Puberty Blockers clinical trial.

[PlainJane999]

Simple question, do those here support the prescription of blockers as part of a clinical trial and why?

I agree with trials on children. I also think they should test weight loss drugs on anorexic children and experiment with cross-species grafting for eg adding a tail and dog ears onto children who think they’re an animal.

Word games, your second paragraph is clearly what I was discussing.

Remind me where did the 80% number come from, was it not a survey of parents on a forum ? Maybe I am wrong genuinley asking.

Assuming the 53 dropouts were harmed by puberty blockers is speculative. Dropouts can occur for various reasons, and there is no evidence linking these dropouts to puberty blocker-related harms.

Nor is there any evidence excluding the fact they may have dropped out due to harm.

Furthermore, including non-diagnosed pre-treatment participants captures the natural variety of experiences at the point of entry. There may not be a large enough group of participants between diagnosis and prescription to conduct a cross-sectional study.

The lack of diagnosis in the pretreatment group means we cannot compare groups as they could be fundamentally different. It is a bit like saying the PB group (which is actually a selective group of those about to embark on CSH) are less suicidal than a group of schizophrenics.

Fundamentally, the study shows significant psychological improvements with puberty blocker use, contradicting claims of harm

It shows no such thing as there is no ‘before’ and we have no idea about the dropouts - their inclusion could easily change the result to significantly harm. It would not be the first time ignoring those who dropped out changed the outcome:

www.thepublicdiscourse.com/2020/09/71296/

Moreover, the study was conducted in the Netherlands, where access to gender-affirmative care is less restricted compared to the UK and many other countries.

Why do you think this OP? The Dutch team have said they have a much stricter diagnostic process than elsewhere globally - they’ve said that they are concerned that their research is being used to justify blockers for a far wider cohort than they prescribe to themselves.

All data is relevant and useful.

😂😂🤣😂🤣

Wouldn’t a possible interpretation of these figures be that mostly the children who are prescribed puberty blockers are among the minority whose dysphoria would not have resolved?

https://www.voorzij.nl/more-research-is-urgently-needed-into-transgender-care-for-young-people-where-does-the-large-increase-of-children-come-from/

Dutch article

@PlainJane999 "Why Cross-Sectional? (Not the Same Groups Before and After)
In the current political climate, any sincere effort to capture a snapshot of the care system should be welcomed. All data is relevant and useful. If the study were longitudinal, we might miss this data while awaiting results. The clinic may well be conducting or proposing a longitudinal study. Therefore, engaging in conspiracy-level speculation about the motivations behind a cross-sectional study is unhelpful conspiracy. We must remain evidence-led and avoid assuming malicious intent."
They started this study in 2020.
If they were planning to do a longitudinal study they'd have four years of data now. It would be worth it's weight in gold!! We wouldn't have to wait for it!!!

These papers looked at desistance rates. I'm not sure if the 80% is from one of these or some other research.

https://pubmed.ncbi.nlm.nih.gov/21216800/
https://pubmed.ncbi.nlm.nih.gov/23702447/
https://pubmed.ncbi.nlm.nih.gov/18981931/

Well yes that's the point of the long term follow up. But as there are detransitioners then that cannot be true.

What is the thing you think you are solving with blocking someone's ability to become an adult? What is the differential diagnosis to identify these people?

Also this, but it's behind a paywall, so I can only see the first couple of paragraphs.

https://adc.bmj.com/content/104/6/611

First, their use leaves a young person in developmental limbo without the benefit of pubertal hormones or secondary sexual characteristics, which would tend to consolidate gender identity. Butler provides evidence that intervention with a gonadotrophin-releasing hormone analogue (GnRHa) promotes a continued desire to identify with the non-birth sex—over 90% of young people attending endocrinology clinics for puberty-blocking intervention proceed to cross-sex hormone therapy. In contrast, 73%–88% of prepubertal GD clinic attenders, who receive no intervention, eventually lose their desire to identify with the non-birth sex. Our concern is that the use of puberty blockers may prevent some young people with GD from finally becoming comfortable with the birth sex.

There is a study which had a figure of 80 children (63%) categorised as desisting but they weren't actually followed up, just everyone who didn't proceed at the clinic was categorised in this way. Have you got an actual link for the 80%?

Sorry if someone has already posted this, it discusses the 80% desistance rate:

https://www.transgendertrend.com/children-change-minds/

And Jesse Signal discusses the Dutch study here and says
Steensma and his colleagues never simply assumed those 80 kids had desisted — they got in touch with most of them, and, true to that ‘assumption,’ they weren’t dysphoric.
http://medium.com/@jesse.singal/everyone-myself-included-has-been-misreading-the-single-biggest-study-on-childhood-gender-8b6b3d82dcf3#:~:text=Of%20the%20total%2080%20kids

I think it’s a good idea. I have a DD who is showing signs of early puberty and the thought of her getting her period at 9 is something I’m really worried about. A few friends have DDs in similar positions.

I wouldn’t currently put her on puberty blockers as I’ve read reports of women with very early osteoporosis due to puberty blockers, but it would be nice for girls going through genuine early puberty to have options to delay that.

I don’t think they should be offered for gender dysphoria. But there is a place in medicine for them.

There is already a (licenced) place for them in the treatment of precocious puberty and has been for decades. Treatment is centred in paediatrics and endocrinology.
I wouldn't trust anyone employed by the gender identity service to run any sort of clinical trial. They have been shown to have no understanding of ethics, keeping medical records, collecting data, informed consent, sticking to a protocol, basic safeguarding.

Menarche at 9 wouldn’t be classified as ‘precocious’, 7 would.

https://www.nhs.uk/conditions/early-or-delayed-puberty/

Not that puberty at 9 isn’t challenging of course, it’s just not considered to be abnormal, certainly not abnormal enough to justify medical intervention.

Any research carried out via gender services would be irrelevant to precocious puberty anyway (and vice versa, which is why it’s not ok to use precocious puberty research to justify prescribing to kids who ID as transgender).

Fingers crossed your DD is just having a slow burn puberty and the early signs won’t manifest in an earlier than average first period (definitely the case for my own DD).

edited to make clear that the NHS advice (linked above) is to contact your GP if a DD starts her period before she turns 8.

There are also much less drastic ways to stop periods. Using puberty blockers just to stop periods would be like using a sledge hammer to crack a nut.

Fwiw @llamadrama16 , I started my period at aged 9 and I don't recall it being an overly horrible experience. Possibly because we'd only recently had the lessons on periods etc in PSHE - But then (and I may be wrong here) I don't think 9 counts as precocious just yet, it's early but not too early so as to require blockers thankfully!

From memory I was the first in my year to get my period, but it wasn't a massive wait before other girls got theirs too ~

What are Risks of Talking Therapy ?
There is a significant lack of evidence that relying solely on talking therapy will address underlying issues, potentially worsening mental health problems such as depression, anxiety, and suicidal ideation.

This is false, there is a lack of evidence for a psychological therapeutical approach for specifically gender dysphoria, if you accept gender dysphoria as a diagnosis not a symptom. There is copious evidence for a psychological therapeutic approach for underlying conditions that may lead to the symptoms of gender dysphoria, such as trauma, autism, body dysmorphia, anorexia, anxiety, depression, etc.

It is also sensible to assume that even IF you consider gender dysphoria to be its own, stand alone diagnosis, it makes sense to consider that given it is psychological distress, it is not a leap to assume that a psychological therapeutic approach to helping it would be akin to helping other types of psychological distress. Therefore while it can be (weakly) argued there is “no evidence” it cannot be argued that is unlikely to play a significant role.

In contrast, it is a massive leap to assume that hormonally altering a child’s body is any way to solve a child’s psychological distress, let alone the best way, given we know that abnormal hormone levels are nearly always associated with negatively altered mood.

Having said all that, I wish people would stop pretending that puberty blockers and cross sex hormones are anything about relieving a child’s psychological distress. We all know that it’s really about physically actualising a child’s declared “gender identity” so they achieve a more desired aesthetic outcome, as a result of older adults who lament their physical appearance campaigning for children to not have to appear like they do. Discussion around psychological distress and suicide is merely a smokescreen to cover up this reality because sterilising children so they “pass” better is a much harder sell.

We all know that it’s really about physically actualising a child’s declared “gender identity” so they achieve a more desired aesthetic outcome, as a result of older adults who lament their physical appearance campaigning for children to not have to appear like they do. Discussion around psychological distress and suicide is merely a smokescreen to cover up this reality because sterilising children so they “pass” better is a much harder sell.

But they do say it's about a better aesthetic outcome. They admit that they advocate sterilising children so that they "pass" better. But it's not really about the children.

The real reason for transing children is to deflect attention from the obvious fact that most late transitioning males do so because of a sexual fetish. They tell stories about their childhood which are usually impossible to disprove, which indicate that they were always drawn to things like feminine clothing as children.

They then point to little boys who like to wear pretty dresses and play with dolls and say that they were just like them, and how wonderful it would have been to have transitioned as a child. Of course there can't be any sort of sexual motive behind this, because obviously the children don't have a sexual motive.

Since they say that they knew they were trans as children, they argue that it would have been better to have had medical treatment as children, so they push for children to have this treatment, simply to reinforce the idea of a "pure" non-sexual motive for their own transition.

Trans children were invented to sanitise the sexual motives of middle-aged male transitioners.

No.

Main reason being is that they don't work. They leave the child in a state of limbo. You cannot grow out of your believes if you are prevented from growing. Hurting children (and we already know that this is something they do) only to scientifically show they don't work is immoral.

I haven't rtft but I understood it as follows:
In gender cases, the only use of PBs should be as part of a clinical trial. Any clinical trial that seeks to evaluate using PBs for gender cases will need to pass ethical tests. It will be impossible to pass those ethical tests.
It wasn't in Cass's remit to evaluate those ethical tests but it can't have been lost on her that they were highly unlikely to be met.

I understood one possibility is to enrol existing previous patients into a retrospective study. GIDS deliberately blocked Cass from finding out about previous clinical outcomes, on the grounds of privacy, but there's scope for achieving something on a voluntary basis.

Obviously there'll be some pissed-off patients who've been harmed, and some who are proselytisers for the cause, so the data would be a mess. But some data has got to be better than no data?

1. Are they actively and directly asking to be?
2. Have they done so consistently and coherently for an extended period of time?
3. Are they able to describe the long-term, permanent implications of doing so?
4. Have they demonstrably reached Tanner stage 2 at an appropriate age?
5. Have they been on a course of GnRH agonists for at least a year's 'cooling off period' since the initial request?

If the answer to all the above is yes, then it seems reasonable to assess suitability on an individual case-by-case basis by multiple field experts.

Describing something is very very different from being able to understand the implications of it. A child may be able to describe how they will lose sexual function, but if they have any understanding of what that means then they have been sexually abused.