Puberty Suppressing Hormones, House of Commons, Wes Streeting taking a firm and intelligent stand

[ScrollingLeaves]

Wes Streeting is doing a good job of calmly holding his own in Parliament on this issue of puberty blockers being banned pending a trial.

Some MPs have been standing up and speaking about ‘trans kids’ and suicide and so on, and how young people currently taking puberty blockers will source drugs from other sources as they will be left so desperate. Certain MPs have shown no inkling of the wider issues concerning gender dysphoria among troubled young people.

WS read out report saying that suicide figures of trans people were skewed, and reporting of it dangerous.

Others have seemed to be more aware. Sir John Hayes has brought up those who were vilified for whistleblowing such as Kathleen Stock, the lives ruined by the Tavistock and how it could have happened? WS has just paid tribute to Hannah Barnes. Women’s concerns.

“I am very disappointed in behalf of our trans children….” Vikki Slade. She says there is no information on suicides for those on a gender waiting list. WS says all child deaths are monitored and reviewed.

Jim Allister asking about parental consent and age for the puberty blocker trial. WS ethical concerns are being taken very seriously.

“A breach of young people’s human rights” Carla Denyer (Green).

Robin Swann County Antrim asking about closing access to puberty blockers through loopholes.

Anyway, it is worth hearing WS. It seems to be the first time someone from Labour, who is allowed to speak, has seemed to have a depth of understanding about gender issues. He also speaks lucidly and with nuance.

I don’t know if he is just very clever, but in the end slippery, or actually someone who will make a difference for the better but was impressed.

The easiest way to get through the REC would be to only include those who are experience very high levels of distress and for whom current quality of life is dire (e.g not going to school, rarely leaving the house, not eating, self harming etc.). It will be difficult to justify the potential risks for populations who are functioning relatively well on a daily basis.

Didn't the earlier trial show that mental health for many children deteriorated when taking these drugs? Wouldn't it be hard to justify damaging the bodies of physically healthy children in order to try to improve their mental health, when there is no evidence from previous experiments that this 'treatment' is effective, and in fact may cause a deterioration in their mental health?

Can you point me to some information about a similar trial to this one: where a drug has been approved for use in a physical condition, and is being trialled for use in an unrelated mental condition?

"Didn't the earlier trial show that mental health for many children deteriorated when taking these drugs? Wouldn't it be hard to justify damaging the bodies of physically healthy children in order to try to improve their mental health, when there is no evidence from previous experiments that this 'treatment' is effective, and in fact may cause a deterioration in their mental health?"

This is the crux of it. There is conflicting evidence. If there wasn't any evidence indicating positive outcomes, it would be hard to get through REC. I think there is evidence indicating efficacy in the form of case studies and testimonies. There is some evidence for this not being the case more generally. Cass highlighted that there isnt a clear picture.

The REC will need to decide if the potential for positive impact outweighs the risks.

"Can you point me to some information about a similar trial to this one: where a drug has been approved for use in a physical condition, and is being trialled for use in an unrelated mental condition?"

Have a look into Lamotrigine. It was originally licensed for epilepsy but is now also used for bi-polar disorder.

The easiest way to get through the REC would be to only include those who are experience very high levels of distress and for whom current quality of life is dire (e.g not going to school, rarely leaving the house, not eating, self harming etc.). It will be difficult to justify the potential risks for populations who are functioning relatively well on a daily basis.

And would also need to exclude from those who are functioning so poorly and in dire distress, the children who may be functioning poorly due to autism/trauma/family issues etc.

The original Dutch study at the root of this intervention only included those with no co-morbidies and otherwise healthy functioning and stability at home.
So this wouldn't this then be the opposite to that?

"And would also need to exclude from those who are functioning so poorly and in dire distress, the children who may be functioning poorly due to autism/trauma/family issues etc."

This is an interesting aspect as there are equality issues to consider. Back in the day, we used to control for lots of confounding variables through exclusion criteria but there is now an expectation (and legal requirement) to be inclusive.

I am sympathetic to this argument in many ways. Drugs have mostly been trialled on male populations only as women (with their pesky menstrual cycles and pregnancies etc) were excluded. This makes women less protected.

If there is a potential benefit to a drug, children with protected characteristics shouldn't be excluded from participating in trial unless there is a strong reason for doing so. Similarly, if there are significant questions about potential risks/benefits, children without protected characteristics shouldn't be used as 'cannon fodder' whilst protecting the 'most vulnerable'.

@Brainworm
Thank you for sharing your knowledge!

Thanks @kiterunning. My comments are tentative (I tried to phrase them as such) as I have no insider knowledge about the proposed research. Also, whilst I have experience of being part of a REC, my background is mental health, not medicine.

As a mental health professional can you point me towards a definition of the condition in children which this trial aims to treat?

Gender dysphoria was originally classified as a mental health condition, but I think it has been moved (in one of the diagnostic manuals, at least) to 'sexual health'. It's unclear how a sexual health condition in adults relates to what appears to be a mental condition in children.

The NHS website used to have a definition of gender dysphoria in children which was almost exclusively based on stereotypes (with a nod towards dislike of the sexual organs). It no longer gives any definition at all.

Before any trial takes place, surely it first has to be defined exactly what the condition is that is being treated and how these drugs aim to alleviate the symptoms.

If the trials are going to be conducted with the primary purpose of monitoring mental health outcomes - why not use an established anti anxiety/depression medication? Puberty blockers were not intended for treating mental health conditions, and one can only assume that any positve impact of puberty blockers on mental health would in large part be a side effect of blocking puberty - so a kind of placebo effect which is secondary to the physical consequences.

I cannot believe that the NHS has allowed itself to be so captured in this way. It makes no medical or scientific sense at all...not to me, anyway.

Young people and/or their parents want to block their natural puberty because they believe they are in the wrong body and should have the puberty of the opposite sex. This is clearly a crazy idea that should never have been entertained in the first place.

The NHS has clearly left itself open to being sued, which is maybe another reason for conducting such a trial; so as to find some clinically approved reason for the use of puberty blockers for young people suffering mental and emotional distress.

I tend to use the term 'gender distress' to acknowledge the formulation that the patient holds. My formulations always go wider than gender and incorporate all the factors that could be/are contributing to the overwhelm/distress/poor functioning.

I have no idea what terms and definitions will be used in the research protocol, and subsequent study - if approved.

The question is what is this positive evidence and who collated it and under what circumstances? There is also evidence aplenty that there is negative consequence and that in many cases mental health deteriorates.

I suspect that there is a desire tro find good reasons for use..... That is certainly what I picked up on in Wes Streeting's recent speech.

I am a bit familiar with clinical trials (for anti-cancer drugs, though, so ethically the process is very different). My understanding is that puberty blockers followed by cross sex hormones will likely pose very different risks compared to puberty blockers followed by normal puberty. The duration of treatment is also different. Doesn't this imply that safety needs to be assessed specifically?

"The NHS has clearly left itself open to being sued, which is maybe another reason for conducting such a trial; so as to find some clinically approved reason for the use of puberty blockers for young people suffering mental and emotional distress."

The Tavi was operating like the Wild West. It didn't follow the standard protocols within medicine and their maverick approach infiltrated the endocrine clinic at UCL. Prior to the Cass review, this might have been possible. There are so many eyes on this now, that the level of scrutiny this research is attracting greater scrutiny to the ethical approval procedures and criteria etc.

"I suspect that there is a desire tro find good reasons for use..... That is certainly what I picked up on in Wes Streeting's recent speech."

I think the evidence that was presented to Cass and Streeting probably falls into the classification of 'practice-based evidence'. Practitioners and young people probably provided case studies and testimonials as to positive outcomes.

Practice-based evidence should be attended to in all fields of medicine, and followed up with robust research to test it more carefully.

It's an interesting ethical point to compare licensed puberty blocker use in early onset puberty - where puberty is only delayed to an appropriate age, then the drugs stopped - and the use of them to completely prevent natural puberty, which arguably there is no safety data on. I would argue that phase 4 is inappropriate here as we have little hard data on long term outcomes from total puberty prevention. It's more similar to taking an adult drug and using it in young children- I don't know what the regulatory framework is there.

Setting out the primary outcome measure here is crucial. If it's level of distress (as I would expect) there are already studies showing no benefit from puberty blockers.

I have been wondering about this too Gnome.

I expect the original trials will be accepted in relation to understanding how the drug is metabolised, short term side effects and optimum dosage to achieve outcomes whilst limiting side effects.

If the original trials included participants at different Tanner stages, then they might be seen to be sufficient to consider this a phase 4 trial, regardless of age - as I assume pubertal stage is more significant than age.

He needs to do something about this arrogant monomaniac grifter

archive.ph/dDnwN

https://www.thetimes.com/uk/healthcare/article/former-trans-charity-boss-to-defy-ban-on-puberty-blockers-qxtd8cbfz

In case anyone here reading does not realise this person had her son castrated abroad when he was sixteen. She and her husband had decided he was trans as a young child because her husband did not accept his effeminate, possibly gay traits.

No she needs to prove she was right by getting other children on the same path.

Found a share token so thought I'd add it too:

https://www.thetimes.com/article/65ca700b-ad5a-4f9e-ba29-0e0a62e6fa62?shareToken=776a3e30f3ce5552d5fe3937df7f4e1f

I'm glad that someone is reporting on her shockingly irresponsible behaviour.

I've always wondered why she wasn't prosecuted for child abuse. I believe from what I read that her son at that time was only 15. And yes the move to deal with that overseas is to break UK laws/culture etc. She will spend the rest of her life justifying that to anyone. The now mid-20s adult seems settled in their decision - so that at least is a small positive for that young person.

I know this is a little off thread, but I saw this article and I wanted to post it

https://archive.ph/ZYjHE

https://www.telegraph.co.uk/news/2024/12/21/gender-fluid-appreciation-trans-parents-day-nhs-calendar/

I hate to think how much is going on pins and lanyards, or how the staff can stand up under the weight of them all.

Be more Helen...

"Helen Joyce, director of advocacy at Sex Matters, a human rights charity said: “The NHS has one job: to provide healthcare to everyone. No doubt that does involve public health messaging, like days to raise awareness of dementia or menopause symptoms.
“But endless tripe about special identities is not only tiresome, it’s a distraction from what medical professionals should be doing. It makes NHS staff look obsessed with trivial nonsense like made-up genders and preferred pronouns. Over time that’s bound to erode patients’ trust.
“This is all a waste of time and money. The NHS needs to drop the performative nonsense and focus its efforts on treating sick people and improving the nation’s health.”
NHS England was asked for comment."

International Pronouns Day?

What utter tosh.