Puberty Blocker Trial Paused

[CrocsNotDocs]

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

Good start. Now shut it down.

Honestly I feel like Cassandra.

We were all Spartacus.

We are all Cassandra.

I have a trans daughter who benefited from blockers. So I can't pretend this is abstract for me.
But I'm curious what you're hoping happens for the young people currently in distress, waiting for help, if the whole pathway shuts down. Not the activists, not the ideologues. The actual kids. What's your alternative for them? Because "just wait" wasn't a neutral option for my daughter. It was watching her disappear. If there are genuine concerns about the evidence base, I'm all for better research and careful oversight. But "shut it down" with nothing in its place isn't protection. It's abandonment dressed up as caution.

It’s not, Sarah. It’s prevention of osteoporosis, preserving IQ and encouraging speaking therapy which is evidenced to help in distress from dysmorphia.

I am sorry, your child was distressed and I am sure you made decisions from the advice you were given - but the long term outcomes are that these kids need psychological and not pharmacological support. We should be providing that and lots of it, at least before considering drugs and surgeries.

Twitter post by Jon Pike, commenting on today's announcement:

"The latest news from Wes Streeting looks good. Here's one of the figures, Dr. Derek Glidden, who refused to co-operate and is now likely to be forced to do so. I know Glidden from the World Rugby workshop back in 2020: he gave his expert opinion that trans-identified males would be unreasonably harmed if they were not allowed to play in women's rugby. Funny how the same names crop up, isn't it? Fortunately, the working group ignored the opinion of this charlatan. World Rugby was the first International Federation to take a decisive pro-fairness and pro-women position, despite his best efforts. Now it looks like the legal privileges that allowed him to block research on adolescent treatment are to be removed. Maybe those mills are grinding slowly, but exceedingly fine, again."

x.com/runthinkwrite/status/2027090824513904690

Firstly, I hope everything is going well for you and your (presumably now adult?) child.

Secondly, to directly answer your question, the alternative is:

• no medical intervention
• talking therapy, with no social transition (it's perfectly possible to never need to reference anyone's sex-based or preferred pronouns in such a situation), to understand why the child feels uncomfortable with their body
• directly address specific areas of body dysphoria, without moving away from the reality of sex
• help the child process what it means to "be" a boy or girl, from a foundation of fact. Explore stereotypes and how these can be navigated.

This is watchful waiting in action. It may take years but a neutral exploration of what's driving the distress is more likely (than not) to result in a child reconciling with their own body. From the original cohort, we know that 80% grow out of it. With the latest cohort, which has had far more external influence that could have led to a belief that they are in the wrong body, I should imagine that percentage would be much higher.

Thank you for the kind wishes. She is 16 and doing well.
I appreciate you laying out an actual alternative rather than just saying no. That's more than many people do, and it lets us have a real conversation.
I have some genuine questions about this approach though.
The 80% desistance figure gets cited a lot, but it comes from studies of children referred to clinics in the 1980s and 90s, many of whom wouldn't meet current criteria for gender dysphoria. They included kids who were gender nonconforming but not necessarily distressed about their bodies. Comparing that cohort to adolescents with persistent, intensifying dysphoria isn't straightforward.
On watchful waiting specifically: this was the approach with my daughter for over a year. Talking therapy, no medical intervention, exploration of what was driving the feelings. She didn't reconcile with her body. She got worse. Significantly worse. The dysphoria didn't come from stereotypes or confusion about what girls can do. She understood perfectly well that girls can have short hair and play football. That wasn't the issue.
I'm not saying watchful waiting is wrong for everyone. For some young people, time and therapy will be enough. But presenting it as the answer for all young people in distress assumes the distress always has the same cause and the same resolution. It doesn't.
The question I keep coming back to is: what happens to the young people for whom watchful waiting doesn't work? At what point, after how many years of escalating distress, does medical intervention become acceptable in your view? Or is the answer simply never, regardless of outcome?

To be blunt, we are sceptical that your child benefited and we do not believe that going through puberty is a life threatening condition that can be solved by preventing a child from reaching sexual maturity.

I do not think children in severe mental distress should be abandoned, and it is clear that no other avenues like therapy have been explored by these clinics.

I hear you, and I don't think we're as far apart as it might seem.
I agree that psychological support should be the first line of response, and that it should be well funded and readily available. The current situation where young people wait years for any help at all is failing everyone, regardless of what treatment they eventually need.
On the specific concerns you raise: yes, there are questions about bone density and blockers. The research is ongoing, and monitoring matters. But "preserving IQ" isn't quite accurate to the current evidence. The studies that raised cognitive concerns were small and methodologically limited. I'm not dismissing them, but they're not settled science either.
Here's what I keep coming back to though. You say "speaking therapy which is evidenced to help in distress from dysmorphia." But gender dysphoria isn't the same as body dysmorphia. They present differently, respond to different interventions, and have different trajectories. Treating them as interchangeable leads to approaches that don't actually address what the young person is experiencing.
My daughter had therapy. Lots of it. It helped with her anxiety, her depression, her ability to cope with school. What it didn't do was make her feel at home in her body. That's what blockers, and later hormones, did.
I'm genuinely open to better research, longer assessment periods, more psychological support alongside any medical intervention. What I can't accept is the assumption that the right answer for every young person is no medical pathway ever, regardless of their individual presentation and regardless of how they respond to other approaches.
What would evidence need to show for you to consider that medical intervention might be appropriate for some young people?

Can you clarify exactly what you think the medical pathway involves?

What I can't accept is the assumption that the right answer for every young person is no medical pathway ever, regardless of their individual presentation and regardless of how they respond to other approaches.

Very few people (and I'm not one of them) assume that no medical pathway, ever, would be the best option for some young people.

What would evidence need to show for you to consider that medical intervention might be appropriate for some young people?

Firstly, some clear guidelines to be able to distinguish for whom medical intervention would be the best option, and for whom it wouldn't.

Secondly a good evidence base that medical intervention can produce a beneficial outcome over a person's entire life. Not just making them happier in their teens - but adulthood too.

Thirdly, some genuine acceptance across the communities that even with the most extreme medical interventions, people's legal sex remains unchanged.

Fourthly, I'd like a consistent rational explanation for the explosion of trans-identifying young people in recent years. Thirty years ago the equivalent was anorexia and bulimia - in epidemic proportions. Unlike being 'trans', however, treatment for eating disorders didn't involve irreversible body modification.

I feel that since this is a psychological issue, the constant societal background of "yes you really can become a man/woman" is immensely damaging.

Yes! I am exactly the same with these Reddit threads. It's like you can feel your brains leaking out of your ears...! 😁

Well if a patient is described as 'transgender' I would expect the letters to be using cross-sex pronouns. And a transman would get testosterone, a transwoman oestrogen (or be discussing them clinically). So you should be able to work out pretty easily who is what sex. Someone who is non-binary and not on drugs less so, but really it's the effects of drugs and surgery that are of interest.

I agree it's dangerous if sex is inaccurately recorded and a person comes in acutely unwell as the reference ranges / risk of pregnancy / gynae or testicular problems will be obscured.

So she's 16.

Well that's laid my mind to rest about the long term effects of blockers and how it leads to further medicalisation and how they are safe and she and everyone like her will be happy and fulfilled without problems in her 40s. Based on one child.

(Slaps forehead about the absence of understanding of absolutely anything and the mentality of 'we must do something, anything even if unproven because we'll someone said blockers are great and are a magical long term bullet')

That sounds you hear may well be the kicking of the can down the road for an unavoidable clash with reality that's merely been delayed a couple of years. Only with added steroids.

That sounds you hear may well be the kicking of the can down the road for an unavoidable clash with reality that's merely been delayed a couple of years. Only with added steroids.

That is very much my anecdotal wider family experience. Same monstrously unhappy young (now) adult, only now having added a lifetime's medical issues and no chance ever of having a family of her own.

That's a fair question.
The pathway my daughter followed began with extensive assessment through GIDS, which at the time involved multiple appointments over many months, exploring her history, her feelings, her mental health, family dynamics, and whether there were other factors contributing to her distress. It wasn't a single conversation and a prescription.
After that assessment, she was prescribed puberty blockers, which paused the development of secondary sex characteristics that were causing her significant distress. The purpose was to give her more time to mature and be certain, while preventing changes that would have been irreversible and deeply distressing for her.
More recently, she's begun cross-sex hormones, which will cause feminising changes. This decision came after further assessment, after years of living consistently in her gender, and with full understanding that some effects are permanent.
What the pathway doesn't involve, at least not until adulthood and after years of living in role, is surgery. The narrative that children are being rushed into operating theatres isn't what's actually happening in the UK system.
I want to be clear: I don't think this pathway is right for every young person who questions their gender. I don't think assessment should be cursory. I think careful, individualised assessment matters enormously.
But I also watched my daughter before and after. The difference isn't subtle. She went from someone who could barely leave her room to someone who has friends, goes to school, talks about the future.

Fourthly, I'd like a consistent rational explanation for the explosion of trans-identifying young people in recent years.

For me, this is the crux.

I don't know if you know Transgender Trend, sarahd89? But Stephanie Davis Arai, who runs it and has seen and heard from thousands of trans identified children and their parents, has said that every child she comes across is either same sex attracted, has suffered from some kind of trauma, often sexual, or is on the autistic spectrum.

And presumably, in the cases of boys, there might be an emerging fetishistic element.

The clinicians at the Tavistock also confirmed that the children going through their doors were similar. In fact, they were worried that they were 'transing away the gay'.

So for me, the obvious question is that once you have eliminated any of those reasons, why would a child feel so disconnected from their own body?

I honestly don't see how you can prescribe lifelong medication with very serious side effects without understanding that.

Do you have any idea why your daughter has gender dysphoria?

More recently, she's begun cross-sex hormones, which will cause feminising changes.

So you have a son.

Shall we talk about how there may be differences in effectiveness of puberty blockers for the other sex or are you a world leading expert who can tell us the longitudinal data on that too?

So your son has not had a puberty at all? Is that right?

I appreciate you laying this out clearly. It helps me understand where you're coming from, and I think some of your points deserve a serious response.
On your first point, about clearer guidelines for who would benefit from medical intervention, I agree. Better assessment protocols would help everyone. The difficulty is that human beings don't always fit neatly into diagnostic categories, and what looks obvious in retrospect isn't always clear at the time. But yes, better tools for distinguishing different presentations would help.
On your second point, about long-term evidence, this is where I have some frustration with how the debate is framed. The Dutch studies followed patients into adulthood and showed sustained benefit. More recent research from the Netherlands and other countries with established gender clinics has continued to show positive outcomes for carefully assessed patients. It's not perfect, and the population presenting has changed, but it's not true that there's zero long-term evidence. Calling for more research is reasonable. Using "we need more research" to mean "stop all treatment while we wait decades" is a different thing entirely. We don't apply that standard elsewhere in medicine.
On your third point, about legal sex, I think this is a separate question from whether medical treatment helps individuals. Making access to healthcare contingent on resolving political disputes puts young people in the middle of an adult fight they didn't start.
On your fourth point, about the increase in numbers, I think multiple things can be true simultaneously. Greater awareness means more people come forward. Social influence likely plays a role for some. Some who present today wouldn't have met older criteria. But the young people who transitioned decades ago and are now living ordinary adult lives complicate a narrative that this is simply a social contagion that will pass.

The pathway my daughter followed began with extensive assessment through GIDS, which at the time involved multiple appointments over many months, exploring her history, her feelings, her mental health, family dynamics, and whether there were other factors contributing to her distress. It wasn't a single conversation and a prescription.

GIDS was shut down in part because they were prescribing these drugs on the basis of just a few appointments.

while preventing changes that would have been irreversible and deeply distressing for her.

The change is reaching sexual maturity. How do you think your child will navigate adult life if they are maintained in a permanent pre-pubscent state?

As an articulate thoughtful person with personal involvement you are going to be overwhelmed with the quantity of questions put to you. I hope you're ready for it....

Here's one:
The purpose [of puberty blockers] was to give her more time to mature and be certain, while preventing changes that would have been irreversible and deeply distressing for her.

Was any thought given to the suggestion that puberty blockers actually prevent the kind of maturation and changes that resolve gender dysphoria? It's not just the body that changes during puberty; adolescents are not just different from adults in body shape size and strength.

So many threads that I can't post on because if I did I'd be deled and banned.
🤬

What I can tell you is what I've ruled out, at least to my own satisfaction. My daughter isn't same-sex attracted, or at least that's not the whole picture. She's attracted to boys, which as a trans girl would make her straight, not gay. So "transing away the gay" doesn't fit her. She hasn't experienced sexual trauma. We've explored this carefully, with professionals, and there's nothing there. She's not autistic.
So the categories you've listed, same-sex attraction, trauma, autism, emerging fetishism, none of them apply to her. And yet here she is, consistent since early childhood, distressed by puberty, relieved by treatment, thriving now in a way she wasn't before.
I understand the desire for a neat explanation. I'd quite like one myself. But my daughter doesn't fit the pattern you're describing, and I suspect she's not the only one.
You ask why a child would feel disconnected from their body if none of those factors apply. I don't have a satisfying answer. I don't think anyone does yet. But I'm not sure "we don't fully understand the cause" is sufficient reason to withhold treatment from someone who is suffering and who responds well to it. We treat many conditions without fully understanding their origins. The question is whether the treatment helps.
What would you need to see to accept that some cases, even if you can't explain them, might be genuine?

She went from someone who could barely leave her room to someone who has friends, goes to school, talks about the future.

At 16 do you think your child fully understands that there is no possibility of becoming an adult female?