Stonewall's response to Transgender Trend

[Eachpeachporch]

I wonder if anyone has had the experience of sharing the Transgender Trend schools resource pack and getting Stonewall's response to it as a reply? Does anyone have any thoughts on what Stonewall says here? Any help much appreciated! www.stonewall.org.uk/node/62946

Why indeed datun. Why indeed.

@Helleofabore

And yet, adults who suffer from gender dysphoria have claimed that they would like to not suffer from gender dysphoria. It is NOT like being gay according to them. So, do we take your word for it suggestions, or others who have been through at great deal of support for their gender dysphoria to be able to cope with their material reality?

And you keep saying you are uncomfortable with medical transition for children and teenagers, yet keep posting material supporting medicalised transition for teenagers.

Everyone identifies the causes of and expresses their difficulties with their sexuality or gender ID in different ways, and of course cultural shifts and changing beliefs can be instrumental in this - so being gay / trans at certain times in certain cultures might cause a lot of shame to a person and distress in that way, and at other times another gay person or transgender person might attribute the source of their distress not inwardly but outwardly, perhaps at a hostile social environment and discrimination they face.

But of course no one, gay or transgender, who experiences distress WANTS to experience that distress, but how they articulate the distress takes different directions "I wish I wasn't gay/ trans" / "I wish I didn't have so much trouble living as gay / trans person due to the culture that we're in. (ie I am happy in myself being gay/ trans).

Regarding medical transition I think all other alternatives should ideally be explored first, but there are times when it is an appropriate way forward.

@Awiltu

For anyone interested in the study referred to in the Finnish review, a search suggests that it is this one (the relevant details match up):

Costa R, Dunsford M, Skagerberg E, Holt V, Carmichael P, Colizzi M. Psychological support, puberty suppression, and psychosocial functioning in adolescents with gender dysphoria. J Sex Med 2015;12:2206–2214

To answer some of suggestionsplease1's questions, as the full text is behind a paywall:

And it's Finnish not UK based evidence. I'm not allowed to include any non-UK evidence because it's not relevant to our particular culture and population, but you apparently are?

It's a UK study conducted in London at GIDS.

But this study would obviously fall far short of your requirements for us to consider - where is the reference to the matched cohort design? What a poorly designed study eh, not to include that.

This was a longitudinal study of 2 cohorts of gender-dysphoric young people. All 201 participants received psychological assessment and intervention for 6 months via GIDS before eligibility for puberty blockers was assessed. At the 6-month point, participants who were assessed as eligible for puberty blockers were assigned to one of 2 cohorts.The immediate-eligibility cohort received psychological support plus pharmacological puberty suppression, while the delayed-eligibility cohort received psychological support only. Assignment to the delayed-eligibility cohort was on the following basis: "In those specific cases clinicians needed more time to make the decision of starting GnRHa because of possible comorbid psychiatric problems and/or psychological difficulties."

Both cohorts were followed up 12 months and 18 months. Results for both cohorts were compared to a large sample (N=169) of young individuals without observed psychological/psychiatric symptoms who completed the same adolescent psychosocial function measures as the two gender-dysphoric groups.

Of course you will know full well that the baseline characteristics for both cohorts are likely very different - namely in the degree to which they experienced gender dysphoria in the first place - those experiencing greater distress (amongst other considerations), would have been more likely to be put forward for GnRH analogues in addition to psychological intervention, and those for whom it was considered that their distress could be adequately managed by psychological intervention alone of course were in that cohort.

No, the opposite was true. The cohort assigned to the immediate-eligibility group had numerically (though not statistically) higher measures of psychosocial function than the delayed-eligibility group, and the delayed group were assigned to that cohort precisely because they demonstrated signs of more significant psychiatric or psychological difficulties.

You will, of course, know that. It would be unethical to proceed in any other way - unless you think they're just taking the 270 kids and randomly assigning them to a treatment group with no individualised plan?

It is not unethical to compare two treatment pathways where definitive objective evidence of clinical benefit is lacking, precisely in order to collect that missing evidence.

But of course, as it happens the results you have found show that all cohorts fared well.

The results are more nuanced than that.

The study showed that measures of psychosocial function improved significantly across the entire participant group (pooled across both cohorts) after 6 months of psychological intervention and support. However, when each group was considered separately, significant improvement in psychosocial function was observed only in the delayed-eligibility cohort, who (according to the criteria for assignment to that cohort) showed signs of more serious psychological and psychiatric difficulties.

From the 6-month point, where the 2 cohorts diverged in the treatment received, the immediate-eligibility group (who received puberty blockers plus psychological support) showed significant improvement in psychosocial function at the 12- and 18-month follow-up points, compared to the 6-month point.

In contrast, the delayed-eligibility group (who received psychological support only) showed small numerical improvements in psychosocial function measures at 12 and 18 months, which were not statistically significant. However, in the delayed-eligibility group, psychosocial function at 12 and 18 months remained significantly better than at baseline (prior to starting any psychological intervention).

Also worth noting that, despite the apparent differences between outcomes for each cohort, direct comparison of psychosocial function at 18 months showed no statistically significant difference in psychosocial function between the group that had received puberty blockers plus psychological intervention and the group that had received psychological intervention only.

So this would obviously fall far, far short of the rigorous study design that you need to consider, so I don't know why you're even referring to it? It doesn't count right? Just like the the scores of studies I have linked to.

The study is flawed, but not for the reasons you suggest.

This study had enormous problems with participant retention. By the 12-month time point, less than 2/3 of participants remained in each cohort, and by the 18-month point, only around 1/3 of participants in each cohort remained in the study. The reasons for loss to follow-up are not reported, so we have no idea whether these participants left because their mental health improved or because it worsened. That is a huge drop-out rate - so big that it raises questions about how well-matched the final cohorts remaining after 18 months were, and makes it very difficult to draw meaningful conclusions about the impact of puberty blockers.

The summary version - psychological intervention improves mental health in gender dysphoric adolescents, especially those who are experiencing greater psychological difficulties or psychiatric comorbidities. Any additive benefit of puberty blockers is difficult to evaluate due to the very high dropout rate during follow-up.

Thanks for that, interesting to see more and have the confirmation about the baseline characteristic differences between the two groups.

Out of interest, is this a thing now:

No, the opposite was true. The cohort assigned to the immediate-eligibility group had numerically (though not statistically) higher measures of psychosocial function than the delayed-eligibility group, and the delayed group were assigned to that cohort precisely because they demonstrated signs of more significant psychiatric or psychological difficulties.

Are we allowed to refer to 'numerically higher' numbers of something in discussions of results where the results are not significant?! Is that not frowned upon? Was a p value calculated? Do you have what it was if so? Or the 2 means?

And you seem to be conflating degree of psychosocial function with degree of gender dysphoria when you write that "the opposite is true" about my speculation. That's really not valid, they are not synonymous concepts.

"It is not unethical to compare two treatment pathways where definitive objective evidence of clinical benefit is lacking, precisely in order to collect that missing evidence."

Well sure, but you will see that I said it would be unethical for the participants in the studies to be randomly allocated to treatment groups with no individualised plans - that would be unethical right?

I don't have any particular problems with the study, I was simply pointing out that it would not meet the virtually impossible standards some people are setting for research to be considered in this area of discussion. This was a point I have made very clear all along; research can generate valuable information despite certain limitations being unavoidable.

I think you're putting a bit of a slant in your summary version (and drop out of course may be completely unrelated to improved or worsened mental health; mental health is not a central factor in drop out rates for other longitudinal research as far as I'm aware, which is probably often at similarly high levels over an 18 month period)-

...Why don't we go to the researchers' conclusion: "Psychological support and puberty suppression were both associated with an improved global psychosocial functioning in GD adolescents. Both these interventions may be considered effective in the clinical management of psychosocial functioning difficulties in GD adolescents."

@OldCrone

I have a friend (yes I know, sample n = 1) who is a mid 50's woman, who has for the entirety of her life felt real unhappiness and disgust with her female form and a sense that she should have been born a boy. She has been unable to have intimate relationships due to this. She looks on these options now with envy, that happiness and relationships might have been possible for her had she been in her teens at this time, but she considers at her age that that ship has sailed.

I'm quite happy being a gay woman myself, I don't want a cure, and I imagine many trans people might say the same - they don't want a cure that would stop them desiring to be and to be recognised as they other sex, they just want to be the sex that they identify as and for others to acknowledge that.

Cure suggests you feel trans-identified people have a problem. The word cure was used to suggest gay people had a problem too. I think most of us would turn around now and say that it is not us that have the problem; it's society that has a problem with us.

Are you saying that your friend's disgust with her female body is entirely due to 'society'? How would a change in societal attitudes help such a person to accept her body and enable her to have intimate relationships? Is she a lesbian who has internalised the homophobia around her to the extent that she thinks, like Fox Fisher, that homosexual relationships are 'deviant'?

You are comparing the experiences of two very different people: a desperately unhappy woman who hates her body and as a result has found intimate relationships difficult, and you, a gay woman who is happy with her sexuality, and saying they are somehow the same. In what way are they the same?

If your friend could be cured of her disgust with her body (and her internalised homophobia if she is same-sex attracted), why do you think this would be such a terrible outcome? Why do you think altering her body, and becoming a lifelong medical patient, is preferable?

No, I'm not saying any of that! I am saying there is a hugely complex, personal, individual picture for each person experiencing difficulties, and the job of therapy is to tease the nuances out to try to find a best way forward for each individual person.

So yes, for my friend, I don't think societal attitudes would have made a huge amount of difference, but they would have improved things a bit for her. For example she would have changed pronouns if that had been a viable option decades ago. She has a unisex first name and is a Dr so that lessens some of the tension she experiences amongst pronouns anyway. She has always presented in a more (stereotypically) masculine fashion. Her psychosocial functioning is strong despite the gender dysphoria she experiences limiting her in intimate relationships.

I haven't asked her your question but I am pretty sure I know her answer as I know her very well - her feelings are so central to her identity that you would be asking her to be a different person if she was to accept that a magic wand could 'cure' her. It's so deep rooted, so instinctual, so integrated to her self-concept, so tightly wound around everything else that she is, that it's not amenable to 'cure' without fracturing her altogether.

And I think this sense is something that both gay and trans people can relate to.

Sure, philosophically you can entertain that phenomenon, but then it just wouldn't be you anymore, you would have lost yourself, you wouldn't know who you were anymore.

(She's quite happy with her friends using female pronouns for her as we have done for decades btw, I'm not being disrespectful!)

Are we allowed to refer to 'numerically higher' numbers of something in discussions of results where the results are not significant?! Is that not frowned upon? Was a p value calculated? Do you have what it was if so? Or the 2 means?

Perfectly valid to clarify when reporting results that there was an apparent numerical difference which did not reach statistical significance - that is effectively saying it looked like there might be a difference but this difference wasn't "real" when tested statistically. With an underpowered study (as this one was), a numerical difference which doesn't reach significance might be an indicator that with a bigger sample size the difference might have reached significance.

What you can't do is treat a non-significant numerical difference as if it was a "real" statistical difference and draw any conclusions from the existence of that difference.

While we're being strict about stats, this study involved lots of statistical tests, comparing outcomes at multiple different combinations of time-points within each group, and also between groups. The more individual statistical comparisons that are run as part of an analysis, the higher the chance that one of the tests will produce a significant result in error (called a false positive). The correct statistical practice to guard against the problem of false positives when making multiple comparisons is to make a correction to the p value used, so that the "bar" for a significant result is higher and the chance of a false positive is reduced. There are several accepted methods for doing this, but I couldn't find any evidence that this study applied any correction. If a correction had been applied, many of the weaker significant results wouldn't have survived (and the study results would have looked a lot less interesting).

And you seem to be conflating degree of psychosocial function with degree of gender dysphoria when you write that "the opposite is true" about my speculation. That's really not valid, they are not synonymous concepts.

I agree, however it's the study itself that does the conflating. There were no measures of gender dysphoria severity obtained, only measures of psychosocial function. The whole premise of the study was that gender dysphoria results in psychological distress which in turn impairs psychosocial function, and treating gender dysphoria successfully should therefore be associated with a reduction in psychological distress and an improvement in psychosocial function. The authors used psychosocial function as a proxy measure of distress associated with gender dysphoria.

Well sure, but you will see that I said it would be unethical for the participants in the studies to be randomly allocated to treatment groups with no individualised plans - that would be unethical right?

No it wouldn't - that's exactly how randomisation to a treatment arm works, for example in a blinded RCT. In fact, randomly allocating participants to a treatment that isn't individualised minimises the risk that outcomes will be affected by bias and confounding factors. In the case of this study, participants weren't randomly allocated, and there was indeed a confound of a difference in the psychological and psychiatric profile of the 2 groups.

I think you're putting a bit of a slant in your summary version (and drop out of course may be completely unrelated to improved or worsened mental health; mental health is not a central factor in drop out rates for other longitudinal research as far as I'm aware, which is probably often at similarly high levels over an 18 month period)

It's a huge drop-out rate considering the timeframe and circumstances. That order of participant attrition would usually raise alarm bells during the peer review process, particularly if the authors haven't included any explanatory information or data.

The drop-out occurred after the 6-month time point when participants were assigned to a treatment group. This means that GIDS lost track of 2/3 of participants within a year of starting them on puberty blockers (1/3 within the first 6 months). They also lost track of similar numbers of participants over the same timescales in the group which they identified as showing evidence of more complex or serious psychological or psychiatric problems.

The issue is not whether changes in mental health caused participants to drop out. The issue is that, in a study speciifically designed to measure mental health outcomes following intervention, we don't know how the mental health of participants who dropped out changed over time in comparison to participants who remained in the study, so we don't know how participant drop-out has influenced the study's results.

Why don't we go to the researchers' conclusion: "Psychological support and puberty suppression were both associated with an improved global psychosocial functioning in GD adolescents. Both these interventions may be considered effective in the clinical management of psychosocial functioning difficulties in GD adolescents."

Because the data presented in the study don't justify the "both interventions are effective" conclusion in the final sentence.

Everyone identifies the causes of and expresses their difficulties with their sexuality or gender ID in different ways, and of course cultural shifts and changing beliefs can be instrumental in this - so being gay / trans at certain times in certain cultures might cause a lot of shame to a person and distress in that way, and at other times another gay person or transgender person might attribute the source of their distress not inwardly but outwardly, perhaps at a hostile social environment and discrimination they face.

But of course no one, gay or transgender, who experiences distress WANTS to experience that distress, but how they articulate the distress takes different directions "I wish I wasn't gay/ trans" / "I wish I didn't have so much trouble living as gay / trans person due to the culture that we're in. (ie I am happy in myself being gay/ trans).

Regarding medical transition I think all other alternatives should ideally be explored first, but there are times when it is an appropriate way forward.

I know you are determined to follow the Denton playbook of conflating trans and sexual orientation, suggestionsplease1, but making them synonymous is going a bit far! Particularly since you can't even define sexual orientation in the context of gender ideology.

@Awiltu

Are we allowed to refer to 'numerically higher' numbers of something in discussions of results where the results are not significant?! Is that not frowned upon? Was a p value calculated? Do you have what it was if so? Or the 2 means?

Perfectly valid to clarify when reporting results that there was an apparent numerical difference which did not reach statistical significance - that is effectively saying it looked like there might be a difference but this difference wasn't "real" when tested statistically. With an underpowered study (as this one was), a numerical difference which doesn't reach significance might be an indicator that with a bigger sample size the difference might have reached significance.

What you can't do is treat a non-significant numerical difference as if it was a "real" statistical difference and draw any conclusions from the existence of that difference.

While we're being strict about stats, this study involved lots of statistical tests, comparing outcomes at multiple different combinations of time-points within each group, and also between groups. The more individual statistical comparisons that are run as part of an analysis, the higher the chance that one of the tests will produce a significant result in error (called a false positive). The correct statistical practice to guard against the problem of false positives when making multiple comparisons is to make a correction to the p value used, so that the "bar" for a significant result is higher and the chance of a false positive is reduced. There are several accepted methods for doing this, but I couldn't find any evidence that this study applied any correction. If a correction had been applied, many of the weaker significant results wouldn't have survived (and the study results would have looked a lot less interesting).

And you seem to be conflating degree of psychosocial function with degree of gender dysphoria when you write that "the opposite is true" about my speculation. That's really not valid, they are not synonymous concepts.

I agree, however it's the study itself that does the conflating. There were no measures of gender dysphoria severity obtained, only measures of psychosocial function. The whole premise of the study was that gender dysphoria results in psychological distress which in turn impairs psychosocial function, and treating gender dysphoria successfully should therefore be associated with a reduction in psychological distress and an improvement in psychosocial function. The authors used psychosocial function as a proxy measure of distress associated with gender dysphoria.

Well sure, but you will see that I said it would be unethical for the participants in the studies to be randomly allocated to treatment groups with no individualised plans - that would be unethical right?

No it wouldn't - that's exactly how randomisation to a treatment arm works, for example in a blinded RCT. In fact, randomly allocating participants to a treatment that isn't individualised minimises the risk that outcomes will be affected by bias and confounding factors. In the case of this study, participants weren't randomly allocated, and there was indeed a confound of a difference in the psychological and psychiatric profile of the 2 groups.

I think you're putting a bit of a slant in your summary version (and drop out of course may be completely unrelated to improved or worsened mental health; mental health is not a central factor in drop out rates for other longitudinal research as far as I'm aware, which is probably often at similarly high levels over an 18 month period)

It's a huge drop-out rate considering the timeframe and circumstances. That order of participant attrition would usually raise alarm bells during the peer review process, particularly if the authors haven't included any explanatory information or data.

The drop-out occurred after the 6-month time point when participants were assigned to a treatment group. This means that GIDS lost track of 2/3 of participants within a year of starting them on puberty blockers (1/3 within the first 6 months). They also lost track of similar numbers of participants over the same timescales in the group which they identified as showing evidence of more complex or serious psychological or psychiatric problems.

The issue is not whether changes in mental health caused participants to drop out. The issue is that, in a study speciifically designed to measure mental health outcomes following intervention, we don't know how the mental health of participants who dropped out changed over time in comparison to participants who remained in the study, so we don't know how participant drop-out has influenced the study's results.

Why don't we go to the researchers' conclusion: "Psychological support and puberty suppression were both associated with an improved global psychosocial functioning in GD adolescents. Both these interventions may be considered effective in the clinical management of psychosocial functioning difficulties in GD adolescents."

Because the data presented in the study don't justify the "both interventions are effective" conclusion in the final sentence.

OK on your first point it appears that the rigour I would expect for discussion of studies has been relaxed - that would never have been permitted when I was examining research, and yes we were all very aware of the import of power - please see my analogy where I referred to the issue of power specifically (it was a central point I made). If your approach is typical it seems examination of research has really dumbed down in recent years - what do you think on that point?

Of course you will be aware that your relaxed approach diverges greatly from the standards GC feminists are applying to the research.

I note that you have not answered my questions about the figures, Can you provide the raw data please, or at least the p values / the means, range - it sounds like you have access to this data so it is appropriate that you make it available to others to analyse.

"Well sure, but you will see that I said it would be unethical for the participants in the studies to be randomly allocated to treatment groups with no individualised plans - that would be unethical right?"

No it wouldn't - that's exactly how randomisation to a treatment arm works, for example in a blinded RCT. In fact, randomly allocating participants to a treatment that isn't individualised minimises the risk that outcomes will be affected by bias and confounding factors. In the case of this study, participants weren't randomly allocated, and there was indeed a confound of a difference in the psychological and psychiatric profile of the 2 groups.

I think we are talking at cross purposes here - I understand how randomisation works, what I am talking about is the treatment of the human participants in this study. We are not talking about a lab experiment where rats are injected with a drug or a placebo, we are talking about a vulnerable human population where the primary intention is to improve their wellbeing; the studies are secondary to this purpose. The preliminary, detailed work would have been about assessing who was suitable for psychological intervention alone, and who was suitable for medical pathways alongside psychological intervention. The cohorts would have been decided on this basis. If they were not determined on this basis that would have been an unethical way forward for the participants in this study and they could probably sue the researchers.

Do you not agree?

I have to say that I would not be happy with a researcher drawing the conclusions you seem happy to arrive at, when they have such a relaxed approach to the analysis of data and are happy to ignore statistical significance whilst believing they are correct in drawing conclusions that differ from the researchers' own.

Please provide the raw data.

Blinded studies with placebos don't just take place in "rats in a lab injected with a drug or placebo", suggestions.

@suggestionsplease1 Can you provide the same statistical rigour for any of the studies you have cited here, or otherwise interpret their design and conclusions as representing significant meaning to the treatment of minors suffering from gender dysphoria?
The study cited in the Finnish clinic's review was the most applicable and informative available at the time and has given them cause for caution in this new and alarmingly expanding cohort.

You don't seem to agree, but who are you to question the clinicians on the ground with a wealth of direct patient experience?

These studies cannot by their very nature be compared with the design and execution and rigour of a clinical drugs trial, although I'm certain the clinicians involved did their best to make the study as informative as possible, and will continue to assess the changing landscape of their patient numbers and profiles

What I get from your comments, @suggestionsplease1, is that you consider it unethical to have put a group of young people through a psychoanalytical treatment pathway instead of on medication to block puberty. Is that correct?
Do you not consider it a positive that minors suffering from gender dysphoria might be supported just as well by psychoanalytical treatment as medicalisation? Would it not be preferable if this provided a long-term solution to their dysphoria?
Or are you a strict proponent of The Dutch Protocol?
Your consistent use of the phrase 'GC feminist' is troubling. What do you mean by 'GC'?
Have you listened to Sue Evans, 40+ years a psychoanalyst, and formerly of Tavistock GIDS? Webinar posted previously.
What do you take from her experience?

For those who haven't seen the Swedish position:
segm.org/Sweden_ends_use_of_Dutch_protocol#:~:text=According%20to%20the%20%E2%80%9DDutch%20Protocol,at%20the%20age%20of%2016.

Just for anyone interested, this article from a year ago:
www.voorzij.nl/more-research-is-urgently-needed-into-transgender-care-for-young-people-where-does-the-large-increase-of-children-come-from/

suggestionsplease1, why on earth would you assume that I have access to the raw data from this study? I found the paper online with a 30-second Google search of key terms and numbers from the summary in the Finnish report - something you could easily have done yourself in order to answer your own questions. I gave a short evaluation of what is, methodologically speaking, a very straightforward study design and analysis - anyone with a reasonable grasp of research methodology could have given the same sort of critique. Do researchers often appear on Mumsnet to announce "Aw, shucks, forgot to do that darn multiple comparisons correction" about their own published work?

The paper's authors are listed on the link I gave. If you want to discuss access to the raw data, you should contact the corresponding author.

OK on your first point it appears that the rigour I would expect for discussion of studies has been relaxed - that would never have been permitted when I was examining research, and yes we were all very aware of the import of power - please see my analogy where I referred to the issue of power specifically (it was a central point I made). If your approach is typical it seems examination of research has really dumbed down in recent years - what do you think on that point?

Do you understand the difference between reporting data and interpreting data, suggestions? Reporting data involves an objective description of the information collected and the output from statistical analyses. Interpreting data involves presenting an opinion about what your observations and statistical results mean, and specifically whether they do or do not support the experimental hypotheses made prior to data collection.

There is nothing remotely "dumbed down" or "relaxed" about reporting that 2 summary measures appear to be numerically different but are not statistically different. In fact something like "Although there were apparent numerical differences in X and Y, this difference did not reach statistical significance when tested with analysis method A" is fairly standard wording in the results section of a quantitative study.

What would be dumbed down would be to take that numerical difference, ignore the statistical result, and interpret the data as if that difference was a genuine statistical difference. Which I didn't.

I have to say that I would not be happy with a researcher drawing the conclusions you seem happy to arrive at, when they have such a relaxed approach to the analysis of data and are happy to ignore statistical significance whilst believing they are correct in drawing conclusions that differ from the researchers' own.

Again, you seem to fundamentally misunderstand what a research paper is, and what it isn't. A paper presents the objective findings from a data collection exercise, along with the authors' interpretation of what those findings mean and how they relate to the research questions they are asking. Data interpretation is subjective - it is the authors' opinion about what their results mean. There is almost always more than one way to interpret a particular set of data, and the authors' own interpretation is not automatically gospel just because they're the ones making it. Science is full of differing opinions and interpretations of the same body of evidence.

When a research paper is reviewed for publication, the most important issue is whether the methodology used to collect the data is sound. Beyond that, reviewers (and editors) generally don't pull authors up on their interpretation of the data unless it's outrageously off-target or a clear over-reach. It's then up to readers to make up their own minds whether they think the data support the authors' interpretation or not.

And to deal with this separately, because it's an important point:

We are not talking about a lab experiment where rats are injected with a drug or a placebo, we are talking about a vulnerable human population where the primary intention is to improve their wellbeing; the studies are secondary to this purpose. The preliminary, detailed work would have been about assessing who was suitable for psychological intervention alone, and who was suitable for medical pathways alongside psychological intervention. The cohorts would have been decided on this basis. If they were not determined on this basis that would have been an unethical way forward for the participants in this study and they could probably sue the researchers.

Do you not agree?

This study was indeed a secondary outcome of a clinical process primarily intended to improve the mental health of participants. Where it gets muddy is that assignment to treatment arms appears to have been on the basis of the presence or absence of factors other than gender dysphoria. All participants were considered eligible for puberty blockers to treat gender dysphoria. Participants were only assigned to the "delayed-eligibility" group because clinicians considered there were additional psychological or psychiatric factors beyond gender dysphoria that needed to be explored or addressed before puberty blockers could be given. So the ethical element to treatment arm assignment relates to the ethics of addressing these additional mental health issues, not the ethics of treating gender dysphoria per se.

This key difference has a knock-on effect in how we can interpret the study's findings. The study hasn't compared whether psychological intervention alone or psychological intervention plus puberty blockers produces better outcomes in a population of similar gender-dysphoric adolescents. The study has actually compared whether psychological treatment of gender dysphoric teens with additional complex mental health issues produces better outcomes than using puberty blockers in a group of gender dysphoric teens without additional complex mental health issues. They're comparing apples and oranges.

Imagine instead that the same study was conducted with a group of participants who were all considered equally eligible for immediate treatment with puberty blockers. In that case, it would only be unethical to assign a participant to the psychological-only intervention arm if there was an existing body of evidence demonstrating that this intervention was ineffective or produced an inferior outcome to puberty blockers in this group of individuals. No such evidence base exists for gender dysphoric adolescents (no matter how hard TRAs try to pretend that it does).

Imagine instead that the same study was conducted with a group of participants who were all considered equally eligible for immediate treatment with puberty blockers. In that case, it would only be unethical to assign a participant to the psychological-only intervention arm if there was an existing body of evidence demonstrating that this intervention was ineffective or produced an inferior outcome to puberty blockers in this group of individuals. No such evidence base exists for gender dysphoric adolescents (no matter how hard TRAs try to pretend that it does).

Really key point!

And I'm still no closer to understanding why suggestions is so keen to promote treatment of a condition that suggestions doesn't think should have any kind of cure.

I find it odd that @suggestionsplease1 does not seem to have applied any evaluation or rigour to the mass citation drop of a few pages previous.
Or any sort of coherent narrative between them?

If I have interpreted the tone correctly, I think that some posters are upset that their plopped down links were not accepted as overwhelming evidence to support their claim. I take it that we were supposed to be impressed with the sheer number of them and not expect any coherent narrative about them.

I mean, the fact that the plop even included one that was corrected to reflect the fact that there was actually NO evidence of improvement and the 51 bank of studies came with a clear and obvious lack of balance points to a 'plop' gotcha rather than an actual honest discussion and maybe honest interpretation of each and every study that was presented.

However, I also believe that some posters on this thread have a rather prejudiced view on, what are we referred to? 'the GC feminists'? and maybe even quite a different understanding of what many of us believe to what the reality is.

suggestions appear to think that any published study putting a remotely positive spin on transition is a kind of irrefutable truth, exempt from any further critical evaluation. The mere fact such studies exist at all should be enough to silence all further argument.

That kind of "just accept this and don't think about it too much in case you end up at wrongthink" approach seems oddly familiar...

@Datun

And I'm still no closer to understanding why suggestions is so keen to promote treatment of a condition that suggestions doesn't think should have any kind of cure.

That's a really good point.

What is this treatment for if it's not trying to cure some aspect of 'being trans'?

suggestions said that trans people don't want a cure that would stop them desiring to be and to be recognised as they other sex, they just want to be the sex that they identify as and for others to acknowledge that.

Although their desire to be the opposite sex is causing them distress (gender dysphoria), they don't want this feeling to be cured, allowing them to live happily in the body they have (which might be an achievable goal), instead they want to be the opposite sex, even though this is impossible. The treatment is an attempt at a cure for being the opposite sex to that which they want to be, and is always doomed to failure because people can't change sex.

They don't want a cure for wanting to be the opposite sex, but they do want a 'cure' for being the sex they are. Is that right suggestions?

suggestions said that trans people don't want a cure that would stop them desiring to be and to be recognised as they other sex, they just want to be the sex that they identify as and for others to acknowledge that.

I didn't even want to address that sentence. It's got hopeless written all over it.

It's wanting to promote a desire in people for something they can never have. And trying to get everyone else to pretend they can, even when they all know they can't.

I can't believe anyone with an ounce of empathy would ever write anything so wretched.

@Awiltu you are happy to refer to 'numerically...higher'' measures as if this had some importance - this is news to me - 5.00009 is numerically higher that 5.00008 but it's unlikely to tell us anything meaningful unless you have participants in the billions perhaps, whilst ignoring the statistically significant information the researchers found:

"GD adolescents receiving also puberty suppression had significantly better psychosocial functioning after 12 months of GnRHa (67.4 ± 13.9) compared with when they had received only psychological support (60.9 ± 12.2, P = 0.001)."

If you think that is an unbiased, good way forward for analysing studies I am staggered.

I assumed you must have access to raw data to be able to come to your summary version - that you feel that the drop out rate means you can not make inferences about the benefit of puberty blockers - the researchers would have accounted for the drop out rate in their analysis, as standard, and they still are reporting statistical significance. I thought you had maybe run a different analysis to arrive at your conclusion, because otherwise I don't see how your speculation is justified. This study has been published in a reputable, peer - review journal:

"The Journal of Sexual Medicine maintains the highest standards of peer review and pursues editorial approaches that help us avoid bias. All submitted manuscripts are reviewed for quality, novelty, scientific importance, and relevance to The Journal's readership."

But you must think they have gone wrong somewhere?

And you seem to think that just about every study, in every country, by every organisation, university etc, ever carried out on this area has gone wrong somewhere, yes?

You must think all the literature reviews collating the information have gone wrong somewhere too?

That is a really unusual position for a researcher to take, and would normally indicate great bias on the part of that researcher.

Imagine instead that the same study was conducted with a group of participants who were all considered equally eligible for immediate treatment with puberty blockers. In that case, it would only be unethical to assign a participant to the psychological-only intervention arm if there was an existing body of evidence demonstrating that this intervention was ineffective or produced an inferior outcome to puberty blockers in this group of individuals. No such evidence base exists for gender dysphoric adolescents (no matter how hard TRAs try to pretend that it does).

OK, so you seem to be saying that until there is an evidence base for medical treatment it is unethical to give that treatment.

Let's put aside for the time being that it sounds very likely that you won't accept any evidence given anyway (as the study we're talking about feels it has indeed found that evidence), and lets focus on the fact that this involves a circular argument - 'you can't treat someone until you prove it is effective, you can't prove it is effective until you treat some people with it'.

That's not how treatment plans work in their infancy - imagine if you were developing a cancer drug, and you're beginning to see some nice evidence from your computer modelling, testing on lab-grown human cells and then on your animal studies ...you're getting a very good idea that this is going to be very helpful in the treatment of cancer - do you not start the trials on human patients because someone out there feels that it's not safe enough? You have to take a well-judged approach in collaboration with all the experts in the field (and not at the say-so of a keyboard warrior) and you move forward with the treatment on human patients at the right time and you improve the quality of life and save lives in the process of doing this. If you waited years until the keyboard warrior's unreasonable (and clearly impossible with your circular reasoning) evidential requirements were met lives would be lost and quality of life would maintain at a low level for all those people who would hope to benefit.

Sorry, I perhaps shouldn't have used the phrase keyboard warrior there - I thought it was used to refer to someone who posts a lot on a subject they feel strongly about but it appears it can also imply an abusive style, and that's not what I meant.

It's wanting to promote a desire in people for something they can never have. And trying to get everyone else to pretend they can, even when they all know they can't.

This is the crux.

You're as much of a keyboard warrior as anyone else on this thread, Suggestions.