Why the NHS puberty blocker trial is appalling

[Soontobe60]

Stella O’Malley from Genspect telling it like it is - that a state endorsed trial of puberty blockers for gender dysphoric children should NOT go ahead.
the NHS are not walking into this nightmare blindly - there are enough experts out there telling them what will happen happen to these children if they’re given these life changing drugs.
https://x.com/genspect/status/1989896741358113127?s=61&t=gKvvk-rWmOlYFGMZN8QVvQ

Or is it that he’s surprised by Kemi expressing concern?

Because supposedly everyone in government agreed that everything in the Cass report was correct, including the trial, so why is she now retracting that agreement…?

He's not surprised, it's just a turn of phrase being deployed politically to reject her comments.

Thanks to @UtopiaPlanitiafor the summary earlier. It prompted me to look at the current licensing for triprorelin.

https://www.medicines.org.uk/emc/product/780/smpc

I note that it can be used in Endometriosis, (good luck with that diagnostic pathway) but that additional meds are often given to reduce vasomotor symptoms and preserve bone density.

With regard to adolescents, treatment should be stopped around the physiological age of puberty and to preserve bone density, should not be continued in girls with a bone maturation of 12-13 and in boys a bm of 13-14.

Risks include increased risk of depression and convulsions in women and children.

In precocious puberty, they say that after cessation of treatment subsequent bone mass accrual is preserved and peak bone mass in late adolescence does not seem to be affected by treatment, but then go on to add Slipped capital femoral epiphysis can be seen after withdrawal of GnRH agonist treatment. The suggested theory is that the low concentrations of oestrogen during treatment with GnRH agonists weaken the epiphysial plate. The increase in growth velocity after stopping the treatment subsequently results in a reduction of the shearing force needed for displacement of the epiphysis.

Turning to adverse effects, the long term study of children cited included 35 patients. In men, it is given for prostate cancer, so adverse effects may be linked to original disease and other treatments. In women though, as a consequence of decreased oestrogen levels, the most commonly reported adverse events (expected in 10% of women or more) were headache, libido decreased, sleep disorder, mood changes, dyspareunia, dysmenorrhoea, genital haemorrhage, ovarian hyperstimulation syndrome, ovarian hypertrophy pelvic pain, abdominal pain, vulvovaginal dryness, hyperhidrosis, hot flushes and asthenia.

i was fascinated by this thread on X by Richard Bentall. Bentall is a clinical psychologist whose work I've previously admired - he wrote a really interesting book called Madness Explained, which challenges some of the widely-held beliefs about mental illness.

He's written a lengthy thread about why the puberty blockers trial is actually a good thing - it's rigorous, it's thorough, it's ethical, it's methodologically sound, etc etc etc.

And the reason I'm fascinated is that it ignores the glaring problem, which is that it's all based on a completely nonsensical premise. It's tooth-fairy science. It's starting from the assumption that children can be born in the wrong body, and that the best way to treat children's unhappiness with their bodies is to alter their body. It doesn't matter how brilliantly designed the trial is when the intervention it's testing is based on an entirely unscientific and false conception of reality.

x.com/RichardBentall/status/1993301204441743751

Copying over from what I said on the other thread, because it seems relevant here:

Just caught a clip of Helen Joyce (not clear who was interviewing her) who summed things up very neatly: “Being male is not an illness, being female is not an illness”.

This trial of a drug that will physically alter a child’s body is unethical, because there is nothing, physically, to treat.

This trial of a drug that will physically alter a child’s body is unethical, because there is nothing, physically, to treat.

Precisely. It still amazes me that intelligent, educated people – experts even – can't understand this obvious fact.

Absolutely bizarre.

'I am sure that many of those complaining about the King's research don't know anything about it, don't really care about child welfare, and are just attention-seeking narcissists (see examples). '

Is he including Marcus and Sue Evans in this? I can't see that anyone could accuse them of 'not knowing' about the relevant research.

It is absolutely WILD that a professional would suggest people raising concerns are 'narcissists'. Just wild. I suppose the initial ad hom - that criticisms are 'hysterical', is the tell, isn't it.

But his whole thread is riddled with omissions, distortions, and inaccuracies, so I find it very strange that he is so confident in accusing others of not knowing anything about it.

'it has been claimed on one hand that PBs reduce distress in gender dysporic (GD) kids and give them time to think, on other that the drugs carry a suicide risk'

The term is 'gender incongruent', now. And the suicide risk is hardly the headline concern.

'Importantly both child and parent must understand the clinical trial and give informed consent.'

Nope. The parent gives consent, the child 'assents'.

'There is an amazingly comprehesive set of other measures.'

a) How happy are you with your clitoris?
b) Would you want to change your clitoris if it were possible through medical or surgical treatment?

Does her/his facial expression usually seem appropriate to the particular situation, as far as you can tell

My life would be meaningless if I would have to live as my assigned sex; - do you agree?

11. Has someone touched or fondled your genitals?

1. My parents probably believe they are bad parents because I am gender-expansive/trans* - agree - disagree?

https://archive.ph/Dskqe

Oh, wait, Richard has more to say:

'There are a lot of questions that this trial won't answer. We badly need to know about the cultural, social, psychological and biological causes of GD, especially as the researchers note soaring rates'

No shit, Richard. Is this you asking in a measured way, but accusing others asking the same question of being 'hysterical', by any chance?

What a prick.

Helen Joyce and Brendan O'Neill discussing the trial:

TransActual are not impressed with the PB trial.

“This research is not about the safety of these medications which have been used for this very purpose since 1989. It is the result of an ideological view at the very top of the NHS that being trans is a ‘less desirable outcome.’

https://transactual.org.uk/blog/2025/11/22/transactual-statement-on-launch-of-puberty-blocker-trial/

'It is unambiguously a violation of medical ethics to coerce young people into this study as the only legal way to access the medications they need and want, to gatekeep which specific young people are accepted, and even worse to choose via lottery which of them will receive a sub-par version of the treatment.'

Actually agree with this. Crikey, never thought I'd be on the same page as Transactual.

'... the trial is in all likelihood an elaborate pantomime to generate a false sense of scientific legitimacy'

Well, yes.

Has anybody at all supported this trial so far, other than that twat upthread who appears not to know the first thing about any of it?

How many times an hour are we told about trans being most vulnerable and most oppressed and the terrible risk of not surviving if not getting exactly what is wanted in the given moment, and day of remembrance needed because all the assaults and worse, yada yada yada -

how is that not a less desirable outcome?

I know, I know, it's not supposed to make sense....

It's the usual unscientific entitled TRA bollocks like this

Until those who openly associate with anti-trans organisations like SEGM and Genspect are entirely removed from positions of power over trans healthcare, there cannot be trust between the trans community and the DHSC or NHS. Nor can any other marginalised group in the UK trust the DHSC or NHS to act in an unbiased or evidence-based way.

I guess Transactual would prefer if puberty blockers were handed out with party bags at kids' parties.

Who is the group that said that every child should have their puberty blocked, so that everyone could choose what puberty they get to go through?

Also, relatedly, which group said that not wanting children to grow up with avoidable physical and mental issues as a result of the use of PBs and cross-sex hormones was ableist?

Not sure about a group positing that? Although it does sound vaguely familiar.

There is this:

And this study, where a 'non binary' person asked for permanent puberty blockade.

'In this article, we analyse the novel case of Phoenix, a non-binary adult requesting ongoing puberty suppression (OPS) to permanently prevent the development of secondary sex characteristics, as a way of affirming their gender identity. We argue that (1) the aim of OPS is consistent with the proper goals of medicine to promote well-being, and therefore could ethically be offered to non-binary adults in principle; (2) there are additional equity-based reasons to offer OPS to non-binary adults as a group; and (3) the ethical defensibility of facilitating individual requests for OPS from non-binary adults also depends on other relevant considerations, including the balance of potential benefits over harms for that specific patient, and whether the patient’s request is substantially autonomous'

https://jme.bmj.com/content/46/11/743

He doesn't seem to have grasped that the goal of 'puberty blockers' is permanent prevention of sexual maturation. He only seems to understand them as a drug that can be analysed in the same way that one might analyse a drug used to treat depression.

He says

"16/24 Primary outcome is child's QoL after 2 years. I suspect many lay people do not understand that this is standard in trials today - what could be more important than the child's overall qulity of life?"

Has he not read the concerns raised by the Tavistock whistleblowers? Has he not considered that a child who is traumatised by puberty may well be happy to delay body changes for a couple of years - but what then?

"21/24 This study will provide a lot of information about PBs including whether they cause net harm. This should reasure those who think they're bad but probably won't because the most shouty critics aren't interested in evidence nor, actually, child welfare."

Again, he doesn't seem to understand the goal of the treatment. We already know quite a lot about GnRH analogues because they are already widely used for a variety of purposes. What we don't know is the impact of a preventing a child going through puberty. Effectively, they are being used to create a DSD.

it's a very typical "I know nothing about this, but I am confident that those people must be wrong, so I'm going to tweet about it anyway" thread.

I'd dispute that the trail is either any of the things he claims but Bentall's a sentimentalist/ intellectually lazy about genderwoo so there's no point engaging with him on the topic.

https://www.quackometer.net/blog/2025/11/pathways-a-trial-built-on-missing-data-pseudoscience-and-quiet-cruelty.html

'Picture a 12-year-old girl who starts blockers under PATHWAYS this winter. By the time she is 30 she may never know what an orgasm feels like and will certainly never carry a pregnancy. That is not a rare side-effect from what we know already; it is the intended physiological outcome of the treatment this 12 year old is being invited to “consent” to.

A majority of the children in such clinics arrive with autism, histories of trauma, depression, or eating disorders. Almost all cannot yet imagine adult sexual relationships or parenthood. To ask them to consent to a pathway that carries a substantial risk of permanent infertility and anorgasmia is to ask them to consent to something they cannot meaningfully understand. The consent forms may be legally watertight; they are ethically threadbare.

So what sort of results can we expect? Allow me to take a punt. The children who receive blockers immediately will, on the whole, report being “happy”. The children forced to wait a year for the treatment they have been told is life-saving will, on the whole, report being “sad”. The headline conclusion will be that puberty blockers must be offered as early as possible because they improve wellbeing. The two-year follow-up is conveniently too short for the serious skeletal, sexual, and fertility harms to become undeniable, so the treatment will be declared “safe and well-tolerated”. Critics who point out the blindingly obvious methodological flaws will be dismissed as bigoted, hateful, or “anti-trans”. This trial could not have been better designed if the brief had been: “Produce the most quack-friendly trial methodology possible while retaining a veneer of scientific respectability.”

If PATHWAYS had been submitted to the Cass Review as one more observational study it would have been graded low quality and filed under “inconclusive”. Instead it has been granted the status of the definitive trial, the one that will finally settle the matter. It will do no such thing. At best it will generate numbers that can be spun either way. At worst it will provide a veneer of scientific respectability for continuing to offer puberty suppression to children on the basis of ideology rather than science and evidence.'

'Ethical trials require a clear intent to answer a scientific and clinical question that can inform future treatment decisions. It is hard to see what that question is. The trial is formally to test a treatment for “gender incongruence”. But this is not a clinical diagnosis.'

'Because the psychosocial support is constant and the drug is the only thing that moves, any observed change in mood, self-harm, or quality-of-life scores can be attributed to the counselling just as plausibly as to the hormone suppression. The trial has no mechanism for disentangling the two. It is rather like testing a new analgesic by giving every patient in the study the drugs and a daily massage and then wondering if the massage or the pills reduce the pain. '

As with the posters who try to argue for it here demonstrate: huge amounts of passion, and even huger amounts of ignorance regarding even the basic facts, never mind the obvious flaws, issues and predictable outcomes. Feelings create reality. It's not something associated with functional thinking and relating to the world or to others. This really needs renaming as Verucca Salt Syndrome when it comes to adults: 'don't care how, I want it now'.

https://www.thetimes.com/article/4218fb8b-6d16-4661-9413-71ab39c6d8d3?shareToken=1d5af9ec26d14909f3c0f929cc67cd1e

It’s an absolute farrago of nonsense, that’s what this so-called trial is.

The 'two spirit' nonsense is also reported in the Telegraph

https://archive.ph/uihfU

https://www.telegraph.co.uk/news/2025/11/27/puberty-blocker-trial-ask-children-two-spirit-transgender/