Psychological outcomes from puberty suppression

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A bit of a dense read, but rather seems to show that gender blockers are not the amazing psychologically life saving intervention that some parties would like us to believe. Link to research article published a few days ago

Apologies if it's already been posted, but couldn't find it.

Small study size is a real issue and will continue to be

The original study was uncontrolled and has a small sample size. The very small sample size at 36 months is particularly important to bear in mind when interpreting results. The reason for the reduction in sample size is given as “people were recruited at different ages (12–15 years) but left the study soon after their 16th birthday”; no further explanation is given about why this was the case (Carmichael et al., Citation
2021a). While the individual level change approach can be applied irrespective of sample size and lack of a controlled design, there remains a fundamental problem that there is insufficient data to draw firm conclusions about the safety and efficacy of this treatment.
Relatively few participants fell into the borderline or clinical range at baseline (27%–58% depending on the scale). This is lower than a typical CAMHS population; Gibbons et al. (Citation
2021) found around 90% of their sample to be in the clinical or borderline range at baseline. This suggests that the GIDS participants may have been less distressed when they were referred to the clinic than typical CAMHS referrals and may indicate a relatively low referral threshold operating at the time period studied. I find this significant, referrals were clearly 'acceptance' at all costs

Here we have it, biological sex might be important after all. Who'd a thought

For example, the approach could be used to look more closely at biological sex in order to say, for example, that "x% of biological boys improved"; "x% of biological girls deteriorated"; “x% of biological boys experienced side effect A” and so on, which would improve consent processes in clinical practice until better data is available

Common sense has entered the room
For example, it would be possible to analyze routinely collected outcome data for children who do not take up puberty blockers to generate comparable data on Reliable and Clinically Significant Change as a naturalistic control group.

Thanks op, went down well with the morning cuppa

Experimental treatment then.

Which unfortunately is being pushed in some places as if it was securely evidence based.

Wow!

That's very damning of the original study - and rightly so. No recording data by sex, self report, tiny sample, no decent conparator (anywhere in all available research, never mind within the study). And that drop out rate - 2/3 drop out at 2 years and 3/4 drop out at 3!

But in summary, as far as it's possible to tell from the appalling 'research': the treatment is at best useless, with a definite possibility of worse-than-useless.

I don't think it was drop-out rate that necessarily made the numbers decrease though. They said that the age range was 12 - 15, stopping shortly after the 16th birthday, but some were older than 12 when first recorded, which would be the reason why they have fewer years available.

The thing I don't quite understand is that the purpose behind blockers isn't that they are intended to cure or benefit mental health in-and-of themselves, they were supposed to buy time to think while the kids grew older. This wasn't happening in practice due to the affirmation-only model, but I think it's beside the point.

Surely the purpose of these tests should be to establish what harms they do when used for their intended purpose, e.g. what irreversible damage is done by blockers, what are the long-term health effects, and then a sensible risk assessment can be made as to their utility.

I don't know why they are looking at whether blockers themselves are benefiting (or otherwise) the mental health of trial participants.

That's still a drop-out rate, though - even if it's a planned end point they are still lost to follow up, so the data are incomplete.

The thing I don't quite understand is that the purpose behind blockers isn't that they are intended to cure or benefit mental health in-and-of themselves, they were supposed to buy time to think while the kids grew older. This wasn't happening in practice due to the affirmation-only model, but I think it's beside the point.

It isn't just the affirmation model which prevents the children from being able to make a more mature decision, it's the effect of the blockers themselves. As well as stopping the body from maturing, puberty blockers also stop brain development, so the child ends up chronologically older, but with the body and brain of a much younger child.

It's not possible for puberty blockers to do what the child gender clinics are claiming for them, because of this impact on brain development. The only way for a child to have the capacity to make a mature, adult decision is for them to go through puberty.

Experimental treatment is not of itself a bad thing. Most experimental treatments (eg new cancer drugs, treatments for heart disease, surgery techniques) are carried out within carefully developed protocols built on prior evidence and assessed for ethical consideration. These experimental protocols are designed to ensure there can be a good degree of confidence in the results (eg sufficient followup, reduced bias, enough power/sample size) and that harms are monitored so trials can be stopped. And the results are published promptly.

In the main, puberty blockers are not experimental treatments, they are simply harmful unproven treatments. Snake oil.

Small sample size, lack of blinding, short followup, large loss to followup, and lack of control are all things associated with larger reported positive effect size. Across medicine, trials that address these issues show reduced impact of the intervention.

As well as stopping the body from maturing, puberty blockers also stop brain development, so the child ends up chronologically older, but with the body and brain of a much younger child.

Ah. More filling for the pies? But legal?

@OldCrone

Thanks, understood.

It is the very short follow-up times in most of the studies looking at this which to me look like one of the major problems in the whole field, because many of the negative effects only become apparent over long time periods.

This is not so much about this particular study as the field in general, especially when viewed in the light of the many (though still anecdotal) reports I have seen that suggest several years (even seven to ten) pass before health-related problems and regress appear to rise.

My guess would be that this is because of the underlying but usually not stated fear that in the absence of something like puberty blockers the child might seriously consider suicide.

And yes, that is not what the blockers are supposed to be about.

I think the idea that puberty blockers were meant as a pause to reflect is bogus.

They weren't, they were meant to create a more physically perfect fake male or female. It's Frankenstein stuff.

The idea of the pause was always to make it sound more plausible and harmless. Of course plenty of people believed it, but that was never the original purpose.

That's exactly it, @TempestTost.

They go on about "time to reflect", but at the same time they defend social transition of even very young children by saying that those children "know who they are". Both of these can't be true. Either they don't "know who they are" and need the time to think and work it out (in which case they should never be medicated), or they do, in which case there is no need for the time to think.

And yes, it is really about being a more convincing imitation of the opposite sex (for male children, this doesn't apply to girls). The adult males who have transitioned later in life say that they wish they had had puberty blockers, not because they needed time to decide, but because they think they would "pass" better as adults.

There was never any real reason to give this medication to children. Trans children were invented by older male transitioners to support their claim that they had "always been trans". Even when they only discovered their inner woman in their 40s or 50s after fathering children.