The reason Cass says the evidence is weak is that she excluded any study that was not double-blinded. But how do you double blind a study where the treatment is "stops puberty"? She excluded any...
The reason Cass says the evidence is weak is that she excluded any study that was not double-blinded. But how do you double blind a study where the treatment is "stops puberty"? She excluded any paper that showed benefit.
Also, it's striking that she demands huge amounts of gold-plated evidence to prescribe puberty blockers, but requires no evidence at all for her proposed changes.
Anyone saying PBs are "experimental" is either anti-trans or is unwittingly pushing anti-trans talking points. PBs have long been used for children, they are licenced for use in children and they are licenced to stop puberty in children with precocious puberty. This contrasts with many meds used in paediatrics which are often not licensed for use in children, and / or are being used for different conditions.
If you read the anti-trans argument you'd get the impression that thousands of children were being given these meds after a single appointment, and that rates of regret were sky high. The reality in the UK was that children had to wait for years to get their first appointment after referral, they then underwent rigorous gate-keeping psychological assessment that was deeply pathologising, they were then referred to endocrinology who'd prescribe. This ended up being very small numbers of children, and the fact that they all went on to fuller transisition after their 18th birthdays, with very low rates of regret (far lower than for eg knee replacement or cancer treatment) is evidence that PBs were only given to people who really needed them
Hopefully this means they if they say that the evidence is weak they will instead run their own (as yet unannounced) studies so we can have some quality evidence on this
It is unethical to force people to take part in medical research in order to access healthcare, and this is what Cass proposes. And the evidence for this form of healthcare is as good as, or better than, a bunch of other stuff we also do in other areas of healthcare that have equally big impact on a person's life: why the double standard? Why force trans people to be part of a trial but not anyone else?
On blinding a study, one of the issues is that if the results are so obvious even before unblinding (e.g., starting puberty), you’ll have patients going out and obtaining blockers on their own,...
On blinding a study, one of the issues is that if the results are so obvious even before unblinding (e.g., starting puberty), you’ll have patients going out and obtaining blockers on their own, outside of the study, thus negating the study. There’s also ethics issues with respect to mental health.
Many/most trans folks tend to view the British media as being near-uniformly hostile to trans issues, at best “concern-trolling”. Dan can probably give a better rundown.
META/OT: Is it just me who finds this topic - and the group it's posted in - a bit off-color? I thought we had established a while ago that ~lgbt was "for and by" lgbt people, rather than "about"...
META/OT: Is it just me who finds this topic - and the group it's posted in - a bit off-color? I thought we had established a while ago that ~lgbt was "for and by" lgbt people, rather than "about" lgbt people. I don't think this article fits that, and it feels a bit ...intrusive. And I'm not even lgbt.
If this topic hadn't been talked about to death in lgbt spaces, and there wasn't a broad consensus about it, it might be a relevant discussion to have, but I think both those ships have sailed quite conclusively.
You yourself recognized that the last thread of this was "overwhelmingly negative about the NHS stopping prescribing Puberty Blockers". So, this post does feel like continuing a painful discussion...
You yourself recognized that the last thread of this was "overwhelmingly negative about the NHS stopping prescribing Puberty Blockers". So, this post does feel like continuing a painful discussion that has already been had. If I were less charitable here on tildes, I would make the assumption that that was the intent. If that was not the intent, I would suggest you be more mindful in the future about what you choose to share in the tag, especially considering that you seem to also be a strong defender of a stance that many LGBTQ+ are negatively affected by.
EDIT: I want to make clear that my intention is not to be aggressive or judgemental towards you. Tone is hard for me.
I'm going to limit my thoughts here to the mental health side of things - if a trans kid is referred to therapy, best practices are social transition (which this report warns against), referral...
I'm going to limit my thoughts here to the mental health side of things - if a trans kid is referred to therapy, best practices are social transition (which this report warns against), referral for medical transition as puberty approaches, while still treating any co-occuring mental health concerns. That may or may not include gender dysphoria at a diagnostic level. This report suggests that neurodiversity or mental health disorders or ACEs could be the "root cause" of trans identity. And thus it says not to do any of the best practices from a mental health lens.
In 2023 trans youth (in the US) who has everyone in their home respect their pronouns had about half the rate of suicide attempts of those trans youth in homes where none or only some people respected their pronouns. To toss out even social transition means there will be more dead trans kids.
And I personally think that some people consider that a feature but far more will read this and assume that these policy changes are "logical" and aren't trans advocates just being "emotional" and I don't fucking care.
This report is a deliberately biased look at the evidence, excluding research that doesn't support the intended conclusion based on flimsy reasoning, to provide post-hoc justification for the UK's...
I would say this report lays out the reasons why. Main reason being that there is “remarkably weak evidence” that they improve the health and well-being of young people.
This report is a deliberately biased look at the evidence, excluding research that doesn't support the intended conclusion based on flimsy reasoning, to provide post-hoc justification for the UK's anti-trand legislation at the hands of an explicitly anti-trans ruling party. Of course when you deliberately ignore the evidence you don't like, it looks "remarkably weak".
She's going very much further than blocking pbs for children. In England people who are 16 or older are presumed to have capacity to make medical decisions, and a core concept of that is that...
I would say this report lays out the reasons why. Main reason being that there is “remarkably weak evidence” that they improve the health and well-being of young people.
She's going very much further than blocking pbs for children.
In England people who are 16 or older are presumed to have capacity to make medical decisions, and a core concept of that is that people are allowed to make unwise choices - even if that choice will cause them harm. Cass wants to prevent any trans healthcare (other than conversion therapy) for anyone under the age of 25. This would require a change in the law, and it is an attack on Gillick competence. And that should worry anyone, because attacking Gillick has been an explicit aim of the fundamentalist Christo-right groups
that have funded anti-trans organisations in the UK - it's how they're going to go after reproductive health.
There's remarkably weak evidence for a bunch of paediatric meds because most meds are not tested on paediatric populations. Why the double standards? Weak evidence of benefit is one thing (it's not true, she excluded a lot of evidence for bad reasons), but where's the evidence of harm? Regret rates are very low. So far the overwhelming harm we see in gender care is the lack of access to it.
Why is it reasonable to have a separate service of U25 in this area of treatment but not literally any other gender affirming care? Or any other care at all? Fertility treatment? Breast...
Why is it reasonable to have a separate service of U25 in this area of treatment but not literally any other gender affirming care? Or any other care at all? Fertility treatment? Breast enhancement? Lupus?
Do those separations restrict access to care? ETA: Mental health: That doesn't seem like 18-25 year olds are shunted into this but that they might be able to continue to access some resources til...
Do those separations restrict access to care?
ETA:
Services are usually for anyone under 18. You may be able to use some services up to the age of 25.
Mental health: That doesn't seem like 18-25 year olds are shunted into this but that they might be able to continue to access some resources til older.
Cancer: doesn't mention age or services
Social services:
Until the age of 18, services for children and young people with long-term health conditions are provided by child health and social care services.
From 18, they're usually provided by adult services.
Between the ages of 16 and 18, the child will start a "transition" to adult services.
25 is not the norm even in those areas.
Meanwhile anyone over 16 can get cosmetic surgery.
Gender affirming surgery is ok for cis teens but not trans teens.
I made edits that Note that the links you provided do not support the statements you made. At the age of 16 they can consent even if it is not always recommended. Everything I can find says that...
I made edits that Note that the links you provided do not support the statements you made.
Everything I can find says that it is in fact legal at the age of 16 to get cosmetic surgery without parental consent. Whether that surgery is recommended by a doctor or may have additional caveats before the age of 18 still doesn't restrict it until 25.
I'm not a debatey person, and will probably not continue with this discussion as it's highly distressing to me, but I really want to hear you expand on this specific point.
For most young people, a medical pathway will not be the best way to manage their gender-related distress. For those young people for whom a medical pathway is clinically indicated, it is not enough to provide this without also addressing wider mental health and/or psychosocially challenging problems.
I'm not a debatey person, and will probably not continue with this discussion as it's highly distressing to me, but I really want to hear you expand on this specific point.
I see. I think when I first read the post, I made the false assumption that it was implicitly agreed with. The problem I foresee with treating a medical pathway as a last resort is that it will...
I see. I think when I first read the post, I made the false assumption that it was implicitly agreed with.
The problem I foresee with treating a medical pathway as a last resort is that it will undoubtedly lead to under-diagnosis. As a trans person, I myself attributed my gender dysphoria to all factors other than the fact that... I had gender dysphoria. It took another decade to actually seek help for this reason. Undoubtedly, a "professional" would jump to the same conclusion as I did. Many trans people have depression, anxiety, or are neurodivergent, and these factors often lead to the dysphoria part not being taken as seriously as it should. There is a reason why many trans people exaggerate their actual feelings on their gender dysphoria, and it's because medical gatekeeping is widely known and is already a problem.
The reason Cass says the evidence is weak is that she excluded any study that was not double-blinded. But how do you double blind a study where the treatment is "stops puberty"? She excluded any paper that showed benefit.
Also, it's striking that she demands huge amounts of gold-plated evidence to prescribe puberty blockers, but requires no evidence at all for her proposed changes.
Anyone saying PBs are "experimental" is either anti-trans or is unwittingly pushing anti-trans talking points. PBs have long been used for children, they are licenced for use in children and they are licenced to stop puberty in children with precocious puberty. This contrasts with many meds used in paediatrics which are often not licensed for use in children, and / or are being used for different conditions.
If you read the anti-trans argument you'd get the impression that thousands of children were being given these meds after a single appointment, and that rates of regret were sky high. The reality in the UK was that children had to wait for years to get their first appointment after referral, they then underwent rigorous gate-keeping psychological assessment that was deeply pathologising, they were then referred to endocrinology who'd prescribe. This ended up being very small numbers of children, and the fact that they all went on to fuller transisition after their 18th birthdays, with very low rates of regret (far lower than for eg knee replacement or cancer treatment) is evidence that PBs were only given to people who really needed them
Here's a run-down of problems of the Cass review: https://www.tandfonline.com/doi/full/10.1080/26895269.2024.2328249
It is unethical to force people to take part in medical research in order to access healthcare, and this is what Cass proposes. And the evidence for this form of healthcare is as good as, or better than, a bunch of other stuff we also do in other areas of healthcare that have equally big impact on a person's life: why the double standard? Why force trans people to be part of a trial but not anyone else?
Fuck the BBC.
On blinding a study, one of the issues is that if the results are so obvious even before unblinding (e.g., starting puberty), you’ll have patients going out and obtaining blockers on their own, outside of the study, thus negating the study. There’s also ethics issues with respect to mental health.
Many/most trans folks tend to view the British media as being near-uniformly hostile to trans issues, at best “concern-trolling”. Dan can probably give a better rundown.
META/OT: Is it just me who finds this topic - and the group it's posted in - a bit off-color? I thought we had established a while ago that ~lgbt was "for and by" lgbt people, rather than "about" lgbt people. I don't think this article fits that, and it feels a bit ...intrusive. And I'm not even lgbt.
If this topic hadn't been talked about to death in lgbt spaces, and there wasn't a broad consensus about it, it might be a relevant discussion to have, but I think both those ships have sailed quite conclusively.
Bare minimum the downer tag should be added.
You yourself recognized that the last thread of this was "overwhelmingly negative about the NHS stopping prescribing Puberty Blockers". So, this post does feel like continuing a painful discussion that has already been had. If I were less charitable here on tildes, I would make the assumption that that was the intent. If that was not the intent, I would suggest you be more mindful in the future about what you choose to share in the tag, especially considering that you seem to also be a strong defender of a stance that many LGBTQ+ are negatively affected by.
EDIT: I want to make clear that my intention is not to be aggressive or judgemental towards you. Tone is hard for me.
I'm going to limit my thoughts here to the mental health side of things - if a trans kid is referred to therapy, best practices are social transition (which this report warns against), referral for medical transition as puberty approaches, while still treating any co-occuring mental health concerns. That may or may not include gender dysphoria at a diagnostic level. This report suggests that neurodiversity or mental health disorders or ACEs could be the "root cause" of trans identity. And thus it says not to do any of the best practices from a mental health lens.
In 2023 trans youth (in the US) who has everyone in their home respect their pronouns had about half the rate of suicide attempts of those trans youth in homes where none or only some people respected their pronouns. To toss out even social transition means there will be more dead trans kids.
And I personally think that some people consider that a feature but far more will read this and assume that these policy changes are "logical" and aren't trans advocates just being "emotional" and I don't fucking care.
This report is a deliberately biased look at the evidence, excluding research that doesn't support the intended conclusion based on flimsy reasoning, to provide post-hoc justification for the UK's anti-trand legislation at the hands of an explicitly anti-trans ruling party. Of course when you deliberately ignore the evidence you don't like, it looks "remarkably weak".
She's going very much further than blocking pbs for children.
In England people who are 16 or older are presumed to have capacity to make medical decisions, and a core concept of that is that people are allowed to make unwise choices - even if that choice will cause them harm. Cass wants to prevent any trans healthcare (other than conversion therapy) for anyone under the age of 25. This would require a change in the law, and it is an attack on Gillick competence. And that should worry anyone, because attacking Gillick has been an explicit aim of the fundamentalist Christo-right groups
that have funded anti-trans organisations in the UK - it's how they're going to go after reproductive health.
There's remarkably weak evidence for a bunch of paediatric meds because most meds are not tested on paediatric populations. Why the double standards? Weak evidence of benefit is one thing (it's not true, she excluded a lot of evidence for bad reasons), but where's the evidence of harm? Regret rates are very low. So far the overwhelming harm we see in gender care is the lack of access to it.
Why is it reasonable to have a separate service of U25 in this area of treatment but not literally any other gender affirming care? Or any other care at all? Fertility treatment? Breast enhancement? Lupus?
Do those separations restrict access to care?
ETA:
Mental health: That doesn't seem like 18-25 year olds are shunted into this but that they might be able to continue to access some resources til older.
Cancer: doesn't mention age or services
Social services:
25 is not the norm even in those areas.
Meanwhile anyone over 16 can get cosmetic surgery.
Gender affirming surgery is ok for cis teens but not trans teens.
I made edits that Note that the links you provided do not support the statements you made.
At the age of 16 they can consent even if it is not always recommended.
Everything I can find says that it is in fact legal at the age of 16 to get cosmetic surgery without parental consent. Whether that surgery is recommended by a doctor or may have additional caveats before the age of 18 still doesn't restrict it until 25.
I'm not a debatey person, and will probably not continue with this discussion as it's highly distressing to me, but I really want to hear you expand on this specific point.
I see. I think when I first read the post, I made the false assumption that it was implicitly agreed with.
The problem I foresee with treating a medical pathway as a last resort is that it will undoubtedly lead to under-diagnosis. As a trans person, I myself attributed my gender dysphoria to all factors other than the fact that... I had gender dysphoria. It took another decade to actually seek help for this reason. Undoubtedly, a "professional" would jump to the same conclusion as I did. Many trans people have depression, anxiety, or are neurodivergent, and these factors often lead to the dysphoria part not being taken as seriously as it should. There is a reason why many trans people exaggerate their actual feelings on their gender dysphoria, and it's because medical gatekeeping is widely known and is already a problem.