42 votes

Children to no longer be prescribed puberty blockers, NHS England confirms

28 comments

  1. [4]
    TanyaJLaird
    Link
    The unstated subtext of all of these anti-trans laws is quite simple. There is a classic principle of legal philosophy that states, "it is better for a hundred guilty men to go free than for one...
    • Exemplary

    The unstated subtext of all of these anti-trans laws is quite simple.

    There is a classic principle of legal philosophy that states, "it is better for a hundred guilty men to go free than for one innocent man to be unjustly imprisoned."

    For opponents of trans care, they operate on the philosophy: "It is better for a hundred trans people to suffer and be denied treatment than for one cisgender individual to mistakenly transition and later regret it."

    That is the unstated assumption behind concerns about kids being "too young to know" or handwringing about people "making mistakes." The unstated assumption is that fundamentally, the lives of cisgender people are worth 100 times that of a transgender person. And since the regret and detransition rates really are just in the 1-2% range, that is approximately the value these people put on the lives of trans people. The suffering of a cisgender person who mistakenly transitions more than balances the suffering of a hundred trans people who are denied transition. The life of a cisgender person is worth more than that of a hundred trans people. If a hundred trans people had to die to save the life of one cis person, then that is fully justified.

    Deep down, the people advocating these laws simply do not believe that the life of a trans person is worth anything at all. They fundamentally do not accept that cis and trans people both possess lives of equal value. If a hundred trans people must be sacrificed to save one cis person from the kind of gender dysphoria every trans person experiences, then so be it. After all, to these people, the life of a trans person is very literally worthless. They would sacrifice a million trans people if it kept one cis person from being mildly inconvenienced.

    81 votes
    1. chocobean
      Link Parent
      To add to this horrific value equation, there is also a dark undercurrent of "giving them their just deserts": it's worthwhile to "save" that one poor misled teen, but all those other people who...

      To add to this horrific value equation, there is also a dark undercurrent of "giving them their just deserts": it's worthwhile to "save" that one poor misled teen, but all those other people who "chose sin" or whatever they call it, they deserve mental anguish and perhaps they even think suicide is "fair" consequences of choosing sin or perversion". There's also rhetoric about how suffering is what will "cure" them.

      Heavy use of air quotes, my apologies, but I've heard these kinds of rhetoric for years from these people and it makes me sick to type them without air quotes to mentally distancing myself from these horrible words.

      30 votes
    2. MechanicalMagpie
      Link Parent
      I've also found that a lot of people who think this way also feel that trans people are fundamentally broken and damaged and degenerate, and that not only are they saving cis people, they're also...

      For opponents of trans care, they operate on the philosophy: "It is better for a hundred trans people to suffer and be denied treatment than for one cisgender individual to mistakenly transition and later regret it."

      I've also found that a lot of people who think this way also feel that trans people are fundamentally broken and damaged and degenerate, and that not only are they saving cis people, they're also like.....swooping in and saving the trans people from themselves, because, to them, someone mentally healthy couldn't possibly want HRT or surgery or whatever, and obviously (heavy sarcasm here), bodily autonomy doesn't extend to things that they think are gross.

      21 votes
    3. NomadicCoder
      Link Parent
      It's an interesting thought, and a way of thinking that I hadn't considered, but I strongly suspect that it's much simpler than that... Having grown up in that ultra-right-wing religious...

      It's an interesting thought, and a way of thinking that I hadn't considered, but I strongly suspect that it's much simpler than that...

      Having grown up in that ultra-right-wing religious environment I'm fairly certain that the thinking goes: "trans different, trans scary, trans bad; I don't know why, but that's what I have to say to fit in with the people in my church who also don't know what to believe, nor why, but they're saying it to fit in too".

      ...so glad to have escaped that brianwashing, just wish I'd have escaped it much earlier than I did -- so many wasted years.

      12 votes
  2. Queef_Latifa
    Link
    Insanity. The one thing that is a constant besides death and people are being told that they can not have bodily autonomy. Even just being able to stop puberty until someone is completely sure...

    Insanity. The one thing that is a constant besides death and people are being told that they can not have bodily autonomy. Even just being able to stop puberty until someone is completely sure what they want THEIR body to look like is so helpful when it comes to body dysmorphia.

    39 votes
  3. [2]
    drannex
    Link
    This policy is going to cause so much suffering, and many entirely preventable deaths.

    This policy is going to cause so much suffering, and many entirely preventable deaths.

    30 votes
    1. chocobean
      Link Parent
      I would love to be part of an intuitive to walk along side our young people suffering, and to encourage them to hold on until they can finally breathe and live. Don't let those horrible people...

      I would love to be part of an intuitive to walk along side our young people suffering, and to encourage them to hold on until they can finally breathe and live. Don't let those horrible people win: live.

      If anyone knows of a sort of....big brother (?) or kids help phone type of volunteering opportunities please let me know

      7 votes
  4. [5]
    TallUntidyGothGF
    (edited )
    Link
    As I mentioned in my response to the public consultation, I just don't see how forcing a vulnerable demographic to participate in research to access a standard treatment using a drug that is known...

    As I mentioned in my response to the public consultation, I just don't see how forcing a vulnerable demographic to participate in research to access a standard treatment using a drug that is known to be safe, is not a fundamental transgression of medical research ethics. For the love of God, it's right there in the Helsinki Declaration.

    I also noted that the Cass review does not actually support or suggest repealing access to the drugs, only notes that more, and higher quality, evidence, must be collected, especially on long-term outcomes. This fact seems to be missing in many popular discussions of the matter. I agree that more evidence should be collected, however this can be approached without revoking the existing access to treatment, and indeed should be, considering the stakes, existing evidence in support of its use, and the lack of evidence indicating harm.

    A deeply foolish and shameful intervention that makes even worse a system that is already comprehensively failing vulnerable children and adults alike.

    30 votes
    1. [4]
      krellor
      Link Parent
      I don't follow the UK regulations closely, but I sit on an IRB in the US and am familiar with the policies and philosophy guiding when treatment can be contingent on participation in a research...

      I don't follow the UK regulations closely, but I sit on an IRB in the US and am familiar with the policies and philosophy guiding when treatment can be contingent on participation in a research trial. I'm happy to answer any questions on that front if it would be helpful.

      6 votes
      1. [3]
        TallUntidyGothGF
        Link Parent
        Thanks for the offer, I would be happy to hear any thoughts you have on it, or on the subject in general. I work in the healthcare system in the UK and have quite some experience with the relevant...

        Thanks for the offer, I would be happy to hear any thoughts you have on it, or on the subject in general. I work in the healthcare system in the UK and have quite some experience with the relevant ethics processes - I don’t doubt it is legal and within what is made possible by current policy, and I don’t exclude the possibility that such a movement can ever be morally justified, I just think it is fundamentally morally wrong in this case.

        4 votes
        1. [2]
          krellor
          (edited )
          Link Parent
          In general, clinical trials are done before there is good data showing that a treatment is safe and effective. IRB's are given significant latitude in their review of study protocols to ensure...

          In general, clinical trials are done before there is good data showing that a treatment is safe and effective. IRB's are given significant latitude in their review of study protocols to ensure research is done ethically. Since a large part of ethical medical research is identifying and protecting agency, IRBs spend a lot of time on the topic of informed consent, what information is shown to prospective participants, the formatting, and the appearance of inducements to participate. So conditioning known effective care on participation is compromising their ability to exercise agency.

          Generally speaking, you need to be very careful when describing what treatments are contingent on participation in a study, because it is unethical to withhold approved medical care. Additionally, there are many considerations when the participants in a study might not be a net beneficiary of the research being conducted. In the US one major reference would be the Belmont report.

          IRB's do spend a great deal of effort to make sure that research with human subjects is done ethically, and that any investigative treatments given are monitored closely, and double so with minors, where questions of informed consent are more difficult. The participants will have the possible benefits and risks explained to them, and since the participant would likely be considered to derive benefit from the study, I believe they would only need one parents consent (please don't quote me though).

          This particular situation sort of puzzles me, but I'm not familiar with the regulatory knobs and dials available in the UK. On the one hand, taking at face value the need to perform more studies to a higher standard to strengthen the standards of care, I can see the government directing new studies and some intermediary treatment guidelines.

          What I struggle with is halting new patients from receiving care while longitudinal studies are performed. I'm not worried about research participants receiving ethical treatment and care, if the IRBs in the UK are anything like the one I am on. But its pretty extreme, and rare, to walk back a previously available treatment that is known to be not only effective for at least some of the population, but the only treatment available.

          In the cases in the US that I'm familiar with, the recommendation to pull treatments from the market came after concluding no benefit. The example that comes to mind is Makena which was a drug to prevent preterm birth, but was concluded to have no efficacy. It was also the only such drug. I don't believe the FDA would have pulled the drug of it was effective for even a small subset of the population.

          So it really feels like the UK is really missing a middle ground here, where studies can be given time to occur, while still offering treatment with a revised and provisional set of guidelines. The goal should be to minimize harm, but I don't see how halting all care for minors achieve that.

          Sorry if I got a little long or off topic. I'm happy to elaborate on any details.

          Have a great day!

          11 votes
          1. DanBC
            Link Parent
            The difficulty is that many paediatric medications are not licensed for use in children because they haven't been tested in children. Most paediatric prescribing is done "off label". But puberty...

            On the one hand, taking at face value the need to perform more studies to a higher standard to strengthen the standards of care, I can see the government directing new studies and some intermediary treatment guidelines.

            The difficulty is that many paediatric medications are not licensed for use in children because they haven't been tested in children. Most paediatric prescribing is done "off label". But puberty blockers were tested on children, and they're licensed for use in children, and they're licensed to halt puberty in children. The only complication is that they're licensed for precocious puberty, not for gender incongruence.

            9 votes
  5. [9]
    Akir
    Link
    The thing that makes this seem bizzare to me is that when I was a kid I always thought of the UK as a shining example of LGBT rights, because they had civil partnerships available for same-sex...

    The thing that makes this seem bizzare to me is that when I was a kid I always thought of the UK as a shining example of LGBT rights, because they had civil partnerships available for same-sex partners.

    This is just unconscionable.

    9 votes
    1. [8]
      Arthur
      Link Parent
      We're not called TERF island for no reason. Our support for LGB people has been mediocre (for western nations). We've allowed same sex marriage and civil partnerships before many, but not as early...

      We're not called TERF island for no reason. Our support for LGB people has been mediocre (for western nations). We've allowed same sex marriage and civil partnerships before many, but not as early as a others. I've brought this up several times on Tildes but we still haven't banned conversation therapy, despite being promised it over 5 years ago. However, generally speaking, if you're LGB in the UK, you won't face too many obstacles. Being trans is a whole different story.

      We have some of the world's loudest 'gender critical' TERFs. I've heard trans people who have gone on record saying they felt more comfortable 15 years ago than they do now. Public discourse and media portrayals of trans people have shifted quite negatively. The Scottish government attempted to make trans people's lives easier and this was shot down by unprecedented action by the UK government. The leader of the opposition has either been silent on the issue or has been negative towards trans people, so things won't get too much better after the General Election later this year.

      TERFs whine and moan about how children are too young to make such big decisions in their life. Puberty blockers are the clear solution to this "issue", as it allows the children time to be sure about their transition before they begin it. If TERFs actually cared about children's wellbeing they would be the biggest supporters of puberty blockers. Instead, they're being banned because of concerns about 'bone density' and consent (because taking away all options is the best way to solve issues of consent /s). I'm almost certain TERFs oppose puberty blockers because it means they'll have a harder time 'clocking' trans people, and will have to face the fact that trans people are just like other people (Of course there are plenty of trans people already that they can't 'clock' but you'll rarely find them admitting that).

      23 votes
      1. [6]
        smoontjes
        Link Parent
        Having unfortunately read quite a few things written by these people, and seen interviews etc.. they wholeheartedly, genuinely do believe that they are saving children. Not unlike Anita Bryant....

        I'm almost certain TERFs oppose puberty blockers because it means they'll have a harder time 'clocking' trans people, and will have to face the fact that trans people are just like other people

        Having unfortunately read quite a few things written by these people, and seen interviews etc.. they wholeheartedly, genuinely do believe that they are saving children. Not unlike Anita Bryant. They really do think they are saviours and fighting a good fight and saving the children.

        They are, needless to say, totally wrong. But they really do think they're doing good.

        10 votes
        1. [5]
          Halfdan
          Link Parent
          Yes, but also no. As I see it, the thing about far-right extremists, including TERFs, is that they spend all their energy lying not only to others, but also to themselves. So while they in some...

          Yes, but also no. As I see it, the thing about far-right extremists, including TERFs, is that they spend all their energy lying not only to others, but also to themselves. So while they in some sense are fully convinced they're saints, they nevertheless have enough self-awareness to know they're pure evil and need to keep their shit stealthy, like Anita Bryant saying "I love gay people" or Rowlings claim that she accidentically liked transphobic tweets, or that she was following transphobic tweets for research, or the "sex are real" which is so hard to untangle that I honestly won't bother, but instead link to Contrapoints doing it here. Try listening to her explaination of the Motte-and-bailey argumentation, then try to fathom how the TERFs came up with the idea of using the sex is real as a motte in this truly incidious manner to hide their agenda whilst simultaniously keeping themselves resonably convinced they're the good guys. Truly remarkable.

          4 votes
          1. [4]
            Maestro
            Link Parent
            As someone who doesn't really follow any of these topics, I really did find the linked video to be rather weak. The entire section you linked to is, as far as I can tell, a lengthy debate over...

            As someone who doesn't really follow any of these topics, I really did find the linked video to be rather weak. The entire section you linked to is, as far as I can tell, a lengthy debate over language and Rowling's double-speaking, mainly on her Twitter (a linguistically dead platform). But lying is not a logical fallacy, and trying to apply a logical fallacy argument to a linguistic fallacy is just not at all compelling.

            2 votes
            1. [3]
              Halfdan
              Link Parent
              Thanks for replying, but I can't really understand what you're saying. You say that Xwitter is a linguistically dead platform, but what does that mean? Likewise, I don't get your last line. In the...

              Thanks for replying, but I can't really understand what you're saying. You say that Xwitter is a linguistically dead platform, but what does that mean? Likewise, I don't get your last line. In the 5 minutes from where I linked, the motte-and-bailey metaphor is used to lay bare the hidden mechanics of the sex-is-real argument. To me, this is the deepest analysis of the core tactics of TERF argumentation. But you don't find it compelling because, well, something I just don't grasp.

              1 vote
              1. [2]
                Maestro
                Link Parent
                Regarding Twitter, my point is that by stripping down the language on the platform to a few words, you require the readers and writers to impart a huge amount of implicit meaning in every post....

                Regarding Twitter, my point is that by stripping down the language on the platform to a few words, you require the readers and writers to impart a huge amount of implicit meaning in every post. It's just not a good way of communicating anything meaningful - it works for jokes and memes where differences in interpretation are perfectly fine, but not for complex subjects where misinterpretation is not. Much of the video you linked is analyzing tweets and phrases, but short phrases like those inherently require additional context that isn't being provided in the tweet itself.

                To maybe put the last sentence in context - Rowling certainly loves to use TERF catchphrases. And Rowling is certainly committing some linguistic abuse by being intentionally vague or lying in her usage of those catchphrases. But being intentionally vague or lying are not logical fallacies. Those are ways of avoiding staking out a logical claim altogether.

                1 vote
                1. Halfdan
                  Link Parent
                  Thanks, I think I get your meaning now.

                  Thanks, I think I get your meaning now.

      2. sparksbet
        Link Parent
        Yeah honestly as a trans person I would rather move back to the US than to the UK. And not even just to a blue state, even in most red states things are less bleak for trans people than they are...

        Yeah honestly as a trans person I would rather move back to the US than to the UK. And not even just to a blue state, even in most red states things are less bleak for trans people than they are on TERF Island.

        3 votes
  6. [7]
    not_a_doctor
    (edited )
    Link
    I'm an idiot, the ages are there. For some reason the website chose to call 17 year olds "children". That is an odd way to phrase it, which makes me think there's malice in the chosen title. Is it...

    I'm an idiot, the ages are there. For some reason the website chose to call 17 year olds "children". That is an odd way to phrase it, which makes me think there's malice in the chosen title. Is it needlessly inflammatory?

    A quick search tells me a girl can begin puberty at 10. At that age, as a parent, I might think it's best to wait a little. At 17? Oh God let the kid decide!

    It doesn't seem helpful to group 10-year-olds and 17-year-olds under "children" like that.

    7 votes
    1. TanyaJLaird
      Link Parent
      Not disagreeing, but providing some context. What's really appalling about bans on gender-affirming care for minors is that the concept of "waiting a little" is literally the foundation upon which...
      • Exemplary

      A quick search tells me a girl can begin puberty at 10. At that age, as a parent, I might think it's best to wait a little. At 17? Oh God let the kid decide!

      Not disagreeing, but providing some context.

      What's really appalling about bans on gender-affirming care for minors is that the concept of "waiting a little" is literally the foundation upon which standard healthcare for trans minors is based. First, extensive therapy is required for anything. Next, for young children, no medical treatments are given, just change of name/clothes. When the kids hit puberty, they're put on puberty blockers. The entire point of puberty blockers is precisely to give people time. You just put off their puberty until they're 16 or so. There's plenty of late bloomers who that happens to naturally. And the drugs trans minors take have decades of use behind them in treating precocious puberty. After being on puberty blockers for several years, the kids will then have the option to take cross-sex hormone therapy at age 16 or 17. They only become eligible for any surgery with permanent effects once they're 18.

      And here's the thing. There are some trans people who know REALLY early. There are some trans adults today who insisted from the moment they could first talk that their assigned gender was wrong. There are even people who have severe discomfort and dysphoria about their natal genitals and before they're even in elementary school.

      If we had perfect knowledge, we would give treatment for kids this young. If you had some magical perfect brain scanner that you could put a 5 year old in and it would report, with 100% accuracy, "this kid is trans and needs surgery," then yes, there are actually five year olds out there who would benefit greatly from full bottom surgery. Doing that on those with the strongest dysphoria really would save some lives. There are actually five year olds out there who would benefit from sex reassignment surgery.

      But we don't. Even for kids who are hospitalized for trying to alter their own parts with kitchen knives. Everybody had to wait until they're 18 before they're eligible for any surgery. (Some places allow top surgery at 16 or 17, but nowhere does bottom surgery before 18.)

      And honestly, this is one of those cases where waiting is probably best. Because we don't have that perfect brain scanner that you can sit a 5 year old in and measure their level of gender dysphoria. We shouldn't be doing anything permanent on kids so young without such perfect information.

      The entire structure of trans care for minors is based on an extremely cautious "let's wait" approach.

      32 votes
    2. [5]
      updawg
      Link Parent
      Legally you are a child until you are 18. What's weird about that?

      For some reason the website chose to call 17 year olds "children". That is an odd way to phrase it

      Legally you are a child until you are 18. What's weird about that?

      7 votes
      1. [2]
        DanBC
        Link Parent
        Not for healthcare in England. In England as soon as you're 16 you are presumed to have capacity to consent to any medical treatment, and you can decline almost any medical treatment apart from...

        Not for healthcare in England.

        In England as soon as you're 16 you are presumed to have capacity to consent to any medical treatment, and you can decline almost any medical treatment apart from immediately life-saving treatment (such as blood transfusions).

        For people under the age of 16 capacity isn't relevant and we talk about competence, and we use tests such as Gillick or Fraser to see if the child can retain and weigh up information. It's possible for a 14 year old to make their own medical choices - independent of their parents - if they're competent.

        This change is an attempt to change the law, and it's unlikely to survive legal challenge by people aged 16 or 17.

        14 votes
        1. sparksbet
          Link Parent
          Of course the same TERFs who want to cut off children from puberty blockers also have been itching to get rid of Gillick competency too...

          Of course the same TERFs who want to cut off children from puberty blockers also have been itching to get rid of Gillick competency too...

          1 vote
      2. [2]
        not_a_doctor
        Link Parent
        I suppose that, since I'm not part of UK's legal environment, when I read the word "child" I picture someone much younger.

        I suppose that, since I'm not part of UK's legal environment, when I read the word "child" I picture someone much younger.

        4 votes
        1. Malle
          Link Parent
          Off topic, and speculating: It could be difference in usage between things such as child/adult, minor/adult, child/adolescent/adult, and child/teenager/adult which feeds into this. To me, "minor"...

          Off topic, and speculating:

          It could be difference in usage between things such as child/adult, minor/adult, child/adolescent/adult, and child/teenager/adult which feeds into this.

          To me, "minor" seems more or less equivalent with "child" in the child/adult dichotomy. Meanwhile, "child" also has other well-established meanings so is ambiguous. In such cases, when "child" is ambiguous, one might go for the less or non-ambiguous choice instead, using "child" only when it is in the more narrow sense. This can change people's perception of the word over time.

          In other words, if "minor" is used instead of "child" when talking about people under the age 18 — to avoid ambiguity — "child" may more and more only be used to refer to "people who are not yet adolescent" or "people who are not yet teenagers".

          7 votes
  7. Removed by admin: 3 comments by 3 users
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