Netherlands Puberty Blocker Review Comes to Opposite Conclusion, Dismisses Cass Review

[ForZingyCat]

https://www.gezondheidsraad.nl/adviesonderwerpen/behandeling-en-begeleiding/transgenderzorg-voor-jonger

Now say it slowly in your head and try to consider the difference between that and what you’re advocating. Then you can go back, read the whole blog you posted, watch the video hosted by the expert who wrote the blog you cited and consider why you’re so keen on setting children on a lifelong pathway of medication.

From that blog.

James thought he was a trans woman for several years and started transition before pausing. Through trauma-focused therapy he came to understand that his hatred of his body was rooted in childhood sexual abuse he had never spoken about. I wish a therapist had screened for what happened to me before affirming what I thought it meant, he says. I needed to do the trauma work first.

I don't understand what you mean.

The claim was that a child must go through endogenous puberty in order to mature into an adult and develop an understanding of their identity. But there is no evidence for this claim.
Indeed there are many groups of children who don't because of a range of different medical conditions (one example being children with POI). There is no evidence that these children don't grow up into mature adults with a sense of identity.

'Gender' is the problem - not the solution. If someone is distressed by 'gender' you don't prescribe them more of it.

When somoene approaches a mental/ health professional for counselling, they shouldn't really have a firm desitination or prescription in mind. Other than to feel better or to get well.

You seem to be suggesting that people with gender distress will always be seeking to transition to some degree or other, as they have already concluded that this is what will relieve their distress.

There is plenty of evidence that the human maturation process involves those stimulated by pubertal changes.

"Puberty shapes human brain maturation by driving a powerful wave of structural remodeling, hormonal activation, and network fine-tuning. This biological transition triggers changes in gray matter pruning, white matter growth, and emotional-control circuitry.Puberty opens a sensitive window of high brain adaptability, letting the nervous system fine-tune networks built during childhood.

Synaptic pruning: Gray matter peaks around puberty and then thins out as unused neural connections are cut away, making active pathways more efficient
Increased myelination: White matter steadily increases, adding protective insulation to nerve fibers that speed up communication across different brain regions
Late prefrontal cortex: The front control system—responsible for long-term planning, impulse control, and logical judgment—keeps developing well into a person's twenties"

No I don't think that people with gender related distress will always seek to transition, some will be wanting this, others not necessarily.

In terms of your claim that patients should have no thoughts about their treatment before arriving at counselling seems odd.
Would you apply the same standard to every other area of medicine or mental health? If someone seeks counselling because they think leaving an abusive relationship, changing careers, or starting antidepressants might improve their wellbeing, do we insist they’ve approached therapy incorrectly because they’ve already identified a possible solution? Or is it more reasonable to explore whether their hypothesis fits their circumstances?
People often seek help because they already have a hypothesis about what’s causing their distress or what might help.
(In fact when I make a GP appointment these days , I have to fill out a form which includes asking me this question!)
Someone with chronic pain may think they need surgery. Someone with depression may think they need medication. Someone struggling with infertility may think they want IVF. The role of the clinician isn’t simply to endorse or reject those ideas, but to explore them, test them against the evidence, discuss alternatives, and help the person make an informed decision.

I think the problem here is that you are interpreting this conversation through the lens of your own experience

You brought up experience. You said people with no experience of having dysphoria can't possibly understand what it feels like to have dysphoria. I say men and boys with no experience of being female can't possibly understand what it feels like to be a girl or a woman.

And yet someone associating their feelings of discomfort with an entirely meaningless conviction that they are the opposite sex appears to be your discriminating factor between normal teenaged anxieties and cause for life changing medical treatment. It's just an idea! A meme. A label a child may pick up to explain their own feelings, that certain circles are /encouraging/ children to pick up and use to label their feelings, and like all ideas if someone keeps reiterating and framing their understanding of the world through it, it can come to dominate their minds. Because thought patterns that are repeated become stronger. Not because there's any unavoidable reality behind it.

A professional practitioner doesn't "validate" distress, they acknowledge it and create a space in which to explore it.

If a young person suffering with anorexia seeks help, the therapist doesn't validate their feelings by agreeing that they are too fat or too big; they explore those feelings to identify their root causes. You cannot fix gender dysphoria by using the framework of gender....that would be a totally closed circuit with no exit route.

I'd be particularly concerned by those young people who had already decided that transition would be the solution to their distress - not blindly accepting of it.

I think we may be talking at cross purposes .

You’re describing normal adolescent brain development, and I don’t disagree with any of that. Puberty is associated with major changes in the brain, including those you listed.

However, none of the evidence you’ve cited shows that these developmental processes only occur during natal puberty, or that they fail to occur if puberty is medically induced with sex hormones. There are questions about optimal timing- brain maturation is influenced by age, experience, genetics, and hormones- puberty is clearly important.

But whether there is evidence that puberty associated with birth sex is uniquely necessary for adult brain maturation or identity development. I haven’t seen evidence demonstrating that.

The role of the experienced professional practitioner is is to identify and to prescribe. That is not the role of the patient.

"The hypothesis" you are suggesting originates from with the closed system framework of 'gender'. It is the job of the practitioner to explore and question that framework. 'Gender' is a mental/social construct and/or concept. If somone has framed their distress in the language and symbolism of 'gender' then that is what they will feel is causing them distress'. Even if their feelings on centred on their sexed body it is not the body that is the problem, but the mental perception of it.

I've listened to accounts by detransitioners in which they have disclosed that the feelings they used to suffer from when suffering from anorexia were the exact same feelings that they experienced when they then went on to feel 'gender dysphoric'. The language and symbols you use to give shape or meaning to your distress directly impact your thinking and perceptions of what you think your problem is.

I dont believe I said it was " impossible" for someone without dysphoria to understand what it feels like- I don't think it's impossible. I simply acknowledged that it can be very difficult to understand for those who haven't had that experience - , in the context of a long conversation about what gender dysphoria is which ended with something to the effect of - " how can someone feel they are in the wrong sex category. That's impossible."

You are suggesting that gender dysphoria is meaningless and a "a meme". I don’t accept that premise. Gender dysphoria is a a very real and often profoundly distressing medical condition. You may disagree about its causes or the best way to treat it, but dismissing it as nothing more than a meme is an assertion, not an argument. Where is the evidence that the distress is created by adopting a label, rather than the label being an attempt to describe an already existing experience?

I’ve been reading along and feel reminding ourselves of the concept of “Tooth Fairy science” could be helpful
https://genspect.org/the-nhs-puberty-blocker-trial-science-built-on-make-believe/

The treatment of POI induces female puberty in female children. The treatment acknowledges that the female child needs to go through female puberty, and creates the conditions that allow this to happen as close to the ‘natural’ time as possible. You on the other hand advocate the prevention of that natural timing and, further, that it is perfectly fine to subsequently induce a male puberty in a female. You somehow seemed to have convinced yourself that these are the same.

Meanwhile you ignore or dismiss anything that challenges your view, even when it is evidence that you initially introduced (although presumably didn’t really explore - what a surprise).

One thing I do agree with you on, and I think a lot of other people would as well, is that there should be more research in psychological support to give people the necessary space to decide how far they want to take their transition, and what goals they want to reach.

No, not at all. TRAs are ferociously against the idea of any psychotherapy that wouldn't be exclusively pro-complete medical transition. Any such therapy is described as "conversion therapy" and decried as utterly transphobe. I mean, there's a reason it doesn't exist yet, and that reason is that TRAs are completely against it.

The feelings of distress are very real and should be taken seriously. The idea that the reason for the distress is that the person in some sense is or should be the other sex is just an idea that they attach to explain/understand their distress. They have no possible means to know what it feels like to be the opposite sex because they aren't.

The difference between i'm deeply distressed about the changes of puberty because I'm autistic and I'm deeply distressed about the changes of puberty because I'm really a boy - is just in the explanation the person is hanging on their distress. The seriousness of the distress is the same either way.

I wasn’t suggesting that treating POI and gender dysphoria are “the same.” They’re clearly different clinical situations with different aims. The comparison was about a specific claim—that interruption or alteration of endogenous hormone exposure necessarily produces unique or catastrophic effects on brain development. If that claim were true in the absolute way it was suggested, it would have implications beyond medical care for childhood gender dysphoria. That was the point I was making.

You’re also assuming that endogenous puberty is always the correct outcome. In cases of persistent gender dysphoria, clinicians who support hormonal interventions do so because they conclude that, in that individual’s clinical circumstances, the risks of not treating outweigh the risks of treatment. Whether that judgment is ultimately supported by the evidence is a legitimate question, but it isn’t answered simply by asserting that “natural puberty” is always preferable.

Finally, it’s unfair to suggest I’m ignoring evidence. I’ve engaged with the evidence you’ve presented and questioned whether it supports the conclusions you’re drawing from it. I even went back and re-read the blog after your post. That demonstrates a willingness to reconsider the material, not dismiss it. It also highlights a recurring tendency on your part to make assumptions or inferences without sufficient basis. Challenging an interpretation isn’t the same as dismissing the evidence itself

In cases of persistent gender dysphoria, clinicians who support hormonal interventions do so because they conclude that, in that individual’s clinical circumstances, the risks of not treating outweigh the risks of treatment.

Not at all. There's no risk assessment done. Affirming is the only acceptable attitude from the clinicians, and medical transition is the only approved treatment. That's literally what WPATH recommended and what clinicians have been religiously doing, because doing otherwise would have meant being labelled transphobic and being hounded by WPATH and the TRAs.

I think you’re reducing gender dysphoria to a post hoc explanation for distress, but that’s not how it’s understood clinically or how many people who experience it describe it.

Gender dysphoria isn’t simply the thought, “I am really the other sex,” attached to otherwise unexplained distress. It’s a persistent pattern of distress centred on one’s sexed body, the development of secondary sex characteristics, and/or being perceived and treated as one’s natal sex. The distress isn’t arbitrary and then given a convenient explanation; it is specifically focused on those aspects of one’s embodied experience and social categorisation.

You may be right that no one can literally know what it feels like to be another sex. But people don’t have to know that in order to know that being seen as, or developing as, their natal sex feels profoundly wrong or intolerable to them. We routinely accept that people are reliable reporters of their own internal experiences without requiring impossible comparisons to someone else’s.

The comparison with an autistic young person distressed by puberty also overlooks something important. Two people may experience equally severe distress while the nature, focus, and underlying mechanisms of that distress differ. The fact that both are distressed doesn’t mean they are experiencing the same phenomenon or that the same intervention is appropriate. Clinical assessment isn’t just about recognising that distress exists; it’s about understanding its nature, context, and likely causes before deciding how best to respond.

The comparison with an autistic young person distressed by puberty also overlooks something important. Two people may experience equally severe distress while the nature, focus, and underlying mechanisms of that distress differ. The fact that both are distressed doesn’t mean they are experiencing the same phenomenon or that the same intervention is appropriate. Clinical assessment isn’t just about recognising that distress exists; it’s about understanding its nature, context, and likely causes before deciding how best to respond.

That's literally the problem: this assessment is not done. It is very well known that the recent cohorts of "trans kids" are absolutely stock full of autistic kids, gay kids, traumatised kids, or sexually abused kids, all of which should be thoroughly assessed before being put on a transition pathway - but that doesn't happen.

It was the reason the first whistleblowers at Tavistock spoke up: because kids which would have been refused, or at least thoroughly examined, at the beginning of the program, were now being routinely accepted, with no concern as to whether their distress was not created by entirely different causes.

And no, things have not got any better since then. The assessment exists only in theory; in practice, attempting it is considered conversion therapy.

Why do you jump from saying that they are distressed about their sexed bodies to they want to be the opposite sex? The second doesn't necessarily follow the first.

Yes, that's true, and it's a good point. And not everyone's experience will be the same. I'm almost hesitant to whisper the word non-binary, as I am conscious that's likely to open a whole new can of worms, but there are certainly people who, despite feeling distressed by aspects of their natal sex, do not feel that they fit comfortably into the opposite gender role either.

Equally, there are many people who describe not only acute distress as they develop the secondary sex characteristics associated with their natal sex, but also a profound sense of relief, calm, or congruence when they are recognised and treated as the opposite sex. As discussed in the blog, this is sometimes referred to as gender euphoria.

Of course, the existence of one group does not negate the experiences of the other. Both are well described, even if they raise different clinical and conceptual questions.

Gender euphoria when treated as another gender
A relief or quiet joy when you are perceived, addressed, or treated as the gender you experience yourself to be. People often describe this as the clearest signal. The contrast between the everyday low-level distress and the sudden relief of being seen correctly can be one of the most diagnostic experiences. Some people only realise the dysphoria was there once they feel it lift.

As discussed in the blog, this is sometimes referred to as gender euphoria.

And as the blog make clear that relates to adults, not children. Yet still you persist in advocating for their medicalisation.

I'm certainly not here to defend the practices of GIDS. Imo it was a deeply flawed service in a number of respects, and there are legitimate criticisms of its consistency and clinical practice.

However, I think it's a mistake to characterise clinical practice as simply accepting every young person's self-description without assessment, particularly for those under 18. The overwhelming majority of children referred to GIDS were never referred for any form of medical intervention. I posted the figures earlier in the thread, and since the Cass Review and the closure of GIDS, access to medical interventions has become even more restrictive.

In practice, most young people received ongoing psychological assessment over multiple appointments often spanning years, alongside what was characterised as a "watchful waiting" approach. Those assessments were intended to explore their developmental history, mental health, neurodevelopmental profile, family and social circumstances, sources of distress, expectations, and the potential benefits and risks of different approaches.

Whether those assessments were always carried out well, consistently, or to an appropriate standard is a separate question—and one on which there has been substantial criticism. But that is different from saying that assessment existed only in theory, or that clinicians simply accepted every conclusion a young person reached without exploration. I don't think the evidence supports that characterisation.

There has been considerable debate and change over time in how best to support children experiencing gender-related distress. Some clinicians have argued for more cautious approaches, while others have argued that access to medical interventions should remain available to appropriately assessed individuals. I have not heard a suggestion that treatments should be offered without any assessment.

It is reasonable to debate whether particular guidelines have placed enough emphasis on uncertainty, evidence quality or alternative approaches, but that is different from saying clinicians are simply not assessing risk or that they are all acting out of ideological pressure. Those are claims about individuals' motives and professional practice that require evidence rather than assumption.

I think a useful question is not whether clinicians should always "affirm" or "not affirm" a child's experience in the abstract, but what form of assessment and support best helps a particular person given their own individual clinical presentation, available evidence and the uncertainty involved.

"Gender euphoria when treated as another gender
A relief or quiet joy when you are perceived, addressed, or treated as the gender you experience yourself to be. People often describe this as the clearest signal. The contrast between the everyday low-level distress and the sudden relief of being seen correctly can be one of the most diagnostic experiences. Some people only realise the dysphoria was there once they feel it lift."

So, trans-identified people will only feel relief and/or euphoria by forcing the rest of us to lie and pretend they are really the opposite sex, when we know full well they are not and will never be the opposite sex.

It's quite bizarre that the treatment for a supposed medical/psychological condition is dependent on the behaviour of others and obliging others to go along with a pretence.

This is why I believe that before there is any contemplation of things like puberty blockers, children who have "gender dysphoria" should be told that they are not actually changing sex, that they will not experience the puberty of the other sex and that many - if not all - people will never perceive them as the opposite sex and they should not expect to be able to force others to perceive them as the opposite sex.