Interesting study on puberty blockers

[Hoardasurass]

If you ignore the bs about born in the wrong body crap in the headline, the research that the article is about looks like it may (when expanded) deliver a final death blow to the myth that puberty blockers are safe and reversible

Puberty blockers given to children in wrong body may lower their' IQs https://www.dailymail.co.uk/news/article-12960869/Puberty-blockers-given-children-say-born-wrong-body-want-change-gender-lower-IQs.html?ito=native_share_article-nativemenubutton

I still don't understand the Tavistock's approach to collecting data on the many children they treated. As in, not collecting any data at all. If they were so sure that they were doing the right thing, why didn't they collect the data and publish a study or two?

Because the only reason of course that anyone would ever do a study is to annoy trans people. It's not like anyone cares about children after all. Or has any ethics.

No, @LentilFaculties they will definitely argue this but it should hold no truck with the medical profession and their legal/professional obligations.

The impact of this study should be that doctors should now be required by law to explain to potential patients the impact of these medications in terms of now largely proven cognitive deficits - and, really, the govt should step in and ban their prescribing on this basis so that those shady doctors willing to argue that the risk of cognitive damage is outweigh the benefits of gender care are criminalised.

They banned the prescribing of Ozempic for weight-loss within a few months purely due to national shortage, they should be able to do this now merely on the basis of the study and a requirement to investigate further.

Because they knew that it wasn't the right thing and are covering their collective arses

With any other experimental medical treatment there'd be treatment protocols, and ethics committees, and outcome collection and change of treatment if the outcomes weren't what was expected, and then follow up, and publishing of data. And yet ...

Quite!
Why is treatment for gender identity issues of a lower standard than treatment for other issues? Why do people accept - demand, even - a lower standard of care for trans identifying children?

They had to have two attempts to get it past an ethics committee, and the second time it was submitted to a different committee.

The proposal—“Early pubertal suppression in a carefully selected group of adolescents with gender identity disorder” —was rejected by the NHS Research Ethics Committee, on the grounds that it was not a proper randomized trial and therefore could not yield valid results (GIDS 2019b). The revised proposal (Viner 2010) argued that a randomized trial was not practical. Just as importantly, perhaps, it was submitted to a different Research Ethics Committee. This committee approved the experiment in February 2011. Aside from the absence of any control group, what is surprising is how the proposal failed to maximize information on the effects of GnRHa. Children were asked to consent to completing questionnaires only until they were 16. If they had been asked to give consent for the researchers to access their medical records in perpetuity, then GIDS would have been able to analyze effects of the drugs over the long term.

https://users.ox.ac.uk/~sfos0060/Biggs_ExperimentPubertyBlockers.pdf

The data is shocking. It's a scandal of epic proportions that involves so many professionals who have abandoned their ethics and responsibility to safeguard children, in favour of pandering to self centred adults determined to use children for their own ends.

This https://tavistockandportman.nhs.uk/news/early-intervention-study-shows-puberty-blockers-are-a-well-received-intervention-in-carefully-selected-patients/ piece of chip wrapping fluff.

Nice (net)work(ing) jolly - pg 14 of the doc. I’m sure the PowerPoint slides were colourful.
https://www.wpath.org/media/cms/Documents/History/Symposium/2014/2014%20Thailand%20Symposium%20Program.pdf

Funny how some people’s professional biography completely misses out huge chunks of their areas of “expertise”.

There are huge divides in belief and practice between human and animal medicine. Not because of the difference in species, but where you'd expect it to be the same. It's very interesting and strange.

This is a much more recent and larger scale study investigating this with a trans population, and finding no negative effective of treatment:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9574895/

It also does more groundwork than the study mentioned in the opening post in that it looks at expected trends of IQ increase in a teenage population according to educational attainment over the teenage years...if the teenager engaged with vocational / academic education. It found trends for trans teenagers who had gender affirming / puberty suppressing treatment replicated trends that would be expected in the general population, ie. No indication of any decrease in IQ after treatment.

Thanks for that, @suggestionsplease1. On a quick first look, the thing that jumped out was the lack of a control group. Participant outcomes seem to have been compared with a hypothetical cohort.

Author claims: "A randomized controlled trial in which some of the adolescents receive PS and others do not, would provide the most accurate estimate of the effect. However, since such studies are not at all desirable from an ethical perspective, other methods will have to be explored".

It isn't remotely clear why they couldn't source a control group from children who were not seeking to delay puberty.

To do this properly the researchers would have to assign some children to puberty suppressing treatment and other children to no such treatment. Ideally this would be a matched process - so the subjects would be similar in other key areas, eg, age, existing educational attainment, IQ.

Of course, ethically they can do no such thing as it is a clinical decision from healthcare professionals involved in the child's treatment that determines whether treatment is appropriate or not, not some researcher's exploring concerns about IQ.

So that is why they state it is not desirable from an ethical perspective.

They have instead researched whether the educational attainment of trans adolescents treated with puberty suppressants matches trends seen in the general population, and they have found that they do...ie. no apparent detriment from treatment.

In fact they also note that those receiving treatment have performed more strongly in educational attainment compared to the general population, and suspect that this is due to the positive effects of psychological counselling this population received during their gender affirming treatment, which may have increased intrinsic motivation regarding education.

You haven't explained why they couldn't source a control group from children who were not seeking to delay puberty.

Well they have! They compared to 26,504 adolescents in the general population (who I assume were not seeking to delay puberty)..."A meta-analysis that included results from 20 studies with 26,504 participants"

Oh and then 70,000 English children as well (next point down in the discussion)

They said there was no control group.

"A randomized controlled trial in which some of the adolescents receive PS and others do not, would provide the most accurate estimate of the effect. However, since such studies are not at all desirable from an ethical perspective, other methods will have to be explored to gain a better insight."

🙄 Studies like these can not ethically have a control group as you seem to conceive it, as I have already outlined.

They could of course have taken 72 random adolescents who did not desire or have puberty suppressing treatment and performed the same measurements on them to match the 72 that have had treatment....but that would have resulted in weak findings because of the low number.

They have done something far better that that and used populations in the 10,000s to analyse and compare trends, and this is a far more robust approach than limiting this 'control' to 72.

Of course, they can not generate these same large scale figures for the trans adolescents having treatment as they do not exist, that is an inescapable limitation.

I kind of get the control group thing... they've compared the same kind of measurements with other studies (larger group) rather than taking some of the trans people and not giving them PBs/hormones/surgery to make a control group (although different methods of measuring IQ and educational achievement).

What I don't get is why they're measuring IQ at the start and educational achievement at the end? Why not IQ at the end and then they could compare each individual's scores?

The study seems to say that the higher your IQ before the start of treatment, the higher your educational achievement is likely to be at the end and this matches what you see in non-treated people. So there's still a link between higher IQ at the beginning and higher achievement at the end but presumably that would still be true if either the PBs or hormones/surgery caused equal amounts of negative effect to all of them.

I'm just commenting on what the researchers said. Here it is for the third time.

A randomized controlled trial in which some of the adolescents receive PS and others do not, would provide the most accurate estimate of the effect.

If you disagree, perhaps you should explain to them why this would give a poor result.

The participation rate was quite low. I wonder what the results would have looked like if the other 40% had participated.

Of the 119 adolescents who were eligible for this study, 72 participated. There were several reasons for non-participation; some could not be contacted because correct address information was lacking, some agreed to participate but did not fill out the questionnaires despite repetitive reminders, and some declined to participate.

Well a randomised controlled trial would give the most accurate result, it's just not ethically possible for researchers to orchestrate this.

The best control would be a matched group who do not receive puberty suppressing treatment but were still trans identified, because what you want to discover is the direct impact of puberty suppressants on IQ, and trans status may already impact IQ ( eg. Do young trans people miss more education than non-trans people due to bullying, mental health concerns...do these issues relating to trans status impact IQ already? ).

So therefore a control group who is not trans is not really appropriate and limits the conclusions that can be made.

Future research may be able to do an analysis along these lines, but it would have to be with groups that had formed prior to and independent of the researchers' study concern, as the researchers should obviously not be assigning people to the study conditions of treatment vs non-treatment.

It seems likely that they did not have this data available to analyse (eg. Maybe these specific measurements have not been taken in trans adolescent populations who have not received puberty suppressants)

In any event, it is a far superior research effort in terms of relevance to the trans population than the study on children experiencing precocious puberty.

What did you think of the data showing "their educational achievement was on average higher. In our study, 51.4% of the participants was higher educated compared to 35.5% in the general Dutch population of the age of 15–25 years"

So a higher percentage of the trans population receiving treatment was higher educated compared to the general Dutch population.

15 points is an awful lot. See this: www.sciencedirect.com/topics/mathematics/intelligence-quotient

In some samples standard deviation from the mean was 7-10 points.

And the fact is that any drug with effects, has side effects. Pretending a drug, especially one with an effect as large as these, could have no side effects is baffling.

Trans identity being more common in highly educated cohorts is not a surprise to me at all.

It's rife in universities and amongst the highly strung daughters of our techy friends in particular.

The control group thing is bogus I think, because the objection assumes that the treatment is in fact effective and necessary and without significant risks, which hasn't been established. That's what they are trying to discover by studying the drg. So it's begging the question which is a logical fallacy.

In fact you could easily make the opposite case - that it is unethical to assign kids to the group that is actually getting the drug, because we don't know what the outcomes are. This applies to kids getting it for precocious puberty as well as off label uses.