Sunlight in Australia

[octaurpus]

I am very, very surprised to see this. Trailer for an upcoming news story in Australia on one of our commercial networks. https://www.facebook.com/watch/?v=877974177284537&ref=sharing

Did you even look at GenderGP and what Gender GP has done in the past?

Look up Helen Webberley?

You realise that Gender GP provides hormones to under age patients on the basis of a 30-60 minute phone call? That it operates outside of the UK so that the UK regulators cannot shut it down?

Again, you are now posting very harmful links to a known rogue organisation that will send prescriptions to under age children in the UK. And yet you are criticising this program without any engagement (based on evidence) with the content.

I really have thought this through a great deal and I have asked 'who does it benefit' many times on threads.

Well meaning people who simply have never done the research are the ones who constantly dismiss this as being either the 'experts know' while ignoring the many experts who are stating clearly that there are issues.

Or they are heavily invested because they are either trans or have a trans loved one and again have not critically evaluated the information that is out there.

The reality is that trans people are being failed by the medical systems and it is because WPATH started to push to adopt treatments that are NOT in line with the Dutch Protocol. A group set up to protect trans people has caused them harm by doing this. Trans people's health care is in tatters and repeating mantras and misinformation is not going to help those harmed.

Gender GP is a private clinic set up by Drs Michael and Helen Webberley.

Both were suspended for medical malpractice following adverse outcomes for a number of young patients, one of whom committed suicide after receiving hormone treatment.

Michael Webberley was eventually permanently struck off and Helen Webberley successfully appealed her suspension.

Both continued to practice from a cowboy clinic they set up in Spain during the period of suspension. They saw patients via Skype and issued private prescriptions for hormones to underage patients they had never met face to face.

The latest esteemed individual to join the payroll is Susie Green, former CEO of Mermaids, who flew her child to the US for puberty blockers at 12 and to Thailand on the eve of their 16th birthday for a penectomy and vaginoplasty. There is a video online of her appearing to laugh about the fact that the vaginoplasty was only partially successful due to the fact that her child had started puberty blockers so young that there wasn't enough tissue to work with to perform a proper penile inversion.

Just adding this as there seems to be some misinformation on this thread that some treatments are beneficial to trans people's mental health.

I would like to see a peer reviewed study on which treatments. Because not one study was produced in the Tavistock vs Bell case. Not one.

Instead, for a while, this study was being posted on these boards as evidence ... until it was corrected. No conclusive improvement after gender affirming surgeries.

No improvement to mental health at all....

The discredited study by Richard Branstrom (Karolinska) & John Pachankis (Yale)

https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.2019.19010080

https://www.thepublicdiscourse.com/2020/09/71296/?fbclid=IwAR1qhY36S81bxLIL-Gm04MemcwA8R0OBpG5iCy_CrUM6tGttrO98Un-WLTE

A major correction has been issued by the American Journal of Psychiatry. The authors and editors of an October 2019 study, titled “Reduction in mental health treatment utilization among transgender individuals after gender-affirming surgeries: a total population study,” have retracted its primary conclusion. Letters to the editor by twelve authors, including ourselves, led to a reanalysis of the data and a corrected conclusion stating that in fact the data showed no improvement after surgical treatment. The following is the background to our published letter and a summary of points of the critical analysis of the study.

Here are some more clinicians pushing back.

www.wsj.com/articles/trans-gender-affirming-care-transition-hormone-surgery-evidence-c1961e27

It is archived.

Youth Gender Transition Is Pushed Without Evidence
July 13, 2023 4:51 pm ET

As experienced professionals involved in direct care for the rapidly growing numbers of gender-diverse youth, the evaluation of medical evidence or both, we were surprised by the Endocrine Society’s claims about the state of evidence for gender-affirming care for youth (Letters, July 5). Stephen Hammes, president of the Endocrine Society, writes, “More than 2,000 studies published since 1975 form a clear picture: Gender-affirming care improves the well-being of transgender and gender-diverse people and reduces the risk of suicide.” This claim is not supported by the best available evidence.

Every systematic review of evidence to date, including one published in the Journal of the Endocrine Society, has found the evidence for mental-health benefits of hormonal interventions for minors to be of low or very low certainty. By contrast, the risks are significant and include sterility, lifelong dependence on medication and the anguish of regret. For this reason, more and more European countries and international professional organizations now recommend psychotherapy rather than hormones and surgeries as the first line of treatment for gender-dysphoric youth.

Dr. Hammes’s claim that gender transition reduces suicides is contradicted by every systematic review, including the review published by the Endocrine Society, which states, “We could not draw any conclusions about death by suicide.” There is no reliable evidence to suggest that hormonal transition is an effective suicide-prevention measure.

The politicization of transgender healthcare in the U.S. is unfortunate. The way to combat it is for medical societies to align their recommendations with the best available evidence—rather than exaggerating the benefits and minimizing the risks.

Signed by

This letter is signed by 21 clinicians and researchers from nine countries.
FINLAND
Prof. Riittakerttu Kaltiala, M.D., Ph.D.
Tampere University

Laura Takala, M.D., Ph.D.
Chief Psychiatrist, Alkupsykiatria Clinic

UNITED KINGDOM
Prof. Richard Byng, M.B.B.Ch., Ph.D.
University of Plymouth

Anna Hutchinson, D.Clin.Psych.
Clinical psychologist, The Integrated Psychology Clinic

Anastassis Spiliadis, Ph.D.(c)
Director, ICF Consultations

SWEDEN
Angela Sämfjord, M.D.
Senior consultant, Sahlgrenska University Hospital

Sven Román, M.D.
Child and Adolescent Psychiatrist

NORWAY
Anne Wæhre, M.D., Ph.D.
Senior consultant, Oslo University Hospital

BELGIUM
Em. Prof. Patrik Vankrunkelsven, M.D. Ph.D.
Katholieke Universiteit Leuven
Honorary senator

Sophie Dechêne, M.R.C.Psych.
Child and adolescent psychiatrist

Beryl Koener, M.D., Ph.D.
Child and adolescent psychiatrist

FRANCE
Prof. Celine Masson, Ph.D.
Picardy Jules Verne University
Psychologist, Oeuvre de Secours aux Enfants
Co-director, Observatory La Petite Sirène

Caroline Eliacheff, M.D.
Child and adolescent psychiatrist
Co-director, Observatory La Petite Sirène

Em. Prof. Maurice Berger, M.D. Ph.D.
Child psychiatrist

SWITZERLAND
Daniel Halpérin, M.D.
Pediatrician

SOUTH AFRICA
Prof. Reitze Rodseth, Ph.D.
University of Kwazulu-Natal

Janet Giddy, M.B.Ch.B., M.P.H.
Family physician and public-health expert

Allan Donkin, M.B.Ch.B.
Family physician

UNITED STATES
Clin. Prof. Stephen B. Levine, M.D.
Case Western Reserve University

Clin. Prof. William Malone, M.D.
Idaho College of Osteopathic Medicine
Director, Society for Evidence Based Gender Medicine

Prof. Patrick K. Hunter, M.D.
Florida State University
Pediatrician and bioethicist

Transgenderism has been highly politicized—on both sides. There are those who will justify any hormonal-replacement intervention for any young person who may have been identified as possibly having gender dysphoria. This is dangerous, as probably only a minority of those so identified truly qualify for this diagnosis. On the other hand, there are those who wouldn’t accept any hormonal intervention, regardless of the specifics of the individual patients.

Endocrinologists aren’t psychiatrists. We aren’t the ones who can identify gender-dysphoric individuals. The point isn’t to open the floodgates and offer an often-irreversible treatment to all people who may have issues with their sexuality, but to determine who would truly benefit from it.
Jesus L. Penabad, M.D.
Tarpon Springs, Fla.

What is interesting to see here is very few of these signatories are out and vocal on social media. Levine and Malone are probably the best known.

So, you won't engage with the studies and papers posted then?

Oh well. I will keep posting them, maybe you will read them and understand this is the tip of the iceberg of the information that is out there if you care to look.

https://segm.org

SEGM and Genspect.org are two great starting places.

This is not an attack. It is a considered response to your comment.

In Brisbane, there are clinics where 13 year olds can get mastectomies - 13 years old! They don’t “advertise” that they will remove the breasts of a 13 year old girl, but phone calls asking for the surgery for 13 year olds are met with agreement to perform mastectomies.

Anyone who thinks that a 13 year old can consent with full understanding of the consequences to such drastic surgery to healthy body tissue is captured and shouldn’t be around children.

Add to the above the fact that all this gender ideology crap is enshrined in law, and dissenters are threatened with repercussions via anti-discrimination commission/etc, and it is inevitable that Australian children will (and are currently) suffer horrendously.

Just adding this link to the Cass Review Interim Report.

cass.independent-review.uk/wp-content/uploads/2022/03/The-Cass-Review-Interim-Report-Final-Bookmarked.pdf

What is repeated through out is the 'lack of evidence' that underlines any of the use of PB or cross sex hormones in the treatment of not only children but of adults.

Here is some more clinicians questioning and raising alarms:

This is a report of a conference session from Dr Stephen Stathis. He is a clinical psychiatrist who founded the Queensland gender clinic. He is now saying that puberty blockers are not reversible in some important areas and that the evidence is weak in their continued use.

He has hinted that Australian gender clinics are now jointly researching puberty blockers.

He also feels that adolescents cannot give consent for these drugs.

“The Gillick test requires the child to understand fully the treatment proposed.”

“Dr. Stathis said: “I’ve asked QCs [senior barristers], what does it mean for an adolescent to fully understand what is proposed, particularly for lifelong treatment? No one can give me an answer.”

“”I would say I don’t believe, based on the definition of Gillick, that an adolescent does have the capacity to understand.””

www.genderclinicnews.com/p/yes-our-evidence-is-weak

this is a very long article by Bernard Lane and it is very worth reading. It seems a balanced report on Dr Stathis’ session.

---

Here is 2018 and Polly Carmichael discussing social contagion as an issue.

March 2018: Polly Carmichael had told an ACAMH conference:
“without a doubt there are some young people who are finding a community, friends and all sorts of things through joining a group who have an interest around gender and I think that for some of those we would be very foolish not to acknowledge that it's probably the case that they are caught up in something rather than it being an expression of something that has arisen from within. So there is a lot of concern.”

“I have been shocked by some of the things that are swilling around the internet that young people have access to. There are numerous groups on Reddit and Tumblr that many of the young people that are attending our service are going onto..maybe it's also the dissing of expertise, in a way, so that there is a feeling that this is about who I am, so what does anyone else know? It's a very odd situation in some way.`”

---

Two prominent transwomen clinicians, one who could led WPATH next year have stated they are against some of the current practices in trans health. Marcy Bowers and Eric Anderson. Particularly fast tracking to hormonal treatments. Article by Abigail Shrier.

bariweiss.substack.com/p/top-trans-doctors-blow-the-whistle

---

www.smh.com.au/national/nsw/now-i-m-hopeful-we-can-we-talk-about-teens-and-gender-20211031-p594q6.html

Now I’m hopeful we can talk about teens and gender

Dr Sandra Pertot

I found this very clear as an explanation

Although there is agreement across all clinicians working with gender-questioning adolescents that they typically report a history of mental health problems, increasingly some clinicians will consider the possibility that the client has come to the belief they are transgender as a way of providing an explanation for and resolving their pre-existing problems. In my experience, gender-affirming therapists strongly disagree, believing that anything other than immediately affirming the client’s expressed belief they are transgender will compound the harm. My view is that it is precisely because of the high rate of mental health problems in this group that a careful and comprehensive mental health assessment is required as a first step. Shepherding all of these vulnerable young people down the same pathway is poor clinical practice.

---

As well as this article in the Washington Post from Dr Laura Edwards-Leeper & Erica Anderson, L E-L has tweeted about social transitioning done by schools.

“ I think this is a bad idea in 99% of circumstances. Professionals who know what they’re doing should be involved; and by not including parents, it ultimately makes the situation worse for the kid (unless the parent is abusive- that’s the 1%). I’ve actually never seen this go well”

www.washingtonpost.com/outlook/2021/11/24/trans-kids-therapy-psychologist/

mobile.twitter.com/drlaurael/status/1462968319636480004

The Washington Post article points out that many clinicians are not following the WPATH guidelines of comprehensive assessment and rmental health support.

The standards of care recommend mental health support and comprehensive assessment for all dysphoric youth before starting medical interventions. The process, done conscientiously, can take a few months (when a young person’s gender has been persistent and there are no simultaneous mental health issues) or up to several years in complicated cases. But few are trained to do it properly, and some clinicians don’t even believe in it, contending without evidence that treating dysphoria medically will resolve other mental health issues. Providers and their behavior haven’t been closely studied, but we find evidence every single day, from our peers across the country and concerned parents who reach out, that the field has moved from a more nuanced, individualized and developmentally appropriate assessment process to one where every problem looks like a medical one that can be solved quickly with medication or, ultimately, surgery. As a result, we may be harming some of the young people we strive to support — people who may not be prepared for the gender transitions they are being rushed into.

^^

"attacked"? Seriously?

Maybe the next n+1 question to ask is how many clinicians speaking out will it take before the general public who seem to be determined to deny the evidence is there that shows that trans health is at an all time low standard listen to the clinicians?

I believe there is already hundreds. Will it be thousands? Tens of thousands?

Here are some more links:

The Dutch Model is falling apart

By Stella O'Malley / 2 January 2023

First, Stella O’Malley writes about an article in Nederlands that is throwing a great deal of light on the Dutch Protocol. It also seems that there will be a review of the patients that the Dutch team had not previously included in their papers.

This article in the Nederlands points out the dangers on only using a nation’s own sources with no international input or even wide review.

genspect.org/the-dutch-model-is-falling-apart/

---

Here is another study:

The Myth of “Reliable Research” in Pediatric Gender Medicine: A critical evaluation of the Dutch Studies—and research that has followed

E. Abbruzzese, Stephen B. Levine, Julia W. Mason

www.tandfonline.com/doi/full/10.1080/0092623X.2022.2150346

Our analysis of the Dutch protocol has been written with three goals in mind. First, we wanted to definitively refute the claims that the foundational Dutch research represents “solid prospective research” that provides reliable evidence of net benefits of youth gender transition. In fact, it is much better described as case series—one of the lowest levels of evidence available (Dekkers et al., Citation2012, Mathes & Pieper, Citation2017). Second, we aimed to demonstrate that the type of non-comparative, short-term research that the gender medicine establishment continues to pursue is incapable of generating reliable information. And third and most importantly, we wanted to remind the medical community that medicine is a double-edged sword capable of both much good and much harm. The burden of proof—demonstrating that a treatment does more good than harm—is on those promoting the intervention, not on those concerned about the harms. Until gender medicine commits to conducting high quality research capable of reliably demonstrating the preponderance of benefits over harms of these invasive interventions, we must be skeptical of the enthusiasm generated by headlines claiming that yet another “gender study” proved benefits of transitioning youth. This time-honored concern about risk/benefit ratio is a sobering reminder that the history of medicine is replete with examples of “cures” which turned out to far more harmful than the “disease.”

---

A treasure trove of studies relating to whether there is conclusive improvement to transgender people's lives after medicalised treatment paths can be found in this Medium article by JLCederblom

medium.com/@JLCederblom/the-lukewarm-perjury-of-jack-turban-a85903109051

There is an abridged version as well.

It is actually a run down of the evidence presented by Jack Turban's Declaration in Support of Plaintiff's Motion for a Preliminary Injunction in Brandt et al vs Rutledge et al in the US District Court for the Eastern District of Arkansas.

In it is this review listed as footnote 15. Baker, K. E., et al, (2021) Hormone Therapy, Mental Health and Quality of Life Among Transgender People: A Systematic Review. Journal of the Endocrine Society.

academic.oup.com/jes/article/5/4/bvab011/6126016

I was interested particularly in this finding.

Quality of Life

Among adolescents, a mixed-gender prospective cohort (n = 50) showed no difference in QOL scores after a year of endocrine interventions, which included combinations of GnRH analogues and estrogen or testosterone formulations [30]. No study found that hormone therapy decreased QOL scores. We conclude that hormone therapy may improve QOL among transgender people. The strength of evidence for this conclusion is low due to concerns about bias in study designs, imprecision in measurement because of small sample sizes, and confounding by factors such as gender-affirming surgery status.

And this under Depression

Among adolescents, 2 mixed-gender prospective cohorts (n = 50 and n = 23, respectively) showed improvements in depression scores after 1 year of treatment with GnRH analogues and estrogen or testosterone formulations (both P < 0.001) [30, 38]. Another prospective study reported that BDI scores improved almost by half among adolescents (n = 41) after a mean of 1.88 years of treatment with GnRH analogues to delay puberty (P = 0.004) [34]. The overall improvement after several subsequent years of testosterone or estrogen therapy in this cohort (n = 32) was smaller, however, resulting in no significant change from baseline [35]. No study found that hormone therapy increased depression.

Anxiety

Among adolescents, 1 prospective study saw mean anxiety scores in a mixed-gender group (n = 23) improve from 33.0 ± 7.2 to 18.5 ± 8.4 after 1 year (P < 0.001) [38], but another reported no changes in anxiety after approximately 2 years of puberty delay treatment with GnRH analogues and 4 years of hormone therapy (n = 32) [35].

Suicide

The risk of bias for this study was serious due to the difficulty of identifying appropriate comparison groups and uncontrolled confounding by surgery status and socioeconomic variables such as unemployment. We cannot draw any conclusions on the basis of this single study about whether hormone therapy affects death by suicide among transgender people.

^^

@OCaptain If you really do want to discuss in good faith then I hope you haven't been scared off the thread.

The transgender healthcare industry (and it is an industry) has really done a number on people with liberal, "progressive" views by painting a picture of these interventions as being necessary treatments with a high success rate for people suffering from debilitating dysphoria who just want the chance of a normal life. People who oppose these treatments are portrayed as anti trans bigots who want people to be forced to live a lie.

But, as ever, the truth is much more nuanced than that.

The bold claims that, for example, only 1% of trans people detransition are not backed up by any credible evidence.

The claim that something like 40% of trans people have attempted suicide is another one: taken from a very small, self selecting sample with apparently no controlling for mental health comorbidities. It is a completely unreliable figure which has then been taken out of context and quoted to thousands of worried parents, often accompanied by questions such as, "Would you rather have a trans son or a dead daughter?"

Children who believe they want hormones and surgery are coached by online communities to say they will commit suicide if they don't get them, thus shoring up this unreliable figure even further.

Campaigners tell us that medical transition for children is something that almost never happens, despite the existence of many clinics doing a roaring trade in puberty blockers (who are puberty blockers for, if not children?) and surgeons posting pictures of 13 year old patients who have had double mastectomies on social media.

We are constantly being told that puberty blockers are safe and reversible despite the growing body of evidence to the contrary, and the fact that almost all children who take puberty blockers go on to take cross sex hormones (making it incredibly difficult to get any data on whether the effects of puberty blockers are indeed reversible in those who stop taking them) is evidence that puberty blockers were the right course of treatment for all those children, not that puberty blockers were what put those children on an unstoppable pathway to irreversible transition.

Meanwhile the UK charity which both lobbies the government for better access to puberty blockers and helps individual children access to them (via the same Gender GP referred to above) despite declaring in a court of law that they are not medical experts and do not get involved in anything medical, were found to have a self confessed paedophile on their board of trustees. Clearly, a known paedophile should not be involved with any children's charity, but the fact that he was involved with one which actively promotes stopping puberty in children is even more concerning.

I genuinely believe that millions of people like you - usually progressive, feminist, pro equality, left leaning voters in their 30s and 40s who want to bring their children up to be good, kind, happy, responsible citizens - have closed their eyes and ears to these issues because they simply cannot believe that their own political tribe could possibly support something so atrocious, and that these stories must just be made up by right wing conservatives trying to sow political division.

But we are not right wing conservatives and we are not making anything up. We are people just like you with a lot of the same beliefs and attitudes, who love our children and believe in acceptance and equality.

The numbers aren't really the issue - the important thing is the principle. Double mastectomies should only be performed on women with breast cancer or, after extensive counselling, on women at high risk of breast cancer.

No one should be having their breasts removed to "treat" gender dysphoria.

It doesn't really matter if it's only half a dozen who have had the surgery. That's half a dozen too many. And once you accept the principle that it's acceptable to offer double mastectomies for gender dysphoria, then there is no limit to the number who might end up having them. Could be six, could be 600, could be 6,000 - and so on. In the US, there were 13,000 such operations in 2019. It's probably more now.

Regarding that 1% claimed detransition number - it comes from the US Transgender Survey, which is only open to people who currently identify as trans or gender diverse. The ones who detransitioned and never retransitioned weren’t eligible to answer the survey. They were out of scope.

Even so:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8213007/

A total of 17,151 (61.9%) participants reported that they had ever pursued gender affirmation, broadly defined. Of these, 2242 (13.1%) reported a history of detransition.

And this from a study by the very activist Jack Turban. I’m not sure who is a less reliable source, him or Gender GP. Both have a conflict of interest. The actual detransition rate can’t be ascertained from that source.

More recently, better research has been done or considered. This one looks to be a promising meta-analysis. https://link.springer.com/article/10.1007/s10508-023-02623-5
It is important for those considering medical intervention to know that the likelihood of regret, detransition, and discontinuation is unknown, that regret and detransition can be traumatic, and that the extremely small numbers quoted by some (Bustos et al., 2021; McNamara et al., 2022; Rosenthal, 2021; Turban, 2022) are not reliable or representative.

This post is a good summary of why the “research” purporting to show positive outcomes from “gender affirming care” is mostly rubbish. https://jessesingal.substack.com/p/the-new-highly-touted-study-on-hormones

@OCaptain I would suggest reading some of the threads here on Helen Webburley (Gender GP) before citing anything she has to say on this subject.

Then there was this review of US Military health insurance records for transition persistence.

academic.oup.com/jcem/article-abstract/107/9/e3937/6572526?redirectedFrom=fulltext&login=false

”Continuation of Gender-affirming Hormones Among Transgender Adolescents and Adults”

Christina M Roberts,
David A Klein, Terry A Adirim,
Natasha A Schvey, Elizabeth Hisle-Gorman

22 April 2022

Results
The study sample included 627 transmasculine and 325 transfeminine individuals with an average age of 19.2 ± 5.3 years. The 4-year gender-affirming hormone continuation rate was 70.2% (95% CI, 63.9-76.5). Transfeminine individuals had a higher continuation rate than transmasculine individuals 81.0% (72.0%-90.0%) vs 64.4% (56.0%-72.8%). People who started hormones as minors had higher continuation rate than people who started as adults 74.4% (66.0%-82.8%) vs 64.4% (56.0%-72.8%). Continuation was not associated with household income or family member type. In Cox regression, both transmasculine gender identity (hazard ratio, 2.40; 95% CI, 1.50-3.86) and starting hormones as an adult (hazard ratio, 1.69; 95% CI, 1.14-2.52) were independently associated with increased discontinuation rates.

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So this review found 30% of people who were taking hormones stopped taking hormones by 4 years!

Why do people stop taking hormones? Good question. Would it be so difficult to think that the majority of people stopping taking hormones might have DETRANSITIONED?

It is well worth considering isn't it?

Sex Matters has done a 3 part series on current treatment options and the issues around them.

https://sex-matters.org/advice/resources-for-parents/

Another Australian study on the impact of media .

Association of Media Coverage of Transgender and Gender Diverse Issues With Rates of Referral of Transgender Children and Adolescents to Specialist Gender Clinics in the UK and Australia

Ken C. Pang, PhD Nastasja M. de Graaf, MSc; Denise Chew, MD;

Question
Is media coverage of transgender issues associated with referrals of transgender and gender diverse (TGD) children and adolescents to specialist gender services?

Findings
In this serial cross-sectional study across an 8-year study period during which more than 5000 TGD young people were referred to 2 pediatric gender clinics in the UK and Australia, a significant association was found between weekly referral rates and the number of TGD-related items appearing within the local media 1 to 2 weeks beforehand, for the UK only in week 1 and for Australia only in week 2.

'froth' - my fucking god, the callousness.

The Australian , Natasha Robinson, 17th February 2023

www.theaustralian.com.au/science/doctor-scrutiny-on-gender-clinic-reveals-legal-and-safety-fears/news-story/8af81768fde27884caf18fff345ab78a?amp&nk=251396453faa0730705a45251160583c-1676662448

(Plug the above link into archive dot ph)

Senior physicians at the NSW Children’s Hospital Westmead’s gender clinic have studied the physical and mental health of 79 patients in a rare academic study of the outcomes of children who presented with gender distress and gender dysphoria. The findings cast doubt on the scientific basis of the gender-affirming approach followed by the nation’s other children’s hospitals.

In an open access academic paper, CHW psychiatrists, endocrinologists and other physicians, and a senior medical ethics expert, called for a “much more nuanced and complex approach” as analysis revealed 88 per cent of children presenting at Westmead’s gender clinic had at least one co-morbid mental health condition, with more than 50 per cent diagnosed with behavioural disorders or autism. One in five children who consulted the clinic with gender-related distress later had these feelings resolved, and almost one in 10 with a formal diagnosis of gender dysphoria, some who had taken puberty blockers and cross-sex hormones, later discontinued transitioning.

And

The CHW doctors have raised concerns that “many unknowns remain” regarding the long-term effects of puberty blockers, which are described by the Royal Children's Hospital Melbourne as “reversible in their effects”. International evidence is in fact casting greater doubt on whether the effects of these medications are reversible. Endocrine reviews of the CHW patient cohort documented side-effects in 23 of the 49 young people prescribed puberty blockers, including low bone density, hot flushes, weight gain and anxiety. The CHW doctors raised concerns about long-term effects on patients’ sexual function in adulthood.
Within the 9 per cent cohort of patients with a diagnosis of gender dysphoria who had desisted – that is, discontinued the transgender pathway 4-9 years after consulting the gender clinic – three had undergone puberty suppression beginning at the average age of 12. Three had taken cross-sex hormones, one from as young as 15, but not prescribed by CHW. The effects of cross-sex hormones, including infertility, are irreversible.

This is the study

Distress: A Prospective Follow-Up Study

by Joseph Elkadi, Catherine Chudleigh, Ann M. Maguire, Geoffrey R. Ambler, Stephen Scher and Kasia Kozlowska

www.mdpi.com/2227-9067/10/2/314

This prospective case-cohort study examines the developmental pathway choices of 79 young people (13.25–23.75 years old; 33 biological males and 46 biological females) referred to a tertiary care hospital’s Department of Psychological Medicine (December 2013–November 2018, at ages 8.42–15.92 years) for diagnostic assessment for gender dysphoria (GD) and for potential gender-affirming medical interventions. All of the young people had attended a screening medical assessment (including puberty staging) by paediatricians. The Psychological Medicine assessment (individual and family) yielded a formal DSM-5 diagnosis of GD in 66 of the young people. Of the 13 not meeting DSM-5 criteria, two obtained a GD diagnosis at a later time. This yielded 68 young people (68/79; 86.1%) with formal diagnoses of GD who were potentially eligible for gender-affirming medical interventions and 11 young people (11/79; 13.9%) who were not. Follow-up took place between November 2022 and January 2023. Within the GD subgroup (n = 68) (with two lost to follow-up), six had desisted (desistance rate of 9.1%; 6/66), and 60 had persisted on a GD (transgender) pathway (persistence rate of 90.9%; 60/66). Within the cohort as a whole (with two lost to follow-up), the overall persistence rate was 77.9% (60/77), and overall desistance rate for gender-related distress was 22.1% (17/77). Ongoing mental health concerns were reported by 44/50 (88.0%), and educational/occupational outcomes varied widely. The study highlights the importance of careful screening, comprehensive biopsychosocial (including family) assessment, and holistic therapeutic support. Even in highly screened samples of children and adolescents seeking a GD diagnosis and gender-affirming medical care, outcome pathways follow a diverse range of possibilities.

Conclusions

The data from this study show that when young people with gender distress present to health services seeking medical interventions, they end up following a diverse range of developmental pathways. The availability of gender-affirming medical interventions for the treatment of gender dysphoria is a recent one, evolving from the work of clinicians in the Netherlands. Early studies have suggested that medical interventions were associated with positive outcomes. This early body of work consequently served as the foundation for subsequent treatment guidelines and became established in medical systems via streamlined assessment processes and treatment pathways. The concept of medical affirmation was embedded in the broader culture by media and internet channels.

Together, these processes gave young people with gender-related distress a clear message: “This is the best way to proceed,” and “The medical affirmation pathway will take away your gender dysphoria.” For many young people and their families, however, these messages favouring medical interventions, coupled with professionals’ affirmation of this pathway, potentially displaced their consideration of other options or other pathways.

The young people and families who presented to our service typically came to us with settled ideas concerning their prospective treatment pathways. In particular, based on what was known at the time, and given the severity of the young persons’ distress, they and their families considered medical treatment for gender dysphoria to be the single best option. In the last five years, however, the gender-affirming medical model has been questioned by both clinicians (who have highlighted the current lack of a solid evidence base and detransitioners (who have highlighted the potential for adverse outcomes). The current evidence suggests the need for a much more nuanced and complex approach. As research data pertaining to long-term outcomes continues to accumulate, “the best way to proceed” is likely to be seen as ranging over a much more diverse range of treatment options and pathways, with each supported by a stronger evidence base than is currently available.

And I have probably posted an overload. However, it is vital that misinformation is countered and the reality is stripped back so people can begin to understand what is happening here.

Australia and NZ College of Psychiatristspublish a warning there is not enough evidence.

//www.ranzcp.org/news-policy/policy-and-advocacy/position-statements/gender-dysphoria

The Royal Australian and New Zealand College of Psychiatrists have now updated their guidance.

They are now warning that there is NOT ENOUGH evidence to recommend affirming only treatments or indeed any particular treatment plan. They now say that underlying health issues should be treated at the same time. And warn that medicalisation of children and teens be very careful and thoroughly explored considering the ‘paucity’ of evidence at this time.

Interestingly, they indicate that there are a couple of long term studies under way which will be interesting to see when they are published. One is a longitudinal study on trans patients in Australia.

hearing about a 16 year old girl being subjected to an unnecessary double mastectomy as, essentially, an experiment, and dismissing discussion of it as 'froth', does require quite the starting position

Do you understand how parents cannot, in some states in Australia, refuse to agree to affirming only care without having the risk of losing their children to have the court make decisions for that child?

It has already happened.

That combined with the outrageously inflated and weaponised suicide statements means parents in some states in Australia have very little option if they wish to keep a relationship with their child.

And those suicide statements are over inflated. The studies they come from generally have a confirmation bias because of either the wording, or that they are a incentivised open access survey akin to marketing research. They should never have been utilised to form policy or to make such statements.

Clinicians have stated very clearly two findings.

Firstly that suicide is no more common in that group as it is in the groups with the same co-morbidities.

And Secondly, that suicide numbers and attempts do not change with transition treatments. They continue to be at least as high as before treatment

Some parents, unless they are contacting support groups that provide unbiased information are faced with the emotional manipulation of their children. And I have now posted at least two reports that show that children and teens are being heavily influenced and coached by social media AND by trans support groups and heavily invested people claim to be 'allies'.

It's just - I watched a short clip of the woman interviewed and it was heartbreaking. To then be met by someone apparently dismissing her suffering so lightly is quite staggering. As if she isn't even a person.

I guess PP was perhaps referring to the programme rather than the woman involved. But it was flip. And yes, callous.

'Ms Jeffries describes her life as a 'clusterf*' and said she will always carry the scars, physical and mental, of the choices she now regrets.
When she was 16, she said she 'was just looking for a sense of belonging' and found comfort in online communities.
'And then it's, like, if you do transition, it's, like, oh, everyone gives you so much love,' she said. '

I can imagine. We are allowed to say that this is how cults operate, yes? To be clear I don't think that 'transgenderism' is a cult, per se, but groups within that ideology display many of the same group dynamics as cults.

And I would hope that we could show compassion for vulnerable people who are abused and misled by harmful movements.

I’ll add that to the list. Also worth asking what other area of child health is anyone questioning so stridently in the world right now?