The Cass Review, a comprehensive study of adolescent gender care in the UK headed by Dr. Hilary Cass, a consulting pediatrician, was released today. I lack the expertise to evaluate it critically, but here are the points that jumped out at me:
- There's no single approach that's right for everyone. Transitioning is right for some and wrong for others.
- Overall, the evidence is thin for everything. "This is an area of remarkably weak evidence, and yet results of studies are exaggerated or misrepresented by people on all sides of the debate to support their viewpoint."
- There has been a huge increase in the number of referrals for gender treatment.
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- This increase has been so rapid that it's unlikely to be caused solely by increased acceptance of trans identities.
- WPATH guidelines for gender affirming care in children have been extremely influential, but they "lack developmental rigour."
- Among adolescents who were given puberty blockers, studies show that "no changes in gender dysphoria or body satisfaction were demonstrated."
- Hormone therapy suffers from a lack of high-quality research.
- Hormone therapy does not reduce the risk of suicide.
- Research on the long-term outcomes of psychosocial interventions is as weak as research on the outcomes of medical interventions.
One of the major themes of the report is the toxicity of the gender debate:
- The authors of the Review wanted to conduct a large-scale study of long-term outcomes but were unable to. It required the participation of NHS gender clinics, but they were told "the necessary cooperation had not been forthcoming."
- The area of gender transitioning has become so contentious that many doctors are afraid of treating gender-questioning teens at all.
- Other doctors, for fear of backlash, simply refer them immediately to a gender clinic. This skips the normal diagnostic process and risks missing indicators such as depression, anxiety, or autism.
- "One of the major challenges for the Review has been the difficulty in having open, honest debate as people with differing views can find it uncomfortable to sit together in the same room or on the same stage."
- In a BBC interview, Cass added: "There are few other areas of healthcare where professionals are so afraid to openly discuss their views, where people are vilified on social media, and where name-calling echoes the worst bullying behaviour."
The single biggest throughline in the Review is that we have high-quality evidence for almost nothing, one way or the other. Anyone claiming that the science is settled is badly misrepresenting things.
"people with differing views can find it uncomfortable to sit together in the same room or on the same stage"
Well, sort of. The gender-critical side has always been willing to engage with the gender-woo side. It's the latter who refuse to debate. There are many examples of real-life debates getting scheduled but then the trans activist bows out before it happens.
I can't imagine why that might be.
Does the "gender-critical" side include the politicians who are obviously using the issue to stir up the "Christian" base? In what way have they been engaging or actually debating? Those politicians have no interest in any actual unbiased research - the truth is irrelevant to them.
They've been active mostly in the UK and other Commonwealth countries. They're feminist journalists and commentators for the most part, not politicians. And if you think they haven't been engaging, you're not informed on this topic.
OK, now explain the 540 attempted anti-trans bills in the US.
https://translegislation.com/
If you had a better argument, you wouldn't be trying to deflect.
Two things can be true: Republicans can be trying to ban something AND the thing they're trying to ban can be unwise, per every serious systematic review of the evidence.
There's no evidence that pediatric sex trait modification saves lives. None.
This is correct.
"If you had a better argument, you wouldn't be trying to deflect."
I'm not sure what you mean. I said that gender-critical activists, who are concentrated in the Commonwealth, have been willing to debate this topic. Your link does not address what I said.
You're exactly right. Most of the gender critical people in England, Scotland, Ireland and Europe are liberal feminists who see the dangers of self ID and the dangers to children and vulnerable adults.
Right. They'd never do something politically charged like, I don't know, support a Heritage Foundation panel pushing Heritage talking points. https://www.nbcnews.com/feature/nbc-out/conservative-group-hosts-anti-transgender-panel-feminists-left-n964246
Some gender-critical feminists do appear on right-wing platforms, that's true. There's controversy among the community as to whether that's the right thing to do. But in any case, feminists don't speak on right-wing platforms to "push Heritage talking points" - they do it because they want to present feminist arguments against trans ideology and no one else will let them do that.
And since there appears to be some confusion around this, let me clarify something else. "Gender-critical" does not describe most American Republicans.
Gender-critical feminists are opposed to the notion that if a person embodies (say) feminine stereotypes, that means that person must be female, regardless of that person's physiology. Trans ideology, in contrast, embraces this view.
Most American Republicans are just the opposite of gender-critical feminists in one sense: they love gender roles and want to reify them at every opportunity.
Most American Republicans happen to side with gender-critical feminists in another sense: they are suspicious of trans as a concept.
It would be helpful if we don't conflate factions who are not the same.
They seem to be in a lot of agreement with American Conservatives though. Supporting the Heritage Foundation: https://www.nbcnews.com/feature/nbc-out/conservative-group-hosts-anti-transgender-panel-feminists-left-n964246
Welcoming neo-nazis into their spaces: https://heterosexualnonsense.substack.com/p/nz-media-regulators-say-its-perfectly
Definitely far from the Republicans here.
Gender-critical feminists, as a rule, do not "support the Heritage Foundation." I explained this above.
The Nazi story from New Zealand is made up. There was a feminist event, and some neo-Nazis showed up nearby to stir things up. The Nazis were not "welcomed."
Calling it "gender-woo" is using a pejorative to describe the people you disagree with. Describing the others with a pejorative and saying "we've always been open to reasonable debate" is a definite sign that some asshole is about to talk to me like I'm 5 so they can get applause from the audience. It's the go to rhetorical tactic of the Shapiros of the world.
I am not interested in applause.
Agreeing to debate someone is not an acknowledgment that the other side has the right of anything. Of course I'm critical of nonsense. My point is that gender ideologues are afraid of open debate because their positions make no sense.
Anyone who uses the term gender woo sounds like a gender ideologue as does in fact anyone who calls other people gender ideologies.
I have Tourette’s and dyspraxia which makes me neurodivergent as hell. I am alienated from my body to the point where the whole concept of gender seems odd and irrelevant to me. I have no trouble understanding why people might feel alienated from the gender they were assigned at birth.
You wrote: "The single biggest throughline in the Review is that we have high-quality evidence for almost nothing, one way or the other."
The two branches -- medicalize or don't -- aren't really equal, because the side effects of medical treatment are significant.
As the Cass report says, we have no good evidence that transitioning kids medically helps them psychologically. But we do know that putting a child on puberty blockers, followed by cross-sex hormones will probably make them both sterile and unable to enjoy sex. And maintaining the trans person's appearance will require taking these drugs for the rest of their life.
I don't understand how you can get true informed consent for such a process from a 12 year old.
Informed Consent? That would actually require that we really know the risks b/c, you know, there have been rigorous studies over long periods of time. Instead we get activist selling points like "You have to transition or your kid will commit suicide."
Is there some truth amongst all the lies? I suppose so ... but until we're at 99% true you just have to toss out the whole argument.
Kevin says "we have high-quality evidence for almost nothing, one way or the other".
Well, there is certainly no good evidence for transition improving lives, plenty of (perhaps anecdotal) evidence of harm and then there's the whole thousands of years of human history in which we got along pretty well without puberty blockers and cross sex hormones. So to be clear, the burden of proof is on those who wish to change this foundational status quo ... and they've got smoke but no fire.
"then there's the whole thousands of years of human history in which we got along pretty well without puberty blockers and cross sex hormones."
I'd just like to respectfully point out that this history could also be described as "people like me got along pretty well without puberty blockers and cross sex hormones and others kept their unhappiness to themselves".
To know which version is closer to the truth you need to listen to people who are not like you.
Yeah ... no.
This is the silent minority argument of left-handedness and homosexuality. Its true that our understanding of humans has changed dramatically (you're dyslexic not an idiot; etc) but that's largely an artifact of the modern world (reading isn't an essential survival skill until recently).
Homosexuality has been observed in varying ways throughout history, and has been at least understood as a thing regardless of the moralizing. And there's some interesting science and theorizing on the evolutionary role of homosexuality in promoting group survival.
But I see no way to arrive at "there's been MILLENIA of trans people suffering quietly and committing suicide because they didn't have the concept of gender nor access to synthetic cross-sex hormones." From an evolutionary perspective this makes no sense, and that makes transness a modern, probably 1st world, problem.
If you want to ignore the vast scope of history and evolution, then you need to have an argument about how the modern world is affecting people. I'll allow that it might be possible to "be born in the wrong body" ... but only if you can identify the cause. Maybe its something in car tire dust that if ingested during the 29th day of pregnancy has this effect. GREAT! now we know a) the experience of the person is not social nor psychological (in the sense of maladaptation) and we finally have a differential in diagnosing gender dysphoria. AND we can also set about banning that tire compound in order to prevent all the suffering it causes.
I have been saying for years now, what we know about transgender is this:
Some people are born with the external characteristics of one sex who report that mentally they identify as someone who should have the external characteristics of the other sex. And nobody knows why they this is so.
While I can understand transgender people not wanting to "debate" people who's entire message is FOAD, the issue I see is that if you do not accept the basic ideological underpinnings of modern transgender theory,(which again, is not based on any actual facts, aside from the statement above)you are simply lumped in with the FOAD crowd.
My guess is the increase is likely by way of rising use of certain classes of chemicals that trigger phenotype/epigenetic changes.
Plastics and plasticizers would be my primary suspects -- many of the plastics we use, even if free of phthalates and BPA, are estrogenic.
In which case, shouldn't we be a bit more concerned about the wide use of PVC, PEX, and all other plastics? As noted in prior years, upwards of ~90% of food, water, and persons in America have microplastics, and on average, Americans consume tens of thousands of microplastics every year.
My second guess would be particulate pollution of a particular type, on account that they have, through the olfactory, direct access to the CNS, skipping the blood-brain barrier.
Or maybe all of the above.
Puberty blockers were developed to deal with early onset puberty. There was a number to theories as to what triggers it, hormones in food supply to endocrine disrupters--but I haven't looked into that recently.
GnRH agonists were developed to fight prostate cancer, then employed as chemical castration for sex offenders, then roped into a few more uses, including giving them to kids who start puberty in kindergarten or first grade.
When given to a 5 or 6 yr old girl, the two year implant leads to menarche at 8 or 9 (the normal range for menarche is 9 to 17 years). Nobody has any solid data on what happens when you put one in the arm of a 12 yr old girl, but we've done it many many times at this point.
It's a scandal, is what this is.
The number of trans children, as in those who want to physically transition to the opposite sex, is exceedingly small. It's different than gender-neutral and even cross-dressing. That makes high quality studies almost impossible to carry out.
So it's anecdotes and meta analyses of small studies. Not great.
The number of kids who identified as the opposite sex used to be vanishingly small, as in 2 out of 10,000 kids. More recently the numbers have been skyrocketing (se chart above).
The problem is that the Dutch had an idea and just ran with it, and instead of saying "where's your proof that this is safe and effective?" the rest of the world grabbed it and ran as well.
The Dutch noted that adult transsexuals (mostly MtF) were not terribly happy and had high suicide rates. They wondered if that was because they did not pass as women, and hey what if we tried these GnRH agonists that block all sex hormones? They thought the puberty blockers would give kids "time to think" but as it turned out, it just concretizes what could have been a temporary cross-sex identification.
In the before times, a supermajority of trans-identified kids re-identified with their sex as they went through puberty. A majority of them turned out to be gay.
There is an odd claim here, and another in the Guardian article from her. The odd one above is that the rise in the increase is so rapid that it is unlikely to be a result of increased social acceptance. Actually an increase in social acceptance seems to be one of the things that would best explain a rapid rise in referrals. A commenter above thinks this is meant to mean that there is something in the water causing the spike, When I read it I thought the idea was that it had to be something beyond mere acceptance to actual social preference. But it seems very weird. The reason that gay couples have become so much more visible than when I was young is that homosexuality has become more socially acceptable. It is actually hard to think of something else that so clearly could explain a rapid climb, something that before was not considered acceptable now is. I am curious why that claim was supposed to make sense.
The other is an odd claim that puberty blockers do not give people more time to make decisions about transitioning. It would seem almost by definition that they do. Whether that time is used to make better choices may be questionable, but obviously if one is going to choose to transition it would be better to do it before puberty. The guardian article gives this as if it makes sense, but it really doesn't seem to.
Of course it is funny to see that the comments so far are mostly from opponents of gender care for teens who take the report to prove people on the other side are wrong, but then go on to assert, against the evidence of the study, that we know that these things are harmful. Of course Drum himself is drawing the conclusion that the study actually draws that drawing such a conclusion in either direction is premature.
What can explain a rapid rise of anything is a fad. People do what those in their peer groups do and this compulsion is certainly not absent from pre-puberty children. Such children have little or no understanding of what it really means to be male or female as they don't have the hormones which determine reproductive behavior. There are stereotyped gender roles for boys and girls but those may be more in service of preparing them for their adult roles than a result of any physical differences.
If the current proliferation of children wanting to change gender is largely a fad then the question will probably be decided simply by time as some other fad takes its place.
I didn't say that social acceptance is the only thing that can explain a rapid increase, just that it is one of the things that can explain a rapid rise. What you are saying is that you prefer another explanation, which is fine, but does nothing to counter the oddity of saying that the rapid rise cannot be explained by acceptance.
The fad theory is really the flip side of the social acceptance side. One involves a social bar being removed, the other involves a social advantage being conferred. So are you agreeing that the thing I pointed to is weird? Or are you just giving your pet theory?
"Actually an increase in social acceptance seems to be one of the things that would best explain a rapid rise in referrals."
I think social contagion is a much better explanation. (The idea of "something in the water" is indeed nonsense.)
"It would seem almost by definition that [...] puberty blockers [...] give people more time to make decisions about transitioning."
No, and the study writeup explains why. Children who go on puberty blockers almost universally go on to cross-sex hormones. Blockers aren't a pause, they're a fast track.
People diagnosed with cancer almost universally go on to receive treatment for cancer. This does not make it a conspiracy, it just makes sense. If someone thinks they're trans, the doctor listens to the patient and agrees that the likelihood is good, but just to be sure let's use the puberty blockers to give another couple years to be extra sure and talk through it even more... Yea, they're already understanding who they are, another few years of introspection is far more likely to confirm than it is to produce a sudden reversal. Liken it to cancer just disappearing all on it's own.
Cancer can't disappear on its own. Cross-sex identification can. That's exactly why immediate medicalization shouldn't be the first approach.
In the days before routine use of puberty blockers, most kids with cross-sex identification desisted with the onset of puberty.
Cancer CAN disappear on its own. It doesn't happen often, but it happens often enough to have a name; "spontaneous remission".
And therefore we should give children puberty blockers, QED.
As I noted to the other person who made your first comment, that isn't really responsive to the point I made. Your explanation is very similar to the one being rejected above, it involves changes in attitudes towards such treatments. And what we seem to be agreeing about is that such changes can produce rapid growth in treatments. Isn't it strange then that the study thinks that such a change cannot produce rapid change.
With your other point maybe you aren't being clear. People take puberty blockers because they think they are transgender and want to avoid puberty which will move their body into what they see as the wrong gender. If they are right then it is not surprising that when they choose they would decide they are in fact transgender. The opponents of this treatment are contending that they are being rushed into it. The idea seems to be that in many cases it is a phase that they will pass out if given the chance. What you claim as evidence seems to more directly support the idea that it is not a phase, the kids are not being pushed into it, they are simply reflecting their beliefs about their bodies.
Why is what you give as evidence that hormone blockers are a fast track not really just evidence that most people who choose to go on hormone blockers for this reason are not just going through a phase?
It is true that I picked these two examples of strange claims because they seemed to suggest the author had a slant against gender care for teens. Your defenses of her seem to make this more explicit. They both build in a slant against gender care for teens.
"Rising acceptance" as an explanation for an increase in cross-sex identification in young people only makes sense if there were thousands and thousands of closeted trans children in past generations. There's no evidence this was so.
So your evidence is that something that was being kept hidden was well hidden? Given the population of the world it would be shocking if there were not thousands of such cases in history. Now the numbers are even higher than that. But you seem to be making clear here that you are not really making arguments based on evidence.
I repeat: there is no evidence of an epidemic of closeted trans children in previous generations. "Well it was hidden" is wishful thinking, not an argument.
There is no argument to respond to. You decided that in a country of 300 million people with little acceptance of people outside of gender norms there could not have thousands of transgender children. That is inane. It is possible that there were not such children, but you have no evidence that there were not. And the fact that you think you do shows that you don't understand how evidence works.
We have plenty of experience with how gay people used to be closeted. But you have just decided that you can tell that there were not a significant number of closeted transgender people at a time when there was even less acceptance.
You have to make an actual argument before you can expect people to answer it. When you just reveal your prejudices then people should just laugh at you.
"There is no evidence this happened" is not the same as "I have proof this didn't happen." I'm stating the former, which is a fact. You appear to be reading me as saying the latter, but I did not.
That out of the way, "there is no evidence" is still telling.
I see you were not making an argument against the idea that the rapid rise in gender referrals was due to increased acceptance of such treatment, you were just repeating the confusion of necessary and sufficient conditions of your previous comment. So we agree that it is quite possible that the rise is due to that, and the author of the study is wrong to say that this couldn't be true.
Dude. Parse my words all you like. I stand by what I wrote, which was:
""Rising acceptance" as an explanation for an increase in cross-sex identification in young people only makes sense if there were thousands and thousands of closeted trans children in past generations. There's no evidence this was so."
That's the same thing the Heritage Foundation panel said. What a good faith way to explain that the people disagreeing with you are not acting rationally because they've been infected. That's certainly a humane way to describe the people you disagree with.
Again - I do not have to claim people are acting rationally when they're not, out of some sense of being "humane."
Further: The study doesn't *prove* that "gender-affirming care" is harmful, no. And it asserts that the evidence base is thin on either side, yes. The problem is that "gender-affirming care" *is* the standard *despite* that lack of evidence. This is a scandal.
The "evidence" that gender-affirming care (without the scare quotes) is helpful is in the tens of thousands of lives that attest to how much happier they are after receiving it.
I could talk about my own daughter, or I could point you to surveys. Which do you prefer?
You want to ban it, it seems, with no evidence of any harm. And there's definitely no evidence of harm to any other parties.
If you're going to point to anything published by young Jack Turban (who has made a career of datamining the 2015 USTS), we're going to have to have a discussion about the uselessness of convenience sample surveys for medical research.
But sure, what's your favorite survey?
The Cass Review says that virtually everyone who uses puberty blockers moves on to hormones, so *effectively* they have little impact. It's a bit of a strange argument, but it kind of makes sense.
If one thinks that the people who go on hormone blockers because they think they are transgender actually are transgender it is not at all curious that they would then go on to get the treatment appropriate for being transgender. If one believes that preteens go on hormone blockers because they are going through a phase, or because it is cool, then it is surprising that they would almost all go on to more serious treatment. If the authors of the Cass Review are presuming the latter their conclusions are somewhat suspect.
They seem to be suggesting that being transgendered is a choice like anti-gay activists have claimed that being gay is a choice, and so their evidence suggests that the choice is made when they get the blockers and then just confirmed later. But if the children are really transgender, then the evidence does not support what they are claiming.
Note the usual argument is that preteens can't yet know if they are transgender, so the decision should be put off until they can make an informed choice. The complaint is that these preteens are being forced into a choice they will later regret. Here we have evidence that these critics of of hormone blockers are wrong, and yet it gets warped into an argument for the opposite. That seems worrisome if one is going to use this study as a standard for where the evidence lies. The problem with hormone blockers was not supposed to be that they fail to stop people from become transgender. It was supposed to be that they hurt children who later learn they are not. It sounds like the evidence they should have announced is that this latter fear is overblown. Instead they interpreted it in almost the opposite manner.
Right.
My first clue that something was wonky in pediatric gender medicine was when everyone involved told me that 99+% of kids put on puberty blockers go on to the cross sex hormones and the rest, and then looked at me like "See? The kids, they know who they are!"
I've been a pediatrician more than 25 years. 99+% of kids can't hold on to what they want to be for Halloween in two months. They're kids! Adolescents are in an identity formation period, and it's normal to try on various identities. What's not normal is medicalizing it.
I've met too many detransitioners to have 100% confidence that kids "know who they are" when the thing they're supposed to know is that there is something wrong with their body, that somehow they have a girl brain in a boy body, or vice versa.
By all reports it appears that the number of detranstioners is a quite small percentage, in fact it appears that it is small enough to be consistent with the claim that "virtually everyone" who gets the hormone blockers goes on to get further treatment.
The usual attack on the people who support how things are currently being done is to accuse them of ignoring the science and basing their views on anecdotes. But you seem to be doing exactly that here. The study by people who show no signs whatsoever of being biased in the direction of gender therapy shows that a very small percentage of these children change their mind as they would if your analysis of the situation were right, and your response is to claim some anecdotal cases.
I was wrong describing the paper that showed a 29.8% discontinuation rate for cross sex hormones over a 4 yr period in a large population. It was published in 2022, not 2021. Here:
https://academic.oup.com/jcem/article/107/9/e3937/6572526?login=false
This is really important. Hormones give. They do not take away. Putting someone on estrogen without putting them on T blockers means that they will develop BOTH male and female secondary characteristics.
Seriously, that's so wrong it hurts.
It's testosterone that acts like that. Most transmen have their ovaries shut down by the massive doses of testosterone they are taking.
Giving puberty blockers to females puts them into immediate menopause and has led to significant bone issues.
But note the study that shows the benefits to such care have not been established also can't establish the harms. If you think the harms are real then you think the study is insufficient. And yet you still use it to attack the other side.
Can't it be all three?! Some increase is explained by social acceptance, some by social contagion, and some by changes in the environment? Oh, and almost certainly, some by bad data.
Of course it can. But the claim above is that the rapid rise shows that it is not primarily due to acceptance, and that is a very strange claim to make. It would not at all surprise me if it is some combination of the three. But I am trying to understand the mindset of someone who takes it as obvious that a rapid increase in numbers shows that it cannot be due to social acceptance. My worry is that it indicates writers who were predisposed to rule out the idea that what we are seeing is an undertreated problem getting the level of treatment it deserves. And such people are likely to read the data in ways that fit their preconceptions.
The issue with puberty blockers is that a lot of people figure out their sexuality by going through puberty.
What we see IRL is that if you put a gender dysmorphic child on blockers, 98% of them will end up on X-sex hormones. But something like 90% gender dysmorphic children not put on blockers revert to their CIS identity after puberty. Most turn out to be gay.
And there's no doubt that putting a child on puberty blockers followed by X-sex hormones is harmful. Doing so sterilizes the child.
The sterilization of children has been justified by claims of high rates of suicide being reversed by treating with puberty blockers and the rest. This is nonsense. There is no data to support this, and growing data that suggests the opposite. It's chilling, when you look at it.
Chen et al, 2023 was the first paper to report on a large NIH-funded multicenter study of pediatric sex trait modification via puberty blockers and cross sex hormones. Multimillion$ study, in what are supposed to be the best gender clinics in the United States:
https://pubmed.ncbi.nlm.nih.gov/36652355/
"The most common adverse event was suicidal ideation (in 11 participants [3.5%]); death by suicide occurred in 2 participants." <-- from the abstract
That's a horrific suicide rate, it's more than 20 times the background rate for kids in this age group. In the application for NIH funding, the researchers said they planned to track 8 measures of mental health. They reported on 2 of them. What happened with the 6 measures they didn't report??
I saw on Twitter that the Cass study rejected something like 98% of studies (which coincidentally found positive results for gender transition) because they did not meet their standard for rigor. For example most of the positive studies did not include double blind testing. However, since it is impossible to do that, the motives and conclusion of this study is sketchy at best. (It is readily apparent if you are giving a placebo or hormones to a person so no double blinds).
Sure double-blind is a gold standard, but there are LOTS of other research designs that build credibility. For instance, random assignment to treatment groups and having actual control groups. These are easy to do ... and the baloney about we can't do these because its withholding "lifesaving care" doesn't hold b/c all cancer studies, etc use these. ( and yeah ... further evidence that this is all off-label, non-FDA approved, experimentation on live subjects).
Its easy ... kids come in seeking help. You say "We don't really know what to do so we'll randomnly assign you to a treatment and we'll see what happens and we'll follow up for the next ten years". The fact that this hasn't been the standard, and low quality reigns, is one of a) they don't want to know b) they do know, and don't want to share that c) its all about ideology, so who cares about pesky evidence? d) they really have no idea what they are doing and aren't qualified to do actual research.
"It's impossible to do a double-blind study" --> "gender-affirming care is A-OK."
Really?
Yeah, you saw that on Twitter but did you see any references to high quality studies that were rejected because they weren't "double blind?" No you did not.
Evidence based medicine is a thing. It's a whole field of study and there are reasons that we value large sample sizes over small ones and controlled studies over "you know what would be cool. . . " (which is basically what the original Dutch Studies turned out to be).
The original Dutch Studies, which started with ~110 kids, selected the first 70 who qualified (introducing bias) and completed the process with 55 kids, one of whom DIED from sepsis secondary to the use of colonic tissue for vaginoplasty (when you block puberty, the penis does not grow large enough for the usual penile inversion procedure, and you need to use tissue from somewhere else).
They only collected full data on like 40 of their subjects, and the biggest positive results, on the UGDS (Uttrecht Gender Dysphoria Scale) came from *switching the questionnaires* after "sex reassignment surgery."
In other words, at the end of the study, they were asking young people with non-erectile phalloplasties if their erections bothered them, and they were asking other young people without a uterus if their periods bothered them. Of COURSE the scales improved! The whole field is full of piss poor "science" like this.
It's a scandal, is what this is.
The Dutch studies? That was back in the 1980s! If you have to go back to the era of rampant homophobia, nuclear nihilism, smoking on airplanes, and trickle-down economics to find your scary data, then maybe you're not bringing you A-game? Much of what happened in the 1980s is not ok now, and looking at healthcare from back then to demonize modern healthcare is as ridiculous as it sounds. Try looking up WPATH standards, you'll see that there's no vaginoplasty nor phalloplasty done on anyone underage. The only surgeries done under the age of eighteen is - extremely rarely - someone who has had some breast growth (by the way, this ONLY happens if puberty blockers were denied, so further evidence for the implementation of puberty blockers) at age 16 or 17 might have breast tissue reduction if it is plainly obvious that the patient is trans and it would be an obvious benefit for the patient. I hope you can understand the logic in all this.
We all saw Jazz Jennings get genital surgery at 17 on national TV. Surgeries are happening to children all the time.
I know women who declared a trans identity, were put on PBs and then testosterone and had their breasts removed, then changed their mind and detransitioned ALL before they made it to 18.
There are more and more detransitioners every day, exemplifying the fact that gender identity is NOT internal, eternal and immutable.
The latest WPATH Standards of Care (SoC 8) removed all age limitations for treatment.
Yes they did.
They also removed the Ethics Chapter and added a new chapter on Eunuchs. A document suggesting that children could identify as eunuchs, with links to "The Eunuch Archives," an old style website that has a lot of basically story porn (fiction, I hope) about castrating young men against their will.
"The Dutch studies? That was back in the 1980s!"
Um, NO. Its generally considered that the first paper of the cluster of work referred to as the Dutch Studies came out in 1996. Further work was done through the early 2000s - with actual patients from that period - and the authors have continued to publish.
The studies are worse than not being double blind -- of course you can't do that.
But I've read a bunch of these studies. What you see in them are one or more of the following flaws:
1 -- very short follow up periods, like 3-12 months
2 -- loss of large numbers of participants to followups
3 -- very biased survey samples
4 -- very small sample sizes
You also typically don't find any evidence of improved mental health.
The editor in chief of the British Medical Journal has posted an article about the Cass Review here: https://www.bmj.com/content/385/bmj.q837
In it, he says: "One emerging criticism of the Cass review is that it set the methodological bar too high for research to be included in its analysis and discarded too many studies on the basis of quality. In fact, the reality is different: studies in gender medicine fall woefully short in terms of methodological rigour; the methodological bar for gender medicine studies was set too low, generating research findings that are therefore hard to interpret. The methodological quality of research matters because a drug efficacy study in humans with an inappropriate or no control group is a potential breach of research ethics. Offering treatments without an adequate understanding of benefits and harms is unethical. All of this matters even more when the treatments are not trivial; puberty blockers and hormone therapies are major, life altering interventions. Yet this inconclusive and unacceptable evidence base was used to inform influential clinical guidelines, such as those of the World Professional Association for Transgender Health (WPATH), which themselves were cascaded into the development of subsequent guidelines internationally (doi:10.1136/bmj.q794)."
It does seem odd that a British consultant could summarily dismiss the currently available evidence, while the American medical establishment — the AMA, the American Academy of Pediatricians, the American Psychological Association and the American Psychiatric Association — seems to accept it.
Yeah ... there are some very interesting structural differences at play here. Criticisms of adoption by the Endocrinology and Pediatric associations make it pretty clear that the "endorsement" was a) never actual put to membership to consider or vote on b) was adopted without looking at actual evidence. I can't speak about the other orgs.
Regardless, the Cass report is based on a review of evidence. There is plenty of evidence that the aforementioned medical groups adopted their policies for political reasons, not medical ones.
And ... remember, the Cass report is just the most recent domino. Other European health services have been conducting their own reviews and rejecting the WPATH/TRA position.
1) Nothing about the study was done "summarily." I suggest you read it.
2) Hilary Cass is a pediatrician, not a "consultant."
3) The American medical establishment is wrong. This fact will come out in due course.
bad Jim wrote, "the American medical establishment — the AMA, the American Academy of Pediatricians, the American Psychological Association and the American Psychiatric Association"
Cressida responded, "The American medical establishment is wrong."
Cressida, I really wish I had your level of oblivious self-confidence. It must be nice to live like that.
Well, I'll say that Cressida is probably looking at the direction of medicine in Europe and reading the trendline. We do a lot of that around here.
What basis do you have for asserting the AMA etc are right?
Five Parrots, I guarantee that I've spent more time learning about this topic than you have. If you don't like my comment, that's your business, but it is not "oblivious."
I came away from your comments that you were a fairly credible, fairly thoughtful person. Until your last two, that is. Now my impression of you has switched to the polar opposite of the above, that is, that you're _not_ credible and you are _not_ thoughtful.
You might want to chew on that one a bit, and what most people here do for a living. TL;DR: you're not endearing yourself to them.
This forum attracts a disproportionate number of people who sound intelligent, and probably *are* intelligent, but who have the fatal character flaw of lacking any love for truth.
I'm not trying to endear myself to anyone. All I said is that I'm not "oblivious." Not sure why that's such a cardinal sin, but OK.
I love this!
{dump a bag of evidence on the table }
"But that's not MY Truth so its clearly wrong!"
or from Leor Sapir:
"A: all experts agree.
B: here are experts who disagree.
A: they don't count as experts.
B: why not?
A: because they're transphobic.
B: how do you know?
A: because they disagree."
What we're seeing here is the oft observed distinction between one group that wants evidence and another group that is operating purely on faith and emotion.
Ignore the rotting flowers and stinky shoes.
You're also coming across as disturbingly literal-minded. That's not a good look either. It suggests you are incapable of doing nuance.
"you might want to chew on that"
"you're not endearing yourself"
"that's not a good look"
Lefty comment spaces are so embarrassing sometimes. Shaming tactics do not work on me, so save your breath.
Your peers are judging your intellectual rigor and finding it wanting.[1] That expiicit enough for ya? Lest you misunderstand (or pretend to misundertand) you're not being pranged for your conclusions; you're being pranged for how you got there.
[1] Being found wanting is not shaming, it's _grading_. Peer review if you want to fancy it up. Which suggests there's more than a little paranoia inside of you.
Readers, just follow this thread and judge for yourselves.
LOL - my tangles with ScentofViolets on this and other issues leave me confident that I have the nuance of a ballet dancer vs that of a bulldozer.
"I guarantee that I've spent more time learning about this topic than you have."
Irrelevant. The question is whether you know more about it then the people who deal with these issues every day because their jobs require it: the people rikiwilchins cited below.
The reason I believe in global warming is not because I'm an expert in climatology. It's because I listen to those who are experts. I wish more people would do so.
It's not irrelevant at all. I was only explaining why "oblivious" is not apt. If you want to think I've interpreted a situation incorrectly, that's up to you, but it's inaccurate to state that I'm unaware of that situation.
Dr. Cass is a highly respected pediatrician and it took over four years for this report to be released, she certainly wasn't dismissing any real evidence. What you are describing is ideological capture of major American medical organizations. If you look at their statements, they all reference each other.
Only the Endocrine Society bothered to do a review of evidence, and then they made strong recommendations based on weak evidence. They said basically "we're just the mechanics, we can't tell you how to diagnose gender dysphoria, but we'll tell you how to transition them."
It was the American Academy of Pediatrics that leapt into that breach saying "Ooh! Ooh! We know how you identify the kids to transition! You just ask them!!" The 2018 AAP statement is full of errors and has this odd disclaimer that Dr. Jason Rafferty is solely responsible for its content. He was a protege of Michelle Forcier (the "can a chicken commit suicide?" professor) and was simply a true believer in the religion of the gendered soul.
There is no blood test, no scan, no certified questionnaire that can identify the minority of children who will maintain a transgender identity long term. We are flying blind, particularly in pediatric gender medicine.
The AMA, the APA - they just followed suit. No evidence review at all.
Wow, you sound like a climate denialist. This is the same argument they make about the overwhelming scientific opinion that's against them.
"They all just cite each other". "Ideological capture".
Yeah. Sure.
LOL - you sound like a flat earther!
There is boatloads of evidence for agw.
The Cass report just said there is essentially no evidence for gender transition in children & teens.
What is the common thread here?
Not so odd. For example in general American medicine is in favor of circumcision (mgm) and European medicine is not. Using the same evidence.
In America the medical establishment circles the wagons because Republicans want to hurt people.
Circumcision is a cultural thing, not a medical/scientific thing. The rate of circumcision in the United States is dropping, particularly on the West Coast.
Pediatricians should not be telling parents that circumcision is medically indicated, because it is not, at least not universally.
I am not in favor of state legislatures telling doctors how to do their job. I am also not in favor of medical organizations ignoring a growing body of evidence, which is what is happening with my professional organization, the AAP.
Well, it's not just the UK. The public health departments of Sweden, Finland, Denmark, Norway and France have similar positions as the UK.
Also, this isn't the only study that dismissed gender affirming care in the UK. The Tavistock center was shutdown earlier as well.
Kevin writes: Anyone claiming that the science is settled is badly misrepresenting things.
While this is true, that is not all that is going on. There is a belief system, not at all scientific, that asserts that a female can in some sense "really" be a male, or that a male can have an "innate gender identity" that is female. This underlies, for instance, the concept of "transgender child" and the image is indeed very powerful. While strictly speaking this is not a religious viewpoint, it is quite similar.
One must admit that there can be other interpretations , for instance as a psychological disorder or simply as a "gender journey". But the metaphysical notion is the one that captures so many minds. It is quite similar to the intuition that we each have a soul. Who could doubt it?
You are right. The idea of an innate gender identity that is separate from one's physical body is very much like the idea of an eternal soul.
Trans Women Are Women is pretty close to a catechism. There are many parallels.
I find it fascinating that the usual suspects who hang out in Kevin's comment section are studiously ignoring this post. I hope it's because they are engaging with the nearly 400 page report and preparing their studied rebuttals. I look forward to seeing what those can be.
It reminds me of when I had an adolescent German Shepherd of some size and he was a bit obnoxious in the dog park (no fights, just rudeness, paw on the shoulder type stuff). Then one day there was a magnificent mature male GSD and I thought "Good, finally someone will put this rude child in his place!" However, my dog studiously ignored and avoided the older GSD, thus avoiding this outcome.
I went looking - a little - for responses for Cass reactions from WPATH, HRC, etc. Nothing. They seem to be assiduously avoiding the topic, which is probably smart and yet at the same time it shows their utter disregard for evidence.
In a few days I will post it to DKos. I have been a member for 20 years. We'll see if I get banned.
Learn from my experience: if you are being swarmed and down-rated, stop adding comments that can be down-rated. Your score can get to a point where you are autobanned, and there is no return.
Just post the piece and let it stand for itself.
I admit, it is hard for to get past the moral/ethical dimensions of this to the medical questions. It seems to me that broadly speaking, you believe in an individual's right to bodily autonomy or you don't.
We can discuss at what age that right "kicks in," I guess, but the reality is that there are very few people of good faith with whom to have the debate and even if you are lucky enough to find one of those people, the argument between "I have a right to be who I am" and "the science is unsettled" would appear to be a case of people talking past each other.
An individual's right to bodily autonomy is easy to accept when the individual is an adult. The issue is when you think of young kids and what is the best decision that can be made on their behalf.
I am a parent, and I don't really know how I would have reacted if I had encountered such a situation with one of my kids. I love my kids. But I also know that the love I have for my children, however sincere, is imperfect, skewed by self-delusion, narcissism, projections, and many other things. Ultimately, I wish them to grow up with a sense of agency over their lives, be their own person, be able to make choices, and hopefully act in a way that will result in some good in this world. What they will become in time, is a fact of life. It is not entirely under my control.
It is one thing to imaging having to contemplate a medical treatment for a grave ailment (heart surgery, orthopedic corrections, etc) on a young g child because you believe that this will increase the range of possibility in the future. But having to make hard complex socio-medical decision about trans-treatment with young kids must be a nightmare. Personally, I think I would choose prudence. I would resist and postpone a decision about trans-treatment out of fear of causing more irreversible harm, and would go down this road only if I felt that there is really no choice and no other alternative.
As I said, we can discuss at what age that right to bodily autonomy kicks in, and one dimension of that discussion is the role of parents.
I am close friends with the parents of two trans offspring (wo different families), one of whom is now 15 and the other of which is now in his 20s but who has identified as male since he was 12 or 13. Both sets of parents have been supportive, and both offspring appear to have benefited from that support. In both cases, the road to transition was strewn with obstacles that everyone in the families found difficult and hurtful.
That admittdly anecdotal personal experience has probably informed my position on this, which is that creating even more obstacles to transitioning is cruel and insulting to the people involved. At the very least, it seems to me, you should have very powerful data on your side before you deny people the right to choose to be who they say they are. And the whole premise of this article is that no such definitive data exists.
Maybe this comes down to where the burden of proof lies, and I understand that people of goodwill can differ. People of ill will, however, seem to be pretty unanimous. Which s aways te way, it seems.
Thank you both for these replies. "Ultimately, I wish them to grow up with a sense of agency over their lives, be their own person, be able to make choices, and hopefully act in a way that will result in some good in this world." If all parents thought his way this probably wouldn't be a big issue. I trust thoughtful, caring parents, doctors, and kids to work this out themselves and government can stay out of it. Unfortunately, not everyone is thoughtful and caring. This does not mean it must become a public policy issue. We could, of course, decide that people have the freedom to make bad decisions. We do that in many cases.
"Maybe this comes down to where the burden of proof lies, and I understand that people of goodwill can differ."
THIS
The thing is, a lot of times youth DONT KNOW who they are. So they may be uncertain as well. And there are people on all sides telling them they are this and that.
Or maybe let 'em do whatever they want; it's their life. People can make mistakes at any age. That's how we assemble "collective knowledge", given that we can't experiment on people in any controlled way.
The saddest aspect of this: The very first bullet point from the study says "Transitioning is right for some and wrong for others." And yet this thread quickly filled with people saying transitioning is wrong, period.
Nah, the joy here is that the Cass report pushes gender transition waaaay back in line with other treatments and considerations, and actually encourages treatment of pre-existing conditions. Listening to detransitioners its quite obvious that many of them were told "Transitioning will cure your anxiety, your depression, your trauma, your autism, your history of sexual abuse, etc" and then they discovered it didn't.
I've always allowed that there might actually be "people born in the wrong body" but we don't have a test for that. Until then its a really seems a side-effect of other untreated conditions.
Or, the hate isn't for Trans people ... its hate for the lack of evidence. Its hate for permanent solutions to temporary problems. Its hate for big-stick solutions over subtlety and patience.
"Transitioning will cure your anxiety, your depression, your trauma, your autism, your history of sexual abuse, etc" and then they discovered it didn't.
No one other than anti-trans bigots say this.
"no one other than anti-trans bigots"
You should probably expand your media consumption.
Oh Kevin. Really? There is no medical debate over pediatric care. There IS a political one though. It is a mystery to me that you are wiling to pick apart WSJ data but accept trans-critical reports like this with total credulity. For the record, cisgender kids routinely access the same or similar hormonal medications to cause similar bodily changes (or pause/prevent them) for precocious puberty and contrasexual puberty, and have w/o problem since 1980. They only become "controversial" when trans kids take them. Also the following 27 natioal medical organizations have ALL endorsed care as safe, recommended and effective for trans kids:
American Academy of Child and Adolescent Psychiatry, American Academy of Dermatology, American Academy of Family Physicians, American Academy of Nursing, American Academy of Pediatrics, American Academy of Physician Assistants, American College Health Association, American College of Nurse-Midwives, American College of Obstetricians and Gynecologists, American College of Physicians, American Counseling Association, American Heart Association, American Medical Association, American Nurses Association, American Osteopathic Association, American Psychiatric Association, American Psychological Association, American Public Health Association, American Society of Plastic Surgeons, Endocrine Society, National Association of Nurse Practitioners in Women’s Health, National Association of Social Workers, National Commission on Correctional Health Care, Pediatric Endocrine Society, Society for Adolescent Health and Medicine, World Medical Association, World Professional Association for Transgender Health
The report addresses this. Medical institutions tend to cite each other, without evidence. That's how you end up with myths stated as proven fact.
Please. Now you sound like a creationist. "Sure, every major scientific institution says I am wrong, but I don't care."
It's in the report.
Ah. My mistake. It's Dr. Cass who is acting like a creationist.
Many American and Canadian institutions, yes, but there's a completely different view of treating gender dysphoria in Europe.
"There is no medical debate over pediatric care " Um ... yeah. The whole Cass report is clearly debate. The British Medical Journal is following suit as well. The Norwegians, Swedes, Finns... they've practically SETTLED the debate.
Saying "there is no debate" ignores the many medical professionals who do not agree with these positions - and really, you have to understand how these associations come to adopt them - and its not by careful presentation of evidence to all members and having them vote. Its done by small committees that are more worried about steering their organization through the shoals of shifting opinion than any actual evidence.
"There is no medical debate over pediatric care" is akin to Putin or any other strongman insisting the 99% FOR vote is a clear indication of support and love int he country.
This is the fallacy known as appeal to authority. It fails even as that, because the health authorities of multiple western countries with longer histories of providing medical transition have decided that pediatric sex trait modification is unwise.
I had a difficult child. We went through all the testing. Spent lots of money.
Tried some different prescription meds to no avail.
Nobody ever asked us if, perhaps, the child had gender dysphoria.
She did, she told me and transitioned at 25. She is very happy now.
I wish those books they want to ban had been on the shelf; that someone had asked me if, just maybe, she suffering gender dysphoria.
And if you are wondering about her private bits: it's rude to ask people about their genitals.
I agree, we probably have very little scientific data on the outcomes of different medical treatments; because my experience suggests we were almost completely medically blind to the condition just a few decades ago.
What you have here, along with Doctor Jay, is a case study. An anecdote. Its worth just as much as a desister or a detransition story. It is worth consideration but it lacks applicability.
What we will never know is what the outcome would have been without transition - this can go either way. This is why we have to look at larger collection of data for evidence of effectiveness. And the Cass report simply states there isn't evidence that children should take the path your 25 year old did.
You are full of bull hockey.
Because we do know the outcome without transition, since the transition did not happen until she was 25.
We knew she isolated herself and could barely leave her home, constantly thought about committing suicide, and did not feel that life was worth living.
And we know that after two brief weeks of estrogen, she felt lonely and we know that now, more than a decade later she thrives (and is on her way to earning a PHD in computer science).
So yes, it is an anecdote, but to dismiss it because we don't know what would have happened is exactly the problem most transgender people face; we want to dismiss them and their needs instead of listen to their stories when they tell us what they need.
Men did that to women, too, for centuries; dismissed them and their needs and essentially forced them into household slavery. We don't know what would have happened if men had not done that; but you still seem to cling to the habit. You should work on that.
Meanwhile the trans people themselves say that transition has made them much, much, much happier.
https://ustranssurvey.org/
So, while I support science, I think it has to take that context into account.
Do we say, "we need more research" when a cisgendered teenager wants a boob job? Do we pass laws forbidding it? How about when a 20 year old wants it?
Or when a 40 year old male wants HRT because his testicular cancer wrecked him? Do we say, "we need more research?"
NONE of the treatments that trans people seek and want were developed for the purpose of assisting transition. Absolutely none of them.
Hormone blockers were developed to address early-onset puberty, for instance.
I'm all for knowing more, it's when that's used as an excuse to demonize a class of people and deny them the thing they need to be happy that I have a problem.
Absolutely. My daughter had to go through 2 years of therapy and (again) try an antidepressant.
Finally, after all that, she was given estrogen and an anti-androgen,
Two weeks after beginning this regime, she called and said the last thing in the world I had expected to hear from her, "Mom, I'm lonely." The child who had always isolated wanted to be with other humans. Two weeks into taking estrogen.
My daughter is beautiful. She's brilliant. She's kind and caring and generous. She's gentle. She is a fine human, and I'm proud of her and love her beyond measure.
But it was a long, dark road getting there, and I believe we could have done a better job if we'd had more knowledge about gender dysphoria. Not judgement, but knowledge.
And how are you? Longtime, no see. Glad to see you're still thinking.
+1
Wow, zic. It's great to hear from you. I didn't know that I could add you to the list of people I know with whom I share a parenting challenge.
Why don't you take a look at this: https://stainedglasswoman.substack.com/p/oh-st-my-child-just-told-me-theyre
I think you'd like this writer.
And by the way, is Tom still playing? I listen to those recordings and think of y'all.
Thank you, I'll read this later today when I rest.
And yes, he's got a gig Sunday next in Cambridge.
"NONE of the treatments that trans people seek and want were developed for the purpose of assisting transition. Absolutely none of them."
YES - that is the problem. There has never been an FDA application to demonstrate that these are safe or even necessary. Sure, gnRh agonists were first commercialized for precocious puberty - and also used in veterinary settings - and that's what it is labeled for. LOTS of drugs are used off label and that's between a patient and a well-informed doctor. But as Cass states - and others have before - puberty blockers are not harmless and evidence shows they are probably more harmful than beneficial.
So again ... you experience is a case study. I'm glad its worked for you. I insist on a higher level of evidence.
BTW out of 3499 patients audited by the Cass Review, only 10 detransitioned and they only spoke to 2 to find out why. Once again, detransition is proven to be incredibly rare.
That's a detransition rate of 0.2% which is actually LOWER than most studies, which are around 1% or sos.
The reason the "detransition" rate was so low is that the gender clinics themselves did not follow up with patients. Again, this is in the report.
One small point: In these discussions Republicans *always* point out that gender-affirming treatments cause permanent, irreversible change in people's bodies. But they never mention that puberty does, too.
Nor do they mention that every single treatment used to treat gender dysphoria is also done - was created to treat - cisgendered people, usually in much greater numbers.
And gosh, nobody's talking about banning them in this context.
"This increase has been so rapid that it's unlikely to be caused solely by increased acceptance of trans identities."
This seems like an assertion based on nothing, and in defiance of common sense. Better luck next time.
There has been a change in the last 20 years over criteria needed to medically endorse transition. One of them, and this is important, is there was a "hetero" requirement. After transition, the patient was required to be heterosexual. This cuts down the field A LOT.
This was dropped something like 10 to 15 years ago, and has resulted in a lot more people getting treatment, or even realizing that they are trans.
Because sexual preference is not the same thing as sexual identity. Not at all.
Between 1940 and 1970 the proportion of left-handed children rose by 6X (2% in 1939, 12% in 1972). This coincided with the era when social rejection of left-handedness vanished and lefties were finally accepted.
According to the report, the increase in cross-sex identified children increased 100X over about ten years and shows no sign of stopping. So, not quite the same thing.
General rule of law with respect to parenting: it is legal to do anything to your children that is not clearly harmful. The bar for restrictions is very high.
So to you anti-trans haters out there: bleep bleep bleep. The giant bleep that you can bleepity bleep with is over there —>.
I thank you in advance for staying out of my family’s business until you have proof of serious harm.
I've read a majority of the comments and I'm specifically interested in the claim that, "we have high-quality evidence for almost nothing, one way or the other." I don't believe this to be the case. We do have high quality evidence that transition helps; however, it was omitted for an inconsistent application of evidence standards.
I'm linking here to a good article that was published prior to the full release of The Cass Review, https://www.tandfonline.com/doi/full/10.1080/26895269.2024.2328249. This article looks at the pieces of the larger review that have been released between 2020 and 2023. I want to specifically call attention to section 4 under results which looks at the evidence standards used. If you're interested in the subject area it is worth a read. As a good example of how the reports evidence standards are flawed, read the following,
" For reasons of fea-sibility and ethics no RCTs have been conducted, nor are any currently planned. Even for preco-cious puberty, a planned RCT into puberty block-ers was unsuccessful when participants in the non-treatment arm noticed their puberty had not been blocked, and dropped out of the study in order to access puberty blockers from a different source (Mul et al., 2001)."
RCT being Randomized controlled clinical trials
The Cass Report generally flattens a lot of discussion and good science by just presenting some evidence against trans healthcare and omitting any evidence that says otherwise and relies on some older evidence specifically on desistance that is clearly worse than more modern studies.
I'm glad Kevin commented on The Cass Report, but I believe assuming all of its evidence is based in good faith is not a good idea. Consider for a moment that the report is perfectly trying to do science: Why would almost every study which reaches a negative conclusion about trans healthcare be included, while also failing to include existing peer reviewed studies demonstrating the benefit of gender affirming care for children which reach higher standards of evidence then some that are included?
Here is the editor in chief of the BMJ writing on the same topic:
https://www.bmj.com/content/385/bmj.q837
After reading the whole of this article, it mischaracterizes the cause behind a lack of studies. This article provides grounds for people to call all of trans medicine a 'scandal' when it makes unsubstantiated claims like, "A spiralling interventionist approach, in the context of an evidence void, amounted to overmedicalising care for vulnerable young people." This is outright misrepresenting even The Cass Report's own data. The Cass Report only had less than 10 desistances (which their evidence on the theory of desistance as a whole is outdated and actually worse in quality compared to more modern studies).
It also refers to the omitted studies as "inconclusive and unacceptable" which I can tell you is not true. Even if this were true SHOW ME. The Cass Report puts in no effort to engage with WHY the evidence omitted is inconclusive and WHY it is unacceptable. If the evidence doesn't meet your quality standard then provide some theory for how it got the results it did, rather than just ignore it exists.
It is a practical fact of science that we can't test everything as thoroughly as possible because of ethics. Studies attempted to have control groups but those control groups left the study because in this instance control means not giving people the healthcare they need. The Cass Report asks for the impossible and then lowers that bar to include other studies that align with the author's political beliefs. This is not good science.
Even if RCTs are impossible, it still wouldn't justify proceeding as if RCTs had been done and had shown unmitigated success.
If RCTs can not be done, we are obligated to be *more* cautious, not less.
We are sterilizing kids, many of whom are autistic, many of whom would have grown up to be healthy gay adults, some of whom have unexamined histories of trauma.
I fear the backlash to this is going to set back gay rights and trans rights for decades.
I am not saying we should act as if RCTs exist. I am saying an "Independent review of gender identity services for children and young people" that attempts to be comprehensive should consider what studies we do have. The Cass Review has failed to include countless studies which do demonstrate positive effects for children who transition. The fact that those weren't included in The Cass Review means any conclusion The Cass Review tries to make is missing crucial data.
Can you share a link to one of the countless studies that demonstrate positive effects for children who transition? I need to expand my reading, because I haven't seen those.
Anyone who went to a gay bar in the 20th century noticed a small but significant number of transvestites there. These people were almost certainly trans. I also suspect many if not most “butch” lesbians were in fact trans people who were passing as lesbians. Ang of course this doesn’t reflect the closeted trans people who couldn’t dare come out even in a gay bar.
I have dyspraxia which means gender means so little to me beyond sex and peeing I would identify as nonbinary if I cared enough about gender.
The notion any of this is new or just a fad reflects people’s cosseted lifestyles and the bigotry that existed before. The number of trans people may be inflated or it may also be a reflection of edge cases like mine in which people straddle the gender worlds but the notion that this was something very rare before and it’s mostly a fad now is as silly as people thinking people were gay because of their mothers or they couldn’t cut it with women (sentiments that were common when I was growing up)
Oh my, yes. The gay bars also had the best comedy acts and the best fill-in-the-blank nights.
I want to bring out the discussion below which Drum was nice enough to contribute to because I think it says something about the author's perspective.
There is currently a divide on gender care issues that has been noted by many. On the one side we have what can be called the woke crowd, represented by every major medical organization in the US. Their view is that while there is a lot of gender exploration among children, by the time that children reach the point of wanting interventions like puberty blockers, it is likely because they are transgender, and that between the parents and the doctors involved we should expect that children get puberty blockers for transgenderism because they are transgendered.
Against this we have two groups that may be uneasy partners. We have the religious crowd that things there are no transgender people because it is an affront to God who created Adam and Eve, not Adam and Pat. And then there is the (liberal) anti-Woke crowd that accepts that some level of transgenderism is real, but that because of the evils of wokeness children who are just going through a phase, or have other mental conditions are being rushed to gender clinics where they are being pushed into treatments like puberty blockers.
The nice thing about this split (ignoring the Adam and Pat crowd which likely isn't interested in evidence anyway) is that puberty blockers, by delaying when more serious measures are taken, creates a natural test of these two theories. If the woke crowd is right, then the children who get puberty blockers would go on to further treatments. If the anti-woke crowd is right then we would expect a significant number of children who take puberty blockers to regret it and not get further care.
This study which apparently provides evidence of nothing else does seem to answer this question. Apparently the number of children who regret the puberty blockers is negligible. Victory for team woke, and a real blow to team anti-woke. But oddly this gets reported as if it is the opposite. Instead it is presented as if the choice disappeared when they got the puberty blockers. I could see ways in which that might be justified. Maybe it would be unhealthy to not do the further treatment after taking the puberty blockers. Drum helpfully provided the answer. It is simply that the children do not change their minds over time that is taken as evidence that the choice has been taken away from them.
To me that suggests something about where the people behind this study are coming from. If someone has a different way of understanding this I would be interested in hearing it.
There is another odd claim above, that the rapid rise in children sent to gender care cannot be due to changes in acceptance of that care. Again this seems to be off in the same direction. I don't see any odd statements that could be read to suggest a balancing slant. If anyone else has seen something that suggests that these odd claims are balanced rather than putting the thumb on the scale for one side I would be interested in that as well.
"The nice thing about this split (ignoring the Adam and Pat crowd which likely isn't interested in evidence anyway) is that puberty blockers, by delaying when more serious measures are taken, creates a natural test of these two theories."
Your are simplifying and presuming WAY too much here to get to your preferred conclusion of the test your are proposing. First, this is by no means an insignificant action - the effects of delaying puberty are significant, and allowing a body to continue to grow absent sexual hormones means that important brain development doesn't happen ... and little things like a loss of 10 pts of IQ are noted as well as irreversible bone density problems. Those aren't pretty serious!
Second, you're assuming a sterile system. Its not. Those kids are affirmed, told how brave they are, asked how excited they are to start the next phase of their transition, told that misgivings are normal and they just need to stay the course. and generally given attention. What we've seen elsewhere in this machine is that you are given love and attention up until the moment you question it ... and then you're cut off.
This means that any fair test - randomly assigned of course! - would mean that the non-medicalized group would get the same amount of resources and attention ... and be told "you're so brave to resist the trend and be the real person you were born into." Then I'd believe that the real difference in group conditions was the Lupron.
And really, do you think that 99% of 12 year olds are really fixed on anything in their lives? This is when I knew we were being lied to - there is no "time to think" with this, the decision has been made and kids are on the fast track to further transition. You've essentially preserved their identity in amber and prevented them from going through the very process of growing up that is essential to identity formation.
so sorry, you "test" is meaningless as presented. Throw in an RCT with a comparable non-medical intervention and then we can talk.
How is it that you know so much about all these kids' experiences? And they are all so similar? I can also imagine some of what you describe going on (well with the exception of advice to ignore misgivings. Anything is possible, but would a loving parent or qualified medical care giver really give advice like that?). Encouragment, validation, these seem like good things though it is conceivable one could cross a fuzzy line into persuasion and even pressure.
But aren't these kids much more routinely shamed and ostracized? Wouldn't many teens who feel they are trans wish with all their hearts that they could just be "normal"? Wouldn't they be wishing they had acceptance and respect while getting none? Indeed they might feel these things so strongly they take the tragic and irreversible step of suicide. Where is that in your "Those kids" tale above?
I confess feeling alot of discomfort about surgical procedures and hormonal therapies on minors. What if it is an irreversible mistake? But you know what? My discomfort is irrelevant, as is yours. Like abortion, it is simply no one else's business.
Besides, I am way more skeptical of all the claims that all these kids are chosing such a difficult path to be "cool" or to please a "woke" parent. Does not pass the sniff test by a long shot. And it is the height of hubris to imagine your armchair, outsider opinion should carry any weight, let alone more, than the choices of other human beings you don't even know.
"How is it that you know so much about all these kids' experiences? "
Well, I listen. I read. I observe. I engage in conversation. And most importantly I listen to the experiences of detransitioners because they are the "errors" in the system, and an old axiom on data and model analysis is that you have to be able to explain your errors (not ignore them).
"But aren't these kids much more routinely shamed and ostracized?" In ways, yes. My observation is that there are a lot of comorbidities that already have a kid feeling excluded/weird/unaccepted ... at least more than normal. But within on-line communities and school counselor offices they find loving acceptance, And then more of that in the Gender Clinic.
OF COURSE kids are going to go along with it. Its a nutrient gradient. They need accepting peers, they need to belong.
What they don't need is medical experimentation, permanent solutions to temporary problems and insistence that they have fixed characteristics than cannot and should not change via growing up.
And yeah, if you're in Oklahoma or something your experience might be different. I'm in peak-liberal Portland.
You listen to "detransitioners."
Yet most long-term studies suggest there are so few people that detransition as to be none.
I suggest an alternative: you are performing the same sort of conversion-therapy torture that was done to gay and lesbian people to make them be hetero.
Perhaps you're not giving good, solid medical care, but you're abusing people who are already amongst the most-abused group of people in the world.
Sickening.
There Are No Long-Term Studies. It's right in the report.
"Detransitioners" with quotes. Lovely.
To the rest of the world, isn't it interesting how the discussion goes like this:
a) We have to do all this stuff for this group of transgender people!
b) why? Its so few of them, why bother?
a) how dare you ignore a vulnerable minority?
b) aren't there people who detransition, making the number of transgender people even smaller?
a) They don't really exist, and if they do Fuck Them
Ah. "Anecdotal data for me but not for thee."
Not my kid. Nobody asked, the idea of being 'trans' was not on anybody's radar in 1990's.
So your hypothesis is flawed; there are controls to compare, they're just generational. Which was my whole point below.
You present the very worst side of medicine, where it's all statistics about the patient lives/dies but lacks any consideration of quality of life.
I was a bit sarcastic about how clean the test is. But it is certainly good prima facie evidence. I was curious how much the people on the anti-woke side were interested in evidence. You seem to be one data point on the side of not very.
First you seem to have gotten the experiment wrong. We are looking at a group that got the hormone blockers an seeing if over time they decided to get the further treatment. You have an argument that the people who got chose to get the further treatment were treated better than those who did not. But that comes too late in the process to affect the test (and apparently applies to too few people to be significant anyway).
You then fall back an a priori argument which grossly distorts what is going on here. After all, the children who feel so certain that they are transgender that they can get doctors to put them on hormone blockers does not represent 12 year olds in general. Did you really miss that, or just not care if you were making a serious argument.
Note that your arguments actually argue against your position. Can you imagine 99% of teenagers being fixated on something? In general no. The fact that the ones that get hormone treatment remain so suggests that this is not just the kind of passing phase you want to claim, without evidence, that it is. The variable nature of children in general actually tells against taking the evidence here the way you do. But then you began with your conclusion right, and worked back to the evidence.
This is a dog's breakfast of an argument.
Currently, families are told that puberty blockers are a harmless pause that give a kid "Time To Think" <-- that's the name of Hannah Barnes' excellent book about the rise and fall of the Tavistock, the world's largest pediatric gender clinic. The NHS has closed the Tavistock.
As Anna Hutchinson, a therapist at the Tavistock who became a whistleblower said "what's the chance that among hundreds of kids given time to think, every one of them ends up thinking the same thing?"
I was told by everyone, from the trans woman running a youth group (and support group for parents, including those who had moved from OK and TX to OR so their kids could get transition covered by public health insurance) to the pediatric endocrinologist, was that 99+% of kids put on PBs go on to the rest (hormones, etc) and that's proof that kids know who they are.
I thought to myself no, that means your puberty blockers are not a harmless pause, they are concretizing what was formerly a temporary cross sex identification in most children.
There's a reason England and Finland and Sweden and Norway have restricted access.
Here's a lecture by Dr. Baxendale about puberty blockers:
https://youtu.be/z5ZnRKqqByg?si=KkjQxpJyfGR3Bjfk
I think a level-set is in order.
There's a faction who are opposed to transitioning minors; call them Side A. There's a faction who encourage transitioning minors; call them Side B.
I'm seeing a through-line on this thread along the lines of: Well, the Cass Report concludes that the safety and efficacy of transitioning minors is pretty much uncharted territory; the topic has a thin evidence base. Therefore, neither Side A nor Side B should take the Cass Report as any kind of vindication.
Here's why that argument is wrong. Side B has *thoroughly* captured all institutes of health in the US and UK. We've been transitioning minors for years, and now we're being told that we don't have good evidence that that treatment is safe and effective.
Damn straight Side A sees that as vindication! It's cold comfort for the children who received inadequate treatment, unfortunately, but at least we can put a stop to it going forward.
Your framing strikes me as slanted from the outset. In a way very similar to the pro-life crowd wanting to recast pro-choice as pro-abortion. I think it would be more fair to characterize Side B as those who believe that transitioning minors is a valid option in the right circumstances.
Also, I would suggest that the only good evidence that it is not harmful would be the lack of evidence that it is. Am I wrong about that?
Fine. In my second paragraph, replace "minors" with "minors who present with a desire to transition."
Nothing else changes.
I disagree about your side B.
Parents to not come to transitioning easily. Those I know got there because they saw transition ease the mental anguish and suffering that could be eased in no other way.
But the people you pretend to be arguing for, the children who received treatment, don't seem to think they need any comfort at all. If these children were being seriously harmed this survey should have picked up on that. And as you acknowledge it did not.
This is not a case of mentally ill people being sent for shock treatment. This is a case of people choosing a treatment for what they perceive as a problem and generally coming away thinking they made the right choice. If there were serious harms those people couldn't identify then that would be significant. But there isn't. It is not them that are unhappy with their choice, it is you.
"don't seem to think they need any comfort at all": Tell that to Keira Bell, Chloe Cole, Ritchie Herron, or any other detransitioner who's gone public.
Less than 10 people detransitioned in The Cass Report. I don't think we should completely discount those who detransition but that's far from the drastic over prescription of HRT that people gesture at. The Cass Report's own data shows a regret rate less than we see for hip replacement surgeries and lip fillers.
I said this above, but again:
The reason the "detransition" rate was so low is that the gender clinics themselves did not follow up with patients. Again, this is in the report.
Does the report substantiate that or is that just a claim without something to back it up? This lower detransition rate is consistent with studies from other countries and the UK studies that were thrown out, some of which did follow up, especially the non UK based studies.
So now you're suggesting I read the report for you?
If you search "follow-up" in the report, you will find multiple references to "lack of follow-up" or "attrition in follow-up" or "follow-up fell off over time" or "short follow-up" and the like.
I'm not saying this *proves* that detransition rates are higher than the clinics claim. But if you fail to follow up and then tout "we found no detransitioners!", then a) yes, the low detransition rate is an inevitable result of your follow-up policy and b) don't be surprised if you meet some skepticism.
What I mean by substantiate is something very simple, the report provides the theory that detransitioning is underreported because of a lack to follow up. Does it actually show that this MUST be true? I can make the unsubstantiated claim that "actually the people who detransition would self select and follow up themselves so the hospital itself doesn't need to follow up,"
OR "we don't need to follow up because we can just track which people stopped getting their prescriptions and that would be an overestimate of the detransition rate as some people might transfer provider without directly reporting it."
Now neither of those claims I made are scientific or scientific, they are both theories that could be true, just like yours. Stop claiming a 400 page report that does no science and DOESN'T ACKNOWLEDGE THE STUDIES THAT DO FOLLOW UP (which you ignored from my previous message).
None of the claims you are making are scientific, don't be surprised if you meet some skepticism.
I'm just applying Occam's Razor here. Of course anyone could come up with multiple explanations for the low detransition rate. I just think the one I raised is clearly the likeliest. You disagree. OK.
There are a small percentage of people who get abortions who are then regretful that the option was available to them. They stand out for their rarity. What you seem to be indicating is that something similar is going on with detransition. The fact that the few that have have become celebrities in the anti-transgender circles suggests that they are not very common.
And the fact that virtually none of the children who go on hormone blockers decides not to continue on. Here the issue is not one of a lack of follow up. Additionally, the question of what percentage detransitions is not subject to the problems that led to their ruling out other studies. The question isn't whether this group does X more than a comparison group, but whether people who get this treatment feel it was a mistake to do so.
Here is a case where all of the evidence is against you and you are stuck arguing that all of the available evidence could be misleading. And that is always possible. But it is a rather evidence free way to bet.
Lots of words here, but my position is not complicated. US and UK providers have been transitioning children even though the evidence for the safety and efficacy of that treatment is thin at best. If you want to defend that, go ahead. I do not.
. . . and the practice is about to halt, for the most part, in the UK, after an extensive evidence review commissioned by the NHS.
But 95-90% of children who *don't* go on puberty blockers revert to CIS (typically gay) identities. This is consistent with the idea, which I've heard a number of cis gay people say, that people figure out their sexuality when they go through puberty.
So, the evidence is consistent with the idea that most gender dysphoric children will turn out to be cis (and probably gay) if they go through puberty, but if they get put on puberty blockers, they'll end up lifelong medical patients, sterilized and with lessened sexual function. That doesn't sound like a harmless treatment.
And of course, that's nothing like abortion. Getting an abortion doesn't have any long term physical downsides (it's safer than being pregnant). And as we've seen in various red states, failing to get an abortion after a partial miscarriage can cost a woman her fertility, her health or even her life.
When you have a child starting on puberty blockers at 10 -12, and progressing to X-sex hormones (as 98% of children put on PBs do), you have a case of children who have no idea what they're signing up for, electing a treatment that means lifelong treatment with hormones.
I just don't believe that a 12 year old can give informed consent to being sterilized and losing all sexual function including the ability to have biological children. I don't think they have a clue about what they're agreeing to.
This is also why I think it is a bad idea to teach young children that they can choose to be a boy or a girl. You're teaching them nonsense -- we simply don't have the technology to do that. We can make a boy *sorta look like* a girl and vice versa, but that's not the same thing, obviously.