New paper argues that “gender-affirming care” for adolescents should not be measured by whether it’s “effective”

[UtopiaPlanitia]

Thread on TwiX from journalist Leor Sapir:

https://x.com/LeorSapir/status/1872632988531372290

"A new paper argues that “gender-affirming care” for adolescents should not be measured by whether it’s “effective” at reducing psychiatric distress and improving life functioning. Authors (inc. A. de Vries) gesture toward an “autonomy” focused model.

To be clear, this line of thinking has animated the “affirming” model for a while now. The authors are now saying it explicitly. Clinical/psychosocial outcomes don’t really matter, apparently. This isn’t medicine."

https://bmcmedethics.biomedcentral.com/articles/10.1186/s12910-024-01143-8

The things that de Vries has been saying in recent years about adolescent gender treatments (in various interviews) have really worried me - she seems desperate that the world should accept that there is medical value in her 'Dutch Protocol' and she has never seemed particularly worried or guilty about the death of one of the patients who was part of her original study group. For de Vries, passability of patients appears to be the most important outcome.

I haven't read this but surely this is acknowledging that this is all for cosmetic purposes? If there is no measurable benefit US insurers and the NHS should not be getting involved.

Surely all healthcare should have a measurable outcome?

They are now pivoting to say the quiet bits out loud, aren’t they?

Sometimes, I hope that there is a circle in Hell reserved for people who experiment on children and vulnerable adults where there is no medical benefit for the patient.

There has been a pivot in recent years towards certain doctors describing transition treatments as being part of a 'gender journey'. This means doctors can tell themselves that patients who go on to detransition are just on another stage of this gender journey.

It’s despicable and displaces all sense of responsibility or accountability from doctors to the patients instead.

It’s basically saying ‘We gave them what they said they wanted. If they don’t want it anymore it’s not our fault.'

I shall put that on my reading list for 2025. In the interim, I shall ponder whether I'm in need of an updated course in biomedical ethics or if that's now to be discarded for a new model in which autonomy trumps all (unclear whether informed consent is part of those autonomy considerations).

Really weird paper.

I note that it's in a journal with an impact factor of 3.1. Top end medical journals will have an impact factor of 50, 60 or more.

I wish them luck in recasting the point of something identified as a medical treatment for a tiny number of distressed children to an experience for lots of adolescents to go through, like an escape room or a theme park.

Because WPATH and Eunuch gender just isn't deranged enough for the authors of this paper.

Reading my way through this new paper I was not reassured when it stated that:

'Furthermore, typical evidence-based medicine practices (i.e., relying on scientific evidence and clinical expertise) may not always help to inform decision-making in this context [25]. Meeting the “gold-standard” of evidence-based medicine can help to legitimize the provision of care, protecting against criticism that treatment approaches are unfounded [31,32,33].

However, some scholars argue that meeting this “gold-standard” through performing randomized controlled trials in transgender adolescent care is both methodologically inappropriate and unethical as it may deny or delay treatment, thereby making it difficult to recruit participants willing to risk being assigned to a non-treatment group [27, 34]. Given this context, the “gold-standard” of evidence-based medicine has not been considered suitable for guiding research practices for GAMT for youth, which is believed to contribute to uncertainty around the legitimacy of this care practice and its evidence base [25]. Despite the criticism surrounding GAMT for youth and its corresponding evidence base, experts within the field of transgender adolescent care have aimed to systemize care by integrating available evidence, patient values, and clinical expertise to create care models.'

All of this seems to be more of the effort to exceptionalise children with gender distress to allow them to be treated with a lower standard of medical care. De Vries et al are also writing this paper as if the WPATH SOC were a rational and well-founded series of documents with research to back them up rather than the ideologically-framed hodgepodge that it is.

Sometimes I feel people like de Vries et al live on a different planet to the rest of us when they justify ruining perfectly healthy bodies and call it medicine. De Vries' continued insistence that her way of practicing gender medicine is the best way reminds me of Dr Freeman who went to his grave fighting to have lobotomies recognised as medically safe and helpful.

Almost three years ago, De Vries told Stella O'Malley that she was busy concluding an updated study on the original cohort that gave rise to the Dutch Protocol, all 70 of them.

I wonder if it was poor outcomes from these ex patients that prompted De Vries to write the linked paper.

I wouldn't be entirely surprised if that was something to do with this new paper and its redefinition of happiness and success. I was hoping that the data de Vries was intending to collect would prove to be useful for the current cohorts of children, so I sincerely hope she is planning to release the data and not do an Olson-Kennedy and just sit on it because the outcomes weren't what she wanted.

Redefinition of terms and criteria was what happened when the number of detransitioners became large enough to get public attention - the gender clinics redefined 'transition' into 'gender journey' in which all things that happen to patients, even things that damage them and that they hate, are valid stages in the journey.

After decades of pushing medical transition as the insta-cure to all dysphoria, basically, the queer theory influenced doctors are queering the definition of happiness now too 🙄

There's just no end to the shapeshifting squirms these people are ready to go for."If it feels good, do it" has it's place in how we live. But that place isn't medicine. It isn't science. It's how you decide which fun fair car to ride. That's different.

The very first reference is to a newspaper article by Andrea Long Chu, the sissy porn fetishist and he of “expectant asshole” fame🤮. How do they expect to still be taken seriously?

This is the essence of Queer Theory, they are now simply queering the outcomes so that old fashioned things like physical and mental functioning can be downgraded compared to (elusive) 'patient values'.

Word games defending horrific damage to children and vulnerable young adults.

AsPP have said if it isn't medicine/ medical intervention it shouldn't be paid for by NHS

Tnanks @UtopiaPlanitia Like you I expect the negative results started rolling in. I suspect this is a last-gasp attempt to keep the circus on the road. The central content of the paper looks pretty clear - so far there's plenty of evidence that gender affirming treatment doesn't improve function and no evidence to say it does improve function (and we're not going to look at any new data because that might really show us up) But we can tart it up (and justify SOC8) by "using trans negativity as a theoretical lens" and so conclude we should keep taking the medicine anyway - or rather, we should keep spooning the medicine down any adolescent who doesn't run screaming from it - because reasons.

With any luck this paper will be cited forever though not in the way that de Vries (presumably) hopes. I've downloaded in case it vanishes.

They can make whatever they like out of queer theory but what I fucking resent is their dragging in feminist theory which they refer to in the same breath as queer theory to back up giving bad medical care to adolescents. Forced teaming or what. As an aspiring feminist myself - not in my name, arseholes.

This is an academic paper. Normally you'd need a very good reason for citing anything that isn't another academic paper or a book.

An opinion piece in a newspaper written by a fetishist really isn't an appropriate source in a paper about child transition.

Sometimes I feel people like de Vries et al live on a different planet to the rest of us when they justify ruining perfectly healthy bodies and call it medicine. De Vries' continued insistence that her way of practicing gender medicine is the best way reminds me of Dr Freeman who went to his grave fighting to have lobotomies recognised as medically safe and helpful.

This is spot on. They seem to have become so immersed in their delusion that mutilating the healthy bodies of children is "healthcare" that they can't see how insane the whole thing looks to anyone who hasn't succumbed to the cult of genderism.

I skip read that because, frankly, it was a lot of word salad nonsense. Their research methodology is rubbish. They’ve selected only studies that have quantitative measures of outcomes. Why? If you’re looking at outcomes, qualitative research is going to give you a broader view of outcomes. It’s referenced badly, or perhaps it’s just the formatting on my phone but they refer to “Chu” in the discussion but the link to their referencing of this quote doesn’t match up so it’s impossible to follow through properly. I suspect it’s Andrea Long Chu.

Interestingly they are critical of SOC8 from WPATH but not because it’s a load of unevidenced crap but because WPATH have tried to demonstrate that there is evidence of benefit.

Their argument seems to be we should let kids with gender dysphoria have what they want because they want it and not have any evidence based of an intervention making things better. They seem to argue autonomy is all. It doesn’t matter whether there is benefit, we should give people want they want because they want it. Can you imagine if we extended that principle across medicine?

There are rightly limits to people’s autonomy, a big one being you can’t demand a treatment that is not clinically necessary and particularly if there is evidence of potential harm. This seems to place autonomy above all other principles of medical ethics, namely non maleficence (first do no harm) and justice (that people can equally access treatment or intervention). We’re going to let trans kids (sic) or transgender adults have whatever they want but not extend that to all other aspects of medicine? Reminds me of that bonkers Action for trans health manifesto.

Medical capitalism/consumerism at its best.

Well, I've been surprised by how some people who seem like reasonable and intelligent adults are pushing for children to be given puberty blockers. Including several elected MPs.

There are rightly limits to people’s autonomy, a big one being you can’t demand a treatment that is not clinically necessary and particularly if there is evidence of potential harm.

Especially when these people are not adults but adolescents. Who are not fully mature, who are known to make impulsive decisions, who are not able to conceptualise some long term harms. Whose autonomy society restricts in other ways for good reasons.

I'd like to see de Vries et al discuss adolescents' right to an open future.

It’s referenced badly, or perhaps it’s just the formatting on my phone but they refer to “Chu” in the discussion but the link to their referencing of this quote doesn’t match up so it’s impossible to follow through properly. I suspect it’s Andrea Long Chu.

It's the first reference.

Using this perspective, we critically analyze the normative assumptions underpinning the SOC8 research evidence and argue for acknowledging the intrinsic complexity of GAMT, including the often enduring presence of negative affect throughout and beyond transition 1,2,3].

'I was not suicidal before hormones. Now I often am.

I won’t go through with it, probably. Killing is icky. I tell you this not because I’m cruising for sympathy but to prepare you for what I’m telling you now: I still want this, all of it. I want the tears; I want the pain. Transition doesn’t have to make me happy for me to want it.'

Chu, from Times article above.