Bayswater have posted this thread which echoes the reservations I have.
start
The NYTimes podcast "The Protocol" paints a picture of a golden era in paediatric gender medicine before the arrival of new and more complex adolescent-onset patients. An audit of UK GIDS referrals in 2000 suggests a rather different tale. 1/11
The 2000 audit of 124 paediatric referrals to the GIDS clinic is described in @hannahsbee "Time to Think": Only 2.5% had "no associated problems", 70% had more than five "associated features", including profound difficulties/vulnerabilities outlined in the next tweet. 2/11
57% had difficulties with parents/carers, 52% difficulties with peer relationships, close to 1/4 exhibited "inappropriately sexualised behaviour" (a red flag for CSA), a similar number had a history of self-harm, 25% had spent time in care (compared to 0.67% of children in general), 42% had lost one or more parents through separation or bereavement, 38% had families with mental health problems, a similar proportion had families with physical health problems. 3/11
In short, straightforward cases where the only issue was in relation to "gender" were very rare indeed. Similar data is lacking for the Dutch clinic, but there is no reason to believe they would have been seeing fundamentally different patients. 4/11
The account given by the Dutch gender clinicians (which escapes even modest journalistic scrutiny in The Protocol) is that careful screening weeded out those complex kids to identify the ones who simply had the misfortune to be born in the wrong body. There is no account of how or why a child might reach this conclusion, or the disproportionate impact on kids who would otherwise turn out to be gay. 5/11
And assuming a vaguely similar patient cohort to the early GIDS patients, the rates of onward referral for PBs at the Dutch clinic suggest that many are likely to have had other difficulties. A study of Dutch patients from 1997-2018 found that for the children who presented to the clinic before the age of 10, rates of progression to puberty blockers among those "potentially eligible" were 53% of females, 36% of males. 6/11
Of the supposedly "straightforward" cases, another haunting question lingers: how can we know from individual accounts that their chosen path was the best option? Lack of regret does not mean that a treatment is safe, effective or medically necessary. This is why we have robust clinical trials. 7/11
But when @JamieWhistle points out that "customer satisfaction" alone cannot justify clinical interventions, this is greeted with surprise by podcast host Austin Mitchell: What else could possibly matter? "Evidence of clinical benefit" Reed replies. And yet Reed is framed as someone with "extreme" views, quite unlike the moderates who are allowed to claim this is all ok as long as we are careful. 8/11
Podcast host Azeen Ghorayshi tells us that Dr Cass's position is that "there are absolutely kids who benefit from these treatments" (Episode 5, 32:05), and yet earlier in the same episode her co-host admits that "what the evidence actually showed was ... we don't know" (12.02). This contradiction isn't even acknowledged let alone explored. 9/11
Rather than objective scrutiny, we get subjective storytelling, as if contrasting personal opinion will lead us to the truth. And crucially, the truth is not always found in the middle ground: good journalism should be open to that possibility. 10/11
So De Vries is given the final word, blaming "politics" for doubts about her treatment. She is left unchallenged about an array of inconvenient details such as her own recent admission of "the often enduring presence of negative affect throughout and beyond transition". 11/11
x.com/bayswatersg/status/1932164156813361175?s=46