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

“Then let's see what the TRAs have to say about the permanent brain damage and loss of IQ”

I’m guessing they wouldn’t miss what they never had..?!

No indication of any decrease in IQ after treatment.

Okay, this study is AMAZING.

It doesn't show what suggestionsplease says it does, unsurprisingly.

Okay, I guess it doesn't indicate any decrease, because it doesn't indicate anything about overall changes in IQ, and it seems the study was actively designed to try to avoid showing that while looking like it did.

I'd almost go so far as to say it's fraud. I note the authors - I see de Vries' name, one of the Dutch researchers who pulled the "let's switch the sex of gender dysphoria test" trick to get a "reduction in gender dysphoria".

So, the study gets off to a good start. It's gathering baseline data. IQ tests on a large population before treatment. Fantastic.

And they go back after 8 years. Great! But then what?

The obvious thing to do would be to conduct another IQ test, right? Right? ...

Apparently, they didn't. That's... disappointing. Why not? I guess it's more effort, but having gone to all the trouble to do the initial tests, and kept tabs on the population for 8 years (unlike other groups), surely you'd want to do this? (They still could. Maybe it was during Covid?)

Okay, let's accept they couldn't do another IQ test. So they look at academic achievement. Okay, that's a reasonable proxy. So, obviously, they look at how final academic achievement matches up to the original IQ tests, right? Look for any sort of loss versus peers?

Well, no, not exactly. They apparently have that information, but they're not presenting it. Why not? This is where it starts to look like fraud. Checking how well they're performing academically is the most important thing here - they have the information, and they're not revealing it.

So what are they saying? What was their null result they did choose to, very selectively, reveal?

"No reduction in correlation".

Okay, what does that mean?

IQ tests at 12 correlate to ultimate academic achievement. Higher IQ, higher academic achievement. (Not a super-strong correlation, but clearly correlated).

All they checked was that this was still true after puberty blockers. Initial IQ still correlated as strongly to academic achievement. So the initially-high-IQ children still did better than the initially-low-IQ.

Well, that's a big fat nothing.

It would be consistent with either

a) Puberty blockers not affecting IQ
b) Puberty blockers fairly uniformly reducing IQ

The only thing it suggests is that puberty blockers don't flatten IQ. They don't make the lower IQ children close the gap with the higher ones.

Fantastic. I don't think anyone ever thought that would be the effect.

So what the fuck is going on here? They apparently failed to collect the most useful data, and then did a sort of weird twist on the data they had to apparently try to generate an expected null effect. The aim basically seems to be to produce a paper that "looked at children's IQ" and "saw no effect" so that people can point at it.

Is there any sort of process whereby someone can get hold of their data to run the sensible analysis? What did the academic achievement of their cohort look like compared to the expected result for untreated children of the same IQ? What was the average difference? Not the correlation, the actual results?

Okay, as that was a bit wordy, here's an illustration, to show what they DIDN'T give us. (First graph attached)

They've confirmed that there's still an upward trend of (pre-treatment) IQ versus achievement in their subjects, and it's as "tight" as in the general population.

But they've not told us where the trendline is in comparison. Matching, or lower as in my illustration?

If I had to hazard a guess, the population is too small for it to be statistically significant, and there would be too many other confounding factors, like the family backgrounds of the children. (I can actually imagine the sort of parents who will shepherd their children into gender clinics might be the sort who shepherd them academically too - that might be a positive effect relative to the population).

So maybe they're sort of sidestepping it by looking at the statistical significance figure itself - it's a bit meta. I'm not aware of any standards for statistical significance of statistical significance differences

They do have "figure 1" in their paper (second graph here), giving a coarse indication of their subjects' trends, but there's no comparison attempt versus the population.

Thank you necessary.

I, and I'm sure almost everyone else, was just waiting for someone to debunk suggestionsplease1 claims.

They've never yet produced anything even remotely credible. they're like a Duracell powered propaganda generator. Almost everything they say, I assume is the opposite of what's true. So as a litmus test, they're infallible.

I love Mumsnet! A galaxy of intelligent, informed women (and some men) with the collective skills to spot bullshit at a hundred paces! Thank you @NecessaryScene for this.
The determination of transactivists to silence, manipulate or gloss over research and data relating to these vulnerable children is an international scandal.
I hope one day to see all these dodgy medics in court being made to account for their professional misconduct.

Incredible analysis necessary.

I think you'd really have to measure IQ again for meaningful results, rather than use academic achievement.

While I agree a proportion of the children are from pushy middle class backgrounds, don't forget the high number of children in care who ID as trans. And the high incidence of neurodivergence amongst "trans kids" will mean there are a lot of children whose academic achievements won't match their IQ potential. Especially if all the focus from parents and teachers has been on gender and not on accessible education, healthy mind/body and positive relationships.

There are claims (made through very small scale studies on a completely different population of children with a different condition) that puberty suppressing treatment negatively impacts IQ.

This is a study on the correct population that indicates academic attainment is consistent with trends seen in the general population, ie. There is no obvious detriment after puberty suppressing treatment for educational attainment, which correlates with IQ.

It did actually find that the population who did receive treatment had higher levels of engagement with higher education .."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"

In this way it challenges the picture put forward by the research on girls with precocious puberty.

The research on girls with precocious puberty is questionable in terms of its relatability to trans populations as it is well known that precocious puberty already exerts an impact on IQ scores of this population. So this a poor cohort to compare against.

The matched control process in some of the studies is also questionable, some appear to have done simple age-matching with non CPP girls, whereas to get better answers about the influence of puberty suppressing treatment they should have matched against girls with CPP who did not receive this treatment.

It did actually find that the population who did receive treatment had higher levels of engagement with higher education .."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"

In order to make this a meaningful comparison, the two populations compared should be similar. They say this about the children given puberty blockers:

PS can be prescribed to transgender adolescents who have shown persistent, long lasting GD, have no interfering psychological difficulties, are socially supported and understand the pros and cons of this treatment

The 'general Dutch population' also includes children from unstable family backgrounds (including children in care), those with "interfering psychological difficulties", immigrant children who might have missed out on part of their education, and so on. Their comparison is meaningless.

What is the higher education rate for children from nice middle class families with supportive parents?

This is a study on the correct population that indicates academic attainment is consistent with trends seen in the general population, ie. There is no obvious detriment after puberty suppressing treatment for educational attainment, which correlates with IQ.

You really don't understand what you're reading, do you? I thought I'd made it clear enough.

I'll try again.

The trend remains consistent. Children starting with higher IQ normally do better.

And among children treated with puberty blockers, children starting with higher IQ still do better.

All they're showing is that puberty blockers do not eliminate the advantage of starting with higher IQ.

The authors actually state this quite clearly in the abstract.

This study aimed to examine the association between pre-treatment intelligence and educational achievement after gender-affirming treatment including puberty suppression

The association between IQ pre-treatment and educational achievement post-treatment in transgender adolescents who received gender-affirming medical treatment including puberty suppression appears to be similar to the general population. This may reflect that gender-affirming medical treatment including puberty suppression does not negatively affect the association between IQ and educational achievement.

@suggestionsplease1 doesn't seem to understand what this paper is about.

What a strange paper - very well explained by NecessaryScene (thank you)

It is extremely odd not to measure IQ at the end point. Educational attainment can measured in different ways, children take different qualifications in different countries and I don't even know how you start to compare that (this is partly why Universities such as Oxford have aptitude tests e.g. the PAT for admissions in Maths and Physics and do interviews etc - because just looking at qualifications alone, even with references, from a load of different countries is really hard to compare) and it is even stated that the comparison studies don't measure IQ at the same age. You can't really draw any firm conclusion and even the paper's conclusion is resoundingly unscientific and vague in that the correlation with educational attainment is 'similar'. Hmmm, I wouldn't even go that far.

The failure to compare the 72 trans children with 72 of their peers who have grown up in the same country under the same educational system and are either trans but unmedicated or not trans is weird because they are the comparable population, not children in other countries. They say it's a low number - well yes, that means you can't have any confidence in what you've seen with the 72 children you did study then, no?

In the UK, private education has quite a big difference on educational attainment relative to state education - which has nothing to do with IQ. Other countries have better state schools - things like teacher to student ratio, whether students have private tutors can make a really big difference in final grades. These factors cannot really ever be fully controlled for in such studies.

The whole paper seems disingenuous and a very strange thing to study when the obvious thing would have been to measure IQ at the start and throughout (and at the end) of the study period. Why didn't they do this?

Indeed, as is the prevalence of high functioning autism (and thus higher than average IQ) amongst the trans cohort - especially amongst girls.

It’s important not to cherry pick the positives in this study and discard the possible variables that likely impact them, especially if on the other hand stating that the negatives must arise as a result of such uncontrolled-for variables…

All they're showing is that puberty blockers do not eliminate the advantage of starting with higher IQ.

Mind you, that's not a totally meaningless indication. It means that if you're adding a confounding factor, it's not overwhelming the starting position.

If puberty blockers had a big enough and variable enough effect, then that random effect of how much the puberty blockers affected each individual could start to reduce the correlation with initial starting IQ.

But it still wouldn't tell you anything directly about the average effect. A reduced correlation could be equally due to

• Puberty blockers increasing IQ, effect scattered from 0 to +30
• Puberty blockers not changing IQ on average, effect scattered from -15 to +15
• Puberty blockers decreasing IQ, effect scattered from -30 to 0.

All of those would reduce correlation with initial IQ basically the same amount.

A not significantly changed correlation could be equally due to:

• Puberty blockers significantly increasing IQ, consistently by +28 to +30
• Puberty blockers not significantly changing IQ on average, effect scattered from -1 to +1
• Puberty blocker significantly decreasing IQ, consistently by -28 to -30

So this study is suggesting that whatever effect puberty blockers have, that effect is not massively variable. It doesn't directly indicate positive or negative effects, or how severe, just a limit on the variation.

It is reasonable to surmise that consistent large effects are less likely - the variation is going to tend to correlate with the effect, so you can hope that your failure to see large correlation loss implies a smallish effect.

But it's a bizarre way to approach the problem when you have the raw data. They could have just told us what the average difference from the IQ-matched population was, to directly get a measure of the effect.

suggestionsplease1doesn't seem to understand what this paper is about.

I kind of have some sympathy here. Even a normal person might look at this and conclude that, well, obviously they're studying what a normal person would want to see from IQ data.

Why on earth would they be writing a paper to report "no reduction of correlation of initial IQ" rather "no reduction of initial IQ"? It's bonkers.

There's probably a name for this sort of trick - getting viewers to fill in what they expect, because what you're doing is so unexpected.

I do wonder how many endocrinologists were involved in the puberty blocker craze (as opposed to non medically trained psychotherapists and psychologists). Because the role of puberty in developing vital bodily functions such as neurological development, bone mass development, fibrous tissues such as tendons and ligaments, is really Endo 101. Were these professionals really never consulted?

@CantDealwithChristmas I understood that only endocrinologists could prescribe them? That was part of the scandal with the Tavistock - one appointment and then you’d see the in-house endo and get a script immediately. Scandalous really as I had to have full endo blood tests before being prescribed bHRT, and then have to have 12 follow up (full) blood tests to continue.

I may be completely wrong on this, though!

as it is well known that precocious puberty already exerts an impact on IQ scores of this population

Citation please.

Yes, at the Tavistock it was the endocrinologists who prescribed these drugs. But it seeems to have been done on the advice of the psychologists and psychotherapists, who were saying that the child's distress was caused by puberty, and the best solution (for their mental health) was to temporarily block puberty, perhaps suggesting that if they were left to develop normally there would be a high probability that the child would kill themself.

The endocrinologists may also have been convinced by the 'true trans' argument, that some people are 'really trans' and that this is the best treatment for those people.

The endocrinologists would be concerned with the physical implications of following the 'expert' advice of the psychologists, not questioning this advice.

One still has to ask, why a 50-year-old woman, fully developed and at the end of her fertile period, has to get various bloodtests to get the medication, but for a teenager, there are obviously no such precautionary tests. Is it because the use of puberty blockers is an off-label use? But especially in that case one would expect precautionary testing before and throughout use.

@NecessaryScene is it the same trick as when politicians campaign on a 'time for change' ticket? The slogans are strong but the nature of the change is usually pretty unspecified, leaving the public free to imagine they're being offered whatever kinds they'd like. There must be a term for it.

The whole paper seems disingenuous and a very strange thing to study when the obvious thing would have been to measure IQ at the start and throughout (and at the end) of the study period. Why didn't they do this?

Maybe for the same reason they call these children 'transgender adolescents' and the treatment 'gender affirming care.'

There's no way I would trust the neutrality of people so steeped in TRA language.

I remember reading the story of a young person who was transitioning in the noughts - when, in Australia, lots of lesbian women in their 20s sought medical transition. This patient said to her endoinologist, "Are we just guinea pigs to you?" He laughed, and said, "If you were guinea pigs we'd be collecting some kind of follow up data."
So I think this whole, horrendous medical scandal has involved as many endocrinologists as other specialties.
(And I wish, at the time, I'd realsed recording names and dates would be important. I let these horror stories wash over me and didn't think anything could be done.)

Re endocrinologists.

I linked up thread to an Early Intervention “Study” from The Tavi & the corresponding WPATH Symposium notes that Polly Carmichael & Prof Russell Viner attended - presenting the “study” findings.

i met RV (2010/ 2011) & (I believe) he was introduced as an endo. However, in his recent bio write ups, I can’t find any mention of this particular field of expertise…

Anyway, he’s gone on to have a Very distinguished career.

Thanks for the explanation, Necessary.

The question of cohort studies is a real old chestnut in this context as well. For the study of puberty blockers, as far as I am aware, there was never a study comparing the outcome of a random assignment to two groups, one given puberty blockers, the others put on the gold standard at the time, which was watchful waiting.

Presumably the Dutch study group decided not to bother. That was the time when it should have been done and the perfect opportunity as the patients were not champing at the bit for puberty blockers at that time, and parents and patients perhaps could have been persuaded.

Despite that (and various other issues) making their results weak and low quality, their study was seized on and more or less advertised as the new treatment - a bandwagon many in the industry jumped on, while others who wanted to continue with watchful waiting were demonized and driven out.

Thereafter, despite the poor evidence base, it was described as unethical to withhold puberty blockers and carry out proper controlled trials. The reality is that puberty blockers had been missold as the answer to everything and patients and parents would no longer accept being possibly placed into the watchful waiting group.

It has been an incredibly unethical journey throughout, driven by politics and ideology and never by gold standard, evidence based medicine.