Research into detransition in RCPsych journal

[WarriorN]

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

A very insightful piece of research

This critique echoes my cognitive biases about the purported value of these questionnaires after having taken the ACE and BCE today:

www.coyneoftherealm.com/2017/11/15/stop-using-the-adverse-childhood-experiences-checklist-to-make-claims-about-trauma-causing-physical-and-mental-health-problems/

Offhand, however, I'm not familiar with alternative psychological evaluation instruments that the authors of the paper in question might have used.

Dr Jess Taylor has been critical of how BCEs are used (I don't remember details) but I also have reservations. Some people have more or less resilience than others and any neuro diversity of any sort, or even just different characters, can change how one individual copes with similar events.

I don't know enough about the wider area of research though to fully comment. As a teacher a child with many "ACEs" is always on our radar.,

Thanks, WarriorN - I've located a video talk by Jess Taylor that I'll watch later.

I wonder if they used ACEs in the study because that was what was recorded in the patients’ notes they were assessing rather than choosing them as a methodological tool? (Disclaimer: it might say in the study but I haven’t checked)

@GrandmaMazur

I wonder if they used ACEs in the study because that was what was recorded in the patients’ notes they were assessing rather than choosing them as a methodological tool? (Disclaimer: it might say in the study but I haven’t checked)

Spot on: if that's what was recorded at that centre then that's all that was available to them.

More accurately, I ought to have questioned why anyone thought it was a suitable instrument to include as part of the assessment process.

To be fair, the ACE does seem to have been adopted without prior review and validation, afaict. That Taylor video is eye-opening and I'm shocked that Public Health England (if I understood her correctly) are partly behind this.

Yea that's what I've seen Time (ive had a brain burp and used BCEs rather than Aces in my last post.)

Thanks for the explanation, Alexa.

[quote TimeToDateAgain]Thanks, WarriorN - I've located a video talk by Jess Taylor that I'll watch later.

[/quote] Wow. That video is awful! (The one Dr Taylor is critiquing not the one you’ve linked to) How on earth did that get made???

It is awful, I've been shown it in safeguarding sessions. I will add that we then did some stuff on BCEs.

@WarriorN

Thanks Alexa

Is it just me sniggering that the answer comes from Alexa?

@WarriorN

It is awful, I've been shown it in safeguarding sessions. I will add that we then did some stuff on BCEs.

I had to renew safeguarding training earlier this year but it was online which is possibly why this wasn't part of it.

It was an extra bit of safeguarding stuff around trauma.

We had an excellent one around whistle blowing and safeguarding linked to culture of a work place; how this can make it harder to follow good safeguarding practise due to blurred personal boundaries or strong characters dominating the culture of the setting.

I've been sniggering at Alexa too!

@JellySlice

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.

No shit, Sherlock.

Is this a reputable study in a reputable journal?

It’s a pretty reputable journal and it’s as good as study as possible when it can only be done retrospectively, because no one had the foresight, diligence or interest in ensuring good follow up prospectively.

The question should be, why has it taken this long for something obvious to everyone to be published in a medical journal?

Unfortunately some of them really seemed to believe that they would actually change sex once they transitioned and the reality could have a huge impact on their mental health.

This is appalling. Surely medics have a responsibility to give full information on the outcomes before seeking consent?

Surely medics have a responsibility to give full information on the outcomes before seeking consent?

One of the known ethical issues in consenting people for a trial is therapeutic optimism . I'm not talking about children here necessarily but adults - so there shouldn't be the extra problems.

Even if the trial recruiter asks for the 'teachback' as a way to check that somebody understands that (say) this Phase 1 trial is not going to have a curative outcome for them because it's just a dose-finding study (for a drug), an adult will give the 'correct' response. But…probing further, alongside this intellectual acceptance, the person has therapeutic optimism that somehow it will be different for them and they will have a curative outcome.

For scenarios such as those who believe they will change sex, they have a ready made supportive network telling them that this is true ('Don't listen to the doctors, they have to tell you that'). This mythology is maintained by ostracising the detransitioners and others who question the narrative.

It's like those groups who genuinely believed that they would live forever. As time went on, and people observed themselves ageing and began to question how this immortality would work, they would be excluded. If reports came in of their deaths, 'They stopped believing'. I've sometimes wondered what happened to this people and if they ever acknowledged the reality around them. (Of course, I could be wrong, and they're all hanging out in Shangri-La with She ).

@WhatMattersMost

I think the politically incorrect, but more truthful imo, interpretation of the much-touted connection between trans and mental health issues leading to suicide is that many of those who attempt or commit suicide are not suicidal because they need to transition and are being prevented from doing so: they are transitioning because they are trying to deal with already-existing suicidal feelings whose causes are linked to childhood abuse and/or neglect - which they then find to their despair and detriment are not solved after transitioning.

There was an organisation previously who were claiming that transitioning could cure autism.

So there are forums of peers telling them transitioning will be a magic bullet, backed by advocacy groups with cod science and then doctors seem to view mentioning risks as a tick box exercise. No wonder detransitioners are feeling suicidal when it's not the solution they expected.

Checking and it turns out it was GIRES who made these claims:
mobile.twitter.com/MrsNickyClark/status/1300736691502829568

It is worth noting that this study finds that

"Twelve people (6.9%) met our case definition of detransitioning."

which should give pause to those rushing towards transition as an appropriate solution for everyone who asks for it.

Brand new US website attempting to track numbers of detransitioners and encourage contacting their surgeons/ drs:

detranscount.wixsite.com/website

Tweet promoting the site twitter.com/kev_cub27/status/1445763374390734856?s=21

There was an organisation previously who were claiming that transitioning could cure autism.

Lupron was also touted as an autism treatment.

Quite notably, "Science Based" Medicine's Gorski - who's now totally gung-ho on giving Lupron to trans kids - was part of the pushback on that.

The comparison with his current behaviour is almost comical.

Chemical castration for autism: After three years, the mainstream media finally notices (Gorsky, 2009)

But of all the biomedical woo to which autistic children have been subjected, one form of woo stands out as being particularly heinous. Indeed, I agree with our fearless leader Steve in characterizing it as an “atrocity.”

I’m referring to Mark and David Geier’s favored “treatment” for autistic children, namely a drug called Lupron.

Now, he's all for it, as long as it's for "trans kids".

Now, he's all for it, as long as it's for "trans kids".

Baffling.

More specifically, that would be for girls (I can't think why lupron would be helpful to gender non-conforming boys).

And, if the current trends in numbers were to be confirmed, they would largely be girls on the autism spectrum. So, an atrocity for the autism, but completely understandable for other reasons.