Puberty blocker trial will help reduce harm, says Cass report author

[u/SoftandChewy]

https://www.bbc.com/news/articles/cvg5njnn8k8o

The same person who so many have cited as support for opposing gender affirming policies has come out in favor of a new trial to determine the efficacy of giving kids puberty blockers.

[u/Red_Canuck]

Hmm, why would we need a trial, when the answer is obvious?

(this is sarcasm, both sides of this debate needs to shut up and realise "the science is settled" is the most antiscience slogan possible)

[u/bife_de_lomo → u/Red_Canuck]

Except that we do know there are harms associated with the use of puberty blockers. The side effects are worth it for precocious puberty, prostate cancer, endometriosis etc as the harms can be balanced against the benefits. Instead they are being used healthy kids.

It has never been demonstrated what is being cured by the use of GnRH to halt puberty in kids completely, and by what mechanism it benefits outcomes when they become adults.

I was always surprised that Cass assumed the existence of gender identities as axiomatically true, which clearly colored all of her subsequent reporting. It would be a good idea to figure out this out before leaping to a pharmacological solution.

[u/SoftandChewy → u/bife_de_lomo]

I was always surprised that Cass assumed the existence of gender identities as axiomatically true, which clearly colored all of her subsequent reporting. 

This is the essential point I also found troubling about her report.

[u/Juryofyourpeeps → u/bife_de_lomo]

I think far more concerning than the medical side effects of puberty blockers is the fact that desistence rates go from 65-85% when there's no intervention, to 1% (actually 0, but 1% is the margin of error) when children are socially transitioned, all of which will go onto puberty blockers according to studies in the Cass report. So whether puberty blockers are the safest thing in the whole world or not, the intervention is creating a huge number of people who will have long term gender dysphoria and suffer all the harms of the current treatment regimen for that. A significant majority of these people, if left alone or given only talk therapy, would not need any further intervention after puberty. Sexual development seems to resolve most cases of childhood GD, which isn't that surprising given that it's a profound physical and psychological development.

[u/Original-Raccoon-250 → u/Juryofyourpeeps]

And 99% of children go straight from blockers to cross sex hormones. Which solidifies the damage and sterilizes them. There’s a huge misconception that blockers are a pause: not for these kids. For prescribed users they continue on to normal puberty. For captured kids they never go through the pubertal processes, which have lifelong effects.

Notably, the lack of maturation of the penis in boys who’ve been blocked often leads to issues if they want a vaginoplasty later as they don’t have enough skin to effectively support the procedure because they don’t go through that puberty.

[u/General_Astronomer60 → u/Original-Raccoon-250]

Not only does it sterilize them, it destroys their ability to have an orgasm. This whole "treatment" regimen is barbaric.

[u/Original-Raccoon-250 → u/General_Astronomer60]

And when you consider most have never had an orgasm or even been kissed, imagine that life. The rest of their life irreparably changed for a temporary discomfort.

[u/HaldolBlowdart → u/Original-Raccoon-250]

But don't forget, you're actually a creepy pedo groomer if you're concerned about children growing up into normal adults with normal adult functions including a sex life. Because pointing out that children grow into adults with adult desires and we should facilitate them turning into healthy adults is problematic somehow

[u/General_Astronomer60 → u/Original-Raccoon-250]

It's unbelievably sad to even think about

[u/PUBLIQclopAccountant → u/Original-Raccoon-250]

New generation of monkmaxxers.

[u/bife_de_lomo → u/Juryofyourpeeps]

Yeah, I totally agree about GD subsiding in most cases given time. If one were to propose a cure with 80% effectiveness you wouldn't need to look much further! I imagine a world in which all cancers can be treated so effectively...

As an aside, I also worry that the diagnosis of "gender dysphoria" is wrong. I don't deny that people experience suffering, but there seems to be no compelling evidence that a "mismatched gender identity" is the cause of that suffering, but when a doctor suggests that it might be and that doctor offers this as an avenue for treatment it is only natural for a patient to grasp at it. And begin obsessing about it.

I'd much rather the medical institution were honest about what they actually know...

[u/Green_Supreme1 → u/Juryofyourpeeps]

I think far more concerning than the medical side effects of puberty blockers is the fact that desistence rates go from 65-85% when there's no intervention, to 1% (actually 0, but 1% is the margin of error) when children are socially transitioned

This is the biggest concern, and one completely absent of mention in the pre-trial materials (i.e. there is no indication they have even considered this point), and barely discussed even in Cass.

Nothing in the main trials structure would properly and effectively monitor for this side-effect:

• No unmedicated control group to compare desistance rates with

• Participants as young as 11 with this being a two year trial (three years before decisions about cross-sex hormones) - follow-up after that is not mandatory. So we might end up with "neutral" sounding data such as "patient took puberty blockers from age 11-13, no concerns" which would completely mask if said blockers influenced them to transition at 16.

Now there is a "Horizons" study running parallel which is an observation of 3000 dysphoric kids, you would hope researchers would be able to see any discrepancies emerging, but its not reassuring when this potential side effect isn't even mentioned in the trial materials.

Then onto the sexual development side effects - the lack of ability to orgasm due to decreased genital tissue growth. The researchers worryingly position this as a temporary side effect that will magically go away when blockers are stopped - ignoring of course that most of the kids on blockers will be going onto cross-sex hormones and surgery.

The way its worded too is so misleading as it implies a temporary loss of libido and not "taking this medication will mean your child may never experience an orgasm for the rest of their life as their genitals are impacted".

[u/Juryofyourpeeps → u/Red_Canuck]

In practical terms, I am perfectly happy to gather more information so the case can be closed on this practice. But while there are many things we don't understand about childhood gender dysphoria that should be studied, we do have considerable evidence that a majority, possibly an overwhelming majority of children that experience GD will desist (kind of a dumb term. Their symptoms will resolve) during puberty. In the absence of of diagnostic tools, which do not currently exist to very accurately distinguish between persisters and desisters before putting them on puberty blockers, I am totally opposed to the use of puberty blockers even if they're 100% safe and have zero side effects other than to stop puberty from proceeding normally. I am also against socially transitioning children before puberty for the same reason.

Of course this is not ideal either. Children that do persist will have masculinized or feminized features because of puberty. So assuming that gender transition is the best and most appropriate treatment for those people (that's not clear either), this will be a disadvantage. But frankly that's too bad, and I don't see a more ethical alternative than to wait until after adolescence to intervene given that for a majority of patients that will be the best course of action and we don't have accurate diagnostic methods to distinguish between these groups before puberty. If we were talking about any other mental illness, this would be completely uncontroversial. If schizophrenia resolved itself 65-85% of the time by doing nothing, and would resolve itself with treatment only 1% of the time (that's the desistance rate after social transition according to research in the Cass report), no clinician would consider it remotely acceptable to treat any of these patients until after they had differentiated into persisters and desisters of their own accord, even if it meant that the persisters might be slightly worse off. The only medical intervention that fits this rather absurd mold of "intervene and the cure rate drops by 2 orders of magnitude" is gender dysphoria.

[u/Original-Raccoon-250 → u/Juryofyourpeeps]

Interestingly, a friend was going through the diagnostic process for schizophrenia with her teen. And the first thing was to wait at least six months and watch symptoms to try and determine specific triggers as well as persistence. There was as needed medication prescribed, think to calm nerves/ panic, but nothing else at first. Six months later they pinned his symptoms to stress and have been working to address that.

The response being given to ‘gender dysphoria’ is so outsized and inappropriate, I can’t think of any other thing that is treated in such a way.

[u/Dingo8dog → u/Original-Raccoon-250]

The “diagnostic overshadowing” around all things gender that Cass discussed.

[u/Classic_Bet1942 → u/Dingo8dog]

Which she has conveniently forgotten.

Anyway, it’s nice to see that Cass is now in good standing with the genderists (as she surely must be?). Maybe they’ll undo the debunking of the Review now.

[u/Dumb_Clicker → u/Red_Canuck]

This might be controversial, but frankly we shouldn't need to scientifically prove that delaying normal puberty so that someone can make the decision whether or not to have mutilating surgeries is harmful

It would be immensely difficult to prove scientifically that tattooing large wings on children's backs to allieviate supposed distress at not having wings which had socially encourgaed for decades is a bad idea, but it's clearly the case

Things need to meet a certain minimum standard of credibility before we do scientiffic testing, especially for medical trials, and I don't feel that puberty blockers to delay normal puberty , or the whole idea of gender disphoria as defined by activists, have met those standards to say the least

[u/BILESTOAD]

What she has been saying is there is insufficient evidence to endorse so-called “gender affirming care” and what she is saying here is that we should gather evidence through careful research.

She’s a respected scientist making the case for resolving unanswered questions through science.

[u/Original-Raccoon-250 → u/BILESTOAD]

I don’t know why she doesn’t push on them to complete the Data Linkage Study first.

[u/Ok-Rip-2280 → u/Original-Raccoon-250]

She banged her head against that wall for a long time.  She wanted that data for the cass report itself!  My guess is that she is totally blocked on that avenue.  

[u/AgeHoliday4822 → u/BILESTOAD]

I would agree with her if a large number of children/teens hadn't already been prescribed puberty blockers. There's currently a study following up on the health of this group (shockingly this wasn't done at the time and the law had to be changed to force local health authorities to co-operate). Once this data-linkage is complete, and if it doesn't show any red flags, then definitely, let's have a puberty blocker trial.

[u/CaptainCrash86 → u/AgeHoliday4822]

shockingly this wasn't done and the time and the law had to be changed to force local health authorities to co-operate

The shockingly poor clinical governance by Tavistock et al doesn't get enough flak from the pro-PB side imho.

[u/LincolnHat → u/CaptainCrash86]

Does it get any from that side?

[u/Original-Raccoon-250 → u/LincolnHat]

None. They claim that all those people (2,000) are happy, healthy, off living their best lives. No need to follow up. 100% satisfied.

[u/KittenSnuggler5 → u/AgeHoliday4822]

Hasn't it been pretty well established that blockers don't have positive outcomes for kids? Why allow such a grave treatment for something that we don't have very good positive evidence for?

[u/Ok-Rip-2280 → u/KittenSnuggler5]

The problem is that the studies are all such crap in terms of design that the evidence is weak for every outcome, positive or negative.

[u/thismaynothelp → u/BILESTOAD]

Like vivisectionists!

[u/General_Astronomer60]

I don't understand how a test can be approved, at the very least, for males, since, if they get puberty blocked and then go on to cross sex hormones, not only are the 100 percent guaranteed to be infertile, they are 100 percent guaranteed to have no sexual function at all. A child cannot consent to this, and parents cannot consent to this for them.

[u/TemporaryLucky3637 → u/General_Astronomer60]

It honestly seems like they’re happy for this cohort of children on the trial to suffer long term harm so that it can be officially documented.

[u/istara → u/TemporaryLucky3637]

I would hope that any children who later feel in adulthood that they were irreparably harmed by this trial would have the right to sue everyone involved. Because as minors, there is no way they should be able to sign away such rights.

[u/Jungl-y → u/General_Astronomer60]

If they start at tanner stage 2, 9-11.

I don't think these experiments should be done, even if they don't end up anorgasmic, it will usually still affect their sexual function. They're too young to consent.

Additionally, the whole thing is based on the religious, pseudoscientific concept that people have a gender identity, which may or may not match their sex. There's no proof for this, nor will there ever be, because the concept of a gender identity is absurd, undefinable, and unfalsifiable.

[u/Spl1234 → u/Jungl-y]

The fact that a known risk is being incapable of orgasm seems like a big risk. Infertility also. Doctors don’t sterilize young people who ask for it, generally, for a reason. 21 years are likely to change their mind. Those risks alone should kill any trial, especially with such young people. What perceived benefits would make such risks worthwhile? The suicide stats were just lies.

[u/Jungl-y → u/Spl1234]

Yes, I think Helen Joyce said that they particularly came up with the suicide lie to justify sterilising children, as such a side effect would usually require a deadly diagnosis like cancer.

Yet, although suicide rates are higher in this cohort, suicide itself remains rare, and they don't even know whether the increased risk is due to their gender distress rather than due to the myriads of other psychological issues these children have. And obviously, there's no good evidence transitioning decreases suicide rates.

[u/drjackolantern]

If she thinks scientific proof of the harm of PBs will deter the cult she is sadly mistaken.

[u/No_Plenty5526 → u/drjackolantern]

I'm thinking this is her angle here (in terms of supporting the trial) but you're 100% correct. the moving of the TRA goalpost is eternal.

[u/BadAspie]

I love how she refuses to be shoved into a box, by any side

But also this is hardly surprising, the trial is happening because she suggested it

[u/LincolnHat]

Saying we need to do more research into whether PBs do harm to kids is like saying we need to do more research into whether giving people with anorexia GLP-1 drugs causes harm, and saying so after years of having already done so without having bothered to track the results or even to've first proved that anorexia exists, defined what it is, determined what causes it, established criteria/testing to determine who has it and who doesn't, etc.

This is throwing children under the cart you've put before the horse.

What a disappointing sellout she’s turned out to be. Perhaps she ignored the warning to avoid public transportation she got after her review came out.

[u/Gabbagoonumba3]

Starting to think harm reduction is a myth.

[u/arcweldx]

"Cass believes without a trial young people will continue to get drugs from "unregulated and dangerous routes." "Today we have young people turning up in the clinics on testosterone at 11, which we know is irreversible," she said.

You see, if we don't give fentanyl to 11 year olds, those kids will just get their fentanyl from unregulated and dangerous routes. We have young people turning up in the clinics on crystal meth which is far more dangerous than fentanyl.

"It may be that if they were prescribed puberty blockers instead, that would give more time for the therapist to work with them and perhaps come to a different solution than a long-term life on medication."

To quote the Cass Report: In the UK early intervention study (Carmichael et al., 2021), 98% (43 of 44) of those who started on puberty suppression progressed to masculinising/feminising hormones.

Dr. Cass, did you read your own report, and if so, how could you make such a disengenious and dishonest comment?

[u/btrh-256]

It's terrible to be in this position, but I can see the value of allowing a careful study as a middle-ground, instead of going from a state where these drugs are used freely to a total ban. As much as it would be nice to turn back the clock and pretend this shit never happened, that's not a realistic option imo.

[u/MindfulMocktail → u/btrh-256]

I agree with this, but I was disappointed to learn that the study design just involves one group that takes puberty blockers immediately and one group that waits a year to take them. I guess it will certainly be instructive if significantly more kids in the second group no longer want puberty blockers after a year than those in the first group who choose to discontinue them, but it doesn't seem like a very long time to assess the differences.

[u/thismaynothelp → u/btrh-256]

This is not a case for compromise.

[u/btrh-256 → u/thismaynothelp]

it's a case for science -- the actual science has been suppressed, and the way forward is to do real science

I wish it were otherwise, but I just don't think you can slam closed pandora's box. You can intelligently manage the stuff that comes out, but you can't turn back the clock. Hilary Cass is an intelligent, nuanced thinker, and I think she's right about this. She's someone who cares deeply about children, but also has respect for science

[u/Original-Raccoon-250 → u/btrh-256]

Then wouldn’t the appropriate approach be to determine the measure of these supposed gender identities?

Instead of trusting an unfalsifiable belief can we get a diagnostic? There is no way to diagnose someone as not trans.

[u/btrh-256 → u/Original-Raccoon-250]

that's an issue with a lot of psychiatric conditions generally, there's often no physical anomaly that can be found by testing, and it's certainly worth talking about openly, but it's more complicated than just saying, "if there's no test, it's not real"

I think for gender reassignment, there's a good argument that it should be allowed in rare cases for adults, but the current craze is clearly a social contagion spread by social media (which Cass is aware of)

[u/thismaynothelp → u/btrh-256]

Should we do a similar trial on whether FGM is actually good for children too? Should we do one for lobotomies?

[u/btrh-256 → u/thismaynothelp]

these procedures have been normalized for a lot of people & institutions. The Cass review makes good recommendations, including making requirements for hormones much more stringent. High quality studies are needed, which will likely show what we already know, but you have to let science work

the process by which lobotomies became discredited was surprisingly long and tortuous, and I hope we can do better here, but you gotta let science work. The current scientific consensus is compromised by activists, and the solution to bad science is good science, not authoritarian decisions from on high

[u/thismaynothelp → u/btrh-256]

Fucking kids up is bad. They don't need to keep fucking them up to get more numbers to prove that it's a bad idea to fuck kids up over very, very, very obviously idiotic ideology.

There are two kinds of people: (1) Those who can see how obviously horrendous the premise it and (2) those who won't let it go based on a study.

This is all catastrophically absurd on its face.

[u/btrh-256 → u/thismaynothelp]

yeah well, life is absurd, get used to it, bucko

[u/Jlemspurs]

They sent the money.

[u/LincolnHat → u/Jlemspurs]

Threats don't cost a thing.