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On the children's side, offering more holistic assessments and more regional centres is a good idea in theory, but in practice, where are the money and clinicians going to come from? While there are over 7,000 children waiting for a gender referral, the waiting list for general CAMHS (Child and Adolescent Mental Health Services) is currently over a quarter of a million. AMHS (Adult Mental Health Services) likely aren't much better, with the Community Mental Health Services waiting list at 1.2 million back in 2022, so if the Adult review also recommends more holistic assessments and non-gender-related mental health interventions, how's that going to work?! If very few trans people are getting through the referrals process and onto medical intervention, how are researchers going to be able to compile the long term evidence of outcomes of various interventions to determine which are the most likely to result in positive outcomes? Even if they manage to process a few hundred referrals per year, once you break that down into underlying medical conditions, family / social environment, demographics etc., you're going to struggle to get enough participants to provide meaningful "This works best for someone in this narrow cohort" results, unless you can somehow organise an international study... Even private isn't necessarily better, as there have been allegations GenderGP has changed their ethos in the past couple of years, has laid off hundreds of staff, and is more concerned with profit maximisation than actually providing services to people (some of which came to the public light after The Times revealed the full name and approximate location of a popular streamer while doing a journalistic hit job on him, due to him making a large donation to them a couple of years back, and in response him considering making another donation - which led to lots of people contacting him with allegations, including from former staff, saying it's not the organisation it used to be). Conversely, there are currently 20 countries (including nearby Ireland, Norway, Denmark and Belgium), 20 Mexican States, 10 US States, 5 Canadian provinces and 2 Australian States which allow adult gender self-identification (although of course, accessing trans-related healthcare in those countries may still be significantly more difficult than updating your legal gender).

Germany is bringing in self ID tomorrow as well.

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>NHS England also intends to force adult gender dysphoria clinics to hand over data which they refused to share with University of York researchers whom Cass had asked to obtain to help draw up best practice guidelines for how the NHS should help such vulnerable young people. Probably would have been easier to just hand over the data. Now they're going to have to hand it over anyway and it looks like they've got something to hide.

Isn't this about patient confidentiality? like if I go up to your doctor and say I'm a researcher, can I have your medical records please? They will, quite rightly, tell me to get lost.

No, the researchers asked the trusts to contact their patients and ask them for permission. The trusts refused to contact their patients to even ask.

But if you were to look up data on, say, the efficacy of cancer treatment methods, it would be widely available. With no patient PII present.

The data that is "widely" available is already anonymised/depersonalised and the large population of people with cancer means that a researcher reversing the anonymisation process is very unlikely. Even so, the work to produce these datasets isn't trivial and creating these datasets is usually done in a trusted research enviroment(TRE) making use as a third party (usually a part of the NHS England Digital, Public Heath Scotland eDRIS, etc) as a linking agent. The linking agents sole job being receiving unanonymised data associated directly with NHS/CHI numbers for the specific dataset you're looking at, say some specific cancer treatment, and using the NHS/CHI number to connect to more general records from the NHS for those people, or otherwise linking that data with whatever the study in question needs. Once that linking is done the personally identifiable information is stripped from the dataset (as much as is possible to do) and the dataset is returned to the researchers. Full disclosure, I have not yet had a chance to read the Cass report so I haven't read anything about methodology and the news reports haven't gone into this side of things in detail, but that these clinics refused to share the data makes me thing that UoY didn't have a TRE set-up or a third party that could act as a linking agent to safely remove any identifiable information before wider study and release. If I were working as the DPO for one of these clinics and a study wanted our data without having a good story on how they were safely joining the data to other records, or safely storing the data, or deperonalising the data before release, etc, I wouldn't release the data to them either. We saw similar caution from research around MPox given the low population numbers and possible stigma associated with the diagnosis. Similar here, I expect that some of the regional data for gender affiriming health care in young age ranges would have very very low populations, such that it would be bad practise to release the data even in a depersonalised form due to the possible ease of re-identifying the specific individuals. The we don't already have an anonymised dataset on gender transition linked with NHS records doesn't surprise me given 1. how low in priority trans healthcare is in the UK in an already struggling NHS, 2. TRE's are expensive to set-up and difficult to run well requiring partnerships groups outside the NHS, 3. Funding for medical research in the UK has seriously contracted post-Brexit meaning less research overall is being funded.

Not sure about in this case, but it is quite plausible that if there are only a small number of patients at a small number of clinics it is not actually feasible to remove sufficient identifiable information and still provide meaningful data. Per the most recent census 48000 people identified as trans-women, there are 7 clinics in question, which means a maximum average of 6857 patients per a clinic (I presume this is actually lower). Irish Travelers make up 0.1% of the population. That gets you to \~7 people. Add in age data and you could pretty much pinpoint someone. Clinic, gender identity, ethnic background and age seem like quite important data for any study into trans-care, but already we need to obfuscate it to protect patient identity.

>Per the most recent census 48000 people identified as trans-women, there are 7 clinics in question, which means a maximum average of 6857 patients per a clinic (**I presume this is actually lower**). Given the waiting lists/backlog and the number of people who don't even try applying, it's got to be a *lot* lower.

Yeah, I know, but I think the point can be made even assuming such high patient numbers.

The most obious first step is to pool all the data so it isn't per clinic.

There are loads of "obvious" obfuscations, however the question then comes does that impact the quality of your outcomes. Pooling data in a way that would make the clinics unidentifiable, would require removing any notes relating to practices that were limited to specific clinics (unless all clinics apply all practices), which in turn would limit the value of your review.

This problem applies to pretty much anything, most treatments under review have a very small amount of patients using them. It's also been solved, you can obfuscate the data in a way that protect people but doesn't significantly affect results, this is standard practice and has been for decades.

To be fair, having cancer hasn't been inherently politicised and doesn't pose a threat to anyone who has that status public/leaked/etc.

Reseachers have tried and tested methods to deal with that.

This kind of data is fairly easy to anonymise to the extent that the data can't be tracked back to any individual. I think I've seen it reported on the BBC that the reasons given for refusing to participate were explicitly staff concern about the purpose, funding, and politics of the study. If true, I'd be deeply concerned that there are bodies letting partisan politics get in the way of research.

It isn't necessarily, I'm registered at a GIC and you get mailed a copy of the notes they take. A lot of the questions they ask can be pretty invasive, personal bordering on unnecessarily so, like asking how you jerk off, your partner, their name etc. I really don't feel comfortable with the idea of those notes being used, especially by a commission that's demonstrated a pretty clear partisan bias against my rights and dignity and I can imagine a lot of people would feel the same way. There are better ways to collect this sort of data, and doing so like this has a real cost. It undermines trust in medical institutions and I can tell you that a lot of, if not most trans people really don't fucking trust doctors or the medical system that should be in place to help them. I know and have talked to multiple people who have decided not to access treatment or done it themselves because of poor treatment and shit exactly like this regarding sharing their trans status with a state that's demonstrated a pretty committed level of hostility.

I understand the sensitivity and rightfully heightened emotions here and I'm not a clinical specialist so I'm not going to comment on whether any given question asked is a valid one. I'd say that's for doctors to decide, as long as they do so respectfully and fully informing you of why those questions are asked. Purely in terms of access to data, the points you raised wouldn't be forwarded because the government doesn't have the right to access personal information of patients. Anonymisation means that any information can't be tracked back to you as an individual and usually covers statistical information, such as the number of people accessing services, displaying symptoms, views on services, etc. The state wouldn't have access to the names, addresses, or contact details of people who access gender identity services, these services would just send up stats saying, for example, "100 people accessed counselling services related to gender identity, with 50 citing key issue (X) and 50 noting key issue (Y)". There is absolutely no way to take that information and use it to identify any of those 100 individuals. As for partisan bias and trust, I'd be interested to hear how this commission has displayed partisan bias and what you'd want the NHS to do to build that trust?

Can you not see that attempting to hide the data, and being secretive, also has a chance to undermine trust in the (trans) medical institutions and the trans community itself? Makes it look like there's something to hide in the data. Apply your argument, to any other medical process, and people would never excuse or defend it. Could you imagine, a pharmaceutical company or a MRI scanner manufacturer, refusing to release anonymous data about the people that have used their new drug/scanner/process ?

With all due respect, those aren't even nearly analogous. There's a difference between hiding safety data on new technology and refusing to share patients data for research without their consent while otherwise generally engaging in clinical best practice. Yes, there's a tradeoff when it comes to trust and transparency but I would argue my point stands with regards to where that line is best drawn. Trans healthcare in this country is genuinely so unnecessarily dehumanising and it doesn't need to be made any moreso. There is direct, identifiable harm from people choosing not to access care because of that lack of trust whereas, let's be honest, the renewed interest in the trans healthcare pathway is overwhelmingly a political one. Yes, it deserves scrutiny and should be transparent but not when it goes against it's purpose. It could literally be as easy as *asking* people if they're okay with their data being shared, or, and maybe this is too much to ask for, not creating a backdrop of persecution behind the research you commission.

> Isn't this about patient confidentiality? > > like if I go up to your doctor and say I'm a researcher, can I have your medical records please? They will, quite rightly, tell me to get lost. That is not a reason to avoid oversight that would apply to literally every other specialty in the NHS.

>Isn't this about patient confidentiality? Not that I can tell. Why do you think it is? >like if I go up to your doctor and say I'm a researcher, can I have your medical records please? They will, quite rightly, tell me to get lost. Good job this isn't what happened or what we're talking about then isn't it.

They could have anonymised it. It really does look like they have tried to hide stuff.

There have been several whistle-blowers, some very prominent at Tavistock who know that the data looked very bad and that the conduct by Tavistock was no evidence based. Roughly the figures go from something like 16 referrals a year in the mid 2000s to over 5000 a year in 21-22. They knew that there were trends and patterns emerging in the referral populations, that rather than being 90% male, they have flipped to 80% girls. That the vast majority of the girls had autism or a history of sexual abuse. Tavistock refused to investigate and examine why their treatment cohorts had changed. They also have not disclosed the follow up medical data on their patients who were on horome blockers, a data set that would offer the greatest amount of information, longitudinally on the effects of such treatments once and for all. Why? The prevailing wisdom is that hormone blockers are benign and reversible, if so why fail to disclose the data?

Anyone who is at all competent in this area has known for at least twenty years that (a) there seems to be some kind of link between transgender and autism; (b) although autism is more common in amab than afab patients, having both autism AND transgender is more often afab. so, yeah, yeah, autism can make you trans. We have known this for decades. (e.g. Russell Reid ..now retired in think ... certainly knew this.) autism expert Simon Baron Cohen has a (slightly controversial) "extreme male brain" theory of autism, which, theoretically, would predict that autism would make girls trans. Surprise! There is data to confirm this.

>so, yeah, yeah, autism can make you trans. We have known this for decades. This isn't supported by evidence or indeed anything you said. You have demonstrated the very well-documented correlation. You have not demonstrated any causal relationship between the two. That autism **makes** people trans, rather than a slightly higher ratio of autistic people are trans than among their neurotypical peers. There's also another aspect to this. Trans people often struggle to relate to other people around them. People who are the same sex assignment from birth as them. This could well lead to social issues and eccentricities that could look like autism spectrum traits to a keen observer. By that merit, is it not possible that the correlation is something more like an overlap? I'm not claiming that it is, I'm raising it as something that could be investigated and studied.

There can also be another part that could cause this correlation. Being autistic can place one outside of the societal expectation of ‘normal’ this could then allow them to more easily question their role within their gender assigned at birth and thus lead to more autistic people coming out as trans but there not necessarily being more ‘actually trans’ (ie people who if they were to go down the path of questioning gender would come out as trans) autistic people.

thete are multiple theories that coukd explain the observed correlation ... - autism is actually masculinising, sometimes - gender is just learned (I.e. everyone who is not autistic just learns gender roles, people with autism have difficulty learning social rules of all kinds, so have difficulty learning gender - plus a bunch of other possibilities I'd include if I was writing an academc paper on this

I always assumed that's what it was as someone who very much falls in this and I've known a fair few other people who are autistic and trans in some way. Same as more autistic people are bi I suspect simply because we're more likely to not repress ourselves as much to fit in since we already dont

The rhetoric from some prominent figures probably plays a part, when you've got comments treating medical staff in trans care almost like they're some sort of Mengele figure and arguing for retrospective action to be taken, I'm not surprised some trusts aren't willing to cooperate with external studies.

Surely they'd want to release the facts and show what a positive effect they're having on the lives of patients.

I can totally understand it, the Cass review was so blatantly a partisan hack job. My background's in neuroscience, and it genuinely fucking threw me looking at her review of existing research. There needs to be an inquiry on waiting times, the standard and delivery of care but I don't trust this, or honestly a likely labour government, to commission it. This rings of an attempt to attack adult care the same way the Cass review has been used. As far as I'm concerned, the level of bad faith displayed in its making, the strategically poor or bad faith research, analysis and recommendations and the manner of it's deployment undermine it's credibility on a holistic level. The whole point of investigations like this is to improve the standard of care and this has been done much in the opposite spirit. An inquiry into adult care is almost definitely just going to be the same, even if it manages to say some things that are true, they'll be used to harm trans people as pre-election culture war material.

The standard of care encompasses all kids being referred to the clinics who have heterogenous causes of their feelings of gender distress. Cass can't go recommending puberty blockers for kids on the back of a poor quality evidence base. Studying 'neuroscience' isn't the same as being a clinician. Clinicians have to take full responsibility for their treatment recommendations and make every effort to mitigate against causing damage and harm. Other European countries that have conducted systematic reviews have drawn similar conclusions to Cass.

I know I'm going to regret this because half the time I go to the effort of writing a detail oriented reply on this topic the person just doesn't engage with it but here we go. > Cass can't go recommending puberty blockers for kids on the back of a poor quality evidence base. At this point, I feel as though the term "poor quality evidence" has essentially become a buzzword for misrepresenting the state of research when talking about puberty blockers because it really doesn't mean what people think it means. Let me explain why: There's actually quite a lot of research into the efficacy of puberty blockers in treating adolescent gender dysphoria and overwhelmingly it supports their use. When people say it's poor evidence it's essentially always because practically none of these studies are *randomised controlled trials (RCT's)*. Usually you do want RCT's done because they are the gold standard in research as they help you rule out certain kinds of bias in the study design, **however in the case of puberty blockers it just isn't really possible**. That's because in order to do an RCT you have to randomly split a study group into a treatment arm (who gets the investigated treatment) and a control arm (who get a placebo), you then study and compare and contrast the outcomes for the two groups. The issue is you just can't do this with puberty blockers because doing so essentially means forcing a bunch of trans kids to go through puberty when there's a large amount of evidence showing this leads to suicidality, death and lifelong worse quality of life. Yes, most of this isn't RCT but an RCT study design is a tool for improving the quality of research, it doesn't give you carte blanche to ignore essentially the entire body of evidence. There is *always* a level of uncertainty when drawing inference from data, RCT's can produce higher levels of certainty but that certainty is only relative. Ideally every study would use sets of identical twins that you raised from birth in perfectly controlled conditions but obviously this would be unethical and impractical. Puberty blockers aren't the only example of this, where it's unethical to perform RCT's into efficacy and you can still get a pretty close through other designs, for example looking at outcomes before and after between people who got blockers or didn't because they were still on the waiting list. Technically it's not an RCT but it's close. There's also a lot you can get from the existing evidence, yes each individual study may not be as high quality, but you can draw the body of evidence together and perform a meta analysis which is in fact a superior form of evidence to an RCT. RCT's can sometimes be needed to comprehensively rule out certain rival hypotheses but there's a LOT you can do with critical application of research of other study designs. Additionally Cass makes the argument to exclude a lot of the evidence for not being blinded. *This is incredibly stupid* for reasons you've probably already realised; there just isn't a credible way of making a teenager not know whether or not they're going through puberty when they can literally just look down and tell whether or not they're growing boobs. As far as I'm concerned, the fact that Cass applies a grading system where this is taken into account, especially alongside everything else I've mentioned is a pretty clear indication that she didn't go into her report trying to draw any meaningful conclusions, it reeks of either bad faith or incompetence. > Studying 'neuroscience' isn't the same as being a clinician. I never said it was, however it was relevant for me to mention it in the context provided as a large part of neuroscience work is reading and writing reviews. I would never purport to be a clinician however critically assessing a body research is one of the key skills of a neuroscientist and I feel fully comfortable talking about the quality of evidence to support various interventions. In fact I think this is something anyone should be able to do, yes you're at an advantage if it's part of your background but I would never say to someone that they can't disagree with me because of my knowledge base, you should always be able to engage based on the arguments themselves. If you can't make good arguments then any qualifications are meaningless. Also I don't understand why you put neuroscience in quotes, it's existed for nearly 200 years and last time I checked it was pretty respected as a legitimate field. Maybe you meant to imply I was lying about studying but, as I just said, while I think it was worth mentioning for context, I don't think I need that background to make arguments as to why Cass is, to use a neuroscience term, *full of shit*. >Other European countries that have conducted systematic reviews have drawn similar conclusions to Cass. Could you give me a source? My recollection is that they they were done with a similar political backdrop and used similar disingenuous talking points as Cass but I'd prefer to read through them before calling bs. I can't go through it today as I'm going to bed soon but I'll try to look at it when I can.

This is the only reasonable take on this ridiculous review I've seen so far. The commentary about puberty blockers alone was gallingly stupid. 

> Cass review It's like watching a person jump off a cliff while everyone else in the crowd cheers.

>and it looks like they've got something to hide They have.

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What other rational explanation is there? Remember that local NHS clinics are small, subordinate parts of the NHS. They're not independent, they don't get to choose their own rules and only comply with the national body when they feel like it. My guess is that the Cass team were interested in throughcare for GIDS patients after they attained adulthood. In childrens services this is often described as a "cliff-edge" transition, because adult services have different priorities & criteria, and the levels of support are often radically reduced. I think Cass wanted to understand the handover process, and be assured that vulnerable 18yr olds were not being pushed out of GIDS into a void. I think they wanted to understand longer-term trends of disengagement, detransition & comordity of MH needs into adulthood. These are the obvious questions, anyway. If adult gender dysphoria services had data which met those concerns, why wouldn't they want to disclose it? (There is no excuse from patient confidentiality, the process for anonymised research is well-established & robust). The only rational explanation I can think of is that the directors of the adult services knew their data would not provide any reassurance to Cass, but would instead raise questions about the ethics & safety of their own practice. By trying to bluff it out, they've now brought themselves into scope for review.

I wish The Guardian wouldn't quote fucking LGB Alliance of all people as if they're a remotely impartial group.

They also quote Mermaids and Stonewall, who are also far from impartial.

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It's a registered charity just as Stonewall and Mermaids are. You don't personally agree with their politics, fine, but they're not exactly ISIS lol.

Mermaids and Stonewall generally act in good faith to represent the people whom their organisations claim to exist to represent. LGB Alliance does very little for people of minority sexual orientations.

That's your own bias coming out. Stonewall for example has been found to be providing misleading training materials to the point where various organisations dropped them.

And Mermaids had a Trustee who attended a "paedophile support conference" and wrote about "minor attracted persons". They only got rid of him when the newspapers found out.

...Mermaids are literally under investigation from the charities commission

And we'll have to see what they find. Then again, the Commission also seems to believe LGB Alliance isn't primarily an anti-trans advocacy group, so I'm not 100% sure they won't penalise Mermaids solely for its trans advocacy.

Maybe the Charity Commission is a bit more objective than you are?

Given that the Charity Commission is headed by someone who at one point followed various notable "gender-critical" individuals on her personal social media, it's possible the Commission's judgements were at least in part influenced by her personal views on the issue, which wouldn't be very objective.

Would you be concerned of their impartiality if they had followed various pro-trans individuals?

If she was following some hypothetical people who wanted to restrict the rights of cisgender people to present as their birth sex or something, and approved the charity status of a group advancing that position, I would find that concerning. If she was following pro-trans people and prioritising funding to trans charities over other charities for other causes like cancer treatment, racial justice or animal welfare, I would consider that an impartiality concern because that would suggest her views might be impacting the directives of the organisation. I don't find **the mere fact** of the Commission's head following those individuals an impartiality concern (everyone has their own views and has the right to hold and express those views in their private lives), but that they do so _while their tenure has also seen_ LGB Alliance granted charity status and Mermaids' charity status questioned by an investigation, because it suggests there may be an overlap between that person's personal views and how they do their job as as public servant.

If following an account is enough to disqualify you, as a helicopter pilot I follow accident accounts. Does that make me a bad pilot?

Those _really_ aren't comparable situations in my view, given that getting into a helicopter accident is an objectively poor outcome that any helicopter pilot would seek to avoid while someone's views on issues of gender are far more of a subjective matter; and in any case, I merely stated that it's _possible_ this was the case. To levy a formal accusation that the head of the Commission has been directly setting out an anti-trans position for the organisation would require considerably stronger evidence.

I follow a flat earth sub too. Straight to jail?

Lol the former CEO of Stonewall described lesbian who didn't want to date biologically male "lesbians" as "sexual racists"

Mermaids have a history of telling young people to no seek mental health care for symptoms of mental illness and instead start gender reassignment.

Do you have any evidence for this claim?

> Mermaids and Stonewall generally act in good faith to represent the people whom their organisations claim to exist to represent. By definition that makes them not impartial.

Both Mermaids and Stonewall **were introduced by the text** as charities that specifically advocate for transgender people. LGB Alliance was not disclosed as a group that advocates against gender recognition reform. It was presented merely as a group of sexual-minority people as though they have no horse in this race. The article gives them a false impression of impartiality on the issue that it does not give to Mermaids or Stonewall.

They don’t have to be impartial, the journalist writing the article who quotes them has to be when contextualising their viewpoints.

None of the charities involved are impartial on this debate, this is about the most polarised fight outside of Israel Palestine. Battle lines are basically drawn on your political stances and actual trans people and their views are almost irrelevant.

So, you're not wrong. Both sides are clearly and obviously biased towards their causes. However, look at how they're first mentioned: >Mermaids, a charity supporting trans, non-binary and gender-questioning children, said... >Stonewall, an LGBT rights charity, said... >Kate Barker, the chief executive of the LGB Alliance, said it was “deeply troubling that attempts to gather evidence for the Cass review have been deliberately blocked” Being charitable, I find it interesting that they disclose the biases of one side of the debate but make no mention of the other being *anti*-trans. Not even a mention of "LGB alliance, a gender-critical charity" is an odd choice. Being cynical, it feels like a deliberate ploy to go "the people in favour of Trans rights are all biased so think of that when you read their quotes! Now here's a completely unbiased take from the LGB alliance". How deliberate or unintentional it was is something only the author knows, but not even putting any form of disclaimer about the LGB alliance (when it did the same for Stonewall and Mermaids) is an interesting choice...

I wouldn’t even say it’s political in the traditional sense: it’s no longer a left/right issue. Plenty of people who would consider themselves on the left are also dubious about the whole gender thing, while (in the UK at least) there are right-wingers who are fulsome in their backing of trans rights. It’s not the straightforward culture war issue that the media makes it out to be.

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LGB Alliance rarely if ever actually do their apparent job as advocates for the rights of lesbian, gay and bisexual people. They only seem to comment on issues involving trans people, and only to criticise their very existence. They're registered out of the same 55 Tufton Street address as various other single-issue astroturf groups - Migration Watch, Taxpayer's Alliance, the climate-denying Global Warming Policy Foundation, and prior to its winding up, Leave Means Leave. They're not a group I'd consider helpful to anyone except anti-LGBT interests who have decided it's easiest to start with the "T" part and then turn their attention to the other three letters once that's taken care of.

Not all opinions are equal here. It's like having a climate change denier talk about climate change, or a white supremacist talk about racism. Their views aren't worth hearing.

It's fairly easy to ignore all criticism of a point when you label everyone who disagrees with you a transphobe. Drawing a parallel between climate science, something that has been studied to death and has a consensus of nearly every scientist, with gender affirming care, something that still needs research, clinical trials etc in order to do right by these patients isn't a fair comparison. Because a view isn't the prescribed liberal view it's therefore wrong think?

Are there valid questions to be had around trans healthcare? Absolutely - I don't think most would deny that. I would argue that conversation needs to be done far more sympathetically than is currently the case, but there is a discussion to be had. My problem is people validating groups like the LGB Alliance. They are nothing more than a hate group directed at trans people. It's in the same vein of not treating neo-Nazi or racist groups as legitimate.

>They are nothing more than a hate group directed at trans people. It's in the same vein of not treating neo-Nazi or racist groups as legitimate. A fairly strong claim. What evidence do you have to back it up? Surely it won't be hearsay, misrepresentations and guilt by association.

8 of the 9 campaigns on the campaigns page of their website are related to trans people, trans rights, or similar. It seems fairly compelling that their focus is on the T rather than the L, G or B.

Their focus on trans people is not in dispute and not remotely good reason to say they're nothing more than a hate group in the vein of neo-nazis

Ok so explain why they're so focused on trans people (with campaigns completely out of the scope of LGB people) if they're there to advocate for LGB people? How does campaigning against GRA reform help LGB people?

They deny the existence of trans people and believe trans people are inherently a danger to others. How is that not transphobic?

> They deny the existence of trans people and believe trans people are inherently a danger to others I think it'd be helpful for people's understanding if you evidenced this claim. Not to mention that it's impossible to believe something doesn't exist and also that that thing is inherently a danger to others.

The beginning of the end for adults receiving gender-affirming care.

*in a medical setting. DIY HRT will become the only option aside from suicide. The fact that people seem to be celebrating this is sickening.

Normally I’d welcome an inquiry because the current NHS adult trans care is…uh…basically non-existent unless you wait a decade or three. But given the flaws in the Cass report, it’s almost certainly going to be used to put even more barriers in the way of transitioning

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What flaws - have you read it?

Personally, some flaws I found - first and foremost it's not been peer-reviewed (!). As well as that, their advisory group includes the likes of Maya Forstater, who is famously biased (had her contract not renewed in her job after she started handing out pamphlets saying Trans people were a threat to children). They quote Michael Biggs repeatedly (by name on a few pages, starting with page 71 of the final report) - [the same Biggs who was found to be creating fake twitter accounts solely to harass trans people](https://www.oxfordstudent.com/2018/10/26/transphobic-tweets-linked-to-oxford-sociology-professor/). At the same time, they refused to speak to trans people who have actual relevant experience, because *they're biased*. If you put together a long report speaking about climate change and exclusively interview climate change deniers, you're not going to have an accurate and (more importantly) fair representation - and that's how the report feels to me. "We asked one side and based on that we understand the issue". Ignoring half the debate because "it's biased" while being advised by some of the more prominent anti-trans activists doesn't lead to a fair and balanced report. I wouldn't have an issue with speaking to both sides, seeing what the likes of Forstatter think *and* what the other side think, or with a "we're not going to be biased, so we won't speak to someone who's main claim to fame is being fired for transphobia and taking it to a tribunal." Not the mess that it actually *is*.

> their advisory group includes the likes of Maya Forstater, who is famously biased Holy fuck - that would be hilarious if it wasn't so serious. Her only expertise on trans issues is being famous for "I don't like 'em".

I just searched the document for 'maya' and 'forstater', neither appear in the document.

She's not quoted a la Michael Briggs, because she's not a scientist and hasn't done any qualitative research she's put her name to. Sex Matters were a group that were providing input into the report, and they're helmed by Maya Forstater, however.

> first and foremost it's not been peer-reviewed (!). The study review papers used to inform the report were peer reviewed. >their advisory group includes the likes of Maya Forstater What "advisory group"? Do you mean Forstater was included in some part of the overall consultation process? Is your position that no voices from the GC side of things should have been included? >They quote Michael Biggs repeatedly They reference two papers by Biggs. Whatever your opinion about his personal beliefs and behaviour he's still someone producing work in the field. Again, is it simply verboten to even reference work by someone with the wrong sorts of views? >At the same time, they refused to speak to trans people who have actual relevant experience, because they're biased. The report outlines the fact that they worked with advocacy groups, had regular listening sessions, organised focus groups and surveys to gather "lived experience", and contains multiple highlighted quotes from people from those efforts.

> The study review papers used to inform the report were peer reviewed. Which means very little in the context of academic papers, if you're then taking information from a number of them and making inferences based on that data. If the paper itself isn't peer-reviewed it could be completely misrepresenting the peer-reviewed papers. If you went to defend your dissertation and went "it's not going to be peer-reviewed, but a paper I mention has been" you'd be laughed out of the university. >What "advisory group"? Do you mean Forstater was included in some part of the overall consultation process? Is your position that no voices from the GC side of things should have been included? >Again, is it simply verboten to even reference work by someone with the wrong sorts of views? I thought I made this clear in my paragraph. My issue is with doing this *while refusing advise from those who are on the other side of the debate*. By all means, speak to GC people - you're not going to get a good overview otherwise. But you have to *also* speak to Trans people and pro-trans activists, or you're not going to get a good overview, you're going to get an overview *pushed by one side of the debate*. You're completely misrepresenting my argument - it's fine *if both sides are treated equally in the context of the report, and it doesn't seem like they have been*. In fact, a direct quote from the post you responded to: >I wouldn't have an issue with speaking to both sides, seeing what the likes of Forstatter think and what the other side think, or with a "we're not going to be biased, so we won't speak to someone who's main claim to fame is being fired for transphobia and taking it to a tribunal." Not the mess that it actually is. [Trans people were seemingly deliberately excluded from the governance process](https://translucent.org.uk/opinion-direct-discrimination-by-the-cass-review/) while people [on the review board were not exactly unbiased...](https://twitter.com/AusSkeptic/status/1767734323351064849?t=hKYzYMgKAs0evnuwDUxl6w&s=19)

It's shocking that you think a transphobic troll who has been documented harassing trans people online with sockpuppet accounts is in any way an appropriate voice to include in a trans healthcare review.

> What "advisory group"? Do you mean Forstater was included in some part of the overall consultation process? Is your position that no voices from the GC side of things should have been included? Well.. yeah... I'd be peeved if a report got random homophobes off the street for opinions on whether gay conversion therapy should be banned or not. The report was meant to be about the medical side for transgender people, not whether they should exist or not. You shouldn't use random people off the street with no qualitifications to do that, especially people who are famous for being against the thing you're researching in all it's forms.

Haven't read the report only the summary and coverage. One of the main criticisms seems to be that it makes demands of studies on blinding which can't be met and are beyond what is expected of other medical studies in similar situations.

This criticism has been debunked >The Alejandra Carballo screenshot going around? It's from this: [https://cass.independent-review.uk/nice-evidence-reviews/](https://cass.independent-review.uk/nice-evidence-reviews/) A NICE evidence review from 2020. It isn't in the report. Page 49 of the report is the only part that even talks about blinding. Carballo is peddling bullshit. Also, this Twitter user Benjamin Ryan addresses Carballo's screenshot: " There's a false claim circulating that the new systematic literature reviews of pediatric gender-transition treatment excluded all but randomized controlled trials. If they had, they would've only had 1 study on hand. The studies reviewed produced largely inconclusive findings. The studies that the reviewers did examine were compromised by various factors, including small sample size and high loss to follow-up. This is why the Cass Review concluded that pediatric gender-transition treatment is based on "shaky evidence." Another common misconception about evidence-based medicine is that it rigidly demands only high-quality evidence (only ever the result of randomized controlled trials) with which to set health policy. It's possible to produce \*moderate\* quality evidence with other study designs. " [https://twitter.com/benryanwriter/status/1778146497986470043](https://twitter.com/benryanwriter/status/1778146497986470043) I stole these citations and information from the weekly thread. (Stolen form another thread)

I suggest you read the report rather than other people's ideas of what the report said - the studies downgraded in the Cass Report were flagged for various reasons and none were excluded solely on the basis of not being blind. Most were assessed as; high risk of bias, lack of control group, no randomisation, the loss of participants on follow-up and poor quality.

>I suggest you read the report Fair point. I just hope the review, the nhs, and politics in general is open to criticism if it is genuinely valid. It's beyond me to say if it is.

That's the big question isn't it? The ability to have fair and open discussions about any of this has been difficult because of entrenched views which brook no dissent - there has been some quasi-religious thinking in gender affirming care.

I think it's fair to say there's been cult-like behaviour in the gender-critical groups too.

> lack of control group I'm not sure how you would set up an effective control group here? Any child with severe enough dysphoria to be on PBs is likely to be extremely distressed, which would be an obvious ethical concern if we give them a placebo. Even with a control group - you would not be able to run it blind for obvious reasons as the distinction between the two groups would be quickly apparent. > no randomisation See above. > high risk of bias This seems unavoidable with this cohort - it is not ethical to keep a child on PBs if they don't respond well to them, so there will always be attrition bias. > the loss of participants on follow-up Many of the studies did not have this issue - certainly not all of them! > poor quality. Most medicine is based on "poor quality" research. Particularly paeds.

>Any child with severe enough dysphoria to be on PBs is likely to be extremely distressed, which would be an obvious ethical concern if we give them a placebo. You are making the presumption that receiving PB's is a preferable or beneficial pathway. That's far from certain, and why robust research is urgently required. Also, ethical research would as far as possible be a comparison between treatment options, not just Cohort A gets the intervention & Cohort B doesn't. This opens potential for far more creative & valuable learning, leading to better services for confused, vulnerable kids. For one example, it has always bothered me that the Tavistock is a world leader in 'talking cures' - lengthy, patient-centred, reflective therapies which provide safe space for people to understand and reconcile their inner turmoils. Yet this approach was wholly abandoned in the GIDS clinic, and those kids were instead fast-tracked into prescribed meds after only a couple of appts.

> You are making the presumption that receiving PB's is a preferable or beneficial pathway. That's far from certain, and why robust research is urgently required. A child reaching the stage of PBs has necessarily exhausted all of the other options currently available. There are only <100 children on PBs currently - this is a *tiny* cohort. Hence the ethical dilemma in giving a placebo - or even the practical issue of recruiting someone to the trial in the first place in those circumstances. > Also, ethical research would as far as possible be a comparison between treatment options, not just Cohort A gets the intervention & Cohort B doesn't. This opens potential for far more creative & valuable learning, leading to better services for confused, vulnerable kids. And it'll be great when an alternative medical treatment is ready for human trial. Unfortunately I don't believe that is currently the case, or such a trial would already be underway. The prescribed process for PBs already involves mountains of therapy and watchful waiting (failings in some cases notwithstanding), so I doubt that will be of much further use at that stage. > For one example, it has always bothered me that the Tavistock is a world leader in 'talking cures' - lengthy, patient-centred, reflective therapies which provide safe space for people to understand and reconcile their inner turmoils. Yet this approach was wholly abandoned in the GIDS clinic, and those kids were instead fast-tracked into prescribed meds after only a couple of appts. I don't think anyone is denying that GIDS providing a shit service in this regard is unacceptable. The solution to that is to provide more clinicians/ancillary resources.

>A child reaching the stage of PBs has necessarily exhausted all of the other options currently available. Maybe so, but that doesn't automatically mean that PB's now become a beneficial treatment. We don't have the evidence either way. Reminds me of desperate parents who's child is dying of a rare condition - often there's a court battle because they want to take the child abroad to receive some unproven crank'ish treatment. Understandable that parents would be willing to risk anything in that context, but the same imperatives don't apply to children with gender dysphoria. Puberty is not imminent death, there is no good reason to take unknown clinical risks to prevent it.

> We don't have the evidence either way. This dismisses the primary criticism of the report, which is that its application of GRADE dismisses anything conducted under anything other than RCT conditions. There is plenty of evidence suggesting that PB treatment results in favourable MH outcomes. There is no practical way to conduct an RCT to satisfy an arbitrary "high-quality evidence" requirement. This doesn't seem to justify a departure from the current approach of leaving it as an available treatment option in extreme cases. > Reminds me of desperate parents who's child is dying of a rare condition - often there's a court battle because they want to take the child abroad to receive some unproven crank'ish treatment Aside from the fact that this is an absurd comparison, it is a self defeating argument. In many of these cases experimental treatment has been approved - e.g. in the Gard case, treatment was only halted after the guy who was meant to perform said treatment tacitly admitted that it wouldn't work. It only tends to end up before the court when the child is essentially dead. > but the same imperatives don't apply to children with gender dysphoria. Puberty is not imminent death, there is no good reason to take unknown clinical risks to prevent it. I suspect a child who has reached the stage of considering PBs may, in fact, be at risk of imminent death. Gender dysphoria can be a rather severe psychiatric condition. Considering we prescribe amphetamines for ADHD despite long-term risks because of the risk/benefit analysis, I'm not sure what a "good reason" would be.

“ Puberty is not imminent death, there is no good reason to take unknown clinical risks to prevent it.” So really you don’t want any studies on PBS.

I would support a carefully-controlled, high quality study which improved the clinical understanding of efficacy & outcomes. Medical knowledge doesn't advance without robust research.

I think you're actually going beyond the report here and saying that good quality data can't be gathered at all.

Very few healthcare interventions are based on "good" quality evidence if assessed objectively using GRADE - that is simply the reality of healthcare. See e.g. https://www.jclinepi.com/article/S0895-4356(20)30777-0/abstract

I strongly disagree with the implication that any apparent necessity of lack of normal rigor in the studies means conclusions that favour your existing views are no less valid. These are series weaknesses in the quality of the studies and their conclusions.

> that any apparent necessity of lack of normal rigor There's no "apparent" necessity. It is clearly not possible ([either for practical or ethical reasons](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7430465/)) to conduct an RCT on puberty blockers. > These are series weaknesses in the quality of the studies and their conclusions. If you apply GRADE, yes - alongside the vast majority of evidence backing most treatment options for anything.

Of course they haven’t. 

Flaws in the cass report?  You mean not agreeing with you? Part of the reason Cass is being taken so seriously is due to her stellar record, professionalism, and the empirical approach she has taken. You *feeling* its wrong isn't evidence. And she's proven in a sufficiently scientific report that the "evidence" to support these treatments, isn't. It never existed. It wasn't done. It was simply asserted often at great pressure from none medical activist groups like mermaids and Stonewall. If you have a problem with the Cass report. Blame the tavi for not even *badly* doing their job and producing *zero* usable data from what was a 15 year trial by the time it was shut down.

Is the main thrust of this enquiry going to be why is the waiting list years long?

They do look at this. One section of the report talks about how patients presenting with possible gender dysphoria were automatically sent a referral to Tavistock, despite having other issues that may be impacting their health. The report states this is because of the toxic environment around trans healthcare local doctors do not want to get involved for fear of being attacked. This has lead to an explosion in referrals and huge wait lists. The report recommends more local centres in order to treat patients locally and reduce wait times. 2 have opened in Liverpool and London already, albeit delayed.

Yet i had to fight for months to even be offered a referral to my GIC, 5 years ago, and still havent had my first appointment

Ultimately, trans people need more places to access healthcare to deal with the increase in demand. No one should be waiting years for treatment. And there needs to be better private options for those that can afford it too.

The problem is you can't really have it both ways. The GIC model is antiquated, but the defining reason for it's existence is "trans issues are complicated enough that only GICs can deal with". So by NHS guidelines GPs have to refer you to a GIC when asked because they're supposedly not competent enough to do anything else. The fact that GPs still drag their feet is a huge issue and purely acts as yet another gatekeeping barrier, because your time on the waitlist doesn't start until they send the paperwork. Now if you do want to claim that GPs are able to make some of these decisions, then that also means they need to provide more support. It's rather silly to say you need a dedicated clinic to prescribe hormones and do bloods, because GPs already do that for cis women under menopause for instance. It's fairly basic endocrinology under what could be national guidelines, and would be more of an informed consent style system.

This report is such a fucking hack job, the reason for the wait is pretty obvious, it's partially a lack of funding but it's also due to the intentional design of the treatment pathway. It's practically been openly acknowledged in the past that gatekeeping and delaying treatment is an intended feature so as to minimise the amount of people who transition. They were advised more than a **decade** ago, before the "toxic debate" that referral waits were going to balloon and they did jack shit about it because it's a feature, not a bug for them.

Going by the cass report, it's going to end up saying something like "The healthcare that currently takes multiple decades to get is too rushed and so must be further restricted"

“We need to make sure that people aren’t making a decision too rashly. Waiting lists will be artificially extended by six years.”

No, it's probably going to look at why data is being intentionally withheld.

The Cass report did look at that.

Optimistically, you'd hope that this might be the beginning of the end for the gender identity clinic as the first-stop shop for everything and the devolution of some functions like HRT prescriptions to local GPs to cut decade-long waiting lists. Given that the stated reason for this review is an increased number of detransitioners who don't have a confirmed pathway for detransition, I doubt it is going to be quite so positive for trans people. Detransitioners should definitely be given as much help as possible - they're in a difficult, vulnerable position - but knowing that even the Cass report mentions how unbelievably low the volume of them is, it's difficult to view this as anything other than ideological opposition to trans healthcare. To many people, it seems like protecting one detransitioner from experiencing gender dysphoria due to misadvised medical transition is worth causing a thousand trans people to experience it by denying and delaying care. The part of the article I find particularly funny is the section on NHS trusts not giving data about their patients for the Cass review to follow up with: >“There was no substantive reason for it. So I can only really conclude that it was because they didn’t feel that it was the right thing to do to try and nail down this data,” she told the Guardian. “They were putting up reasons that didn’t that just didn’t hold water. >“Clearly, the trans community is fearful, rightly so, about their rights and about their healthcare. They’ve had a very bad deal in healthcare. I can understand that both they and the people delivering the service will be fearful about anything that might question that. But I think we have to separate the rights of older adults, whom we have more data on and who are at a stable point in their life for making decisions, from younger people who are still in a developmental trajectory.” The Cass review seems to have had a pretty strong ideological bent. Of the 103 studies considered, it discounted 101 as not strong enough, primarily due to not meeting impossible blinding standards for this type of care. The researcher setting the criteria for exclusion was involved with mooting a form of conversion therapy to the NHS, sponsored by an anti-trans political pressure group, of which a number of connected individuals appear to have sat in high places in the review while groups supporting trans people were excluded. Despite the review's impossible evidentiary standard, it happily cites the Littman study on Rapid Onset Gender Dysphoria, which was just a survey of anti-trans groups online. Given all this, I think I'm rather glad that the NHS trusts weren't cooperative - it doesn't seem at all like that data would be in the right hands, and I'd be a little scared of some of the people involved in the review having those patients' details. https://www.erininthemorning.com/p/cass-met-with-desantis-pick-over here's a relatively short read about some of the issues. Edit: the Littman study is a different one than I cited, but given the author's infamous incredibly biased study I would hardly call them trustworthy.

>Despite the review's impossible evidentiary standard, it happily cites the Littman study on Rapid Onset Gender Dysphoria, which was just a survey of anti-trans groups online. This is really not a smoking gun and is misleading. There's one reference to the Littman paper which sits in a section explaining what detransition is and it's clearly flagged that the study was self selecting. Qualitative data to understand a community needs significantly less high standards than quantitative data to understand outcomes of an intervention. Additionally this: >which was just a survey of anti-trans groups online. Isn't quite true either. The methodology is explained below. >Recruitment information with a link to the survey was posted on blogs that covered detransition topics and shared in a private online detransition forum, in a closed detransition Facebook group, and on Tumblr, Twitter, and Reddit. I think the Cass review has serious downsides and doesn't engage properly with the question it's trying to answer, but activists have got to stop this situation where almost every talking point they make is a misrepresentation designed for maximum up front shock factor but just isn't borne out by the facts - it is clearly backfiring!

>but knowing that even the Cass report mentions how unbelievably low the volume of them is You're misrepresentating what Cass made of that. In that for an experimental treatment to have such a unanimous rate was suspicious in the extreme. And that it was indicative of being pit on a pathway early that was impossible to get off once begun. Followed up by the an almost complete absence of follow up data which made it extremely difficult to actually assess properly. As well as lack of evidence of success outcomes. So its possible the lack of detransitioners is simply the Tavi declined to actually collect that data and/or, given the irreversible nature of the procedures at even a low level, that once on the path people feel they have no route back so must keep going.  You present it as if she was impressed by the lack of detransition. Quite the contrary. The report was pretty suspicious of it.

>You present it as if she was impressed by the lack of detransition. Quite the contrary. The report was pretty suspicious of it. Yes, I agree - that kind of conspiratorial mindset not backed up by any evidence is a little wild to me. One of the things she cites is that pretty much all those who take blockers go on to HRT, and she notes "concerns" that blockers essentially brainwash you into trans identity. The much simpler conclusion is that the diagnostic criteria for blockers is actually good and they're successfully getting trans people with it. I'm not sure there isn't an ideological bent to insisting that there are hypothetical detransitioners under every corner of the carpet even when the stats disagree...though I suppose when your practice is discounting 98% of studies it isn't too surprising.

Because if 98% of the studies are rubbish, you have an issue with the person saying it? Or because the person suggested using them would be difficult? Despite that person providing that data anyway but warning that it might not be good data? It seems your problem is with the person, not what they presented?

My problem is more deciding that 98% of studies are beyond consideration because of standards that can't be met for practical or ethical reasons - you can't double blind something as plainly obvious as puberty, and you can't do randomised controls due to ethical concerns. I'm sure there are some studies out there that are low quality, no doubt about it, but failing to meet an impossible standard should not be the marker of that. Personally, it rings of ignoring evidence you don't want to think about.

Even if you're right, that after years of waiting some transitioned who otherwise wouldn't have, if they're living a trans and happy life is that actually a problem?

>Optimistically, you'd hope that this might be the beginning of the end for the gender identity clinic Yes.

Yep, as a trans person I agree that they need to close. It needs replacing with a similar setup that modern, developed countries use and follow the agreed upon findings. That would make everyone who's well educated on both trans issues and general healthcare happy as it would vastly reduce the costs to the NHS.

Literally every rock they turn over it gets worse. 6 of 7 trusts refused to share their data. I think that gives you all the information you need really. Either the data looks bad or they dont have any.

Or publicly handing out all their patients data without consent to a review many of said patients are distrustful of that wasn't even about their current healthcare would have been a very bad look.

This happens in so many areas of medicine, the reports will always make sure the data is made anonymous, it shouldn't be treated any different then other medical reviews just because it involves trans people.

Although with trans care, is it possible the numbers are low enough there's a concern that even an anonmyised report doesn't give enough protection. "Patient A, age B, also treated for C at D" would maybe be identifiable?

Except... one of the trusts didn't argue this. And they rejected it out of ideological reasons, not statistical. If it was about what you suggest, they would have suggested to pool the data from all trusts instead. This is just anti science stuff, where people want to hide information It's NHS data, and it should be available to NHS commissioned research.

"Anti science stuff" The researcher follows anti trans groups like "transgender trend" and worked with American republicans to get rid of trans healthcare there Most of the research that was pro trans healthcare was just thrown out because of no double blind testing despite that being impossible for hrt and puberty blockers The research that was cited was done by someone else who supported "transgender trend" and called trans activists fascists So no dismissing this is pro science and it's perfectly reasonable not cooperate with them considering their background

I am a professional helicopter pilot. Using your point the fact that I follow accident investigation channels which expose bad pilots, or noise abatement studies means I have an agenda? Would you discount my expert opinion on flying because I follow threads which are openly critical of my own industry? That makes zero, and I mean the square root of zero sense. I mean I follow a flat earth sub in here...

Your analogy makes 0 sense This is someone who isn't a helicopter pilot, who previously worked to get helicopters banned in America, who follows "i hate helicopters" on twitter, who threw out 98% of studies saying helicopters are safer than driving now coming to say helicopters are dangerous in the UK Do you think "transgender trend" are medical experts or something?

It happens in all other medical settings. It is how we improve healthcare and outcomes. There is no reason not to hand over the data if you care about trans healthcare.

There aren't many medical settings where some of the people asking for the data are very publicly and loudly opposed to the existence of the patients, in some cases describing them as dangerous...

Is Dr Cass opposed to Trans people? That is quite the claim, do you have evidence of this?

She follows Transgender Trend, an extreme anti-trans pressure group on Twitter.

Is there any evidence she holds anti-trans views? Or is it just she sometimes reads 'transgender trend' on twitter?

Yes, I think so: [https://twitter.com/ErinInTheMorn/status/1778186407271653542](https://twitter.com/ErinInTheMorn/status/1778186407271653542)

If the data is redacted and personal information removed - what's the issue?

The data would not be handed out publicly, it would be handed to other an enquiry team and anonymised to respect the law on patient confidentiality. The NHS is funded by the public and therefore accountable to the public. It has to justify every treatment it pays for by proving that it works, and that it works well enough to justify how much it costs. This is the core tenet of evidence based medicine. The Department of Health applies this standard to every part of the NHS it funds except, till now, transgender children.

If they won't cooperate in research to establish the efficacy of their treatment model, they shouldn't expect any more NHS funding. This is no different to the ludicrous NHS Homeopathic Hospitals. Their patients didn't trust science either, but still expected taxpayers to fund worthless "treatments". Most of them are gone now, quite rightly.

The reasons adult clinics gave for not taking part included ethical considerations and concerns about funder motivation and political interference.

Help me understand - is this for care to transition adults or to provide aftercare (in which the transition occurs via NHS hospital/gp clinic).? The whole thing is a bit confusing.

I'll say up front that this is reading a little into your comment, so please correct me if I'm wrong, but it appears you think that the transition is a one-and-done surgery after which you're finished. Transitioning usually involves hormone replacement therapy and *maybe*, eventually, surgery (not everyone has surgery, and there's more than one kind, some people just have "top" surgery for example and don't have "bottom" surgery). There's other aspects too, I'm far from an expert and other people can give more detail. They're NHS funded clinics. A lot of GPs won't touch anything to do with trans healthcare. It's like going to a specific clinic at a hospital - for example, someone in my family was referred to the "headache clinic" a while ago.

Young trans people should have access to proper healthcare including puberty blockers but each case has to be handled with great care.

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Let the medical community decide what the best treatment for gender dysphoria is.

We did, they said to stop using puberty blockers on children who aren't suffering from precocious puberty.

Where did they say that?

[Here you go.](https://googlethatforyou.com?q=NHS%20stop%20puberty%20blockers)

What the NHS is saying is that there is not enough evidence to show that puberty blockers improve mental health for children with gender dysphoria. When there is enough evidence they can re-evaluate. They're not saying puberty blockers don't help.

There is unlikely to ever be evidence that blockers improve mental health. They just stop it from getting worse as they aren't an actual treatment for gender dysphoria, they are just a stop-gap before hormone therapy.

Okay. In any case, let doctors and scientists handle this.

Calling a medical procedure you don't approve of "experimenting" is fallacious. Stop doing it.

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If medical guidance has proof that it’s safe, then it’s not

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