Puberty Blocker Trial Paused

[CrocsNotDocs]

https://www.telegraph.co.uk/gift/e0a6d8e8751dbca8

Good start. Now shut it down.

My brother cant remember being 3. He can only remember from age 7 which I find really weird but apparently DH is the same. DS is like me and can remember things from age 2/3.

This is why I find my brothers recollections so weird. I'm older and can remember him being born. The seems to lack context in a way I have.

From the Observer report:
Cass said. “[raising the age limit to 14] would make the design really, really flawed and you should not be subjecting children to a flawed study.”

Oh yeah, THAT is what makes the whole thing flawed and unsuitable for children....

My earliest memory is from before my brother was born, as my mother had to spend the third trimester in bed (1950s) and I was (sort of) looked after by a housekeeper. I vividly remember her chasing me through the house brandishing a window pole after some naughtiness on my part, which dates it to when I was about two and a half. No one else saw - I only told my mother about it when I was an adult - so it’s definitely my own memory.
Apologies for the slight derail.

The overarching problem is that of trying to reconcile a position that being trans is natural and a normal part of human variation whilst also seeking medical intervention. The NHS is based on a medical model of treating disease. ‘Being trans’ needs to be conceptualised as a disease or condition for medical intervention to be provided.

Cass’ position is unremarkable from a medical perspective. Her work has led her to suspect that there could be a rare medical condition whereby PB could improve outcomes and the way to determine this is a clinical trial. She is simply saying, we don’t know enough, we need to find out before drawing conclusions.

I am all for evidence based medicine and I think we could get to a place where a PB trial is ethical. However, far more needs to be understood about the condition PBs could prove effective for, and the beneficial outcome being sought through their use. We would need to have a clear understanding of the desired impact of PBs and a informed position of the likelihood of them delivering this. It is unacceptable that the Pathways trial doesn’t set this out.

From a medical perspective, undoubtedly the best outcome is resolution of symptoms without endocrine or surgical intervention. Clearly, it is better if people feel content in their sexed bodies and do not undergo treatment that brings risks and undermines health. However, this isn’t being acknowledged because this isn’t the outcome desired by the ‘patient group’. This is what needs attending to and addressing.

What I don't understand is how this trial could help the small number of children that Cass really believes are true trans.

Because it's not addressing that. It's not identifying them.

We know that puberty blockers tend to lock in the identity, so how will you know?

Surely, once you strip out the children who've been abused, the ones who are likely gay, the ones with autism, the ones with all the co-morbid issues, and you're left with children who genuinely have none of those things. That's the starting point.

Why are those children (if there are any) gender distressed?

That has to be the beginning of everything. Long before you decide that you should treat them with something that will have horrendous side effects, surely you have to bloody identify what's wrong with them in the first place??

Her work has led her to suspect that there could be a rare medical condition whereby PB could improve outcomes and the way to determine this is a clinical trial

The problem with this approach is that 'trans' is as much a philosophical as a psychological concept.

I know the analogies have been done to death, but if the argument is that this isn't just some kind of dysmorphia or delusion that can be treated like any other mental illness, you are then proposing that there is a right and wrong brain for a man or a woman. There is no evidence of that.

On the other hand there are centuries of sexism.

However, far more needs to be understood about the condition PBs could prove effective for, and the beneficial outcome being sought through their use.

We know the desired outcome. It is to prevent male puberty because boys can more easily pass as the opposite sex.

Cass has now lost all credibility with me. As I recall there were many others involved in compiling the report, which now seems just as well, because I would hate to think what sort of report Cass would have written if it had been all her own work.

I still don't know why anyone (let alone a paediatrician) would think 'pausing puberty' is a good idea, what are they pausing it for?, what magic do they expect to happen during the pause?

It is physically impossible for a human to be born in the wrong body or to change their sex, no amount of pausing or thinking is going to change that reality.
🤯😤🤯😤🤯😤🤯

I think this is bang on.

i also still think that there is valuable “evidence” locked up in the files from previous patients (now adults) that Cass couldn’t access during the review. Retrospective data analysis plus follow up with patients who are willing to participate. It won’t have the kudos of a shiny new trial but it could (although I doubt it) provide Cass’ desired evidence of benefits without causing further harms.

As pp observed I do think Cass gave herself away with this:

"“I have not changed my position an inch since I wrote my report, and yet, suddenly, people from the gender-critical side of the debate seem surprised or discomforted that I'm supporting a trial,” she said.

“But I called for a trial two years before the report, and I said in the report that everything that we do to these young people needs to be done in the context of a proper research programme, because otherwise we can't improve what we're doing for them.”"

Bit rich of her to be saying the MHRA intervention is political not scientific, when she admits her report findings were pre-determined by her own beliefs rather than science.

Also explains why she smeared us last week by saying we were supposedly "weaponising" children. She's the one desperately fighting to inflict irreversible harm on children for an ideological purpose, not us.

Cass is a single doctor. Her opinions are worth listening to, but we should never consider a single doctor or expert to have the final word in medicine. The worst kind of doctor or scientist is someone who won't change their opinion or belief based on new evidence, and who won't admit doubt. Doesn't matter if the argument is about hip replacements, gender dysphoria or treating ingrowing toe nails. Hanging onto the words of a single expert is risky - see the thread on parental alienation for another example.

we know the desired outcome. It is to prevent male puberty because boys can more easily pass as the opposite sex

Presently, there are more girls seeking PBs than boys. They know that that blocking puberty is unlikely to improve their future capacity to pass and may in fact reduce it through limiting their height, but they still try and obtain them.

In the field of high quality research, stating ‘we know’ needs to be supported by empirical evidence. It shouldn’t be based on opinion, logic, anecdotes or common sense.

People often ridicule research findings for ‘finding’ the obvious. But research often contradicts ‘the obvious’ and highlights flaws and gaps in established narratives used to explain phenomena.

Her work has led her to suspect that there could be a rare medical condition whereby PB could improve outcomes and the way to determine this is a clinical trial

You don't treat children with, by her own admission, non-evidenced drugs, which will have devastating effects on them for a condition that she suspects they might have.

It's the only question. Why are these children gender distressed? What are they actually treating?

Presently, there are more girls seeking PBs than boys. They know that that blocking puberty is unlikely to improve their future capacity to pass and may in fact reduce it through limiting their height, but they still try and obtain them.

Yes, but that is not a rational justification. People are sold all sorts of things on the internet.

When I say 'desired outcome' I mean the reason that the protocol was developed in the first place.

Cass moved the debate on somewhat but no one woman can conclude it. So it moves forward despite where she stays.

Other women will pick up now and the trials hopefully will be stopped not just paused.

What is the desired outcome for girls?

In the field of high quality research, stating ‘we know’ needs to be supported by empirical evidence. It shouldn’t be based on opinion, logic, anecdotes or common sense.

When you are assessing whether it is ethical to carry out a trial at all, opinion and logic are the only resources you have.

Here, the fundamental question is whether it is ever ethical to prevent a child from going through puberty.

Isn’t her position simply that we don’t yet know which treatments work best and more research is needed?

I don’t think there is an issue with her saying her position hadn’t changed, if the above is understood to be her position. She found there was insufficient evidence and she still thinks this to be the case.

In terms of her position on the Pathways trial, I am aware that she has said that it would be unethical to run the trial if it is conducted with only those over the age of 14. I don’t think anyone is disagreeing with this statement.

Has she challenged the concerns raised by the MRHA? I would likely take issue with her if she has, but suggesting a trial that blocks puberty post Tanner stage 3/4 isn’t worth doing is not unreasonable.

That given the choice they would rather not have periods or breasts, even if only for a few years and regardless of the consequences.

That would have been me. Puberty was so awful, both physically and mentally, that I would have done anything to escape it. I did attempt suicide, but as I didn’t have the Internet to inform me, my attempt was unsuccessful.

I meant in terms of clinical outcomes. Why would anyone prescribe harmful drugs to physically healthy girls because those girls don't want periods or breasts?

There are 3 broad questions that drive decision making of ethics committees, under which other key matters sit:

Is the knowledge worth having?
Is it acceptable to involve participants in this way?
Do potential benefits outweigh potential harm?

High risk trials happen in the context of these questions - Early bone marrow transplants had mortality rates of around 50% but trials were conducted. It’s not difficult to see why.

There are widely differing perspectives when it comes to the 3 broad questions as applied to the Pathways trial. I believe that they are significantly influenced by whether or not the ‘condition’ being ‘treated’ is understood as primarily a medical or a social one.

The overarching problem is that of trying to reconcile a position that being trans is natural and a normal part of human variation whilst also seeking medical intervention.

This is just one of the contradictions in the trans narrative. If trans is a natural and normal part of human variation (like being gay), it doesn't need medical intervention.

By framing it as something needing medical intervention it's stating that being trans is not normal or natural, but something which needs to be treated with medication.

If it needs medical intervention, a cure which would reconcile the brain with the sexed body should be seen as the best solution, since this would leave the body in a fully healthy state.

The demands of the trans lobby, by framing such a cure as conversion therapy, means that we can't even consider or investigate such a cure as a solution for people who believe they are 'trans'. As a result, what we should be doing is completely at odds with what is actually being done.

We're even forced into a position where people are 'celebrated' for having a medical condition leading to demands that doctors cause harm to their healthy bodies. It's insane.

This is, in my view, the overriding flaw in the trial.

What is the desired outcome for any of the participants in relation to the condition, as opposed to its constituent parts/ symptoms.

From a medical perspective, it’s a no-brainer. The goal of symptoms desisting and for patients to be discharged without need for physical interventions that carry harms and risks is blindingly obvious. This doesn’t involve any positioning on gender non conformity or living your life in any way, yet TRAs position it as wanting to eradicate trans people and conversion therapy.

If we are to have a medical trial, using the scientific method, it needs to be presented as such, with clearly defined terms and good and poor outcomes defined in advance.

She does seem to be challenging the concerns raised by the MHRA. From the Observer article:

Cass told The Observer she was “disappointed” by the MHRA’s intervention. “There are no new research findings and the MHRA hasn’t presented any new evidence,” she said. “It feels to me like they are responding to political pressure rather than to science.”

So, the MHRA have effectively changed their mind - there is, as Cass said, no new evidence, despite the fact that the MHRA have said there is. BUT, the MHRA should have spotted these issues the first time round. The fact that they have done so now is a good thing. If it only came after “political pressure rather than science,” that’s only because they got the science wrong the first time, and pressure was required to make them see this.

If Cass can’t get her head around that, I have no respect for her.

Well may you ask!