Puberty Blocker Trial Paused

[CrocsNotDocs]

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

Good start. Now shut it down.

That’s my understanding too.

Jolyon Maugham’s analogy of researching the efficacy of condoms when applied after sex made a fair point.I think his take that this is part of a conspiracy to conclude that they ‘don’t work’ is off.

I don’t think the proposed trial makes it clear what the purpose of blocking puberty is, which might account for the MRHA considering a 14+ study viable.

A useful interjection from Cass would be to explain what she thinks the delay enables or improves. She ruled out ‘time to think’ stating there was evidence that this isn’t an outcome.

One of the key points that the Cass Report made was that trans identifying kids were a multiple cohort with lots of different issues and very differing needs

One of these is on the basis of sex - girls have very different needs and as adults may have very different outcomes due to that sex because puberty blockers to stop development of sex act in different ways on different sexes.

Yet at no point when talking about children does Cass herself seem to emphasize this. This is pretty important as all the research to date has been dominated by males - the amount done on females is limited and what we do know about seems to have worse outcomes for girls.

The fact that this trial doesn't separate girls and boys at all and make a clear distinction is a fairly hefty oversight.

It's like saying C-sections are bad and comparing data on studies purely on outcomes rather than the method you attempt to give birth - thus emergency CS are an outcome of attempting a VB as well as assisted deliveries whilst attempting a planned CS might include a small percentage of VBs or EMCS.

If you fail to make this type of distinction you get results which are wildly distorted. Given this is literally about sex it's essential for the study not to be gender neutral in its findings because it may make particularly adverse outcomes for one sex invisible.

I find it incredible that this isn't being shouted loudly by those advocating for the trial. It's a huge issue.

I find it incredible that this isn’t being shouted loudly by those advocating for the trial

I think those advocating for the trial are as diverse a group as the group of children and young people who sit within the ‘trans’ label.

Aligned with this, there are quite disparate hopes within the group who are seeking puberty blockers.

I hadn’t realised that they hadn’t done this.

that’s either a shocking example of how VERY badly these so called drs and experts understand the issues. Or possibly they knew it was never going to go through ethics. Based on Keira’s post upthread and everything else we know I think tbe former.

Realistically it should be TWO completely separate trials. Not one.

Because sex.

Even the new cut-off age of 14 doesn't distinguish between girls and boys, who as a cohort experience puberty at different ages.

This seems very much to be about enabling a cohort of boys to "pass" better as adults - that is, adults as measured in years against society's decision that 18 is legally an adult, but possibly not mature physically or mentally/emotionally.

Maybe someone could propose an RCT where those in the treatment group were just told no by the adults.

She's implicitly starting the trial with an assumption that the use of puberty blockers to block natural puberty could be a good and justifiable treatment for some children with mental and emotional distress. In so she's accepting the premise that some children are 'trans' and will never be happy unless they feel that they can pass as the opposite sex.

On one hand she says that "most children desist once past puberty", but then she's also saying that not endorsing the blocking of puberty is "unethical". The reason, one assumes, that she thinks age14 and over is unethical is that the children that will be attending are hoping to have their puberty blocked before they get to that age. Totally contradictory and inconsistent.

There is a lay explanation here: www.kcl.ac.uk/ioppn/assets/pathways/trial/pathways-trial-easy-read.pdf

“PATHWAYS TRIAL is a research study that will explore how puberty suppressing
hormones (medicines that pause puberty) impact the physical, social, and emotional
wellbeing of young people with gender incongruence.”

If you want the full protocol, it’s here: www.kcl.ac.uk/ioppn/assets/pathways/trial/pathways-trial-protocol.pdf

It’s incredibly light on the whole definition of “gender incongruence”:

^“Gender incongruence is characterised by a marked and persistent disparity between
an individual’s experienced gender and the birth-registered sex, which may lead to a
desire to ‘transition’, to live and be accepted as a person of the experienced gender”^

I would expect to see far more critical discussion on the epidemiology, pathophysiology, clinical presentation and description of the unmet medical need that the trial is hoping to address. Defining gender and transition would be a start.

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.”

It's interesting she should say that because when I heard there was going to be a trial I thought it was a political decision not a clinical one. I'm now wondering if she was one of the ones who were putting on the pressure to make that decision, Streeting has been saying all along that he was only doing what was recommended in the Cass report. Maybe her response above it sour grapes because she's not getting her way.

If the trial goes ahead, would Cass bear any responsibility if the test subjects sued later down the line?

Or is she at a sufficient distance to avoid any of that?

I think the part that needs unpacking is - what is the problem with gender incongruence that PBs are considered a potential treatment for (or part solution to).

Gender incongruence is framed as neither a healthy or unhealthy condition but one that can give rise to distress. With this in mind, is the goal of treatment to remove the distress but not the incongruence, because there is nothing wrong with incongruence? Or, is it the case that removing the experience of incongruence is the goal, and therefore ‘fixing’/ curing the condition?

TRAs and WPATH hate engaging with ‘the medical model’ because it requires there to be a diagnosable disease or condition and treatment goals. They just want people to be able to make body modifications if/when they choose

Didn't she attend a meeting to agree the trial before the report that carries her name was published?

I expect that somewhere along the lines a behind the scenes agreement to carry out a trial was part and parcel of the report being allowed to be published.

Completely agree!!

Which is basically about sexist ideas of woman = sexually attractive and beautiful + homophobia.

Which is all kids of wrong. Especially when you consider this is about children and their sexual appeal.

The fact that this trial doesn't separate girls and boys at all and make a clear distinction is a fairly hefty oversight.

This is an excellent and vital point!

It strikes me just how MANY issues there are with the trial, and that it's hard to grasp them all at once.

Then, how revelatory it feels when you think you've considered them all, and then someone brings up another one, like this- and how obvious it seems when you see it.

It really is like a hall of mirrors.

What is quite scary is the number of children (and adults) who seem to believe that taking cross sex hormones results in a child going through the puberty for the opposite sex.

Rather than just damaging their body.

Some of the beliefs being expressed would be considered indicative of psychosis (i.e. a loss of contact with reality) and treated as such if it weren't for all the social pressure to be "on the right side of history" on this subject.

And as is often pointed out, whose interests are served by having potentially available a group of people who are legally adult, but whose bodies look like those of children, and who may not be fully mature psychologically and emotionally?

I came across a post from Emma Hilton on x saying that if Cass thinks the trial is pointless if limited to children 14 and older why were those 14+ included in the trial in the first place

I guess this fits with the screwed up definitions they hold for what sex is.

When you define sex as a compilation of superficial features that are manufactured by exogenous hormones and cosmetic surgery, puberty can be regarded as the process by which these features are acquired.

Redefining puberty so it strips it of its entire meaning/ focus on reproduction aligns with redefining ‘woman’ so it no longer refers to reproductive role.

Very good point!

I think it's vital to point out how poor methodology and thought processes have dogged medicine, arguably particularly women's health for years.

It's not just invisibility of women in healthcare, it's also the deliberately flawed premises of studies to show an outcome that supports an ideology.

That's why I use CS v VB because it shouldnt be like that because an EMCS is an outcome of an attempted VB - it's not somehow disconnected and ELCS have very different risk profiles to EMCS so lumping them together is fundamentally flawed. Yet this is how data was compared for years and years. It was only in around 2009 when women started questioning this and going hand on a second that this started to change. 2009. (I know because I was doing a lot of reading on the subject and it's all on MN as to how this developed over the years). It's made me realise the sheer level of arrogance and pig headedness within the profession at times.

There was one particular WHO study that said in its conclusion that VBs were less risky - except when you looked at the data they were using that's not what it said at all. It said that ELCS were marginally less risky than a VB. WHO deliberately wrote an incorrect conclusion because their results didn't match their political agenda.

It's absolutely fucking bonkers.

This of course is like gold dust to conspiracy theorists. And it is exceptionally troubling because it undermines health research in general.

It is so fucking frustrating.

If your basic premise, your methodology and what you are seeking to find out are off in your hypothesis then your study is not fit for purpose. This is a study messing about with sex. For it to be effectively not immediately saying "oo well there might be differences between the sexes" is to fail to understand and acknowledge the known issues about default male body in medical research. This isn't an out there concept. It's one that's very much one which is front and central within research circles ATM. It absolutely is a regressive space to be in.

But that's the issue and point. The whole idea of being a trans kid is based on regressive ideals rather than actual robust science.

It's always women who get the shitty end of the stick on this too.

Apparently Dr Cass is critical of the suspension of the trial.

“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.
“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.”

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.”
The trial was launched after Cass’s 2024 review of gender services, which said research was needed since there was little evidence whether or not puberty- suppressing hormones helped children with gender dysphoria. After the paediatrician’s report, the NHS stopped use of the drugs at gender identity clinics, although they continue to be used for children whose puberty begins abnormally early.
Cass said the trial was necessary because “we genuinely don’t know if some children will benefit or have no benefit”.
By raising the age limit to 14, it would cut out children who might benefit, which “will make the results invalid”, Cass said. “It would make the design really, really flawed and you should not be subjecting children to a flawed study.…

She is more critical of the suspension of a trial than the suspension of 300+ kids puberty.

“It feels to me like they are responding to political pressure rather than to science.”

Annoying when that happens isn't it, Hilary?