New Finnish Study on 'gender affirming' care and suicide ideation

[sunshinellight]

I haven't seen a thread on this so linking it here
https://nypost.com/2024/02/24/opinion/a-finnish-study-is-changing-how-we-approach-trans-kids/

A major new study out of Finland found that providing cross-sex hormones and gender-transition surgeries to adolescents and young adults didn’t appear to have any significant effect on suicide deaths.

Link to the study is in the article.

If anyone wants to look, Erin Reed has a thread on the fruit farms where they are discussing this article written by Erin.

I read it too - that seems to be Erin's main argument but it doesn't quite make sense to me. As I read it, Erin points out that the study controlled for patients who had psychological intervention, and concluded that transition didn't make them more or likely to commit suicide. Erin says that the psychological intervention was only there because they were suicidal so we'd expect both groups to be suicidal. Sure, but if transition didn't help either way (and demonstrably does do physical harm, to urinary function etc etc as described upthread), wouldn't it be overall better just to have the psychological treatment, which doesn't do physical harm?

If a treatment definitely does some harm, the benefit has to be proven to outweigh the harm, and if there's an alternative treatment that doesn't cause harm but has a similar benefit, that's always preferable - that's a basic medical principle isn't it!

As other posters said, the key thing is the best and safest outcome for the children concerned to ensure any life changing decisions are made with appropriate understanding taking into account the full context and any co-morbidities

yup

dress it up as <checks notes> right wing Christian boomer scaremongering all you like. We’re just a groundswell of people who want evidence based medical treatment for our kids. The horror.

huge thank you to all the marvellous warriors on here.

I haven’t read Erin’s, erm critique of the paper. I have read the paper though.

I can’t see how the comment regarding over control is valid either. It’s a cohort study with matched controls and conclusions support what is known about suicide in the wider population I.e that it is linked to severe mental illness and men are more likely to complete suicide than women. The conclusion that young people with gender dysphoria follow this trend is not surprising. From my own practice (small UK based General Practice) of the young people who have concerns around their gender identity all have concurrent MH problems or a background of trauma. The one adult male has other feelings about gender identity that will be familiar to MNers of this board.

Having said all that though Robin clearly has some expert knowledge of this study that I must have missed but then I’ve only spent 20 years of undergrad and postgrad study learning how read and critique medical publications.

Care to enlighten me Robin?

It’s a cohort study with matched controls and conclusions support what is known about suicide in the wider population I.e that it is linked to severe mental illness and men are more likely to complete suicide than women

YY. I asked similar questions on another thread, Faffertea.

How else did people want cohort matching done? How else did they want it controlled for a comparable group with plausible matching of severity of psychiatric conditions within the data that are available and without the high risk of identifying individuals (given the numbers are so small)?

We've long needed a study with comparable cohorts. The arc of this matches others.

The York Tavi study is delayed and will be picked up by the NHS (it's not coming out within the lifespan of Cass). There is a KCL prospective study for which the Chief Investigator is Emily Simonoff.

Professor Emily Simonoff has been confirmed as Chief Investigator and will now lead on developing the detailed proposal for the planned research on puberty suppressing hormones in early onset gender dysphoria. Emily is Professor of Child and Adolescent Psychiatry at the Institute of Psychiatry, Psychology and Neuroscience, King’s College London, where she is also currently Head of the Department of Child and Adolescent Psychiatry and Director of the King’s Maudsley Partnership for Children and Young People. She has extensive research experience and is also academic lead for the Child and Adolescent Mental Health Services Clinical Academic Group at the South London and Maudsley NHS Foundation Trust. The research is being developed through the National Research Collaboration Programme, a joint partnership between the National Institute for Health and Care Research (NIHR) and NHS England.

https://www.england.nhs.uk/commissioning/spec-services/npc-crg/gender-dysphoria-clinical-programme/implementing-advice-from-the-cass-review/cyp-gender-dysphoria-research-oversight-board/

We need more, well-designed, research. The Finnish study is a useful contribution. The patient population deserves more evidence-based medicine, not less.

I assume what Erin wants is for the ‘controls’ to somehow remove the association between poor mental health and suicide.

Erin seems to want to believe that poor mental health is a side effect of being untransitioned. The alternate explanations that wanting to transition might be a manifestation of mental health problems or that transition treatment may have no meaningful effect on co-morbid mental health conditions seems to be unacceptable.

All evidence must reinforce the narrative that transition is the answer. And any issues arising from transition are just ‘transphobia’.

It’s actually amazing that cutting off people’s healthy genitals is viewed as the humane and reasonable response to anything.

Brave Sir Robin ran away.
Bravely ran away away.

Yes, brave Sir Robin turned about
And gallantly he chickened out.
Swiftly taking to his feet,
He beat a very brave retreat.
Bravest of the brave, Sir Robin!

The York Tavi study is delayed and will be picked up by the NHS (it's not coming out within the lifespan of Cass). There is a KCL prospective study for which the Chief Investigator is Emily Simonoff.

Wasn't there another study that the York researchers were doing on behalf of Cass looking at the outcomes for previous patients of GIDS? I think there was some tweek to the Data Protection Act in order to access NHS records. Does anyone have an update on that?

The study you have linked to looks like a new study on a new cohort of children undergoing puberty suppression.

I think I've answered my own question, this is the study I was thinking of and the final analysis/write up is not due untill the summer of 2025 so not within the time frame of Cass.

https://www.york.ac.uk/media/healthsciences/documents/research/GIDS_FullProtocol_v3.1_25_07_2023.pdf

It is absolutely astonishing isn't it. It will eventually be seen as being as barbaric as lobotomies once this current madness has passed and the reality of how much damage has been done becomes clear.

…telling patients that bottom surgery “seldom functions correctly,…

I’d be interested to know what is considered to be correctly functioning genitalia following surgery.

That’s a good point. There’s both the question of what the standard for ‘functioning correctly’ is (it will already be a long way short of functioning like the sexual organs of the opposite sex) and then how often outcomes fail to meet even that (low) standard.

At some point it is important to actually be honest about what the possible outcomes actually are. Telling people that they can change sex is irresponsible. Telling people they can have a penis or a vagina is irresponsible. They may gain something with some semblance of one, but it will not be a penis or a vagina. And the difference will matter.

The current narrative referred by TRAs sets people up for failure and disappointment. That’s a problem.

Twitter thread of interest to this thread. The article linked to is in German but the thread provides a translation of the article into English (links to those 3 tweets with translation included at the bottom of this post):

x.com/benryanwriter/status/1762480596922593385

'A new systematic literature review, by Germans, of puberty blockers (PB) and cross-sex hormones (CSH) to treat gender dysphoria (GD) in kids concludes: "Current evidence does not clearly suggest that GD symptoms and mental health significantly improve when PB or CSH are given to minors with GD."

^econtent.hogrefe.com/doi/10.1024/1422-4917/a000972#_i38^

German researchers concluded the same thing that Finnish researchers concluded last week: that psychotherapy should be the primary intervention for children with gender dysphoria (GD). Their systematic literature review of the use of puberty blockers and cross-sex hormones to treat GD found:

"The currently available studies on PB andCSH in minors with GD show significant conceptual and methodological flaws. The current body of evidence is very limited, based on very few studies with small samples and problematic methodology and quality. Adequate and meaningful long-term studies are equally lacking. Current evidence does not clearly suggest that GD symptoms and mental health significantly improve when PB or CSH are given to minors with GD. Children and adolescents with GD should therefore primarily receive psychotherapeutic interventions that address and reduce their experienced burden. Any decision to use PB and/or CSH should be made on a case-by-case basis after judicious risk benefit evaluation and, if possible, within clinical studies. Beforehand, psychiatric/psychotherapeutic diagnosis and treatment of concomitant mental disorders should be undertaken."

https://x.com/benryanwriter/status/1762483754696573142?s=20

https://x.com/benryanwriter/status/1762483758513442842?s=20

https://x.com/benryanwriter/status/1762483762569363463?s=20

Does anyone know if the people working in the government to produce the Ban Conversion Therapy ( other than possibly Kemi Badenoch) would be up to date on these research results being published?

https://x.com/mariekehoogwout/status/1762507686715810216?s=46&t=ZX_bLozRqm8etdGICMcAvA

Unsure how related this is but the Dutch parliament has asked their government to carry out research on the outcomes of children who have been treated under the Dutch protocol.

Very good news.

Yes, that's the York Tavi/GIDS study that was supposed to run and complete as a Cass deliverable. That won't happen within Cass but is being picked up by the NHS. (In keeping with the York item you linked. I find it cheerful that this isn't going to fall by the wayside but there is a pick up plan.)

Yes, the KCL is a prospective study. It will be fascinating to read the actual research question(s), study designs and outcomes, the ethics review, and governance structure.

Just adding the WPATH leak document here for completeness. It also mentions the suicide issues.

Here is one link to the WPATH pdf
https://static1.squarespace.com/static/56a45d683b0be33df885def6/t/65e64b9e5cbd756da9fbbdfa/1709591479160/Final+WPATH+Report.pdf

and another just in case that one disappears in the future.
https://environmentalprogress.org/big-news/wpath-files

Here are some of the reactions:
https://www.dailymail.co.uk/news/article-13156695/Trans-healthcare-doctors-exposed-admitting-patients-young-mentally-ill-understand-consequences-treatment.html

https://www.telegraph.co.uk/news/2024/03/05/wpath-tansgender-hormone-therapy-cancer-links-leaked-emails/

https://sex-matters.org/posts/updates/wpath-the-truth-about-gender-affirming-healthcare/

https://genspect.org/the-wpath-files-revealed/

https://www.transgendertrend.com/wpath-unmasked-wpath-files/

Here is a summary from Michael Shellenberger.
https://x.com/shellenberger/status/1764800595473686865?s=20

And the first part. Much more of it requires images.

Here is the threadreader version:

https://threadreaderapp.com/thread/1764799914918490287.html

THE WPATH FILES

Advocates of gender-affirming care say it’s evidence-based.

But now, newly released internal files from the World Professional Association for Transgender Health (WPATH) prove that the practice of transgender medicine is neither scientific nor medical.

American Medical Association, The Endocrine Society, the American Academy of Pediatrics, and thousands of doctors worldwide rely on WPATH. It is considered the leading global authority on gender medicine.

And yet WPATH’s internal files, which include written discussions and a video, reveal that its members know they are creating victims and not getting “informed consent.”

Victims include a 10-year-old girl, a 13-year-old developmentally delayed adolescent, and individuals suffering from schizophrenia and other serious mental illnesses.

The injuries described in the WPATH Files include sterilization, loss of sexual function, liver tumors, and death.

WPATH members indicate repeatedly that they know that many children and their parents don’t understand the effects that puberty blockers, hormones, and surgeries will have on their bodies. And yet, they continue to perform and advocate for gender medicine.

The WPATH Files prove that gender medicine is comprised of unregulated and pseudoscientific experiments on children, adolescents, and vulnerable adults. It will go down as one of the worst medical scandals in history.

Why I Am Publishing WPATH Files And How I Got Them

The written WPATH Files come from WPATH’s member discussion forum, which runs on software provided by DocMatter.

Ninety seconds of the 82-minute video was made public last year. We are making the full video available for the first time.

One or more people gave me the WPATH Files, and my colleagues and I attempted to summarize them as a series of articles. We quickly realized the topic was too sensitive, complex, and large to be dealt with as a work of journalism, and we moved the project to the research institute I founded seven years ago, Environmental Progress (EP).

The Files are authentic. We redacted most names and left only those individuals who are leading gender medicine practitioners to whom we sent “right-of-reply” emails. We know WPATH members discussed our emails internally. No WPATH leader or member has denied that the Files are anything other than what they appear to be.

EP is publishing a 70-page report to provide context for the 170 pages of WPATH Files. Mia Hughes is the author of the report. It and accompanying summary materials can be downloaded at the link below. That link also provides a link to the full WPATH video.

Late transitioning males really need to back off and leave paediatric matters to doctors and parents.

I think that if someone is here saying that Read has any credibility that should be considered, perhaps they really need to lift their bar for credibility higher. Or maybe that low bar explains a great deal.

Anyway, here are just a couple of rather glaring issues with Read’s rebuttal.

Read wrote:

'When addressing supposedly "scientific" citations, the report's performance is equally lacking. For example, in the editorialized section, the report asserts that transgender individuals who undergo gender reassignment surgery "do not show positive outcomes," citing four references to support its claim. These citations include a 2004 article from The Guardian, an article from a conservative site called "The New Atlantis," which self-describes not as an academic journal but as a "public journal of ideas," the frequently misquoted "Swedish Study" whose author has expressly corrected misinterpretations by anti-trans organizations, and a quality of life study that is 15 years old, evaluating surgeries performed 30 years ago, when social discrimination likely significantly influenced the outcomes. This contrasts sharply with much newer research from peer-reviewed articles that demonstrate a substantial improvement in the quality of life for transgender individuals.'

And this is the 'much newer research' they refer to.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5440516/

Quality of life improves early after gender reassignment surgery in transgender women

from 29 October 2016

Conclusion:

To our knowledge, this is the largest prospective study to follow a group of transgender patients with regards to QoL over continuous temporal measure points. Our results show that transgender women generally have a lower QoL compared to the general population. GRS leads to an improvement in general well-being as a trend but over the long-term, QoL decreases slightly in line with that of the comparison group.

Maybe Read should have spent more time with their own research on that one.

This also seems to not be saying what Read wants it to say but I could be wrong and there could be something in the study (I could not access the study):

'For instance, they follow the incorrect claim that citations “do not show positive outcomes” with a discussion between WPATH members centering best practices on the ability transgender people to orgasm after puberty blockers, presumably to highlight the aforementioned “no positive outcomes.” To ensure factual accuracy, studies have shown that those who took puberty blockers are capable of orgasm, with 84% reporting orgasm capability and 12% not trying, similar to cisgender rates of anorgasmia.'

And this was one of the links embedded under the 'capable of orgasm' link where I assume the statistics come from.

https://academic.oup.com/jsm/article-abstract/13/9/1438/6940484?redirectedFrom=fulltext&login=false

Patient-Reported Esthetic and Functional Outcomes of Primary Total Laparoscopic Intestinal Vaginoplasty in Transgender Women with Penoscrotal Hypoplasia

Results
Patients graded their life satisfaction a median of 8.0 (range = 4.0–10.0) on Cantril's Ladder of Life Scale. Patients scored a mean total score of 27.7 ± 5.8 on the Satisfaction With Life Scale, which indicated high satisfaction with life, and a mean total score of 5.6 ± 1.4 on the Subjective Happiness Scale. Functionality was graded a median score of 8.0 of 10 (range = 1.0–10.0) and esthetics a score of 8.0 out of 10 (range = 3.0–10.0). The mean Female Sexual Function Index total score of sexually active transgender women was 26.0 ± 6.8.
Conclusion
This group of relatively young transgender women reported satisfactory functional and esthetic results of the neovagina and a good quality of life, despite low Female Sexual Function Index scores.

“despite low Female Sexual Function Index scores.” So, how has Read been able to confidently say that orgasm is working…. If anyone has access to this study, did the study then check 'male sexual function'? Are these male people having anal sex and orgasming or what is happening?

However, this is most concerning. Read then misuses these anorgasmic stats of women to justify male people who have had their ability to orgasm removed due to surgery is a false comparison too. This paper below (linked to Read’s article) discusses multiple reasons that build that number. And only some of the reasons are about a medically induced condition. And let's be clear, extreme modification of a healthy body part is medically induced. So, Read’s use of 12% not looking dissimilar to female rates of anorgasmia is clearly a significant overreach and a false use of that stat.

https://archive.is/CUS5H

You have my full agreement.