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

[ForZingyCat]

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

I wonder whether the particpants and their parents are assuming that having had cross-sex treatment, the children will in future be legally and socially accepted as their target sex.

I think that is a very dangerous implicit commitment for the trial to make, given it is absolutely not something they have any control over.

The more the inherent sexism of treating trans people as if we believe they legimately are the opposite sex is recognised, and more the practical challenges of establishing a man/woman boundary anywhere other than physical sex become obvious, the less likely that accomodation is becoming.

The world these children believe they will live in as adults may not be one that is actually available to them. But the medical damage they did in the belief it would give them it will be forever.

Perfectly demonstrating my point about needing the literature review to be led by general paediatrics experts. A balanced panel of people working with gender issues would need to include people like Dr Az. Do you think PB prescribers would work amicably with him?

Right I see that makes sense. The question around capacity to weigh the potential benefits versus risks is valid, as is the concern that the risks may be greater for children. I'm still interested though in this - I've removed the factors you've said apply more to children, but these all apply equally to adults:

Benefits

• Likes their body a little better - maybe.

Harms:

• Said body has been subjected to a hormonal treatment with potentially grave...physical consequences.
• If they continue to full medical transition:
• Their body is subjected to a life-long hormonal treatment.
• Their body is subjected to heavy surgery.
• Their body is permanently sterilised.

And yet for you the benefits still came out on top. I think that's worth reflecting on, and what is really contained within that benefits bucket that isn't really conveyed here with the language on the page.

Apologies if you found the words "gently suggest" patronising. I was trying not to be combative, but on reflection I can see that this just sounds condescending. Something to reflect on.

I'm not sure what you mean? I neither feel compelled to defend Cass, nor to attack her. I just wanted to point out that the argument she used did not refer to an actual case.

To make that argument you would need evidence that withholding the treatment really does pose a risk. There's no compelling evidence that not giving children puberty blockers raises the risk of psychological harm.

As far as I know the most serious risk that Dr Cass has raised is that some of these children would obtain similar medication illegally and without medical supervision. But that's not very compelling and it's not an argument that's made in favour of any other medical treatment for children. Children who are medicated illegally by their parents or who obtain drugs themselves are usually protected by social services.

Maybe for children who have been raised "in stealth" as the other sex there could be an argument to block their puberty for a few months while they are prepared for the changes they will necessarily encounter at puberty and adjust to reality and life as their actual sex. But I have never seen that proposed.

Sorry you are right, I was more spinning off your post and thinking about the broader conversation where someone asked me to defend that reasoning.

I didn't ask you to defend that reasoning I asked if you thought it was an example of a quality argument from someone seriously engaged in the issue

There's no compelling evidence that not giving children puberty blockers raises the risk of psychological harm.

Persistent gender dysphoria can cause profound distress with devastating consequences, particularly at such a vulnerable stage of development. I don't think this is seriously disputed by any clinician working in this area.
The relevant question is how best to alleviate that distress while balancing the potential benefits and risks of different interventions.

I don't find Cass's arguments compelling and I don't think she has the relevant expertise or experience to serious engage on this issue.

May I add to/tweak the last as I see it?

Benefits:

• Likes their body a little better - maybe [and for a short period of time].

Harms:

• Said body has been subjected to a hormonal treatment with potentially grave [irreversible] intellectual and physical consequences.
• Implicit message from authority that one's sex and puberty type is a choice to be made and will result in full social treatment in line with that choice.
• [Desistence is less likely due to:

-- gravity of steps taken/ sense of investment; -- the natural puberty being prevented being itself a significant factor in resolving gender distress (but not allowed to happen); -- allowing natural puberty to begin at a later date would result in being socially out of step with peers; -- likelihood of social affirmation acting as reinforcement.]

If they continue to full medical transition:

• Their body is subjected to a life-long hormonal treatment.
• Their body is subjected to heavy surgery.
• Their body is permanently sterilised.
• [Studies suggest they are more likely than not to be no happier or actively less happy - I must find the links].

-[Ongoing downstream iatrogenic physical issues as a result of temporary or long-term doses of hormones at opposite sex levels (particularly female people taking testosterone)]

Believing you are the sex other than you are is a perfect example of confusion.

Feelings come and go. They shift and change, even if some endure for longer than others. 'Liking' one's body more is no guarantee that one always will 'like' one's body going forward. Feelings of discomfort, alienation and/or anxiety have a habit of re-appearing and attaching themselves to different 'objects' or sets of circumstances.

High likelihood of brain damage.

It was the NHS' statement that "the impact on the developing teenage brain is unknown" (now removed from their website and a lot more nebulous) that led my husband and me saying no to my daughter when she asked to go on PBs to give her time to think about whether she really wanted to be a girl.

That was 4 years ago and I can still remember that conversation to this day. I'm sitting in exactly the same chair right now. I had no idea about anything to do with gender identity. I told her that we weren't going to let anyone experiment on her brain but that I would find out everything I could to support her.

That was my WTAF entry into all of this, before I even realised how many more of those moments I would have on my journey of understanding.

You describe trans people as "confused". Have you ever considered that your interpretation of their experience might rather be mistaken?

Regardless of whether people like her conclusions; she is a senior paediatrician with a lifetime of experience.

Feelings and 'interpretations' don't detract from the fact that one's sex is immutable no matter how one feels about it.

If one truly believes that they have an inner 'gendered' soul they are mistaken. The concept of a soul is just that - a concept - not measurable reality. And a concept that is heavily reliant on sex based stereotypes. Children are being led to believe things that are simply not true......this is neglectful at best, and abusive at worst. Confusion is the bedrock of gender ideology. It activley nurtures ambiguity, uncertainty and confusion.

As above, she's a senior paediatrician, and I don't doubt her expertise within general paediatrics. However, she does not have specialist expertise in this area of clinical care/ practice. She's is no more qualified to speak especially authoratively on this than on paediatric oncology, or neurosurgery or any other specialist area of care.

Apologies @Seethlaw you covered this with the likelihood of intellectual impact.

I tend to refer to it as a likelihood of brain damage, because to me that's what it is. It's the chemical/biological version of what was done physically with lobotomies.

Edited to add: it's also deeply personal to me as at that point I trusted the NHS fully in what it said. I would have continued to do my research but had it not been said so explicitly on their website (it's very wishy washy now) I would have assumed that the NHS would only ever allow doctors to prescribe treatments that were safe. I would have assumed the unknown aspects related to whether they were effective or not.

I've been appalled at what I then learned about this "treatment". I'm glad it got banned. I'm incredulous that anyone thinks trailing it is ethical.

Whether sex is immutable is a separate question from how we understand the psychological experience of gender dysphoria. I don't think many clinicians would describe trans people as believing they literally have a "gendered soul", and I don't think that reflects how most trans people describe their own experiences either.

You also seem to assume that gender incongruence can only arise from confusion or from internalising sex stereotypes. I don't think that follows. It is a complex psychological phenomenon, and I would be cautious about reducing it to a single explanation that may not reflect people's actual experiences.

You have a strong opinion on this subject which you are presenting as factual. You insist that trans people are confused. My question was and is - have you ever stopped to reflect on whether your own interpretation of these issues may be confused?

I didn't have the same benefits in mind as too many of those kids.

I didn't want to become a man, because that's impossible. I didn't even need to pass as a man 24/7. I only wanted to become a woman who presents as a man, and that was achievable, so that was enough for me.

Ah no, I also wanted to masculinise my body, and already the lower voice and the top surgery almost entirely took care of that, though the eventual beard is great too.

So I wanted things that I knew I could achieve and - crucially - which didn't depend on anyone else affirming or validating me.

You say it's about gendered categories, but then you describe sexed categories. The sexism comes when we insist particular roles, personalities, behaviours, hairstyles etc must be associated with a sex category. And as you admitted in your previous post, maybe without that sexism they wouldn't wish they were the other sex in the first place.

We all agree I think that they can't actually be the other sex. Any more than a tall person can be short for wishing it. You could attempt drastic medical routes to shorten their legs but it would be a medical harm and unethical as there's nothing medically wrong with them to start with.

What is this "gender" apart from a pretence at being a sex you're not and compliance with the associated gender stereotypes?

Sex is sex. Can't change. Gender is stereotypes. Completely optional. It's fine to be a woman and not behave like an average woman. Tbh not even sure the average woman behaves like the gender role assigned to the female sex either these days.

Persistent gender dysphoria can cause profound distress with devastating consequences, particularly at such a vulnerable stage of development.

But that's the thing: we don't know that. Plenty of adults who transition were "trans kids" who survived without "devastating consequences" (I was one of them), so why assume that any kid who presents with gender dysphoria will necessarily experience those consequences?

the severity of the condition

We are talking about a psychological disorder in children which normally resolves itself during puberty (in 80% or more of cases, this is well documented).

That didn't really answer my question, but either way -

I think you're assuming that other trans people are motivated differently from you, but you haven't really established that. Why assume that your motivations are unique, or that other people necessarily have less realistic expectations?

If, in your case, the perceived benefits of medical intervention outweighed the drawbacks, why not allow for the possibility that other people are motivated by much the same underlying needs and are making a similar judgement about the balance of benefits and risks?

People often describe their experiences differently and use different language or concepts to make sense of them. That doesn't necessarily mean the underlying motivations are different, or that your reasons for pursuing medical interventions are somehow more valid than theirs.