that it is something in the water (literally!).

Helleofabore · 04/10/2021 00:01

www.ncbi.nlm.nih.gov/pmc/articles/PMC5580378/

quite a number of the transitioners seemed to have detransitioned to the point where they stated they were no longer living 'as the opposite sex'? This is a small study but states:

135 natal males (119 living in the female role, 12 in the male role, 4 did not report their current gender role) and 66 natal females (60 living in the male role, 5 in the female role, 1 did not report a current gender role)

So... 8.88% of males and 8.33% of the females (this does not include those who did not answer the question which if the answer was to detransition would make these figures higher). And in Figure 3. 22.2% of those who socially transitioned, detransitioned.

ButterflyHatched · 04/10/2021 00:03

@OldCrone - my treatment was in fact handled by Viner and Brain about five years before that paper was published!

NotBadConsidering · 04/10/2021 00:07

@Helleofabore

NotBadConsidering

That interesting. Did it refer to the improvement with puberty blockers only then?

I think I posted a study that followed up on patients on the European mainland over a 10+ year period and included stats relating to after genital surgery patients. On that one, by 10 years 8-9% were no longer living as the sex they had transitioned too. It was a released around 2015 to 2017.

The Costa study did. Michael Biggs wrote a letter in reply, but I can’t access that through my institution and it requires a one off payment of 35 USD! I’m all for pointing out errors in studies they’ve posted on MN but not at that price! All I can infer is that if Michael Biggs felt compelled to write to them, there will certainly be question marks about the validity of the data.

Through this whole thread, which is almost full, ever since Butterfly started engaging, nothing has advanced the knowledge of what we know:

• individual adults say they’re happy, but don’t know how any of their peers are
• there is lack of knowledge among individuals about their own health risks
• there is repeated efforts to use poor, low quality, short term studies to demonstrate benefits to the medicalisation of children despite many organisations specialising in analysis of medical evidence ruling them out
• there has been no one who has defended the ability of a 10 year old child’s ability to consent to giving up their future sexual function as an example, which is telling. Everyone knows these children do not have the capacity to consent to such a thing. Consent remains the crux of the matter.
• there has been persistent avoidance needing regular reminders that the cohorts are different; there is no evidence this pathway helps girls with trauma and distress.
• no one can even accurately describe what is being treated.

I stand by my belief that the medical affirmative pathway of puberty blockers, wrong sex hormones and surgery being administered to children without the capacity to consent to the long term consequences, treating a vague condition, with significant, severe physical side effects is the medical scandal of our time.

Helleofabore · 04/10/2021 00:20

Thank you Keira, for your bravery in speaking out.

For more information, remember you can visit the Post Trans site below. Such inspirational people speaking out and trying to cut through the noise.

post-trans.com/

Helleofabore · 04/10/2021 00:32

Here is a website for a growing network of practitioners around the world working to support the much needed research into providing a range of treatment options for trans people, particularly young people.

segm.org/

Helleofabore · 04/10/2021 00:35

Here is another group worth looking at their resources too.

genspect.org/

Helen8220 · 04/10/2021 00:35

And here is the very clear and well reasoned decision of the Court of Appeal
www.judiciary.uk/wp-content/uploads/2021/09/Bell-v-Tavistock-judgment-170921.pdf

Helleofabore · 04/10/2021 00:36

Thank you again Keira.

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