Health Secretary updates MPs on Government and NHS England’s work to improve gender identity services & implement recommendations of Dr Hilary Cass’s independent review. Includes extension of puberty blocker ban to Nov 26th & review of adult svcs

[TorghunKhan]

https://questions-statements.parliament.uk/written-statements/detail/2024-09-04/hcws70

'Gender incongruence' is the woo they're going with these days.

Translates as: 'the feeling in your head about how you imagine someone of your sex should feel doesn't match how you feel'.

The new centres are based in leading children's hospitals where medical ethics are the basis of developing of child medicine. So presumably the usual quacks and queer theory extremists who've been able to dominate this area will have limited influence?
Although, the shameful trans capture of the Great Ormond Street Hospital charity might suggest a loophole that activists might seek to exploit to put pressure on staff - but hopefully that won't get them near trials and ethics committees etc?

This.

No child with mental health issues so severe that they are threatening suicide should be anywhere near a clinical trial for puberty blockers. The idea that young children with “gender” issues are at massively increased risk of suicide or that threats of suicide get you treatment or on a study is so dangerous. You cannot possibly be considered to have the capacity to consent to experimental treatment that will affect your adult fertility and sexual function if you are a suicidal child.

Not sure why there is quite so much hostility to this trial. We support the Cass Review because it was an appropriately scientific and fact-based investigation, which appears to have countenanced the idea of such a trial in principle.
If we discount in advance the possibility of the puberty blocker trial being similarly sober and scientific, then aren't we at risk of being as disreputably anti-scientific as the frothing Cass deniers?
Of course it will be challenging to define effective ethical parameters, but there are professionals whose job this is, and they will be scrutinised.
And, after all, there is the possibility that within the vastly inflated number of people who have been deemed as requiring these sorts of hormonal interventions, there is a hard core of individuals for whom they might be appropriate. Let clinicians look at this in an appropriate evidence-based way. Isn't that what we all wanted?

I mean, we could propose all sorts of other experiments to see what happens when we subject children to various medical 'treatments'. To protest at the suggestion is not 'frothing'.

I guess the devil will be in the detail but the main reason I’m against it is because there is no clinically objective way to diagnose “gender incongruence”. The diagnosis is always based on clothes, toys and the feelings of a child who nine times out of ten has spent far too much time on the internet and has been coached on what to say to get treatment. They know that same sex attracted, autistic children and those with significant mental health issues are massively over represented. I just don’t understand how they will be able to ethically “treat” children when there’s no serious diagnostic criteria in the first place.

Exactly, the devil will be in the detail -- of which we currently know zero. And if there aren't adequate diagnostic criteria, then the business of devising a trial will start to clarify that difficulty by achieving some sort of operational definition of the people who even begin to jump through the (hopefully many and rigorous) hoops that will precede participation in the trial.

I thought the whole thrust of the Cass Review suggested the necessity of such a trial.

Cass also wanted access to the data of outcomes of those already experimented on. This should be a priority before any new study.

Wasn't the problem that they didn't even gather that evidence, though? There was some data Cass was refused, but my understanding was that there just was no data collection or proper diligence done by Gids.

https://www.newstatesman.com/politics/health/2024/03/inside-the-collapse-of-the-tavistock-centre

'between 2011 and 2014, 44 children aged 12-15 joined the Gids/UCLH early intervention study.'

'By 2016, those participating in Gids’ early intervention study had all been receiving puberty blockers for at least a year. “In terms of our early intervention I guess the other thing is that our results have been different to the Dutch… We haven’t seen any change in terms of psychological well-being,” Carmichael told trans health professionals'

'...over 30 years, Gids appeared to have collected no meaningful data on its patients or its only treatment pathway. It could not tell the court how many young people had been referred for puberty blockers, how old they were, what sex they were, or if they had gone on to take hormones. With true British understatement, three High Court judges expressed their “surprise” at this.

I'm very much for a clinical trial on one proviso: it needs to be ethical and safe.

If the only way to achieve this is to use retro data, so be it. For example, they could do IQ tests, brain scans and bone density tests on the previous cohorts now, then map them against averages for their age. Obviously it's not as good as getting an actual baseline data for each individual child, then checking it throughout the trial, but it's better than risking brain damage on someone who is yet to take puberty blockers.
Presumably any trial would need to track these things over a number of years, so retro data plotted against averages for ages could be useful e.g. a child who had puberty blockers from the age of 11-18, ending in 2020 would now be 22. There are several data points that could be captured here and used as part of the data analysis, such as age first started, number of years on blockers, age when blockers finished.

If instead they are accepting new patients, the ethics of selecting the right ones are a minefield, as stated above by several PPs. Informed consent for possible permanent brain damage is presumably impossible (also there is highly likely to be loss of fertility and possible/likely osteoporosis).

So yes, trials and evidence gathering is the way forward. But, to put it bluntly, that's also what Mengele did. Apparently his data gathering and analysis skills were excellent. However, it's only viable if it's ethical and safe (which Mengele's experiments clearly weren't).

I'm hostile to any trial which subjects children below the age of consent to potential infertility, brain and bone damage, loss of sexual function and more. It just seems so incredible that any civilised society would even consider such side effects as "acceptable". As @BonfireLady points out, these side effects are in Mengele territory.
In the past some in the medical profession have committed major outrages by experimenting on those unable to consent - look back at grim history of experimenting on the poor, different ethnic groups, those with mental disabilities, even more recently trialling drugs in African countries to avoid the restriction placed on live medical research in the West.
Given that the medical profession has not only stood by, but actively championed what's happened to children and young people under the guise of "trans rights" there needs to be considerable evidence that those involved in these "trials" are responsible ethical medics holding children's needs and safety at the forefront of that they're doing.
Although I'm optimistic that children's hospitals will enable this, given the medical profession's collusion in this scandal, we need convincing.

Would appropriate retro data be available, though? I thought that one of the problems with handing out PBs so readily was that almost everyone then progressed to cross-sex hormones - which would be a massive confounding factor into research on the effects of PBs

I took from this statement that as the new centres are meant to be more rigorous before accepting new patients, they will be better placed to do monitoring for trials.

But for me that raises the question of there may be little "evidence" during the period of treatment, and real problems may only occur later in life.

So as said up thread, surely the best most immediate assessment would be to go back through those previously treated and collect evidence from them.

Although given lack a accurate recording this may not be possible.

If it is only new patients who will be part of this clinical trial, are we going to end that in 20 years time the NHS (if it still exists) will be being sued for use of puberty blockers without having satisfactorly completed clinical trials.

The trans community is disproportionately affected by issues of mental ill health, suicide and self-harm. We have a duty to them to lower the temperature and look for common ground away from the toxicity of the current debate.

Is the first sentence a statement that is agreed? That as a group trans people have higher rates of mental health issues.

And whether it is right or not, what is the evidence that because it is a matter of debate is what is causing this vulnerability. Not wanting to be heartless, but if these issues happen to a higher extent in the trans community isn't that part of their issues. It just sounds like GC people are being told to shut up.

Retro data would be as good as the way it is handled.
If someone has gone on to take cross-sex hormones already at the time when their data is added, the age at which this started/ended (and the number of years they've been taken for) can also be captured as data points.

It's then down to the data analysis to see if any statistically significant conclusions can be drawn which separate the effects of puberty blockers from the effects of cross-sex hormones. Possibly so, possibly not.

So yes, imperfect, but again... better than risking permanent brain damage on a new cohort of children who are yet to receive any medical intervention. No matter which way you look at it, medical experimentation on children is probably not going to be a good idea.

No matter which way you look at it, medical experimentation on children is probably not going to be a good idea.

But surely medical trials involving children do in fact occur? Otherwise how could data on treatment options for children be generated?

Medical trials that are treating a medical condition.

How is 'liking the wrong toys' a medical condition?

How is 'liking the wrong toys' a medical condition?

Well obviously it isn't, and I absolutely share the scepticism about 'gender incongruence' and 'gender identity'. But nonetheless there are children presenting at clinics with extreme gender dysphoria. I strongly believe that almost all of them will be there as a result of other conditions, or as a result of how terrifying it is to grow in to womanhood in a society that so aggressively sexualises womens bodies.
I just don't think I can say a priori that there simply aren't any children whose experience of gender incongruity might, just might, necessitate treatment on its own terms.
The PB trial won't (or at any rate shouldn't) be happening in a vacuum. Ethically it could only happen if there was adequate psychological exploration and screening for eg trauma, autism, etc. The development of those psychological and screening protocols, alongside any data that can be gathered if any children pass through that screening and are deemed suitable for the PB trial, will be an evidence-based way of determining whether there are in fact children whose interests are served by medical intervention.

The whole point is that we need to use appropriate and well-established evidence-gathering protocols to move forward. I would hope that the trial might be constructed in a way that left open the possibility that no children were deemed appropriate subjects for PBs. That would be an evidence-based (rather than social media based) way of putting the whole issue to bed.

But nonetheless there are children presenting at clinics with extreme gender dysphoria.

Which is WHAT?

What is Gender Dysphoria?

I just don't think I can say a priori that there simply aren't any children whose experience of gender incongruity might, just might, necessitate treatment on its own terms.

What is Gender Incongruity then?

Once you have defined it in medical terms, then you need to be able to diagnose it with some tests. Putting a doll and a truck in a room? Putting two sets of clothes out? What would the test be? What if they picked the doll and the trousers? Or the truck and a dress? What then?

If you are arguing that a trial should go ahead, you need to explain why.

Yes they do - but so closely scrutinised with difficult issues around consent, parental rights to consent, quality of life, long term impairment versus saving a life being intensely discussed and evaluated.

The notion of treating mentally unwell children who believe they've been born in the wrong body with life altering drugs (and subsequent brutal experimental surgery) rather than addressing their co morbidities and disordered thinking ought to be morally unacceptable.

Adults are a different matter but the targeting of children and the failure of trusted adults and organisations to protect them from this ideology is unacceptable. We now need the moral courage to say "no more".
No more gaslighting children that their bodies can be fixed with a sex change. No more pretending that life long bodily impairment is an acceptable price to pay
No more kowtowing to queer theory activists trying to smash the social contract, family life and child safeguarding.

Edited to say that yes - hopefully going through the motions to try to run trials and then to find that they're not ethical or possible in consent terms will happen.
But we shouldn't have to jump through these hoops in order to safeguard children.

Has anyone ever suggested we try treating anorexic children with Ozempic and bariatric surgery?

We could monitor the effectiveness and any side effects. 'Ethically and safely'.

Such a good example. There's a reason we steer these children away from the toxic pro Ana sites where their disordered thinking about food and their bodies will be encouraged. Because we try to safeguard these mentally vulnerable children.
But children thinking they're born in the wrong body - welcome to Mermaids, Stonewall, Gendered Intelligence, GIRES and countless other groups. 😡

I can't see how it will get through to be honest

How do you screen to avoid transitioning those who would turn out to be gay adults if allowed to go through puberty?