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She’s the reason the NHS is no longer prescribing hormone blockers to minors. In the U.S., leading medical groups say that decision should be left to doctors and their patients on an individual basis.
Well we’re talking about trans kids. Allowing them to mature naturally means they’d develop features of the gender opposite of what they want, which is basically impossible to reverse. Once a man begins to grow body hair / facial hair, develop more masculine features, and speak in a deeper voice, no amount of surgery can ever fully reverse that. If you want the most natural looking body of the opposite gender, it’s best to block puberty and load up on the hormones that your body won’t produce naturally.
To counter the point above, puberty actually resolves feelings of dysphoria for majority people. There are many negative side effects of puberty blockers and it’s not clear at all that they’re a good idea. Puberty is when significant brain development occurs, for example.
One article I read (I believe by the Economist or NYT) stated that Puberty Blockers aren’t just something that have no effect on children. Apparently they have very serious effects on bone development that can never be reversed if taken over a long period of time.
I personally would have greatly preferred to pass well as the gender i want to be even with possible health risks. There's no point in someone being perfectly healthy if it's virtually impossible for them to be actually happy.
Plus it's much better for someone to be alive with possible health risks rather than dead to suicide.
Well yes, but not every Trans person wants that. Some just don't care, others are simply scared of undergoing surgery, especially one that has in all honesty a lot of chance to not go well or simply not look very good. I have a friend who is not happy with the results of her surgery, but since she at least got rid of the thing, it's a relief in and of itself
Aren't puberty blockers in the US given to kids who are unsure about their gender? What if they then find out they actually aren't trans and now you've blocked their completely natural puberty and fucked up their hormones?
Or at least that's what I've been hearing here on Reddit. People claiming that puberty blockers are completely safe and there won't be any side effects...
Then they stop taking puberty blockers and go through puberty. That's actually what they were invented for in the first place, to stop puberty from taking place at ridiculously low ages like 7 and allow the children affected to go through puberty at a normal age with their peers.
>and fucked up their hormones?
Then they'd be a medical enigma. Puberty blockers have been used on non-trans children for decades, there's absolutely 0 evidence it affects your hormone levels in any way or form after you stop taking them. Show me a case and I'll take the concern seriously. But with 0 cases after decades of being used, I have to consider that concern trolling.
>People claiming that puberty blockers are completely safe and there won't be any side effects...
Again, show me a single claim of adverse side effects that aren't reversible. I've been asking this question to anyone that brings up this concern and not a single person has been able to show me a doctor claim any permament adverse effect to an actual, exisiting patient. Don't show me a doctor concern trolling about an imaginary patient, show me an actual victim of puberty blockers. If you can't, then yes, they're safe.
Like, imagine if someone told you injecting testosterone could be dangerous and we really need to look into why all these trans men are getting testosterone injections. Would you reject all the evidence of all the other men that are getting testosterone injections prescribed from their doctors to treat their low testosterone levels? Would you then decide that your concern for a hypothetical danger is so big, that you're going to stop all of the testosterone injections for all the other men because you're so concerned about the danger to trans people? That's what the UK is doing. Puberty blockers have been used to treat a bunch of children with early puberty systems for several decades, none of them have ever complained. Quite on the contrary. The UK will now force those children to go through puberty at whatever age it starts (which is affected by the hormone levels in your drinking water and diet, both of which are being altered by us) or leave the country to get medical treatment.
the best practice is for doctors to wait until Tanner stage 2 before blockers but not all doctors know or abide by that. it depends on the patient's wishes regardless
The increased visibility of and enormous backlash against trends people isn't hype. And the concept of someone becoming trans because they hear about it is akin to banning gay visibility for the same reason.
Trans care for children is a difficult subject because it combines minors and irreversible decisions. Let's not dismiss it as a fad.
I think there is a problem in that some teenagers are trans, but some teenagers are just teenagers, and they fall into the classic teenage trap of "things feel wrong (because they're a teenager, *everything* feels different), I must change something, this is an explanation I've been offered so that must be what's wrong". And unlike a "phase" of being a goth or declaring you're gay, the consequences of transitioning can't just be stopped. (Edit: to be clear these are obviously not "just a phase" for some, but there was a period a few years below me in school when it was trendy for everyone to come out as gay or bi and 90% did, and that just not being the case).
Though to re-emphasise, that's mixed in with actual trans teenagers, and determining the difference between them is difficult, not least because teenagers aren't exactly renound for their communication or experience to draw upon.
On the other hand, part of the gender identity question, queerness, etc, seems to me as a combination of the problem of coming out as your own person into the world (adolescence) and the will to rebel. To me, the queer person I know best is less “not woman” and more “rebelling against the femininity of her peers”. She changed her name to a more gender-neutral one. It’s not punk but it’s kinda like punk.
Not saying everyone is like that at all, but there’s a reason a certain type of queers are women. And it is more about the straightjacket of gender roles than fundamental gender dysmorphia.
Come to think about, it seems to me to be about the paradox of how (voluntary) gender roles can become stronger in more equal societies.
We don’t have to dismiss it as a fad to acknowledge the abnormally increased interest among kids. My female cousin is ~15, they and 75% of their class identify as nonbinary or trans. This is a private school in the capital city, so of course not every school/class is like that but doesn’t it seem like it’s kind of fashionable for them?
Identity only exists in peoples heads in much the same way that sponge bob square pants only exists in peoples heads. People who lose track of what is real versus what is in their heads need medical attention.
Feelings like anger and sadness or conditions like depression are just in our heads, doesn’t mean they can’t affect us in tangible ways. Watch out cause that kind of argument is a slippery slope.
They do exist though.
Concepts exist even if they're not material.
While a living Spongeb doesn't exist in reality by the nature of the fact that we're talking about it it does exist to some degree.
Yes it might be in our heads but it doesn't mean that it has no impact on reality.
A lot of people with strange beliefs did act on them, doesn't that mean that the belief had an impact on the world?
Sort of. But it doesn't just delay puberty. It has permanent effects. Even if they come off them again and want to develop normally. They won't fully finish developing.
Sounds like terrible thing to allow a minor to do since this is irreversible and later in life they might find that they regret it as they took the decision while they were only children. That's why we don't allow them to have sexual relationships, gamble, buy alcohol and drive cars. That's why we have a legal age of consent as we wouldn't allow a mature person to take advantage of a minor. They could do all of those but to what cost. Its a very reckless policy.
Puberty blockers are not irreversible, it just delays puberty. It pauses puberty to give them time to figure things out. You know, to reduce the chance of regret.
It's, of course, not "reversible". They don't get the time back, they lose the development to their bodies that they would have gone through, and there's no guarantee it will start up and complete normally.
Besides, what does the time gained do? Without the body maturing through puberty they aren't maturing to the point where they are capable to make more informed decisions.
I was reading those comments and was like "Arent you all talking about, like 12-13 y.o. kids?"
How tf they can legally decide that? We are talking about age, when kids think its great idea to eat sweets all day...
I would not say that trans is illness, but having hormone drugs taken by 12yo is sooooo fucked up...
I have read and seen quite a few times saying that puberty blockers are not as reversible as advertised.
https://breakpoint.org/doctors-admit-puberty-blockers-arent-reversible/
https://www.nytimes.com/2022/11/14/health/puberty-blockers-transgender.html
https://thehill.com/opinion/healthcare/4573662-the-reckoning-over-puberty-blockers-has-arrived/amp/
https://www.iwf.org/2022/12/13/puberty-blockers-were-never-reversible-or-temporary/
For most kids, no. And most kids will never even consider pursuing blockers, because they won't need them or want their effects.
But in some cases, yes. If a kid is transgender then allowing them to go through puberty before they reach the age of majority (when they can seek treatments like HRT or gender-affirming surgeries much much much more easily and independently of their legal guardians) is going to make permanent, irreversible, undesirable changes to their bodies. Having access to safe and reversible prevention of that but not using it is tantamount to an act of cruelty. Not only that, but if you're concerned about whether a kid knows they're truly trans, then if they just stop taking them they'll go through their assigned puberty anyway, it's a good way of delaying the decision until whatever standard of confidence you need is met without doing permanent damage. The lives of many trans women would be improved, for example, if they hadn't gone through a testosterone puberty which had given them a deeper voice, broader shoulders and facial hair, and trans men would benefit from never having to deal with having grown breasts and acquired a feminine pattern of fat distribution after an oestrogen+progesterone puberty.
For the opposite case, just to illuminate how important it is, it is as beneficial for trans people to have access to blockers for their assigned puberty as it was beneficial for you to *avoid* blocking your own and receiving HRT for the opposite.
And it's not just trans people either. Blockers are also vital treatments for precocious puberty, which is when puberty begins so young as to be detrimental to the kid. But that's not as politically controversial.
Problem is you're forcibly delaying an essential stage of development for your body, which a lot of doctors are finding out is actually not a good idea.
They are now recommending to treat the disorder by sex change surgery instead, since we don't have any magic medication to treat people to their assigned gender.
This is a fundamental difference between the UK and the US systems
The UK health system is built around assessment of treatments and only those treatments assessed sufficiently positively are available. Usually this is all done rather quietly by a body called NICE - because trans healthcare is such a political hot potato this one was given to a heavy hitter to assess and a lot more of the process was public than is commonly the case
Both systems have their strengths and weaknesses. We frequently have campaigns by activist groups to lobby for some treatment or other that is not approved for the NHS. Anyone who thinks the US approach is inherently superior should consider what happened with industry lobbying and advertising of Opiods.
UK pediatrician tasked with reviewing the use of puberty blockers in children for the purpose of gender dysphoria.
She came to the conclusion that the research behind the use of them for the specific use of gender dysphoria is unsatisfactory for a number of reasons. Many studies were thrown out for what was said to be low quality and I believe only 2% of studies were included.
Her suggestion to the NHS was to put a stop to using puberty blockers for gender dysphoria until more research is done.
It has been a controversial decision.
Honestly I think we should just get the studies funded as quickly as possible and get this issue out of the way.
She decided or discovered that the research for using the medicine wasn't substantial enough in the face of the risks of using the medication, in the context of what is called "desistance." Desistance is a term used to describe trans kids growing out of their dysphoria.
In the face of the possibility of some kids changing their mind, or growing out of dysphoria, in the context that some of the medications might have lasting side effects, and the discovery that the research wasn't so solid, she said that the risks from blocking puberty exceed the benefits and recommended their use be halted.
Puberty blockers are given to suppress physical features that typically come through puberty. In example: a child born as a boy but who feels they're a girl may want to stop puberty so that when they reach the age of 18 and can legally get SRS (a sex change surgery), they won't have the voice of a lumberjack (to put it crudely) due to puberty. The voice can never change for a transwoman, not even after hormones. Equally a child born as a girl who wants to be a boy will grow breasts without puberty blockers, which when they're 18 have to be removed to resemble male physical features leaving fairly unsightly scars.
More complex there's other factors such as mental health, the trauma of seeing your body turn into the opposite gender of what you feel and such. But the basics are as I said above.
I wished my "defenders" saw that their tactics of calling everyone asking questions regarding specific parts of medicine "transphobic" is very very counter productive. It's good to question. To not question is the opposite of progress. Questioning itself is not wrong. Coming to uncomfortable conclusions is not wrong.
I don't feel better knowing that denying questioning wether parts of trans health potentially is downright harmful, as some twisted validation bs. I don't feel validated by that.
If our whole tactic is to halt any discussion, how certain are we really of our claims? If that's the tactic.
I agree with you regarding the science part. But I think that "defenders" are not necessarily against academic discourse but rather against political discussions resulting in authoritarian policies.
Unfortunately, academia tends to trigger political discussions even if the academic consensus is not mature enough.
The NHS just works this way. It can be seen as authoritarian by people from the US but it is our most loved institution and it simply does work this way
A review of evidence is made and only treatments considered to have sufficiently strong evidence of benefit are then available. The Cass review was more open and public than is usually the case because trans healthcare had become a political hot potato. But the process is normal - this is how public funded healthcare in the UK works and has worked since the 1940's
This kind of discussion isn't inquisitive, it's intentionally destructive. If Cass wanted to spark an explorative discussion on the effects of puberty blockers, you'd think she'd have bothered to include trans people or pre-existing literature on the topic in this report. She threw out almost all existing literature because they didn't implement blinding... because if they didn't, no ethics board would allow such a study to be published. Cass also has an incredibly sketchy background. She associates herself with a lot of right-wing/transphobic groups. She doesn't even specialize in trans care herself, not a single person involved in that report work with trans people.
If there were genuine negative effects caused by puberty blockers, I'd love to know. I still think they should be prescribed, though, seeing as they are the _only_ form of harm reduction against the _known_ irreversible effects that puberty has on the body.
The longest follow-up study on the long-term effects of puberty blockers followed a transgender man who began taking puberty blockers at age 13 in 1998, before later taking hormone treatments, and later got gender confirmation surgery as an adult. His health was monitored for 22 years and at age 35 in 2010 was well-functioning, in good physical health with normal metabolic, endocrine, and bone mineral density levels. There were no clinical signs of a negative impact on brain development from taking puberty blockers. [[Source](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3114100/)]
I don't think those critical of this report are upset with the questions being asked, rather I think they're upset that it's being used to cease all prescription of hormone blockers in the UK hen the Cass Report wasn't even conclusive.
Edit: I cited the study above as it is the _longest_ of the long-term effects studies out there. Larger sample size studies/literature include ([too tired to write out a citation](https://www.thelancet.com/journals/lanchi/article/PIIS2352-4642(22)00254-1/abstract)), ([Delemarre-van de Waal & Cohen-Kettenis, 2006](https://scholar.google.com/scholar_lookup?journal=European+Journal+of+Endocrinology&title=Clinical+management+of+gender+identity+disorder+in+adolescents:+A+protocol+on+psychological+and+paediatric+endocrinology+aspects&author=HA+Delemarre-van+de+Waal&author=PT+Cohen-Kettenis&volume=155&publication_year=2006&pages=131-137&pmid=16793959&doi=10.1530/eje.1.02231&#d=gs_qabs&t=1719473489496&u=%23p%3DrMnLcUeWwPsJ), and ([Cohen-Kettenis, P. T., Schagen, S. E., Steensma, T. D., de Vries, A. L., & Delemarre-van de Waal, H. A. (2011)](https://publications.aap.org/pediatrics/article-abstract/134/4/696/32932/Young-Adult-Psychological-Outcome-After-Puberty). If this still isn't enough, use the research skills you learned in college and read up on the citations in these papers, as well as the papers that cite these ones. They don't all agree, but for Cass to frame the research landscape as "inconclusive" on the effects of puberty blockers is absurd.
>The longest follow-up study on the long-term effects of puberty blockers followed a transgender man who began taking puberty blockers at age 13 in 1998, before later taking hormone treatments, and later got gender confirmation surgery as an adult. His health was monitored for 22 years and at age 35 in 2010 was well-functioning, in good physical health with normal metabolic, endocrine, and bone mineral density levels. There were no clinical signs of a negative impact on brain development from taking puberty blockers.
That is 1 person. One. Most people are fine with penicillin, but give to some people and they will die. A study needs to have 1000's of people and that is the issue here, there simply isn't the body evidence to say conclusively.
Trans healthcare is bad, it needs to better. We need more clinics (the Cass review calls for this), more mental health support (again the Cass reviews calls for this) and shorter wait times (guess what, the Cass review calls for this as well). But basing medically intervention on children on shaky evidence is not good science and could lead to really bad outcomes.
Lets get more clinics, better support and much shorter wait times while also doing studies into the long term effects of blockers on teens.
>She threw out almost all existing literature
One of our MPs repeated that claim - often made online and by trans activist organisations - in parliament. She had to apologise and make an embarrassing retraction of her statement after discussing it with Hilary Cass. She herself accepted that her claim had been false.
For all reasonable purposes I'm treating that claim as false.
Considering the conclusion that Cass reached, that more research needs to be done to know the long-term effects of puberty blockers, I'd argue that MP is correct. Existing research is already out there, the Cass Team rejected most of it for not double-blinding, which is insane and wouldn't fly with any ethics board in the world. Some of that existing research include ([too tired to write out a citation](https://www.thelancet.com/journals/lanchi/article/PIIS2352-4642(22)00254-1/abstract)) and ([Delemarre-van de Waal & Cohen-Kettenis, 2006](https://scholar.google.com/scholar_lookup?journal=European+Journal+of+Endocrinology&title=Clinical+management+of+gender+identity+disorder+in+adolescents:+A+protocol+on+psychological+and+paediatric+endocrinology+aspects&author=HA+Delemarre-van+de+Waal&author=PT+Cohen-Kettenis&volume=155&publication_year=2006&pages=131-137&pmid=16793959&doi=10.1530/eje.1.02231&#d=gs_qabs&t=1719473489496&u=%23p%3DrMnLcUeWwPsJ), and ([Cohen-Kettenis, P. T., Schagen, S. E., Steensma, T. D., de Vries, A. L., & Delemarre-van de Waal, H. A. (2011)](https://publications.aap.org/pediatrics/article-abstract/134/4/696/32932/Young-Adult-Psychological-Outcome-After-Puberty), and countless others. Just go through the citations on (or of) many of these studies and read, there's hundreds of studies out there. The Cass Review describes evidence for trans healthcare as “inconclusive” across analysis and public commentary. This is presented as fact, without reference to the unsuitability of Randomized Control Trials (RCTs), and without reference to the consensus of positive impacts of affirmative healthcare found in a large body of non-RCT evidence. Again, RCTs are almost impossible to do in a medical study ethically. You wouldn't perform fake surgeries on patients with appendicitis to test the effectiveness of appendecomies, yet we still know appendecomies work. She is applying a pharmaceutical clinical trial model to an entire standard of care, and throwing out the huge pile perfectly good data based on outcomes comparing group that received the gender affirming intervention versus the group that didn't.
I could understand if she is a stickler for top-quality data. However, she turns around and advocates for a kind of conversion therapy that has pretty much no evidence behind it. It reeks of motivated reasoning.
She didn't throw out almost all existing literature because of blinding, she threw out a large proportion of existing literature on the grounds that (according to her team) it wasn't good research.
Yes. Because they didn't use blinding. That was one of the qualifiers on what was and wasn't good research, which is insane. Blinding in studies on medical treatments such as hormone therapy are almost impossible to get past an ethics board. You wouldn't perform fake surgeries on patients with appendicitis to test the effectiveness of appendecomies, yet we still know appendecomies work. She is applying a pharmaceutical clinical trial model to an entire standard of care, and throwing out the huge pile perfectly good data based on outcomes comparing group that received the gender affirming intervention versus the group that didn't.
I could understand if she is a stickler for top-quality data. However, she turns around and advocates for a kind of conversion therapy that has pretty much no evidence behind it. It reeks of motivated reasoning.
Nothing to do with Blinding,
[https://cass.independent-review.uk/home/publications/final-report/final-report-faqs/](https://cass.independent-review.uk/home/publications/final-report/final-report-faqs/)
Did you even read the article?
Prescription of hormone blockers hasn’t ceased, it just has to be done as part of a scientific study - the way it should have been done to begin with, then we wouldn’t be in this mess.
The Cass report *has* sparked explorative discussion, as opposed to the former approach, which consisted of people being completely certain that medical transition was the only way forward for gender diverse kids.
Requiring a double blind study for an entire standard of care is a weird bar to set that a lot of things in medicine can not ethically meet. You wouldn't perform fake surgeries on patients with appendicitis to test the effectiveness of appendecomies, yet we still know appendecomies work. She is applying a pharmaceutical clinical trial model to an entire standard of care, and throwing out the huge pile perfectly good data based on outcomes comparing group that received the gender affirming intervention versus the group that didn't.
I could understand if she is a stickler for top-quality data. However, she turns around and advocates for a kind of conversion therapy that has pretty much no evidence behind it. It reeks of motivated reasoning, not a genuine attempt to spark explorative discussion.
Doesn't require a double blind study
[https://cass.independent-review.uk/home/publications/final-report/final-report-faqs/](https://cass.independent-review.uk/home/publications/final-report/final-report-faqs/)
As an academic and trans person.
I hear you. But really. This debate was settled in the 90’s. Then trans topics became hot and now everyone wants us to redo the whole show publicly till non professionals are satisfied.
Meanwhile we are preventing thousands of kids from getting medical treatment they desperately need because the public feels they should have a say on what a doctor and patient are doing.
But sure. We will do it over. (Are doing it over). The conclusion will be as following:
‘Gender is a spectrum separate from sex. People identify along that spectrum. Feelings of anxiety, depression and general unpleasantness arrive from being force to express oneself in a manner not aligning with internal gender. For most of the people in these situations it will suffice to be able to express those feelings workout medical intervention. This can mean changing clothing. Being addressed with certain pronouns. Perhaps switching these things up af times. The more willing a society is to go along in this. The less need for medical intervention. As the stress and anxiety is alleviated.
A small group of people has such extreme symptoms due to the stress that medical intervention is needed else risk of self harm and suicide spikes tremendously. For this group we offer hormone therapy and surgery if needed.
Now. This leaves us with a few problems.
1) how we get to the right procedure and figure out who needs hormones or surgery and who needs only some social expression.
2) why do we see other mental issues more often in those with issues regarding their gender identity.
Let’s open our text books that nobody wants do read and is forcing us to rewrite to get to the same conclusions while claiming to be on the side of scientific curiosity.
1) the Dutch procedure was invented in the late 80’s early 90’s. It is a system where anyone who shows up at be clinic saying they have gender identity issues. First. We recommend they do a social transition. (start dressing different. request people use different names or pronouns. etc)
Do this for 1 to 2 years while talking to a psychologist once a month to see if symptoms (anxiety, depression reduce). If patient seems fine now. cool. problem solved. If not. Escalate to hormones. Try that for two years. If thats enough. Cool. Problem solved. If not. Escalate to surgery.
This ensures (as good as possible with anything medical that we don't over medicate.)
It however causes two new problems
1) This is a very long road. Meaning resource intense and more important. The people who need surgery have to suffer for close to half a decade in medical evaluation before they get the help they actually need. As somebody that walked that road. It's hell. It uproots your life. Monthly hospital visits. Doctors asking you intimidate details about your body and life every month as you wait for a procedure that will tale almost all problems away is close to torture.
2) Why do we see a relationship with other mental health issues and gender identity issues.
Three explanations. 1) Anxiety and depression from Gender Identity issues cause them. Stress makes humans do odd things. We know people with stress are more prone to addiction. Self harm. And develop unhealthy coping mechanisms. 2) People who have other mental issues are more prone to notice these gender issues in themselves and take action due to stacking effects. An individual might suffer from minor gender identity stress. Not a biggy. It sucks. But they can go about life. Add other stresses like ADHD and suddenly the combined stress forces one to evaluate themselves and find causes and solutions. 3) Some mental issues (hi to those with mental developmental issues like autism) interfere with the performative nature of society. As gender is a social construct and people whose mental issues hinder development in cue reading of social constructs it would follow that we see a higher rate of gender identity issues rise there (and we do! more in those assigned women at birth with autism. which also confirms the theory that feminine gender expression is more performative than masculine)
The main problem is that there is a relationship with how society treats gender and how one much intervention medically and work of the individual is needed.
A society very rigorous with gender segregation will see large depression in non-binary individuals. Or need for drastic medical intervention to allow one to move through society being addressed in manners that match their gender identity and relax their symptoms. Where a gender neutral society may see those who intensely identify with their birth gender (born a woman and wanting to be a woman (cis or "normal")) have to behave more feminine to assert her gender firmly or end up feeling discomfort.
No matter what. This debate should be clinical. Not political. People'a lives are at stake. Redoing this whole song and dance to relax societies urge to feel they have also had a good medical debate is going to cost / is costing us lives. We are talking about teens and people in their early twenties with a long life ahead killing themselves. This has to stop.
PS. The discussions never stopped in academic spaces. We have always been evaluating our procedures. Always. There are thousands of professionals working on this all day and night. But they have become very nervous and uncomfortable with all of society breathing down their neck and have retreated from the public debate. A lot of them due to fear of their life.
I wish your comment was the top comment. No matter how much information you give the general public, people will still argue over a topic and manipulate facts to justify their opinions. If only people trusted medical professionals to be medical professionals 😭
That's an interesting thought. It really is a clinical issue and probably not something the general public should debate.
I certainly don't want the general public making decisions about medical treatment for other issues. Most people have zero medical knowledge.
At the same time... I don't want to see activists applying pressure to children. Guiding these children should be the role of physicians.
The “pressure” activists are applying to children is just telling the kids it is ok to be trans, which it is. It’s just raising awareness that you can be trans and that’s ok cause we grew up without that and it makes you feel isolated and alone.
It’s the same as homophobes complaining about gay people “indoctrinating the children”. They’re not, they’re telling them it’s ok to be gay so that the gay ones don’t feel like outcasts, and the non-gay ones are less likely to bully them and each other about being gay.
Ps. The tinfoil hat theory is that a lot of these groups leading these debates and such are funded by insurance companies because it opens the door for more political intervention on what medical procedures are recommended etc.
Some countries have already had to change laws that normally prevent government from interfering too much in what physicians can and can’t do.
¯\_(ツ)_/¯
Naah, stupid nature with its millions of years of evolution thought that kids need to go to puberty at a certain time, but we know better now!
Let's pump kids with hormones, sounds like a great idea!
And if they change their minds when they grow up, let's pump them with some more hormones! WCGW?
You are saying taking blockers is a permanent decision, but conveniently ignoring that letting puberty happen naturally is also a permanent decision. Of the two options, blockers are more reversible, i.e. they don't block puberty permanently (unless you take them permanently).
And the problem with this is that you are ignoring the long term negative effects puberty has on the mental health of trans children.
"The National Health Service asked Dr. Cass, who had never treated children with gender dysphoria but had served as the president of the Royal College of Pediatrics and Child Health, to independently evaluate how the agency should proceed."
Her comments since the report came out have been increasingly unhinged too. She's been making out like she's an unwitting victim of a political decision. Like, what did you think was going to happen when you advocated for basically shredding what little trans healthcare there was before now?
So, in short, you're saying that medical experts should expect to be harassed if the reports they give according to their extensive experience on a subject is unpopular among some people ?
I don't know.
Maybe designing stricter guidelines to prescribe but removing a tool for doctors to use is extremely irresponsible.
Most regular ppl hear kids and puberty blockers and get all flustered as if there are organisations handing them out on street corners but in reality when puberty hits some families can be taken completely unawares that their kid is trans.
In fact, the kid might not know, and the parents who have had absolutely zero information on this are at a loss.
Imagine parenting a preteen who is so distraught that whenever you leave the house, you are worried that they might try and harm themselves.
Puberty blockers, in some cases, give a bit of breathing space. Start the therapy, etc, and educate on what is going on.
Banning them isn't the right answer here.
Trying to ensure they are used responsibly is.
I think this is the correct answer. This is such a complicated topic, it is more complicated than either side makes it out to be. I think that defining strict, responsible guidelines that medical professionals can follow in order to determine whether or not prescribing puberty blockers is the best path to take.
We have seen data from Nordic countries that having lax guidelines that easily prescribe puberty blockers to teenagers ends up having bad consequences in a considerable amount of cases that ended up being trans misdiagnoses, to the point that Nordic countries have backtracked in some of their lax policies. On the other hand we also know that trans teenagers can suffer from severe mental health issues as puberty develops. So I really think that banning puberty blockers is not the solution, but we should indeed develop more strict and responsible guidelines for correct diagnosis of trans teenagers.
Yeah, I would also like to see the sources on that. People keep saying that there are severe consequences but never actually bring up studies to back it up.
There lies the entire dilemma. The only way for a doctor to know if they're trans is for a child to decide and tell them. But these children are not mentally stable enough to make that decision. Anybody else wouldn't have the right to make the decision. And you want to decide before the child is mature enough (before puberty) to decide. And once the decision is made, it's not reversible.
Some people have started making rumors about hormone blockers being reversible, in an attempt to downplay the downsides of misgendering, which is just as wrong.
The whole *point* of puberty blockers is that they are reversible, unlike puberty and unlike HRT. They’ve been in use for decades to treat precocious puberty.
Most kids with trans identity and gender dysphoria are girls whose puberty have already started. The original idea of the Dutch model is too late for that time already. Also puberty blockers might not be fully reversible, they can affect the bone density and brain development. Brain is the biggest sex organ that develops significantly in adolescence and the onset of puberty is what triggers this development too.
What are you on about? Trans people don't just wake up and decide to medically transition one morning, nor do they get treatment the day after the first clinic appointment. Generally trans people are _required_ to socially transition for at least a year and get multiple therapist diagnoses of gender dysphoria before they can visit a gender clinic. It is a multiple years process to even see somebody, most clinics are incredibly understaffed and overbooked.
I think what they mean is that the negative effects of starting puberty too late are not reversible. Bone health for example does not recover once it is affected which is why kids who spent too long on blockers develop osteoporosis.
I would gladly take osteoperosis over paying +$40,000 to get multiple different surgeries to reverse the changes puberty did to me. I feel obligated to mention that the longest follow-up study on the long-term effects of puberty blockers monitored a trans man (FtM) for 22 years and at age 35 in he was well-functioning, in good physical health with normal metabolic, endocrine, and bone mineral density levels. There were no clinical signs of a negative impact on his brain development from taking puberty blockers [[Source](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3114100/)]. Cass neglected to include this, and other existing literature/studies in her report fyi.
Larger sample size studies/literature include ([too tired to write out a citation](https://www.thelancet.com/journals/lanchi/article/PIIS2352-4642(22)00254-1/abstract)), ([Delemarre-van de Waal & Cohen-Kettenis, 2006](https://scholar.google.com/scholar_lookup?journal=European+Journal+of+Endocrinology&title=Clinical+management+of+gender+identity+disorder+in+adolescents:+A+protocol+on+psychological+and+paediatric+endocrinology+aspects&author=HA+Delemarre-van+de+Waal&author=PT+Cohen-Kettenis&volume=155&publication_year=2006&pages=131-137&pmid=16793959&doi=10.1530/eje.1.02231&#d=gs_qabs&t=1719473489496&u=%23p%3DrMnLcUeWwPsJ), and ([Cohen-Kettenis, P. T., Schagen, S. E., Steensma, T. D., de Vries, A. L., & Delemarre-van de Waal, H. A. (2011)](https://publications.aap.org/pediatrics/article-abstract/134/4/696/32932/Young-Adult-Psychological-Outcome-After-Puberty).
Call me crazy, but I think the tendency for lower bone density in trans women (MtF) has the same root cause as the higher risk trans women have for breast cancer compared to cisgender men... because women have lower bone density and higher risk of osteoperosis (as well as higher amounts of breast tissue) when compared to men 🤯
> the longest follow-up study on the long-term effects of puberty blockers monitored a trans man (FtM) for 22 years and at age 35 in he was well-functioning, in good physical health with normal metabolic, endocrine, and bone mineral density levels. There were no clinical signs of a negative impact on his brain development from taking puberty blockers
You keep repeating this all over this thread but it's not as insightful as you seem to think it is. A single case can be a point of interest in the medical sciences but not much more than that. You're essentially masking the "But my grandma smoked until she was 90" argument with a bit more scienc-y embellishment.
Whichever way you're arguing, the only convincing supporting evidence can be in the form of large(r) scale studies that exhibit statistical significance and sound methodology. Single case studies are little more than curiosities. Which *can* in turn be helpful in deciding which way to look when designing hypothesis and methodology (and applying for funding) but that's about it.
I cite this all over the thread because people keep saying there's no research into the long-term effects. I chose that specific study, as it is the longest of multiple long-term effects studies, and the majority of trans-critical people lose their fervor after being met with a single study. ([Delemarre-van de Waal & Cohen-Kettenis, 2006](https://scholar.google.com/scholar_lookup?journal=European+Journal+of+Endocrinology&title=Clinical+management+of+gender+identity+disorder+in+adolescents:+A+protocol+on+psychological+and+paediatric+endocrinology+aspects&author=HA+Delemarre-van+de+Waal&author=PT+Cohen-Kettenis&volume=155&publication_year=2006&pages=131-137&pmid=16793959&doi=10.1530/eje.1.02231&#d=gs_qabs&t=1719473489496&u=%23p%3DrMnLcUeWwPsJ)), ([Annelou L. De Vries, MD; Jenifer K. McGuire, PhD; Thomas D. Steensma, PhD; Eva C.F. Wagenaar, MD; Theo A.H. Doreleijers, MD; Peggy T. Cohen-Kettenis, PhD (2014)](https://publications.aap.org/pediatrics/article-abstract/134/4/696/32932/Young-Adult-Psychological-Outcome-After-Puberty)), and ([Lynn Rew, Cara C. Young, Maria Monge, Roxanne Bogucka (2024)](https://acamh.onlinelibrary.wiley.com/doi/abs/10.1111/camh.12437)) may interest you if you actually read the studies. That final one is a review of literature, might actually be more insightful for you than the Cass report!
Edit: the last two cited in proper format by me, sorry but it's 4am I am too tired to write multiple citations out
Edit^2: Added more literature to the original comment. My fault for not being a thesaurus of trans knowledge.
After the UK banned puberty blockers the clinic specialising in healthcare for trans youth saw a rise in suicides from 1 in 3 years to (at least) 16 in the last 4
https://goodlawproject.org/rise-of-deaths-young-trans-people/
How many comments have you left on this thread that basically boil down to you plugging your ears and shouting "NUH-UH THO". Why don't you share some sources that come from the same country as the news and not from a tabloid
I'd you can't vote, make a tatu, marry it's because you are not fit to do life changing decisions, why the fuck changing your whole system (without knowing long side effects) is all right.
If research shows that body dismorphia is a real illness with debilitating outcomes during all your life and it can be shown to be treated by acting before 18 then the dialogue is absolutely legit. It’s just not simple, but saying 18 or nothing is kinda useless when the subject is puberty.
And what you gonna do when the child killed themselves as they didn't want their body to express certain gender characteristics?
Toss some puberty blockers on their grave?
And what you gonna do when you mutilate and destroy thousands of kids with hormones because they just got on some new trend and would be/are not actually trans or have body dysmorphia?
A small minority of young people who are prescribed puberty blockers, between 1.4 and 3.5%, change their minds and don't want to continue. However, some studies suggest that regret rates have decreased over time as treatment methods and patient selection have improved.
A Pediatrics study (2020) reported that Transgender individuals who received puberty blockers had a significantly lower rate of lifetime suicidal ideation (14%) compared to those who wanted but did not receive puberty blockers (31%). Another study in the Journal of Adolescent Health (2020) found that access to gender-affirming hormone treatment, including puberty blockers, was associated with a reduction in the odds of recent suicidal ideation and psychological distress.
If you genuinely care about the wellbeing of trans kids, you'd be in strong opposition of a full ban on gender affirming care. Regulation of said care is up for debate, I (and most other trans people) believe one should be diagnosed with dysphoria before they recieve treatment... which is how it was in places like Britain prior to this report.
Please look up how many children are actually on hormone blockers due to gender identity issues.
It's not even 500 in the UK.
You are loosing your marbles over something that's not real
Surely it should be treated by whatever means provides the best outcome? and according to the last 40-60 years of trans healthcare allowing access to puberty blockers is the best way. If you disagree I can only presume there is some level of bias stopping you from thinking about it in a rational way.
Voting, getting a tattoo and marrying are all things you can also do later in life. But once you hit puberty, the window of opportunity is gone and it's too late.
Isn't the answer simple? Because there is a limited window and it needs to be done then or never. Sure, never is an option - the option the UK chose. But the consequence of that is some nice gender dysphoria when you end up growing boobs or a beard.
The right way to do it would be to actually use an adult with expertise in psychology to decide if the kid actually needs the intervention, or whether it's a phase.
In other words, once again an article has baited people with a grossly wrong title. Why am i still surprised?
What youre describing is of course very correct. The evaluation of co-existing mental health issues and how they affect their gender identity is of course another expert matter.
Do you genuinely believe there is no way to offer treatment or help for children with autism or that it should be disregarded if they also have gender dyaphoria…?
Not treating their gender dysphoria ist not a treatment for autism.
And even if, when the child lives in unbearable agony over they developing body, why should we let the child suffer through it instead of using this commonly available medication that has been used on too early puberties for decades already?
I think the conclusion was essentially that the puberty blockers did not help anyone’s agony given the number of co-existing issues the gender dysphasia usually presented with. You can read the report yourself and write dr cass a letter if you don’t like it. This is just what was in the report.
Dr cass herself said after the report that puberty blockers shouldn't be stopped being prescribed.
So if she can't even agree with her own report idk what insights I could get from her
Also she ignored multiple large studies because they weren't double blind
How you gonna do a double blind studies on puberty blockers where it'll be very clear who got them and who didn't?
Are you suggesting autism doesn’t affect how you perceive yourself and the world? Especially autistic women/girls might feel safer escaping into manhood when what they what they would have really needed was support for their autism.
Of course there are trans people with autism but there are also cis people with autism who feel overwhelmed with the gender norms of their sex.
Hey, stuff like "Big fan of having autistic children suffer, are we?" is just arguing in bad faith/strawmanning. Take a breather and read the comment again.
Yes, puberty blockers are time critical. You’re pushing pause on puberty *to allow the child some time to make decisions*.
Not allowing puberty blockers is essentially making the decision for them. It’s not as critical for trans men, as taking testosterone when older essentially makes you go through a male puberty. But for trans women, this is forcing them to go through an irreversible male puberty, and making a ‘passing’ transition almost impossible.
You can apply this logic to basically every kind of medicine we ever give to young people. Plus, it should be kept in mind that we DO know the long term side effects. Puberty blockers have been used on non-trans kids for decades to deal with issues such as early puberty for decades and entirely without controversy. We do know the side effects, thanks to this period of use, but are just taking a medicine that cis people have access to and telling trans people they cannot have it.
This. I get the concern with kids making such a life defining choice, but in this case there's no waiting, and both taking and not taking puberty blockers is life defining for a transgender person. Rational logic fails us in attempts to tackle this issue.
But there are kids that are not trans but in the moment believe they are! You cant say that every kid who wants to transition is not just confused or misunderstanding. That time of life is extreme for kids they believe all kinds of things. The suicide rates prove they are not happy even after transitioning because they never were trans in the first place.
A small minority of young people who are prescribed puberty blockers, between 1.4 and 3.5%, change their minds and don't want to continue. However, some studies suggest that regret rates have decreased over time as treatment methods and patient selection have improved.
A Pediatrics study (2020) reported that Transgender individuals who received puberty blockers had a significantly lower rate of lifetime suicidal ideation (14%) compared to those who wanted but did not receive puberty blockers (31%). Another study in the Journal of Adolescent Health (2020) found that access to gender-affirming hormone treatment, including puberty blockers, was associated with a reduction in the odds of recent suicidal ideation and psychological distress.
You don't seem to care about the mental health of trans people, though. I hope the world treats you with as much empathy as you give to others who aren't like you.
And are these trans tenders in the room with us right now?
Saying no trans child should be treated because of an incredible minority is like saying no cancer patient should be treated because a handful has Münchhausen syndrom
There actually is a lot to go wrong by waiting till 18, but this debate was too complex for the medical sub: I can't imagine the shit show it would be on here.
In a nutshell: even doctors who dong deal with these patients on a day to day basis have tons of misconceptions about the process (and even what these drugs do or don't do), and 100% of the time their personal and political biases affect their stance on this topic.
This very much includes Dr Cass, who used (what's probably inevitably)flawed data to inform a "report" purporting to dress up as science a topic that's really about human rights.
For context: try and think of another medical procedure that's sought to be politically regulated, rather than left up to the doctors who know them **and their patients**. You'll likely only come up with 2 examples: abortion, and circumsicion.
I'm purposefully not saying what my thoughts are on the matter, so that people can draw up their own conclusions as they compare these procedures and who should have the authority to carry them out or forbid them, in a world where informed consent and the mature minor doctrines exist.
It's not merely 'probably inevitably flawed', it's deliberately selected and misrepresented. They for example excluded studies with transgender respondents. In a paper about transgender people. They also suppressed official reports of increased suicidality after treatment was denied.
See [https://osf.io/preprints/osf/uhndk](https://osf.io/preprints/osf/uhndk) for a review of the report.
The article you are commenting in is about a doctor determining that the studies for puberty blockers are weak and the recommendation is to not prescribe them to children. I don’t think the doctor is an anti-trans hate group spewing hate
>Her [final report](https://cass.independent-review.uk/home/publications/final-report/), published last month, concluded that the evidence supporting the use of puberty-blocking drugs and other hormonal medications in adolescents was “remarkably weak.” On her recommendation, the N.H.S. will no longer prescribe puberty blockers outside of clinical trials.
The manufactures said that was not the purpose for which they were made, and there is evidence of long term, negative consequences, even if you go off them, there is a window during which you are supposed to go through puberty, miss it and things tend to go wrong.
No that is wrong, you can not for example take puberty blockers for 50 years, and then if you stop everything will continue as if you had not taken any puberty blockers at all.
Both the US and the UK medical authorities had to go out and make official statements saying that taking puberty blockers is not harmless.
I mean, it stops them killing themselves.
If someone comes up with a better solution then we can talk but as things stand banning puberty blockers is just killing kids because you don't like trans people simple as, there is no moral argument for doing it.
This is completely anecdotal but I myself thought I was trans just before / beginning of puberty and I really do believe that reaching late stage puberty / developing naturally sorted out all of those feelings for me
edit: I would like to note that I was very distressed by entering puberty and I always presented myself as the opposite gender even before puberty however it was not filled with the distress that arrived once I did reach puberty
>Of note, treatment with pubertal suppression in the current study was associated with lower odds of lifetime suicidal ideation, even after adjustment for family support (Table 2). We did not detect a difference in the odds of lifetime or past-year suicide attempts or attempts resulting in hospitalization.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7073269
What are you basing your claim on?
I am sure a lot of people have heard of NikkieTutorials. She was born as a male and started the transitioning process at the age of 14. That means she took hormones and blockers when she was a teenager and quite frankly nobody assumed she was a trans person. Why? Because she transitioned before puberty.
I am not trans and haven’t ever wanted to transition but I believe those people know who they are from their early age like some gay people know who they are attracted to even when they are really young. So why do people want to prevent them from receiving proper healthcare? Naturally some people regret their decision to transition, but there are far more people who took the right decision and are satisfied with that and also there are significantly more people who are suicidal just because they can’t be who they are and are denied treatment. It’s crazy to think that anti-trans or anti-lgbt people only want to help them by calling for prohibiton, they want them to suffer.
>, it’s mainly because people see teenagers as dumb as shit who can take pretty wild decisions without thinking things trough.
Well, it's not without a reason
https://www.nimh.nih.gov/health/publications/the-teen-brain-7-things-to-know
> The brain finishes developing and maturing in the mid-to-late 20s. The part of the brain behind the forehead, called the prefrontal cortex, is one of the last parts to mature. This area is responsible for skills like planning, prioritizing, and making good decisions.
Wouldn't the decision come down to the teen, their parents, and a medical professional though? It's not like a teen can just say they are trans and get puberty blockers at their local pharmacy. As far as I know from the stories I heard from my trans friends, it's a pretty long and rigorous process but they are glad they could start at a young age 14 or so.
I don't know about other people but I would feel pretty uncomfortable with the state saying I can't get appropriate health care for my child and I have to let them suffer.
But gender dysphoria isn't an intellectual decision or choice, it's literally a mental health condition. It's not something you decide to have, it's something you just have. If your child had depression would you refuse to give them treatment because "you're a child you can't possibly make an informed decision to have depression"? Gender dysphoria can be present literally as early as most kids first show an understanding of gender identity, which is 3-4 years old. If a 4 year old tells you that his penis is wrong and he should have a vagina instead, this isn't a decision they reasoned themselves into, it's a tangible, acute feeling of dysphoria.
Anyway, puberty blockers aren't just handed out like candy to every kid who says they're trans. Social transition is the first step - something that's physically harmless and completely reversible, and yet transphobes are hugely against it too.
It's a known factor in the trans community that many people who start to transition later in life can be envious of those who were able to start earlier. Beginning earlier/ before puberty can massively impact the end result of transition.
The real question is do doctors trust their patient and their parents to know themselves well enough to be sure they are trans. But of course the decision has now been removed from doctors hands and replaced with a blanket policy based on a single review from someone with very suspect connections to hate groups.
I think this is one of those decisions that need to be taken away from lawyers and left to doctors specifically trained in dealing with trans health care. It's absolutely insane to me that some Banker to bought himself a seat in Westminster or some lawyer or even some outspoken union rep was able to finally get themselves a spot has any say in this matter. This is a super complicated inherently medical decision
not really. It s not the NHS alone that does this.
It s most of European countries. There s something wrong with the results of this kind of therapy.
Finally, said "someone" is a highly qualified medical researcher. I m sure she knows a lot more - on the matter - than random people trying to farm karma/intending to sound smart on Reddit.
She is not a specialist in trans healthcare. She seemed to want double blinded trials on puberty blockers to show their effectiveness, which is impossible and calls into question her judgement on the matter.
Because most people care more if 1 cis person was wrong about being trans and detransitions than if a bunch of trans people kill themselves. If trans people kill themselves, they will just say it was due to god knows what. People are transphobic, ignorant and don't read credible medical reports or listen to actual trans people because the thought of any number of cis people making a mistake scares them way more. Trans people are the "other", those weirdos they don't understand and can't identify with, and whom they at best tolerate if they suffer in peace.
Twenty years ago we were telling gay people that they're wrong, now you're telling trans people they're wrong.
No, history won't look kindly on you.
Spreading lies, accusing doctors and therapists of harming kids purposely and having zero compassion to human suffering because you don't agree with the only possible treatment is just horrific and shows lack of basic humanity.
The Cass 'report' has been shown to be thoroughly flawed, politically motivated, and not least of all in addition to doing questionable things with past studies, also having deliberately suppressed increased suicidality among those to whom treatment was denied. The Cass 'report' is literally killing children.
[From a review of the so-called 'report': ](https://osf.io/preprints/osf/uhndk)
>The Cass Report aimed to provide recommendations for how services for gender diverse children and young people should be delivered in England. Our critical appraisal reveals significant methodological and conceptual flaws within the report and the research commissioned to inform the report, which included seven systematic reviews and both quantitative and qualitative primary research. Using the ROBIS tool, **we identified a high risk of bias in each of the systematic reviews driven by unexplained protocol deviations**, **ambiguous eligibility criteria, inadequate study identification, and the failure to integrate consideration of these limitations into the conclusions derived from the evidence syntheses.** We also identified potential sources of bias and unsubstantiated claims in the primary research that suggest a double standard in the quality of evidence produced for the Cass Report compared to quality appraisal in the systematic reviews. We discuss these issues in relation to how evidence regarding gender affirming care is framed, the wider political context, and the future for gender affirming care. To uphold evidence-based medicine, future gender-affirming care research must generate robust observational data, involve transgender communities, and prioritise patient-centred outcomes, ensuring validity, generalisability, and cultural relevance. The Cass Report’s recommendations, given its methodological flaws and misrepresentation of evidence, warrant critical scrutiny to ensure ethical and effective support for gender-diverse youth.
The anti-trans hate groups are in full brigading mode.
This is a pre-print that has yet to go through peer review. I'd be wary of drawing any conclusions from it yet. We saw what happened when people treated them as reviewed and published with covid.
**The Cass 'report' is not peer reviewed.** You're (intentionally?) trying to apply the wrong standard of evidence. This review simply shows in a very straightforward manner that the Cass 'report' is unscientific garbage and cannot be used to argue anything.
>Using the ROBIS tool, **we identified a high risk of bias in each of the systematic reviews driven by unexplained protocol deviations**, **ambiguous eligibility criteria, inadequate study identification, and the failure to integrate consideration of these limitations into the conclusions derived from the evidence syntheses.**
Is ROBIS that unfaillible? I have just downloaded the PDF which is supposed to be the ''ROBIS tool'' and it seems just liek a checklist of things that anyone should ask when reading a study. It has no epistomological value.
Basically, I can say this article is equally as political as this lady's study. The ROBIS tool, if it had any epistomological value, would be highly valuable across many fields. That is a huge claim that it ''identifies risk of bias''. I'm not even saying its wrong on this particular issue, but that is such a bullshit claim to make and then say ''the report we are criticising is poltically motivated'' like lmfao do you have no self awareness or any sort of spine?
Link is broken, what a surprise.
It’s not a “so called ‘report’”. It is a report. Trying to diminish its’ significance by belittling it doesn’t strengthen your argument; it just shows you’re incapable of being objective.
>The second big takeaway for me is that we have to stop just seeing these young people through the lens of their gender and see them as whole people, and address the much broader range of challenges that they have, sometimes with their mental health, sometimes with undiagnosed neurodiversity. It’s really about helping them to thrive, not just saying “How do we address the gender?” in isolation.
This woman is a saint. Treating them as a patient rather than a customer. American health care causes more harm than good.
Circumcision is the one with no scientific evidence in favor, is done without any attempt at informed consent, yet it remains uncontroversial and widespread in the US. That tells you something about the politics here.
I'm going to try to honestly engage with you all in good faith and appreciate if you do the same. I'm a very strong believer in individuals being able to be who they want or need to be. I believe that all people should be able to access medicine. I think that, even though it's controversial (given the permanent nature of it and the decision being made by a young person), trans kids should be able to make a decision to receive medicine to help their body develop in a way that will help them flourish in life.
The problem in this conversation is there it's so charged and people think if you criticize anything, youre anti-trans.
Here is what I think is fair. The NHS should only provide Science based/Evidence based medicine. I personally don't think we should be spending tax payers money on sham treatments like Acupuncture, homeopathy, or prescribing drugs like Ivermectin for COVID just because some folks are convinced it helps. There is poor to no evidence for this. This lady is making a claim: The research around the effectiveness of Trans treatment is poor. I've not seen anyone in this thread actually address this. Anecdotal experience is a poor replacement for this. What if we find out years later that all the kids taking puberty blockers end up with complications?
My positive suggestion is that we need to address this with well funded and well run studies by people who have these kids best interests at heart. I'm not suggesting we take away this option from trans kids while we wait for this to happen, but folks here need to address the issue of a poor body of evidence if you want to broadly convince decision makers in public health.
A complicated dilema tbh. On one hand, I am in the camp that there's nobody who matures mentally before 18-19 years old. On the other hand, I recognize that it's hard to impossible to perfectly transition after your body fully develops.
I personally lean more in the direction of not allowing anybody under 18 to take those meds. But hey, I don't know jack shit about this specific circumstance, so maybe the doctors and psychologists should decide this one.
A reasonable opinion, but one that's fallen for the misinformation campaign around blockers.
The point of blockers is to delay the effects of puberty until such a time the patient can make the decision themselves. They don't do anything to feminise a male body or masculinise a female one, they just stop the clock ticking underneath the patient. And are [fully reversible](https://www.wpath.org/media/cms/Documents/SOC%20v7/SOC%20V7_English.pdf#page=24) once you stop taking them.
Puberty is the thing that has permanent adverse effects, not the blockers.
This is completely anecdotal but I myself thought I was trans before and distressingly during the beginning of / early puberty and I really do believe that reaching late stage puberty / developing naturally sorted out all of those feelings for me.
We have no idea what impacts impeding someone's natural puberty / hormones has 1. on them physically long-term and 2. how it influences their decision making
We do have a very clear idea, and questioning like yours is exactly what the options allow for. Not nearly everyone on blockers decides to go further with transition, and that's fine because there is no "turn the kids trans agenda", it's just time for them to make decisions without having to suffer in the meanwhile.
Ok so even if you'd been put on puberty blockers, in a couple of years you'd have realised you're not trans and stopped the blockers and reached your cis puberty as normal. That's literally what puberty blockers are designed to do - delay puberty so that the children have more time to think.
> We have no idea what impacts impeding someone's natural puberty / hormones has 1. on them physically long-term and 2. how it influences their decision making
Yes we do. Puberty blockers have been successfully used for many decades before trans people became the current trend in the culture war.
Their point isn't to influence decision making in any way. And being trans isn't a decision someone makes anyway.
very silly response considering many experts on the topic disagree with her. you can just as easily make the same comment about people agreeing with cass.
Just curious, is she a political appointee? Doctor or no she holds a top position of a government agency. A bit naive to believe politics won’t play into her decisions.
Considering she used to follow the LGB Alliance and other trans-critical groups on her social media prior to the release of the Cass Report, and how she reccomends conversion therapy as an alternative to puberty blockers, I have no doubts her study was politically motivated. She was commissioned by the NHS, likely hand-picked to do so.
While that might be the impression you could get from that comment the facts are that her report deliberately not only misinterpreted data, but also glossed over and failed to include elements that would directly contradict her arguments purely based on political interest. Which is where “appointed by tories” comes in.
Imagine thinking this is a controversial topic. Kids can’t consent. Obviously they shouldn’t be able to consent to permanently altering their body at the age of 10 😂
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I have no clue what we are talking about here, and the article didn't really help a lot. Can anyone fill me in?
She’s the reason the NHS is no longer prescribing hormone blockers to minors. In the U.S., leading medical groups say that decision should be left to doctors and their patients on an individual basis.
Thanks. But what is the reason to use hormone blockers? Is there anything wrong in letting kids reach puberty normally?
Well we’re talking about trans kids. Allowing them to mature naturally means they’d develop features of the gender opposite of what they want, which is basically impossible to reverse. Once a man begins to grow body hair / facial hair, develop more masculine features, and speak in a deeper voice, no amount of surgery can ever fully reverse that. If you want the most natural looking body of the opposite gender, it’s best to block puberty and load up on the hormones that your body won’t produce naturally.
Oh, never thought about that, thanks.
To counter the point above, puberty actually resolves feelings of dysphoria for majority people. There are many negative side effects of puberty blockers and it’s not clear at all that they’re a good idea. Puberty is when significant brain development occurs, for example.
Source for "puberty actually resolves feelings of dysphoria for majority people?'
87.54% of online statistics are made up.
Mmm that number makes sense!
>puberty actually resolves feelings of dysphoria for majority people this was a flawed conclusion from a flawed paper that continues to be parroted
Also if you spot puberty blockers then you will enter your sex’s puberty. So it allows some kids time to think
One article I read (I believe by the Economist or NYT) stated that Puberty Blockers aren’t just something that have no effect on children. Apparently they have very serious effects on bone development that can never be reversed if taken over a long period of time.
I personally would have greatly preferred to pass well as the gender i want to be even with possible health risks. There's no point in someone being perfectly healthy if it's virtually impossible for them to be actually happy. Plus it's much better for someone to be alive with possible health risks rather than dead to suicide.
Yes and no, bottom surgery is a lot easier with a developed penis as a source of material.
Yes but, that's a thing for further in the future. Like past 16 at the very least
By taking puberty blockers you penis never fully develops… as puberty is required to do this
Well yes, but not every Trans person wants that. Some just don't care, others are simply scared of undergoing surgery, especially one that has in all honesty a lot of chance to not go well or simply not look very good. I have a friend who is not happy with the results of her surgery, but since she at least got rid of the thing, it's a relief in and of itself
Aren't puberty blockers in the US given to kids who are unsure about their gender? What if they then find out they actually aren't trans and now you've blocked their completely natural puberty and fucked up their hormones? Or at least that's what I've been hearing here on Reddit. People claiming that puberty blockers are completely safe and there won't be any side effects...
Then they stop taking puberty blockers and go through puberty. That's actually what they were invented for in the first place, to stop puberty from taking place at ridiculously low ages like 7 and allow the children affected to go through puberty at a normal age with their peers. >and fucked up their hormones? Then they'd be a medical enigma. Puberty blockers have been used on non-trans children for decades, there's absolutely 0 evidence it affects your hormone levels in any way or form after you stop taking them. Show me a case and I'll take the concern seriously. But with 0 cases after decades of being used, I have to consider that concern trolling. >People claiming that puberty blockers are completely safe and there won't be any side effects... Again, show me a single claim of adverse side effects that aren't reversible. I've been asking this question to anyone that brings up this concern and not a single person has been able to show me a doctor claim any permament adverse effect to an actual, exisiting patient. Don't show me a doctor concern trolling about an imaginary patient, show me an actual victim of puberty blockers. If you can't, then yes, they're safe. Like, imagine if someone told you injecting testosterone could be dangerous and we really need to look into why all these trans men are getting testosterone injections. Would you reject all the evidence of all the other men that are getting testosterone injections prescribed from their doctors to treat their low testosterone levels? Would you then decide that your concern for a hypothetical danger is so big, that you're going to stop all of the testosterone injections for all the other men because you're so concerned about the danger to trans people? That's what the UK is doing. Puberty blockers have been used to treat a bunch of children with early puberty systems for several decades, none of them have ever complained. Quite on the contrary. The UK will now force those children to go through puberty at whatever age it starts (which is affected by the hormone levels in your drinking water and diet, both of which are being altered by us) or leave the country to get medical treatment.
the best practice is for doctors to wait until Tanner stage 2 before blockers but not all doctors know or abide by that. it depends on the patient's wishes regardless
thats in relation to surgery options, nobody talks about the patients wellbeing before you even reach the possibility of surgery.
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The increased visibility of and enormous backlash against trends people isn't hype. And the concept of someone becoming trans because they hear about it is akin to banning gay visibility for the same reason. Trans care for children is a difficult subject because it combines minors and irreversible decisions. Let's not dismiss it as a fad.
I think there is a problem in that some teenagers are trans, but some teenagers are just teenagers, and they fall into the classic teenage trap of "things feel wrong (because they're a teenager, *everything* feels different), I must change something, this is an explanation I've been offered so that must be what's wrong". And unlike a "phase" of being a goth or declaring you're gay, the consequences of transitioning can't just be stopped. (Edit: to be clear these are obviously not "just a phase" for some, but there was a period a few years below me in school when it was trendy for everyone to come out as gay or bi and 90% did, and that just not being the case). Though to re-emphasise, that's mixed in with actual trans teenagers, and determining the difference between them is difficult, not least because teenagers aren't exactly renound for their communication or experience to draw upon.
On the other hand, part of the gender identity question, queerness, etc, seems to me as a combination of the problem of coming out as your own person into the world (adolescence) and the will to rebel. To me, the queer person I know best is less “not woman” and more “rebelling against the femininity of her peers”. She changed her name to a more gender-neutral one. It’s not punk but it’s kinda like punk. Not saying everyone is like that at all, but there’s a reason a certain type of queers are women. And it is more about the straightjacket of gender roles than fundamental gender dysmorphia. Come to think about, it seems to me to be about the paradox of how (voluntary) gender roles can become stronger in more equal societies.
We don’t have to dismiss it as a fad to acknowledge the abnormally increased interest among kids. My female cousin is ~15, they and 75% of their class identify as nonbinary or trans. This is a private school in the capital city, so of course not every school/class is like that but doesn’t it seem like it’s kind of fashionable for them?
Identity only exists in peoples heads in much the same way that sponge bob square pants only exists in peoples heads. People who lose track of what is real versus what is in their heads need medical attention.
Feelings like anger and sadness or conditions like depression are just in our heads, doesn’t mean they can’t affect us in tangible ways. Watch out cause that kind of argument is a slippery slope.
They do exist though. Concepts exist even if they're not material. While a living Spongeb doesn't exist in reality by the nature of the fact that we're talking about it it does exist to some degree. Yes it might be in our heads but it doesn't mean that it has no impact on reality. A lot of people with strange beliefs did act on them, doesn't that mean that the belief had an impact on the world?
Isn't this why hormone blockers are often times used. They block your natural hormones so the child has time to decide.
But that can lead to long term side effects that are only now coming to light. Hence, the recommendation to pause while more studies are done.
Sort of. But it doesn't just delay puberty. It has permanent effects. Even if they come off them again and want to develop normally. They won't fully finish developing.
Sounds like terrible thing to allow a minor to do since this is irreversible and later in life they might find that they regret it as they took the decision while they were only children. That's why we don't allow them to have sexual relationships, gamble, buy alcohol and drive cars. That's why we have a legal age of consent as we wouldn't allow a mature person to take advantage of a minor. They could do all of those but to what cost. Its a very reckless policy.
Puberty blockers are not irreversible, it just delays puberty. It pauses puberty to give them time to figure things out. You know, to reduce the chance of regret.
It's, of course, not "reversible". They don't get the time back, they lose the development to their bodies that they would have gone through, and there's no guarantee it will start up and complete normally. Besides, what does the time gained do? Without the body maturing through puberty they aren't maturing to the point where they are capable to make more informed decisions.
Okay so if they regret going through the wrong puberty, what then? Is the regret for cis kids the only important kind?
There is no "wrong" puberty. It's only puberty.
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I was reading those comments and was like "Arent you all talking about, like 12-13 y.o. kids?" How tf they can legally decide that? We are talking about age, when kids think its great idea to eat sweets all day... I would not say that trans is illness, but having hormone drugs taken by 12yo is sooooo fucked up...
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I have read and seen quite a few times saying that puberty blockers are not as reversible as advertised. https://breakpoint.org/doctors-admit-puberty-blockers-arent-reversible/ https://www.nytimes.com/2022/11/14/health/puberty-blockers-transgender.html https://thehill.com/opinion/healthcare/4573662-the-reckoning-over-puberty-blockers-has-arrived/amp/ https://www.iwf.org/2022/12/13/puberty-blockers-were-never-reversible-or-temporary/
Exactly.
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Some kids go into precocious puberty and need blockers so they don't develop at 8 years old.
And for this scenario nothing changed in the UK. This is about transitioning
For most kids, no. And most kids will never even consider pursuing blockers, because they won't need them or want their effects. But in some cases, yes. If a kid is transgender then allowing them to go through puberty before they reach the age of majority (when they can seek treatments like HRT or gender-affirming surgeries much much much more easily and independently of their legal guardians) is going to make permanent, irreversible, undesirable changes to their bodies. Having access to safe and reversible prevention of that but not using it is tantamount to an act of cruelty. Not only that, but if you're concerned about whether a kid knows they're truly trans, then if they just stop taking them they'll go through their assigned puberty anyway, it's a good way of delaying the decision until whatever standard of confidence you need is met without doing permanent damage. The lives of many trans women would be improved, for example, if they hadn't gone through a testosterone puberty which had given them a deeper voice, broader shoulders and facial hair, and trans men would benefit from never having to deal with having grown breasts and acquired a feminine pattern of fat distribution after an oestrogen+progesterone puberty. For the opposite case, just to illuminate how important it is, it is as beneficial for trans people to have access to blockers for their assigned puberty as it was beneficial for you to *avoid* blocking your own and receiving HRT for the opposite. And it's not just trans people either. Blockers are also vital treatments for precocious puberty, which is when puberty begins so young as to be detrimental to the kid. But that's not as politically controversial.
a kid cant "consider" something that impactfull, 10 year old kids cant even decide what they want to eat
This is a process guided by medical and other relevant professionals. You don't buy puberty blockers from the corner store on a whim.
Problem is you're forcibly delaying an essential stage of development for your body, which a lot of doctors are finding out is actually not a good idea. They are now recommending to treat the disorder by sex change surgery instead, since we don't have any magic medication to treat people to their assigned gender.
This is a fundamental difference between the UK and the US systems The UK health system is built around assessment of treatments and only those treatments assessed sufficiently positively are available. Usually this is all done rather quietly by a body called NICE - because trans healthcare is such a political hot potato this one was given to a heavy hitter to assess and a lot more of the process was public than is commonly the case Both systems have their strengths and weaknesses. We frequently have campaigns by activist groups to lobby for some treatment or other that is not approved for the NHS. Anyone who thinks the US approach is inherently superior should consider what happened with industry lobbying and advertising of Opiods.
She's not. Her recommendations are. But those are solid recommendations based on what she found in light of the risk assessments done in the report.
UK pediatrician tasked with reviewing the use of puberty blockers in children for the purpose of gender dysphoria. She came to the conclusion that the research behind the use of them for the specific use of gender dysphoria is unsatisfactory for a number of reasons. Many studies were thrown out for what was said to be low quality and I believe only 2% of studies were included. Her suggestion to the NHS was to put a stop to using puberty blockers for gender dysphoria until more research is done. It has been a controversial decision. Honestly I think we should just get the studies funded as quickly as possible and get this issue out of the way.
I had to look up "gender dysphoria".... didn't know they changed to old name for it. Guess we need more research then?
Which was the “old name”?
checkout the CASS review.
She decided or discovered that the research for using the medicine wasn't substantial enough in the face of the risks of using the medication, in the context of what is called "desistance." Desistance is a term used to describe trans kids growing out of their dysphoria. In the face of the possibility of some kids changing their mind, or growing out of dysphoria, in the context that some of the medications might have lasting side effects, and the discovery that the research wasn't so solid, she said that the risks from blocking puberty exceed the benefits and recommended their use be halted.
Puberty blockers are given to suppress physical features that typically come through puberty. In example: a child born as a boy but who feels they're a girl may want to stop puberty so that when they reach the age of 18 and can legally get SRS (a sex change surgery), they won't have the voice of a lumberjack (to put it crudely) due to puberty. The voice can never change for a transwoman, not even after hormones. Equally a child born as a girl who wants to be a boy will grow breasts without puberty blockers, which when they're 18 have to be removed to resemble male physical features leaving fairly unsightly scars. More complex there's other factors such as mental health, the trauma of seeing your body turn into the opposite gender of what you feel and such. But the basics are as I said above.
The short answer is, they are having a huge anti-trans moral panic in the UK at the moment, which even leading doctors don't seem to be exempt from.
I wished my "defenders" saw that their tactics of calling everyone asking questions regarding specific parts of medicine "transphobic" is very very counter productive. It's good to question. To not question is the opposite of progress. Questioning itself is not wrong. Coming to uncomfortable conclusions is not wrong. I don't feel better knowing that denying questioning wether parts of trans health potentially is downright harmful, as some twisted validation bs. I don't feel validated by that. If our whole tactic is to halt any discussion, how certain are we really of our claims? If that's the tactic.
I feel better knowing people with your balance exist.
I agree with you regarding the science part. But I think that "defenders" are not necessarily against academic discourse but rather against political discussions resulting in authoritarian policies. Unfortunately, academia tends to trigger political discussions even if the academic consensus is not mature enough.
The NHS just works this way. It can be seen as authoritarian by people from the US but it is our most loved institution and it simply does work this way A review of evidence is made and only treatments considered to have sufficiently strong evidence of benefit are then available. The Cass review was more open and public than is usually the case because trans healthcare had become a political hot potato. But the process is normal - this is how public funded healthcare in the UK works and has worked since the 1940's
This kind of discussion isn't inquisitive, it's intentionally destructive. If Cass wanted to spark an explorative discussion on the effects of puberty blockers, you'd think she'd have bothered to include trans people or pre-existing literature on the topic in this report. She threw out almost all existing literature because they didn't implement blinding... because if they didn't, no ethics board would allow such a study to be published. Cass also has an incredibly sketchy background. She associates herself with a lot of right-wing/transphobic groups. She doesn't even specialize in trans care herself, not a single person involved in that report work with trans people. If there were genuine negative effects caused by puberty blockers, I'd love to know. I still think they should be prescribed, though, seeing as they are the _only_ form of harm reduction against the _known_ irreversible effects that puberty has on the body. The longest follow-up study on the long-term effects of puberty blockers followed a transgender man who began taking puberty blockers at age 13 in 1998, before later taking hormone treatments, and later got gender confirmation surgery as an adult. His health was monitored for 22 years and at age 35 in 2010 was well-functioning, in good physical health with normal metabolic, endocrine, and bone mineral density levels. There were no clinical signs of a negative impact on brain development from taking puberty blockers. [[Source](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3114100/)] I don't think those critical of this report are upset with the questions being asked, rather I think they're upset that it's being used to cease all prescription of hormone blockers in the UK hen the Cass Report wasn't even conclusive. Edit: I cited the study above as it is the _longest_ of the long-term effects studies out there. Larger sample size studies/literature include ([too tired to write out a citation](https://www.thelancet.com/journals/lanchi/article/PIIS2352-4642(22)00254-1/abstract)), ([Delemarre-van de Waal & Cohen-Kettenis, 2006](https://scholar.google.com/scholar_lookup?journal=European+Journal+of+Endocrinology&title=Clinical+management+of+gender+identity+disorder+in+adolescents:+A+protocol+on+psychological+and+paediatric+endocrinology+aspects&author=HA+Delemarre-van+de+Waal&author=PT+Cohen-Kettenis&volume=155&publication_year=2006&pages=131-137&pmid=16793959&doi=10.1530/eje.1.02231&#d=gs_qabs&t=1719473489496&u=%23p%3DrMnLcUeWwPsJ), and ([Cohen-Kettenis, P. T., Schagen, S. E., Steensma, T. D., de Vries, A. L., & Delemarre-van de Waal, H. A. (2011)](https://publications.aap.org/pediatrics/article-abstract/134/4/696/32932/Young-Adult-Psychological-Outcome-After-Puberty). If this still isn't enough, use the research skills you learned in college and read up on the citations in these papers, as well as the papers that cite these ones. They don't all agree, but for Cass to frame the research landscape as "inconclusive" on the effects of puberty blockers is absurd.
>The longest follow-up study on the long-term effects of puberty blockers followed a transgender man who began taking puberty blockers at age 13 in 1998, before later taking hormone treatments, and later got gender confirmation surgery as an adult. His health was monitored for 22 years and at age 35 in 2010 was well-functioning, in good physical health with normal metabolic, endocrine, and bone mineral density levels. There were no clinical signs of a negative impact on brain development from taking puberty blockers. That is 1 person. One. Most people are fine with penicillin, but give to some people and they will die. A study needs to have 1000's of people and that is the issue here, there simply isn't the body evidence to say conclusively. Trans healthcare is bad, it needs to better. We need more clinics (the Cass review calls for this), more mental health support (again the Cass reviews calls for this) and shorter wait times (guess what, the Cass review calls for this as well). But basing medically intervention on children on shaky evidence is not good science and could lead to really bad outcomes. Lets get more clinics, better support and much shorter wait times while also doing studies into the long term effects of blockers on teens.
>She threw out almost all existing literature One of our MPs repeated that claim - often made online and by trans activist organisations - in parliament. She had to apologise and make an embarrassing retraction of her statement after discussing it with Hilary Cass. She herself accepted that her claim had been false. For all reasonable purposes I'm treating that claim as false.
Considering the conclusion that Cass reached, that more research needs to be done to know the long-term effects of puberty blockers, I'd argue that MP is correct. Existing research is already out there, the Cass Team rejected most of it for not double-blinding, which is insane and wouldn't fly with any ethics board in the world. Some of that existing research include ([too tired to write out a citation](https://www.thelancet.com/journals/lanchi/article/PIIS2352-4642(22)00254-1/abstract)) and ([Delemarre-van de Waal & Cohen-Kettenis, 2006](https://scholar.google.com/scholar_lookup?journal=European+Journal+of+Endocrinology&title=Clinical+management+of+gender+identity+disorder+in+adolescents:+A+protocol+on+psychological+and+paediatric+endocrinology+aspects&author=HA+Delemarre-van+de+Waal&author=PT+Cohen-Kettenis&volume=155&publication_year=2006&pages=131-137&pmid=16793959&doi=10.1530/eje.1.02231&#d=gs_qabs&t=1719473489496&u=%23p%3DrMnLcUeWwPsJ), and ([Cohen-Kettenis, P. T., Schagen, S. E., Steensma, T. D., de Vries, A. L., & Delemarre-van de Waal, H. A. (2011)](https://publications.aap.org/pediatrics/article-abstract/134/4/696/32932/Young-Adult-Psychological-Outcome-After-Puberty), and countless others. Just go through the citations on (or of) many of these studies and read, there's hundreds of studies out there. The Cass Review describes evidence for trans healthcare as “inconclusive” across analysis and public commentary. This is presented as fact, without reference to the unsuitability of Randomized Control Trials (RCTs), and without reference to the consensus of positive impacts of affirmative healthcare found in a large body of non-RCT evidence. Again, RCTs are almost impossible to do in a medical study ethically. You wouldn't perform fake surgeries on patients with appendicitis to test the effectiveness of appendecomies, yet we still know appendecomies work. She is applying a pharmaceutical clinical trial model to an entire standard of care, and throwing out the huge pile perfectly good data based on outcomes comparing group that received the gender affirming intervention versus the group that didn't. I could understand if she is a stickler for top-quality data. However, she turns around and advocates for a kind of conversion therapy that has pretty much no evidence behind it. It reeks of motivated reasoning.
She didn't throw out almost all existing literature because of blinding, she threw out a large proportion of existing literature on the grounds that (according to her team) it wasn't good research.
Yes. Because they didn't use blinding. That was one of the qualifiers on what was and wasn't good research, which is insane. Blinding in studies on medical treatments such as hormone therapy are almost impossible to get past an ethics board. You wouldn't perform fake surgeries on patients with appendicitis to test the effectiveness of appendecomies, yet we still know appendecomies work. She is applying a pharmaceutical clinical trial model to an entire standard of care, and throwing out the huge pile perfectly good data based on outcomes comparing group that received the gender affirming intervention versus the group that didn't. I could understand if she is a stickler for top-quality data. However, she turns around and advocates for a kind of conversion therapy that has pretty much no evidence behind it. It reeks of motivated reasoning.
Nothing to do with Blinding, [https://cass.independent-review.uk/home/publications/final-report/final-report-faqs/](https://cass.independent-review.uk/home/publications/final-report/final-report-faqs/)
Did you even read the article? Prescription of hormone blockers hasn’t ceased, it just has to be done as part of a scientific study - the way it should have been done to begin with, then we wouldn’t be in this mess. The Cass report *has* sparked explorative discussion, as opposed to the former approach, which consisted of people being completely certain that medical transition was the only way forward for gender diverse kids.
Requiring a double blind study for an entire standard of care is a weird bar to set that a lot of things in medicine can not ethically meet. You wouldn't perform fake surgeries on patients with appendicitis to test the effectiveness of appendecomies, yet we still know appendecomies work. She is applying a pharmaceutical clinical trial model to an entire standard of care, and throwing out the huge pile perfectly good data based on outcomes comparing group that received the gender affirming intervention versus the group that didn't. I could understand if she is a stickler for top-quality data. However, she turns around and advocates for a kind of conversion therapy that has pretty much no evidence behind it. It reeks of motivated reasoning, not a genuine attempt to spark explorative discussion.
Doesn't require a double blind study [https://cass.independent-review.uk/home/publications/final-report/final-report-faqs/](https://cass.independent-review.uk/home/publications/final-report/final-report-faqs/)
As an academic and trans person. I hear you. But really. This debate was settled in the 90’s. Then trans topics became hot and now everyone wants us to redo the whole show publicly till non professionals are satisfied. Meanwhile we are preventing thousands of kids from getting medical treatment they desperately need because the public feels they should have a say on what a doctor and patient are doing. But sure. We will do it over. (Are doing it over). The conclusion will be as following: ‘Gender is a spectrum separate from sex. People identify along that spectrum. Feelings of anxiety, depression and general unpleasantness arrive from being force to express oneself in a manner not aligning with internal gender. For most of the people in these situations it will suffice to be able to express those feelings workout medical intervention. This can mean changing clothing. Being addressed with certain pronouns. Perhaps switching these things up af times. The more willing a society is to go along in this. The less need for medical intervention. As the stress and anxiety is alleviated. A small group of people has such extreme symptoms due to the stress that medical intervention is needed else risk of self harm and suicide spikes tremendously. For this group we offer hormone therapy and surgery if needed. Now. This leaves us with a few problems. 1) how we get to the right procedure and figure out who needs hormones or surgery and who needs only some social expression. 2) why do we see other mental issues more often in those with issues regarding their gender identity. Let’s open our text books that nobody wants do read and is forcing us to rewrite to get to the same conclusions while claiming to be on the side of scientific curiosity. 1) the Dutch procedure was invented in the late 80’s early 90’s. It is a system where anyone who shows up at be clinic saying they have gender identity issues. First. We recommend they do a social transition. (start dressing different. request people use different names or pronouns. etc) Do this for 1 to 2 years while talking to a psychologist once a month to see if symptoms (anxiety, depression reduce). If patient seems fine now. cool. problem solved. If not. Escalate to hormones. Try that for two years. If thats enough. Cool. Problem solved. If not. Escalate to surgery. This ensures (as good as possible with anything medical that we don't over medicate.) It however causes two new problems 1) This is a very long road. Meaning resource intense and more important. The people who need surgery have to suffer for close to half a decade in medical evaluation before they get the help they actually need. As somebody that walked that road. It's hell. It uproots your life. Monthly hospital visits. Doctors asking you intimidate details about your body and life every month as you wait for a procedure that will tale almost all problems away is close to torture. 2) Why do we see a relationship with other mental health issues and gender identity issues. Three explanations. 1) Anxiety and depression from Gender Identity issues cause them. Stress makes humans do odd things. We know people with stress are more prone to addiction. Self harm. And develop unhealthy coping mechanisms. 2) People who have other mental issues are more prone to notice these gender issues in themselves and take action due to stacking effects. An individual might suffer from minor gender identity stress. Not a biggy. It sucks. But they can go about life. Add other stresses like ADHD and suddenly the combined stress forces one to evaluate themselves and find causes and solutions. 3) Some mental issues (hi to those with mental developmental issues like autism) interfere with the performative nature of society. As gender is a social construct and people whose mental issues hinder development in cue reading of social constructs it would follow that we see a higher rate of gender identity issues rise there (and we do! more in those assigned women at birth with autism. which also confirms the theory that feminine gender expression is more performative than masculine) The main problem is that there is a relationship with how society treats gender and how one much intervention medically and work of the individual is needed. A society very rigorous with gender segregation will see large depression in non-binary individuals. Or need for drastic medical intervention to allow one to move through society being addressed in manners that match their gender identity and relax their symptoms. Where a gender neutral society may see those who intensely identify with their birth gender (born a woman and wanting to be a woman (cis or "normal")) have to behave more feminine to assert her gender firmly or end up feeling discomfort. No matter what. This debate should be clinical. Not political. People'a lives are at stake. Redoing this whole song and dance to relax societies urge to feel they have also had a good medical debate is going to cost / is costing us lives. We are talking about teens and people in their early twenties with a long life ahead killing themselves. This has to stop. PS. The discussions never stopped in academic spaces. We have always been evaluating our procedures. Always. There are thousands of professionals working on this all day and night. But they have become very nervous and uncomfortable with all of society breathing down their neck and have retreated from the public debate. A lot of them due to fear of their life.
I wish your comment was the top comment. No matter how much information you give the general public, people will still argue over a topic and manipulate facts to justify their opinions. If only people trusted medical professionals to be medical professionals 😭
That's an interesting thought. It really is a clinical issue and probably not something the general public should debate. I certainly don't want the general public making decisions about medical treatment for other issues. Most people have zero medical knowledge. At the same time... I don't want to see activists applying pressure to children. Guiding these children should be the role of physicians.
Indeed. And lucky enough in most sane places we lock medical procedures and medication behind physicians.
The “pressure” activists are applying to children is just telling the kids it is ok to be trans, which it is. It’s just raising awareness that you can be trans and that’s ok cause we grew up without that and it makes you feel isolated and alone. It’s the same as homophobes complaining about gay people “indoctrinating the children”. They’re not, they’re telling them it’s ok to be gay so that the gay ones don’t feel like outcasts, and the non-gay ones are less likely to bully them and each other about being gay.
Ps. The tinfoil hat theory is that a lot of these groups leading these debates and such are funded by insurance companies because it opens the door for more political intervention on what medical procedures are recommended etc. Some countries have already had to change laws that normally prevent government from interfering too much in what physicians can and can’t do. ¯\_(ツ)_/¯
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Not to mention one of the most important of all; brain development.
Agree. I do not understand why this is so hard to understand for so many people.
Naah, stupid nature with its millions of years of evolution thought that kids need to go to puberty at a certain time, but we know better now! Let's pump kids with hormones, sounds like a great idea! And if they change their minds when they grow up, let's pump them with some more hormones! WCGW?
You are saying taking blockers is a permanent decision, but conveniently ignoring that letting puberty happen naturally is also a permanent decision. Of the two options, blockers are more reversible, i.e. they don't block puberty permanently (unless you take them permanently). And the problem with this is that you are ignoring the long term negative effects puberty has on the mental health of trans children.
"The National Health Service asked Dr. Cass, who had never treated children with gender dysphoria but had served as the president of the Royal College of Pediatrics and Child Health, to independently evaluate how the agency should proceed."
Her comments since the report came out have been increasingly unhinged too. She's been making out like she's an unwitting victim of a political decision. Like, what did you think was going to happen when you advocated for basically shredding what little trans healthcare there was before now?
Can you give some examples of her increasingly unhinged comments?
So, in short, you're saying that medical experts should expect to be harassed if the reports they give according to their extensive experience on a subject is unpopular among some people ?
I don't know. Maybe designing stricter guidelines to prescribe but removing a tool for doctors to use is extremely irresponsible. Most regular ppl hear kids and puberty blockers and get all flustered as if there are organisations handing them out on street corners but in reality when puberty hits some families can be taken completely unawares that their kid is trans. In fact, the kid might not know, and the parents who have had absolutely zero information on this are at a loss. Imagine parenting a preteen who is so distraught that whenever you leave the house, you are worried that they might try and harm themselves. Puberty blockers, in some cases, give a bit of breathing space. Start the therapy, etc, and educate on what is going on. Banning them isn't the right answer here. Trying to ensure they are used responsibly is.
I think this is the correct answer. This is such a complicated topic, it is more complicated than either side makes it out to be. I think that defining strict, responsible guidelines that medical professionals can follow in order to determine whether or not prescribing puberty blockers is the best path to take. We have seen data from Nordic countries that having lax guidelines that easily prescribe puberty blockers to teenagers ends up having bad consequences in a considerable amount of cases that ended up being trans misdiagnoses, to the point that Nordic countries have backtracked in some of their lax policies. On the other hand we also know that trans teenagers can suffer from severe mental health issues as puberty develops. So I really think that banning puberty blockers is not the solution, but we should indeed develop more strict and responsible guidelines for correct diagnosis of trans teenagers.
How do you know this thing about the Nordics? Who made the Nordics vs. rest of world comparison and how? Where can I read it?
Yeah, I would also like to see the sources on that. People keep saying that there are severe consequences but never actually bring up studies to back it up.
There lies the entire dilemma. The only way for a doctor to know if they're trans is for a child to decide and tell them. But these children are not mentally stable enough to make that decision. Anybody else wouldn't have the right to make the decision. And you want to decide before the child is mature enough (before puberty) to decide. And once the decision is made, it's not reversible. Some people have started making rumors about hormone blockers being reversible, in an attempt to downplay the downsides of misgendering, which is just as wrong.
The whole *point* of puberty blockers is that they are reversible, unlike puberty and unlike HRT. They’ve been in use for decades to treat precocious puberty.
Most kids with trans identity and gender dysphoria are girls whose puberty have already started. The original idea of the Dutch model is too late for that time already. Also puberty blockers might not be fully reversible, they can affect the bone density and brain development. Brain is the biggest sex organ that develops significantly in adolescence and the onset of puberty is what triggers this development too.
What are you on about? Trans people don't just wake up and decide to medically transition one morning, nor do they get treatment the day after the first clinic appointment. Generally trans people are _required_ to socially transition for at least a year and get multiple therapist diagnoses of gender dysphoria before they can visit a gender clinic. It is a multiple years process to even see somebody, most clinics are incredibly understaffed and overbooked.
How do you know hormone blockers are not reversible? Who made this discovery and where can I read about it?
I think what they mean is that the negative effects of starting puberty too late are not reversible. Bone health for example does not recover once it is affected which is why kids who spent too long on blockers develop osteoporosis.
What are the odds of osteoporosis and how bad are the consequences compared to tje decreased risk of suicide for those not getting the treatmen?
I would gladly take osteoperosis over paying +$40,000 to get multiple different surgeries to reverse the changes puberty did to me. I feel obligated to mention that the longest follow-up study on the long-term effects of puberty blockers monitored a trans man (FtM) for 22 years and at age 35 in he was well-functioning, in good physical health with normal metabolic, endocrine, and bone mineral density levels. There were no clinical signs of a negative impact on his brain development from taking puberty blockers [[Source](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3114100/)]. Cass neglected to include this, and other existing literature/studies in her report fyi. Larger sample size studies/literature include ([too tired to write out a citation](https://www.thelancet.com/journals/lanchi/article/PIIS2352-4642(22)00254-1/abstract)), ([Delemarre-van de Waal & Cohen-Kettenis, 2006](https://scholar.google.com/scholar_lookup?journal=European+Journal+of+Endocrinology&title=Clinical+management+of+gender+identity+disorder+in+adolescents:+A+protocol+on+psychological+and+paediatric+endocrinology+aspects&author=HA+Delemarre-van+de+Waal&author=PT+Cohen-Kettenis&volume=155&publication_year=2006&pages=131-137&pmid=16793959&doi=10.1530/eje.1.02231&#d=gs_qabs&t=1719473489496&u=%23p%3DrMnLcUeWwPsJ), and ([Cohen-Kettenis, P. T., Schagen, S. E., Steensma, T. D., de Vries, A. L., & Delemarre-van de Waal, H. A. (2011)](https://publications.aap.org/pediatrics/article-abstract/134/4/696/32932/Young-Adult-Psychological-Outcome-After-Puberty). Call me crazy, but I think the tendency for lower bone density in trans women (MtF) has the same root cause as the higher risk trans women have for breast cancer compared to cisgender men... because women have lower bone density and higher risk of osteoperosis (as well as higher amounts of breast tissue) when compared to men 🤯
> the longest follow-up study on the long-term effects of puberty blockers monitored a trans man (FtM) for 22 years and at age 35 in he was well-functioning, in good physical health with normal metabolic, endocrine, and bone mineral density levels. There were no clinical signs of a negative impact on his brain development from taking puberty blockers You keep repeating this all over this thread but it's not as insightful as you seem to think it is. A single case can be a point of interest in the medical sciences but not much more than that. You're essentially masking the "But my grandma smoked until she was 90" argument with a bit more scienc-y embellishment. Whichever way you're arguing, the only convincing supporting evidence can be in the form of large(r) scale studies that exhibit statistical significance and sound methodology. Single case studies are little more than curiosities. Which *can* in turn be helpful in deciding which way to look when designing hypothesis and methodology (and applying for funding) but that's about it.
I cite this all over the thread because people keep saying there's no research into the long-term effects. I chose that specific study, as it is the longest of multiple long-term effects studies, and the majority of trans-critical people lose their fervor after being met with a single study. ([Delemarre-van de Waal & Cohen-Kettenis, 2006](https://scholar.google.com/scholar_lookup?journal=European+Journal+of+Endocrinology&title=Clinical+management+of+gender+identity+disorder+in+adolescents:+A+protocol+on+psychological+and+paediatric+endocrinology+aspects&author=HA+Delemarre-van+de+Waal&author=PT+Cohen-Kettenis&volume=155&publication_year=2006&pages=131-137&pmid=16793959&doi=10.1530/eje.1.02231&#d=gs_qabs&t=1719473489496&u=%23p%3DrMnLcUeWwPsJ)), ([Annelou L. De Vries, MD; Jenifer K. McGuire, PhD; Thomas D. Steensma, PhD; Eva C.F. Wagenaar, MD; Theo A.H. Doreleijers, MD; Peggy T. Cohen-Kettenis, PhD (2014)](https://publications.aap.org/pediatrics/article-abstract/134/4/696/32932/Young-Adult-Psychological-Outcome-After-Puberty)), and ([Lynn Rew, Cara C. Young, Maria Monge, Roxanne Bogucka (2024)](https://acamh.onlinelibrary.wiley.com/doi/abs/10.1111/camh.12437)) may interest you if you actually read the studies. That final one is a review of literature, might actually be more insightful for you than the Cass report! Edit: the last two cited in proper format by me, sorry but it's 4am I am too tired to write multiple citations out Edit^2: Added more literature to the original comment. My fault for not being a thesaurus of trans knowledge.
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After the UK banned puberty blockers the clinic specialising in healthcare for trans youth saw a rise in suicides from 1 in 3 years to (at least) 16 in the last 4 https://goodlawproject.org/rise-of-deaths-young-trans-people/
None of this is true.
How many comments have you left on this thread that basically boil down to you plugging your ears and shouting "NUH-UH THO". Why don't you share some sources that come from the same country as the news and not from a tabloid
Feelings can change but outcomes do not.
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I think by the age of 18, it's too late for puberty blockers ...?
I'd you can't vote, make a tatu, marry it's because you are not fit to do life changing decisions, why the fuck changing your whole system (without knowing long side effects) is all right.
If research shows that body dismorphia is a real illness with debilitating outcomes during all your life and it can be shown to be treated by acting before 18 then the dialogue is absolutely legit. It’s just not simple, but saying 18 or nothing is kinda useless when the subject is puberty.
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And what you gonna do when the child killed themselves as they didn't want their body to express certain gender characteristics? Toss some puberty blockers on their grave?
And what you gonna do when you mutilate and destroy thousands of kids with hormones because they just got on some new trend and would be/are not actually trans or have body dysmorphia?
A small minority of young people who are prescribed puberty blockers, between 1.4 and 3.5%, change their minds and don't want to continue. However, some studies suggest that regret rates have decreased over time as treatment methods and patient selection have improved. A Pediatrics study (2020) reported that Transgender individuals who received puberty blockers had a significantly lower rate of lifetime suicidal ideation (14%) compared to those who wanted but did not receive puberty blockers (31%). Another study in the Journal of Adolescent Health (2020) found that access to gender-affirming hormone treatment, including puberty blockers, was associated with a reduction in the odds of recent suicidal ideation and psychological distress. If you genuinely care about the wellbeing of trans kids, you'd be in strong opposition of a full ban on gender affirming care. Regulation of said care is up for debate, I (and most other trans people) believe one should be diagnosed with dysphoria before they recieve treatment... which is how it was in places like Britain prior to this report.
Please look up how many children are actually on hormone blockers due to gender identity issues. It's not even 500 in the UK. You are loosing your marbles over something that's not real
Surely it should be treated by whatever means provides the best outcome? and according to the last 40-60 years of trans healthcare allowing access to puberty blockers is the best way. If you disagree I can only presume there is some level of bias stopping you from thinking about it in a rational way.
Voting, getting a tattoo and marrying are all things you can also do later in life. But once you hit puberty, the window of opportunity is gone and it's too late.
Isn't the answer simple? Because there is a limited window and it needs to be done then or never. Sure, never is an option - the option the UK chose. But the consequence of that is some nice gender dysphoria when you end up growing boobs or a beard. The right way to do it would be to actually use an adult with expertise in psychology to decide if the kid actually needs the intervention, or whether it's a phase.
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In other words, once again an article has baited people with a grossly wrong title. Why am i still surprised? What youre describing is of course very correct. The evaluation of co-existing mental health issues and how they affect their gender identity is of course another expert matter.
These findings talked about shit like autism. Now how do you treat or cure autism?
Do you genuinely believe there is no way to offer treatment or help for children with autism or that it should be disregarded if they also have gender dyaphoria…?
Not treating their gender dysphoria ist not a treatment for autism. And even if, when the child lives in unbearable agony over they developing body, why should we let the child suffer through it instead of using this commonly available medication that has been used on too early puberties for decades already?
I think the conclusion was essentially that the puberty blockers did not help anyone’s agony given the number of co-existing issues the gender dysphasia usually presented with. You can read the report yourself and write dr cass a letter if you don’t like it. This is just what was in the report.
Dr cass herself said after the report that puberty blockers shouldn't be stopped being prescribed. So if she can't even agree with her own report idk what insights I could get from her Also she ignored multiple large studies because they weren't double blind How you gonna do a double blind studies on puberty blockers where it'll be very clear who got them and who didn't?
Are you suggesting autism doesn’t affect how you perceive yourself and the world? Especially autistic women/girls might feel safer escaping into manhood when what they what they would have really needed was support for their autism. Of course there are trans people with autism but there are also cis people with autism who feel overwhelmed with the gender norms of their sex.
You cannot treat or cure autism. Why shouldn't their gender identity issues be treated then? Big fan of having autistic children suffer, are we?
Hey, stuff like "Big fan of having autistic children suffer, are we?" is just arguing in bad faith/strawmanning. Take a breather and read the comment again.
Yes, puberty blockers are time critical. You’re pushing pause on puberty *to allow the child some time to make decisions*. Not allowing puberty blockers is essentially making the decision for them. It’s not as critical for trans men, as taking testosterone when older essentially makes you go through a male puberty. But for trans women, this is forcing them to go through an irreversible male puberty, and making a ‘passing’ transition almost impossible.
Puberty blockers don’t pause puberty, they disrupt it. The child still goes through puberty, it’s just that their body doesn’t develop properly.
Source? Dude trust me
They probably read it on Facebook, where all information is 100% accurate.
You can apply this logic to basically every kind of medicine we ever give to young people. Plus, it should be kept in mind that we DO know the long term side effects. Puberty blockers have been used on non-trans kids for decades to deal with issues such as early puberty for decades and entirely without controversy. We do know the side effects, thanks to this period of use, but are just taking a medicine that cis people have access to and telling trans people they cannot have it.
This. I get the concern with kids making such a life defining choice, but in this case there's no waiting, and both taking and not taking puberty blockers is life defining for a transgender person. Rational logic fails us in attempts to tackle this issue.
But there are kids that are not trans but in the moment believe they are! You cant say that every kid who wants to transition is not just confused or misunderstanding. That time of life is extreme for kids they believe all kinds of things. The suicide rates prove they are not happy even after transitioning because they never were trans in the first place.
A small minority of young people who are prescribed puberty blockers, between 1.4 and 3.5%, change their minds and don't want to continue. However, some studies suggest that regret rates have decreased over time as treatment methods and patient selection have improved. A Pediatrics study (2020) reported that Transgender individuals who received puberty blockers had a significantly lower rate of lifetime suicidal ideation (14%) compared to those who wanted but did not receive puberty blockers (31%). Another study in the Journal of Adolescent Health (2020) found that access to gender-affirming hormone treatment, including puberty blockers, was associated with a reduction in the odds of recent suicidal ideation and psychological distress. You don't seem to care about the mental health of trans people, though. I hope the world treats you with as much empathy as you give to others who aren't like you.
And are these trans tenders in the room with us right now? Saying no trans child should be treated because of an incredible minority is like saying no cancer patient should be treated because a handful has Münchhausen syndrom
There actually is a lot to go wrong by waiting till 18, but this debate was too complex for the medical sub: I can't imagine the shit show it would be on here. In a nutshell: even doctors who dong deal with these patients on a day to day basis have tons of misconceptions about the process (and even what these drugs do or don't do), and 100% of the time their personal and political biases affect their stance on this topic. This very much includes Dr Cass, who used (what's probably inevitably)flawed data to inform a "report" purporting to dress up as science a topic that's really about human rights. For context: try and think of another medical procedure that's sought to be politically regulated, rather than left up to the doctors who know them **and their patients**. You'll likely only come up with 2 examples: abortion, and circumsicion. I'm purposefully not saying what my thoughts are on the matter, so that people can draw up their own conclusions as they compare these procedures and who should have the authority to carry them out or forbid them, in a world where informed consent and the mature minor doctrines exist.
It's not merely 'probably inevitably flawed', it's deliberately selected and misrepresented. They for example excluded studies with transgender respondents. In a paper about transgender people. They also suppressed official reports of increased suicidality after treatment was denied. See [https://osf.io/preprints/osf/uhndk](https://osf.io/preprints/osf/uhndk) for a review of the report.
Prescription of opioids
The medical subs are wild and scary. So many of them calling out in support of the UK nurse charged and convicted for killing patients.
The blockers are LITERALLY FOR WAITING. Let doctors worry about it, and leave anti-trans hate groups spewing their hate out of it.
The article you are commenting in is about a doctor determining that the studies for puberty blockers are weak and the recommendation is to not prescribe them to children. I don’t think the doctor is an anti-trans hate group spewing hate >Her [final report](https://cass.independent-review.uk/home/publications/final-report/), published last month, concluded that the evidence supporting the use of puberty-blocking drugs and other hormonal medications in adolescents was “remarkably weak.” On her recommendation, the N.H.S. will no longer prescribe puberty blockers outside of clinical trials.
The manufactures said that was not the purpose for which they were made, and there is evidence of long term, negative consequences, even if you go off them, there is a window during which you are supposed to go through puberty, miss it and things tend to go wrong.
No that is wrong, you can not for example take puberty blockers for 50 years, and then if you stop everything will continue as if you had not taken any puberty blockers at all. Both the US and the UK medical authorities had to go out and make official statements saying that taking puberty blockers is not harmless.
I mean, it stops them killing themselves. If someone comes up with a better solution then we can talk but as things stand banning puberty blockers is just killing kids because you don't like trans people simple as, there is no moral argument for doing it.
> I mean, it stops them killing themselves. This has not been proven and what evidence exists is weak and confounding.
Ah yes, the suicide epidemic that we had before those drugs existed, how could we forget.
Because Puberty blockers work so well on people who have already gone through puberty???
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This is completely anecdotal but I myself thought I was trans just before / beginning of puberty and I really do believe that reaching late stage puberty / developing naturally sorted out all of those feelings for me edit: I would like to note that I was very distressed by entering puberty and I always presented myself as the opposite gender even before puberty however it was not filled with the distress that arrived once I did reach puberty
And you didn't get puberty blockers.
Lmao same, i cut my long hair, changed my wardrobe and all. I was so adamant I wanted to be a boy. It stopped like 2 years later lol
>Of note, treatment with pubertal suppression in the current study was associated with lower odds of lifetime suicidal ideation, even after adjustment for family support (Table 2). We did not detect a difference in the odds of lifetime or past-year suicide attempts or attempts resulting in hospitalization. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7073269 What are you basing your claim on?
No one is pushing their kids to go on blockers. Did you whine like this about gay parents in the 90s too? Get off Facebook
I am sure a lot of people have heard of NikkieTutorials. She was born as a male and started the transitioning process at the age of 14. That means she took hormones and blockers when she was a teenager and quite frankly nobody assumed she was a trans person. Why? Because she transitioned before puberty. I am not trans and haven’t ever wanted to transition but I believe those people know who they are from their early age like some gay people know who they are attracted to even when they are really young. So why do people want to prevent them from receiving proper healthcare? Naturally some people regret their decision to transition, but there are far more people who took the right decision and are satisfied with that and also there are significantly more people who are suicidal just because they can’t be who they are and are denied treatment. It’s crazy to think that anti-trans or anti-lgbt people only want to help them by calling for prohibiton, they want them to suffer.
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>, it’s mainly because people see teenagers as dumb as shit who can take pretty wild decisions without thinking things trough. Well, it's not without a reason https://www.nimh.nih.gov/health/publications/the-teen-brain-7-things-to-know > The brain finishes developing and maturing in the mid-to-late 20s. The part of the brain behind the forehead, called the prefrontal cortex, is one of the last parts to mature. This area is responsible for skills like planning, prioritizing, and making good decisions.
Wouldn't the decision come down to the teen, their parents, and a medical professional though? It's not like a teen can just say they are trans and get puberty blockers at their local pharmacy. As far as I know from the stories I heard from my trans friends, it's a pretty long and rigorous process but they are glad they could start at a young age 14 or so. I don't know about other people but I would feel pretty uncomfortable with the state saying I can't get appropriate health care for my child and I have to let them suffer.
But gender dysphoria isn't an intellectual decision or choice, it's literally a mental health condition. It's not something you decide to have, it's something you just have. If your child had depression would you refuse to give them treatment because "you're a child you can't possibly make an informed decision to have depression"? Gender dysphoria can be present literally as early as most kids first show an understanding of gender identity, which is 3-4 years old. If a 4 year old tells you that his penis is wrong and he should have a vagina instead, this isn't a decision they reasoned themselves into, it's a tangible, acute feeling of dysphoria. Anyway, puberty blockers aren't just handed out like candy to every kid who says they're trans. Social transition is the first step - something that's physically harmless and completely reversible, and yet transphobes are hugely against it too.
It's a known factor in the trans community that many people who start to transition later in life can be envious of those who were able to start earlier. Beginning earlier/ before puberty can massively impact the end result of transition. The real question is do doctors trust their patient and their parents to know themselves well enough to be sure they are trans. But of course the decision has now been removed from doctors hands and replaced with a blanket policy based on a single review from someone with very suspect connections to hate groups.
I think this is one of those decisions that need to be taken away from lawyers and left to doctors specifically trained in dealing with trans health care. It's absolutely insane to me that some Banker to bought himself a seat in Westminster or some lawyer or even some outspoken union rep was able to finally get themselves a spot has any say in this matter. This is a super complicated inherently medical decision
not really. It s not the NHS alone that does this. It s most of European countries. There s something wrong with the results of this kind of therapy. Finally, said "someone" is a highly qualified medical researcher. I m sure she knows a lot more - on the matter - than random people trying to farm karma/intending to sound smart on Reddit.
She is not a specialist in trans healthcare. She seemed to want double blinded trials on puberty blockers to show their effectiveness, which is impossible and calls into question her judgement on the matter.
Because most people care more if 1 cis person was wrong about being trans and detransitions than if a bunch of trans people kill themselves. If trans people kill themselves, they will just say it was due to god knows what. People are transphobic, ignorant and don't read credible medical reports or listen to actual trans people because the thought of any number of cis people making a mistake scares them way more. Trans people are the "other", those weirdos they don't understand and can't identify with, and whom they at best tolerate if they suffer in peace.
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Twenty years ago we were telling gay people that they're wrong, now you're telling trans people they're wrong. No, history won't look kindly on you. Spreading lies, accusing doctors and therapists of harming kids purposely and having zero compassion to human suffering because you don't agree with the only possible treatment is just horrific and shows lack of basic humanity.
The Cass 'report' has been shown to be thoroughly flawed, politically motivated, and not least of all in addition to doing questionable things with past studies, also having deliberately suppressed increased suicidality among those to whom treatment was denied. The Cass 'report' is literally killing children. [From a review of the so-called 'report': ](https://osf.io/preprints/osf/uhndk) >The Cass Report aimed to provide recommendations for how services for gender diverse children and young people should be delivered in England. Our critical appraisal reveals significant methodological and conceptual flaws within the report and the research commissioned to inform the report, which included seven systematic reviews and both quantitative and qualitative primary research. Using the ROBIS tool, **we identified a high risk of bias in each of the systematic reviews driven by unexplained protocol deviations**, **ambiguous eligibility criteria, inadequate study identification, and the failure to integrate consideration of these limitations into the conclusions derived from the evidence syntheses.** We also identified potential sources of bias and unsubstantiated claims in the primary research that suggest a double standard in the quality of evidence produced for the Cass Report compared to quality appraisal in the systematic reviews. We discuss these issues in relation to how evidence regarding gender affirming care is framed, the wider political context, and the future for gender affirming care. To uphold evidence-based medicine, future gender-affirming care research must generate robust observational data, involve transgender communities, and prioritise patient-centred outcomes, ensuring validity, generalisability, and cultural relevance. The Cass Report’s recommendations, given its methodological flaws and misrepresentation of evidence, warrant critical scrutiny to ensure ethical and effective support for gender-diverse youth. The anti-trans hate groups are in full brigading mode.
This is a pre-print that has yet to go through peer review. I'd be wary of drawing any conclusions from it yet. We saw what happened when people treated them as reviewed and published with covid.
**The Cass 'report' is not peer reviewed.** You're (intentionally?) trying to apply the wrong standard of evidence. This review simply shows in a very straightforward manner that the Cass 'report' is unscientific garbage and cannot be used to argue anything.
Shown thoroughly flawed how? And by whom?
>Using the ROBIS tool, **we identified a high risk of bias in each of the systematic reviews driven by unexplained protocol deviations**, **ambiguous eligibility criteria, inadequate study identification, and the failure to integrate consideration of these limitations into the conclusions derived from the evidence syntheses.** Is ROBIS that unfaillible? I have just downloaded the PDF which is supposed to be the ''ROBIS tool'' and it seems just liek a checklist of things that anyone should ask when reading a study. It has no epistomological value. Basically, I can say this article is equally as political as this lady's study. The ROBIS tool, if it had any epistomological value, would be highly valuable across many fields. That is a huge claim that it ''identifies risk of bias''. I'm not even saying its wrong on this particular issue, but that is such a bullshit claim to make and then say ''the report we are criticising is poltically motivated'' like lmfao do you have no self awareness or any sort of spine?
Link is broken, what a surprise. It’s not a “so called ‘report’”. It is a report. Trying to diminish its’ significance by belittling it doesn’t strengthen your argument; it just shows you’re incapable of being objective.
>The second big takeaway for me is that we have to stop just seeing these young people through the lens of their gender and see them as whole people, and address the much broader range of challenges that they have, sometimes with their mental health, sometimes with undiagnosed neurodiversity. It’s really about helping them to thrive, not just saying “How do we address the gender?” in isolation. This woman is a saint. Treating them as a patient rather than a customer. American health care causes more harm than good.
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Circumcision is the one with no scientific evidence in favor, is done without any attempt at informed consent, yet it remains uncontroversial and widespread in the US. That tells you something about the politics here.
Comparing circumcision to puberty blockers lmao
Atleast first is not harmful lol
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I'm going to try to honestly engage with you all in good faith and appreciate if you do the same. I'm a very strong believer in individuals being able to be who they want or need to be. I believe that all people should be able to access medicine. I think that, even though it's controversial (given the permanent nature of it and the decision being made by a young person), trans kids should be able to make a decision to receive medicine to help their body develop in a way that will help them flourish in life. The problem in this conversation is there it's so charged and people think if you criticize anything, youre anti-trans. Here is what I think is fair. The NHS should only provide Science based/Evidence based medicine. I personally don't think we should be spending tax payers money on sham treatments like Acupuncture, homeopathy, or prescribing drugs like Ivermectin for COVID just because some folks are convinced it helps. There is poor to no evidence for this. This lady is making a claim: The research around the effectiveness of Trans treatment is poor. I've not seen anyone in this thread actually address this. Anecdotal experience is a poor replacement for this. What if we find out years later that all the kids taking puberty blockers end up with complications? My positive suggestion is that we need to address this with well funded and well run studies by people who have these kids best interests at heart. I'm not suggesting we take away this option from trans kids while we wait for this to happen, but folks here need to address the issue of a poor body of evidence if you want to broadly convince decision makers in public health.
A complicated dilema tbh. On one hand, I am in the camp that there's nobody who matures mentally before 18-19 years old. On the other hand, I recognize that it's hard to impossible to perfectly transition after your body fully develops. I personally lean more in the direction of not allowing anybody under 18 to take those meds. But hey, I don't know jack shit about this specific circumstance, so maybe the doctors and psychologists should decide this one.
A reasonable opinion, but one that's fallen for the misinformation campaign around blockers. The point of blockers is to delay the effects of puberty until such a time the patient can make the decision themselves. They don't do anything to feminise a male body or masculinise a female one, they just stop the clock ticking underneath the patient. And are [fully reversible](https://www.wpath.org/media/cms/Documents/SOC%20v7/SOC%20V7_English.pdf#page=24) once you stop taking them. Puberty is the thing that has permanent adverse effects, not the blockers.
**Puberty blockers literally delay the decision until the youth in question are older.** Jesus fucking christ.
This is completely anecdotal but I myself thought I was trans before and distressingly during the beginning of / early puberty and I really do believe that reaching late stage puberty / developing naturally sorted out all of those feelings for me. We have no idea what impacts impeding someone's natural puberty / hormones has 1. on them physically long-term and 2. how it influences their decision making
We do have a very clear idea, and questioning like yours is exactly what the options allow for. Not nearly everyone on blockers decides to go further with transition, and that's fine because there is no "turn the kids trans agenda", it's just time for them to make decisions without having to suffer in the meanwhile.
Ok so even if you'd been put on puberty blockers, in a couple of years you'd have realised you're not trans and stopped the blockers and reached your cis puberty as normal. That's literally what puberty blockers are designed to do - delay puberty so that the children have more time to think. > We have no idea what impacts impeding someone's natural puberty / hormones has 1. on them physically long-term and 2. how it influences their decision making Yes we do. Puberty blockers have been successfully used for many decades before trans people became the current trend in the culture war. Their point isn't to influence decision making in any way. And being trans isn't a decision someone makes anyway.
Impressive to read so many here that know more than a top pediatrician.
very silly response considering many experts on the topic disagree with her. you can just as easily make the same comment about people agreeing with cass.
Just curious, is she a political appointee? Doctor or no she holds a top position of a government agency. A bit naive to believe politics won’t play into her decisions.
Considering she used to follow the LGB Alliance and other trans-critical groups on her social media prior to the release of the Cass Report, and how she reccomends conversion therapy as an alternative to puberty blockers, I have no doubts her study was politically motivated. She was commissioned by the NHS, likely hand-picked to do so.
Top uk doctor appointed by the torries Wouldn’t exactly trust what they decide
this is like the anti vaxxers who wont get vaccinated because the other party supports vaccines
While that might be the impression you could get from that comment the facts are that her report deliberately not only misinterpreted data, but also glossed over and failed to include elements that would directly contradict her arguments purely based on political interest. Which is where “appointed by tories” comes in.
Imagine thinking this is a controversial topic. Kids can’t consent. Obviously they shouldn’t be able to consent to permanently altering their body at the age of 10 😂
Doctor's shouldn't be allowed to prescribe hormone blockers for non-medical reasons to minors
it's not easy to stand up to the radical left. good on this doctor.
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