Prospect Magazine: Kathleen Stock v Robin Moira White

[Ereshkigalangcleg]

Great discussion.

https://www.prospectmagazine.co.uk/essays/gender-wars-two-opposing-perspectives-on-the-trans-and-womens-rights-debate

Gender wars: two opposing perspectives on the trans and women’s rights debate
A lawyer and philosopher respond to seven propositions—ranging from single-sex spaces to puberty blockers for children

A bit of a looking glass here, methinks. I have contact with several families of trans-identifying young people seeking assistance and the reality is that they are currently prevented from receiving it by the mess caused by the Bell case - to the great distress of those involved. Who do you identify as 'adults seeking to further their political agenda and prevent proper research ; safeguarding etc'? If so, young people would be being hurried through transition and that simply isnt occurring, as far as I can see. And I would be very unsympathetic to that, if it was. I do not recognise this as occurring and I'm pretty close to the relevant space. I fear you are being sold a line by someone.

Firstly, I have had the medical affirmative pathway presented to me by gender specialists with zero critical analysis of these issues, purely ideological, so yes it is happening. And yes children are being rushed through transition. I know children who should absolutely not be on puberty blockers given their history.

And second, you ignored the part about children and families, not just clinicians, being influenced by this idea touted that they should be given access to puberty blockers. They read things that are written by trans activists about how essential they are and feel they are obliged to seek them out. And as for

Who do you identify as 'adults seeking to further their political agenda

The answer is you! You continue to perpetuate and advertise your belief that your life would be better had you had puberty blockers. You think everyone should get the choice of this. Your agenda is to keep repeating this. I don’t know what your motive is but it’s an agenda that is wholly political on a hot political topic; it’s not a medical agenda that’s for sure, because you always ignore the medical aspects.

I don’t believe you have a deliberate agenda that prevents research and safeguarding, but by continuing to advocate for a medical pathway from a political agenda point of view from a position of influence, and putting pressure on the debate with your “I so wish I could have had this option”, you are indirectly making it harder for clinicians to stop this pathway completely in its current format to allow prospective research to occur.

The 80% number is nothing to do with gender dysphoria but comes from a survey of children who display any degree of gender-questioning behaviour - as defined by researchers who had a particular agenda.

This is incorrect. Several longitudinal medical studies of children diagnosed with gender dysphoria prior to puberty (and treated prior to the Dutch Prootocol aka the Affirmative approach being used) showed high and very high desistance rates, up to 96%. The 80% rate may be an aggregate but it is not from a mere survey of sex-stereotype-non-conforming children.

What the studies show is that puberty is the trigger for desistance in this patient cohort, severity of gender dysphoria is not a reliable predictor for persistence or desistance and that gender dysphoria is a more reliable predictor for a child being homosexual than transsexual.

Furthermore, the Dutch Protocol (aka Affirmative Approach) was developed for prepubescent children diagnosed with gender dysphoria, something that occurred rarely, with a prevalence of about 6 in 100,000.

It was not developed for the now prevalent patient cohort of older children, diagnosed in adolescence and post-adolescence at a rate of about 1 in 100, which is why the Dutch clinicians who developed the puberty blocker pathway have long since raised the alarm about their protocol being used on a different patient cohort (and stripped off its most important part to boot - intense psychological assessment exploring root causes coupled with psychological treatment before embarking on puberty blockers).

The Tavistock has already publicly stated that in contravention of the Dutch Protocol, psychological treatment is not part of their treatment approach, and according to whistle blowers as well as detransitioners neither is intense psychological assessment.

So before we even get to whether children under 16 can give informed consent to treatment, we ought to look at whether informed consent can be possible at any age to an experimental treatment offering many life-limiting side effects and few to no benefits beyond cosmetic ones.

Correction: I should say who present with gender dysphoria at a rate of 1 in 100. I don't know what the current prevalence rate is for diagnosis, but referral rate rises of over 2000% strongly suggest we're looking at a far higher prevalence rate than 6 in 100,000.

RMW thanks for replying.

'My belief is that I had all the capacity required to make a choice about my gender aged 12'

You only know you and are thinking of your situation.

If children could be prescribed blockers, then hormones before puberty had kicked in, or was just getting started. It would apply to ALL children.

Girls start puberty younger on the whole than boys.

Some girls start periods at 9, 10. Not terribly uncommon.

That means starting puberty at age 7/ 8.

My own DDs both started puberty at 8.5, the initial visible signs include breast buds.

They both started periods before year 6 (before the final year of primary school). That would be too late obviously. I assume halting breast growth would be important, as I mentioned that's a change that is early in the process.

Meaning they would have really need to start blockers at 8.5 years old.

So putting your personal experiences to one side and considering ALL children, as they would and should be able to make this decision around the start of puberty.

If that means blockers at 7, 8. Which it would, and not rarely but for plenty of children.

Does that alter your opinion on the ability of children across the board to know, understand, give informed consent to blockers, and then hormones while also that much younger?

4w.pub/children-suffered-health-problems-after-puberty-blockers-sweden/

is a recent thing and may not have been absorbed by those who advocate any child who wants them being given puberty blockers.

"the Karolinska Hospital confirmed it was aware of the cases of at least 13 youths who had received puberty blockers and experienced medical side effects as a result. According to a report published this week in Swedish-language SVT, a number of impacted minors experienced "major side effects and medical injuries" as a result of going on puberty blockers."

How many children is an acceptable number to be caused "major side effects and medical injuries" by a chemical given to them by under-informed adults? 13? 130? 1,300?

I don't believe any prepubertal child, no matter how precocious, has the capacity to consent to losing future fertility and sexual function.
Moreover, as the main cohort now presenting at gender clinics are female, the taking of puberty blockers will not help their gender dysphoria, as it will result in their growth being stunted, giving them no hope of "passing" in their chosen gender.

Who do you identify as 'adults seeking to further their political agenda and prevent proper research ; safeguarding etc'? If so, young people would be being hurried through transition and that simply isnt occurring, as far as I can see.

I would suggest reading the Tavistock's own investigations and their whistleblowers' comments. Political steering and politically motivated interference from lobby groups is consistently noted, and the staff themselves have voiced concerns of process is 'hurried' without proper time and care. Methinks. This is public domain information.

And yes I did find your background interesting.

Your long term passion for trains I understand, I have some family members who share it! Not as involved as you though! Being so active in something you love just be brilliant.

Anyway.

You gave some info but it wasn't really clear what you were saying.

I think you were saying that with your impressive science quals etc, and with legal sector being so inclusive, you believe you would have been able to/ would have followed same path.

That really is fantasy.

In your first job, on the railways, were there many women in the same role, or direct equivalents? This was the what, late 70s, early 80s?

You studied science at impy, early 80s? How many women were on your course? Not around generally but your coursemates?

I went to a university that was solely science in the early 90s and even then out of maybe 80 that were my course mates IE same subject same year, there were 5 women including me.

My a level choices were similarly skewed. There were only 4 who did the same a levels, the other 3 were boys.

Constant overt and subtle messages from everywhere that this was weird, why do that? Why not biology instead of X? Two maths is really hard why not just 1? Why not X degree (related but more.. suitable).

This was I reckon 10 years after you.

If you believe that due to your brains and drive you would have had exactly the same opportunities, not met with pushback, overt sexism. Have been evaluated identically to a young man when getting railway job, uni place.

Then you're ignoring a crucial consideration.

Or do you have your own views on the history of girls, women, education, sexism, deeply and widely embedded societal biases, ability to enter massively male jobs/ sectors etc? I'd be interested to hear your thoughts.

The decision-making capacity of children would seem likely to be a topic barristers would learn about; those dealing with cases involving children anyway. Age of criminal responsibility, consent to sex, Gillick competence etc.

I'd have expected a barrister to be likely to show evidence of being well informed on the topic.

On the 'female diaspora', all I can say is that Mitochondrial Eve got around a bit.

@lottiegarbanzo

The decision-making capacity of children would seem likely to be a topic barristers would learn about; those dealing with cases involving children anyway. Age of criminal responsibility, consent to sex, Gillick competence etc.

I'd have expected a barrister to be likely to show evidence of being well informed on the topic.

Yes - capacity as a concept in law also involves the relationship with actual or likely consequences, so someone with disputed capacity can be held to have capacity to make certain decisions but not others - it’s “decision specific”.

A teenager similarly might be held to have capacity on some decisions, but not others. Such as yes on whether to be an atheist (no real consequences), but no on irreversible experimental medical treatment with unknown future side effects (lots of potential consequences).

I can only imagine female diaspora refers to women getting certain kinds of separation from males?

Sort of. En masse (minimal- only some circs) leaving society as a whole, departing from being people in society, in order to get away from men? (In certain circs which varied and still vary around the world).

I don't know if that's the meaning but I can't think of anything else that might fit at all.

(Of course, if God turns out to be real, as per Pascal’s Wager, you seriously lose the bet on the long term consequences of atheism, though 🤣)

@CharlieParley

The 80% number is nothing to do with gender dysphoria but comes from a survey of children who display any degree of gender-questioning behaviour - as defined by researchers who had a particular agenda.

This is incorrect. Several longitudinal medical studies of children diagnosed with gender dysphoria prior to puberty (and treated prior to the Dutch Prootocol aka the Affirmative approach being used) showed high and very high desistance rates, up to 96%. The 80% rate may be an aggregate but it is not from a mere survey of sex-stereotype-non-conforming children.

What the studies show is that puberty is the trigger for desistance in this patient cohort, severity of gender dysphoria is not a reliable predictor for persistence or desistance and that gender dysphoria is a more reliable predictor for a child being homosexual than transsexual.

Furthermore, the Dutch Protocol (aka Affirmative Approach) was developed for prepubescent children diagnosed with gender dysphoria, something that occurred rarely, with a prevalence of about 6 in 100,000.

It was not developed for the now prevalent patient cohort of older children, diagnosed in adolescence and post-adolescence at a rate of about 1 in 100, which is why the Dutch clinicians who developed the puberty blocker pathway have long since raised the alarm about their protocol being used on a different patient cohort (and stripped off its most important part to boot - intense psychological assessment exploring root causes coupled with psychological treatment before embarking on puberty blockers).

The Tavistock has already publicly stated that in contravention of the Dutch Protocol, psychological treatment is not part of their treatment approach, and according to whistle blowers as well as detransitioners neither is intense psychological assessment.

So before we even get to whether children under 16 can give informed consent to treatment, we ought to look at whether informed consent can be possible at any age to an experimental treatment offering many life-limiting side effects and few to no benefits beyond cosmetic ones.

Stonking post

@334bu

I don't believe any prepubertal child, no matter how precocious, has the capacity to consent to losing future fertility and sexual function. Moreover, as the main cohort now presenting at gender clinics are female, the taking of puberty blockers will not help their gender dysphoria, as it will result in their growth being stunted, giving them no hope of "passing" in their chosen gender.

Exactly. If we are honest and admit that blockers for boys are about a more believable aesthetic result at the expense of having a penis that works, that's one thing (and trust me, it's bad enough).

But for girls? The bone density effects are even worse, the suicidality is still there, the outcome is a prepubescent very short person - how does this make for a more believable aesthetic outcome as a "man"?

I don’t see why a nuanced approach to puberty blockers wouldn’t be permitted even if you were a TRA and all for them. Why don’t we ever hear of late transition transwomen saying “for some children, especially boys with a long sustained childhood history of rejecting their gender, I support the availability of puberty blockers; BUT I’m concerned about the huge increase in gender distress in teenage girls, especially those with autism, because the impacts of blockers on that cohort may be more severe, and they may also be masked by other comorbid mental health conditions and/or childhood sexual abuse, and in those cases should be treated with great caution?”

That would be a perfectly respectable position to take and perfectly sensible and rational. But no, we don’t hear this being articulated at all.

In fact I’m quite surprised to hear Robin - who as a barrister ought to know about capacity and decision-making in a lot more depth and complexity - suggesting that complex medical consent in child patients is just exactly like choosing one’s favourite religious belief.

The 80% number is nothing to do with gender dysphoria but comes from a survey of children who display any degree of gender-questioning behaviour - as defined by researchers who had a particular agenda.

Which survey are you referring to? Apart from the studies mentioned by other posters I have found one which says:
...a substantial minority (2–27% across studies) will continue to report GD and may seek services for gender reassignment later in life. ... To date, the prospective follow-up studies on children with GD, for whom the majority would meet the DSM-IV-TR diagnostic criteria for Gender Identity Disorder (GID)1 collectively reported on the outcomes of 246 children. At the time of follow-up in adolescence or adulthood, these studies showed that, for the majority of children (84.2%; n=207), the GD desisted.

Factors Associated With Desistence and Persistence of Childhood Gender Dysphoria: A Quantitative Follow-Up Study

The authors include Thomas Steensma and Peggy Cohen-Kettenis, who are part of the Dutch team who first gave puberty blocking drugs to children. Do you believe they have 'a particular agenda'? If so, what do you think that might be?

I'd have expected a barrister to be likely to show evidence of being well informed on the topic.

The article in the OP gives me the impression that Robin wants people to believe that the courts decided children are able to consent as per Gillick and this can be left to the treating team:

In the recent Bell v Tavistock case, the High Court headed off on a frolic of its own to rule that it was “unlikely” that a child under 14 could be competent to consent to puberty blockers, and that it was “doubtful” a young person aged 14 or 15 could do so, and had to be brought to heel by the Court of Appeal. It affirmed the position represented by the Gillick case as relevant to gender incongruent young people.

But this is not true. Gillick competence still needs to be decided upon by the treating team. The doctor who prescribes the puberty blocker has to be sure that the child fully understands the implications. The court of appeal did not decide that children do understand, it decided that the courts do not need to play a role in that currently.

A barrister should know this, and I suspect Robin does, I would just like Robin to explain why this wasn’t made clear in that particular passage.

And this means that the treating team have a huge responsibility to make sure they’re right on this because now the appeal court has decided they have to make sure consent is obtained properly.

I am 100% confident there are children around the world on puberty blockers who do not understand the pathway they are on.

I am 100% confident there are children around the world on puberty blockers who do not understand the pathway they are on.

I was a while ago on an (unrelated) discussion hobby group in which there was also an 18 year old American transman who had been on blockers and had just started on “T”. It became extremely clear that this very unfortunate young person had had a pretty traumatic life full of family discord and serious medical history (for a condition unrelated to gender identity). They also made frequent comments that revealed (to the older women in the group) that they had Ben given little to no information about side effects of transition and if they had done they had not fully understood them. For example, they did not really fully understand the implications of a full hysterectomy and were genuinely shocked by a discussion between some of the older women about the potential side effects of hysterectomy with oophorectomy (such as organ prolapse, lower life expectancy, adhesions, etc etc.) They had been told - or at least believed - that it was a simple easy procedure which rarely had any side effects, and which would have little impact on their body except for getting rid of an unwanted extra bit. They were flummoxed at why older women with endometriosis found it so difficult to obtain a hysterectomy.

It was pretty dispiriting to realise how little understanding they had of what was involved; and how little either their doctors had told them or that they had understood.

In fact I’m quite surprised to hear Robin - who as a barrister ought to know about capacity and decision-making in a lot more depth and complexity - suggesting that complex medical consent in child patients is just exactly like choosing one’s favourite religious belief.

Not even choosing your favourite religious belief. Just recognising for the first time, that he was a separate person from his parents and need not embrace their every belief and practice unquestioningly as his own. A very first attempt at cutting the parental apron strings and setting out on the long, long journey towards establishing intellectual and social autonomy.

I am 100% confident there are children around the world on puberty blockers who do not understand the pathway they are on.

I was quite surprised reading the witness statements from GIDS patients in the Keira Bell case that GIDS thought that those statements supported their position that those 12 and 13 year old children had a mature understanding of the effects of the puberty blocking drugs. They seemed to me to be showing a very age typical understanding of the issues - sex and relationships as 'not on their radar' and absolute certainty that they would never want their own biological children.

www.judiciary.uk/wp-content/uploads/2020/12/Bell-v-Tavistock-Judgment.pdf

*been not Ben! 😂

This current conversation is a good example of the point I made earlier (hope it was this thread not another!).

About the essential obstacles to discussion, when one set of views is about groups, and the other set of views is about one individual invariably themselves.

I would say the view of an individual that these drugs should be available around the start of puberty, because they believe looking back decades, it would have improved their life. (No way to know what outcome would have been).

That they believe at age 12 they were able to give informed consent. And therefore it's s good idea for children now to be able to receive these treatments around the start of puberty, and presumably with an approach that they are old enough to know what they are doing.

Any change would of course be applicable for all.

12? What about 7, 8? Is a major question I would like robin to answer. Old enough?

And the approach is imo seen in the post, own experience is the only EVIDENCE they have.

One person's imagined / fantasy of how things would have been for them if they had blocked puberty at 12 and then had hormones prescribed.

Is NOT evidence!

In any way shape or form whatsoever.

@CheeseMmmm

And yes I did find your background interesting.

Your long term passion for trains I understand, I have some family members who share it! Not as involved as you though! Being so active in something you love just be brilliant.

Anyway.

You gave some info but it wasn't really clear what you were saying.

I think you were saying that with your impressive science quals etc, and with legal sector being so inclusive, you believe you would have been able to/ would have followed same path.

That really is fantasy.

In your first job, on the railways, were there many women in the same role, or direct equivalents? This was the what, late 70s, early 80s?

You studied science at impy, early 80s? How many women were on your course? Not around generally but your coursemates?

I went to a university that was solely science in the early 90s and even then out of maybe 80 that were my course mates IE same subject same year, there were 5 women including me.

My a level choices were similarly skewed. There were only 4 who did the same a levels, the other 3 were boys.

Constant overt and subtle messages from everywhere that this was weird, why do that? Why not biology instead of X? Two maths is really hard why not just 1? Why not X degree (related but more.. suitable).

This was I reckon 10 years after you.

If you believe that due to your brains and drive you would have had exactly the same opportunities, not met with pushback, overt sexism. Have been evaluated identically to a young man when getting railway job, uni place.

Then you're ignoring a crucial consideration.

Or do you have your own views on the history of girls, women, education, sexism, deeply and widely embedded societal biases, ability to enter massively male jobs/ sectors etc? I'd be interested to hear your thoughts.

I have just looked at my class photo for Imperial Chemistry 83-86 and there were 22 women out of 84 (not including me, of course). It was the most 'female' major subject at Imperial. And my British Rail cohort had 2 women out of 7, not including me again.

What would my life path have been with modern asistance? Who can say but the best way to get me to do something is to tell me it can't be done.

Robin since you’re on the thread right now, can I ask if you also support children aged 12 having access to puberty blockers if they are not trans, but have decided they are non-binary, and want blockers so that they can have nullification surgery later on?