Puberty Blocker Trial Paused

[CrocsNotDocs]

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

Good start. Now shut it down.

I agree.

This being ‘just one of many contradictions’ rings true and I think the multiplicity often leads to getting stuck in the weeds.

Medical trials, a bit like court cases, should provide opportunities for clarity to be established.

I was dismayed that the trial was granted NHS ethical approval despite being opaque. I wondered how closely KCL had been working with MRHA in the development work for the trial. If they had, it would have meant almost certain MRHA approval, but it appears not and the adults may have entered the room! Fingers crossed.

suggesting a trial that blocks puberty post Tanner stage 3/4 isn’t worth doing is not unreasonable.

the trials are of the drugs’ effects. They can have other effects than blocking puberty, which continues beyond a fixed point in time. Subtle but important distinction.

It’s pretty shoddy to suggest the MRHA is bowing to external pressure when their objections are clearly articulated and reasoned.

I get the point about the pointlessness of a study for 14+ but Cass should be challenging the underpinning reasons for specifying a minimum age of 14 if she disagrees. A range of concerns have been raised, Cass should highlight which she agrees or disagrees with and why- to substantiate her claims.

Perhaps she could explain what it is they are treating and why sterilisation is the cure? Go on Dame Hilary, give it your best shot.

I'm happy to have this pulled apart, but I would have thought that if a clinical trial is ethical, it should be possible to explain its purpose to a lay person, and I don't think e.g. Wes Streeting can explain 'gender incongruence' in terms that explain why you wouldn't be treating this like any other mental health condition.

Can anyone suggest a clinical trial that is ethical but that can't be easily explained to a lay person?

It’s not my understanding that the focus of the trial is on the unwanted side effects. I think the primary focus is exploring the impact on quality of life and mental health measures linked to ‘gender incongruence’.

💯

There should be a clearly articulated problem that PBs can be positioned as a probable solution (or part solution) with clearly defined desired outcomes, from good to poor against which the impact of PBs are measured.

They are intending to treat an undefined malady, of which they don't know the cause, with drugs that they know harm people, have no evidence they will help, giving them to people who cannot consent, with no measure of what success would be.

I really wonder how these some of the people involved aren't yet going...err maybe this is a bit risky, I'm out.

Or maybe they are that's why we've got the pause, some people are finally worries about their own skin even if they weren't worried about the children's.

Gender incongruence.

The implication of that phrase is that anyone who doesn’t happily confirm to the social stereotypes around their sex needs drugs and surgery. It sounds like something out of a dystopian novel.

And then people talk about how their DD thought she was a boy but later got keen on long hair, dresses & makeup & now has 2 kids, so there’s a happy ending, wasn’t it a good thing she didn’t go on blockers.

If DDs grow up to have buzz cuts, live in trousers & play rugby & never decide to have kids, it’s still a happy ending if they don’t go on blockers because they’re still just as much women as the ones who develop ‘girly’ tastes, and even if they don’t want to get pregnant they shouldn’t be going through early menopause, having their healthy breasts cut off or taking dangerous drugs that they don’t need.

This isn’t directed at any particular poster because I haven’t read back through the thread lately & my memory is increasingly bad (cheers peri). I just think it doesn’t get said often enough.

What could possibly do wrong?

Gender incongruence is an entirely made up subjective “diagnosis.”

the fact they’ve got no way of predicting, testing or diagnosing in any way shape or form which children might end up ’happy,’ when transitioned as adults, for their whole lives, proves this.

This is the other issue; some MH and wellness books are known to have created more MH issues because they sell and idea that everyone is happy and happy is the goal. The reality is that everyone has days where they don’t feel content or even pretty unhappy. The trick in life is to learn to accept feeling emotional discomfort and find ways to re frame situations.

“Being happy and living a happy life” is the central message behind transitioning.

But what is the research justification?

By which I mean, why do we think that stopping puberty will improve the quality of life of prepubescent kids with gender incongruence? What are the previous studies that suggest that this specific thing might be worth examining as a treatment with this specific outcome?

Like, do we have previous studies that show that stopping puberty was effective in treating some other mental health issue? Or do we have studies that show that something chemically similar to puberty blockers, but not the same drug, had a positive effect on the mental health of kids with gender incongruence? Like, how are we getting to “I know, let’s stop their puberty?” rather than any other flipping thing? Why not, as I’ve said before, prescribe eating ground up glass for breakfast? It seems to have the same level of justification.

You don’t just pull these things out of a hat unless you want to retroactively justify their use when they have already been prescribed for totally different reasons.

This is what I cannot, as a researcher, get my head around.

I think it would be reasonable to question the ethics and validity (and coherence) of "gender incongruence" being in the ICD as it is.

That doesn't seem particularly scientific as a starting point.

The effects of the drugs can be both wanted and unwanted, and those effects can occur in patients who begin the regimen at 14 as well as those who begin a regimen at a younger age. They can still have impact on quality of life and mental health measures linked to 'gender incongruence', even if you start at 14. So there is still something to learn from the outcomes of a trial that begins at 14.

I think it's the reddit style mantrum simplistic argument that says if you don't start at 11 or younger it's not worth doing at all.

If I understand the MHRA position, they're saying that if it turns out that it's 'safe' for children from 14, then the age can be lowered later. Which is a sensible, conservative position for a drug trial.

I don't think I have enough knowledge to have an opinion whether 'safe' can be established or not; but the logic seems sound.

re Reddit; yes that is 100% the narrative. And of course, no other reasoning is allowed. Therefore many believe this to be true.

But here we can also blame the bbc and other broadcasters for never giving a more balanced view.

Diagnostic manuals are littered with subjective diagnoses that are, to all intents and purposes, stories used to explain a combination of thoughts, feelings and behaviours.

The stories change over time. Homosexuality was once mental illness, as were learning disability and autism. Today, LD and autism are neurodevelopmental conditions, but if some autism advocates have their way, autism will go the same way as homosexuality and be removed from medical discourse.

Within the ‘trans world’ many/ most would like gender dysphoria and gender incongruence to follow the same trajectory as homosexuality, but they also want to maintain access to medical intervention, so they are stuck.

Im interested in a particular group of vulnerable and distressed young people who make sense of their significant struggles and dire quality of life through the lens of gender. It’s useful to have a name to group them/ the phenomenon, to enable shared learning.

I think this is probably a ‘me thing’ but I couldn’t care less about what they are saying on Reddit or the trantrums IRL, when it comes to PBs the people I focus on are the medics and medical institutions.

It appears that they may have problems ignoring activism, but surely the antidote of this is a demand that they stick to medicine and the scientific method and take the same approach to this drug trial as all others?

If I understand the MHRA position, they're saying that if it turns out that it's 'safe' for children from 14, then the age can be lowered later. Which is a sensible, conservative position for a drug trial.

But we already use these drugs to treat conditions post puberty.

The goal here is to prevent puberty.

Yes there are a number of current cultural assumptions that have allowed the acceptance of trans as a real thing.

One is the idea that you have a right to be happy and happiness is the goal. This belief means that no distress or discomfort should be expected to be tolerated. And particularly not for an extend periods (like maybe a during puberty).

Another is that identity is an internally driven concept which is innate rater than a socially constructed concept agreed between people. This in fact is one of the biggest assumption changes which isn't discussed enough.

Another is the shift in how we view children, child development and childhood and the move to giving children more autonomy. 'Child voice' and children know what they want ideas are now prevalent in a way they weren't 30 years ago when children were viewed as developmentally unable to make decisions and adults presumed authority over them. This type of thinking led to things such as Gillick and, in my opinion is also central to understanding the grooming gangs phenomenon and why it was ignored. But t's also central to the trans thing.

You then get people who want to promote queer theory, upturn all norms, especially around children, and the ground is ready for them to use all these 'new' assumptions:

Being your authentic self makes you happy and no one should be allowed to stop you being it.
So you must have the drugs you want to be happy.

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I am dismayed by the quality of journalism. I would like to hear critical evaluation and intelligent challenge of differing positions. ‘Balance ’ is usually ticked off by presenting opposing view points. To me, balance comes from critically evaluating a view point.

Couldn’t agree more.

It's Baroness Cass now. Her reward for producing her report was a seat in the Lords.