The Cass report - Peer review

[BeizenderKarneval]

There has been some peer review work done on the Cass review, something that a lot of us in the industry knew was problematic but that has been used by government and a number of notably outspoken individuals to justify their hateful positions

The results and conclusions are quite compelling, and I urge you to read them for yourselves:

Critically appraising the cass report: methodological flaws and unsupported claims

I find this section especially interesting:

“It undermines the legal competence of both children and adults to access medical treatment and dismisses almost all existing clinical evidence on trans people’s healthcare by applying impossible evidence standards which, if applied to other medicines would invalidate more than three quarters of the existing treatments used in paediatric care which, like puberty blockers, are currently being prescribed off-label.”

The report’s primary conclusions rest on excluding 98% of the relevant evidence on the safety and efficacy of puberty blockers and hormones for lack of blinding and controls.

What this means is that they require studies in which some patients are given the treatment, and others are unknowingly given placebos.
This is not only a clear breach of medical ethics and monstrous suggestion, but also impossible due to the obviousness of the impacts of puberty blockers and hormones.

The report also strays far beyond its scope and competence in recommending a review of adult services and in suggesting that young people ought to stay under the care of children and young people’s services until the age of 25.
The latter is based on highly questionable understandings of brain development which have been repeatedly debunked as an oversimplification of the constant changes in human neurology over the course of our lives.

This recommendation, especially in a context of an already broken system of care for both adults and children, has the potential to have a significant negative impact on the lives and wellbeing of trans people in the UK.
Underpinning this report is the idea that being trans is an undesirable outcome rather than a natural facet of human diversity.

This is clear not only from the recommendations but also from the exclusion of trans researchers from the design of the review process and the links individual members of the research team have to anti-trans groups, which the Cass team were warned about.

I look forward to an interesting dialogue.

LMAO. Natacha Kennedy, Chris No one?!

😂😂😂

There's a reason no one will take this seriously.

Seems like the DAVRO play is been made early. 🤣

Thank you @BeizenderKarneval .

If you could put your counterpoints to each of mine in order the next time you post, I would be very interested to know your opinions.

I'd also be very interested to know how strongly you support your original post, as in how strongly you believe it? is it 10/10? is it 4/10? 7?

And based on that, I'd be interested to know what sort of thing would change your mind, what evidence or opinions you'd beed to see for that score to change?

I hereby promise to engage with you in good faith and be polite.

Thank you TangentialContrivences.

I think you have covered much of it with this excellent post. I can add these links in support of the other countries and organisations that also found 'low evidence' findings that the Cass report found.

NICE

arms.nice.org.uk/resources/hub/1070905/attachment

The summary of the conclusion is

Conclusion
The results of the studies that reported impact on the critical outcomes of gender dysphoria and mental health (depression, anger and anxiety), and the important outcomes of body image and psychosocial impact (global and psychosocial functioning), in children and adolescents with gender dysphoria are of very low certainty using modified GRADE. They suggest little change with GnRH analogues from baseline to follow-up.

And France from National Academy of Medicine. They have issued a press release about treatment for gender disphoria in children and adolescents.

SEGM have translated it, but I have also linked up the original version.

segm.org/France-cautions-regarding-puberty-blockers-and-cross-sex-hormones-for-youth

Extract

Transgender identity is a feeling of identifying as a gender different from that assigned at birth, which is persistent and lasts more than 6 months. This experience can cause significant and prolonged distress, which can contribute to an increased risk of suicide [a].

No genetic predisposition has been found.

While this condition has been long recognized, a sharp increase in demand for medical interventions has been observed (1,2) first in North America, then in Northern Europe, and, more recently, in France, particularly among children and adolescents. A recent study of a number of high schools in Pittsburgh revealed a prevalence that is clearly higher than previously estimated in the United States (3): 10% of students declared themselves to be transgender or non-binary or were unsure of their gender [b]. In 2003, the Royal Children's Hospital in Melbourne diagnosed only one child with gender dysphoria, whereas today it treats nearly 200.

Whatever the mechanisms involved in adolescents - excessive engagement with social media, greater social acceptability, or influence by those in one’s social circle - this epidemic-like phenomenon manifests itself in the emergence of cases or even clusters of cases in the adolescents’ immediate surroundings (4). This primarily social problem is due, in part, to the questioning of an overly dichotomous view of gender identity by some young people.

The demand for medical interventions, due to the distress that this condition (which is not a mental illness per se) causes, leads to a growing supply of care in the form of consultations or care in specialized clinics. This involves many pediatric subspecialties. The psychiatric consultations are utilized first, and if the identity is authentic and the discomfort persists, endocrinology, gynecology and, ultimately, surgery become involved.

However, great medical caution must be taken in children and adolescents, given the vulnerability, particularly psychological, of this population and the many undesirable effects and even serious complications that can be caused by some of the therapies available. In this regard, it is important to recall the recent decision (May 2021) of the Karolinska University Hospital in Stockholm to prohibit the use of puberty blockers.

If France allows the use of puberty blockers or cross-sex hormones with parental authorization and no age limitations, the greatest caution is needed in their use, taking into account the side-effects such as the impact on growth, bone weakening, risk of sterility, emotional and intellectual consequences and, for girls, menopause-like symptoms.

A Canadian team finds low evidence

https://nationalpost.com/news/canada/transgender-treatments-for-kids
https://archive.ph/fLMxA

"The Canadian team combed the available evidence, pooling the results of research on puberty blockers and gender affirming hormones for children and youth up to age 26. They graded the evidence using a scoring system co-developed by Dr. Gordon Guyatt, a celebrated McMaster scientist who coined the phrase evidence-based medicine.

Article content

After screening 6,736 titles and abstracts involving puberty blockers, only 10 studies were included in their review. While children who received puberty blockers compared to those who don’t score higher on “global function” — quality of life, and general physical and psychological wellbeing — the evidence was of “very low certainty.” Very low, meaning researchers have “very little confidence in the effect estimate” and that the true effect “is likely to be substantially different from the estimate of effect.”

The studies also provided low certainty of evidence on the impact of puberty blockers on depression. While they may decrease depression in “male-to-female participants,” they didn’t decrease depression scores in the female-to-male group. “We are very uncertain about the causal effect of the (drugs) on depression,” the researchers wrote.

“Most studies provided very low certainty of evidence about the outcomes of interest thus, we cannot exclude the possibility of benefit or harm,” they said."

New Zealand

https://www.health.govt.nz/news/additional-safeguards-for-puberty-blockers

Publication date: 21 November 2024

The Ministry of Health is today releasing an evidence brief and position statement on the use of puberty blockers for gender identity issues and outlining a more cautious approach to their use.

The evidence brief shows a lack of good quality evidence to back the effectiveness and safety of puberty blockers when used for this purpose.

I think there was a German team that came to similar conclusions too. But as you say, Sweden, Norway and Finland. And didn't Denmark also have a team that found this too?

I find it remarkable to still see discussion about Cass' finding about the quality of evidence. It feels very ideologically driven considering all the other national teams with similar findings are being ignored.

@BeizenderKarneval
Interesting response. And, unusually for MN, well thought out, superficially free of conditioned bias, and rational. Thank you.

You must be new around here?

On the second point, I've never heard of opposing evidence being closed down and banned on Reddit (maybe it does and I only look at the balanced, kinder sub-Reddits?), but shutting people down for epxressing an opinion that doesn't align with the cult does happen on MN, doesn't it?

Reddit, the place that is run by TRAs that ban every non TRA board? That Reddit? Oh my days.

Is there a board there that posts any actual evidence that is based on actual non biased studies carried out by people not invested in puberty blockers as an income, that supports their use? If so can you link to it?

Someone's put 50p in the 'mansplaining dickhead' machine again. I wish they wouldn't.

Thank you for posting this. Obviously I knew the use of PB (except in exteme circumstances like precocious puberty) were not backed up with solid, scientific evidence and end up causing more harm than good, but I'd forgotten all the reports worldwide that came to the same or similar conclusions to Cass.
If nothing else your post and this thread has reminded me 😊

Thank you to @TangenitalContrivences and @Helleofabore for your posts.

Please understand that this sub-forum moves very, very quickly and I am due to be at work soon so it is going to take some time to look at your responses and cross-reference them. Please be patient and don't take temporary silence as an indication of thread abandonment!

TangenitalContrivences is my new hero.

I've gone through bullshit 'medical' papers before to find obvious bias and it's always an eye opener.

People take these things at face value far too much.

Maybe Johanna is just a bit busy being sued.

https://www.economist.com/united-states/2024/12/06/americas-best-known-practitioner-of-youth-gender-medicine-is-being-sued

Yeah, I'm sure the reason you won't have heard about opposing evidence being closed down has nothing to do with any GC forum (including r/gendercritical itself) being closed down by TRA mods years ago, and most of the women's forums - especially the lesbian ones - being taken over by TIM moderators to the point that the overlap between r/MTF and r/ActualLesbians is almost total.

Oh imagine, MN has a terrible reputation across the internet! How shall we live with ourselves?

I don't care.
It doesn't matter what "the rest of the internet" thinks.

I thought that worrying about one's reputation went out of fashion in the mid 20th century.
Worrying about "reputation" never did women much good in the long run.

Ah. yes. I forgot that.

MN - the place where there's a regular reflection thread where some goes "are we the baddies?"

In a moment of second guessing themselves and whether actually we are in the wrong or not.

Only to dispassionately rationalise, reflect on bias and ethics, look at data, look at real world impacts and go "na it's not us mate".

Reddit is incapable of such processes because to even express doubt results in excommunication.

I wonder if the group can suggest things that BeizenderKarneval can try posting on reddit to gauge the response?

And I have no problem reading a paper that has a bias. I do, of course, consider that bias very carefully when looking at the conclusion. If the evidence stands up to robust scrutiny, does the bias matter?

Perhaps the OP can post the studies that they believe have been wrongly dismissed that support the use of treatment plans that Dr Cass's report warns against.

I look forward to seeing which studies have been considered convincing and why.

We should all be more Joan Jett.

I assume you aren’t a doctor Biz and that ‘in the industry’ means something else entirely. The Cass Review followed established protocols (something your study doesn’t seem to have done). It doesn’t recommend RCTs because that would not be possible for PBs for very obvious reasons - you couldn’t effectively ‘blind’ them. It was careful, balanced and intelligent.

I am genuinely not sure that any halfway competent reader, medic or not, could read the Cass Report then read what you have set before us and not see the glaring differences between the two so I’m also guessing that you haven’t read Cass.

Agreed and this would be best. I think OP is highlighting that both groups would quickly identify whether their puberty had stopped or if they were in placebo. So the blind part isn’t so useful here - although the outcomes would presumably still be valid

Oh is it that one? With Natasha ‘lady name / man name ‘ Kennedy

You do realise that it’s 9am on a working day and most posters will pop in on their own time later? Your tone is abrupt and if you are female you should work on that - it works well up to age 30-35 but after that will start to undermine your career accomplishments/you’ll get sidelined if you’re not careful.

Anyway based on your timing and tone are you a) based in a different time zone b) a student c) unemployed or d) skiving e) on leave?

Given content and timing. I’ll guess a).

yes sometimes uses either name. Or did a paper under both names?

I mean, don’t pass the basic test for consistency really if you can’t decide which gender you’re working in

Yes, co-authored a paper with himself.

https://itgl.lu/wp-content/uploads/2015/04/Kennedy-and-Hellen-Transgender-Children.pdf

Yes, this can sometimes be a problem with double blind studies. I'm not sure it would be too much of a problem here, since surely puberty blockers don't have dramatic short-term effects - or do they?

(I have read of trials of acupuncture that utilised a method of disguising whether a needle was actually being inserted in order that the patient didn't know whether they were getting treatment or not.)

The OP's objection to double-blind trials is that they are unethical. If that's the case, then most medical research is unethical.