No more puberty blockers for children from the NHS - reported in the Times!

[MrsOvertonsWindow]

This is massive - and long overdue

www.thetimes.co.uk/article/97ce2e81-2884-42f5-bb82-2a2778f2cc91?shareToken=9568e79f0683beea68ffe5e978b05a29

As an aside, TRA are all over social media screaming that this will result in children killings themselves to the extent that Louis Appleby the mental health czar who I think to date has kept out of this issue saying this

Hannah Barnes' article is interesting t.co/u7HBZoAk9X

I think puberty blockers being taken off the table will be powerful in improving both the quality of psychological intervention and in patient engagement in the interventions (rather than a hoop to jump through to get to the blockers).

I have no doubt that there are lots of children and families feeling terrified by this news. Having it confirmed that they are now, definitely going to go through puberty is totally overwhelming for some. What needs to happen now is high quality, accessible support that enables the overwhelm to be addressed and for good levels of functioning to return.

I don't have much (any) faith in this government to provide adequate funding. I also fear that high quality professionals won't want to go near the new services until they see what practice is being supported in them.

In the meantime, my pleasure in the news of 'no blockers' is tempered by concern for the distressed young people in need of support.

But normal development doesn't stop at 17, that's the point. And in the autistic group most vulnerable to gender as an obsession, they are a long way from grown at 17. The cohort I have seen generally can/do not work, live at home, attend appointments with a parent, have awful anxiety/depression- yet are old enough to have unfettered Internet access and 'have capacity' to make life changing decisions. It's heartbreaking and although sometimes I am very glad of the massive GIC waiting lists, waiting in the absence of helpful therapies or holistic care is not a helpful strategy.

I was also initially surprised and thought - well Cass said all this already? But I think many TRAs had been hanging onto the 'interim' nature of the report, to the fact that PBs might be possible in exceptional cases and that somehow the institutional TRAs would override Cass in the final service specs. That hasn't happened - NHSE has backed Cass - and more! - this is major and signals lack of loophole hope for the TRAs.

Is there evidence that children with gender distress face more bullying than other children / bullying because of the gender distress, rather than potentially preexisting bullying being the cause of it?

It just is one of those things constantly mentioned as if it's fact and I wonder what the evidence base is.

We know that activists foster fragility and frame even the mildest disagreement with gender ideology as 'hate'.

I agree with alot of what you say @Brainworm@Brainworm. Except, i don't think gender zealots believe that affirming will fix all issues, i think gender zealots don't think of treatments in terms of achieving the best outcome for for the patient. The name says it all, gender affirming treatment. I suspect in their view treatment that affirms an inner sense of gender identity is all it needs to do. The act of affirmation is comparable to a symbolic religious ceremony, like confirmation in the Catholic church.

If you truly believe in gender identity, then having gender identity match the body is a valid goal in and of itself, regardless of whether the patient is happier, can function more effectively, enjoy sexual arousal or have children. In their view, i suspect having a better alignment of gender soul and body is worth all the potential harms of treatment.

It will be fascinating to see how researchers and ethics committees weigh these potential metaphysical benefits with very clear and real physical harms.

Clinical trials have been done. The original Dutch study was woeful and the Tavistock study showed no benefit. A study on early transition with puberty blockers will never get past an ethics committee. Which shows how evil it is that the treatment has been carried out already despite this. Consider what an ethics committee would have to approve if the study was on puberty blockers at Tanner stage 2:

• the kids will lose their fertility
• they will lose their sexual function before they’ve even experienced it
• they will possibly drop in IQ, this would be part of the study outcomes
• their bone health will be affected
• it will lead to wrong sex hormones and their side effects, and surgery and its side effects
• if left alone and don’t go through this study most will settle down
• they actually aren’t at significantly greater risk of suicide

All of these points would have to be argued against to make an ethics committee consider it worthwhile, given the harms. In particular the last point: better mental health and no death is a valid argument, but it can’t be demonstrated that children kill themselves now, so how will they measure an outcome? Because “passing better” is not going to win anyone over 🙄.

Ok this I like:

Hannah Barnes AT hannahsbee
There will be no medical pathway when new gender services open on 1st April. Plus, NHSE have said its decision to end prescribing is 'not contingent upon the establishment of a clinical study.' If that study doesn't get ethical approval, PBs will remain unavailable on NHS.

How can you get ethical approval if you can't separate out parents not wanting gay kids, autistic kids struggling with puberty, children who have been sexually abused and overly pushy parents who mean that what limited capacity to consent there is, is void?

Especially when we know about a lot of the side effects already.

Does this mean that the whole announcement is a stepping stone to a complete no and not even experimental use?

I also think the following is worth highlighting

Hannah Barnes AT hannahsbee
Young people already receiving blockers from endocrinologists at UCLH or Leeds will remain on them. Those who have been referred to endocrinology by GIDS, but who haven't yet started treatment, will be allowed to do so. PBs will also be available to males 16+ alongside hormones.

So a continuation available without being part of an experiment BUT I note that males and females are being treated differently at 16+.

You have to consider why they've made that decision because it's somewhat striking.

Why are males being allowed to continue at 16+ but not females?

That suggests the evidence for girls is particularly bad and not acceptable. And the who ideological movement is much more favourable to males transitioning in terms of side effects that women and girls and there's perhaps more issues with social contagion for girls.

This seems significant to me. Late transitioning makes particularly need young teenage girls as part of their rhetoric to demonstrate that trans isn't a male sexual fetish. If girls have bigger ethical issues and side effects going on than boys, what is happening and why?

I've always said that the two groups - late transitioning makes and teenage girls need to be treated as separate issues and not just lumped into trans as a homogeneous blob because there's something up.

I wonder what exactly has been identified here and whether it has much more significant long term implications.

There's no doubt that this group of children are exceptionally vulnerable. Schools and families socially transitioning them literally "bake in" that vulnerability by creating a psychological dependency on other people recognising them as the opposite sex. So on a daily basis these children will face complex reactions from others when their claim to be one sex is in contrast to what is observed. Thus resulting in so many interactions feeling inauthentic and therefore a source of distress.
Navigating puberty isn't just about physical development but also the mind and reaching a psychologically healthy place of mind / body alignment? (not a psychologist but this one explains it better than I can):

https://www.transgendertrend.com/teenager-says-theyre-transgender/

Yep, some trials have been done, however, when NICE reviewed the evidence base I believe not a single published study passed their bar for what would be considered to be of sufficient quality to base national care guidelines on.

Gender medicine is not alone in this. Lots of other conditions are in the same place. However, the difference is the charities involved fundraise and make the trials happen and over time the evidence base strengthens and treatment options improve. The lack of charity funding for medical research in gender medicine is an absence that is very hard to explain. I would love someone to ask Stonewall why they havent done this.

I think a key issue in all of this relates to treatment goals.

TRAs advocate for treatment that affirms identity. They think of this as the end goal, but it's not, or rather it can't be in medical terms as this is not something medicine focuses on.

TRAs need to go beyond this and show that being affirmed improves psychological, physical and social functioning and outcomes. This doesn't refer to just reporting how they feel, but showing that treatment results in improvements in attending school/ work, having fulfilling relationships, supporting yourself etc.

The fixation on feelings and identity doesn't cut it in the world of properly run healthcare. TRAs need to regroup and recognise that they aren't going to get NHSE to move the goal posts.

Why are males being allowed to continue at 16+ but not females?

I think this is because the drugs known as ;puberty blockers are testosterone suppressants, often given as part of 'cross sex' hormone treatment.

What other medical condition has the same issues of vulnerable children with social comorbidities in terms of the ethics of a trial? And what other medical conditions have essentially a healthy body? Keeping in mind the purpose here is for cosmetic changes not because there is a physical problem.

And then keep in mind the whole ideological position of the likes of Stonewall about trans NOT being a psychological or mental disorder and being a 'normal state' of being.

It's totally incoherent in terms of wanting clinical intervention which carries significant risks of side effects.

There has to be something of shift somewhere in admitting there is a psychological problem to be fixed is you need this drastic level of medical intervention.

The suicide thing, just doesn't wash even if it is true. Because that itself would indicate psychological distress.

If Stonewall wants to be taken seriously going forward, that has to change. No it's or buts.

And the reason it doesn't want to do that is because that raises questions about the mental state of late transitioning males too. If we are being asked to accept self ID without psychological involvement and investigation of a large group of males that opens a huge can of worms.

TRAs advocate for treatment that affirms identity. They think of this as the end goal, but it's not, or rather it can't be in medical terms as this is not something medicine focuses on. TRAs need to go beyond this and show that being affirmed improves psychological, physical and social functioning and outcomes.

I don’t think they need to go beyond the first part. Before that, they need to explain what identity is being affirmed. I said the other day that the biggest part of the scandal for me is not there’s no evidence that treatments work, it’s that there’s no evidence for what treatments are supposed to be treating. What IS gender identity? How is it innate? How is it defined without being circular?

If the treated condition is gender dysphoria, what even is that? The diagnostic criteria for childhood gender dysphoria is outlined by stereotypes. So how can a child have that diagnosis?

What the hell are these kids even being treated FOR? Explain THAT to an ethics committee.

For this you'd need longitudinal studies which AFAIK don't exist - I wish they did (and please someone let me know if I'm wrong!). Bullying seems to be an almost unifying factor in the gender distress I see - and very commonly:

Same sex attracted -> bullied -> gender distress or
autistic/different -> bullied -> gender distress

which seem clear as daylight to me but gender ideologues would argue that the causation runs the other way:

different-because-unidentified-trans -> bullied -> realised-they-were-trans

It would be so helpful to see good work on causation.

@Brainworm However, those working in addiction services (and, interestingly, many effective treatments for anorexia and self harm are based on these being conceptualised as an addiction) have been more successful in navigating (tolerating?) patient anger and resentment.

Very interesting as you say.

The more I learn about the different groups within the TQ+ umbrella the more addiction appears to be a relevant and helpful word. The focus of the addiction varies greatly between the groups, but this may be the thread that is common to all of them.

Wellll, that's not strictly true. A precise diagnosis isnt needed to run a trial. What is needed is a clearly defined set of outcomes. Relief of gender distress will be one measure no doubt. But there will have to be a raft of safety and quality of life measures alongside this.

I wonder whether the exceptional circumstances clause was to avoid preventing treatment for DSDs. I don’t know enough about it, and am aware that many people with DSDs want the medicalisation or transitioning towards ‘typical’ to stop, but it may still be a desirable option for some.

I like the 'addiction' description.

I read recently an article, in the Telegraph I think, by a woman with trichotillo... summat. She was addicted to pulling out her hair. In short, it started in response to distress but now seems to be an end in itself. The distress was subsumed and, in time, went away but the method for coping remained.

Of course trials need a diagnosis, otherwise how can outcomes be measured if you can’t be sure they’re treating the same thing? If one person has ulcerative colitis and another person has IBS, you can’t tell anything from a trial of a medication for “abdominal distress” can you?

Relief of gender distress will be one measure no doubt

But what is “gender distress”? Distress about hating stereotypes? Or body dysmorphia? Or something else? How can relief of that be measured when a definition can’t be agreed upon?

When even feelings need a distinct definition.

The irony.

I would also like to know if all the pushing of 'gender spectrums' and the reinforcing of girls do XXX and boys do YYY by people pushing gender ideology has had a negative impact. The huge number of LGBTQ+ days, the PHSE materials, the huge number of videos on various social media etc.

For example, gay men collecting Barbies was a common trope in the past, so much so that Smithers collecting Malibu Stacy on the Simpsons worked completely. Now, a boy being interested in Barbie, or pink, or XXX needs to consider that maybe they are actually a 'girl' (if anyone has an image of the chart to hand, please post it).

Has pushing that new idea actually increased gender distress?

Viewing through this angle makes sense. You can see the motivations and how strong they are

We should not have included children in this. Anymore than other things on the same lines

I’m really pleased we are joining Denmark and whoever else was listed as focusing more on children.

I’m angry we were attacked by many for pointing out the harms. But it’s often the way when it comes to adults prioritising their needs over dc

There isn't anything new, other than this time around the announcement has been given a lot more media coverage, as to what has been going on and the consequences of it. That David Bell got such a long slot to say what he had to say on Channel 4 news is quite a breakthrough.

I think we are now in the phase of making it clear that 'being trans' is a narrative, an ideological construction - one that even supposedly clued up journalists such as Evan Davies and Cathey Newman had not previously questioned.

Just adding my delight at this news. DH and I were in the car yesterday evening (must have been around 6:30pm) and it was the first item on the radio news, don't know which station. I actually exclaimed something along the lines of "holy forking shirtballs!" that it had been reported at all.

This has probably been discussed on here before so apologies for asking again, but is it known what actually happens if a 17 year old who has had puberty artificially suppressed by these drugs stops taking them and doesn't proceed to taking cross sex hormones? I assume it's different for boys and girls.

But can a late teen really go through puberty that late and become a normally functioning adult in terms of fertility and sexual function?

I understand the issue with the vast majority of such teens going on to take cross sex hormones, which would obviously result in complete anorgasmia and infertility. And it's clear how blocking puberty makes this outcome not only more likely but almost inevitable.

But in the scenario the TRAs talk about as reassurance, where the child changes their mind and tries to reverse the effects - does it genuinely work?