Reddit thread by a Psychiatrist about youth gender medicine studies

[miri1985]

https://www.reddit.com/r/medicine/comments/15hhliu/the_chen_2023_paper_raises_serious_concerns_about/

Saw this linked elsewhere and thought it was really interesting and well written

Thank you @miri1985 that's a very worthwhile paper.

Is this likely to stay on Reddit? Can it be saved in case it's deleted?

That may be the single most interesting thing I've read on this subject in a long time. First thought...how could Chen, the study's instigator, derive such a false positive conclusion, whereas the author of this thread sees the exact opposite?

Spectrum/neurodiverse teens who've been pushing for transing may be headstrong, but they're super intelligent. They will be reading this thread, and coming to the same conclusion as the author.

I've suspected for a while that the levee will really break not when we adult GCs force a reckoning, or the sunk costs of the swayed elites is cashed in.

But when a critical mass of Generation Alpha so no thanks in no uncertain terms to this madness. And when the target cohort for medicalisation start to rebel. And when the detransitioners' voices reach fever pitch and class actions roll over the old guard.

That's why Sunak's delay to tabling the Trans Conversion Ban legislation is critical. Every day, stuff like this comes in, more detransitioners surface, the multi nation endocrinologists dire warnings recently get made common knowledge, and the most recent NHS in England stern advice to halt Active Affirmation and revert to Watchful Waiting predominantly, is fully promoted.

Every day, the reports and evidence mount. Every day if Sunak is receptive in any way, he must see the Ban could so backfire if Watchful Waiting is effectively criminalised.

This thread will be like a dirty bomb going off in the Trans/Reddit community.

Never before in my decade of getting progressively more despondent on this subject have I been so positive that we're on the cusp of a famous victory. It may take another 5-10 years, but I really feel it now. And this is coming from someone who's a natural glass half empty personality.

This. Will. Not. Hold.

I've archived it but I don't think you can post archive links on Mumsnet

Brilliant!

It's been up for a good 12 hours, and it looks like the poster was in communication with the mods even before posting it. So if it was going to come down I reckon it would have by now.

Looks like the mods are keeping a close eye on responses too so it probably won't turn into a complete bun fight, which is what usually brings these posts down.

It's really interesting, as are the responses. It seems like there are many people in the medical field, who are basically moderate, but have real concerns.

Having read through a lot of the discussion, two things continually strike me:

Firstly, the continued use of the idea of "real trans people" by these medical persons, without any real sense of what that actually represents. Many talk about gender dysphoria, but are they saying that they think dysphoria is caused by being a trans person?

Secondly, many talk about the lack of good evidence for hormone treatment, and there is some back and forth on weighing harms against benefits, which is all well and good. But from what I can see, and I know this is largely true, the whole idea of blockers and hormone therapy in these cases was basically made up. It was never evidence based. So it seems like it should really raise the question, why did this ever start in the first place, because some person imagined it would be effective? Rather than seeing that as the standard.

@Rudderneck
But from what I can see, and I know this is largely true, the whole idea of blockers and hormone therapy in these cases was basically made up. It was never evidence based. So it seems like it should really raise the question, why did this ever start in the first place, because some person imagined it would be effective? Rather than seeing that as the standard.

my read of how this played out is that the Dutch researchers thought of repurposing puberty blockers (used for precocious puberty and off label even there) for young females with dysphoria who were distressed by the idea of going through puberty. And then – in one of the many instances where a single individual ends up having a massive sway – Norman Spack heard about the “treatment” at a conference and realised that it would help male transitioners “pass” as female if they never went through male puberty. Strong thread of homophobia and the belief that effeminate gay men are “really” women, leading to a desire to ensure they pass as such in a way that is acceptable to (notionally) straight men.

the imperative to transition medically comes from the homophobic strand of the ideology. In contrast the “some women have penises” imperative comes from the porn-addled straight male side of the ideology. That’s why they are inconsistent – they come from different places.

Yes, that is also my understanding of how it arose.

But that never had anything to do with evidence based medicine. But then they act as if it is the standard, and there needs to be evidence to deviate from it?

Medicine is full of interventions that were tried without evidence. One of the most compelling books I ever read on the subject was “Normal at Any Cost” by Cohen & Costello. It’s about the use of growth hormones to make short boys taller and tall girls grow less so they don’t become tall women. It was 100% heterosexual stereotype enforcement. And it turned out that it didn’t even work to affect height much and killed many of the boys because Creuzfeld-Jakob disease got into the hormones, which were initially manufactured from human cadavers.

short story is that it doesn’t take that many schmuck endocrinologists to do a lot of damage to children. What we are seeing is just the 21st century version of the same sexism.

and once they’re on that path, pride and an inability to admit error leads to demands for more and more contrary evidence while justifying staying on the chosen path.

The MOD is concerned at the use of puberty blockers, reflecting on how the puberty hormone rush often helps fix identity. The reddit mod. This seems fantastical that a reddit mod might think that. Out loud.

I found that post really interesting. Thank you, Miri1985. I had never read the Chen et al article referenced in the post. It's open access so here is the link if anyone else needs to read it too.

https://www.nejm.org/doi/full/10.1056/NEJMoa2206297

I am actually quite surprised at the limited number of outcomes reported in the study - appearance congruence, life satisfaction and depression/anxiety - and what comes across as a rather blasé attitude to the finding that anxiety/depression levels didn't really improve among participants 'designated male at birth'.

There's a study of detransition listed in the citing articles for Chen et al. It points out the methodological limitations to the 'but hardly anyone detransitions' argument.

https://link.springer.com/article/10.1007/s10508-023-02623-5

I'd be so frustrated if I were James Esses.

That is a considered and thought-provoking post. I’m headed back in to read the responses. I initially copied thevfirst sentence of this paragraph because it’s so good, but the whole paragraph was good, so here goes:

If we say we care about trans kids, that must mean caring about them enough to hold their treatments to the same standard of evidence we use for everything else. No one thinks that the way we "care about Alzheimer's patients" is allowing Biogen to have free rein marketing Aduhelm. The entire edifice of modern medical science is premised on the idea that we cannot assume we are helping people merely because we have good intentions and a good theory. If researchers from Harvard and UCSF could follow over 300 affirmed trans teens for 2 years, measure them with dozens of scales, and publish what they did, then the notion that GAH is helpful should be considered dubious until proven otherwise. Proving a negative is always tricky, but if half a dozen elite researchers scour my house looking for a cat and can't find one, then it is reasonable to conclude no cat exists. And it may no longer reasonable to consider the medicalization of vulnerable teenagers due to a theory that this cat might exist despite our best efforts to find it.

Firstly, the continued use of the idea of "real trans people" by these medical persons, without any real sense of what that actually represents. Many talk about gender dysphoria, but are they saying that they think dysphoria is caused by being a trans person?

We really need an explanation of what medical professionals mean when they talk about "real trans people"? Is a "real trans person" someone who suffers from gender dysphoria, and transition is seen as a cure or treatment for the dysphoria? Or do they believe that "real trans people" are people who were literally born in the wrong body and gender dysphoria is the inevitable result of this mismatch between body and brain?

I would say "the road to Hell is paved with good intentions", but I don't think you can even credit doctors and surgeons in these cases with the merest good intentions.

More like "the road to Hell is paved with arrogant assertions".

This exchange in the comments was telling:

Specifically saying you support gender affirming care first and foremost but here are the concerns I have - is valid. I've literally had this exact conversation in very very public spaces and on very very public platforms. My career wasn’t eviscerated. It’s possible to have these conversations if gone about the right way.

No one should have to say they support something just to be safe making an impersonal, rational, scientific critique of some data.

Having to dance around prefacing dialogue with 'of course I support trans people to live their best life however they see fit blah blah' is the same mental labour as having to remember to use chosen pronouns. And muddies the water for everyone when you have to say you support something which has no evidence base, while pointing out it has no evidence base. Which, of course, is the point.

"I support Christians/Atheists/vegetarians/vegans/red-heads/train collectors/Marvel fans etc etc to live their best life, yada yada"

How preposterous is all that?

"train spotters" DAMN TYPOS, lol

Excellent article thank you OP, and really interesting Reddit discussion (including from the Mod!)

That's a great article. Very encouraging that it's stayed up (so far) on Reddit. I haven't read this thread or the comments on Reddit but will do so later when I have some time to dedicate to it.
Placemarking myself here in the meantime.
Thanks for posting it OP.

Thanks for posting this, it was a very interesting read. There seems to be sunlight seeping into all the gaps in trans ideology at the moment.

The replies are equally interesting, particularly who gets angry with the OP and who doesn't. The mildest of queries into efficacy provokes intense rage in some people.

I've never known anything like trans ideology that is so wide in its spread, yet so lacking in any depth. It's like getting up in the morning, looking out of the window, and seeing nothing but opaque clouds, assuming that there's a storm underway. But on opening the window, seeing that all there is, is condensation in the glass, and it's a bright sunny day.

For the last decade, we've been too afraid to open the window. But now those windows are opening to the horror of TRAs. And it's sunny out there.

This Chen study is going to be one they talk about in the years to come. How people running studies could be so tainted by ideological capture? And how facile and lacking in depth and intellectual rigour the whole "philosophy" was.

His musings on the fact the levels of improvements are below what would be expected even of a placebo are interesting, leading to the inevitable conclusion that the treatments are actively detrimental in terms of treating gender dysphoria (we know they are harmful in other ways).

"Putting biological girls on testosterone is conceptually similar to giving men anabolic steroids, and I remain genuinely surprised that it wasn't more beneficial for their mood in the short term. Some men on high doses of male steroids are euphoric to the point of mania."

Yes, definitely. But I think there's an element of the road to he'll is paved with 'ooh! I wonder what this button will do'. Curiosity, combined with psychopathy, no fear of the consequences, desperate patients and supine regulators.

I googled 'genital ablation' (re. another thread) and found a paper on cutters and the people they cut. It got me wondering what would happen if one of them, say, got an appropriate medical qualification and, just thinking outside the box here, got into gender affirming surgery.

Aside from the reddit thread itself. I think it's almost perhaps more amazing that it was allowed on reddit in the first place.

I think that's an incredibly important point, Truthlikeness. Of course there is no comparison group in the Chen et al study.