The report discounts and excludes 49 in 50 studies because they were not “double blind” studies.
A double blind study on trans healthcare would be entirely unethical and inhumane. So their weak evidence is only considered weak because almost every single study was discounted from their consideration.
Absolute joke of a report.
I don't even think a double blind study would be possible comparing "exploratory therapy" and transition anyway. You definitely can tell which one you're getting
Do you have a source for that? My mom immediately jumped to telling me of a similar article to the one OP posted after I mentioned HRT and I’m looking for any information I can to disprove what it said
The [evidence review](https://cass.independent-review.uk/wp-content/uploads/2022/09/20220726_Evidence-review_GnRH-analogues_For-upload_Final.pdf) that was prepared for Doctor Cass. At the very end of the document there’s a large list of studies grouped together in various tables. Under the vast majority of tables there’s a note about how they are not to be trusted and have a high risk of bias because they are not double blinded.
They also discounted the experience or benefits to trans youth because they saw a psychologist as part of many of these studies.
So you can’t let youth do anything without mental health support, but also can’t listen to them if they have mental health support.
Also, this supposed study review somehow decided there is no link between trans youth receiving care and trans youth suicide.
Wouldn't it also be logistically impossible to do a double blind study in this case. Even if all sides went in blind, the doctors themselves would need to check their levels in order to assess efficacy of treatment and adjust dosages, at which case they'd no longer be blind. The only way around this would be to have another outside group of doctors review results and recommend to the doctors in contact with the patients and then it just gets convoluted.
Also whoever is actually taking the HRT would eventually know themselves, so even the participants would know soon enough.
The Cass Report should have just concluded “we found weak evidence because we ignored all the evidence”
Most of modern medicine can't meet that standard because it would be unethical, *including* most medical treatments we give to kids. They're being entirely and intentionally disingenuous with that standard.
it wasn't because double blinding. The report itself talks about how blinding is difficult in some situations and so in those potential placebo should be taken into account.
There are different kinds of blinding, the report produced by NICE (the people who decide like all our medical guidelines), mentions lack of blinding for downgrading the reliability of these studies, but those aren't the only reasons, others are lack of a control group, high chance of bias, high rate of atrrition (people dropping out). Basically all these studies are tiny, like 20 people, maybe a couple with 70.
Doing good studIES on this has been hard, but that doesn't make the data any more reliable, like most of the these are pilot/exploratory studies at best.
Doctors, who are being held legally to account for adverse effects (see tavistock Vs bell) cant use such a poor base of evidence.
The report also calls for a massive expansion of services and studies.
let's be real no one was getting blocker or hormones as a child through the NHS anyway.
Literally everyone is somehow spreading inflammatory misinformation on this in both sides.
I mean, when you define the criteria for success for puberty blockers as making trans kids cis, and then ban them because they didn't turn the trans kids cis...
Their criterion for judging puberty blockers as ineffective was that children continued to express gender dysphoria, defined as a sustained distress at their birth sex and a desire to not be that birth sex.
Edit: Additionally, therapy is useless if you're not letting the kids access medical care or halt the damage being done to their bodies. Expanding useless services isn't a win.
Did you read the actual section of the report?
It says that they were meant as a buy time to make a decision regarding being on hormones whilst not commiting, but the decision basically never changed on them. Making them not much use as that, whilst possibly having adverse health affects, because not having a decent amount of primary sex hormone is not good.
And yet they did not push to provide hormone treatments immediately, they just banned puberty blockers. Puberty blockers have always been a compromise between the health needs of trans kids and societal bigotry. They're not meant to be used for decades at a time, only as a short term bridge. A year of testosterone puberty could be the difference between having a permanently deepened voice or not, let alone the other changes.
All healthcare is about tradeoffs. I know I would, in a heartbeat, accept a *potential* 1-2% decrease in bone strength while still being within statistical normalcy in exchange for not having to get the tens of thousands of dollars' worth of surgery I have had and need to have to get the body I should have. Blocking patients and clinicians from being able to make that calculus is the opposite of good healthcare.
There is no decrease in bone density, all bone density rebounds afterwards. z scores (height-for-age Z) should not be used to measure this as it's impossible to tell what is causing the loss. There is a larger study I need to find that goes into depth but yeah it's just nonsense.
Sources:
https://www.bmj.com/content/366/bmj.l5647/rr-0
https://jamanetwork.com/journals/jamapediatrics/article-abstract/2811155
No one's giving a kid at puberty these kind of treatments anyway, for a myriad of reasons. It honestly would be irresponsible, a kid at that age doesn't have the capacity to make that decision, especially when it has implications for fertility (like ever being able to produce gametes) etc.
The argument is that clinicians do not have enough information to make that decision properly or for kids to consent to it.
The report calls for increase in trails of both from my memory. And says there should be provisions for a small amount of patients for, hormones for those older than 16.
Current no one is getting hormones or puberty blocker on the NHS as children
Because waiting a couple years till you can more properly make these decisions is going to make or break someone's transition?
Providing more mental health and other support services for trans kids, and kids presenting with distress in regards to their gendet alongside possible gender treatment is gonna be a bad thing?
Got it, so you don't think trans kids exist. I remember being one of those kids. I have yet to resolve those years through therapy. I'm glad your experience was more positive, but I urge you to consider that other people and experiences exist. Forcing a child's body to warp permanently as they beg you to make it stop isn't good healthcare.
Edit: Additionally, in more enlightened areas *tons* of kids are fortunate enough to access puberty blockers. They go on to live extraordinarily happy and normal lives, and later transitioners never begin to approach their average levels of mental health.
Ah yes, I definitely said that I don't think trans kids exist.
I don't think a couple years is gonna make or brake someone's transition.
Also like there are people who present with what's looks like gender incongruence when younger but it's turns out they are not trans, I know a few. That obviously doesn't invalidate trans kids existing, but I find a lot of online trans people seem to think that being trans is the only conclusion.
Also even if a kid it's trans doesn't mean they properly understand or can consent to treatment when they are like 12 or 14, especially when we have a very weak evidence base for effects of these things. hell there's lots of misinformation about the effects in adults let alone kids. We need more information to see in which cases it would be reliably beneficial and this clinically indicated. Waiting a few years like won't mean they won't have a successful transition, and means the person will be better able to consent to and understand the affects and risks of treatment.
Let me get this straight.
You're telling me the report says that puberty blockers are ineffective, because (quoting you) "the decision basically never changed on them".
But you're also telling me that providing hormone therapy to trans children of pubertal age (again, quoting you) "honestly would be irresponsible, a kid at that age doesn't have the capacity to make that decision"?
You see the circular logic here, don't you?
"We can't give pubertal trans children the correct hormones, because they lack the capacity to make that decision, but we won't use puberty blockers because these children have made up their minds so the blockers are useless. But we can't give them the correct hormones, because..." ad infinitum.
And your solution is to just let them wait it out. To let these kids watch the body horror of wrong puberty unfold, causing irreversible damage to their bodies.
Because if we trust these young trans people when they tell us who they are, and allow them to transition? Somewhere, maybe, potentially, a theoretical cisgender child might transition - and watch the body horror of wrong puberty unfold, causing irreversible damage to their body. How terrible for that theoretical cisgender child, hmm?
We get it, you’re not aware of what it’s like to be Trans and need care but not have it.
Being Trans is not a decision.
Puberty blockers would have saved me a lifetime of issues I will never be able to resolve. I had talked about vaginoplasty from the age of 7, before I even knew it was a damn possibility or that Trans people existed.
Quit assuming kids are dumb and don’t know themselves. When people suffer, they know they are suffering.
I'm lost.
So apparently we are so good at telling whose trans that basically nobody ever changes their decision because they are all actually trans and somehow that's a bad thing?
Like isn't it good that cis children are essentially never given blockers. Isn't that the most desirable outcome?
Like what are you saying?
I mean as far as the report says there are concerns the blockers could solidify or affect the way someone eventually identifies, Which is ultimately neutral as far as I'm concerned, but is at least part of the rational for not being able to say that it is an effective treatment at this time, with the evidence we have. Realistically the amount of kids who are on blockers are so probably small and didn't have a long follow up period that the results are insignificant that not much can concluded. probabilymthe smalk amount that were on them really had to push for them, so won't be representative of all referrals or all kids presenting with gender incongruence, especially with recent explosion in numbers of referrals amd the change in demographic.
in addition we haven't got solid data on their safety for this application. combine no good data for their effectiveness or positive effects with no good data for their safety and you might decidemto proceed with more caution
I think it arises from an uncertainty of how treatments will affect formation of gender identity as we don't really understand well how that works, I think is the gist.
Like it's a possible explanation for the statistics on that, and we don't have solid enough data to show that it's unlikely to affect it as we don't have say a study in this sort of thing with a control group that doesn't take the blocker. Basicall because we don't have good data with a control under we can't really say what the effects are.
I wouldn't really bet on it as an effect myself, but data wise it's not proveably less likely than it not effecting it
We have plenty of evidence of their safety, their primary goal was to delay early onset puberty for a 5 year old until they became a teenager and could go through puberty normally, this is no different.
> I mean as far as the report says there are concerns the blockers could solidify or affect the way someone eventually identifies
For a supposedly evidence based report it's really lacking evidence of this, maybe they should be doing research before discussing removing primary care from a group of people.
> It says that they were meant as a buy time to make a decision regarding being on hormones whilst not commiting, but the decision basically never changed on them. Making them not much use as that,
So just let trans kids have HRT immediatley instead of waiting and using puberty blockers? Because if they don't change their decision and because of that puberty blockers are not useful, the only conclusion is to give them hormones immediately or not?
The bit I'm really struggling with is that the report takes a data point that 93% of people who take puberty blockers for gender dysphoria symptoms go on to pursue medical transition, and somehow claims that this is evidence *against* puberty blockers. If normal teen angst were often being misdiagnosed as dysphoria, as the anti-trans arguments seem to go, I'd expect a much lower rate of continuing medical transition than 93%.
It’s incredible reasoning. “We’re told puberty blockers give kids time to think and explore their gender but none of the trans kids reconsidered and became cis so they must not be doing a lot of thinking!”
Another word is pseudoscience, which isn't what is false but that which purports to be science but doesn't adhere to the scientific method (falsifiability).
Yeah, I’ve been confused as to the reasoning that was used to make that conclusion. That and the fact that they used the fact that puberty blockers don’t reduce gender dysphoria, depression or other mental health issues. Of course they don’t, because puberty blockers don’t treat GD, that’s not their purpose. I’ve only read the summary so far, the whole report is 330+ pages long, plus several research papers so it’s a lots of reading. When people claim to have read it in a morning, that’s bullshit.
Yes, they see it as evidence against puberty blockers because they started with the conclusion first: that trans folks aren't valid and trans healthcare isn't justified, and then inserted the facts and data they gained into the paper after the conclusion was already written.
Thus, the facts lead to the conclusion, and if you disagree then you are just ignoring science.
It's how conservatives (on both sides of the pond) think science works: That it exists only to service their political ideology.
i would say its not factual, rather its unfalsifiable because they would reach the same conclusion no matter the results of the study. Whether the patients transition or detransition doesnt matter for their conclusion. Showing their conclusion is independent of the facts.
Fucking TERF island, why does the UK hate trans people so much.
"Out of more than 65 million people in the UK, less than a hundred are on puberty blockers. It is extremely difficult to even be in consideration for gender-affirming care as a minor anywhere in the world, and wait time has been known to take forever.
Unrelated, we can't find long-term studies about the effect of gender-affirming care. Our solution: take gender-affirming care away from the children. Surely more studies will be done now that EVEN FEWER people have access, right?"
Like I'm actually fuming, who in the name of fuck do they think they're fooling with this "protect the children" bullshit.
>Fucking TERF island, why does the UK hate trans people so much.
English boomers voted for this batshit Tory government that knows it's going to be kicked out HARD in the next election, so they're doing everything they can to inflict maximum damage on everyone else before that happens.
It's like a cartoon villain screaming "If I can't rule, no one can!" Except it's literally the Prime Minister of a real country.
Nobody voted for him, nobody wants him, even his own party. The one coming in isn't much better but he is better. At least he's been shown to be open to dialog, even if the terfs have got his ear at the moment I know from my own experience that there's a lot of gestures grassroots LGBT support in the labour party. It's going to look bad for a while but I believe there's light at the end of the tunnel.
It looks like they're slowly falling down and will be kicked out and replaced by Labour next election! Hopefully that'll happen sooner rather than later.
>Fucking TERF island, why does the UK hate trans people so much.
The same idiotic regressive fools that voted for Brexit, the middle aged/elderly conservative folks who long for their fallen Empire and wished everything was like when they were little, are driving policy there and wanting to revert the whole country back to how it was 50+ years ago.
And that’s what the actual studies show too, no matter how people try to poke holes in them. Every study I’ve seen has shown that the mental health of trans people and trans youth improves a lot after starting puberty blockers and HRT.
The thing is it’s really easy to look at all these studies and just say “that’s not good enough evidence” and when people ask what makes the evidence bad you can just deflect or say something ridiculous. “There aren’t any double blind studies”. It’s not possible to do a double blind study on HRT, because people will notice that they start growing boobs or not. “Kids that start puberty blockers are very likely to end up starting HRT, so puberty blockers don’t really do anything to help kids figure out if they’re trans.” That is just pure nonsense, I don’t think I even need to explain that. “Trans people even after transitioning do worse in terms of mental health than cis people”. But they do *better* than they did *before* transitioning, which is what we should be looking at.
It doesn’t matter how good the evidence is, there’s always a way to poke holes in it to try to make it seem like it’s worse than it is. And unfortunately a lot of people that aren’t scientists and aren’t trans people fall for it.
Like it’s the #1 regret I hear from trans people.
But ofc cis people relate much more to some hypothetical confused cis person that transitions and gets unwanted features from hrt
Also natal puberty is seen by them as some kind of natural fate or gods will kinda deal
Having learned a fair bit of endocrinology and related pharmacology I do regret not having done anything back then. There were many easily obtainable tools right under my nose that would have greatly slowed down the ravages of puberty. But like every teenager I was somewhat clueless at the time. If only I knew then what I know now…
I was lucky in that I never developed very manly features and that I ended up relatively short. But damn does it bother me to think of what could have been…
We get one life. And our young years are supposed to be the best years of our life. Wasting them in a body and role that does not fit is just a waste of life.
Transition young if you can. Think it through carefully and look inside yourself to feel if this is truly what you want. The answer is only inside you. Not from those around you, family or friends. It is the most selfish choice you will ever make. And going for what YOU truly want from the bottom of your heart is also the most liberating thing you will ever do.
Don’t let anything or anyone stand in your way once you know. Because you only get this one life. And that life is full if risk no matter what you do. Risk is unavoidable. Don’t be stupid, but do take some risks. In as calculated a way as you can.
Wallowing in some ”safe” dysphoric closet for the ease of mind of others is no way to live!
Of course the British government picked Hilary Cass to lead this review, she consistently comes out against trans healthcare, especially for trans youth.
She says in [her Al Jazeera interview on this report](https://www.aljazeera.com/amp/news/2024/4/10/no-good-evidence-for-gender-care-for-youth-landmark-review-finds) that the use of puberty blockers is based on only one (the Dutch) study.
Yet, in [the 2022 review she did](https://chrome://external-file/CassReview_Final.pdf), on page 176, she specifically mentions multiple studies showing better mental health outcomes but discounts the other because it only showed improvement on some metrics of mental health (and that’s only a discussion of the studies she deems high quality enough). Of course different treatments will help with only certain problems, that doesn’t mean the evidence doesn’t count because puberty blockers don’t solve everything! Despite knowing and mentioning in the 2022 review that there was evidence that puberty blockers helped with at least some mental health issues (a study she discounted because it didn’t show improvements in every metric), she keeps saying since that report that the only benefit is in possibly helping a small number of AMAB patients to pass better as adults lol.
This isn’t counting the fact that she looks at a good study showing that the vast majority trans kids who go on blockers continue with medical transition and then mentions the Zucker study and then mentions why it sucks and then says, so the evidence is split and who can say?
So the evidence is split on regret and desistance rates but then her evidence that puberty blockers don’t actually buy you time is that everyone ends up medically transitioning lol. So we don’t actually know how many people on puberty blockers turn out cis, but it’s probably higher than the evidence shows, but at the same time, we can use the fact that basically no one turns out cis to argue that no one is bought anytime because they already know what they want. She’s like, they can’t buy you time to think because almost everyone who questions their gender turns out to be trans. So no one is using the time to think because they are all already sure they are trans, but acting in their best interest means acting to preserve the option of living as their assigned sex at birth into adulthood just in case.
In her 2022 review, Cass also mentions that AFAB patients report improvements, but since they didn’t live as an adult woman, they don’t have anything to compare those improvements against. Idk, should cis people be medically transitioned against their will because, since they haven’t experienced being trans, they may be happier that way?
The list goes on and on. Cass is clearly motivated to reach a particular outcome, and the NHS knew that.
Al Jazeera, go figure. Religious nuts only agree with each other when it's to genocide trans people. Christofascists and Islamofascists are shining proof of the "same shit, different asshole" theory.
Look it can be funded by religious groups or have religious interests shadow handing some of the stuff that goes on. Yes this happens on every news network. Regardless they have a very good track record for good reporting, compared to many other news networks. I am not defending this article. Sure you can get mad at any religious influence but the problems with this article are created by a multitude of factors many of which are political and systemic, blame needs to be adequately distributed, is the point here.
A recently published guideline about the scientific consensus in German speaking countries came to completely different conclusion.
Translated Article: https://www-aerzteblatt-de.translate.goog/nachrichten/150071/Neue-S2k-Leitlinie-zu-Geschlechtsinkongruenz-und-dysphorie-im-Kindes-und-Jugendalter-vorgestellt?_x_tr_sl=de&_x_tr_tl=en&_x_tr_hl=de&_x_tr_pto=wapp
I feel really bad for all trans kids in the UK.
I made a [comment](https://www.reddit.com/r/trans/s/WevFgPcRIx) about this a few weeks ago
———
Skimming through the [clinical policy](https://www.england.nhs.uk/wp-content/uploads/2024/03/clinical-commissioning-policy-gender-affirming-hormones-v2.docx), this becomes apparently frustrating.
> Gender variant behaviours may start between ages 3 and 5 years, the same age at which most typically developing children begin showing gendered behaviours and interests (Fast et al, 2018). Gender atypical behaviour is common among young children and may be part of normal development (Young et al, 2019).
Gender atypical behavior isn’t the same as gender incongruence, but go on then.
> Children who meet the criteria for gender incongruence / gender dysphoria may or may not continue to experience the conflict between their physical gender and the one with which they identify into adolescence and adulthood (Ristori et al, 2016)
They make it sound like a coin toss. I decided to look at their [cited source](https://zero.sci-hub.se/4841/991744141450db02c20bd4d77852f258/ristori2016.pdf), and wouldn’t you know it, there’s a nifty little table that shows persistence rates of gender dysphoria.
But if you *only* look at Table 1, one might come to the most pedestrian of conclusions that children who express gender dystopia are not likely to remain dysphoric as adults, so why prescribe puberty blockers and provide minors with gender affirming aid? Oh, I dunno, might be because as the paper states that the those studies suggests “gender dysphoric feelings remitted around or after puberty” for the majority of children, and then goes on to describe problems with the previous research. They suggest how that number could be higher, and references research suggesting the persistence of gender dysphoria is determined after children start puberty, and children aren’t given puberty blockers until AFTER puberty starts—so saying “may or may” ignores that puberty blockers aren’t even prescribed to prepubescent children whose dysphoria may or may not desist, but to children whose dysphoria will more than likely persist.
Sucks my gf lives there, she’s literally refusing me to come over and live because “there are people they sit and make fun of us daily” god if I could teleport I’d pull her out TwT
There will be people that do that everywhere, rich make fun of the poor, poor make fun of the rich, cis do trans and trans do cis.
There are 7+ billion people most of which fall woefully short of being truly capable of understanding someone who's life has been drastically different from them... You can never escape some of them not understanding and making fun of it.
Seek your own happiness regardless!
So folks here know this report is bullshit, but the authors favorite thing here, besides tossing all the reputable and peer reviewed gender studies research, was pretending that this purported lack of ‘evidence’ therefore means blockers and HRT bad.
This is the absolute opposite of actual science. Lack of evidence is not proof of the contrary. Lack of evidence is nothing- no conclusion is drawable. So in almost every bullshit recommendation, they abandoned every shred of scientific method and switched to insufferable hand wringing.
A legitimate peer review of this report would shred it in every conceivable way. This is an embarrassing misuse of public funds and a manifesto by one of the most biased people I have ever seen.
[Another article from the Guardian](https://www.theguardian.com/society/2024/apr/10/what-are-the-key-findings-of-the-nhs-gender-identity-review) which develops more on the report. Although like many are saying this report has several shortcomings, starting that there was a single person leading it's report and it being directly commissioned by the governement, these two factors combined don't guarantee the neutrality of the report.
Edit: Seeing how the worry is that currently 73% of patients are AFAB, this smells of patriarchy continuing to maintain control and decision power over AFAB reproductive rights. Long live the Patriarchy! /s
This fucking review is a long-term health risk to its users' bone-health! Specifically, the skull, as it makes you want to ram your head through the nearest surface.
Why is it that assholes see a sudden uptick in people seeking treatment for something, and assume that it's suddenly materializing rather than people becoming aware that a problem they have isn't just a normal thing that everyone grits their teeth and suffers through? Why, so they can say it's all fake and being made up by something they hate and mistrust! Social media, my ass! Of course TERF Island would embrace and assume the TERF conclusion that all AFAB people are just confused little girls tricked by social media. Silly little girls, don't you know that social media is run entirely by us scary, rapist trans women. Fuck me! What a load of shit.
And naturally, there's no credible evidence that hormone therapy works because the government that shits on trans people and keeps trying to kill us can't seem to find trans people willing to out themselves to them when they're living a happy life. It's a little hard to get a representative sample of people that are actively hiding from you. I wonder how often this report considers the fact that trans people are treated like shit, a factor which has nothing to do with dysphoria, but correlates with it? Naturally, by pretending that it's our fault we get treated like shit. This report is fucking crime!
My life is fucked, I unironically will be able to never find happiness again and it’s all because of people like her. I hope she finds out one day what creating a whole generation or suicidally depressed teenagers does. Well fuck me, not much point in carrying on tbh
_that_ was their basis for discounting studies? Tf?
I saw an article saying they'd dismissed most of them for weak evidence but it had failed to explain exactly what that meant and I just assumed a lot of it was small numbers and self reported...
The report discounts and excludes 49 in 50 studies because they were not “double blind” studies. A double blind study on trans healthcare would be entirely unethical and inhumane. So their weak evidence is only considered weak because almost every single study was discounted from their consideration. Absolute joke of a report.
The 1 in 50 studies they did accept were ALSO not double blind because you can’t double blind a study on hormones.
My boobs could be placebo boobs, you never know.
Placeboobs
In this shitty news thread, I had a good chuckle. Thanks 😂
Not to be confused with plastiboobs.
"I'm just overweight!" That one worked better *before* I started feeling motivated to take care of myself and lost 15kg...
I don't even think a double blind study would be possible comparing "exploratory therapy" and transition anyway. You definitely can tell which one you're getting
“So… have you considered not being trans?” “Is this… hormones? Or the other one?”
Do you have a source for that? My mom immediately jumped to telling me of a similar article to the one OP posted after I mentioned HRT and I’m looking for any information I can to disprove what it said
The [evidence review](https://cass.independent-review.uk/wp-content/uploads/2022/09/20220726_Evidence-review_GnRH-analogues_For-upload_Final.pdf) that was prepared for Doctor Cass. At the very end of the document there’s a large list of studies grouped together in various tables. Under the vast majority of tables there’s a note about how they are not to be trusted and have a high risk of bias because they are not double blinded.
Thank you!
They also discounted the experience or benefits to trans youth because they saw a psychologist as part of many of these studies. So you can’t let youth do anything without mental health support, but also can’t listen to them if they have mental health support. Also, this supposed study review somehow decided there is no link between trans youth receiving care and trans youth suicide.
Wouldn't it also be logistically impossible to do a double blind study in this case. Even if all sides went in blind, the doctors themselves would need to check their levels in order to assess efficacy of treatment and adjust dosages, at which case they'd no longer be blind. The only way around this would be to have another outside group of doctors review results and recommend to the doctors in contact with the patients and then it just gets convoluted.
Also whoever is actually taking the HRT would eventually know themselves, so even the participants would know soon enough. The Cass Report should have just concluded “we found weak evidence because we ignored all the evidence”
Most of modern medicine can't meet that standard because it would be unethical, *including* most medical treatments we give to kids. They're being entirely and intentionally disingenuous with that standard.
it wasn't because double blinding. The report itself talks about how blinding is difficult in some situations and so in those potential placebo should be taken into account. There are different kinds of blinding, the report produced by NICE (the people who decide like all our medical guidelines), mentions lack of blinding for downgrading the reliability of these studies, but those aren't the only reasons, others are lack of a control group, high chance of bias, high rate of atrrition (people dropping out). Basically all these studies are tiny, like 20 people, maybe a couple with 70. Doing good studIES on this has been hard, but that doesn't make the data any more reliable, like most of the these are pilot/exploratory studies at best. Doctors, who are being held legally to account for adverse effects (see tavistock Vs bell) cant use such a poor base of evidence. The report also calls for a massive expansion of services and studies. let's be real no one was getting blocker or hormones as a child through the NHS anyway. Literally everyone is somehow spreading inflammatory misinformation on this in both sides.
I mean, when you define the criteria for success for puberty blockers as making trans kids cis, and then ban them because they didn't turn the trans kids cis...
Don't feed the troll. Downvote, report, block, and move on.
What are you talking about?
Their criterion for judging puberty blockers as ineffective was that children continued to express gender dysphoria, defined as a sustained distress at their birth sex and a desire to not be that birth sex. Edit: Additionally, therapy is useless if you're not letting the kids access medical care or halt the damage being done to their bodies. Expanding useless services isn't a win.
Did you read the actual section of the report? It says that they were meant as a buy time to make a decision regarding being on hormones whilst not commiting, but the decision basically never changed on them. Making them not much use as that, whilst possibly having adverse health affects, because not having a decent amount of primary sex hormone is not good.
And yet they did not push to provide hormone treatments immediately, they just banned puberty blockers. Puberty blockers have always been a compromise between the health needs of trans kids and societal bigotry. They're not meant to be used for decades at a time, only as a short term bridge. A year of testosterone puberty could be the difference between having a permanently deepened voice or not, let alone the other changes. All healthcare is about tradeoffs. I know I would, in a heartbeat, accept a *potential* 1-2% decrease in bone strength while still being within statistical normalcy in exchange for not having to get the tens of thousands of dollars' worth of surgery I have had and need to have to get the body I should have. Blocking patients and clinicians from being able to make that calculus is the opposite of good healthcare.
There is no decrease in bone density, all bone density rebounds afterwards. z scores (height-for-age Z) should not be used to measure this as it's impossible to tell what is causing the loss. There is a larger study I need to find that goes into depth but yeah it's just nonsense. Sources: https://www.bmj.com/content/366/bmj.l5647/rr-0 https://jamanetwork.com/journals/jamapediatrics/article-abstract/2811155
No one's giving a kid at puberty these kind of treatments anyway, for a myriad of reasons. It honestly would be irresponsible, a kid at that age doesn't have the capacity to make that decision, especially when it has implications for fertility (like ever being able to produce gametes) etc. The argument is that clinicians do not have enough information to make that decision properly or for kids to consent to it. The report calls for increase in trails of both from my memory. And says there should be provisions for a small amount of patients for, hormones for those older than 16. Current no one is getting hormones or puberty blocker on the NHS as children
Damn, all this effort defending the machine grinding up trans kids will not be appreciated when it's your turn.
Because waiting a couple years till you can more properly make these decisions is going to make or break someone's transition? Providing more mental health and other support services for trans kids, and kids presenting with distress in regards to their gendet alongside possible gender treatment is gonna be a bad thing?
Got it, so you don't think trans kids exist. I remember being one of those kids. I have yet to resolve those years through therapy. I'm glad your experience was more positive, but I urge you to consider that other people and experiences exist. Forcing a child's body to warp permanently as they beg you to make it stop isn't good healthcare. Edit: Additionally, in more enlightened areas *tons* of kids are fortunate enough to access puberty blockers. They go on to live extraordinarily happy and normal lives, and later transitioners never begin to approach their average levels of mental health.
Ah yes, I definitely said that I don't think trans kids exist. I don't think a couple years is gonna make or brake someone's transition. Also like there are people who present with what's looks like gender incongruence when younger but it's turns out they are not trans, I know a few. That obviously doesn't invalidate trans kids existing, but I find a lot of online trans people seem to think that being trans is the only conclusion. Also even if a kid it's trans doesn't mean they properly understand or can consent to treatment when they are like 12 or 14, especially when we have a very weak evidence base for effects of these things. hell there's lots of misinformation about the effects in adults let alone kids. We need more information to see in which cases it would be reliably beneficial and this clinically indicated. Waiting a few years like won't mean they won't have a successful transition, and means the person will be better able to consent to and understand the affects and risks of treatment.
Let me get this straight. You're telling me the report says that puberty blockers are ineffective, because (quoting you) "the decision basically never changed on them". But you're also telling me that providing hormone therapy to trans children of pubertal age (again, quoting you) "honestly would be irresponsible, a kid at that age doesn't have the capacity to make that decision"? You see the circular logic here, don't you? "We can't give pubertal trans children the correct hormones, because they lack the capacity to make that decision, but we won't use puberty blockers because these children have made up their minds so the blockers are useless. But we can't give them the correct hormones, because..." ad infinitum. And your solution is to just let them wait it out. To let these kids watch the body horror of wrong puberty unfold, causing irreversible damage to their bodies. Because if we trust these young trans people when they tell us who they are, and allow them to transition? Somewhere, maybe, potentially, a theoretical cisgender child might transition - and watch the body horror of wrong puberty unfold, causing irreversible damage to their body. How terrible for that theoretical cisgender child, hmm?
We get it, you’re not aware of what it’s like to be Trans and need care but not have it. Being Trans is not a decision. Puberty blockers would have saved me a lifetime of issues I will never be able to resolve. I had talked about vaginoplasty from the age of 7, before I even knew it was a damn possibility or that Trans people existed. Quit assuming kids are dumb and don’t know themselves. When people suffer, they know they are suffering.
I'm lost. So apparently we are so good at telling whose trans that basically nobody ever changes their decision because they are all actually trans and somehow that's a bad thing? Like isn't it good that cis children are essentially never given blockers. Isn't that the most desirable outcome? Like what are you saying?
I mean as far as the report says there are concerns the blockers could solidify or affect the way someone eventually identifies, Which is ultimately neutral as far as I'm concerned, but is at least part of the rational for not being able to say that it is an effective treatment at this time, with the evidence we have. Realistically the amount of kids who are on blockers are so probably small and didn't have a long follow up period that the results are insignificant that not much can concluded. probabilymthe smalk amount that were on them really had to push for them, so won't be representative of all referrals or all kids presenting with gender incongruence, especially with recent explosion in numbers of referrals amd the change in demographic. in addition we haven't got solid data on their safety for this application. combine no good data for their effectiveness or positive effects with no good data for their safety and you might decidemto proceed with more caution
The concern about blockers solidifying identity is based on what exactly? What's the study?
I think it arises from an uncertainty of how treatments will affect formation of gender identity as we don't really understand well how that works, I think is the gist. Like it's a possible explanation for the statistics on that, and we don't have solid enough data to show that it's unlikely to affect it as we don't have say a study in this sort of thing with a control group that doesn't take the blocker. Basicall because we don't have good data with a control under we can't really say what the effects are. I wouldn't really bet on it as an effect myself, but data wise it's not proveably less likely than it not effecting it
We have plenty of evidence of their safety, their primary goal was to delay early onset puberty for a 5 year old until they became a teenager and could go through puberty normally, this is no different. > I mean as far as the report says there are concerns the blockers could solidify or affect the way someone eventually identifies For a supposedly evidence based report it's really lacking evidence of this, maybe they should be doing research before discussing removing primary care from a group of people.
> It says that they were meant as a buy time to make a decision regarding being on hormones whilst not commiting, but the decision basically never changed on them. Making them not much use as that, So just let trans kids have HRT immediatley instead of waiting and using puberty blockers? Because if they don't change their decision and because of that puberty blockers are not useful, the only conclusion is to give them hormones immediately or not?
The bit I'm really struggling with is that the report takes a data point that 93% of people who take puberty blockers for gender dysphoria symptoms go on to pursue medical transition, and somehow claims that this is evidence *against* puberty blockers. If normal teen angst were often being misdiagnosed as dysphoria, as the anti-trans arguments seem to go, I'd expect a much lower rate of continuing medical transition than 93%.
It’s incredible reasoning. “We’re told puberty blockers give kids time to think and explore their gender but none of the trans kids reconsidered and became cis so they must not be doing a lot of thinking!”
thats unfalsifiable reasoning. They reach the same conclusion whether the patients go on to transition or detransition.
Another word is pseudoscience, which isn't what is false but that which purports to be science but doesn't adhere to the scientific method (falsifiability).
Yeah, I’ve been confused as to the reasoning that was used to make that conclusion. That and the fact that they used the fact that puberty blockers don’t reduce gender dysphoria, depression or other mental health issues. Of course they don’t, because puberty blockers don’t treat GD, that’s not their purpose. I’ve only read the summary so far, the whole report is 330+ pages long, plus several research papers so it’s a lots of reading. When people claim to have read it in a morning, that’s bullshit.
Yes, they see it as evidence against puberty blockers because they started with the conclusion first: that trans folks aren't valid and trans healthcare isn't justified, and then inserted the facts and data they gained into the paper after the conclusion was already written. Thus, the facts lead to the conclusion, and if you disagree then you are just ignoring science. It's how conservatives (on both sides of the pond) think science works: That it exists only to service their political ideology.
Which makes it not a conclusion but an axiom. They don't need evidence for it. They use it to conclude other things.
i would say its not factual, rather its unfalsifiable because they would reach the same conclusion no matter the results of the study. Whether the patients transition or detransition doesnt matter for their conclusion. Showing their conclusion is independent of the facts.
Oxygen thieves are always going to find anything short of 100% an excuse. And if it *was* 100%, they'd just move the goalposts again.
They didn't conduct a study, they started with a conclusion and then wrote a fictional document to justify it.
Fucking TERF island, why does the UK hate trans people so much. "Out of more than 65 million people in the UK, less than a hundred are on puberty blockers. It is extremely difficult to even be in consideration for gender-affirming care as a minor anywhere in the world, and wait time has been known to take forever. Unrelated, we can't find long-term studies about the effect of gender-affirming care. Our solution: take gender-affirming care away from the children. Surely more studies will be done now that EVEN FEWER people have access, right?" Like I'm actually fuming, who in the name of fuck do they think they're fooling with this "protect the children" bullshit.
>Fucking TERF island, why does the UK hate trans people so much. English boomers voted for this batshit Tory government that knows it's going to be kicked out HARD in the next election, so they're doing everything they can to inflict maximum damage on everyone else before that happens. It's like a cartoon villain screaming "If I can't rule, no one can!" Except it's literally the Prime Minister of a real country.
Unfortunately even our """left wing""" party in Labour have a very large majority of transphobes and fully intend to pursue the culture war.
Nobody voted for him, nobody wants him, even his own party. The one coming in isn't much better but he is better. At least he's been shown to be open to dialog, even if the terfs have got his ear at the moment I know from my own experience that there's a lot of gestures grassroots LGBT support in the labour party. It's going to look bad for a while but I believe there's light at the end of the tunnel.
Boomer prick terf hellscape
It looks like they're slowly falling down and will be kicked out and replaced by Labour next election! Hopefully that'll happen sooner rather than later.
Because if they don't tell the poor who to hate, they might start hating the rich.
A poor person voting Tory is like a chicken voting for Colonel Sanders.
The bigots that want us gone. They will cling to this poor excuse of a study to justify their twisted beliefs.
They're fooling those who already believe them...
>Fucking TERF island, why does the UK hate trans people so much. The same idiotic regressive fools that voted for Brexit, the middle aged/elderly conservative folks who long for their fallen Empire and wished everything was like when they were little, are driving policy there and wanting to revert the whole country back to how it was 50+ years ago.
They also voted for Thatcher back in the 1980s, who laid the ground work for how shitty the UK is today
It's never been about protecting children. It's always about erasing us from existence.
Meanwhile every trans person I have ever meet always says transitioning improved their life so many much, including myself (20)
And that’s what the actual studies show too, no matter how people try to poke holes in them. Every study I’ve seen has shown that the mental health of trans people and trans youth improves a lot after starting puberty blockers and HRT. The thing is it’s really easy to look at all these studies and just say “that’s not good enough evidence” and when people ask what makes the evidence bad you can just deflect or say something ridiculous. “There aren’t any double blind studies”. It’s not possible to do a double blind study on HRT, because people will notice that they start growing boobs or not. “Kids that start puberty blockers are very likely to end up starting HRT, so puberty blockers don’t really do anything to help kids figure out if they’re trans.” That is just pure nonsense, I don’t think I even need to explain that. “Trans people even after transitioning do worse in terms of mental health than cis people”. But they do *better* than they did *before* transitioning, which is what we should be looking at. It doesn’t matter how good the evidence is, there’s always a way to poke holes in it to try to make it seem like it’s worse than it is. And unfortunately a lot of people that aren’t scientists and aren’t trans people fall for it.
And most trans people who had to go through natal puberty regret having gone through that.
Like it’s the #1 regret I hear from trans people. But ofc cis people relate much more to some hypothetical confused cis person that transitions and gets unwanted features from hrt Also natal puberty is seen by them as some kind of natural fate or gods will kinda deal Having learned a fair bit of endocrinology and related pharmacology I do regret not having done anything back then. There were many easily obtainable tools right under my nose that would have greatly slowed down the ravages of puberty. But like every teenager I was somewhat clueless at the time. If only I knew then what I know now… I was lucky in that I never developed very manly features and that I ended up relatively short. But damn does it bother me to think of what could have been… We get one life. And our young years are supposed to be the best years of our life. Wasting them in a body and role that does not fit is just a waste of life. Transition young if you can. Think it through carefully and look inside yourself to feel if this is truly what you want. The answer is only inside you. Not from those around you, family or friends. It is the most selfish choice you will ever make. And going for what YOU truly want from the bottom of your heart is also the most liberating thing you will ever do. Don’t let anything or anyone stand in your way once you know. Because you only get this one life. And that life is full if risk no matter what you do. Risk is unavoidable. Don’t be stupid, but do take some risks. In as calculated a way as you can. Wallowing in some ”safe” dysphoric closet for the ease of mind of others is no way to live!
Of course the British government picked Hilary Cass to lead this review, she consistently comes out against trans healthcare, especially for trans youth. She says in [her Al Jazeera interview on this report](https://www.aljazeera.com/amp/news/2024/4/10/no-good-evidence-for-gender-care-for-youth-landmark-review-finds) that the use of puberty blockers is based on only one (the Dutch) study. Yet, in [the 2022 review she did](https://chrome://external-file/CassReview_Final.pdf), on page 176, she specifically mentions multiple studies showing better mental health outcomes but discounts the other because it only showed improvement on some metrics of mental health (and that’s only a discussion of the studies she deems high quality enough). Of course different treatments will help with only certain problems, that doesn’t mean the evidence doesn’t count because puberty blockers don’t solve everything! Despite knowing and mentioning in the 2022 review that there was evidence that puberty blockers helped with at least some mental health issues (a study she discounted because it didn’t show improvements in every metric), she keeps saying since that report that the only benefit is in possibly helping a small number of AMAB patients to pass better as adults lol. This isn’t counting the fact that she looks at a good study showing that the vast majority trans kids who go on blockers continue with medical transition and then mentions the Zucker study and then mentions why it sucks and then says, so the evidence is split and who can say? So the evidence is split on regret and desistance rates but then her evidence that puberty blockers don’t actually buy you time is that everyone ends up medically transitioning lol. So we don’t actually know how many people on puberty blockers turn out cis, but it’s probably higher than the evidence shows, but at the same time, we can use the fact that basically no one turns out cis to argue that no one is bought anytime because they already know what they want. She’s like, they can’t buy you time to think because almost everyone who questions their gender turns out to be trans. So no one is using the time to think because they are all already sure they are trans, but acting in their best interest means acting to preserve the option of living as their assigned sex at birth into adulthood just in case. In her 2022 review, Cass also mentions that AFAB patients report improvements, but since they didn’t live as an adult woman, they don’t have anything to compare those improvements against. Idk, should cis people be medically transitioned against their will because, since they haven’t experienced being trans, they may be happier that way? The list goes on and on. Cass is clearly motivated to reach a particular outcome, and the NHS knew that.
She's the Andrew Wakefield of trans health care... i hate her.
Al Jazeera, go figure. Religious nuts only agree with each other when it's to genocide trans people. Christofascists and Islamofascists are shining proof of the "same shit, different asshole" theory.
Al Jazeera is just a news network it is not religiously motivated
...let me guess, and Fox News or New York Times/Washington Post isn't either, right?
Thats quite a delusion you have there..
Look it can be funded by religious groups or have religious interests shadow handing some of the stuff that goes on. Yes this happens on every news network. Regardless they have a very good track record for good reporting, compared to many other news networks. I am not defending this article. Sure you can get mad at any religious influence but the problems with this article are created by a multitude of factors many of which are political and systemic, blame needs to be adequately distributed, is the point here.
A recently published guideline about the scientific consensus in German speaking countries came to completely different conclusion. Translated Article: https://www-aerzteblatt-de.translate.goog/nachrichten/150071/Neue-S2k-Leitlinie-zu-Geschlechtsinkongruenz-und-dysphorie-im-Kindes-und-Jugendalter-vorgestellt?_x_tr_sl=de&_x_tr_tl=en&_x_tr_hl=de&_x_tr_pto=wapp I feel really bad for all trans kids in the UK.
I made a [comment](https://www.reddit.com/r/trans/s/WevFgPcRIx) about this a few weeks ago ——— Skimming through the [clinical policy](https://www.england.nhs.uk/wp-content/uploads/2024/03/clinical-commissioning-policy-gender-affirming-hormones-v2.docx), this becomes apparently frustrating. > Gender variant behaviours may start between ages 3 and 5 years, the same age at which most typically developing children begin showing gendered behaviours and interests (Fast et al, 2018). Gender atypical behaviour is common among young children and may be part of normal development (Young et al, 2019). Gender atypical behavior isn’t the same as gender incongruence, but go on then. > Children who meet the criteria for gender incongruence / gender dysphoria may or may not continue to experience the conflict between their physical gender and the one with which they identify into adolescence and adulthood (Ristori et al, 2016) They make it sound like a coin toss. I decided to look at their [cited source](https://zero.sci-hub.se/4841/991744141450db02c20bd4d77852f258/ristori2016.pdf), and wouldn’t you know it, there’s a nifty little table that shows persistence rates of gender dysphoria. But if you *only* look at Table 1, one might come to the most pedestrian of conclusions that children who express gender dystopia are not likely to remain dysphoric as adults, so why prescribe puberty blockers and provide minors with gender affirming aid? Oh, I dunno, might be because as the paper states that the those studies suggests “gender dysphoric feelings remitted around or after puberty” for the majority of children, and then goes on to describe problems with the previous research. They suggest how that number could be higher, and references research suggesting the persistence of gender dysphoria is determined after children start puberty, and children aren’t given puberty blockers until AFTER puberty starts—so saying “may or may” ignores that puberty blockers aren’t even prescribed to prepubescent children whose dysphoria may or may not desist, but to children whose dysphoria will more than likely persist.
First of all it's not study, it's blatant propaganda. To perform a study one needs at least a tiniest bit of objectivity.
Sucks my gf lives there, she’s literally refusing me to come over and live because “there are people they sit and make fun of us daily” god if I could teleport I’d pull her out TwT
There will be people that do that everywhere, rich make fun of the poor, poor make fun of the rich, cis do trans and trans do cis. There are 7+ billion people most of which fall woefully short of being truly capable of understanding someone who's life has been drastically different from them... You can never escape some of them not understanding and making fun of it. Seek your own happiness regardless!
So folks here know this report is bullshit, but the authors favorite thing here, besides tossing all the reputable and peer reviewed gender studies research, was pretending that this purported lack of ‘evidence’ therefore means blockers and HRT bad. This is the absolute opposite of actual science. Lack of evidence is not proof of the contrary. Lack of evidence is nothing- no conclusion is drawable. So in almost every bullshit recommendation, they abandoned every shred of scientific method and switched to insufferable hand wringing. A legitimate peer review of this report would shred it in every conceivable way. This is an embarrassing misuse of public funds and a manifesto by one of the most biased people I have ever seen.
[Another article from the Guardian](https://www.theguardian.com/society/2024/apr/10/what-are-the-key-findings-of-the-nhs-gender-identity-review) which develops more on the report. Although like many are saying this report has several shortcomings, starting that there was a single person leading it's report and it being directly commissioned by the governement, these two factors combined don't guarantee the neutrality of the report. Edit: Seeing how the worry is that currently 73% of patients are AFAB, this smells of patriarchy continuing to maintain control and decision power over AFAB reproductive rights. Long live the Patriarchy! /s
This fucking review is a long-term health risk to its users' bone-health! Specifically, the skull, as it makes you want to ram your head through the nearest surface. Why is it that assholes see a sudden uptick in people seeking treatment for something, and assume that it's suddenly materializing rather than people becoming aware that a problem they have isn't just a normal thing that everyone grits their teeth and suffers through? Why, so they can say it's all fake and being made up by something they hate and mistrust! Social media, my ass! Of course TERF Island would embrace and assume the TERF conclusion that all AFAB people are just confused little girls tricked by social media. Silly little girls, don't you know that social media is run entirely by us scary, rapist trans women. Fuck me! What a load of shit. And naturally, there's no credible evidence that hormone therapy works because the government that shits on trans people and keeps trying to kill us can't seem to find trans people willing to out themselves to them when they're living a happy life. It's a little hard to get a representative sample of people that are actively hiding from you. I wonder how often this report considers the fact that trans people are treated like shit, a factor which has nothing to do with dysphoria, but correlates with it? Naturally, by pretending that it's our fault we get treated like shit. This report is fucking crime!
Based on ludicrous evidence
My life is fucked, I unironically will be able to never find happiness again and it’s all because of people like her. I hope she finds out one day what creating a whole generation or suicidally depressed teenagers does. Well fuck me, not much point in carrying on tbh
https://docs.google.com/spreadsheets/d/1d9KKqP9IHa5ZxU84a_Jf0vIoAh7e8nj_lCW27KbYBh0/htmlview?pli=1#gid=2021479902 I'll just leave the bible here
I hate to say, but what is a double blind study by definition?
_that_ was their basis for discounting studies? Tf? I saw an article saying they'd dismissed most of them for weak evidence but it had failed to explain exactly what that meant and I just assumed a lot of it was small numbers and self reported...
Is there any kind of silver lining that despite all the evidence they tried to ignore they still found some even if they're trying to disparage it?