New mental health analysis of Tavistock pb trial

[WarriorN]

Bbc report by Hannah Barnes

It doesn't mention their sex though

It appears to be more around the way the data was interpreted and as only 44 children is a very small sample size.

Children on puberty blockers saw mental health change - new analysis www.bbc.co.uk/news/health-66842352

Paper (not yet peer reviewed)

www.medrxiv.org/content/10.1101/2023.05.30.23290763v3

34% deteriorated, 29% improved, 37% no change.

However, for future trials, it also strikes me that self reported surveys do have the potential to play down symptoms and we do know that online sources can school people in what to say.

There's also the impact of how some parents are worryingly forceful about their child transitioning.

I also query how some children accessed them without mh issues in the first place. As surely Gd is distressing?

If they all had distress, pbs only "helped" 29 %

Please correct me if I'm wrong but wasn't this the study that switched the questionnaires mid study, from the female children getting the tests for females at the start and then the male tests at the end (with thr same happening in reverse for the males) thus messing with the results.
Whether this is the study I'm thinking of or not the fact that pbs are harming more children than they help (just talking about mental health consequences not physical) should see them banned from use in children. No other medicine that is supposed to help your mh which has such a risk reward profile would ever be licensed for use in children by NICE, and that's before we discuss the physical harms caused to ALL children who take them.

The thing is, the sample of 44 is tiny and there is no demonstrable link between the drugs and adverse mental health effects yet. And it's fair to say that children taking these drugs are likely to have a fair amount of other issues and stressors affecting them that you might not expect to see in the general population which muddles the picture - it's impossible to say at this stage how much of the MH difficulties or improvements are down to the drugs .

From the BBC article: "However, what neither the original research paper, nor the re-analysis, can do is tell us why these young people fared so differently.

The study is small - just 44 young people. And because of the way the original study was designed - without a control group - experts can't infer cause and effect or say these changes in wellbeing were caused by being on puberty blockers."

Yes I thought that too.

Presumably they are trying to get their processes right future studies so that they're not flawed? As well as demonstrating the flaws of previous ones. ??

To be clear: this is the drug that was used to chemically castrate Alan Turin.

It's incredibly toxic and the long term side effects are still unknown, but potentially life-shortening and clearly life-limiting given that boys given blockers are unlikely to ever be able to have a fulfilling sex life.

How could it be handed out to children with so little regard for research to see if it actually helps?

Yes, this is looking at one aspect of previous data. Which was badly reported.

It's also been demonstrated that it's not a 'time to think pause' as was advertised and it's suggested use - it's the first step of transition.

The evidence base so far is looking extremely weak in it being of any use whatsoever

Switching questionnaires was certainly said about the Dutch studies, but I don't know what methods the Tavistock used for theirs. In any case I expect that questions about mental health outcomes like depression etc wouldn't be affected even if they flipped the sexes.

From what I recall the Dutch studies didn't find an overall improvement in observable mental health either. What they found was only a decrease in dypshoria, which could be accounted for by flipping the sexes in the questions. Everything else stayed the same. Which they spun as success.

Are you on the right thread?

This is a discussion about the impact of un licensed or evidenced drugs on children.

Did you think this was a parking thread?

Not sure that I noticed any communications on this thread that weren't respectful and considerate, @alexjohnson. While your intentions may have been good, I fear your unnecessary intervention is injecting an unhelpful theme of conflict into an otherwise reasonable thread.

If anyone wishes to read the paper it is here:

https://www.medrxiv.org/content/10.1101/2023.05.30.23290763v3.full.pdf

Feel free to ask questions

Are you the study author, @alexjohnson?

If not, why would we want to ask you questions?

And whoever you are, why do we need your permission?

No it’s not the study that switched questionnaires. That was the original Dutch research - the entire basis of puberty blockers - and not this Tavistock research. It’s important they aren’t confused.

Thanks for the clarification not

OP thank you for this thread, lots to think about.

As an aside I would be ignoring scolding attempts to derail.

Thank you for clarifying this is not the Dutch study.

It looks an interesting paper. I'll give it a full read later, but I think the first important point to note is that this is not a new clinical trial. It's a re-analysis of a pre-existing data set from.somebody else's trial, to investigate whether using different analysis methods can extract better information from poor (uncontrolled and small sample size) trials.

I'm strongly in favour of accurate information and in-depth discussion on the use of these drugs, but this is misinformation. GnRH analogues were first developed in 1971, almost 20 years after Turing's death. He was given DES, a synthetic oestrogen and a different class of drug entirely.
There's a great deal wrong with GnRH analogues and how they're used - but that doesn't include high toxicity. They are simply not toxic in the way that many drugs, including paracetamol, are.

To be clear, I think there's strong evidence to support strictly limiting their use in children. But I feel people should be careful to avoid repeating sensationalist misinformation.

Thanks for the clarification.

What a strange headline on the BBC article ("Children on puberty blockers saw mental health change").

If the trial had shown massive improvement in mental health, I'm sure they would be shouting that from the rooftops.

I thought the article title was odd

I don't think it's that strange. Some saw no change, some an improvement, some saw a deterioration. So "change" is probably shorthand for "some improvements and some deterioration".

Regardless, I think it's irresponsible to have a headline which suggests a link to the drugs when the paper and indeed the article appended to said headline suggest that there's no known link at the moment between these drugs and mental health improving / worsening.

Its about as useful as saying "some people taking paracetamol went out and bought cars and some didn't".

I appreciate what this paper is trying to achieve, but as PP has said the source quality of the data is not great, and I'm really not sure how helpful publicising this is given that the results, even if they were obtained through rigourous controlled testing, appear fairly inconclusive with a roughly 1/3 breakdown between improvement, no change, and deterioration. Its all rather odd.

Publishing 'no result' data is massively important. Not doing so is one-of the big problems with research at the moment - only publishing results that show a strong effect skews the data.