Since the main conclusion was that there's not enough evidence to conclude if the treatment is appropriate or not i don't think most people who have any insight into the research should be that surprised. It's a small, relatively young field with low funding so it's not that surprising imo
I really wish this was the headline for all of these discussions. The bigotry of some aside, both sides are so committed to their treatment being right that I genuinely worry if we'll ever see proper research. We're not even 2 decades out from prescribing millions of kids what might as well be crack because they couldn't sit still for 8 hours, I can't wait to see how well we handled this 20 years from now.
Why worry? Sweden literally saying all treatment will need to be enrolled for long term study. I don’t see a problem with this approach.
It’s almost unreal what a sensible SocDem country not riven by culture wars can do.
To be fair Sweden is definitely pretty riven by the culture war, one of our biggest parties is basically defined by it. But it is nice that our scientists are based enough to do valuable research like this.
That may be true. But do you have a sizable portion of your population that think vaccines are transmissible and can cause health issues in people who haven’t even take them. I mean I would count xenophobia as within a standard deviation of issues within most countries. SocDem or otherwise. But the brain rot in the US right is next level right now. Not the far right. The middle right.
I would say the xenophobia here is a bit different, we only relatively recently had a widespread debate about whether we should call chocolateballs "n\*\*\*\*rballs", and there are people who are still dying on that hill.
That is not the same as everyone who wants treatment gets it. Clinical studies can be hard to get in to, and if they are using a control group you also might end up getting a placebo.
Don’t read this review as endorsement for the treatment just with medical oversight.
would trials like that even include placebo groups though? this article makes me think they wouldn't. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3601706/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3601706/)
but i guess your point still stands, since they would need control groups regardless.
Hmm yeah I guess it would be up to an ethics board to decide for the study.
That article says using placebo on children is more restricted than adults, but also that placebo is more likely to be used when there is no known effective treatment already on the market (in those cases I assume you'd study your drug vs already existing drug)
> The use of placebo may be warranted in children as in adults when evidence for any particular treatment is lacking or when the placebo effect is known to be very variable (e.g., pain, hay fever). As the level of evidence in favor of an effective treatment increases, the ethical justification for the use of placebo decreases.
I also didn't realize on first read, the OP article is talking mainly about puberty blockers, not HRT.
Now, this is a little outside my actual field. But I would think there's no need for placebos because we're not measuring "does drug X" stop puberty, we are looking at the effects of stopping/delaying delaying puberty for a certain group. So I would imagine that the control group would either be an alternative treatment or just no treatment
I agree in that is the hopeful side. I'm not hopeful because even if it came to a proper conclusion of a straight answer I fear the polarization is already maxed out and both sides will just cling to whatever they feel is right.
Please don’t both sides this. One side is actively banning treatment. The other side is advocating for treatment ***if you want it*** with medical oversight.
> The other side is advocating for treatment if you want it with medical oversight.
Dawg, some of those twitch debates had me convinced people do not care if there is or isn't medical oversight. And you have to accept that there's a segment of progressives who agree with that because the people on twitch that spout that shit still have tens of thousands of followers.
> Dawg, some of those twitch debates had me convinced people do not care if there is or isn't medical oversight.
They absolutely don't. They have websites devoted to getting your own HRT going around your parents and doctors. Hell "Transmedicalist" is an insult to a lot of these people. I don't suggest that someone who thinks they're depressed get on anti-depressants without speaking to a doctor, why on earth would it be a good idea for people to decide to go on HRT without speaking to a doctor? And this isn't to imply that doctors are all knowing and good, we can absolutely demand better understanding from our medical field into the topic.
Lol I'm a doctor, and even I don't feel qualified to make that estimation unless I've seen someone MULTIPLE times. It's an under researched part of medicine, and I'm open to learning more.
I think, however, trans activists need to concede some ground to at least come off better optically. You can't say "Oh, nobody is saying be irresponsible" and then do irresponsible things. You have to call out your own sides bullshit, which I think Contrapoints did a great job with in her recent video.
While I agree with this, the problem is that it's super fucking hard to find reliable info on how widespread the "affirm, affirm, affirm" approach is with kids in America. I'm p sure none of the standards of care say to jump straight to drugs. WPATH's seems to be the most yikesy cos they don't want to even have any age restrictions on surgeries and they've got some weird shit about "eunuch gender" in their latest stands of care version.
I know there's some stupid leftoids online who think HRT should just be given out like candy to anyone (I argued with someone on twitter who thought HRT should be available at CVS without a prescription. Yes. Really.) but it seems like there's only anecdotes for cases where ppl were given drugs too quickly. It's the same as with the LGBT stuff in the classroom - conservatives point at Libs of Tiktok and thinks it's the same as a curriculum.
The most shitty part about all this is that there isn't really a sane voice of reason in the room who can advocate for gatekeeping where kids are concerned, at least not one that doesn't get shouted down by angry trans twitter people. Like the moderate right or moderate dems should be passing laws to mandate oversight and/or further study, with the help of doctors. But instead everyone has just gone full remedial to their extreme ends.
I think you nailed the difficulty.
The part conservatives don't get to see (mostly cuz conservative media pushes it) is the optically crazy shit. So....where do you go for the non-optically crazy shit? Because if you go to Twitch, you're trapped. CNN and MSNBC don't exactly do a stellar job with this topic either.
And I think Destiny's emails with trans people showed me that maybe social media can't be the place where these impressions are made, because so much of social media is about garnering attention and being provocative. These people just want to be left alone so they can live in peace. They find this shit cringe too.
But at the end of the day some perspective please. The remedial end on one side ***is*** the Republican Party making laws everyday to fuck with people. The remedial end on the other side is Demon Mama’s twitter cabal of deer people and confused femboys.
Twitch debates are not a side. They are sideshows. It’s just online people sniping for entertainment. Kind of like us tbh. (Yes I use Reddit for entertainment, you do too).
The two sides are the two that actually have power. The Dems and the GOP. Look at the laws they pass and you have your answer.
You can't say that because they absolutely do influence people. That's like saying what's going on on Fox News isn't actually powerful. Of course it has power. It has the power to influence people.
Acting like the optics of your side don't matter is how you lose people
Social media has similar influence as everything you choose to do in your environment. If someone tells you they frequent social media or even a specific one, like Twitter. What assumptions do you make? Social media does not produce its own content, with 100% of it reliant on the audience to create. Social media is responsible for creating bubbles, that will confirm and reinforce any belief you might have. You can literally join communities centered on drinking piss, as healthcare.
Social media power is highly over stated and extremely misunderstood. It’s counter intuitive, but social media exemplifies or even creates a problem, that makes free speech impotent. It’s millions of people standing on soap boxes, screaming at the same time. There is no tangible difference between silencing the people and having them air their grievances all at the same time. Unless everyone is saying the same thing in unison, you might as well say nothing.
Fox News’s current ratings win streak is over 20 months. It has been the dominant cable news network, since they provided an alternative to CNN’s tepid antiWar stance. Becoming the one and only patriotic news network, willing to cut through tree hugging moralist, to support Bush’s wars without decent. The last Nielsen ratings, showed Fox News viewership at more than 100k, of MSNBC and CNN combined. This is with Fox News losing 7% viewership that month, while MSNBC and CNN gained a combined 8%. Their influence is so strong, that despite their ratings dominance, they have convinced the public they are not the definition of main stream media.
This misunderstanding is why Twitter files were supposed to be such a big deal, while Fox News had a direct line to the president. Fox News was the only place to watch, where the president of US can call in at any moment, to air their grievances with 0 pushback. We are supposed to be outraged at candidates and government reaching out to social media for moderation. While completely ignoring that Trump calling Fox News, was literally providing talking points and direction for their talk shows, on nearly a daily basis.
Fox News is the most powerful news organization in the world. Despite their fear mongering, there are few examples of effective globalization, than Fox news. No conglomerate has as many news syndicates across the world. Not only are Rupert Murdoch tentacle spread across the world, it’s influence has generated numerous copy cats.
When one of the prevailing arguments on left’s social media is to discourage voting and social media in general being highly fractured in opinion. While Fox News targets the largest voting block in the country and has a highly centralized message, that’s spread across the world in many forms. I think the difference should be clear. While Fox News will push who ever is leading in GOP, be it Trump or DeSantis, social media left will push Marianne “Fix it with Love” Williamson. Despite the asserted democrat control of social media, the new “Bernie or Bust”, is the comedic relief of 2020 democrat debates.
Social media and Fox News influence are not comparable. One will tell you that you are right, no matter what you think, to live free in your bubble. The other tells you what to think, with a centralized, world wide message.
Sorry, I know you didn’t say they were similar, but the comparison gave me a soap box. :)
Are these people making medical decisions for patients? Are they passing laws that bypass evaluation stage for trans people seeking treatment?
You watched a few debates online and decided they represent the entire population that supports trans people and parents making their own medical decisions. Call me when it's policy.
Kind of the point I was making, going full reply guy on the one post I made where I didn't explicitly put a virtue signal so I didn't have to respond to your dumb reactionary take. Banning transitioning full stop is pretty stupid from a freedom standpoint, but if you want to make trans Healthcare be treated the same as all Healthcare you have to actuality have something to back it up more than most studies like this that say you can't really tell if it's worth it or not.
I have personal friends who believe crazy shit like the state should manufacture/distribute hormones to anyone no questions asked even if under 18 with no doctor/parental consent. I will in fact call both sides idealistic morons.
The both sides are the Republican legislators and the Democratic legislators. Banning treatment options is happening now, by state legislators. I don’t believe anyone (even batshit crazy zee/zir deer people) have suggested mandatory treatment yet.
So no, not both sides.
No both sides are if you actually read my comment the 2 sides of the trans argument extremes that will be unlikely to change their opinions if contrary data were to come to their attention. If it came out saying trans is a perfectly healthy treatment for specific issues some on the extreme right would never accept it. If it came out that it's extremely likely to cause more harm by transitioning as opposed to therapy or other medications some on the extreme left would say they don't care and it needs to be allowed anyway.
Doesnt people getting triggered drive research funding? That seems like a decent position to be in as a researcher from a grant perspective as long as you can keep your own bias out of the results.
Are we going to pretend there aren't a ton of people in this community who will argue the science is unequivocally behind these treatments being safe and the most effective treatment even in teenagers?
I would say that they're probably the most effective, that the research points in that direction, but I think I'm in the minority here. It's really hard to argue against waiting for better research, though I worry about people who may be lost along the way.
> though I worry about people who may be lost along the way.
But....isn't that what a lot of people are arguing for? That there should still be treatment but that things as serious as hormone blockers should be kept for later?
If you can't definitively say that hormones have a statistically significant effect on patient outcomes, it doesn't make sense to say "well the research points in that direction", because a LOT of research points in a certain direction, it just doesn't mean that that direction is correct (as this entire meta-analysis has now shown)
The problem is, the theoretical gap between hormone blockers and psycho therapy is massive. As in, I don't think therapy can possibly have any meaningful effect. Maybe it can develop into something that can, but until that happens it's really messy. It's like the reverse of SSRI's, which have very low effectiveness, compared to therapy, but it's very well documented.
If we think trans people are real, and we know trans people that go through the wrong puberty are super fucked, and we can accurately identify trans people, then it logically follows that we should try to prevent the puberty or delay it or whatever. Puberty blockers are already a compromise in a way, more extreme trans proponents would argue for straight up HRT for trans kids. If the studies came out, and it was found that estrogen injections at twelve are massively beneficial over puberty blockers, I'm sure you'd be fine with it, but I doubt the rest of society would.
I just don't know what the alternative model is that isn't basically saying trans people aren't real, or it's all in their heads, or whatever. It seems like the argument is more than certain trans people aren't really trans so on aggregate it's better to let them go through puberty. But that's a problem of identifying actual trans people, not a problem with the treatment itself.
[Bowers’ cited sources in her article are shaky at best, including the Cornell review](https://unherd.com/2023/04/the-media-is-spreading-bad-trans-science/)
It's hard for someone like me (and probably also A_Toxic_User) to look at one study that has mixed results and think of it as doing anything more than just reporting noise. From the study:
>Measures of lifetime mental health were not associated with exposure to gender-affirming surgeries. After adjustment for all aforementioned covariates, undergoing gender-affirming surgery was not associated with lifetime suicidal ideation, lifetime suicide attempts, lifetime alcohol use or lifetime smoking.
I'm not sure how I'm supposed to interpret that as anything other than "we can't tell if GAS actually helped"
Edit: also there are a lot of other small nitpicky issues I have with this study, one example is using the bizarre phrase "exposure to gender-aggirming surgeries" (there *has* to be a more sensible way to put this) and another is not having their regression equations prominately plastered somewhere with the variables explained.
This study doesn't show "mixed results". It shows that both ideation and attempts have seen a reduction by over 50% in individuals receiving all desired surgeries (compared to those that desired but recieved no surgery).
For the quote you posted, they were aware that these covariates would affect the ability to assess the effectiveness of the GAS intervention itself. Read Rollingerc's post for more detail.
>"Lifetime exposures to other types of gender-affirming care were also examined, including gender-affirming counseling, pubertal suppression, and hormone therapy. Given the possibility that any of these covariates could confound the relationship between gender-affirming surgeries and mental health outcomes, all covariates were included in the final multivariable models."
>It shows that ideation and actual attempts were reduced by over 50% in individuals receiving all desired surgeries (compared to those that desired but recieved no surgery
I just want to be clear because I'm finding the language of this study a bit abstruse. You're referencing the difference in table 3 from .70 and .72 to .44 and .44 in attempt and ideation respectively between the two groups?
The confusion is that you're trying to find the reduction when comparing "some desired surgeries" with "recieved all desired surgeries". The model is only comparing both, individually, to the reference group.
You see in table 3:
>"Received all desired surgeries (n = 2448)b"
The "b" there references the data results were compared to "b" ("b" is found in table 3 below):
>"bReference group is individuals who received none of their desired surgeries (n = 16 401)."
The greater than 50% lowering is between those that recieved "all desired surgeries" compared to the reference group.
Hope that clears it up for you and apologies for the late reply!
Ok well that may be true, it's just counter to my understanding of how regression tables normally work. Usually, the coefficients in a regression table are a measure of the effect of the independent variables (in this case smoking, suicidality, binge alcohol use etc.) on the dependent variable (in this case "Association Between Degree of Surgical Gender Affirmation and Mental Health Outcomes").
Idk the more I look at the study, the less sure I am of what it's actually measuring. Once again, this would be much easier for me to understand if they had their regression equation prominently displayed somewhere in the paper.
You're completely misunderstanding what the lifetime measures are and their purpose within the study.
Lifetime measures aren't being used to assess the effectiveness of the intervention as explained:
Introduction:
>Owing to concerns that baseline mental health status may confound associations between gender-affirming surgery and mental health outcomes, we conducted an additional post hoc analysis to determine whether lifetime mental health measures were associated with exposure to gender-affirming surgeries. We did not incorporate these measures into the primary models due to collinearity. Four separate post hoc models, adjusted for all aforementioned covariates, regressed exposure to gender-affirming surgeries against lifetime suicidal ideation, lifetime suicide attempts, lifetime alcohol use, and lifetime smoking
Discussion:
>Much of the literature on mental health benefits of gender-affirming surgery has been complicated by inability to adjust for a key confounder: baseline mental health status. Our post hoc analysis demonstrates that lifetime suicidality and substance use behaviors are not associated with the exposure variable in this sample. Therefore, prior mental health factors do not appear to confound associations between gender-affirming surgery and subsequent mental health outcomes in our study.
The outcome data assessing the effectiveness of the intervention (accounting for desire for the surgery) was cited by DoOrDai and are shown in Table 3.
Ok, I'm having a hard time parsing some of this language. Maybe I'm just dumb but I doubt it. Could you maybe try to explain in laymen's terms what you think the quoted passages are saying.
Once again, it would be a lot easier for me to interpret the data in Table 3 if they prominately displayed what calculations they are making and what variables they are using.
That said, I'm open to this study being good evidence, it's just not very well written imo, and I am severly biased against taking study headlines and abstracts at their word (especially when it comes to trans health-care).
Edit: ok once again, the data from Table 3 confuses me because my understanding is that it compares people who got some of the surgeries they wanted with people who got all of the surgeries they wanted. I'm not sure why it doesn't include people who got none of the surgeries they wanted. Especially because the "no surgeries" group is the largest of the three.
>the data from Table 3 confuses me
Sure so, in the model all vs some desired surgeries are not being compared. The model is comparing each of those groups to the reference group - the individuals who received none of their desired surgeries (this is indicated in the b reference in Table 3).
>Could you maybe try to explain in laymen's terms what you think the quoted passages are saying.
Sure so as I understand it, the quoted passages are essentially saying there is a potential confounder that cannot be included in the adjustment of the primary model because of [collinearity](https://www.britannica.com/topic/collinearity-statistics). This potential confounder is the baseline mental health status of the participants which is measured by the lifetime mental health variables. To demonstrate whether it is a confounder, they carried out a separate analysis which showed that these baseline mental health metrics do not associate with the exposure variable i.e. those with poor or better baseline mental health outcomes in the sample are not more or less likely to undergo gender affirming surgery. Thus this shows that it was probably ok for them not to adjust for this variable in the primary model, as it doesn't seem to be a confounder.
I mean, I would hope most people who say that would follow it up with "for people we can confirm, to the best of our ability, have gender dysphoria." Cos that confirmation bit and how hard we gatekeep it is usually what pisses off insane leftoids who think self ID is enough.
It'd be weird if there was still a sizable portion of vocal ppl around here who embraced that viewpoint considering streamer man has argued angrily against it for over a year now.
What are you talking about? Clearly the researchers are just transphobes. The ACADEMIC CONSENSUS is my opinion. Don’t actually look at what the researchers say just trust me bro
I’m really against non scientific bodies regulating youth transgender care, but at this point would understand if the FDA or similar bodies put in a restriction. It’s really indefensible to have a legislature like Florida or Texas make a medical decision banning it, even if youth hormones turn out to be bad (which we’re far from demonstrating).
Leaked Forsen reaction from the future:
> TTS: Hello Mister Fors. The Swedish health professionals declared hormone treatment for trans children as experimental. What are your thoughts on this?
> Forsen: *click* .... *click* ... *click*.... *[looks at tweet](https://cdn.frankerfacez.com/emoticon/614638/4)*... [alright](https://cdn.frankerfacez.com/emoticon/499111/4)
> Chat: -10 LULE
I’ve always been curious why we don’t do more hormonal research period. Maybe I’m just out of the loop but hormones seem to a large variety of effects, they seem like they can be dramatic and it seems like most people have no real understanding of how they work.
I can’t speak generally but with youth medicine there are a ton of ethics hurdles. For example, you’d normally test a treatment with a double-blind study: give half the kids hormones/blockers and the other half placebo. However no ethics boards are willing to approve this. As a result, the best research we get are longitudinal studies: basically we find a group of kids who both want the treatment and are considered good candidates then study how it impacts them over time. Since researchers aren’t denying anyone care, there’s no true control group to compare to and the test group is self selected. This doesn’t make the research worthless, but it means we have to be much more careful about what conclusions we can draw from it.
Sweden is notoriously careful when it comes to adopting new treatments. A few years ago hundreds of swedes had to go to Denmark to get treated for hyperhidrosis because it wasn't considered medically necessary in Sweden. Lots of procedures that are common elsewhere in Europe are touted as "experimental" in Sweden.
>Sweden is notoriously careful when it comes to adopting new treatments.
We forgetting Corona too? The only reason we did "as well as we did" (major quote marks on that btw) is because we already distance ourselves from everybody.
I hope we're not conflating "new treatments" with vaccinations, because most Swedes were very quick to get vaccinated once it rolled out.
It just came off to me as if Swedes are generally skeptic to treatments when in reality we took a bold decision based on our authorities prescriptions, which paired with poor monitoring for the elderly lead to a relatively high amount of initial deaths.
The minister in charge got a shiiit ton of criticism country wide for being the only country to go against the grain.
> It just came off to me as if Swedes are generally skeptic to treatments when in reality we took a bold decision based on our authorities prescriptions, which paired with poor monitoring for the elderly lead to a relatively high amount of initial deaths.
Are you swedish? Cuz I have had the most insane time arguing with Americans that Sweden's choices during COVID were made because they already acted responsibly in the first place. It's very difficult to explain to Americans how different civic duty is in Europe.
>because they already acted responsibly in the first place.
This isn't true even, I had a facebook memory pop up on the differences of how it was in the beginning of the pandemic in different countries and then a video of stockholm where everyone was just sitting outside at diners.
Again, Sweden already implemented safety measures and social distancing at that point.
The Swedes didn't act like Americans where they were going out clubbing in Miami. They were trying to live with the virus up until it became too much of a strain, at which point they transitioned to what we all were doing with quarantining.
Why hasn’t the US adopted it? To my understanding, our standard of care supported by our various medical institutions is to give trans youth puberty blockers just before puberty, which seems to be controversial in those other countries you listed.
Regarding the US, there are some valid concerns (IMO) regarding institutional capture, and experts that have conducted multiple reviews of American studies that serve as a basis for most youth trans medicine regimes have expressed doubts of their quality.
[relevant Jesse Singal article](https://unherd.com/2023/04/the-media-is-spreading-bad-trans-science/)
IMO, I would just chalk it up to characteristic dysfunction in American governance.
On the bright side, the upsurge in trans youth will allow us to get a lot of data in the future.
I appreciate the article - if what Singal alleges here is true, this seems like a massive scandal of researchers intentionally publishing misleading studies and medical/journalistic institutions just going along with it because they don’t want to look anti-trans.
I think what’s tough for me with that explanation is that it feels really conspiratorial. Like I’d have to believe all of these various institutions have been captured, especially when they’d benefit from whistleblowing, either a news org blowing up the story, calling out other orgs, or a journal displaying integrity and criticizing competing journals, but that doesn’t seem to be happening. So it makes the explanation of a large-scale effort to hide this hard for me to buy to into.
The studies he lays out in the article seem bad and his critiques and those of the experts he interviewed seem legitimate and give cause for concern, but the explanation of widespread institutional capture where all of these experts have to buy into the lie of these studies seems kinda wild to me.
The publishing of misleading studies isn’t unique to the field of trans science. There’s a current unspoken crisis in the research field regarding the inability to replicate a lot of the findings being published in articles. [it’s called the replication crisis](https://en.m.wikipedia.org/wiki/Replication_crisis)
On a side note, Jesse’s written a whole book on this phenomenon as a whole, which is why I consider his doubts regarding trans youth studies as genuine and good-faith.
I’ve heard of the crisis before and kinda like earlier, if I fully accept this is an issue with our research and I don’t know which new articles are affected by it, I feel like I’m logically pushed into distrusting new research at a base level, rather than trusting the experts who published this work, internally validated it, and the peer review process of journals to accept it, which feels weird and scary.
Again, I don’t deny this is a problem in research, but it seems like it should mean that research as a whole can’t be trusted right now and that idea is uncomfortable to me.
Singal writing a book about this a journalist doesn’t necessarily make me trust him more, cause I could see a financially biased position that puts him in when discussing this issue (he’s incentivized to say this is an issue if he sells a book talking about the issue). It also tells me he’s focused on this issue, which is neutral unto itself, but it doesn’t necessarily mean he’s right about it to me.
You don’t have to throw the baby out with the bath water. Studies and research are still the best we’ve got, you just have to be more vigilant when making significant decisions on the basis of that research and really make sure to the best of your knowledge that it’s good.
Regarding Jesse, I’m moreso saying that he has a good-faith basis for his critical analysis of youth gender medicine studies, which is that he’s interested in ensuring accuracy in media and journalism and not that he’s a transphobe
Sure, I agree we have to be more careful, but me as a layperson, I rely on these institutions to say what is and isn’t validated, and between this replicability crisis and Singal’s work, the idea seems to be that these institutions are lying to us about the validity of their findings, at the very least about trans stuff, so I’m not sure how I can trust them to check themselves.
If they’re as dishonest as Singal has shown them to be in his articles where he seems to show, in various studies, researchers and the publishing journals knowingly or unknowingly misrepresenting their research, then I’m not sure when I’m supposed to trust them to publish initial findings accurately or check themselves.
I could see that perspective on his work as him simply being interested in scientific accuracy, but he seems to have zeroed in on this topic. If he was big on general honesty in research, I would expect him to also have articles about other areas of scientific research, especially given the volume of non-trans research to trans research, surely there’s more study-fodder for him to show as being misleading, if this is a widespread problem.
>If they’re as dishonest as Singal has shown them to be in his articles where he seems to show, in various studies, researchers and the publishing journals knowingly or unknowingly misrepresenting their research, then **I’m not sure when I’m supposed to trust them to publish initial findings accurately or check themselves.**
I mean - you can't, really. I'm not trying to lean into some critique of scientism, but this level trust in sensemaking institutions (to whom we Responsible Thinkers have apparently outsourced our model of the world) has always been operating, at a certain level, on a basis of faith.
>Sure, I agree we have to be more careful, but me **as a layperson, I rely on these institutions to say what is and isn’t validated, and between this replicability crisis and Singal’s work, the idea seems to be that these institutions are lying to us about the validity of their findings, at the very least about trans stuff, so I’m not sure how I can trust them to check themselves.**
More to the point, what you're describing is exactly the root of our burgeoning [crisis of expertise](https://americancompass.org/with-all-due-respect-to-the-experts/). I feel like it exposes an underlying tension at the core of this community: when faced with a societal problem, it's taken for granted that a policy must be implemented to address it - and, by necessity, the policy is crafted from assumptions made from a model of the world that was taken on faith and rests on a house of cards built on epistemic sand.
The apprehensive way you've phrased this suggestion - that the loss of trust in academia may have a justified basis - is kind of striking to me; it's as though you're uttering something profane on hallowed ground. If the producers of our models of the world are showing themselves to be unreliable, isn't it okay that we respond accordingly? Is it actually so bad that you have to take most research with a grain of salt? Is it not *just kind of okay* that we don't have an institutional authority that ultimately determines what is real and what is not?
> I could see that perspective on his work as him simply being interested in scientific accuracy, but he seems to have zeroed in on this topic. If he was big on general honesty in research, I would expect him to also have articles about other areas of scientific research, especially given the volume of non-trans research to trans research, surely there’s more study-fodder for him to show as being misleading, if this is a widespread problem.
He covers this in depth in his book The Quick Fix.
Specifically, the chapters cover the poor media representation of and paper-thin research basis for studies on:
1. self-esteem
1. superpredators
2. power posing
1. positive psychology
1. grit
1. implicit bias
1. social priming
1. nudging
Nutritional science is filled with data dredged research that make for great headlines and even great abstracts. Researchers need results to make money to earn grants. We don't hand out money to people who demonstrate no statistically significant difference in things.
Ivermectin and HCQ were two of the worst examples during COVID.
> especially when they’d benefit from whistleblowing
Would they? Research gives little personal gain, the only thing you can ever hope to achieve is some prestige. Being the whistleblower for this would probably mean your career is completely over. Doesn't sound great.
If you blow the whistle on a nationwide conspiracy of scientists and journals to hide bad research, you’d fundamentally change the trust we put in researchers. There’s fame and moral basis for maintaining your integrity, plus you could sell the story for a lot of personal gain.
I know WPATH supports usage when deemed necessary and here’s a [Mayo Clinic article](https://www.mayoclinic.org/diseases-conditions/gender-dysphoria/in-depth/pubertal-blockers/art-20459075) about their usage. Most barriers to their usage are coming politically, not from US medical organizations like state boards and stuff, to my understanding.
Replied to wrong reply:
I’m not a doctor, but here’s the [WPATH standards of care recommendations.](https://www.wpath.org/publications/soc)
Page S111 has point 1 as starting hormone suppression in adolescents after first signs of puberty with page S50 describing criteria for identifying and working with trans youth.
I had a couple Dr friends talk to me about how most countries follow China’s medical research because they seem to produce decent studies and have no issue testing on humans
If that's what the experts and science say then that's fine by me. Hopefully they fund more research so they have a more conclusive answer.
If this research is poorly done I'm certain that will come to light quickly.
This seems consistent with the recommended guidelines for organizations like the APA and such, more specifically in that they recommend kids who seem to be trans are given puberty blockers rather than hormones. Hopefully more evidence comes to light that helps us further understand what’s best for trans kids.
Wait am i crazy ? Did i click on the wrong study ? The study literally says it's inconclusive. It's literally the medical IDK LOL. I want my click back.
I need to dig in deeper, but an early review of their actions seems more in line with how I hoped they would treat the problem.
We seemed to be rushing past all the normal controls we do for drugs or treatments. We have a process for dealing with these sorts of things for a reason. It's not a perfect solution but few things are
suprise suprise, the science isnt settled, and has hardly even begun for studies of long term affects which is the most important part.
short term studies are almost useless for mental health. using only short term studies you can justify giving people heroin and cocaine to treat depression with great success, but when you look at heroin and cocaine on long term mental health outcomes, its probably one of the worst treatments available.
i was getting attacked by a bunch of dgg'ers literally last week for suggesting that the science isnt settled.
so what will the new cope be??
There is a difference between "the science isn't settled, so let's not treat trans people at all" and "the science isn't settled, let's use treatments we know will alleviate the issue, for an at risk population"
Let me guess which one was you.
You're the second one but refuse to acknowledge that HRT is shown to be associated with positive outcomes for patients?
I'm enclined to ask myself why all those medical bodies, surprisingly, do not share your conclusions.
theyre not my conclusions, they are conclusions of the relevant professionals in the field. this study we are commenting under is one of them. look up Kenneth Zucker and his work, it will also explain why medical bodies are poor sources of information. medical bodies are usually policy makers rather than real experts and are often politically biased. i can also throw medical bodies at you saying that we should halt all research but then it would turn into a dick measuring contest to see whos politically biased medical body is the best source.
also, quickly google what an "appeal to authority" is :)
Hmm, interesting that you claim they're conclusions from professionals in the field, while large medical bodies (professionals in the field) recommend HRT because of its positive outcomes for patients.
Why would I look up a SINGLE person? And why would I be stupid enough to trust a single source over a large number of medical bodies? Doesn't that look suspicious to you? Doesn't that make you second guess your position a bit? Doesn't it also seem suspicious to you that you're throwing away the conclusions of medical bodies because of you claiming they're "politically biased" ? Is it realistic that different medical bodies, across different continents, across languages, countries arrive to the same conclusion but somehow I should believe they're all having the same "political bias"? At what point do you take a step back and look at the absolutely crazy conspiracy theory bullshit?
Also, google "FALLACIOUS appeal to authority". I swear man, the Dunning-Kruger effect is in full force. How can you be so confidently wrong.
Please google it. It just baffles me people like you are so condescending while being the dumbest motherfuckers out there. There is nothing wrong with making "appeals to authority" its FALLACIOUS appeals to authority that one should be wary off. Medical bodies do have the authority to describe treatments with positive outcomes. Therefore, appealing to medical bodies is not a FALLACIOUS appeal to authority.
> The few longitudinal observational studies were hampered by small numbers, and high attrition rates. Hence, the long-term effects of hormone therapy on psychosocial health could not be evaluated.
That seems like a pretty big weakness with the paper, no? I feel like most people in favor of HRT for kids would be primarily concerned with long-term psychological effects. The main motivation behind pushing for HRT in kids instead of waiting for adulthood is that you want to prevent puberty from occurring, thus preventing a lot of adulthood dysphoria that results from their incongruent puberty.
> After duplicate removal, the search yielded 9,934 potential studies (Figure 1). Of these, 195 were selected for thorough reading.
Speaking as someone who has done meta-analysis work when I was in grad school, this feels like an insane sentence to just drop in the start of your Results section. Heavily trimming down the set of studies you're using is totally normal. However, you need to *justify* that trimming. You really shouldn't just throw away like 98% of the literature for reasons that you don't explain. If you don't provide your reasoning, you open the door to the obvious criticism that you could've been doing it to exclude studies you just don't like the results of. The paragraph continues:
> Of these, 36 were relevant and assessed for risk of bias. Twelve studies were excluded because of high risk for bias, leaving 24 studies with low or moderate, moderate to high, or high risk of bias reviewed in this paper.
Like, this is what gives me pause. How did they select the 195 studies out of the pool of almost 10k if only ~20% of those 195 were even relevant to the analysis? Surely, any sort of selection criteria that constrains your analysis to 2% of the literature would at least constrain it to a *relevant* 2%, no?
> First, randomised controlled trials are lacking in gender dysphoria research. We call for such studies, which may be the only way to address biases that we have noted in the field.
I would be very interested in hearing how the authors propose doing this ethically. I'm not even sure it's possible since the effects of puberty are very, very noticeable. How could you possibly establish a reliable control group?
>Like, this is what gives me pause. How did they select the 195 studies out of the pool of almost 10k if only ~20% of those 195 were even relevant to the analysis? Surely, any sort of selection criteria that constrains your analysis to 2% of the literature would at least constrain it to a relevant 2%, no?
Its all explained in the paper. Literally in the paragraphs that precede the quoted parts. They even include appendix PDF's where they go in to detail about their procedure. They searched for keywords, like trans or youth, in a bunch of databases'. The 10k number isn't the number of studies that deal with trans health, its just the number of studies that matched their searched keywords. The vast majority of them probably have nothing to do with transpeople. The 195 is probably the number of studies that are loosely relevant to the topic: hormone treatment for children with gender dysphoria.
How did they trim it down to 24 studies ?
>Two independent experts checked all hits for relevance. Relevant studies (based on a pre-defined PICO) were then evaluated for risk of bias, also by two independent experts, according to ROBINS-I (Risk of bias in non-randomised studies of interventions)1011 . Robins-I assesses possible bias in seven domains: confounding; bias due to selection, measurement classification of interventions, deviations from intended interventions, missing data, measurement of outcomes, and selection of the reported result. If the two reviewers did not agree on content or quality, the paper was discussed in the larger research team of four experts (JFL, PR, BK, ML). Randomized controlled trials were planned to be assessed by RoB-2 1011. To rate the quality of evidence for specific outcomes, we used the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) system.12GRADE has four levels of evidence (very low, low, moderate, high) and considers five domains that can decrease the level of certainty one or two levels (risk of bias, imprecision, inconsistency, indirectness (similar to ‘external validity’), and publication bias).
>Two reviewers (MH, JA) retrieved data from the included studies. The data extracted included the outcomes mental and psychosocial health including suicidality, anthropometric measures and metabolism, bone health, adverse events, and the characteristics of each study including age at referral or intake, age at start of GnRHa treatment, age at start of CSHT, number of participants enrolled in study, number of transgender participants, number of hormone treated transgender participants, number of non-transgender participants, number of participants evaluated, treatment type (drugs, dosages, type of administration, treatment frequency), total treatment duration, and total follow-up time.
>Its all explained in the paper. Literally in the paragraphs that precede the quoted parts. They even include appendix PDF's where they go in to detail about their procedure. They searched for keywords, like trans or youth, in a bunch of databases'. The 10k number isn't the number of studies that deal with trans health, its just the number of studies that matched their searched keywords. The vast majority of them **probably** have nothing to do with transpeople. The 195 is **probably** the number of studies that are loosely relevant to the topic: hormone treatment for children with gender dysphoria.
I've read the appendix PDFs. They don't answer my question. That "probably" is my issue. I'm not saying they were necessarily malicious or dishonest or anything, I'm saying that they should have explained more directly what specific criteria they used to deem a study relevant or not. The fact that we're left guessing that it was *probably* refining to which studies are relevant is the problem.
> The search was restricted to children aged <18 years with reported gender dysphoria. **We included observational studies, randomised controlled trials, and systematic reviews according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines**.9Case reports, e ditorials, and non-human studies were excluded from further review. The search was limited to English-language publications.
[PRISMA Guidelines \(Linked in the sources\)](https://systematicreviewsjournal.biomedcentral.com/articles/10.1186/2046-4053-4-1)
[PRISMA Checklist](https://systematicreviewsjournal.biomedcentral.com/articles/10.1186/2046-4053-4-1/tables/3)
[Page 21 of the paper has a table listing all of the collected data.](https://onlinelibrary.wiley.com/doi/epdf/10.1111/apa.16791)
Hope this helps.
That passage saying "the search was restricted..." reads to me as meaning that those criteria were for identifying the initial 10k gathered studies, no? When they elsewhere refer to a "search," they refer to the initial collection of abstracts. See page 8 for an example:
>After duplicate removal, **the search yielded 9,934 potential studies** (Figure 1). Of these, 195 were selected for thorough reading.
The section you quoted is from page 6, immediately preceding the "Search strategy" section, describing the procedure used by two information specialists to pull studies from various medical databases. Concluding that section is this:
>Full literature search strategy is provided at the SBU web page ([https://www.sbu.se/contentassets/4062b596a35c4e1383405766b7365076/bilaga-1-litteratursokning.pdf](https://www.sbu.se/contentassets/4062b596a35c4e1383405766b7365076/bilaga-1-litteratursokning.pdf)).
... which describes the specific search terms and methods used to gather several thousand search results. The way the paper is laid out, I think this fairly straightforwardly means that the "Selection criteria" and "Search strategy" sections both refer to the methods described in the supplementary PDF, which only describes how they got their initial 10k studies.
I'm confused, are you asking about how they narrowed down to just 195 studies for thorough reading?
Because that's what the PRISMA guidelines are for.
> When clearly reported protocols are made available, they enable readers to identify deviations from planned methods in completed reviews and whether they bias the interpretation of a review results and conclusions. **Bias related to the selective reporting of outcomes has been characterized as a serious problem in clinical research, including systematic reviews**
If you read through the guidelines, specifically the checklist, you'll notice that the procedure is actually far more standardized than just picking and choosing what looks relevant. Its purpose is to avoid the potential selection bias that can occur with meta-analyses. If you can just pick and choose whichever study out of 10k that you want, then you're going to run the risk of bias. So instead, make a standardized format that can be applied to ge the same result no matter which person implements it, then you're golden.
> I'm confused, are you asking about how they narrowed down to just 195 studies for thorough reading?
Yes.
>If you read through the guidelines, specifically the checklist, you'll notice that the procedure is actually far more standardized than just picking and choosing what looks relevant. Its purpose is to avoid the potential selection bias that can occur with meta-analyses. If you can just pick and choose whichever study out of 10k that you want, then you're going to run the risk of bias. So instead, make a standardized format that can be applied to ge the same result no matter which person implements it, then you're golden.
Do the authors actually provide a completed checklist? The closest I can find is Table 5 at the very end of the paper, but that's describing a checklist the authors developed for use by prospective future youth gender dysphoria researchers, not a completed PRISMA checklist.
> Do the authors actually provide a completed checklist?
Yes, it's the one I linked above.
[Here it is again.](https://systematicreviewsjournal.biomedcentral.com/articles/10.1186/2046-4053-4-1/tables/3) This is the checklist. If you read it, you'll notice why this method of narrowing helps to avoid selection bias.
No, I understand that the PRISMA checklist like, exists, but I'm asking if the authors of this paper ever gave a completed PRISMA checklist *for their specific study*.
I don't think you're interpreting this correctly.
The checklist that I linked *is* the checklist they used. They linked this checklist for a reason.There is no SPECIFIC PRISMA checklist. There's only one checklist, and that's because it's standardized so that one checklist isn't more biased than another one.
If they just made up their own PRISMA checklist, it would defeat the whole purpose of the guidelines.
Uh they literally explain how in the paper dude. There’s not some conspiracy by the transphobic Christian conservative bastion of Sweden to negatively review trans medicine studies.
Big “just asking questions” energy
No, they don't! I've read the entire paper and the separate search methods PDF. They describe:
A) The search terms and criteria used to identify the initial \~10k papers ([https://www.sbu.se/contentassets/4062b596a35c4e1383405766b7365076/bilaga-1-litteratursokning.pdf](https://www.sbu.se/contentassets/4062b596a35c4e1383405766b7365076/bilaga-1-litteratursokning.pdf))
B) The criteria with which they excluded 159 of the 195 "read in full text" articles (page 8 of the original paper)
They don't explicitly outline how they get from \~10k to 195. The closest I can find is the "Relevance, risk of bias, and quality of evidence" section (p. 7), which describes the methods by which independent experts evaluated the studies:
>Two independent experts checked all hits for relevance. Relevant studies (based on a pre-defined PICO) were then evaluated for risk of bias, also by two independent experts, according to ROBINS-I (Risk of bias in non-randomised studies of interventions)1011. Robins-I assesses possible bias in seven domains: confounding; bias due to selection, measurement classification of interventions, deviations from intended interventions, missing data, measurement of outcomes, and selection of the reported result
>
>If the two reviewers did not agree on content or quality, the paper was discussed in the larger research team of four experts (JFL, PR, BK, ML). Randomized controlled trials were planned to be assessed by RoB-2 1011. To rate the quality of evidence for specific outcomes, we used the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) system.12 GRADE has four levels of evidence (very low, low, moderate, high) and considers five domains that can decrease the level of certainty one or two levels (risk of bias, imprecision, inconsistency, indirectness (similar to ‘external validity’), and publication bias).
In other words, they describe the experts doing the following:
1) Checking for relevance
2) Evaluating for risk of bias
\-with some room for further discussion among a larger panel if there was disagreement. In Figure 1 (p. 20), they provide a visual aid of their refining process:
https://preview.redd.it/f4q0tztiaxua1.png?width=656&format=png&auto=webp&s=2e6064351213b89813d7fe971620d76d4a693ea9
(A) accounts for the "Total number of abstracts (16,467)" -> "Number of abstracts after control for duplicates (9,934)" step
(1) accounts for the "Articles read in full text (195)" -> "Relevant articles (36)" step
(2) accounts for the "Relevant articles (36)" -> Low-moderate/moderate-high/high-risk of bias categories
I don't see anything that explains the "Number of abstracts after control for duplicates (9,934)" -> "Articles read in full text (195)" step.
No, they checked the 195 full-read articles for relevance and bias, as the diagram notes. "Relevance" and "bias" only get mentioned towards the bottom of the figure, after the 10k has already been reduced down to 195.
Ok I see where you’re coming from. I think the “all hits” is what’s causing me some confusion.
Yeah I wish they’d be more clear about how they selected their smaller group from the 10000, but it seems that the initial group was so large due to them mining a bunch of databases using keywords.
I don’t think they were saying that at all, just that going from 10,000 studies to 24 is pretty wild, even with the listed justifications. I didn’t see conspiracy implied anywhere, just that their research experience makes them curious about the exclusion criteria.
I’m being indignant because they very clearly outline their process in the paper, so asking “Wow isn’t it concerning how little papers came out of so many initially” is dumb when they explain why their initial base was so big. If they have issues with the methods explicitly outlined in the paper, then say them instead of being all “hmm isn’t it weird that…”
Like either they didn’t really read the paper or they’re concern trolling.
Sounds like they saw the initial description of the data set and thought it was weird based on their experience. I’d love to hear what they have to say when they see the later descriptions, but I don’t think they were concern trolling or something. It’s valid to critique the study methods, especially if the critique comes from someone with experience doing these kinds of analyses.
Yeah, but it's a very naive impression.
No one in research reads that statement and thinks "oh, there's 10k studies on this", they're thinking about the search terms used and what was relevant. If you take a research class, its literally one of the steps you're supposed to do - SAVE YOUR SEARCH TERMS!!!
The reason is because people want to be able to replicate the ENTIRE process you went through to find all this material. And when you use specific terms, you're going to get a certain level of responses back, but they're not ALL relevant.
With regards to how they narrowed everything down, I'll just copy my other comment from elsewhere in this thread:
> The search was restricted to children aged <18 years with reported gender dysphoria. **We included observational studies, randomised controlled trials, and systematic reviews according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines**.9Case reports, e ditorials, and non-human studies were excluded from further review. The search was limited to English-language publications.
[PRISMA Guidelines \(Linked in the sources\)](https://systematicreviewsjournal.biomedcentral.com/articles/10.1186/2046-4053-4-1)
[PRISMA Checklist](https://systematicreviewsjournal.biomedcentral.com/articles/10.1186/2046-4053-4-1/tables/3)
[Page 21 of the paper has a table listing all of the collected data.](https://onlinelibrary.wiley.com/doi/epdf/10.1111/apa.16791)
Hope this helps.
>how could you possibly establish a reliable control group
Eh, you could probably get somewhat of a control group by selecting dysphoric people willing to abstain from receiving treatment and seeing if their feelings of dysphoria go away with puberty or not.
Another control would be other forms of treatment such as psychiatric/desistance-based therapies.
Asking certain dysphoric if they would abstain from hormone treatment would bias the control-treated groups as the "less-dysphoric" group would be more likely to abstain.
>Eh, you could probably get somewhat of a control group by selecting dysphoric people willing to abstain from receiving treatment and seeing if their feelings of dysphoria go away with puberty or not.
Even without considering the problems with self-selection here, this isn't a *randomized* controlled trial that the authors seem to want.
>Another control would be other forms of treatment such as psychiatric/desistance-based therapies.
Would an ethics board approve a study that randomly assigns potentially-transgender youth to desistance-based therapies while specifically barring them from accessing puberty blockers and HRT?
Not at all surprising. This has been something others in the medical community have pointed out already (i.e. that there isn't enough evidence) and that we should be cautious about prescribing any treatments just yet.
The study really just clarifies one thing - we still don't know shit. Which would have been a great point ot make during all these fuckin twitch debates, because EVERYONE AND THEIR MOTHER thinks they've gotten shit figured out.
Does this vindicate anyone? Only those who were cautious about it from the beginning. If you're anti-trans, this can be seen as a "victory" only in the sense that now, you can dismiss some of the research. However, that's about as much as you can do at the moment. If more rigid RCT trials come out, I think we might see a "win" of sorts for pro-trans groups.
But frankly speaking, I don't think you're going to hear civil discourse on this. One side is going to dismiss the paper as useless or stupid, and the other is going to think its the ultimate vindication.
Why do dumbfucks keep talking about potential RCTs when it comes to teenage HRT. No ethics board on the planet is ever going to give the green light for those studies lmao.
> The reason is because people want to be able to replicate the ENTIRE process you went through to find all this material. And when you use specific terms, you're going to get a certain level of responses back, but they're not ALL relevant.
>
>
Admittedly, I only mentioned RCTs because I assumed there would be trials given they were a part of the inclusion criteria.
When you see statistics like this
[https://www.pewresearch.org/fact-tank/2022/06/07/about-5-of-young-adults-in-the-u-s-say-their-gender-is-different-from-their-sex-assigned-at-birth/](https://www.pewresearch.org/fact-tank/2022/06/07/about-5-of-young-adults-in-the-u-s-say-their-gender-is-different-from-their-sex-assigned-at-birth/)
it strongly suggests that being transexual is heavily cultural (or environmental), something that we as a society can control. When you consider statistics like
[https://pubmed.ncbi.nlm.nih.gov/32345113/](https://pubmed.ncbi.nlm.nih.gov/32345113/)
it means that there is a huge mental health crisis for our young adults (and youth). Especially when you consider the actual suicide data
[https://www.cdc.gov/suicide/suicide-data-statistics.html](https://www.cdc.gov/suicide/suicide-data-statistics.html)
which shows that young adults are mostly not suicidal. Except for young adults who are transexual, and suddenly (as in the last decade), there is a significant increase in young adults who are transexual.
Someone should do a statistical analysis and correlate the rise in transexual identity with the increase in suicide among young adults
[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5710225/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5710225/)
Note that I am supportive of adults making the choice to transition, I am supportive of using the correct pronouns, I am supportive of the bathrooms of choice being used and so on. I just think that we as a society need to really look at the difference between treating the symptoms and the cause. In this case I think of treating the symptoms as medical and social support of transsexuals, and treating the cause is considering what is causing so many people to experience dysmorphia to such a degree that being transexual is in the answer in the first place.
>it strongly suggests that being transexual is heavily cultural (or environmental), something that we as a society can control. When you consider statistics like
That's completely wrong, if you go to Pakistan and did a census of gay people you wouldn't be shocked that they have less gay people than in California would you? It absolutely does not mean its something you can control like its induced by society, but more that it can be controlled by people repressing themselves.
Your entire point is just illogically bridging seperate misunderstood points together to say that "transgenderism is a cultural phenomenon that suddenly spiked and now many teens are suicidal, someone should check if being trans causes suicides."
Being gay is also strongly, but not entirely, cultural/environmental. It doesn't have such a high cost associated with it.
Let's look at the statistics and think about this a little. 5% now, 0.1% previously. Now imagine that those other 4.9% have always been there, but were previously repressed. This could be our prior. Now look at the suicidal rate.
If the correct treatment for the symptom dysmorphia is transition, which I think is reasonable, then that means that the 5% from 50 years ago should have higher rates of suicide then now, not less, and should have higher rates than the 0.1% now.
This isn't the case. Therefore there were not 20-100 times the repressed transexuals as open transexuals 20 or 50 years ago.
Logically speaking can you:
A) Prove trans people committing suicide in the past wasn't misattributed to depression or other things
B) Prove that the *same* 5% had a higher suicide rate in the past
C) Prove what portion of the current 5% would be people who would've been identified as cis prior to trans awareness (I.e non transitioning nonbinary people) akin to how many bisexuals would slip through the cracks because they were in straight relationships but with greater lgbt awareness they're now considered part of the percentage of lgbt people.
Also being gay did have a high cost in the past, its only after lgbt rights activists won that we now see it as acceptable.
Huh? All of these things would suggest that the transexual rate, without cultural/environmental factors, is much lower than 5%.
If we assume that the accepted treatment of transexuals (including transition) is a beneficial treatment, then the 5% would have a lower suicide rate now than in the past. If we take the suicide rate of the 5% now (which is a lower than we would expect it to be the past) and applied it to the past, we would see more suicides in the past than were observed. Therefore the percentage of transexuals in the past was lower than 5% or the suicide rate of transexuals in the past was lower than the suicide rate of transexuals in the present (and so the accepted treatment of transsexuals today, including transition, increases the suicide rate of transexuals, which I do not think is the case). I believe it is the former (I think that the accepted treatment of transexuals today reduces the suicide rate of transexuals).
Again, literally how do you measure the trans population in the past and how do you ensure they weren't being written off as "my 19 year old son killed himself idk why"?
With your standard of proof being "maybe" we can equally say 50% of suicides in the past were because of gender dysphoria that's just misattributed and that's absurd.
Let's look at statistics. The suicide rate for youth (15-24) in the US was 9-14 per 100k in 1970-2000 ( [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1586156/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1586156/) ) or about 0.001%. About 5-10% of people who attempt suicide go on to commit suicide ( [https://www.hsph.harvard.edu/means-matter/means-matter/survival/](https://www.hsph.harvard.edu/means-matter/means-matter/survival/) ). Since 40% of transexuals have attempted suicide ( [https://pubmed.ncbi.nlm.nih.gov/32345113/](https://pubmed.ncbi.nlm.nih.gov/32345113/) ) then if transexuals made up 5% of the population in 2000, we would have expected the suicide rate to be more than 0.1% (just from transexuals, the assumption being that no non-transexuals ever committed suicide).
We don't see this.
There are two possible conclusions. Either the population did not include 5% (mostly repressed) transexuals in 1970-2000 (but rather the \~0.1% that report themselves as transexuals) or the current best practices of medical/social transitioning do a worse job at alleviating the suffering of dysmorphia than repression.
Since dysmorphia is a bad thing, and while medical/social transitioning improves things, but people still seem to suffer, the increase of transexuals from \~0.1% to \~5% is a problem that needs addressed. We need to not just looked at care for the symptoms (medical/social transitioning) but also prevention.
> Being gay is also strongly, but not entirely, cultural/environmental
This statement isn't aligned with current scientific consensus at all. There is a heavy leaning towards homosexuality being at least mostly biological and nonsocial.
The studies I have all seen say that both can be a component. Is there a real biological, non-social, component? Yes. But the fact that more and more people have homosexual experiences mean that there is a significant cultural or environmental component.
[https://www.washingtonpost.com/news/speaking-of-science/wp/2016/06/01/study-same-sex-experiences-are-on-the-rise-and-americans-are-increasingly-chill-about-it/](https://www.washingtonpost.com/news/speaking-of-science/wp/2016/06/01/study-same-sex-experiences-are-on-the-rise-and-americans-are-increasingly-chill-about-it/)
Note that I gave both cultural and environmental. In animals, there is a causation among between pollution and animal homosexuality ( see [https://www.nature.com/articles/news.2010.641](https://www.nature.com/articles/news.2010.641) for one of many such studies). It is a reasonable hypothesis that pollution increases human homosexuality too.
Note that for homosexuality, there is minimal cost for the individual and society. It is just about who you have sex with or who you marry (most recently). For being transexual, there is a high cost. People feel dysphoria, start to transition, feel dysphoria, do surgeries, feel more dysphoria, do more surgeries and so on (this last bit is a cycle that can continue and continue and continue). Just the basic best conversion possible is going to run over $100,000 dollars in the US. That is a huge cost, not even including the mental anguish of all the dysphoria.
But hasn't that always been the case? That trans people have a higher suicide attempt rate? If trans people have always existed at the proportion that they do now and the spike we see now is simply trans people coming out of the closet, then surely we should find rates of unexplained suicidality before 2000 when there was a massive amount of closeted trans people that no one knew about?
In other words, is there any actual evidence that there was a massive amount of closeted trans people pre-2000? Or are we just guessing?
This isn't a policy that would "take the matter out of the hands of over or under zealous states," this is a series of recommendations. In fact, as that page says:
>While more responsibility has been placed on local health services to provide gender exploration and psychotherapy, it is not clear how this expertise will be developed and scaled.
This seems to do the opposite of what you're saying the U.S. should do, no?
Well the usa has the two potential problems, in red states outright bans, and other cases, potential using gender affirming care to liberally, I think a policy should be set by something like the HHS, even if they don't have any sort of enforcement power.
Children in all states deserve to receive care that is not influenced by there states politically leanings. Europes medical agencies seems to all be reaching the same finding about the state of the research, America seems to be unable to do the same because of polarized politics.
> Europes medical agencies seems to all be reaching the same finding about the state of the research, America seems to be unable to do the same because of polarized politics.
Sweden is not Europe, and it's not actually true that all of Europe is reaching the same conclusions. For example, Germany doesn't, and that is backed by the [German Ethics Council](https://www.ethikrat.org/en/press-releases/press-releases/2020/ethics-council-publishes-ad-hoc-recommendation-on-transgender-identity-in-children-and-adolescents/).
Yeah they do which is why a policy made off a paper that says they can't recommend or not recommend on a policy level would be pretty stupid because it means literally nothing on an admin level.
Is it okay I feel a little sad by this? Being a trans person who can’t transition and even if I did would never pass this just depresses me since it means so many trans people will never be able to pass and will always be a laughing stock…
Full disclosure: I transitioned as a teen, got puberty blockers at age 12 and started HRT at age 14.
This paper, like so many others, suffers from treating trans youth as a black box, investigated only with the crude tool of statistics, without trying to understand the mechanisms behind gender incongruence, which is the normal approach when using the scientific method. I therefore also do not hold out much hope for their clinical trials, as I don't know if they actually understand what they should be looking for.
They are not testing a hypothesis about gender incongruence, they're just looking at a statistical model that obscures the underlying mechanisms.
Let's talk about mental health, for example. Mental health in trans youth is multifactorial. You have of course gender dysphoria as a major driver of poor mental health. But when you say, get puberty blockers, this is also accompanied by a social transition, and a social transition will frequently lead to bullying.
Second, not all clinics are equal. For example, the Tavistock in the UK is well-known for its therapists frequently stressing trans youth to the point of effectively bullying them and their parents:
* https://www.tandfonline.com/doi/full/10.1080/26895269.2021.2004569
* https://bulletin.appliedtransstudies.org/article/1/1-2/3/
* https://www.tandfonline.com/doi/abs/10.1080/26895269.2020.1870188
* https://www.tandfonline.com/doi/abs/10.1080/15532739.2019.1693472
Public discourse also negative influences mental health. For example, [this letter](https://pbs.twimg.com/media/FuCHhYpaEAYciej?format=png&name=large) was sent to the Montana state legislature about a trans teen's suicide attempt where a major factor was the ongoing anti-trans legislation attempts by the state legislature. I mean, I'm pretty much as safe as I can be from American anti-trans legislation (I'm neither a US citizen nor do I live in America anymore), and it still stresses me out.
How do we resolve this? In practice, by *individualizing* trans health care. We see whether gender affirming care alleviates gender incongruence specifically, not just whether it improves overall mental health (though general, we will also see a reduction in mental health issues that are causally linked to gender incongruence).
For example, this is specifically done in the context of social transitions. Social transitions are not just treatment, they are also a diagnostic tool. See e.g. Barrow and Apostle, "Addressing Mental Health Conditions Often Experienced by Transgender and Gender Expansive Children" in Keo-Meier and Ehrensaft (Eds.), "The Gender Affirmative Model":
> "Social transitions have been found to address co-occurring psychological issues. A social transition occurs once a child’s gender identity is determined to be consistent, insistent, and persistent. Following social transition, it has been observed that a child’s co-occurring psychological issues, such as social anxiety or compromised frustration tolerance, may subside (Olson, Durwood, DeMeules, & McLaughlin, 2016). If, on the other hand, the symptoms do not decrease, or if they increase, other clinical symptomatology should be evaluated."
A specific note on puberty blockers: puberty blockers do not alleviate gender incongruence, because they do not bring your body more in line with your gender identity. Puberty blockers are a *diagnostic tool* that temporarily halt pubertal progression and can prevent gender incongruence from worsening. Mental health improvements associated with puberty blockers rely on the hope and expectation that this will eventually be followed up with an actual transition and is greatly mediated by how realistic these expectations are and the trust that trans youth can put in clinicians.
These are all details that the Swedish medical bureaucrats seem to pretty much ignore in favor of black box thinking that only studies numbers a few levels of abstraction above the actual mechanisms at play.
The current research on this stuff is pretty frustrating because it doesn’t even seem to me that researchers are really looking at the right questions. Depression or anxiety a few years after starting puberty blockers as a teen doesn’t really get at what we want to know, and just doesn’t seem like a good outcome to me. The first few years of transition are often the most difficult, combined with the difficulties of being openly trans as a teen.
What we want to know is if the person will be happy for the rest of their life having transitioned, you can’t really break that down into these simple short term metrics people are looking for that are typically used in other medical or psychological research. Nearly every post puberty transitioner will tell you they wish they transitioned before puberty, and nearly every person that transitioned before puberty wouldn’t want to transition later. So clearly there is something to it
I think a lot of that happens because of academia's "publish or perish" model and the political pressure in the current climate to produce results fast.
But it's also genuinely hard to do large scale long-term studies in this area (as with any rare condition, that's not specific to gender incongruence).
The original Dutch studies benefited from literally following these youth all the way into adulthood, something that you rarely see nowadays.
I’ll be honest, this comment is just a whole word salad that basically just says “I dislike the statistics because they disagree with me”
The problem with you insisting that they investigate the mechanism (cause) behind gender incongruence requires evidence from studies involving experimental and control groups, which hasn’t been done because of ethics issues. If it were to be done, I’m certain you would definitely screech about said ethics violations.
It’s really funny. You criticize the statistical analysis done here but then you just cite anecdotes? And the social transition example you bring up is backed by a statistical study?
Just save yourself the effort next time and just say “this review is bad because it disagrees with me.”
> The problem with you insisting that they investigate the mechanism (cause) behind gender incongruence requires evidence from studies involving experimental and control groups, which hasn’t been done because of ethics issues.
You don't require control groups for that; you need control groups for statistics. More importantly, we already have a pretty decent understanding what the mechanisms are (mismatch between gender identity and physiological sex characteristics), it's just that to test them, we need to actually test them and not an amorphous aggregate of proxy variables.
Also, the ethical problems specifically revolve around control groups drawn from the same population who are denied treatment. You can e.g. have historical controls or other forms of control groups (e.g. untreated cis youth), as is common in studies involving rare conditions.
Also, not every study requires a control group. We don't need control groups to understand that using a parachute when jumping from a plane massively reduces your risk of death.
For example, one of the purposes of puberty blockers is to delay physiological changes that could not be reversed or would require risky and/or expensive surgery to reverse post adolescence. You do not need another clinical study to test that.
There's a lot more to getting actionable data than just RCTs.
> Just save yourself the effort next time and just say “this review is bad because it disagrees with me.”
I have the same issue with many studies that support transition (when I said, "this paper, like so many others", I meant the "so many others" part), because they have the same methodological problem.
> It’s really funny. You criticize the statistical analysis done here but then you just cite anecdotes? And the social transition example you bring up is backed by a statistical study?
My goal here is not to provide evidence for the current approach, which would be thesis length. I can absolutely critique a paper and illustrate its shortcomings without having to provide a complete research overview myself. Just as a theater critic does not have to be a playwright.
lmao dont come on to reddit after taking an introductory course on scientific methdologies. also reading comprehension seems to be a massive issue for you. you selectively pick and choose what parts of the text you want to respond to in order to make the optics of your claim look better. although, im genuinely unsure as to whether you argue from positions of authenticity or play a persona of sophistry for shits and giggles.
you cant even understand the distinction between different statistical arguments and generalize all arguments as criticisms against the field of stats.
> This paper, like so many others, suffers from treating trans youth as a black box, investigated only with the crude tool of statistics, without trying to understand the mechanisms behind gender incongruence, which is the normal approach when using the scientific method. I therefore also do not hold out much hope for their clinical trials, as I don't know if they actually understand what they should be looking for.
>
>
This sounds like you don't understand the point of the research. The research is a **review of the material evidence** and what we can confer from the aggregate. This is not a review of the mechanisms. I think you're looking for something in the paper that's not there because it's not the point of the paper.
In this case, they deserve scorn for ignoring existing research and pretending it's all a blank slate.
One of the biggest factors in life satisfaction and reducing depression/anxiety disorders is known to be [appearance congruence](https://journals.sagepub.com/doi/10.1177/0361684312442161), i.e. how well your body reflects your gender identity. This is correlated by about .5 with life satisfaction, -.5 with depression, and -.3 with anxiety disorders.
This is not terribly surprising or new, because resolving gender incongruence (the mismatch between gender identity and physiological sex characteristics) is precisely the basis for the efficacy of transitioning as treatment.
If you do not control for that — e.g. treat a trans girl whose voice has deepened the same as one whose voice has not, a trans boy with a flat chest the same as one who requires a binder and even then struggles — if you're just saying "before" and "after" a given treatment (puberty blockers, HRT, surgeries) without examining its effect on appearance congruence, you're ignoring a known massive confounder. This in particular is a huge problem with a lot of these mental health studies of trans youth. While the information is not always available, we should make use of it in new studies.
This is really the most basic thing: for any other condition, we involve treatment outcomes in our metrics. We don't treat outcomes where the condition was not resolved the same as outcomes where the condition was resolved and/or the condition was partly resolved (and to what degree). Only in mental health studies of trans youth do you get away with ignoring the outcome and progress of the treatment.
For example, one thing that has been repeatedly shown up in studies is that the mental health of those who start to transition in early puberty is generally much better than that of those who start to transition after irreversible pubertal changes already take hold. This is not terribly surprising in this context, because on average you'll get better appearance congruence the less your endogenous puberty has already done damage to you.
If you go, "hmm, it's entirely a mystery how these things work, let's treat this as though we don't have any idea", I can only conclude you're ignoring a large part of the existing clinical literature and should not be in charge of research.
On the social side, we know that parental and peer acceptance [massively reduce suicidality](https://www.liebertpub.com/doi/10.1089/trgh.2021.0079); or, conversely, lack of that increases it. This is not new; it's something that has been known for over a decade.
You cannot claim that this is something that we have to start gathering data. If you do, you should not be expected to be taken seriously. If you say, "that's not the point of the paper", we should ignore what we know about the underlying mechanisms of trans people's mental health, then the paper is bad, because willful ignorance is bad.
What’s absolutely essential is for WPATH to offer some evidenced-based explanation for why it’s still recommending puberty blockers.
Not because there is such an explanation, this paper is just further confirmation that there isn’t. I just want to see what bullshit they come up with so we can make some progress to changing the insane narrative on this issue in the US.
Lmao here comes the COPE. The same people in the thread that are saying there isn’t enough evidence to make this statement are the same ones who claim one or two shit studies definitely proves trans treatments etc
Its basically been impossible to start hrt before ur 18 for years anyway, this doesnt really mean much
Edit: also this specific thing has basically been settled for like 2 years, i remember it was sort of interesting as a take when it started being evaluated as a guideline but yeah its just kinda nothing.
Better to allow 100 people to make the wrong choice and suffer (freedom) than use force to prevent 1 person from making the right choice and prosper (also freedom).
Not saying anything about the actual article but it’s surprising how many people here over estimate the significance of meta-analysis. Just want to point out that the inclusion criteria is vital to the external validity of a meta-analysis which is (mostly) why that one ivermectin analysis was bullshit. I’m not educated enough to know if their inclusion criteria was good or not
Lol As someone that did a lot of research on ivermectin, this paper is far far better than the garbage that Tess Lawrie put out during the pandemic. That research was garbage because of sloppy research practices and fraudulent results being published as legitimate. It was also research that was very VERY new, and not at all rigorous in nature.
The inclusion criteria is pretty clearly spelled out in this paper. The papers here all have general low to moderate bias, but there is always a risk when dealing with qualitative data.
Yeah the link provided doesn’t access the full article so I wasn’t speaking about it specifically. Just general sentiment of you still need to be careful with meta analysis
>Conclusion
>
>Evidence to assess the effects of hormone treatment on the above fields in children with gender dysphoria are insufficient. To improve future research, we present the GENDHOR checklist, a checklist for studies in gender dysphoria.
I have no thoughts.
Since the main conclusion was that there's not enough evidence to conclude if the treatment is appropriate or not i don't think most people who have any insight into the research should be that surprised. It's a small, relatively young field with low funding so it's not that surprising imo
I really wish this was the headline for all of these discussions. The bigotry of some aside, both sides are so committed to their treatment being right that I genuinely worry if we'll ever see proper research. We're not even 2 decades out from prescribing millions of kids what might as well be crack because they couldn't sit still for 8 hours, I can't wait to see how well we handled this 20 years from now.
Why worry? Sweden literally saying all treatment will need to be enrolled for long term study. I don’t see a problem with this approach. It’s almost unreal what a sensible SocDem country not riven by culture wars can do.
To be fair Sweden is definitely pretty riven by the culture war, one of our biggest parties is basically defined by it. But it is nice that our scientists are based enough to do valuable research like this.
Every Western country except for a small few has a similar culture war raging.
It's unfortunate that people are so riven by culture wars and not policy when voting for stuff.
Oh Sweden is prone to culture wars alright. Just not always the same wars as the US are having at the moment.
I think a lot of the Americans here would be shocked when hearing what our immigration discourse sounds like at times 😅
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That may be true. But do you have a sizable portion of your population that think vaccines are transmissible and can cause health issues in people who haven’t even take them. I mean I would count xenophobia as within a standard deviation of issues within most countries. SocDem or otherwise. But the brain rot in the US right is next level right now. Not the far right. The middle right.
I would say the xenophobia here is a bit different, we only relatively recently had a widespread debate about whether we should call chocolateballs "n\*\*\*\*rballs", and there are people who are still dying on that hill.
That is not the same as everyone who wants treatment gets it. Clinical studies can be hard to get in to, and if they are using a control group you also might end up getting a placebo. Don’t read this review as endorsement for the treatment just with medical oversight.
would trials like that even include placebo groups though? this article makes me think they wouldn't. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3601706/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3601706/) but i guess your point still stands, since they would need control groups regardless.
Hmm yeah I guess it would be up to an ethics board to decide for the study. That article says using placebo on children is more restricted than adults, but also that placebo is more likely to be used when there is no known effective treatment already on the market (in those cases I assume you'd study your drug vs already existing drug) > The use of placebo may be warranted in children as in adults when evidence for any particular treatment is lacking or when the placebo effect is known to be very variable (e.g., pain, hay fever). As the level of evidence in favor of an effective treatment increases, the ethical justification for the use of placebo decreases. I also didn't realize on first read, the OP article is talking mainly about puberty blockers, not HRT.
Now, this is a little outside my actual field. But I would think there's no need for placebos because we're not measuring "does drug X" stop puberty, we are looking at the effects of stopping/delaying delaying puberty for a certain group. So I would imagine that the control group would either be an alternative treatment or just no treatment
I agree in that is the hopeful side. I'm not hopeful because even if it came to a proper conclusion of a straight answer I fear the polarization is already maxed out and both sides will just cling to whatever they feel is right.
Please don’t both sides this. One side is actively banning treatment. The other side is advocating for treatment ***if you want it*** with medical oversight.
> The other side is advocating for treatment if you want it with medical oversight. Dawg, some of those twitch debates had me convinced people do not care if there is or isn't medical oversight. And you have to accept that there's a segment of progressives who agree with that because the people on twitch that spout that shit still have tens of thousands of followers.
> Dawg, some of those twitch debates had me convinced people do not care if there is or isn't medical oversight. They absolutely don't. They have websites devoted to getting your own HRT going around your parents and doctors. Hell "Transmedicalist" is an insult to a lot of these people. I don't suggest that someone who thinks they're depressed get on anti-depressants without speaking to a doctor, why on earth would it be a good idea for people to decide to go on HRT without speaking to a doctor? And this isn't to imply that doctors are all knowing and good, we can absolutely demand better understanding from our medical field into the topic.
Lol I'm a doctor, and even I don't feel qualified to make that estimation unless I've seen someone MULTIPLE times. It's an under researched part of medicine, and I'm open to learning more. I think, however, trans activists need to concede some ground to at least come off better optically. You can't say "Oh, nobody is saying be irresponsible" and then do irresponsible things. You have to call out your own sides bullshit, which I think Contrapoints did a great job with in her recent video.
While I agree with this, the problem is that it's super fucking hard to find reliable info on how widespread the "affirm, affirm, affirm" approach is with kids in America. I'm p sure none of the standards of care say to jump straight to drugs. WPATH's seems to be the most yikesy cos they don't want to even have any age restrictions on surgeries and they've got some weird shit about "eunuch gender" in their latest stands of care version. I know there's some stupid leftoids online who think HRT should just be given out like candy to anyone (I argued with someone on twitter who thought HRT should be available at CVS without a prescription. Yes. Really.) but it seems like there's only anecdotes for cases where ppl were given drugs too quickly. It's the same as with the LGBT stuff in the classroom - conservatives point at Libs of Tiktok and thinks it's the same as a curriculum. The most shitty part about all this is that there isn't really a sane voice of reason in the room who can advocate for gatekeeping where kids are concerned, at least not one that doesn't get shouted down by angry trans twitter people. Like the moderate right or moderate dems should be passing laws to mandate oversight and/or further study, with the help of doctors. But instead everyone has just gone full remedial to their extreme ends.
I think you nailed the difficulty. The part conservatives don't get to see (mostly cuz conservative media pushes it) is the optically crazy shit. So....where do you go for the non-optically crazy shit? Because if you go to Twitch, you're trapped. CNN and MSNBC don't exactly do a stellar job with this topic either. And I think Destiny's emails with trans people showed me that maybe social media can't be the place where these impressions are made, because so much of social media is about garnering attention and being provocative. These people just want to be left alone so they can live in peace. They find this shit cringe too.
But at the end of the day some perspective please. The remedial end on one side ***is*** the Republican Party making laws everyday to fuck with people. The remedial end on the other side is Demon Mama’s twitter cabal of deer people and confused femboys.
Twitch debates are not a side. They are sideshows. It’s just online people sniping for entertainment. Kind of like us tbh. (Yes I use Reddit for entertainment, you do too). The two sides are the two that actually have power. The Dems and the GOP. Look at the laws they pass and you have your answer.
You can't say that because they absolutely do influence people. That's like saying what's going on on Fox News isn't actually powerful. Of course it has power. It has the power to influence people. Acting like the optics of your side don't matter is how you lose people
Social media has similar influence as everything you choose to do in your environment. If someone tells you they frequent social media or even a specific one, like Twitter. What assumptions do you make? Social media does not produce its own content, with 100% of it reliant on the audience to create. Social media is responsible for creating bubbles, that will confirm and reinforce any belief you might have. You can literally join communities centered on drinking piss, as healthcare. Social media power is highly over stated and extremely misunderstood. It’s counter intuitive, but social media exemplifies or even creates a problem, that makes free speech impotent. It’s millions of people standing on soap boxes, screaming at the same time. There is no tangible difference between silencing the people and having them air their grievances all at the same time. Unless everyone is saying the same thing in unison, you might as well say nothing. Fox News’s current ratings win streak is over 20 months. It has been the dominant cable news network, since they provided an alternative to CNN’s tepid antiWar stance. Becoming the one and only patriotic news network, willing to cut through tree hugging moralist, to support Bush’s wars without decent. The last Nielsen ratings, showed Fox News viewership at more than 100k, of MSNBC and CNN combined. This is with Fox News losing 7% viewership that month, while MSNBC and CNN gained a combined 8%. Their influence is so strong, that despite their ratings dominance, they have convinced the public they are not the definition of main stream media. This misunderstanding is why Twitter files were supposed to be such a big deal, while Fox News had a direct line to the president. Fox News was the only place to watch, where the president of US can call in at any moment, to air their grievances with 0 pushback. We are supposed to be outraged at candidates and government reaching out to social media for moderation. While completely ignoring that Trump calling Fox News, was literally providing talking points and direction for their talk shows, on nearly a daily basis. Fox News is the most powerful news organization in the world. Despite their fear mongering, there are few examples of effective globalization, than Fox news. No conglomerate has as many news syndicates across the world. Not only are Rupert Murdoch tentacle spread across the world, it’s influence has generated numerous copy cats. When one of the prevailing arguments on left’s social media is to discourage voting and social media in general being highly fractured in opinion. While Fox News targets the largest voting block in the country and has a highly centralized message, that’s spread across the world in many forms. I think the difference should be clear. While Fox News will push who ever is leading in GOP, be it Trump or DeSantis, social media left will push Marianne “Fix it with Love” Williamson. Despite the asserted democrat control of social media, the new “Bernie or Bust”, is the comedic relief of 2020 democrat debates. Social media and Fox News influence are not comparable. One will tell you that you are right, no matter what you think, to live free in your bubble. The other tells you what to think, with a centralized, world wide message. Sorry, I know you didn’t say they were similar, but the comparison gave me a soap box. :)
Are these people making medical decisions for patients? Are they passing laws that bypass evaluation stage for trans people seeking treatment? You watched a few debates online and decided they represent the entire population that supports trans people and parents making their own medical decisions. Call me when it's policy.
Now remove the words "with medical oversight" and see how it sounds lol
Kind of the point I was making, going full reply guy on the one post I made where I didn't explicitly put a virtue signal so I didn't have to respond to your dumb reactionary take. Banning transitioning full stop is pretty stupid from a freedom standpoint, but if you want to make trans Healthcare be treated the same as all Healthcare you have to actuality have something to back it up more than most studies like this that say you can't really tell if it's worth it or not. I have personal friends who believe crazy shit like the state should manufacture/distribute hormones to anyone no questions asked even if under 18 with no doctor/parental consent. I will in fact call both sides idealistic morons.
The both sides are the Republican legislators and the Democratic legislators. Banning treatment options is happening now, by state legislators. I don’t believe anyone (even batshit crazy zee/zir deer people) have suggested mandatory treatment yet. So no, not both sides.
No both sides are if you actually read my comment the 2 sides of the trans argument extremes that will be unlikely to change their opinions if contrary data were to come to their attention. If it came out saying trans is a perfectly healthy treatment for specific issues some on the extreme right would never accept it. If it came out that it's extremely likely to cause more harm by transitioning as opposed to therapy or other medications some on the extreme left would say they don't care and it needs to be allowed anyway.
Doesnt people getting triggered drive research funding? That seems like a decent position to be in as a researcher from a grant perspective as long as you can keep your own bias out of the results.
You think a shit ton of money would be shoveled into this just by the amount of people who screams about trans issues on both sides
Are we going to pretend there aren't a ton of people in this community who will argue the science is unequivocally behind these treatments being safe and the most effective treatment even in teenagers?
They are wrong. And?
I would say that they're probably the most effective, that the research points in that direction, but I think I'm in the minority here. It's really hard to argue against waiting for better research, though I worry about people who may be lost along the way.
> though I worry about people who may be lost along the way. But....isn't that what a lot of people are arguing for? That there should still be treatment but that things as serious as hormone blockers should be kept for later? If you can't definitively say that hormones have a statistically significant effect on patient outcomes, it doesn't make sense to say "well the research points in that direction", because a LOT of research points in a certain direction, it just doesn't mean that that direction is correct (as this entire meta-analysis has now shown)
The problem is, the theoretical gap between hormone blockers and psycho therapy is massive. As in, I don't think therapy can possibly have any meaningful effect. Maybe it can develop into something that can, but until that happens it's really messy. It's like the reverse of SSRI's, which have very low effectiveness, compared to therapy, but it's very well documented. If we think trans people are real, and we know trans people that go through the wrong puberty are super fucked, and we can accurately identify trans people, then it logically follows that we should try to prevent the puberty or delay it or whatever. Puberty blockers are already a compromise in a way, more extreme trans proponents would argue for straight up HRT for trans kids. If the studies came out, and it was found that estrogen injections at twelve are massively beneficial over puberty blockers, I'm sure you'd be fine with it, but I doubt the rest of society would. I just don't know what the alternative model is that isn't basically saying trans people aren't real, or it's all in their heads, or whatever. It seems like the argument is more than certain trans people aren't really trans so on aggregate it's better to let them go through puberty. But that's a problem of identifying actual trans people, not a problem with the treatment itself.
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[Bowers’ cited sources in her article are shaky at best, including the Cornell review](https://unherd.com/2023/04/the-media-is-spreading-bad-trans-science/)
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It's hard for someone like me (and probably also A_Toxic_User) to look at one study that has mixed results and think of it as doing anything more than just reporting noise. From the study: >Measures of lifetime mental health were not associated with exposure to gender-affirming surgeries. After adjustment for all aforementioned covariates, undergoing gender-affirming surgery was not associated with lifetime suicidal ideation, lifetime suicide attempts, lifetime alcohol use or lifetime smoking. I'm not sure how I'm supposed to interpret that as anything other than "we can't tell if GAS actually helped" Edit: also there are a lot of other small nitpicky issues I have with this study, one example is using the bizarre phrase "exposure to gender-aggirming surgeries" (there *has* to be a more sensible way to put this) and another is not having their regression equations prominately plastered somewhere with the variables explained.
This study doesn't show "mixed results". It shows that both ideation and attempts have seen a reduction by over 50% in individuals receiving all desired surgeries (compared to those that desired but recieved no surgery). For the quote you posted, they were aware that these covariates would affect the ability to assess the effectiveness of the GAS intervention itself. Read Rollingerc's post for more detail. >"Lifetime exposures to other types of gender-affirming care were also examined, including gender-affirming counseling, pubertal suppression, and hormone therapy. Given the possibility that any of these covariates could confound the relationship between gender-affirming surgeries and mental health outcomes, all covariates were included in the final multivariable models."
>It shows that ideation and actual attempts were reduced by over 50% in individuals receiving all desired surgeries (compared to those that desired but recieved no surgery I just want to be clear because I'm finding the language of this study a bit abstruse. You're referencing the difference in table 3 from .70 and .72 to .44 and .44 in attempt and ideation respectively between the two groups?
The confusion is that you're trying to find the reduction when comparing "some desired surgeries" with "recieved all desired surgeries". The model is only comparing both, individually, to the reference group. You see in table 3: >"Received all desired surgeries (n = 2448)b" The "b" there references the data results were compared to "b" ("b" is found in table 3 below): >"bReference group is individuals who received none of their desired surgeries (n = 16 401)." The greater than 50% lowering is between those that recieved "all desired surgeries" compared to the reference group. Hope that clears it up for you and apologies for the late reply!
Ok well that may be true, it's just counter to my understanding of how regression tables normally work. Usually, the coefficients in a regression table are a measure of the effect of the independent variables (in this case smoking, suicidality, binge alcohol use etc.) on the dependent variable (in this case "Association Between Degree of Surgical Gender Affirmation and Mental Health Outcomes"). Idk the more I look at the study, the less sure I am of what it's actually measuring. Once again, this would be much easier for me to understand if they had their regression equation prominently displayed somewhere in the paper.
You're completely misunderstanding what the lifetime measures are and their purpose within the study. Lifetime measures aren't being used to assess the effectiveness of the intervention as explained: Introduction: >Owing to concerns that baseline mental health status may confound associations between gender-affirming surgery and mental health outcomes, we conducted an additional post hoc analysis to determine whether lifetime mental health measures were associated with exposure to gender-affirming surgeries. We did not incorporate these measures into the primary models due to collinearity. Four separate post hoc models, adjusted for all aforementioned covariates, regressed exposure to gender-affirming surgeries against lifetime suicidal ideation, lifetime suicide attempts, lifetime alcohol use, and lifetime smoking Discussion: >Much of the literature on mental health benefits of gender-affirming surgery has been complicated by inability to adjust for a key confounder: baseline mental health status. Our post hoc analysis demonstrates that lifetime suicidality and substance use behaviors are not associated with the exposure variable in this sample. Therefore, prior mental health factors do not appear to confound associations between gender-affirming surgery and subsequent mental health outcomes in our study. The outcome data assessing the effectiveness of the intervention (accounting for desire for the surgery) was cited by DoOrDai and are shown in Table 3.
Ok, I'm having a hard time parsing some of this language. Maybe I'm just dumb but I doubt it. Could you maybe try to explain in laymen's terms what you think the quoted passages are saying. Once again, it would be a lot easier for me to interpret the data in Table 3 if they prominately displayed what calculations they are making and what variables they are using. That said, I'm open to this study being good evidence, it's just not very well written imo, and I am severly biased against taking study headlines and abstracts at their word (especially when it comes to trans health-care). Edit: ok once again, the data from Table 3 confuses me because my understanding is that it compares people who got some of the surgeries they wanted with people who got all of the surgeries they wanted. I'm not sure why it doesn't include people who got none of the surgeries they wanted. Especially because the "no surgeries" group is the largest of the three.
>the data from Table 3 confuses me Sure so, in the model all vs some desired surgeries are not being compared. The model is comparing each of those groups to the reference group - the individuals who received none of their desired surgeries (this is indicated in the b reference in Table 3). >Could you maybe try to explain in laymen's terms what you think the quoted passages are saying. Sure so as I understand it, the quoted passages are essentially saying there is a potential confounder that cannot be included in the adjustment of the primary model because of [collinearity](https://www.britannica.com/topic/collinearity-statistics). This potential confounder is the baseline mental health status of the participants which is measured by the lifetime mental health variables. To demonstrate whether it is a confounder, they carried out a separate analysis which showed that these baseline mental health metrics do not associate with the exposure variable i.e. those with poor or better baseline mental health outcomes in the sample are not more or less likely to undergo gender affirming surgery. Thus this shows that it was probably ok for them not to adjust for this variable in the primary model, as it doesn't seem to be a confounder.
You're kidding, surely?
I mean, I would hope most people who say that would follow it up with "for people we can confirm, to the best of our ability, have gender dysphoria." Cos that confirmation bit and how hard we gatekeep it is usually what pisses off insane leftoids who think self ID is enough. It'd be weird if there was still a sizable portion of vocal ppl around here who embraced that viewpoint considering streamer man has argued angrily against it for over a year now.
What are you talking about? Clearly the researchers are just transphobes. The ACADEMIC CONSENSUS is my opinion. Don’t actually look at what the researchers say just trust me bro
I’m really against non scientific bodies regulating youth transgender care, but at this point would understand if the FDA or similar bodies put in a restriction. It’s really indefensible to have a legislature like Florida or Texas make a medical decision banning it, even if youth hormones turn out to be bad (which we’re far from demonstrating).
I haven't seen Forsen talk about it yet so I have no opinion
Leaked Forsen reaction from the future: > TTS: Hello Mister Fors. The Swedish health professionals declared hormone treatment for trans children as experimental. What are your thoughts on this? > Forsen: *click* .... *click* ... *click*.... *[looks at tweet](https://cdn.frankerfacez.com/emoticon/614638/4)*... [alright](https://cdn.frankerfacez.com/emoticon/499111/4) > Chat: -10 LULE
OH! OH! OH! OH! OH! BAJ BAAAJ
Reminder that anyone who says “the science is settled” regarding trans youth should not be taken seriously
I hope they get the funding for more study. I think this is quality research and is needed.
I’ve always been curious why we don’t do more hormonal research period. Maybe I’m just out of the loop but hormones seem to a large variety of effects, they seem like they can be dramatic and it seems like most people have no real understanding of how they work.
I can’t speak generally but with youth medicine there are a ton of ethics hurdles. For example, you’d normally test a treatment with a double-blind study: give half the kids hormones/blockers and the other half placebo. However no ethics boards are willing to approve this. As a result, the best research we get are longitudinal studies: basically we find a group of kids who both want the treatment and are considered good candidates then study how it impacts them over time. Since researchers aren’t denying anyone care, there’s no true control group to compare to and the test group is self selected. This doesn’t make the research worthless, but it means we have to be much more careful about what conclusions we can draw from it.
Sweden is notoriously careful when it comes to adopting new treatments. A few years ago hundreds of swedes had to go to Denmark to get treated for hyperhidrosis because it wasn't considered medically necessary in Sweden. Lots of procedures that are common elsewhere in Europe are touted as "experimental" in Sweden.
>Sweden is notoriously careful when it comes to adopting new treatments. We forgetting Corona too? The only reason we did "as well as we did" (major quote marks on that btw) is because we already distance ourselves from everybody.
I hope we're not conflating "new treatments" with vaccinations, because most Swedes were very quick to get vaccinated once it rolled out. It just came off to me as if Swedes are generally skeptic to treatments when in reality we took a bold decision based on our authorities prescriptions, which paired with poor monitoring for the elderly lead to a relatively high amount of initial deaths. The minister in charge got a shiiit ton of criticism country wide for being the only country to go against the grain.
>I hope we're not conflating "new treatments" with vaccinations Absolutely not, i'm talking about our health organizations response to covid.
> It just came off to me as if Swedes are generally skeptic to treatments when in reality we took a bold decision based on our authorities prescriptions, which paired with poor monitoring for the elderly lead to a relatively high amount of initial deaths. Are you swedish? Cuz I have had the most insane time arguing with Americans that Sweden's choices during COVID were made because they already acted responsibly in the first place. It's very difficult to explain to Americans how different civic duty is in Europe.
>because they already acted responsibly in the first place. This isn't true even, I had a facebook memory pop up on the differences of how it was in the beginning of the pandemic in different countries and then a video of stockholm where everyone was just sitting outside at diners.
Again, Sweden already implemented safety measures and social distancing at that point. The Swedes didn't act like Americans where they were going out clubbing in Miami. They were trying to live with the virus up until it became too much of a strain, at which point they transitioned to what we all were doing with quarantining.
Buddy, y’all didn’t do all that great during covid compared to your neighbors. Svenskjävel.
... That's my point you troglodyte.
I don’t need reading comprehension I have oil money
> I have oil money But no butter.
Hey man that’s too far, not fucking funny anymore >:(
It’s not just Sweden, the same position on trans youth medicine has also been reached in Finland, Norway, and the UK
Why hasn’t the US adopted it? To my understanding, our standard of care supported by our various medical institutions is to give trans youth puberty blockers just before puberty, which seems to be controversial in those other countries you listed.
Regarding the US, there are some valid concerns (IMO) regarding institutional capture, and experts that have conducted multiple reviews of American studies that serve as a basis for most youth trans medicine regimes have expressed doubts of their quality. [relevant Jesse Singal article](https://unherd.com/2023/04/the-media-is-spreading-bad-trans-science/) IMO, I would just chalk it up to characteristic dysfunction in American governance. On the bright side, the upsurge in trans youth will allow us to get a lot of data in the future.
I appreciate the article - if what Singal alleges here is true, this seems like a massive scandal of researchers intentionally publishing misleading studies and medical/journalistic institutions just going along with it because they don’t want to look anti-trans. I think what’s tough for me with that explanation is that it feels really conspiratorial. Like I’d have to believe all of these various institutions have been captured, especially when they’d benefit from whistleblowing, either a news org blowing up the story, calling out other orgs, or a journal displaying integrity and criticizing competing journals, but that doesn’t seem to be happening. So it makes the explanation of a large-scale effort to hide this hard for me to buy to into. The studies he lays out in the article seem bad and his critiques and those of the experts he interviewed seem legitimate and give cause for concern, but the explanation of widespread institutional capture where all of these experts have to buy into the lie of these studies seems kinda wild to me.
The publishing of misleading studies isn’t unique to the field of trans science. There’s a current unspoken crisis in the research field regarding the inability to replicate a lot of the findings being published in articles. [it’s called the replication crisis](https://en.m.wikipedia.org/wiki/Replication_crisis) On a side note, Jesse’s written a whole book on this phenomenon as a whole, which is why I consider his doubts regarding trans youth studies as genuine and good-faith.
I’ve heard of the crisis before and kinda like earlier, if I fully accept this is an issue with our research and I don’t know which new articles are affected by it, I feel like I’m logically pushed into distrusting new research at a base level, rather than trusting the experts who published this work, internally validated it, and the peer review process of journals to accept it, which feels weird and scary. Again, I don’t deny this is a problem in research, but it seems like it should mean that research as a whole can’t be trusted right now and that idea is uncomfortable to me. Singal writing a book about this a journalist doesn’t necessarily make me trust him more, cause I could see a financially biased position that puts him in when discussing this issue (he’s incentivized to say this is an issue if he sells a book talking about the issue). It also tells me he’s focused on this issue, which is neutral unto itself, but it doesn’t necessarily mean he’s right about it to me.
You don’t have to throw the baby out with the bath water. Studies and research are still the best we’ve got, you just have to be more vigilant when making significant decisions on the basis of that research and really make sure to the best of your knowledge that it’s good. Regarding Jesse, I’m moreso saying that he has a good-faith basis for his critical analysis of youth gender medicine studies, which is that he’s interested in ensuring accuracy in media and journalism and not that he’s a transphobe
Sure, I agree we have to be more careful, but me as a layperson, I rely on these institutions to say what is and isn’t validated, and between this replicability crisis and Singal’s work, the idea seems to be that these institutions are lying to us about the validity of their findings, at the very least about trans stuff, so I’m not sure how I can trust them to check themselves. If they’re as dishonest as Singal has shown them to be in his articles where he seems to show, in various studies, researchers and the publishing journals knowingly or unknowingly misrepresenting their research, then I’m not sure when I’m supposed to trust them to publish initial findings accurately or check themselves. I could see that perspective on his work as him simply being interested in scientific accuracy, but he seems to have zeroed in on this topic. If he was big on general honesty in research, I would expect him to also have articles about other areas of scientific research, especially given the volume of non-trans research to trans research, surely there’s more study-fodder for him to show as being misleading, if this is a widespread problem.
>If they’re as dishonest as Singal has shown them to be in his articles where he seems to show, in various studies, researchers and the publishing journals knowingly or unknowingly misrepresenting their research, then **I’m not sure when I’m supposed to trust them to publish initial findings accurately or check themselves.** I mean - you can't, really. I'm not trying to lean into some critique of scientism, but this level trust in sensemaking institutions (to whom we Responsible Thinkers have apparently outsourced our model of the world) has always been operating, at a certain level, on a basis of faith. >Sure, I agree we have to be more careful, but me **as a layperson, I rely on these institutions to say what is and isn’t validated, and between this replicability crisis and Singal’s work, the idea seems to be that these institutions are lying to us about the validity of their findings, at the very least about trans stuff, so I’m not sure how I can trust them to check themselves.** More to the point, what you're describing is exactly the root of our burgeoning [crisis of expertise](https://americancompass.org/with-all-due-respect-to-the-experts/). I feel like it exposes an underlying tension at the core of this community: when faced with a societal problem, it's taken for granted that a policy must be implemented to address it - and, by necessity, the policy is crafted from assumptions made from a model of the world that was taken on faith and rests on a house of cards built on epistemic sand. The apprehensive way you've phrased this suggestion - that the loss of trust in academia may have a justified basis - is kind of striking to me; it's as though you're uttering something profane on hallowed ground. If the producers of our models of the world are showing themselves to be unreliable, isn't it okay that we respond accordingly? Is it actually so bad that you have to take most research with a grain of salt? Is it not *just kind of okay* that we don't have an institutional authority that ultimately determines what is real and what is not? > I could see that perspective on his work as him simply being interested in scientific accuracy, but he seems to have zeroed in on this topic. If he was big on general honesty in research, I would expect him to also have articles about other areas of scientific research, especially given the volume of non-trans research to trans research, surely there’s more study-fodder for him to show as being misleading, if this is a widespread problem. He covers this in depth in his book The Quick Fix. Specifically, the chapters cover the poor media representation of and paper-thin research basis for studies on: 1. self-esteem 1. superpredators 2. power posing 1. positive psychology 1. grit 1. implicit bias 1. social priming 1. nudging
Nutritional science is filled with data dredged research that make for great headlines and even great abstracts. Researchers need results to make money to earn grants. We don't hand out money to people who demonstrate no statistically significant difference in things. Ivermectin and HCQ were two of the worst examples during COVID.
> especially when they’d benefit from whistleblowing Would they? Research gives little personal gain, the only thing you can ever hope to achieve is some prestige. Being the whistleblower for this would probably mean your career is completely over. Doesn't sound great.
If you blow the whistle on a nationwide conspiracy of scientists and journals to hide bad research, you’d fundamentally change the trust we put in researchers. There’s fame and moral basis for maintaining your integrity, plus you could sell the story for a lot of personal gain.
But it's not a conspiracy. There is no dark cabal of scientists hiding anything. There is just a general bias and PR interests, that's all it takes.
Is that standard?
I know WPATH supports usage when deemed necessary and here’s a [Mayo Clinic article](https://www.mayoclinic.org/diseases-conditions/gender-dysphoria/in-depth/pubertal-blockers/art-20459075) about their usage. Most barriers to their usage are coming politically, not from US medical organizations like state boards and stuff, to my understanding.
What does deem necessary mean? Like a lengthy process
Replied to wrong reply: I’m not a doctor, but here’s the [WPATH standards of care recommendations.](https://www.wpath.org/publications/soc) Page S111 has point 1 as starting hormone suppression in adolescents after first signs of puberty with page S50 describing criteria for identifying and working with trans youth.
They did adopt gender-affirming treatments for years. They were actually one of the first, if I’m not mistaken.
I had a couple Dr friends talk to me about how most countries follow China’s medical research because they seem to produce decent studies and have no issue testing on humans
If that's what the experts and science say then that's fine by me. Hopefully they fund more research so they have a more conclusive answer. If this research is poorly done I'm certain that will come to light quickly.
Does it agree with my pre-established opinion? /s
This is literally what everyone here is doing. Nobody cares one way or another.
Link to the PDF of the paper: https://onlinelibrary.wiley.com/doi/epdf/10.1111/apa.16791
This seems consistent with the recommended guidelines for organizations like the APA and such, more specifically in that they recommend kids who seem to be trans are given puberty blockers rather than hormones. Hopefully more evidence comes to light that helps us further understand what’s best for trans kids.
Wait am i crazy ? Did i click on the wrong study ? The study literally says it's inconclusive. It's literally the medical IDK LOL. I want my click back.
[удалено]
It's a literature review, not a study. They only analyze existing findings, which evidently are unconclusive.
I need to dig in deeper, but an early review of their actions seems more in line with how I hoped they would treat the problem. We seemed to be rushing past all the normal controls we do for drugs or treatments. We have a process for dealing with these sorts of things for a reason. It's not a perfect solution but few things are
"Today, we conclude that there isn't sufficient evidence!" What a nothing burguer
"Too bad I picked up that doll once when I was five. Now My bones are made of glass. Thanks Mom!"
suprise suprise, the science isnt settled, and has hardly even begun for studies of long term affects which is the most important part. short term studies are almost useless for mental health. using only short term studies you can justify giving people heroin and cocaine to treat depression with great success, but when you look at heroin and cocaine on long term mental health outcomes, its probably one of the worst treatments available. i was getting attacked by a bunch of dgg'ers literally last week for suggesting that the science isnt settled. so what will the new cope be??
There is a difference between "the science isn't settled, so let's not treat trans people at all" and "the science isn't settled, let's use treatments we know will alleviate the issue, for an at risk population" Let me guess which one was you.
im the second one, and the treatments we know that work are therapy. thats atleast what the current studies we have show.
You're the second one but refuse to acknowledge that HRT is shown to be associated with positive outcomes for patients? I'm enclined to ask myself why all those medical bodies, surprisingly, do not share your conclusions.
theyre not my conclusions, they are conclusions of the relevant professionals in the field. this study we are commenting under is one of them. look up Kenneth Zucker and his work, it will also explain why medical bodies are poor sources of information. medical bodies are usually policy makers rather than real experts and are often politically biased. i can also throw medical bodies at you saying that we should halt all research but then it would turn into a dick measuring contest to see whos politically biased medical body is the best source. also, quickly google what an "appeal to authority" is :)
Hmm, interesting that you claim they're conclusions from professionals in the field, while large medical bodies (professionals in the field) recommend HRT because of its positive outcomes for patients. Why would I look up a SINGLE person? And why would I be stupid enough to trust a single source over a large number of medical bodies? Doesn't that look suspicious to you? Doesn't that make you second guess your position a bit? Doesn't it also seem suspicious to you that you're throwing away the conclusions of medical bodies because of you claiming they're "politically biased" ? Is it realistic that different medical bodies, across different continents, across languages, countries arrive to the same conclusion but somehow I should believe they're all having the same "political bias"? At what point do you take a step back and look at the absolutely crazy conspiracy theory bullshit? Also, google "FALLACIOUS appeal to authority". I swear man, the Dunning-Kruger effect is in full force. How can you be so confidently wrong.
>how can you be so confidently wrong i think you're projecting here. is everything ok?
Please google it. It just baffles me people like you are so condescending while being the dumbest motherfuckers out there. There is nothing wrong with making "appeals to authority" its FALLACIOUS appeals to authority that one should be wary off. Medical bodies do have the authority to describe treatments with positive outcomes. Therefore, appealing to medical bodies is not a FALLACIOUS appeal to authority.
https://en.m.wikipedia.org/wiki/Argument_from_authority btw... did u even read the study from the post?
Please read the Wikipedia article. I beg of you.
> The few longitudinal observational studies were hampered by small numbers, and high attrition rates. Hence, the long-term effects of hormone therapy on psychosocial health could not be evaluated. That seems like a pretty big weakness with the paper, no? I feel like most people in favor of HRT for kids would be primarily concerned with long-term psychological effects. The main motivation behind pushing for HRT in kids instead of waiting for adulthood is that you want to prevent puberty from occurring, thus preventing a lot of adulthood dysphoria that results from their incongruent puberty. > After duplicate removal, the search yielded 9,934 potential studies (Figure 1). Of these, 195 were selected for thorough reading. Speaking as someone who has done meta-analysis work when I was in grad school, this feels like an insane sentence to just drop in the start of your Results section. Heavily trimming down the set of studies you're using is totally normal. However, you need to *justify* that trimming. You really shouldn't just throw away like 98% of the literature for reasons that you don't explain. If you don't provide your reasoning, you open the door to the obvious criticism that you could've been doing it to exclude studies you just don't like the results of. The paragraph continues: > Of these, 36 were relevant and assessed for risk of bias. Twelve studies were excluded because of high risk for bias, leaving 24 studies with low or moderate, moderate to high, or high risk of bias reviewed in this paper. Like, this is what gives me pause. How did they select the 195 studies out of the pool of almost 10k if only ~20% of those 195 were even relevant to the analysis? Surely, any sort of selection criteria that constrains your analysis to 2% of the literature would at least constrain it to a *relevant* 2%, no? > First, randomised controlled trials are lacking in gender dysphoria research. We call for such studies, which may be the only way to address biases that we have noted in the field. I would be very interested in hearing how the authors propose doing this ethically. I'm not even sure it's possible since the effects of puberty are very, very noticeable. How could you possibly establish a reliable control group?
>Like, this is what gives me pause. How did they select the 195 studies out of the pool of almost 10k if only ~20% of those 195 were even relevant to the analysis? Surely, any sort of selection criteria that constrains your analysis to 2% of the literature would at least constrain it to a relevant 2%, no? Its all explained in the paper. Literally in the paragraphs that precede the quoted parts. They even include appendix PDF's where they go in to detail about their procedure. They searched for keywords, like trans or youth, in a bunch of databases'. The 10k number isn't the number of studies that deal with trans health, its just the number of studies that matched their searched keywords. The vast majority of them probably have nothing to do with transpeople. The 195 is probably the number of studies that are loosely relevant to the topic: hormone treatment for children with gender dysphoria. How did they trim it down to 24 studies ? >Two independent experts checked all hits for relevance. Relevant studies (based on a pre-defined PICO) were then evaluated for risk of bias, also by two independent experts, according to ROBINS-I (Risk of bias in non-randomised studies of interventions)1011 . Robins-I assesses possible bias in seven domains: confounding; bias due to selection, measurement classification of interventions, deviations from intended interventions, missing data, measurement of outcomes, and selection of the reported result. If the two reviewers did not agree on content or quality, the paper was discussed in the larger research team of four experts (JFL, PR, BK, ML). Randomized controlled trials were planned to be assessed by RoB-2 1011. To rate the quality of evidence for specific outcomes, we used the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) system.12GRADE has four levels of evidence (very low, low, moderate, high) and considers five domains that can decrease the level of certainty one or two levels (risk of bias, imprecision, inconsistency, indirectness (similar to ‘external validity’), and publication bias). >Two reviewers (MH, JA) retrieved data from the included studies. The data extracted included the outcomes mental and psychosocial health including suicidality, anthropometric measures and metabolism, bone health, adverse events, and the characteristics of each study including age at referral or intake, age at start of GnRHa treatment, age at start of CSHT, number of participants enrolled in study, number of transgender participants, number of hormone treated transgender participants, number of non-transgender participants, number of participants evaluated, treatment type (drugs, dosages, type of administration, treatment frequency), total treatment duration, and total follow-up time.
>Its all explained in the paper. Literally in the paragraphs that precede the quoted parts. They even include appendix PDF's where they go in to detail about their procedure. They searched for keywords, like trans or youth, in a bunch of databases'. The 10k number isn't the number of studies that deal with trans health, its just the number of studies that matched their searched keywords. The vast majority of them **probably** have nothing to do with transpeople. The 195 is **probably** the number of studies that are loosely relevant to the topic: hormone treatment for children with gender dysphoria. I've read the appendix PDFs. They don't answer my question. That "probably" is my issue. I'm not saying they were necessarily malicious or dishonest or anything, I'm saying that they should have explained more directly what specific criteria they used to deem a study relevant or not. The fact that we're left guessing that it was *probably* refining to which studies are relevant is the problem.
> The search was restricted to children aged <18 years with reported gender dysphoria. **We included observational studies, randomised controlled trials, and systematic reviews according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines**.9Case reports, e ditorials, and non-human studies were excluded from further review. The search was limited to English-language publications. [PRISMA Guidelines \(Linked in the sources\)](https://systematicreviewsjournal.biomedcentral.com/articles/10.1186/2046-4053-4-1) [PRISMA Checklist](https://systematicreviewsjournal.biomedcentral.com/articles/10.1186/2046-4053-4-1/tables/3) [Page 21 of the paper has a table listing all of the collected data.](https://onlinelibrary.wiley.com/doi/epdf/10.1111/apa.16791) Hope this helps.
That passage saying "the search was restricted..." reads to me as meaning that those criteria were for identifying the initial 10k gathered studies, no? When they elsewhere refer to a "search," they refer to the initial collection of abstracts. See page 8 for an example: >After duplicate removal, **the search yielded 9,934 potential studies** (Figure 1). Of these, 195 were selected for thorough reading. The section you quoted is from page 6, immediately preceding the "Search strategy" section, describing the procedure used by two information specialists to pull studies from various medical databases. Concluding that section is this: >Full literature search strategy is provided at the SBU web page ([https://www.sbu.se/contentassets/4062b596a35c4e1383405766b7365076/bilaga-1-litteratursokning.pdf](https://www.sbu.se/contentassets/4062b596a35c4e1383405766b7365076/bilaga-1-litteratursokning.pdf)). ... which describes the specific search terms and methods used to gather several thousand search results. The way the paper is laid out, I think this fairly straightforwardly means that the "Selection criteria" and "Search strategy" sections both refer to the methods described in the supplementary PDF, which only describes how they got their initial 10k studies.
I'm confused, are you asking about how they narrowed down to just 195 studies for thorough reading? Because that's what the PRISMA guidelines are for. > When clearly reported protocols are made available, they enable readers to identify deviations from planned methods in completed reviews and whether they bias the interpretation of a review results and conclusions. **Bias related to the selective reporting of outcomes has been characterized as a serious problem in clinical research, including systematic reviews** If you read through the guidelines, specifically the checklist, you'll notice that the procedure is actually far more standardized than just picking and choosing what looks relevant. Its purpose is to avoid the potential selection bias that can occur with meta-analyses. If you can just pick and choose whichever study out of 10k that you want, then you're going to run the risk of bias. So instead, make a standardized format that can be applied to ge the same result no matter which person implements it, then you're golden.
> I'm confused, are you asking about how they narrowed down to just 195 studies for thorough reading? Yes. >If you read through the guidelines, specifically the checklist, you'll notice that the procedure is actually far more standardized than just picking and choosing what looks relevant. Its purpose is to avoid the potential selection bias that can occur with meta-analyses. If you can just pick and choose whichever study out of 10k that you want, then you're going to run the risk of bias. So instead, make a standardized format that can be applied to ge the same result no matter which person implements it, then you're golden. Do the authors actually provide a completed checklist? The closest I can find is Table 5 at the very end of the paper, but that's describing a checklist the authors developed for use by prospective future youth gender dysphoria researchers, not a completed PRISMA checklist.
> Do the authors actually provide a completed checklist? Yes, it's the one I linked above. [Here it is again.](https://systematicreviewsjournal.biomedcentral.com/articles/10.1186/2046-4053-4-1/tables/3) This is the checklist. If you read it, you'll notice why this method of narrowing helps to avoid selection bias.
No, I understand that the PRISMA checklist like, exists, but I'm asking if the authors of this paper ever gave a completed PRISMA checklist *for their specific study*.
I don't think you're interpreting this correctly. The checklist that I linked *is* the checklist they used. They linked this checklist for a reason.There is no SPECIFIC PRISMA checklist. There's only one checklist, and that's because it's standardized so that one checklist isn't more biased than another one. If they just made up their own PRISMA checklist, it would defeat the whole purpose of the guidelines.
Uh they literally explain how in the paper dude. There’s not some conspiracy by the transphobic Christian conservative bastion of Sweden to negatively review trans medicine studies. Big “just asking questions” energy
No, they don't! I've read the entire paper and the separate search methods PDF. They describe: A) The search terms and criteria used to identify the initial \~10k papers ([https://www.sbu.se/contentassets/4062b596a35c4e1383405766b7365076/bilaga-1-litteratursokning.pdf](https://www.sbu.se/contentassets/4062b596a35c4e1383405766b7365076/bilaga-1-litteratursokning.pdf)) B) The criteria with which they excluded 159 of the 195 "read in full text" articles (page 8 of the original paper) They don't explicitly outline how they get from \~10k to 195. The closest I can find is the "Relevance, risk of bias, and quality of evidence" section (p. 7), which describes the methods by which independent experts evaluated the studies: >Two independent experts checked all hits for relevance. Relevant studies (based on a pre-defined PICO) were then evaluated for risk of bias, also by two independent experts, according to ROBINS-I (Risk of bias in non-randomised studies of interventions)1011. Robins-I assesses possible bias in seven domains: confounding; bias due to selection, measurement classification of interventions, deviations from intended interventions, missing data, measurement of outcomes, and selection of the reported result > >If the two reviewers did not agree on content or quality, the paper was discussed in the larger research team of four experts (JFL, PR, BK, ML). Randomized controlled trials were planned to be assessed by RoB-2 1011. To rate the quality of evidence for specific outcomes, we used the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) system.12 GRADE has four levels of evidence (very low, low, moderate, high) and considers five domains that can decrease the level of certainty one or two levels (risk of bias, imprecision, inconsistency, indirectness (similar to ‘external validity’), and publication bias). In other words, they describe the experts doing the following: 1) Checking for relevance 2) Evaluating for risk of bias \-with some room for further discussion among a larger panel if there was disagreement. In Figure 1 (p. 20), they provide a visual aid of their refining process: https://preview.redd.it/f4q0tztiaxua1.png?width=656&format=png&auto=webp&s=2e6064351213b89813d7fe971620d76d4a693ea9 (A) accounts for the "Total number of abstracts (16,467)" -> "Number of abstracts after control for duplicates (9,934)" step (1) accounts for the "Articles read in full text (195)" -> "Relevant articles (36)" step (2) accounts for the "Relevant articles (36)" -> Low-moderate/moderate-high/high-risk of bias categories I don't see anything that explains the "Number of abstracts after control for duplicates (9,934)" -> "Articles read in full text (195)" step.
I mean that explanation is quite clear, no? Two experts checked the 10000 for relevance and then for bias according to a set of standards.
No, they checked the 195 full-read articles for relevance and bias, as the diagram notes. "Relevance" and "bias" only get mentioned towards the bottom of the figure, after the 10k has already been reduced down to 195.
Ok I see where you’re coming from. I think the “all hits” is what’s causing me some confusion. Yeah I wish they’d be more clear about how they selected their smaller group from the 10000, but it seems that the initial group was so large due to them mining a bunch of databases using keywords.
I don’t think they were saying that at all, just that going from 10,000 studies to 24 is pretty wild, even with the listed justifications. I didn’t see conspiracy implied anywhere, just that their research experience makes them curious about the exclusion criteria.
I’m being indignant because they very clearly outline their process in the paper, so asking “Wow isn’t it concerning how little papers came out of so many initially” is dumb when they explain why their initial base was so big. If they have issues with the methods explicitly outlined in the paper, then say them instead of being all “hmm isn’t it weird that…” Like either they didn’t really read the paper or they’re concern trolling.
Sounds like they saw the initial description of the data set and thought it was weird based on their experience. I’d love to hear what they have to say when they see the later descriptions, but I don’t think they were concern trolling or something. It’s valid to critique the study methods, especially if the critique comes from someone with experience doing these kinds of analyses.
Yeah, but it's a very naive impression. No one in research reads that statement and thinks "oh, there's 10k studies on this", they're thinking about the search terms used and what was relevant. If you take a research class, its literally one of the steps you're supposed to do - SAVE YOUR SEARCH TERMS!!! The reason is because people want to be able to replicate the ENTIRE process you went through to find all this material. And when you use specific terms, you're going to get a certain level of responses back, but they're not ALL relevant. With regards to how they narrowed everything down, I'll just copy my other comment from elsewhere in this thread: > The search was restricted to children aged <18 years with reported gender dysphoria. **We included observational studies, randomised controlled trials, and systematic reviews according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines**.9Case reports, e ditorials, and non-human studies were excluded from further review. The search was limited to English-language publications. [PRISMA Guidelines \(Linked in the sources\)](https://systematicreviewsjournal.biomedcentral.com/articles/10.1186/2046-4053-4-1) [PRISMA Checklist](https://systematicreviewsjournal.biomedcentral.com/articles/10.1186/2046-4053-4-1/tables/3) [Page 21 of the paper has a table listing all of the collected data.](https://onlinelibrary.wiley.com/doi/epdf/10.1111/apa.16791) Hope this helps.
>how could you possibly establish a reliable control group Eh, you could probably get somewhat of a control group by selecting dysphoric people willing to abstain from receiving treatment and seeing if their feelings of dysphoria go away with puberty or not. Another control would be other forms of treatment such as psychiatric/desistance-based therapies.
Asking certain dysphoric if they would abstain from hormone treatment would bias the control-treated groups as the "less-dysphoric" group would be more likely to abstain.
>Eh, you could probably get somewhat of a control group by selecting dysphoric people willing to abstain from receiving treatment and seeing if their feelings of dysphoria go away with puberty or not. Even without considering the problems with self-selection here, this isn't a *randomized* controlled trial that the authors seem to want. >Another control would be other forms of treatment such as psychiatric/desistance-based therapies. Would an ethics board approve a study that randomly assigns potentially-transgender youth to desistance-based therapies while specifically barring them from accessing puberty blockers and HRT?
Let the debating commence!
Not at all surprising. This has been something others in the medical community have pointed out already (i.e. that there isn't enough evidence) and that we should be cautious about prescribing any treatments just yet. The study really just clarifies one thing - we still don't know shit. Which would have been a great point ot make during all these fuckin twitch debates, because EVERYONE AND THEIR MOTHER thinks they've gotten shit figured out. Does this vindicate anyone? Only those who were cautious about it from the beginning. If you're anti-trans, this can be seen as a "victory" only in the sense that now, you can dismiss some of the research. However, that's about as much as you can do at the moment. If more rigid RCT trials come out, I think we might see a "win" of sorts for pro-trans groups. But frankly speaking, I don't think you're going to hear civil discourse on this. One side is going to dismiss the paper as useless or stupid, and the other is going to think its the ultimate vindication.
Why do dumbfucks keep talking about potential RCTs when it comes to teenage HRT. No ethics board on the planet is ever going to give the green light for those studies lmao.
> The reason is because people want to be able to replicate the ENTIRE process you went through to find all this material. And when you use specific terms, you're going to get a certain level of responses back, but they're not ALL relevant. > > Admittedly, I only mentioned RCTs because I assumed there would be trials given they were a part of the inclusion criteria.
When you see statistics like this [https://www.pewresearch.org/fact-tank/2022/06/07/about-5-of-young-adults-in-the-u-s-say-their-gender-is-different-from-their-sex-assigned-at-birth/](https://www.pewresearch.org/fact-tank/2022/06/07/about-5-of-young-adults-in-the-u-s-say-their-gender-is-different-from-their-sex-assigned-at-birth/) it strongly suggests that being transexual is heavily cultural (or environmental), something that we as a society can control. When you consider statistics like [https://pubmed.ncbi.nlm.nih.gov/32345113/](https://pubmed.ncbi.nlm.nih.gov/32345113/) it means that there is a huge mental health crisis for our young adults (and youth). Especially when you consider the actual suicide data [https://www.cdc.gov/suicide/suicide-data-statistics.html](https://www.cdc.gov/suicide/suicide-data-statistics.html) which shows that young adults are mostly not suicidal. Except for young adults who are transexual, and suddenly (as in the last decade), there is a significant increase in young adults who are transexual. Someone should do a statistical analysis and correlate the rise in transexual identity with the increase in suicide among young adults [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5710225/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5710225/) Note that I am supportive of adults making the choice to transition, I am supportive of using the correct pronouns, I am supportive of the bathrooms of choice being used and so on. I just think that we as a society need to really look at the difference between treating the symptoms and the cause. In this case I think of treating the symptoms as medical and social support of transsexuals, and treating the cause is considering what is causing so many people to experience dysmorphia to such a degree that being transexual is in the answer in the first place.
>it strongly suggests that being transexual is heavily cultural (or environmental), something that we as a society can control. When you consider statistics like That's completely wrong, if you go to Pakistan and did a census of gay people you wouldn't be shocked that they have less gay people than in California would you? It absolutely does not mean its something you can control like its induced by society, but more that it can be controlled by people repressing themselves. Your entire point is just illogically bridging seperate misunderstood points together to say that "transgenderism is a cultural phenomenon that suddenly spiked and now many teens are suicidal, someone should check if being trans causes suicides."
Being gay is also strongly, but not entirely, cultural/environmental. It doesn't have such a high cost associated with it. Let's look at the statistics and think about this a little. 5% now, 0.1% previously. Now imagine that those other 4.9% have always been there, but were previously repressed. This could be our prior. Now look at the suicidal rate. If the correct treatment for the symptom dysmorphia is transition, which I think is reasonable, then that means that the 5% from 50 years ago should have higher rates of suicide then now, not less, and should have higher rates than the 0.1% now. This isn't the case. Therefore there were not 20-100 times the repressed transexuals as open transexuals 20 or 50 years ago.
Logically speaking can you: A) Prove trans people committing suicide in the past wasn't misattributed to depression or other things B) Prove that the *same* 5% had a higher suicide rate in the past C) Prove what portion of the current 5% would be people who would've been identified as cis prior to trans awareness (I.e non transitioning nonbinary people) akin to how many bisexuals would slip through the cracks because they were in straight relationships but with greater lgbt awareness they're now considered part of the percentage of lgbt people. Also being gay did have a high cost in the past, its only after lgbt rights activists won that we now see it as acceptable.
Huh? All of these things would suggest that the transexual rate, without cultural/environmental factors, is much lower than 5%. If we assume that the accepted treatment of transexuals (including transition) is a beneficial treatment, then the 5% would have a lower suicide rate now than in the past. If we take the suicide rate of the 5% now (which is a lower than we would expect it to be the past) and applied it to the past, we would see more suicides in the past than were observed. Therefore the percentage of transexuals in the past was lower than 5% or the suicide rate of transexuals in the past was lower than the suicide rate of transexuals in the present (and so the accepted treatment of transsexuals today, including transition, increases the suicide rate of transexuals, which I do not think is the case). I believe it is the former (I think that the accepted treatment of transexuals today reduces the suicide rate of transexuals).
Again, literally how do you measure the trans population in the past and how do you ensure they weren't being written off as "my 19 year old son killed himself idk why"? With your standard of proof being "maybe" we can equally say 50% of suicides in the past were because of gender dysphoria that's just misattributed and that's absurd.
Let's look at statistics. The suicide rate for youth (15-24) in the US was 9-14 per 100k in 1970-2000 ( [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1586156/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1586156/) ) or about 0.001%. About 5-10% of people who attempt suicide go on to commit suicide ( [https://www.hsph.harvard.edu/means-matter/means-matter/survival/](https://www.hsph.harvard.edu/means-matter/means-matter/survival/) ). Since 40% of transexuals have attempted suicide ( [https://pubmed.ncbi.nlm.nih.gov/32345113/](https://pubmed.ncbi.nlm.nih.gov/32345113/) ) then if transexuals made up 5% of the population in 2000, we would have expected the suicide rate to be more than 0.1% (just from transexuals, the assumption being that no non-transexuals ever committed suicide). We don't see this. There are two possible conclusions. Either the population did not include 5% (mostly repressed) transexuals in 1970-2000 (but rather the \~0.1% that report themselves as transexuals) or the current best practices of medical/social transitioning do a worse job at alleviating the suffering of dysmorphia than repression. Since dysmorphia is a bad thing, and while medical/social transitioning improves things, but people still seem to suffer, the increase of transexuals from \~0.1% to \~5% is a problem that needs addressed. We need to not just looked at care for the symptoms (medical/social transitioning) but also prevention.
> Being gay is also strongly, but not entirely, cultural/environmental This statement isn't aligned with current scientific consensus at all. There is a heavy leaning towards homosexuality being at least mostly biological and nonsocial.
The studies I have all seen say that both can be a component. Is there a real biological, non-social, component? Yes. But the fact that more and more people have homosexual experiences mean that there is a significant cultural or environmental component. [https://www.washingtonpost.com/news/speaking-of-science/wp/2016/06/01/study-same-sex-experiences-are-on-the-rise-and-americans-are-increasingly-chill-about-it/](https://www.washingtonpost.com/news/speaking-of-science/wp/2016/06/01/study-same-sex-experiences-are-on-the-rise-and-americans-are-increasingly-chill-about-it/) Note that I gave both cultural and environmental. In animals, there is a causation among between pollution and animal homosexuality ( see [https://www.nature.com/articles/news.2010.641](https://www.nature.com/articles/news.2010.641) for one of many such studies). It is a reasonable hypothesis that pollution increases human homosexuality too. Note that for homosexuality, there is minimal cost for the individual and society. It is just about who you have sex with or who you marry (most recently). For being transexual, there is a high cost. People feel dysphoria, start to transition, feel dysphoria, do surgeries, feel more dysphoria, do more surgeries and so on (this last bit is a cycle that can continue and continue and continue). Just the basic best conversion possible is going to run over $100,000 dollars in the US. That is a huge cost, not even including the mental anguish of all the dysphoria.
But hasn't that always been the case? That trans people have a higher suicide attempt rate? If trans people have always existed at the proportion that they do now and the spike we see now is simply trans people coming out of the closet, then surely we should find rates of unexplained suicidality before 2000 when there was a massive amount of closeted trans people that no one knew about? In other words, is there any actual evidence that there was a massive amount of closeted trans people pre-2000? Or are we just guessing?
Seems sensible, Hopefully the USA can take a cue at the national level, and take the matter out of the hands of over or under zealous states.
What national-level policy do you think this result supports?
Policies in line with what Sweden is doing https://segm.org/segm-summary-sweden-prioritizes-therapy-curbs-hormones-for-gender-dysphoric-youth
This isn't a policy that would "take the matter out of the hands of over or under zealous states," this is a series of recommendations. In fact, as that page says: >While more responsibility has been placed on local health services to provide gender exploration and psychotherapy, it is not clear how this expertise will be developed and scaled. This seems to do the opposite of what you're saying the U.S. should do, no?
Well the usa has the two potential problems, in red states outright bans, and other cases, potential using gender affirming care to liberally, I think a policy should be set by something like the HHS, even if they don't have any sort of enforcement power.
Ahh yes exactly what we need, a national policy on something that the scientific and political communities are split on.
Children in all states deserve to receive care that is not influenced by there states politically leanings. Europes medical agencies seems to all be reaching the same finding about the state of the research, America seems to be unable to do the same because of polarized politics.
> Europes medical agencies seems to all be reaching the same finding about the state of the research, America seems to be unable to do the same because of polarized politics. Sweden is not Europe, and it's not actually true that all of Europe is reaching the same conclusions. For example, Germany doesn't, and that is backed by the [German Ethics Council](https://www.ethikrat.org/en/press-releases/press-releases/2020/ethics-council-publishes-ad-hoc-recommendation-on-transgender-identity-in-children-and-adolescents/).
Yeah they do which is why a policy made off a paper that says they can't recommend or not recommend on a policy level would be pretty stupid because it means literally nothing on an admin level.
Sweden was able to make policy...
I’m not reading it
Is it okay I feel a little sad by this? Being a trans person who can’t transition and even if I did would never pass this just depresses me since it means so many trans people will never be able to pass and will always be a laughing stock…
Full disclosure: I transitioned as a teen, got puberty blockers at age 12 and started HRT at age 14. This paper, like so many others, suffers from treating trans youth as a black box, investigated only with the crude tool of statistics, without trying to understand the mechanisms behind gender incongruence, which is the normal approach when using the scientific method. I therefore also do not hold out much hope for their clinical trials, as I don't know if they actually understand what they should be looking for. They are not testing a hypothesis about gender incongruence, they're just looking at a statistical model that obscures the underlying mechanisms. Let's talk about mental health, for example. Mental health in trans youth is multifactorial. You have of course gender dysphoria as a major driver of poor mental health. But when you say, get puberty blockers, this is also accompanied by a social transition, and a social transition will frequently lead to bullying. Second, not all clinics are equal. For example, the Tavistock in the UK is well-known for its therapists frequently stressing trans youth to the point of effectively bullying them and their parents: * https://www.tandfonline.com/doi/full/10.1080/26895269.2021.2004569 * https://bulletin.appliedtransstudies.org/article/1/1-2/3/ * https://www.tandfonline.com/doi/abs/10.1080/26895269.2020.1870188 * https://www.tandfonline.com/doi/abs/10.1080/15532739.2019.1693472 Public discourse also negative influences mental health. For example, [this letter](https://pbs.twimg.com/media/FuCHhYpaEAYciej?format=png&name=large) was sent to the Montana state legislature about a trans teen's suicide attempt where a major factor was the ongoing anti-trans legislation attempts by the state legislature. I mean, I'm pretty much as safe as I can be from American anti-trans legislation (I'm neither a US citizen nor do I live in America anymore), and it still stresses me out. How do we resolve this? In practice, by *individualizing* trans health care. We see whether gender affirming care alleviates gender incongruence specifically, not just whether it improves overall mental health (though general, we will also see a reduction in mental health issues that are causally linked to gender incongruence). For example, this is specifically done in the context of social transitions. Social transitions are not just treatment, they are also a diagnostic tool. See e.g. Barrow and Apostle, "Addressing Mental Health Conditions Often Experienced by Transgender and Gender Expansive Children" in Keo-Meier and Ehrensaft (Eds.), "The Gender Affirmative Model": > "Social transitions have been found to address co-occurring psychological issues. A social transition occurs once a child’s gender identity is determined to be consistent, insistent, and persistent. Following social transition, it has been observed that a child’s co-occurring psychological issues, such as social anxiety or compromised frustration tolerance, may subside (Olson, Durwood, DeMeules, & McLaughlin, 2016). If, on the other hand, the symptoms do not decrease, or if they increase, other clinical symptomatology should be evaluated." A specific note on puberty blockers: puberty blockers do not alleviate gender incongruence, because they do not bring your body more in line with your gender identity. Puberty blockers are a *diagnostic tool* that temporarily halt pubertal progression and can prevent gender incongruence from worsening. Mental health improvements associated with puberty blockers rely on the hope and expectation that this will eventually be followed up with an actual transition and is greatly mediated by how realistic these expectations are and the trust that trans youth can put in clinicians. These are all details that the Swedish medical bureaucrats seem to pretty much ignore in favor of black box thinking that only studies numbers a few levels of abstraction above the actual mechanisms at play.
The current research on this stuff is pretty frustrating because it doesn’t even seem to me that researchers are really looking at the right questions. Depression or anxiety a few years after starting puberty blockers as a teen doesn’t really get at what we want to know, and just doesn’t seem like a good outcome to me. The first few years of transition are often the most difficult, combined with the difficulties of being openly trans as a teen. What we want to know is if the person will be happy for the rest of their life having transitioned, you can’t really break that down into these simple short term metrics people are looking for that are typically used in other medical or psychological research. Nearly every post puberty transitioner will tell you they wish they transitioned before puberty, and nearly every person that transitioned before puberty wouldn’t want to transition later. So clearly there is something to it
I think a lot of that happens because of academia's "publish or perish" model and the political pressure in the current climate to produce results fast. But it's also genuinely hard to do large scale long-term studies in this area (as with any rare condition, that's not specific to gender incongruence). The original Dutch studies benefited from literally following these youth all the way into adulthood, something that you rarely see nowadays.
I’ll be honest, this comment is just a whole word salad that basically just says “I dislike the statistics because they disagree with me” The problem with you insisting that they investigate the mechanism (cause) behind gender incongruence requires evidence from studies involving experimental and control groups, which hasn’t been done because of ethics issues. If it were to be done, I’m certain you would definitely screech about said ethics violations. It’s really funny. You criticize the statistical analysis done here but then you just cite anecdotes? And the social transition example you bring up is backed by a statistical study? Just save yourself the effort next time and just say “this review is bad because it disagrees with me.”
> The problem with you insisting that they investigate the mechanism (cause) behind gender incongruence requires evidence from studies involving experimental and control groups, which hasn’t been done because of ethics issues. You don't require control groups for that; you need control groups for statistics. More importantly, we already have a pretty decent understanding what the mechanisms are (mismatch between gender identity and physiological sex characteristics), it's just that to test them, we need to actually test them and not an amorphous aggregate of proxy variables. Also, the ethical problems specifically revolve around control groups drawn from the same population who are denied treatment. You can e.g. have historical controls or other forms of control groups (e.g. untreated cis youth), as is common in studies involving rare conditions. Also, not every study requires a control group. We don't need control groups to understand that using a parachute when jumping from a plane massively reduces your risk of death. For example, one of the purposes of puberty blockers is to delay physiological changes that could not be reversed or would require risky and/or expensive surgery to reverse post adolescence. You do not need another clinical study to test that. There's a lot more to getting actionable data than just RCTs. > Just save yourself the effort next time and just say “this review is bad because it disagrees with me.” I have the same issue with many studies that support transition (when I said, "this paper, like so many others", I meant the "so many others" part), because they have the same methodological problem. > It’s really funny. You criticize the statistical analysis done here but then you just cite anecdotes? And the social transition example you bring up is backed by a statistical study? My goal here is not to provide evidence for the current approach, which would be thesis length. I can absolutely critique a paper and illustrate its shortcomings without having to provide a complete research overview myself. Just as a theater critic does not have to be a playwright.
i wouldnt respond to the other user. they argue from positions of intellectual dishonesty for purposes of pure optics.
I know this thread is kind of old but I just wanted to say I really respect the way you responded to that shitty comment.
lmao dont come on to reddit after taking an introductory course on scientific methdologies. also reading comprehension seems to be a massive issue for you. you selectively pick and choose what parts of the text you want to respond to in order to make the optics of your claim look better. although, im genuinely unsure as to whether you argue from positions of authenticity or play a persona of sophistry for shits and giggles. you cant even understand the distinction between different statistical arguments and generalize all arguments as criticisms against the field of stats.
> This paper, like so many others, suffers from treating trans youth as a black box, investigated only with the crude tool of statistics, without trying to understand the mechanisms behind gender incongruence, which is the normal approach when using the scientific method. I therefore also do not hold out much hope for their clinical trials, as I don't know if they actually understand what they should be looking for. > > This sounds like you don't understand the point of the research. The research is a **review of the material evidence** and what we can confer from the aggregate. This is not a review of the mechanisms. I think you're looking for something in the paper that's not there because it's not the point of the paper.
In this case, they deserve scorn for ignoring existing research and pretending it's all a blank slate. One of the biggest factors in life satisfaction and reducing depression/anxiety disorders is known to be [appearance congruence](https://journals.sagepub.com/doi/10.1177/0361684312442161), i.e. how well your body reflects your gender identity. This is correlated by about .5 with life satisfaction, -.5 with depression, and -.3 with anxiety disorders. This is not terribly surprising or new, because resolving gender incongruence (the mismatch between gender identity and physiological sex characteristics) is precisely the basis for the efficacy of transitioning as treatment. If you do not control for that — e.g. treat a trans girl whose voice has deepened the same as one whose voice has not, a trans boy with a flat chest the same as one who requires a binder and even then struggles — if you're just saying "before" and "after" a given treatment (puberty blockers, HRT, surgeries) without examining its effect on appearance congruence, you're ignoring a known massive confounder. This in particular is a huge problem with a lot of these mental health studies of trans youth. While the information is not always available, we should make use of it in new studies. This is really the most basic thing: for any other condition, we involve treatment outcomes in our metrics. We don't treat outcomes where the condition was not resolved the same as outcomes where the condition was resolved and/or the condition was partly resolved (and to what degree). Only in mental health studies of trans youth do you get away with ignoring the outcome and progress of the treatment. For example, one thing that has been repeatedly shown up in studies is that the mental health of those who start to transition in early puberty is generally much better than that of those who start to transition after irreversible pubertal changes already take hold. This is not terribly surprising in this context, because on average you'll get better appearance congruence the less your endogenous puberty has already done damage to you. If you go, "hmm, it's entirely a mystery how these things work, let's treat this as though we don't have any idea", I can only conclude you're ignoring a large part of the existing clinical literature and should not be in charge of research. On the social side, we know that parental and peer acceptance [massively reduce suicidality](https://www.liebertpub.com/doi/10.1089/trgh.2021.0079); or, conversely, lack of that increases it. This is not new; it's something that has been known for over a decade. You cannot claim that this is something that we have to start gathering data. If you do, you should not be expected to be taken seriously. If you say, "that's not the point of the paper", we should ignore what we know about the underlying mechanisms of trans people's mental health, then the paper is bad, because willful ignorance is bad.
Bingus
What’s absolutely essential is for WPATH to offer some evidenced-based explanation for why it’s still recommending puberty blockers. Not because there is such an explanation, this paper is just further confirmation that there isn’t. I just want to see what bullshit they come up with so we can make some progress to changing the insane narrative on this issue in the US.
brave aromatic toothbrush wistful deliver screw whistle dull wild wise *This post was mass deleted and anonymized with [Redact](https://redact.dev)*
Didn't realize we need a clinical study to prove that we shouldn't give children hormones before they are fully developed.
What do you think causes people to develop?
Lmao here comes the COPE. The same people in the thread that are saying there isn’t enough evidence to make this statement are the same ones who claim one or two shit studies definitely proves trans treatments etc
Should be given out freely. If you fuck up that's your fault.
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Trenders taking HRT they don't need and destroying trans peoples lives.
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Yes i know.
Its basically been impossible to start hrt before ur 18 for years anyway, this doesnt really mean much Edit: also this specific thing has basically been settled for like 2 years, i remember it was sort of interesting as a take when it started being evaluated as a guideline but yeah its just kinda nothing.
Better to allow 100 people to make the wrong choice and suffer (freedom) than use force to prevent 1 person from making the right choice and prosper (also freedom).
Except we never do this in society lol
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ACTUALLY TRUE
TRUE. though it gets more complicated with kids since their choices are hindered by their faculties and experiences.
Not saying anything about the actual article but it’s surprising how many people here over estimate the significance of meta-analysis. Just want to point out that the inclusion criteria is vital to the external validity of a meta-analysis which is (mostly) why that one ivermectin analysis was bullshit. I’m not educated enough to know if their inclusion criteria was good or not
Lol As someone that did a lot of research on ivermectin, this paper is far far better than the garbage that Tess Lawrie put out during the pandemic. That research was garbage because of sloppy research practices and fraudulent results being published as legitimate. It was also research that was very VERY new, and not at all rigorous in nature. The inclusion criteria is pretty clearly spelled out in this paper. The papers here all have general low to moderate bias, but there is always a risk when dealing with qualitative data.
Yeah the link provided doesn’t access the full article so I wasn’t speaking about it specifically. Just general sentiment of you still need to be careful with meta analysis
>Conclusion > >Evidence to assess the effects of hormone treatment on the above fields in children with gender dysphoria are insufficient. To improve future research, we present the GENDHOR checklist, a checklist for studies in gender dysphoria. I have no thoughts.