Australian review into 'gender care' for children

[ArabellaScott]

https://www.saxinstitute.org.au/resource/evidence-for-effective-interventions-for-children-and-young-people-with-gender-dysphoria-update

A rapid review/evidence check.

The findings, on a quick read, repeatedly show that there's not enough research, and that the research available is flawed and low quality, but also somehow concludes that hormones and surgery are helpful.

https://www.abc.net.au/news/2024-09-06/gender-affirming-care-still-safe-effective-and-reversible-review/104322428

'The NSW government commissioned the report by the Sax Institute in the wake of a Four Corners report into gender-affirming care and a growing dispute among some clinicians in NSW about what was best for children with gender issues, as a polarising and sometimes toxic debate over the gender "affirmation" model plays out around the world.
...
A Four Corners investigation into Westmead Children's Hospital's troubled gender clinic revealed it had only seen three new patients as of July last year and was struggling to operate in the wake of a string of staff resignations linked to the publication of controversial research endorsed by the hospital hierarchy.

The paper, published in 2021, found there were "high rates of adverse childhood experiences including family conflict, parental mental illness and loss of important figures via separation" among a sample of 79 children who sought help at the hospital's gender service.
Perhaps most controversially, more recent research conducted at the hospital found gender-related distress was "resolved" or "disappeared" for 22 per cent of those who presented at the clinic.'

... they found that "overall, the evidence about gender dysphoria interventions remains weak due to poor study designs, low participant numbers and single-centre recruitment"..

I still can't believe anyone ever thought 'gender affirming care' was a good idea. What the hell were these people thinking? Even though their conclusions were wrong it still adds to the pile of evidence that drugs and surgery do not work to solve mental distress.

Just reading the ABC article, that is one hell of a mess of findings.

As you say, all throughout is a commentary of low or weak evidence yet, the continued message was 'safe and offered some psychological benefits'. But there was also mention that actually, there was no improvement in mental health.

The entire article is full of conflicting statements.

And I am rather surprised at the findings considering that Sweden, Denmark, Germany and the UK have found that Puberty Blockers are not 'safe or reversible'.

Plus, I thought the intention was to move the gender clinic from Westmead into Randwick hence the winding down of the Westmead unit. I am sure I read an article about that last year.

Yes, Helle. It's really weird to read the headline, which is that PBS are 'safe and reversible' and all roughly positive conclusions about interventions, and then read the body of the article, which repeatedly cites low quality and absence of evidence.

I say weird. It's disturbing.

'How many fingers am I holding up' disturbing.

It reads like a propaganda piece.

And the Sax institute doesn’t come out as a knowledgeable resource on this. Compared to Cass which was run by a paediatric specialist, who not only got university teams researching but interviewed 100s of those actively involved. This seems very light weight in comparison.

The Evidence Check is here.

https://www.saxinstitute.org.au/wp-content/uploads/Evidence-for-effective-interventions-for-children-and-young-people-with-gender-dysphoria-update.pdf

I had a skim read last week to see how they came to the conclusion that PBs are "safe, effective and reversible" and this is how I understood their findings

PB's are safe because there are no serious short term health risks observed amongst the children taking them. Reduction in bone density is the primary concern but it is within one SD and bone density usual recovers once taking cross sex hormones.

PB's are effective because they do what it says on the box and blocks puberty.

PB's are reversible because they don't cause any phenotypic changes e.g no breast growth in boys or voice changes in girls. There is no mention of PB's possibly leading to an altered trajectory.

It's worth noting that the Evidence Check doesn't conclude that PB's are beneficial.

Yes, Thingy. I am reading through now and this is how I read it.

It is disastrously blinkered partly because it is focused on short term health.

It didn't note the calcification of testes which is not reversible and did have long term implications. It did note the lack of development of breasts in girls and penises in boys and noted that this was the desired outcome.

It dismissed the bone density issue with a breezy... but if you do x this will counter it. But I have not seen evidence that this is adequately countered in female patients. And considering then the issue with joints that female bodies have with use of testosterone that leaves so many female people in pain and on crutches, it seems to be a rather harmful dismissal.

Is this a professional level report?

Fucking hell if it is, don't ever need a doctor in Australia is the message here.

Sax Institute:

'We are an Evidence Specialist working collaboratively to embed research into the fabric of policy, program and service delivery decisions. We develop, test and deliver best-practice approaches to working at the interface of research and health decision-making.

Supported by our extensive national network of more than 60 public health research organisations, we work with governments, health organisations, research organisations and a network of experts nationwide to analyse policy problems and find the best evidence-based solutions.'

'The Sax Institute is an independent not-for-profit organisation. We work closely with governments, health departments, statutory agencies and non-government organisations across Australia. Our funding is derived from a mix of government, non-government and competitive grant sources.'

I suspect they are a type of think tank style organisation. Set up with best intentions but I doubt they are more than an advisory group.

While this supposedly was ‘commissioned’ by the NSW government, it is not the stature and reach of a dedicated team such as Cass pulled together.

And they only did an evidence review as far as I have read so far. No other in-depth bespoke qualitative research just for this purpose.

Yes. It's ostensibly an update of the earlier 2021 report, but seems more a response to Cass as far as I can tell.

Also neatly avoiding what is arguably the biggest red flag of all: the unknown impact on the developing teenage brain... with early indications of a negative impact on IQ...

https://x.com/Psychgirl211/status/1704272957055361034?t=LuaLM6u9DiGej4de1YBpDg&s=19

... and other developmental issues..

https://x.com/Psychgirl211/status/1812912510061735973?t=EYGvr3vk3yKcFRljCu26ng&s=09

Apologies, cooking dinner so unable to grab screenshots. Although there is a thread somewhere with the wording from the second link in full. I'll grab it.

10-point IQ loss? Ouch...

My mistake. The thread with the wording from X pasted in was from a different Dr P article.

10-point IQ loss? Ouch...

Indeed. I've seen another thread on X (but forgot to add the link to my useful stuff folder) where Dr P cites a study of more (25?) children, with similarly worrying results.

How can you put 'safe and reversible' and '10 point IQ drop' next to each other.

ArabellaScott · Yesterday 13:15

Sax Institute:

'We are an Evidence Specialist working collaboratively to embed research into the fabric of policy, program and service delivery decisions. We develop, test and deliver best-practice approaches to working at the interface of research and health decision-making.

We are proud of our specialist team of mentally subnormal pangolins and marmosets, who are felled by lemon cheese and Red Bull. All of our reports are checked meticulously by our chief statistician, Ernie, the month old road kill wombat.

How many fingers, Winston?

I wondered about this.

I was going to look at the rest of the paper to see if they had a view in this. And if they acknowledged the calcification of the testes as well.

I suspect they haven’t.